Neurology
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The difficulty in distinguishing episodic tension-type headache from migraine headache is widely acknowledged. The misdiagnosis of migraine as tension-type headache has potentially significant consequences because it may preclude patients with disabling headaches from receiving appropriate treatment. This article explores the symptomatologic, epidemiologic, and pathophysiologic relationships among migraine and tension-type headaches with the aim of elucidating ways to improve their diagnosis and treatment. ⋯ Many migraine attacks are accompanied by tension headache-like symptoms, such as neck pain. Conversely, IHS-defined tension-type headaches are often accompanied by migraine-like symptoms, such as photophobia or phonophobia and aggravation by activity. The health-care provider caring for patients with headache should be cognizant of these overlaps and their implications for the management of patients with headache.
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Data on seizure-like phenomena (SLP) in patients receiving propofol were systematically reviewed. Reports had to provide detailed information on SLP in individual patients who received propofol. Phenomena were classified according to the time point of their occurrence during anesthesia or sedation (induction, maintenance, emergence, delayed [>30 minutes after emergence]) and their clinical presentation (generalized tonic-clonic seizures, focal motor seizures, events presented as increased tone with twitching and rhythmic movements not perceived as generalized tonic-clonic seizures, opisthotonos, involuntary movements). ⋯ SLP may happen in patients with or without epilepsy receiving propofol. The time point of the occurrence of SLP suggests that a change in cerebral concentration of propofol may be causal. To confirm this hypothesis, to estimate the prevalence of propofol-related SLP, and to identify patients at risk, data of higher quality are needed.