DÜRDANE AKSOY, Hatice BARUT, Fazilet DUYGU, BETÜL ÇEVİK, SEMİHA GÜLSÜM KURT, ORHAN SÜMBÜL

Kırım Kongo Kanamalı Ateşinde gözlenen baş ağrısının özellikleri ve hastalık şiddetiyle ilişkisi

Amaç: Kırım-Kongo kanamalı ateşi (KKKA), Kırım-Kongo kanamalı ateşi virüsünün etken olduğu, kenelerle bulaşan, fatal seyredebilen bir hastalıktır. Hastalığın erken belirtileri yüksek ateş, halsizlik, ciddi baş ağrısıdır. KKKA' da sık görülen baş ağrısıyla ilişkili herhangi bir araştırma yoktur. Bu çalışmada KKKA hastalarında gözlenen baş ağrısının özelliklerini ve klinik tablonun şiddetiyle ilişkisini araştırdık.Gereç ve Yöntem: Çalışmaya hastanemizde KKKA tanısıyla yatan baş ağrılı 60 hasta alındı, yatış sürelerine göre: 7 günden kısa yatanlar ''grup 1'', 7 gün ve daha uzun yatanlar ''grup 2'' şeklinde tanımlandı. Kontrol grubu aynı klinikten baş ağrısı olan yüksek ateşli 43 viral pnömoni hastası idi. KKKA hastalarına baş ağrısıyla ilgili sayısal ağrı skalası anketi uygulandı, sonuca göre hastalar ''hafif-ağrılı grup'' ve ''şiddetli-ağrılı grup'' olarak ikiye ayrıldı. Tüm hastalara baş ağrılarının özellikleriyle ilgili ayrıntılar sorularak 'Baş ağrısı sınıflandırma derneğinin' kriterlerine göre migren özelliklerini taşıyıp taşımadığı araştırıldı.Bulgular: KKKA hastalarının % 66.7' sinin ağrısı migren kriterlerine uymakta idi. Bu oran kontrol grubu oranından (%37.5) anlamlı şekilde yüksekti. KKKA hastalarında: Grup 1' deki hastaların baş ağrısı skorları grup 2' den anlamlı şekilde daha düşüktü. Hafif-ağrılı grubun yatış süresi şiddetli-ağrılı gruba göre daha kısaydı (p=0.004) ve Platelet değerleri daha yüksekti (p=0.005).Sonuç: KKKA hastalarında baş ağrısı kontrol grubuna göre daha sık, şiddetliydi ve migrenöz özellikler taşıyordu. Migrende vasküler endotelyal disfonksiyon, vasodilatasyon ve inflamatuar mediatörler sorumlu tutulmaktadır. KKKA' da virusun yaptığı serebral vasküler endotelyal hasar, salgılanan proinflamatuar sitokinler hastalarda migrendekine benzeyen baş ağrılarını tetikliyor gibi görünmektedir. KKKA hastalarında gözlenen migren-benzeri baş ağrısı, her iki hastalıkta serebral vasküler tutulumun ağrı etyopatogenezi açısından önemini vurgulamaktadır

Characteristics of headache and its relationship with disease severity in patients with Crimean–Congo hemorrhagic fever

Objectives: Crimean–Congo Hemorrhagic Fever (CCHF) is a fatal, tick-borne disease. The classic clinical presentation of CCHF is characterized by sudden onset of high fever, chills, and severe headache. There are no previous reports on the characteristics of headaches caused by CCHF. Therefore, we investigated the relationship between CCHF-induced headache and the clinical course of the disease.Methods: We included 60 patients with headache diagnosed with CCHF; they were divided into two groups: group 1 included patients with hospital stay 7 days. The control group included 43 viral pneumonia patients with headache. Patients described the characteristics of headaches and also self-rated the severity with a numeric pain scale that classified headache as either mild or severe.Results: In the group with CCHF, 66.7% of the reported headaches met criteria for diagnosis of migraine. This ratio was significantly higher than that in the control group (37.5%). The headache severity scores in group 1 were lower than those in group 2. The hospitalization length was shorter (p=0.004) and the platelet levels were higher in CCHF patients with mild headache compared with CCHF patients with severe headache (p=0.005).Conclusion: CCHF patients had more often and severe headaches than the controls. The severity of headache may be associated with the severity of vascular endothelial damage, vasodilatation, and abnormal release of inflammatory cytokines in CCHF similar in migraine. Most CCHF patients experienced migraine-like headaches, suggesting that cerebral vessel involvement might be important in both CCHF and migraine

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