There is still a controversy regarding the relationship between sleep apnoea syndrome and headaches, especially morning headaches. Our objectives were: (i) to compare the prevalence and the clinical data of headaches in sleep apnoea syndrome (SAS) and control (snorers) groups defined by polysomnographic recording; (ii) to analyse the clinical improvement of headaches with appropriate treatment; and (iii) to correlate headaches with mood disorders, and nocturnal respiratory and architectural sleep parameters in order to understand the underlying pathophysiological mechanisms. This is a prospective study of 324 consecutive patients referred to our sleep centre for snoring. Of these, 312 patients who underwent sleep polysomnography were finally included. Patients and controls were interviewed about their medical past, headache history and clinical characteristics, their daytime sleepiness (Epworth's sleepiness scale) and their mood disorders (Zerssen's scale). Follow-up of patients with headaches (SAS and control groups), treated or not, was also assessed. According to our definition of SAS, patients were dissociated in SAS (n=164) and snorers (n=148). Fifty-three SAS patients had headaches, of whom 58.5% (n=30) suffered from morning headaches. However, there was no statistical difference between the two groups concerning the prevalence and the clinical characteristics of headaches. In addition, headaches and morning headaches were not correlated with nocturnal respiratory and architectural sleep parameters, nor with excessive daytime sleepiness, but were strongly correlated with mood disorders. In 36 SAS patients, headaches improved under treatment, but this was not statistically different from what was found among untreated snorers. Headaches and morning headaches are common in patients with SAS but may be considered as a non-specific symptom. The underlying mechanisms are not fully elucidated but depression could play an important role. Despite this absence of specificity, the treatment of SAS, especially nasal continuous positive airway pressure, leads to an improvement in headaches in several cases.

Bell's palsy is not uncommon during pregnancy. An association with pre-eclampsia (PE) has been reported previously. Furthermore, it has even been suggested that Bell's palsy could be a predictor of PE. We report three cases illustrating various possible aspects of this association, one of them including the features of HELLP (haemolysis, elevated liver enzymes, and low platelets) syndrome.Keywords general medicine, high-risk pregnancy, maternal-fetal medicine, neurology Case reportsThe main features of Bell's palsy and pre-eclampsia (PE) in the three cases are summarized in Tables 1 and 2. Case 1A 29-year-old gravida 1, para 0 woman was admitted to hospital at 39 weeks of gestation with a history of sudden onset of severe epigastric pain. At admission, blood pressure was normal and there was no proteinuria but HELLP (haemolysis, elevated liver enzymes, and low platelets) syndrome was diagnosed: the platelet count had fallen from 133 Â 10 9 /L at 36 weeks to 83 Â 10 9 /L, aspartate aminotransferase was 362 IU/ L, alanine transaminase was 282 IU/L and total bilirubin level was 10 mmol/L (normal range: 1-17). Corticosteroids were given because of low platelet count (betamethasone, 20 mg intravenously/12 hourly) and labour was induced. Four days after delivery, a left facial weakness occurred and progressed to complete isolated Bell's palsy over two days. Methylprednisolone was given intravenously (60 mg/day) for eight days, followed by oral prednisolone (30 mg/day) for four days. There was a moderate improvement over the next few months but permanent residual left facial palsy remained. Serological examination was negative for viruses as well as for antiphospholipid (lupus anticoagulant, anticardiolipin, anti-2 -glycoprotein type I) and antinuclear antibodies. Three years later, a subsequent pregnancy was completed without any complication except for late slight gestational thrombocytopenia. Case 2A 35-year-old gravida 2, para 0 woman was admitted to hospital at 31 weeks of gestation because of right facial weakness. The pregnancy was a twin gestation following intracytoplasmic sperm injection. Facial weakness progressed to complete facial paralysis within two days. Steroid therapy (prednisone 60 mg/day for 5 days) was followed by complete remission of the palsy within eihjt days. At 33 weeks, a diagnosis of PE was made, leading to a decision to perform a caesarean section: the first newborn weighed 1530 g; the second one was growthrestricted (1170 g). Viral serology was negative for varicella zoster (VZV), cytomegalovirus (CMV), parvovirus B19, HIV and hepatitis B. Treponema pallidum particle agglutination assay and Venereal Disease Research Laboratory tests for syphilis were negative, as were antinuclear and antiphospholipid antibodies. Case 3A 27-year-old gravida 1, para 0 woman was admitted to hospital at 34 weeks of gestation because of right facial weakness. A diagnosis of complete idiopathic right facial palsy was made. She was given oral corticosteroid therapy (prednisone 40 mg/day) and acyclovir fo...

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