Dr. Yohannes Woubishet Woldeamanuel M.D.

All Publications

• Clinical Features Contributing to Cortical Thickness Changes in Chronic Migraine - A Pilot Study. Headache Woldeamanuel, Y. W., DeSouza, D. D., Sanjanwala, B. M., Cowan, R. P. 2018

  Abstract

  The objectives of this cross-sectional pilot study were threefold: to identify regions of cortical thickness that differentiate chronic migraine (CM) from controls, to assess group differences in interregional cortical thickness covariance, and to determine group differences in associations between clinical variables and cortical thickness.Cortical thickness alterations in relation to clinical features have not been adequately explored in CM. Assessment of this relationship can be useful to describe cortical substrates for disease progression in migraine and to identify clinical variables that warrant management emphasis.Thirty CM cases (mean age 40 years; male-to-female 1:4) and 30 sex-matched healthy controls (mean age 40 years) were enrolled. Participants completed self-administered and standardized questionnaires assessing headache-related clinical features and common psychological comorbidities. T1-weighted brain images were acquired on a 3T MRI. A whole-brain cortical thickness analysis was performed. Additionally, correlations between all brain regions were assessed to examine interregional cortical thickness covariance. Interactions were analyzed to identify clinical variables that were significantly associated with cortical thickness.The whole brain cortical thickness analysis revealed no significant differences between CM patients and controls. However, significant associations between clinical features and cortical thickness were observed for the patients only. These associations included the right superior temporal sulcus (R2  = 0.72, P = .001) and the right insula (R2  = 0.71, P = .002) with distinct clinical variables ie, longer history of CM, posttraumatic stress disorder (PTSD), sleep quality, pain self-efficacy, and somatic symptoms. Higher interregional cortical covariance was found in CM compared to controls (OR = 3.1, CI 2.10-4.56, P < .0001), such that cortical thickness between regions tended to be more correlated in patients, particularly in the temporal and frontal lobes.CM patients have significantly greater cortical covariance compared to controls. Cortical thickness in CM patients was predominantly accounted for by CM duration, PTSD, and poor sleep quality, while improved pain self-efficacy buffered cortical thickness. While it is important to address all CM features and comorbidities, it may be useful to emphasize optimizing the management of certain clinical features that contribute to cortical abnormalities including managing PTSD, early management to shorten duration of CM, and improving pain self-efficacy and sleep quality.

  View details for DOI 10.1111/head.13452

  View details for PubMedID 30468246

• Migraine affects 1 in 10 people worldwide featuring recent rise: A systematic review and meta-analysis of community-based studies involving 6 million participants Journal of the Neurological Sciences Woldeamanuel, Y. W., Cowan, R. P. 2017; 372: 307-315

  View details for DOI 10.1016/j.jns.2016.11.071

• Migraine and Complex Regional Pain Syndrome: A Case-Referent Clinical Study. BioMed research international Woldeamanuel, Y. W., Cooley, C., Foley-Saldena, K., Cowan, R. P. 2017; 2017: 5714673

  Abstract

  We studied clinical phenotype differences between migraineurs with CRPS (Mig + CRPS) and those without (Mig - CRPS). Mig + CRPS cases and Mig - CRPS referents aged ≥18 years were enrolled. Diagnosis was made in accordance with International Classification of Headache Disorders-3 beta (ICHD-3 beta) for migraine and Budapest Criteria for CRPS. Migraines both with and without aura were included. A total of 70 Mig + CRPS cases (13% males, mean age 48 years) and 80 Mig - CRPS referents (17% males, mean age 51 years) were included. 33% of Mig + CRPS and 38% of Mig - CRPS exhibited episodic migraine (EM) while 66% of Mig + CRPS and 62% of Mig - CRPS had chronic migraine (CM) (OR = 0.98, CI 0.36, 2.67). Median duration of CRPS was 3 years among EM + CRPS and 6 years among CM + CRPS cohort (p < 0.02). Mig + CRPS (57%) carried higher psychological and medical comorbidities compared to Mig - CRPS (6%) (OR 16.7, CI 10.2, 23.6). Higher migraine frequency was associated with longer CRPS duration. Migraineurs who developed CRPS had higher prevalence of psychological and medical disorders. Alleviating migraineurs' psychological and medical comorbidities may help lower CRPS occurrence.

  View details for DOI 10.1155/2017/5714673

  View details for PubMedID 29214172

  View details for PubMedCentralID PMC5682894

• Headache in Resource-Limited Settings. Current pain and headache reports Woldeamanuel, Y. W. 2017; 21 (12): 51

  Abstract

  This review summarizes the unmet need of headache burden and management in resource-limited settings. It provides a general overview of the nuances and peculiarities of headache disorders in resource-limited settings. The review delivers perspectives and explanations for the emerging burden of both primary and secondary headache disorders. Important discussion on demographic and epidemiologic transition pertinent to low-resource settings is included. A critical analysis of headache disorders is made within the context of growing burden non-communicable disorders in low-resource countries. Challenges are examined and prospective feasible solutions tailored to existing resources are provided to address headache disorders in resource-limited settings.Many low-resource countries are entering into the third epidemiological transition featuring increasing burden of non-communicable disorders of which headache disorders contribute a significant proportion. Exponential population growth involving youthful demographic and massive rural-urban migration is taking place in low-resource countries. Youthful demographic is the natural cohort for primary headache such as migraine. Socioeconomic mobility and lifestyle changes are leading to higher levels of physical inactivity and obesity, both of which are related to headache. Life expectancy is rising in some resource-restricted countries; this increases prevalence of secondary headache attributed to neurovascular causes. Many low-resource countries are still burdened with tropical infectious causes of secondary headache. Health care facilities are primarily designed to respond to infectious epidemic and not to chronic burden such as headache. Many low-resource-restricted settings are plagued by poor and corrupt governance, ill-equipped regimes with malfunctioning health policies, war, and poverty. Many low-resource settings do not have access to generic headache medications such as triptans. Headache training and expertise is low. Healthy lifestyle changes emphasizing on improving regular exercise can be inexpensive method to reducing primary headache burden and its comorbidities (e.g. obesity). Addressing the increasing burden of headache disorders in resource-limited settings is important to avert accrued disability which in turn lowers productivity and socioeconomic performance in a young booming population.

  View details for DOI 10.1007/s11916-017-0651-7

  View details for PubMedID 29143899

• Development, Validation, and Field-Testing of an Instrument for Clinical Assessment of HIV-Associated Neuropathy and Neuropathic Pain in Resource-Restricted and Large Population Study Settings PLOS ONE Woldeamanuel, Y. W., Kamerman, P. R., Veliotes, D. G., Phillips, T. J., Asboe, D., Boffito, M., Rice, A. S. 2016; 11 (10)

  Abstract

  HIV-associated sensory peripheral neuropathy (HIV-SN) afflicts approximately 50% of patients on antiretroviral therapy, and is associated with significant neuropathic pain. Simple accurate diagnostic instruments are required for clinical research and daily practice in both high- and low-resource setting. A 4-item clinical tool (CHANT: Clinical HIV-associated Neuropathy Tool) assessing symptoms (pain and numbness) and signs (ankle reflexes and vibration sense) was developed by selecting and combining the most accurate measurands from a deep phenotyping study of HIV positive people (Pain In Neuropathy Study-HIV-PINS). CHANT was alpha-tested in silico against the HIV-PINS dataset and then clinically validated and field-tested in HIV-positive cohorts in London, UK and Johannesburg, South Africa. The Utah Early Neuropathy Score (UENS) was used as the reference standard in both settings. In a second step, neuropathic pain in the presence of HIV-SN was assessed using the Douleur Neuropathique en 4 Questions (DN4)-interview and a body map. CHANT achieved high accuracy on alpha-testing with sensitivity and specificity of 82% and 90%, respectively. In 30 patients in London, CHANT diagnosed 43.3% (13/30) HIV-SN (66.7% with neuropathic pain); sensitivity = 100%, specificity = 85%, and likelihood ratio = 6.7 versus UENS, internal consistency = 0.88 (Cronbach alpha), average item-total correlation = 0.73 (Spearman's Rho), and inter-tester concordance > 0.93 (Spearman's Rho). In 50 patients in Johannesburg, CHANT diagnosed 66% (33/50) HIV-SN (78.8% neuropathic pain); sensitivity = 74.4%, specificity = 85.7%, and likelihood ratio = 5.29 versus UENS. A positive CHANT score markedly increased of pre- to post-test clinical certainty of HIV-SN from 43% to 83% in London, and from 66% to 92% in Johannesburg. In conclusion, a combination of four easily and quickly assessed clinical items can be used to accurately diagnose HIV-SN. DN4-interview used in the context of bilateral feet pain can be used to identify those with neuropathic pain.

  View details for DOI 10.1371/journal.pone.0164994

  View details for Web of Science ID 000386204500098

  View details for PubMedID 27764177

• The impact of regular lifestyle behavior in migraine: a prevalence case-referent study JOURNAL OF NEUROLOGY Woldeamanuel, Y. W., Cowan, R. P. 2016; 263 (4): 669-676

  Abstract

  Regular lifestyle behaviors (RLBs) of sleep, exercise, mealtime pattern and hydration status independently affect migraine occurrence. We aimed herein to evaluate the differences in migraine occurrence among participants who do and do not maintain the RLB triumvirate. Cases of chronic migraine (CM) and referents of episodic migraine (EM) ≥aged 15 years with charts regularly documenting RLB notes were continuously enrolled from a retrospective case-referent cohort study performed on electronic chart review from January 1, 2014 to January 1, 2015 at the Stanford Headache and Facial Pain Program. Association between RLB prevalence and migraine occurrence was studied. 175 CM and 175 EM patients were enrolled (mean age 44.4 years, 22 % males). Migraine was diagnosed according to the ICHD-3 beta criteria, and was confirmed by a Headache Specialist attending the Clinic. The CM cohort (22 %) exhibited less RLB than the EM cohort (69 %), with crude odds ratio of 0.13 (95 % confidence interval or CI 0.08-0.21). The adjusted odds ratio and adjusted relative risk between RLB+, Meds+ (those taking medication) and CM were 0.67 (95 % CI 0.32-1.40) and 0.74 (95 % CI 0.43-1.28), indicating no significant effect modification. Engaging in regular lifestyle behavior helps quell chronic migraine.

  View details for DOI 10.1007/s00415-016-8031-5

  View details for Web of Science ID 000373742600006

  View details for PubMedID 26810728

• The place of corticosteroids in migraine attack management: A 65-year systematic review with pooled analysis and critical appraisal. Cephalalgia Woldeamanuel, Y. W., Rapoport, A. M., COWAN, R. P. 2015; 35 (11): 996-1024

  Abstract

  Headaches recur in up to 87% of migraine patients visiting the emergency department (ED), making ED recidivism a management challenge. We aimed herein to determine the role of corticosteroids in the acute management of migraine in the ED and outpatient care.Advanced search strategies employing PubMed/MEDLINE, Web of Science, and Cochrane Library databases inclusive of a relevant gray literature search was employed for Clinical Studies and Systematic Reviews by combining the terms "migraine" and "corticosteroids" spanning all previous years since the production of synthetic corticosteroids ca. 1950 until August 30, 2014. Methods were in accordance with MOOSE guidelines.Twenty-five studies (n = 3989, median age 37.5 years, interquartile range or IQR 35-41 years; median male:female ratio 1:4.23, IQR 1:2.1-6.14; 52% ED-based, 56% randomized-controlled) and four systematic reviews were included. International Classification of Headache Disorders criteria were applied in 64%. Nineteen studies (76%) indicated observed outcome differences favoring benefits of corticosteroids, while six (24%) studies indicated non-inferior outcomes for corticosteroids. Median absolute risk reduction was 30% (range 6%-48.2%), and 11% (6%-48.6%) for 24-, and 72-hour headache recurrence, respectively. Parenteral dexamethasone was the most commonly (56%) administered steroid, at a median single dose of 10 mg (range 4-24 mg). All meta-analyses revealed efficacy of adjuvant corticosteroids to various abortive medications-indicating generalizability. Adverse effects were tolerable. Higher disability, status migrainosus, incomplete pain relief, and previous history of headache recurrence predicted outcome favorability.Our literature review suggests that with corticosteroid treatment, recurrent headaches become milder than pretreated headaches and later respond to nonsteroidal therapy. Single-dose intravenous dexamethasone is a reasonable option for managing resistant, severe, or prolonged migraine attacks.

  View details for DOI 10.1177/0333102414566200

  View details for PubMedID 25576463

• Prevalence of migraine headache and its weight on neurological burden in Africa: a 43-year systematic review and meta-analysis of community-based studies. Journal of the neurological sciences Woldeamanuel, Y. W., Andreou, A. P., Cowan, R. P. 2014; 342 (1-2): 1-15

  Abstract

  Headache burden is not adequately explored in Africa. Here, we measured weighted migraine prevalence from community-based studies in Africa.PubMed search was employed using terms 'headache in Africa' AND/OR 'migraine in Africa' for published literature from 1970 until January 31, 2014. PRISMA was applied for systematic review. Forest-plot meta-analysis, inter-study heterogeneity, and odds ratio were used to measure weighted prevalence, inter-gender, and urban-rural differences. Disability adjusted life years (DALYs) for migraine and other neurologic disorders in Africa were extracted from Global Burden of Diseases (GBD) 2000-2030.Among 21 community-based studies included (n=137,277), pooled migraine prevalence was 5.61% (95% CI 4.61, 6.70; random effects) among general population; while 14.89% (14.06, 15.74; fixed effects) among student cohorts. Female students had weighted OR of 2.13 (1.34, 3.37; p=0.0013). Prevalence of migraine was higher among urban population compared to rural settings. Migraine burden is bound to increase by more than 10% DALYs within the next decade.Africa has a crude estimate of 56 million people suffering from migraine. By virtue of mainly afflicting the younger working-age group, migraine disability has wider socioeconomic implications. Improving early headache management access points at community-level, training and research at facility-level, and healthy lifestyle modification among urban residents can help reduce this costly and disabling chronic progressive health problem.

  View details for DOI 10.1016/j.jns.2014.04.019

  View details for PubMedID 24814950

• A 22-year-old Male Farmer from Rural Ethiopia with Difficulty Walking CLINICAL CASES IN TROPICAL MEDICINE. Manson's Tropical Diseases, 23rd Edition (ISBN: 978-0-7020-5101-2) Wioldeamanuel , Y. W. edited by Rothe, C. Elsevier Science Health Science div. 2014; 1st Edition: 261–265

  View details for DOI 10.1016/b978-0-7020-5824-0.00069-5

• Cancer in Ethiopia LANCET ONCOLOGY Woldeamanuel, Y. W., Girma, B., Teklu, A. M. 2013; 14 (4): 289-290

  Abstract

  Ethiopia has a population of more than 84 million people and is expected to become the ninth most populous country in the world by 2050. The growing population coupled with lifestyle changes will mean an increasing burden of cancer. However, oncology services are wholly inadequate--no cancer registry exists, and only one cancer centre, with a handful of doctors and nurses, struggles to serve the entire country.

  View details for Web of Science ID 000317390300034

  View details for PubMedID 23561741

• Tetanus in Ethiopia: Unveiling the Blight of an Entirely Vaccine-Preventable Disease CURRENT NEUROLOGY AND NEUROSCIENCE REPORTS Woldeamanuel, Y. W. 2012; 12 (6): 655-665

  Abstract

  Today, tetanus exacts its toll only in resource-poor countries like Ethiopia. Agrarian rural life with limited vaccine typifies tetanus risk in Ethiopia where current tetanus control trends on expanding infant immunization and eliminating highly prevalent maternal and neonatal tetanus (MNT). Protection by infant tetanus immunization primers disappears within an average of 3 years, if not followed by boosters. Second-year of life, school-based, and universal 10-yearly tetanus immunizations need to be supplemented. Facility-based reviews in Ethiopia reveal a continued burden of tetanus at tertiary-level hospitals where ICU care is suboptimal. Quality of medical care for tetanus is low - reflected by high case-fatality-rates. Opportunities at primary-health-care-units (antenatal-care, family planning, abortion, wound-care, tetanus-survivors) need to be fully-utilized to expand tetanus immunization. Prompt wound-care with post-exposure prophylaxis and proper footwear must be promoted. Standard ICU care needs to exist. Realization of cold-chain-flexible, needle-less and mono-dose vaccine programs allow avoiding boosters, vaccine-refrigeration, and improve compliance.

  View details for DOI 10.1007/s11910-012-0314-3

  View details for Web of Science ID 000310393500005

  View details for PubMedID 22996275

• Neurolathyrism: two Ethiopian case reports and review of the literature JOURNAL OF NEUROLOGY Woldeamanuel, Y. W., Hassan, A., Zenebe, G. 2012; 259 (7): 1263-1268

  Abstract

  Neurolathyrism is a toxic myelopathy caused by ingestion of the Lathyrus sativus grasspea. An irreversible acute to subacute spastic paraparesis or quadriparesis ensues. Despite public education, new cases of this preventable disease still occur. Two Ethiopian cases of neurolathyrism are reported to illustrate the disease, followed by a literature review. Two teenage male farmers from the same village developed irreversible spastic myelopathy following L. sativus ingestion. There was no sensory, sphincter or bulbar dysfunction. Likely causative factors identified were increased consumption of L. sativus prior to and following disease onset, heavy physical exertion and male gender, similar to those reported in the literature. Neurolathyrism is an entirely preventable neurotoxic myelopathy with permanent disability accrued. Treatment is symptomatic. Because of personal disability and subsequent socioeconomic effects, this disease warrants further public health measures to prevent occurrence. Education, avoidance of the grasspea and measures to reduce toxin burden are possible methods.

  View details for DOI 10.1007/s00415-011-6306-4

  View details for Web of Science ID 000306125700001

  View details for PubMedID 22081101

• Expression profile of neuropeptide Y, its receptors and its role in seizures on mouse models of toxoplasmosis and African trypanosomiasis 22nd Meeting of the European-Neurological-Society Woldeamanuel, Y. W. SPRINGER HEIDELBERG. 2012: S54–S55

  View details for Web of Science ID 000306083200145

• Case Study: Watch for Tuberculous Encephalopathy in Endemic Areas WORLD NEUROLOGY Gebremichael, S. G., Adeb, M. D., Woldeamanuel, Y. W. 2009; 24 (6): 12
• Obesity-Related Cortical Thickness Changes in Chronic Migraine Woldeamanuel, Y. W., DeSouza, D. D., Sanjanwala, B. M., Cowan, R. P. WILEY. 2018: S83

  View details for Web of Science ID 000446520900106

• Headache Due to Infections and Disorders of Homeostasis Modern Day Management of Headache: Questions and Answers Woldeamanuel, Y. W. Jaypee Brothers Medical Publishers (P) Ltd. . 2017 ; 1st: 291–301
• Headache Secondary to Nonvascular Intracranial Disorders Modern Day Management of Headache: Questions and Answers Woldeamanuel, Y. W. Jaypee Brothers Medical Publishers (P) Ltd.. 2017; 1st : 280–290
• Spontaneous extracranial hemorrhagic phenomena in primary headache disorders: A systematic review of published cases CEPHALALGIA Peretz, A. M., Woldeamanuel, Y. W., Rapoport, A. M., Cowan, R. P. 2016; 36 (13): 1257-1267

  View details for DOI 10.1177/0333102415618951

  View details for Web of Science ID 000387693900006

• Journal Club: Change in brain network connectivity during PACAP38-induced migraine attacks. Neurology DeSouza, D. D., O'Hare, M., Woldeamanuel, Y. W., Cowan, R. P. 2016; 87 (16): e199-e202

  View details for PubMedID 27754916

• Journal Club: Exacerbation of headache during dihydroergotamine for chronic migraine does not alter outcome. Neurology Woldeamanuel, Y. W., O'Hare, M., DeSouza, D. D., Cowan, R. P. 2016; 87 (16): e196-e198

  Abstract

  Transient headache exacerbation during IV dihydroergotamine (DHE) therapy of migraine may prompt clinicians to prematurely discontinue DHE therapy, potentially depriving patients of the full benefit of DHE infusion. In a recent Neurology® article, Eller et al. evaluated whether or not worsening headache during DHE infusion was associated with suboptimal medium-term headache outcomes.

  View details for PubMedID 27754915

• Case fatality of adult tetanus in Africa: Systematic review and meta-analysis. Journal of the neurological sciences Woldeamanuel, Y. W., Andemeskel, A. T., Kyei, K., Woldeamanuel, M. W., Woldeamanuel, W. 2016; 368: 292-299

  Abstract

  Tetanus is a continued public health neuroinfectious burden in Africa; it accounts for significant proportion of lengthy intensive care unit (ICU) and hospital admissions.This study aimed to describe the pooled case-fatality rates of adult tetanus at African hospitals along with relevant discussions and recommendations.A systematic review using advanced search strategies employing PubMed/MEDLINE and Web of Science inclusive of gray literature handsearch was conducted for facility-based studies on adult tetanus by combining the terms "tetanus", "Africa" spanning all previous years until January 15, 2016. PRISMA and MOOSE guidelines were followed. Studies from non-African countries and studies on neonatal and childhood tetanus were excluded. A meta-analysis with fixed- and random-effects model was performed to identify pooled migraine prevalence. Inter-study heterogeneity was analyzed employing I Oshinaike et al. (2012) (inconsistency).Twenty-seven studies involving 3043 patients were included. Median age was 33.7years (IQR 30-36). Median female to male ratio was 0.5. The geographic distribution of the studies was as follows: 15 (55.5%) studies were from Nigeria, 7 (26%) from Ethiopia, and the remaining single-centered studies were from Ghana (1; 3.7%), Uganda (1; 3.7%), Senegal (1; 3.7%), Democratic Republic of Congo (1; 3.7%), and Tanzania (1; 3.7%). The majority (88%) of the studies were from tertiary specialized or teaching university hospital settings.Median duration of the study period was 6.5years (IQR 4-9.25). Pooled crude tetanus case-fatality rate was found to be 43.2% (95% CI 36.9%-49.5%) on random-effects meta-analysis and 45.5% (95% CI 43.7%-47.2%) on fixed-effects meta-analysis. There was considerable inter-study heterogeneity. A time-series observation did not reveal a trend of decreasing case-fatality rates. Leading causes of death were complications from dysautonomia, aspiration pneumonia, hypoxemia, and sepsis (in descending order). Longer incubation period and longer onset time were associated with lower fatality; the further the wound site from the head, the longer the incubation period. Mechanical ventilation was not available in 26% of the studies; where available, mechanical ventilation and ICU admission was not utilized among most of the cases as the patients could not afford ICU care costs.Despite declining tetanus incidence rates, case-fatality is still high in African care facilities. High rates of tetanus case fatality indicate lower quality of medical care at hospital settings.Most common causes of death are complication arising from dysautonomia and respiratory arrest secondary to laryngospasm. These can be prevented by potent medications and mechanical ventilation; where resources are lacking, nursing in darker and quieter rooms have been proven to be efficacious in reducing the frequency of spasms.

  View details for DOI 10.1016/j.jns.2016.07.025

  View details for PubMedID 27538652

• Indomethacin Responsive Headaches: Exhaustive Systematic Review With Pooled Analysis and Critical Appraisal of 81 Published Clinical Studies HEADACHE Bordini, E. C., Bordini, C. A., Woldeamanuel, Y. W., Rapoport, A. M. 2016; 56 (2): 422-435

  Abstract

  The relationship between indomethacin (IMC) and headache treatment has long intrigued clinicians and clinical researchers in Headache Medicine. Why is it efficacious in many types of headache disorders when other medications are not, and what is the mechanism behind its efficacy? IMC and headache related topics that have been explored in detail in the literature include IMC-responsive headache disorders ("traditional"), pharmacology of IMC, symptomatic headaches responsive to IMC, "novel" headache conditions that respond, cluster headache and IMC, IMC provoking headache, the issue about" absolute" and "non-absolute" effect of IMC on headache disorders, and the morphing trigeminal autonomic cephalalgias (TACs).A PubMed/MEDLINE search was used for Clinical Studies Categories and Systematic Reviews on the PubMed Clinical Queries. The search details were "indomethacin" AND "headache" spanning all previous years until February 1, 2015. Methods were in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Articles were excluded if IMC had not been used to treat headache disorders in adults, if the article concerned IMC-responsive headaches but made no reference to the use of IMC, and articles not addressing the above mentioned topics.The "velocity" of publications on IMC and headache seems to be decreasing, particularly on the use of IMC for the treatment of TACs. The science behind the understanding of the putative mechanisms of IMC's action on headache has moved forward, but the answer to why it works better than other nonsteroidal anti-inflammatory drugs has been elusive. There are case reports of other rare headache disorders that may be responsive to IMC. The dosages of IMC used as a tool for detecting IMC responsive disorders vary according to different centers of investigation. In many circumstances, headache disorders similar to "primary" IMC-responsive disorders are actually symptomatic disorders. Cluster headache as an IMC-resistant headache disorder may not be as absolute as once thought. Sometimes, IMC has been found to provoke headache; differentiating IMC-provoked headache from IMC-resistant headache can make headache diagnosis and management difficult. As for the "absolute" responsiveness of IMC, it is possible that using higher dosages leads to higher sensitivity, probably at the expense of decreased specificity. There are many reports about the occurrence of two or more IMC-responsive disorders (latu sensu) in the same patient, which may be coincidental.

  View details for DOI 10.1111/head.12771

  View details for Web of Science ID 000371076900022

  View details for PubMedID 26853085

• Spontaneous extracranial hemorrhagic phenomena in primary headache disorders: A systematic review of published cases. Cephalalgia Peretz, A. M., Woldeamanuel, Y. W., Rapoport, A. M., Cowan, R. P. 2015

  Abstract

  Head pain is a cardinal feature of primary headache disorders (PHDs) and is often accompanied by autonomic and vasomotor symptoms and/or signs. Spontaneous extracranial hemorrhagic phenomena (SEHP), including epistaxis, ecchymosis, and hematohidrosis (a disorder of bleeding through sweat glands), are poorly characterized features of PHDs.To critically appraise the association between SEHP and PHDs by systematically reviewing and pooling all reports of SEHP associated with headaches.Advanced searches using the PubMed/MEDLINE, Web of Science, Cochrane Library, Google Scholar, and ResearchGate databases were carried out for clinical studies by combining the terms "headache AND ecchymosis", "headache AND epistaxis", and "headache AND hematohidrosis" spanning all medical literature prior to October 10, 2015. Preferred Reporting Items for Systematic Reviews and Meta-analyses and Meta-analysis of Observational Studies in Epidemiology guidelines were applied.A total of 105 cases of SEHP associated with PHDs (83% migraine and 17% trigeminal autonomic cephalgias) were identified (median age 27 years, male to female ratio 1:2.3); 63% had epistaxis, 33% ecchymosis, and 4% hematohidrosis. Eighty-three percent of studies applied the International Classification of Headache Disorders diagnostic criteria. Eighty percent of the reported headaches were episodic and 20% were chronic. Twenty-four percent of studies reported recurrent episodes of SEHP.Our results suggest that SEHP may be rare features of PHDs. Future studies would benefit from the systematic characterization of these phenomena.

  View details for PubMedID 26611681

• Sensory, psychological, and metabolic dysfunction in HIV-associated peripheral neuropathy: A cross-sectional deep profiling study PAIN Phillips, T. J., Brown, M., Ramirez, J. D., Perkins, J., Woldeamanuel, Y. W., Williams, A. C., Orengo, C., Bennett, D. L., Bodi, I., Cox, S., Maier, C., Krumova, E. K., Rice, A. S. 2014; 155 (9): 1846-1860

  Abstract

  HIV-associated Sensory Neuropathy (HIV-SN) is a frequent complication of HIV infection and a major source of morbidity. A cross-sectional deep profiling study examining HIV-SN was conducted in people living with HIV in a high resource setting, using a battery of measures which included: parameters of pain and sensory symptoms (7 day pain diary, Neuropathic Pain Symptom Inventory (NPSI) and Brief Pain Inventory (BPI)), sensory innervation (structured neurological examination, quantitative sensory testing (QST) and intra-epidermal nerve fibre density (IENFD)), psychological state (Pain Anxiety Symptoms Scale-20 (PASS-20), Depression Anxiety and Positive Outlook Scale (DAPOS), and Pain Catastrophizing Scale (PCS), insomnia (Insomnia Severity Index (ISI)) and quality of life (Short-Form (36) Health Survey (SF-36)). The diagnostic utility of the Brief Peripheral Neuropathy Screen (BPNS), Utah Early Neuropathy Scale (UENS) and Toronto Clinical Scoring System (TCSS) were evaluated. Thirty-six healthy volunteers and 66 HIV infected participants were recruited. A novel triumvirate case definition for HIV-SN was used which required two out of three of the following: two or more abnormal QST findings, reduced IENFD and signs of a peripheral neuropathy on a structured neurological examination. Of those with HIV, 42% fulfilled the case definition for HIV-SN (n=28), of whom 75% (n=21) reported pain. The most frequent QST abnormalities in HIV-SN were loss of function in mechanical and vibration detection. Structured clinical examination was superior to QST or IENFD in HIV-SN diagnosis. HIV-SN participants had higher plasma triglyceride concentrations depression, anxiety and catastrophizing scores and prevalence of insomnia than HIV participants without HIV-SN.

  View details for DOI 10.1016/j.pain.2014.06.014

  View details for Web of Science ID 000341873000021

  View details for PubMedID 24973717

• Contributing towards the betterment of translational epilepsy research in Africa: needs, challenges, resources, and opportunities. Current neurology and neuroscience reports Woldeamanuel, Y. W., Girma, B. 2014; 14 (8): 480-?

  Abstract

  Epilepsy affects approximately 50 million people worldwide. Among them, at least 40 million people are currently living in the developing world, where resources and standards of care are suboptimal. Around 90 % of people with epilepsy in resource-poor countries do not currently receive appropriate treatments, at a time when two thirds of these patients could have achieved good control of their epileptic seizures had they had access to appropriate therapies. Scarcity of epilepsy specialists, poor availability or access to diagnostic facilities and treatments, poor community knowledge about epilepsy-related issues, stigma, and other societal and cultural barriers are only some of the issues contributing to this deficiency. These issues in epilepsy treatment have been well recognized, and ongoing concerted efforts to address them have been undertaken by both local authorities and international organizations. In many cases, patients resort to the use of traditional local and alternative medicines (herbs, religious practices, etc.) that are closer to indigenous cosmovision, are more holistic, and are more culture-friendly, preserving an optimum subtlety of Afrocentric character shading. Compared with imported Western medicines, patients find these approaches to be more relevant to their ways of thinking, their ways of being, and their belief systems, more accessible, and more acceptable methods of dealing with health and disease states. The impressive local wealth in these natural resources has established them as a preferred source of healing in these regions, but has also fueled interest in exploring their therapeutic potential in the very few existing local research centers. In this review, we discuss the known issues related to the epilepsy treatment gap in resource-poor regions, focusing in particular on African countries, introduce the role and issues related to the use and validation of alternative medical therapies in epilepsy, and comment on the importance and repercussions of initiatives to validate such therapies, primarily for local practices, but also for possible wider international applications.

  View details for DOI 10.1007/s11910-014-0480-6

  View details for PubMedID 25005223

• A 43-year systematic review and meta-analysis: case-fatality and risk of death among adults with tuberculous meningitis in Africa JOURNAL OF NEUROLOGY Woldeamanuel, Y. W., Girma, B. 2014; 261 (5): 851-865

  Abstract

  Tuberculous meningitis (TBM) is a preventable and curable common health problem among African adults. Poor nutrition, poverty, household crowding, drug resistant tuberculosis (TB) strains, AIDS, and malfunctioning TB control programs are important risk factors. We conducted a systematic review and meta-analysis of published literature reporting case-fatalities of TBM among adults in African countries from 1970 till date. A PubMed search identified relevant papers. Employed terms include 'adult tuberculous meningitis' AND 'tuberculosis Africa'. PRISMA review guidelines were applied. Adult TBM case-fatalities, odds ratio (OR), relative risk (RR), forest-plot meta-analysis for weighted OR and RR, funnel plots, L'Abbé plots, meta-regressed bubble plots, and inter-study homogeneity were computed. Among 15 studies included, adult TBM occurred in up to 28 % of all meningitis forms with case-fatality of 60 % (inverse-variance weighted 54 %). Fixed-effect meta-analysis revealed weighted OR and RR of adult TBM fatalities to be 4.37 (95 % CI 3.92, 4.88) and 2.53 (95 % CI 2.38, 2.69), respectively. Inter-study homogeneity was reliable, regional representativeness was adequate allowing generalizability, and funnel-plots behaved symmetrically with insignificant inconsistency. All cases were initiated with anti-TB medication, while some had 'breakthrough' TBM. In Africa, adult TBM has a significant public health importance with a very high fatality which has remained stagnant for the past half-century. This reflects ongoing low quality of medical care at facilities where lengthy referrals end up. Community-based studies can reveal higher unaccounted morbidity, accrued disability, and larger mortality. Improving access points for early TB management at community-level, developing health infra-structure for comprehensive case management at facility-level, and poverty reduction can help combat this multi-faceted problem-whose reduction can in return help fight poverty.

  View details for DOI 10.1007/s00415-013-7060-6

  View details for Web of Science ID 000335772500001

  View details for PubMedID 23963469

• The Socioeconomic and Neurological Burden of Neurolathyrism in Ethiopia - the saga continues Cassava Cyanide Diseases and Neurolathyrism Network News Woldeamanuel, Y. W. 2014: 3-6
• EHMTI-0318. The place of corticosteroids in migraine attack management: systematic review and critical appraisal Abstracts from the 4th European Headache and Migraine Trust International Congress: EHMTIC 2014 Woldeamanuel, Y. W., Rapoport, A. M., Cowan, R. P. 2014: G42

  View details for DOI 10.1186/1129-2377-15-S1-G42

• What is the evidence for the use of corticosteroids in migraine? Current pain and headache reports Woldeamanuel, Y. W., Rapoport, A. M., Cowan, R. P. 2014; 18 (12): 464

  Abstract

  Corticosteroids are widely prescribed for the management of migraine attacks. The earliest clinical studies examining the efficacy of corticosteroid monotherapy for managing migraine attacks date back to 1952. Since then, 26 heterogeneous clinical studies and four meta-analyses have been conducted to assess the efficacy of corticosteroids in either aborting acute migraine attacks, prolonged migraine attacks or recurrent headaches. Most of these (86 %) studies employed different comparator arms with corticosteroids monotherapy administration while some studies (14 %) evaluated adjunctive corticosteroid therapy. The majority of these clinical studies revealed the superior efficacy of corticosteroids as mono- or adjunctive-therapy both for recurrent and acute migraine attacks, while the remaining showed non-inferior efficacy. Different forms of oral and parenteral corticosteroids in either single-dose or short-tapering schedules are prescribed; there are clinical studies supporting the efficacy of both methods. Corticosteroids can be administered safely up to six times annually. Corticosteroids are also useful in managing patients who frequent emergency departments with "medication-seeking behavior." Migraine patients with refractory headaches, history of recurrent headaches, severe baseline disability, and status migrainosus were found to have the most beneficial response from corticosteroid therapy.

  View details for DOI 10.1007/s11916-014-0464-x

  View details for PubMedID 25373608

• Tetanus Weighs on Neurological Burden in Ethiopia WORLD NEUROLOGY Woldeamanuel, Y. W., Hassan, A. 2010; 25 (5): 14