Ana Podgorac

Institute of Mental Health

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Jasna Zidverc‐Trajkovic

University of Belgrade

Aleksandra Radojičić

Centar za Promociju Nauke

NŠ

Nadežda Šternić

University of Belgrade

Igor Petrušić

University of Belgrade

Zagorka Jovanović

University of Belgrade

Aleksandra Pavlović

University of Belgrade

NČ

Nadežda Čovičković‐Šternić

University of Belgrade

Milija Mijajlović

University of Belgrade

Tamara Svabic-Medjedovic

Centar za Promociju Nauke

Tatjana Pekmezović

University of Belgrade

Cooperative Institutions

University of Belgrade

Centar za Promociju Nauke

Univerzitetski Klinički Centar Srbije

Sechenov University

Oncology Institute of Vojvodina

University of Prishtina

Sapienza University of Rome

München Klinik

University of Priština - Kosovska Mitrovica

Rush University

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Comment on “Central scotoma and ‘muddled thinking’ as migraine aura” by Daroff

Cephalalgia (2013)

Igor Petrušić Jasna Zidverc‐Trajkovic Ana Podgorac Nadežda Šternić

Dear Editor, We are very grateful to Professor Daroff, as well to our patients, for their goodwill in sharing with us their experience of aura. The letter by Professor Daroff (1) is a nice example of the fact that, in spite of contemporary technology, description of symptoms is the first and necessary step to answer the questions ‘why’ and ‘how’. We are in line with Professor Daroff when it comes to using term ‘‘Confused thinking’’ rather than ‘‘Muddled thinking’’ as a better description of such a cognitive state. We could also propose ‘‘Delusional thinking’’ as more appropriate terminology, which more precisely points out the higher cortical dysfunctions associated with visual aura. The appropriate descripter for his described symptoms (2) could be ‘‘Delusional scotoma state’’, for the inability to recognize the nature and duration of his own symptoms that is manifested during reading. We agree that ‘‘. . . failure to recognize negative scotoma at once’’ (3) could be explained by higher cortical dysfunctions due to the cortical spreading depression. While ‘‘delusional’’ thinking may be a scientifically accurate term, introducing such a term could create the erroneous interpretation of a psychiatric cause for the denial during migraine. Migraine was considered to be a psychiatric or, at least a personality disorder, for a long time, before the neurobiology of the disorder became evident. We would like to have more opportunities to study these phenomena (4) in order to determine the timing and sequence of events during aura, as well as the possible localization and mechanism of the particular disorder, before labeling them with a scientific term.

Delusional disorder

10.1177/0333102413505240

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Underestimated phenomena: Higher cortical dysfunctions during migraine aura

Cephalalgia (2013)

Igor Petrušić Jasna Zidverc‐Trajkovic Ana Podgorac Nadežda Šternić

Introduction Aura occurs in 20–30% of patients with migraine. Some descriptions of aura go far beyond the most frequent visual and sensory symptoms, suggesting the involvement of different cortical areas. The aim of this prospective study was to evaluate the frequency and types of disorders of higher cortical functions (HCF) that occur during visual and/or sensory aura. Methods We interviewed 60 patients with visual and/or sensory aura about HCF disorders of praxia, gnosia, memory, and speech, during aura. Patients were divided into two groups, with and without HCF disorders, and were compared in terms of demographic data and aura characteristics. Results From all 60 patients, 65% reported at least one HCF disorder during aura. The patients with HCF disorders had longer-lasting auras (28.51 ± 16.39 vs. 19.76 ± 11.23, p = 0.016). The most common HCF disorders were motor dysphasia (82.05%) and dysnomia (30.74%). Motor dysphasia was more often reported by patients with visual as well as sensory aura ( p = 0.002). The number of HCF disorders correlated with the aura duration ( p = 0.003). Conclusion According to our results, HCF disorders during aura occur more often than previously thought. The aura duration has some influence on the HCF disorders.

10.1177/0333102413476373

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Citations (36)

Ultrasound diagnostics of carotid and vertebral arteries

Nada Sternić Aleksandra Pavlović Ana Podgorac Zagorka Jovanović

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Citations (1)

Usefulness and applicability of web-based headache diagnostic software

The Journal of Headache and Pain (2013)

Aleksandra Radojičić Miloš Nikolić Jasna Zidverc‐Trajkovic Ana Podgorac Nadežda Šternić

Headache diagnostic software (HDS), developed by Headache center, Neurology Clinic in Belgrade integrates a diagnostic expert system able to suggest the correct ICHD-II diagnosis once all clinical characteristics of a patient’s headache have been collected. Purpose The aim of this pilot study was to test its diagnostic accuracy, the usefulness and applicability in the diagnosis of primary headache disorders and medication overuse headache (MOH).

Pain medicine

10.1186/1129-2377-14-s1-p142

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Cluster headache: Is age of onset important for clinical presentation?

Cephalalgia (2014)

Jasna Zidverc‐Trajkovic Kristina Marković Aleksandra Radojičić Ana Podgorac Nadežda Šternić

The age of onset of cluster headache (CH) attacks most commonly is between 20 and 40 years old, although CH has been reported in all age groups. There is increasing evidence of CH with early or late onset and a different course of the disorder. The aim of the study was to analyze the influence of the age of onset on clinical features, disorder course, and therapy effectiveness in CH patients.A retrospective and cross-sectional analysis was performed on 182 CH patients divided into three groups according to the age of onset. The first group consisted of patients with the first CH attack before 20 years of age, the second group was patients with age of onset between 20 and 40 years of age, and the third group was patients with age of onset after 40 years of age. Demographic data, features of CH periods and attacks, and the response to standardized treatment were compared among the groups.Patients with CH onset after 40 years of age reported a lower number of autonomic features and less frequently had conjunctival injection and nasal congestion/rhinorrhea phenomena during their attacks. Diagnostic delay was the longest in the patients with CH onset before 20 years of age.The influence of the age of onset of CH is intriguing for further studies and could possibly extend the knowledge about CH pathophysiology. From a clinical point of view, the differences in CH presentation are insufficient to preclude a correct diagnosis and treatment because the same criteria could be applied regardless of patient age.

Age groups

Cluster headache

Presentation (obstetrics)

10.1177/0333102413520085

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Migraine‐Like Accompanying Features in Patients With Cluster Headache. How Important Are They?

Headache The Journal of Head and Face Pain (2013)

Jasna Zidverc‐Trajkovic Ana Podgorac Aleksandra Radojičić Nadežda Šternić

Background According to the I nternational C lassification of H eadache D isorders diagnostic criteria, the differences between migraine and cluster headache ( CH ) are clear. In addition to headache attack duration and pain characteristics, the symptoms accompanying headache represent the key features in a differential diagnosis of these 2 primary headache disorders. Just a few studies of patients with CH exist examining the presence of nausea, vomiting, photophobia, phonophobia, and aura, the features commonly accompanying migraine headache. The aim of this study was to determine the presence of migraine‐like features ( MF ) in patients with CH and establish the significance of these phenomena related to other clinical features and response to treatment. Methods One hundred and fifty‐five patients with CH were studied, and 24.5% of them experienced at least one of MF during every CH attack. Nausea and vomiting were the most frequently reported MF . The clinical presentation between CH patients with and without MF was not significantly different with the exception of aggravation of pain by effort (20.6% vs 4.1%) and facial sweating (13.2% vs 0.85%), both more frequent in CH patients with MF . Conclusion Inferred from the results of our study, the presence of MF in CH patients had no important influence on the diagnosis and treatment of CH patients. The major differences of these 2 primary headache disorders, attack duration, lateralization, and the nature of associated symptoms, as delineated in the I nternational C lassification of H eadache D isorders, are still useful tools for effective diagnosis.

Phonophobia

Photophobia

Cluster headache

10.1111/head.12077

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Citations (23)

The first prevalence study of primary headaches in adults in a post-conflict area of Serbia

Cephalalgia (2021)

Nenad Milošević Jasna Zidverc Trajković Milija Mijajlović Jovana Milošević Ana Podgorac

The aim of the present study was to establish annual prevalence of primary headaches, migraine, and tension-type headache among adults in a post-conflict area of Serbia.The data for this cross-sectional study was obtained via face-to-face interviews using questionnaires specifically designed for this purpose, in line with the available guidelines. The study sample included adults aged 18-65 years whose native language is Serbian with residence in six predominantly Serbian communities in Kosovo and Metohija. Relevant diagnoses were established according to the diagnostic criteria of the International Classification of Headache Disorders, 3rd edition.The study included 1062 adults. Analyses indicated 47.7% prevalence of primary headaches. The 1-year prevalence of migraine (with aura and without aura) and tension-type headache was established at 15.2% (3.3% and 11.9%), and 32.2%, respectively. One-year prevalence of chronic headache was calculated at 3.5%, while the prevalence of medication overuse headache was slightly lower at 2.9%. Primary headaches were more prevalent among women, participants residing south of the river Ibar, married or cohabiting individuals, as well as among interviewees (persons) who reported feeling unsafe in Kosovo and Metohija. This is the first study of the prevalence of primary headache disorders in Serbia. The obtained data is comparable to the data available for other countries, especially those in the Balkan region.

Serbian

Cross-sectional study

Prevalence

Primary headache

10.1177/03331024211006043

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Citations (2)

Tolosa-Hunt syndrome: is it really necessary to show granuloma? - The report of eight cases

Vojnosanitetski pregled (2016)

Ana Podgorac Jasna Zidverc‐Trajkovic Zagorka Jovanović Aleksandar J. Ristić Aleksandra Radojičić

Introduction. Tolosa?Hunt syndrome (THS) is a rare entity, characterized by unilateral orbital pain associated with paresis of one or more of the oculomotor cranial nerves and caused by a granulomatous inflammation in the cavernous sinus, superior orbital fissure or orbit. The low prevalence of THS with a broad spectrum of other disorders that could cause painful ophtalmoplegia resulted in a stricter diagnostic criteria of THS in the latest edition of the International Classification of Headache Disorders. Current criteria require demonstration of granuloma by magnetic resonance imaging or biopsy. The diagnosis could be difficult and the initiation of treatment delayed due to a high variablity of clinical presentation of TSH. Reducing the number of patients that, based on clinical presentation, could be classified as having THS, but do not fullfil all diagnostic criteria further complicates establishing of correct diagnosis. Case report. Hereby we presented eight patients diagnosed with and treated for THS. Inspite the exclusion of other causes of painful ophtalmoplegia, granuloma could not be demonstrated in a half of patients. Clinical presentation of THS in patients with and without shown granuloma, did not significantly differ concerning headache characteristics (localization, intensity, quality, duration preceding cranial nerve palsy, response to steroids), the affected cranial nerve, disease course and response to the treatment, as well as types of diagnostic procedures that were performed in ruling out other diseases from the extensive differential diagnosis of painful ophthalmoplegia. Conclusion. There is no significant difference between the THS patients with and without demonstrated granuloma.

Tolosa–Hunt syndrome

Superior orbital fissure

Presentation (obstetrics)

Paresis

Cranial nerves

Orbit (dynamics)

10.2298/vsp150703180p

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Citations (5)

EHMTI-0097. Long-term outcome in 201 patients with chronic headache with medication overuse

The Journal of Headache and Pain (2014)

Jasna Zidverc‐Trajkovic Tatjana Pekmezović Aleksandra Radojičić Ana Podgorac Nadežda Šternić

From the cohort of 240 patients with chronic headache with medication overuse (MOH), treated with drug withdrawal and prophylactic medications and evaluated at 1-year follow-up, 57.1% were without chronic headache and without medication overuse, 3.3% did not improve after drug withdrawal and 39.6% relapsed developing recurrent overuse (Cephalalgia 2007; 27:1219-25). The aim of the present study was to evaluate the long-term outcome of these patients. During the next 1-12 years, follow-up examinations were performed in 201 (83.8%) patients. There were no significant differences between patients lost for further examination and other patients regarding age and gender, as well as the outcome on 1-year follow-up. On the last follow-up, 66 (32.8%) patients had chronic headache with medication overuse. Without overuse were 130 (64.7%) patients with episodic and five (2.5%) patients with chronic headaches. During the follow-up period, 47 (23.4%) patients had relapsed developing recurrent overuse. The recurrent overuses occurred once in 33 (16.4%), twice in 13 (5.0%) and thrice in four (2.0%) patients. MOH recurrence occurred during the first three years after the first-year follow-up in three quarters of patients. The majority of patients, 33 (70.2%), overused the same medication. Treatment of MOH recurrence was efficacious in 93.6% patients, with strong advice to cease overused drug in 79.0% and prophylactics in 83.0% patients. During the examined period 20 (23.3%) of the patients with MOH on the first-year follow-up had remission of chronic headache with subsequent decrease of medication use. No conflict of interest.

Pain medicine

Chronic Migraine

Headache Disorders

10.1186/1129-2377-15-s1-d78

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More About Migraine‐Like Features in Cluster Headache

Headache The Journal of Head and Face Pain (2014)

Jasna Zidverc‐Trajkovic Ana Podgorac Aleksandra Radojičić Nadežda Šternić

Center (category theory)

10.1111/head.12289

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