Objectives: Migraine is a headache disorder affecting approximately 12% of the population, predominantly female individuals. Migraine has been associated with vascular events such as stroke and cardiovascular disease. The close connection between these vascular disorders and atherosclerosis is well known. Carotid artery intima-media thickness (CAIMT) is a marker for detection of subclinical atherosclerosis. The present study is an analysis of the presence of subclinical atherosclerosis in migraine patients.
Methods: CAIMT was evaluated in 25 female migraine patients and 27 female controls using innovative ultrasound (US) radiofrequency (RF) data technology. Mann–Whitney U test was used to compare measurements in patient and control groups.
Results: There was a statistically significant difference between mean CAIMT of migraine patients and control group (p<0.005): mean CAIMT was 701±114 μm in migraine patients and 400±64 μm in control group.
Conclusion: Migraine patients are more prone to atherosclerosis compared to healthy individuals. CAIMT measurement with sonography can be utilized in follow-up to detect subclinical atherosclerosis.

Aim: In the last two decades, mirror therapy is becoming widely used on the management of phantom limb pain (PLP). However, the role of nurses on mirror therapy is not well explained yet. This study aimed to determine the effect of mirror therapy on the management of PLP, and to discuss the importance of mirror therapy in nursing care of amputated patients.
Methods: This quasi-experimental study was conducted with 15 amputated patients who had PLP in pain management department of a university hospital and a prosthesis clinic in Istanbul, Turkey. Forty-minutes of practical mirror therapy education was given to the patients and asked to practice for 4-weeks at home. The patients were asked to write down the severity of their PLP before-and-after the therapy each day with 0-10 Numeric Pain Intensity Scale.
Results: Mirror therapy practiced for 4-weeks provided a significant decrease in the severity of PLP. There wasn’t any significant relation between the effect of mirror therapy and demographic, amputation and/or PLP related characteristics. The patients who weren’t using prosthesis had greater effect from mirror therapy.
Conclusions: Mirror therapy can be used as an adjunctive method in the medical and surgical treatment of PLP. It’s a method which patients can practice independently, so that they can enhance their self-control on the phantom pain. As mirror therapy is a safe, economic and easy-to-use method; in the nursing care plan of the patient with PLP, mirror therapy should be considered in the patient’s education plan.

Aim: We aimed to compare the effects of preincisional intravenous dexketoprofen trometamol and acetaminophen on postoperative pain, analgesic requirement, hemodynamic parameters, postoperative tramadol consumption and patient satisfaction in patients undergoing elective septorhinoplasty.
Methods: Sixty patients scheduled for elective septorhinoplasty under general anaesthesia were divided into three groups. Group D (n=20) received 50 mg iv dexketoprofen trometamol, Group A (n=20) received 1 gr iv acetaminophen before surgical incision. Group K (n=20) received no analgesic. Postoperative analgesia was maintained with intravenous tramadol infusion, with the aid of a patient controlled analgesia pump. The visual analogue scale (VAS), total tramadol consumption and patient satisfaction were recorded at 15, 30. minutes and 1, 2, 6, 12, 24. hours postoperatively.
Results: The groups were similar with respect to gender, mean age, body weight, mean surgery and anaesthesia durations (p>0.05). VAS values were the highest in Group K and lowest in Group D (p<0.001). There was no difference regarding the tramadol consumption between group K and group A, but both two groups consumed higher doses of tramadol than group D (p=0.649 and p<0.05, respectively). First analgesic requirement time and side effects were similar in all groups.
Conclusion: We observed that preemptive iv. dexketoprofen trometamol or acetaminophen were both effective for postoperative analgesia in early postoperative period in elective septorhinoplasty under general anaesthesia. We found that preemptive dexketoprofen trometamol was more effective than acetaminophen for postoperative analgesia.

Objectives: Headache during migraine attack may recur during a single attack. The present study evaluated efficacy of both individual and combined use of agents from nonsteroidal anti-inflammatory drug (NSAID) and triptan groups widely used in treatment of migraine attacks.
Methods: A total of 201 attacks in 67 migraine patients were evaluated. Patients were divided into 3 study groups: those receiving rizatriptan 10mg, tenoxicam 20 mg, and rizatriptan + tenoxicam (combination). Patients evaluated severity of headache based on visual analogue scale (VAS) at moment of drug delivery, after 30 minutes, and after 1, 2, 4, 8 and 24 hours. Attacks were evaluated separately for each treatment alternative, and results were also compared.
Results: VAS values were the same at onset of attack, but were lower in rizatriptan and combination groups than in tenoxicam group at 30 minutes and onward. VAS score was above 4 at 60 minutes in tenoxicam group and mean VAS value in this group was found to be significantly higher than values in rizatriptan and combined groups. At 24 hours, VAS scores were similar in combination and tenoxicam groups, while rizatriptan group had higher mean VAS score than the other 2 groups.
Conclusion: When single drug use fails to provide adequate control, combined use of a rapid-acting triptan and a long-acting NSAID appears to be a suitable treatment option.

In this study, we aimed to evaluate the efficacy of the PCA method as well as the attitudes of parents and health care professionals on the usage of PCA on children with SCA.
The parents of children with SCA(n=54) followed by Algology department and the healthcare providers(doctors, nurses)(n=32);totally 86 people were involved in the study.To evaluate the efficacy of the method, a questionnaire was prepared and the level of knowledge of the participants on PCA method;advantages and disadvantages of the method have been questioned.According to 65.6%(n=21) of the heath care providers PCA must be used during acute phase of pain.Great majority of the participants (93%,n=80) thought that pain was effectively controlled during day and night.PCA reduced the fear of unavailability of analgesic drugs in 83.3%(n=45) of parents and in 87.5% (n=28) of health care providers.The fear of exacerbation of pain was significantly reduced in parents(37%) compared to health care providers (9.4%)(p<0.05).Most of the parents (87%,n=47) reported that they did not preferred to use demand dose of analgesic until their children complained from severe pain due to concern of over dose or addiction.Repeated machine alarms(48%,n=26) and the length of refilling time(48%,n=26) were reported as disadvantages of PCA method.In this study, parents and health care professional found PCA method to be effective to relief pain in children with SCA.Fears and biased knowledge of the users about the drug thought to hamper to reach the sufficient analgesic dose.Educational courses for the users about PCA and drugs may increase the effect of PCA method.

Horner syndrome is rarely observed in epidural anaesthesia; it is characterized by ptosis enophthalmos miosis, anisocoria, and conjunctival hyperemia in the affected eye and anhydrosis and flushing on the affected side of the face. It is usually a complication spontaneously resolved without permanent neurological deficits. Intraoral anaesthesia, stellate, cervical and brachial plexus block, thoracic, lumbar and caudal epidural anaesthesia and intrapleural analgesia are the main causes associated with anaesthesia in Horner syndrome. Among the other causes of Horner syndrome are head and neck surgery, trauma and puncture of the internal jugular vein. We aimed to present a case with unilateral Horner syndrome, which appeared in the aortabifemoral bypass after lumbar spinal- epidural anaesthesia.

Summary
In this article, we present a case with diagnosis and treatment process who had mixed type of thoracic outlet syndrome as a result of scalene muscle hypertrophy. Many diseases in the differential diagnosis should be considered to be the definitive diagnosis of this syndrome ¸ questioning the activities of daily living, in addition to provocative tests of physical examination, it is necessary to examine the electrophysiological and imaging. Once diagnosed, despite conservative treatment is not decreased complaints required surgical treatment However, in patients diagnosed late ¸ despite the decrease of complaints after surgery; neurologic deficit remains.

Cluster headache (CH) is characterized by attacks of strictly unilateral severe pain with orbital, supraorbital, or temporal location. They are accompanied by ipsilateral cranial autonomic features. A 45-year-old man presented with a 1-year complaint of right-sided headache. He described episodes of excruciating burning pain in right parietal region. His neurologic examination was normal except 20% muscle loss on the right arm. We report a atypically located cluster headache associated with right arm weakness.