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We also were unable to control institution of the diet.
Patients were given a hand out regarding foods to avoid.
Administration and adherence were at the patient’s
discretion. It is possible those that did not improve did
not follow the diet as was the case in one patient. Even if
the patients followed the diet, they may not have
improved. Finocchi and Sivori (11) report that only
20% of patients in their study had dietary triggers.
A study strength is over 10 years of management with
one surgeon providing a consistent treatment approach. It
is also an interesting concept to add to the literature,
especially in the light of the prevalence of migraine.
A necessary next step is a prospective study. Patients
with PT, who have definitive imaging to rule out serious
pathology, could be randomized to a migraine diet
and followed prospectively to determine resolution of
symptoms.
CONCLUSION
PT can be observed in the context of migraine. Treat-
ment of migraine with diet and medication can possibly
lead to resolution of PT. However, the true association
between migraine and PT needs to be evaluated with
prospective well-controlled studies.
REFERENCES
1. Mattox DE, Hudgins P. Algorithm for evaluation of pulsatile
tinnitus. Acta Otolaryngol 2008;128:427–31.
2. IHS Classification. ICHD-II Migraine. Available at: http://www.
html. Accessed March 20, 2015.
3. Burch RC, Loder S, Loder E, Smitherman TA. The prevalence and
burden of migraine and severe headache in the United States:
Updated statistics from government health surveillance studies.
Headache 2015;55:21–34.
4. Tfelt-Hansen PC. History of migraine with aura and cortical spreading
depression from 1941 and onwards. Cephalalgia 2010;30:780–92.
5. Welch KMA, Dandrea G, Tepley N, Barkley G, Ramadan NM. The
concept of migraine as a state of central neuronal hyperexcitability.
Neurol Clin 1990;8:817–28.
6. Messlinger K, Lennerz JK, Eberhardt M, Fischer MJM. CGRP and
NO in the trigeminal system: Mechanisms and role in headache
generation. Headache 2012;52:1411–27.
7. Scher AI, Stewart WF, Ricci JA, Lipton RB. Factors associated with
the onset and remission of chronic daily headache in a population-
based study. Pain 2003;106:81–9.
8. Ohayon MM. Prevalence and risk factors of morning headaches in
the general population. Arch Intern Med 2004;164:97–102.
9. Wakerley B, Tan M, Ting E. Idiopathic intracranial hypertension.
Cephalalgia 2015;35:248–61.
10. Durcan FJ, Corbett JJ, Wall M. The incidence of pseudotumor
cerebri. Population studies in Iowa and Louisiana. Arch Neurol
1988;45:875–7.
11. Finocchi C, Sivori G. Food as trigger and aggravating factor of
migraine. Neurol Sci 2012;33:S77–80.
PREVALENCE OF PULSATILE TINNITUS
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