Faculty Bibliography

OBJECTIVES/OBJECTIVE:The contribution of depression to mortality in adults with and without HIV infection is unclear. We hypothesized that depression increases mortality risk and that this association is stronger among those with HIV infection. METHODS:Veterans Aging Cohort Study (VACS) data were analysed from the first clinic visit on or after 1 April 2003 (baseline) to 30 September 2015. Depression definitions were: (1) major depressive disorder defined using International Classification of Diseases, Ninth Revision (ICD-9) codes; (2) depressive symptoms defined as Patient Health Questionnaire (PHQ)-9 scores ≥ 10. The outcome was all-cause mortality. Covariates were demographics, comorbid conditions and health behaviours. RESULTS:Among 129 140 eligible participants, 30% had HIV infection, 16% had a major depressive disorder diagnosis, and 24% died over a median follow-up time of 11 years. The death rate was 25.3 [95% confidence interval (CI) 25.0-25.6] deaths per 1000 person-years. Major depressive disorder was associated with mortality [hazard ratio (HR) 1.04; 95% CI 1.01, 1.07]. This association was modified by HIV status (interaction P-value = 0.02). In HIV-stratified analyses, depression was significantly associated with mortality among HIV-uninfected veterans but not among those with HIV infection. Among those with PHQ-9 data (n = 7372), 50% had HIV infection, 22% had PHQ-9 scores ≥ 10, and 28% died over a median follow-up time of 12 years. The death rate was 27.3 (95% CI 26.1-28.5) per 1000 person-years. Depressive symptoms were associated with mortality (HR 1.16; 95% CI 1.04, 1.28). This association was modified by HIV status (interaction P-value = 0.05). In HIV-stratified analyses, depressive symptoms were significantly associated with mortality among veterans with HIV infection but not among those without HIV infection. CONCLUSIONS:Depression was associated with all-cause mortality. This association was modified by HIV status and method of depression ascertainment.

OBJECTIVE: The objective of this review is to describe auditory hallucinations (paracusias) associated with migraine attacks to yield insights into their clinical significance and pathogenesis. BACKGROUND: Isolated observations have documented rare associations of migraine with auditory hallucinations. Unlike visual, somatosensory, language, motor, and brainstem symptoms, paracusias with acute headache attacks are not a recognized aura symptom by the International Headache Society, and no systematic review has addressed this association. METHODS: We retrospectively studied patients experiencing paracusias associated with migraine at our center and in the literature. RESULTS: We encountered 12 patients (our center = 5, literature = 7), 58% were female, and 75% had typical migraine aura. Hallucinations most commonly featured voices (58%), 75% experienced them during headache, and the duration was most often <1 hour (67%). No patients described visual aura evolving to paracusias. Most patients (50%) had either a current or previous psychiatric disorder, most commonly depression (67%). The course of headache and paracusias were universally congruent, including improvement with headache prophylaxis (58%). CONCLUSION: Paracusias uncommonly co-occur with migraine and usually feature human voices. Their timing and high prevalence in patients with depression may suggest that paracusias are not necessarily a form of migraine aura, though could be a migraine trait symptom. Alternative mechanisms include perfusion changes in primary auditory cortex, serotonin-related ictal perceptual changes, or a release phenomenon in the setting of phonophobia with avoidance of a noisy environment.

Headache, a common and disabling symptom in Behcet's syndrome, may be associated with a variety of neurologic syndromes and ocular inflammation, or may present as an isolated feature. Our objective is to describe the various neurologic and ocular syndromes of Behcet's syndrome of which headache is a symptom, and to review the features of isolated headaches in Behcet's. We also report results of a study of headache in Behcet's syndrome patients who are followed at NYU Hospital for Joint Diseases, the first study of its kind in North American patients, and the first to document prevalence of both episodic and chronic daily headache in Behcet's.

Tension-type headache (TTH) is a relatively featureless headache. Many primary and secondary headache disorders can mimic TTH, particularly in its chronic form, chronic tension-type headache. This review will address both primary and secondary disorders that can present with headaches phenotypically similar to TTH, and will focus on clinical pearls that help distinguish these 'mimics' from TTH

Individuals with migraine often have recurrent, painful symptoms, and symptomatic treatments have detrimental side effects and do not prevent further attacks. Studies indicate that riboflavin can be used to decrease headache frequency and lessen the need for symptomatic treatment. Mitochondrial dysfunction may play a role in migraine pathogenesis by interfering with oxygen metabolism. Daily doses of riboflavin, vitamin B2, may improve mitochondrial function by increasing the reserve of brain mitochondrial energy, and there are minimal side effects with daily treatment. However, there is a need for further randomized, double-blind controlled studies to determine the effective dose. Although riboflavin may not fully eliminate migraine nor take effect for several months, riboflavin is a promising prophylactic agent with minimal adverse effects that may significantly reduce the frequency of migraine

Tension-type headache (TTH) is the most prevalent type of headache across all age groups worldwide. TTH is common, disabling, and associated with medical and psychiatric comorbidities. This review will focus on the epidemiologies of episodic and chronic TTH in various age groups, factors associated with progression and remission, comorbidities, and the burden of TTH