Shreyas Ravat ¹, Sandip Chaudhari ¹, Neelima Chafekar ¹

Affiliations
1 Department of Medicine, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik − 422203, Maharashtra, IN

Abstract

Aim: To classify the patients as per the International Classification of Headache disorders 3^rd edition Beta version. To study the demographic details and clinical profile. To study the trigger factors in migraine patients. To study the importance of family history is headache patients. Materials & Methods: The study was a cross sectional observational study of 300 patients at outpatient clinic tertiary health care center, over a period of two years. Patients diagnosed with primary headache were studied with help of an exhaustive questionnaire which covered the relevant details. Results: Our study had 158 migraines (MG), 137 Tension Type Headache (TTH) and 5 Trigeminal Autonomic Cephalgia (TAC) patients. Females are more affected, 1:2.9 in TTH and 1:1.5 in MG. Mean age for MG was 33.37 and for TTH were 36.11. Majority (46-48%) were employed, followed by housewives (43-38%) and students (9-13%) among both the groups. TTH patients had frequency of headache more patients than migraine patients. Family history was positive in 36% in MG and 14% in TTH patients. TTH had dull aching, holocranial pain with pericranial tenderness; whereas migraine had throbbing unilateral pain. Aura was seen only in 21% of MG patients; retinal (67%) being most common. Associated symptoms like nausea, phonophobia, photophobia were seen in 80% of MG patients. Trigger factors on history were present in 64%, which increased to 85% on showing detail list. Most common triggers were climatic, followed by travel, stress and sleep related. Females had hormonal, smell and emotional stress as more common TF. Conclusion: Migraine is most common primary headache presenting in clinics. With predominance in females TTH attacks are more frequent than migraine. TTH showed features like dull aching, pressure like and holocranial pain whereas migraine has throbbing and unilateral pain. Pericranial tenderness is more in TTH patients whereas migraine has associated vasomotor symptoms. It is important to have detail list of all Trigger factors for Migraine patients, so that they can avoid them and prevent their attacks, thus reducing analgesic use. Family history has more influence in migraine patients compared to TTH.

Keywords

Migraine, Pericranial Tenderness, Tension Type Headache, Trigger Factors.

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Akash Berad ¹, Sandip Chaudhari ², Neelima Chafekar ³

Affiliations
1 Postgraduate Resident, Department of Medicine, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik − 422003, Maharashtra, IN
2 Associate Professor, Department of Medicine, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik − 422003, Maharashtra, IN
3 Professor and Head of Department, Department of Medicine, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik − 422003, Maharashtra, IN

Abstract

Introduction: Thyroid hormones have effects on virtually every organ system. The heart is the major target organ for thyroid action. It was thought that thyroid disorder is a circulatory disorder and manifestations of thyroid disorders are due to changes in cardiac work. Over the period it has become clear that the explanation for the altered circulatory hemo-dynamics of thyroid disease is because of involvement of cardiovascular system. Aims and Objectives: To find out the incidence of overt and subclinical cardiac manifestations in patients with thyroid dysfunction and to compare the prevalence of overt and subclinical cardiac manifestations in two subsets of patients belonging to hyperthyroid and hypothyroid groups respectively. Materials and Methods: It was an observational study carried out at the Department of Medicine for the period of August 2017 to December 2019. In total, 230 newly diagnosed patients with thyroid dysfunction were included in the study. Focused clinical and detailed cardiovascular system examination, necessary biochemical investigations were done. All patients underwent detailed 12 lead electrocardiogram and 2D Echo-cardiography procedure. Incidence of overt and subclinical cardiac manifestations in Hyperthyroid and Hypothyroid cases was calculated; and the Prevalence of overt and subclinical manifestations in the two subsets of patients belonging to Hyperthyroid and Hypothyroid groups respectively was compared and data was analyesd. Results: Total hypothyroid patients were 115 and that of hyperthyroid were 115. Incidence of thyroid is much more common in females as compared to males (81% in hyperthyroidism and 92% in hypothyroidism). In hyperthyroid group, 92% patients showed cardiac involvement either in the form of ECG, CXR, 2D ECHO abnormalities and in hypothyroid patients it was 93%. Statistically significant patients presented with symptoms of congestive cardiac failure in hyperthyroid group (73%) but not in hypothyroid group. In the both groups, fatigue was the most commonest presenting symptom related to cardiovascular system. In hypothyroid group, most common cardiac sign was Pulse, Pressure<40 mm of Hg (73%) whereas in hyperthyroidism it was sinus tachycardia (73%). 73% hyperthyroid patients showed sinus tachycardia as the most common ECG finding where again 73% hypothyroid patients showed ST-T changes as a most common ECG finding. Nearly 70% hyperthyroid patients had ejection fraction more than 60% on Echocardiogrphy the procedure and almost all patients of hypothyroidism had ejection fraction less than 60%. Conclusion: Thyroid dysfunction was found to be more common in the females with 41-50 years of age group in hypothyroidism group and 21-30 years in the hyperthyroidism group. Cardiovascular manifestations were the major presenting factors in both the groups pointing towards the adverse effects of thyroid dysfunction, Dyspnea and fatigue were the major cardiac symptoms in the hypothyroidism group. While chest pain and fatigue were the major cardiac symptoms in the hyperthyroidism group. The ECG and 2D ECHO findings in the current study also suggested that in both the groups of thyroid dysfunction, cardiac manifestations are likely to have higher incidence.

Keywords

Echocardiography, Electrocardiography, Hyperthyroidism, Hypothyroidism

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