Background: In chronic migraines(CM), the rate of benefiting from medical treatment is relatively low, and it is known that patients use analgesics extensively. Greater occipital nerve (GON) block, have been started to be used in chronic migraine patients who were refractory to treatment. In this study, we aimed to evaluate the headache attack frequency, analgesic use, VAS (Visual Analog Scale) and MIDAS (Migraine Disability Assessment Scale) scores in the 3-month follow-up of patients we had performed a GON block in our clinic for chronic migraine refractory to medical treatment. Material and Method:A total of 120 CM patients were included in the study. The number of analgesics used, the number of days with pain, and the VAS and MIDAS scores were recorded before the GON block and at one and three months of treatment.Results: There was a statistically significant (p<0.001*) reduction in the number of days with pain, analgesic use, and the VAS and MIDAS scores in the first and third months compared to the pretreatment baseline values in patients who had undergone a GON block. No significant differences between the first and third months. Conclusions:After the GON block, we noted a significant reduction of headaches and improved quality of life in patients who had been experiencing severe headaches despite medical treatment. The GON block has an exceptionally high benefit rate, might be considered as a treatment option before migraines gain chronicity, patients are not exposed to an excessive medical burden and increased treatment costs.

Objectives: Information on the incidence of acute ischemic stroke (AIS), which is an important cause of morbidity and mortality, its association with COVID-19, and its course in infected patients in this pandemic period is limited. In this study, it was aimed to compare the demographic, clinical and stroke characteristics, and the laboratory, prognosis and mortality findings of patients with AIS with and without COVID-19. Methods: This study included 43 patients with a positive nasopharyngeal PCR test who were followed up for AIS, and 70 patients without COVID-19 who were followed up for AIS during the same period. Results: Poor prognosis and mortality were found to be significantly higher in the AIS group with COVID-19 compared with the non-COVID-19 AIS group. In the AIS group with COVID-19, a higher rate of intensive care unit (ICU) need (40% vs. 5%), higher intubation rate (35% vs. 3%) and longer hospital stay (12.9 ± 10.8 vs. 6.6 ± 4.0 days) were observed. In the laboratory examinations, C-reactive protein, ferritin, D-dimer, troponin, and lactate dehydrogenase levels were found to be significantly higher in patients with AIS who were positive for COVID-19. An increase in D-dimer, ferritin and thrombocytopenia were found to be associated with mortality in the COVID-19 positive AIS group. Conclusion: Patients with AIS and COVID-19 had a higher rate of ICU need, higher intubation rate, longer hospital stay, higher mortality, and poorer prognosis than those without COVID-19. High levels of ferritin, D-dimer and fibrin degradation products were associated with a poor prognosis. Keywords: COVID-19, stroke, prognosis, mortality

Background & Objective: Studies have shown that the most common neurologic symptom in patients with COVID-19 is headache, which may even be the first and only symptom. This study aimed to determine headache characteristics such as frequency, duration and localization, as well as the relationship of systemic inflammation with headaches in patients with COVID-19. Methods: A total of 202 patients hospitalized for COVID-19, consisting of 101 patients with headaches and 101 patients with no headache, were included in the study. Demographic characteristics, symptoms, clinical findings, and laboratory results were evaluated. In the group with headaches, visual analog scale (VAS) scores, duration, severity, and localization of pain were recorded. Results: One hundred nineteen (58.9%) of the patients had no headache in their previous medical history, whereas 21.3% (43/202) had a migraine history. Most of the patients with headache experienced short-term attacks of moderate-severity headaches (47.1%) that were pressing in nature (59%), and generalized (32.4%). We divided our patients into two groups according to pain severity: one of patients with mild-to-moderate headache and one of those with severe headache.. Pain characteristics were compared between the groups, and it was observed that the pain duration was longer in the group with severe pain (p<0.001). When the groups with and without headaches were compared, no significant differences were found between the groups regarding inflammatory markers such as lymphocyte count, lactate dehydrogenase, C-reactive protein, ferritin, and D-dimer levels. Conclusion: The headache in our patients with COVID-19 was mostly new-onset, of moderate severity, compressive in nature, and generalized. Inflammatory markers were unrelated to the presence and severity of the headaches.

enlargement of the venous sinuses and pituitary gland, pachymeningeal thickening, subdural fluid collection and/or hematoma, shrinkage of ventricles, effacement of sulci and "sagging brain" sign are MRI features of SIH (1). Interestingly, To the editor: I t was with great interest that we read the paper by Girgis et al. (3) and the related papers regarding spontaneous intracranial hypotension (SIH) in Turkish Neurosurgery. SIH is characterized with orthostatic headache, diffuse dural enhancement on MRI and low cerebrospinal fluid pressure in the absence of trauma history or lumbar puncture (3). Herein, we aimed to share our experience in a man diagnosed with SIH following soccer game managed with epidural blood patch (eBP) and underline potential role of magnetic resonance imaging (MRI) in the treatment response with demonstrative images.A 36-year-old man was admitted with a sudden onset of headache spreading from the neck to the top of the head after a soccer game without a history of trauma. Clinical history revealed that the pain worsened during erect posture. Neurologic examination and laboratory findings were unremarkable. He was referred to computed tomography (CT) and subsequently MRI with the suspected diagnosis of SIH. CT and MRI revealed some features of SIH (Figure 1, 2). However, the rest of the imaging features including "sagging brain" appearance, subdural effusion-hematoma, and pituitary enlargement were missing. He refused invasive imaging modalities like radionuclide cisternography and MR myelography. Nevertheless, based on the characteristic headache and imaging features the diagnosis of SIH was made and he was managed with medical treatment. He did not respond to intravenous hydration, theophylline or caffeinated beverages. Subsequently, he was treated with an autologous epidural blood patch (eBP) performed from the level of T12-L1. Symptoms were dramatically resolved one week after eBP and totally disappeared on the following month. Dural enhancement and venous engorgement also reduced to normal limits after eBP (Figure 3).

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