Rejected

Obesity and headache disorders are two very common conditions in the general population that have been increasing in incidence over the last decades. Recent studies have shown a significant relationship between obesity and headaches, particularly migraine, with an important role in whether the disease is chronic. On the other hand, no such association was found with tension-type headaches. Studies showing an overlapping of hunger-control pathways and those involved in the pathophysiology of migraine may justify the close association between obesity and migraine. Moreover, a secondary headache for which obesity is a strong risk factor is idiopathic Intracranial Hypertension (pseudotumor cerebri), with several studies showing the impact of weight reduction/bariatric surgery in the treatment of the disease. In conclusion, since obesity is a modifiable risk factor, it is important for physicians treating patients with headaches, and particularly migraine, to be aware of the association between these two disorders.

A 38-year-old female patient, with healthy history, was vaccinated with ChAdOx1 nCoV-19 (Astra Zeneca Cambridge, UK). Five days after the second injection, the patient presented headache, vertigo, then fatigue, nervousness, palpitations, shortness of breath, small amplitude tremors, and sweating episodes. Laboratory investigation revealed a suppressed thyroid-stimulating hormone (TSH), with elevated free thyroxine. However, the TSH receptor antibody and anti-thyroid peroxidase antibody were normal and thyroid-stimulating immunoglobulin negative. The patient was maintained on Metoprolol, and no specific treatment was added. After 3 months of following, the patient now feels comfortable. Our literature review found that 21 cases of subacute thyroiditis (SAT) following coronavirus disease 2019 (COVID-19) vaccines were reported. Most patients were young women who presented neck pain and systemic symptoms, with or without fever. These symptoms can appear as early (3 to 5 days), or later (1 month) after vaccination, regardless of vaccine type and mechanism of action. Laboratory tests showed decreased levels of TSH and elevated thyroid hormone. The mechanism of this event remains unknown. Further study is recommended to investigate the possible predisposing factors to developing SAT after receiving the COVID-19 vaccine.

Schmorl's nodes are typically an incidental finding whereby a disc herniates into the vertebral body. The clinical course is rarely symptomatic. Here, we present a 41-year-old male who, following chiropractic manipulation, developed an acute Schmorl's node. The patient was managed successfully with conservative measures. A 41-year-old male with acute on chronic low back pain following a chiropractic adjustment. Imaging demonstrated the development of an acute Schmorl's node of the lumbar four-five disc into the lumbar 4 vertebral body after a chiropractic adjustment. He was treated with conservative measures with over 85% relief of back pain. Acute Schmorl's nodes can develop after the chiropractic adjustment. In the case presented, conservative measures resulted in 85% improvement in pain.

COVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which led to a pandemic started in Wuhan, China, in 2019. The rapid spread of the disease in the world, unprecedented mortality rate, and lack of definitive treatment for the disease have led to a global effort to develop effective vaccines as well as new therapeutic interventions. Immune cells activation with excessive inflammation is an important pathophysiological feature of COVID-19 that may impair the various organs functions. Accordingly, these could cause dysfunction in the brain with some symptoms such as respiratory failure, headache, impaired consciousness, olfactory and taste disorders, and severe neurological disorders such as encephalitis. It was found that there is a two-way communication between the immune system and the nervous system through classical neurotransmitters, hormones, and cytokines. Among neurotransmitters, serotonin plays important roles in the immune system and in regulating inflammatory responses by central and peripheral mechanisms. This article aimed to review the two-way relationship between the immune and the nervous systems by focusing on the serotonergic system and the emerging COVID-19 disease.

Injury to the quadriceps tendon is rare and most commonly occurs in middle-aged men. Few reports are available regarding outcomes after quadriceps tendon rupture in younger patients.

Orthostatic hypotension (OH) is a common non-motor symptom that occurs in Parkinson's Disease (PD) patients. Typical symptoms of OH are lightheadedness, visual disturbance, and fainting; however, nonspecific symptoms such as dizziness, headache, and fatigue are observed in mild cases. Although OH is prevalent in PD patients, it is often overlooked. Further, after diagnosis, the causative drug should be discontinued and non-pharmacological therapy should be performed,; however, if it is ineffective, additional pharmacological therapy should be administered depending on the symptom severity. The symptoms are usually progressive without proper intervention, and motor functions are affected leading to an increased risk of fainting and falls. Early diagnosis and intervention for OH improves the quality of life and prevents complications in PD patients.

Progressive familial intrahepatic cholestasis is a heterogeneous group of genetic disorders characterized by disrupted bile homeostasis. Patients with this disease typically present with cholestasis and pruritus early in life and often progress to end-stage liver disease. The clinical symptoms that patients with progressive familial intrahepatic cholestasis encounter are usually refractory to medical treatment. Although the effects of biliary diversion surgery on native liver survival are not exactly known, this procedure may provide a positive impact on pruritus and laboratory parameters in these patients.

Myofascial pain syndrome (MPS) is the most frequent cause of chronic musculoskeletal pain. According to the International Association for the Study of Pain, diagnosis of chronic pain due to MPS is based mostly on demonstration of trigger points and reproduction of pain by maneuvers which place stress upon proximal structures or nerve roots. The lack of a formal, widely accepted, criterion-based diagnostic guideline hampers adequate management of this disorder. The gluteus medius muscle is a primary stabilizer of the pelvis during gait and myofascial disorders result in increased sensitivity, spontaneous pain, and weakness in the leg abduction. Also, MTPs of the gluteus medius muscle are common features of patellofemoral and low back pain. Three trigger points are described for the gluteus medius muscle: anterior, middle and posterior, but anatomical correlation is still lacking.

Despite decades of research examining the biological mechanisms of pain, few new treatments have been developed. Cannabis has been used for centuries to treat pain, and previous evidence indicates that non-∆9-tetrahydrocannabinol and non-cannabidiol constituents of Cannabis can produce pain relief in animal models. The Cannabis-related terpene ß-caryophyllene (BCP) produces pain relief in various pain tests with varying degrees of efficacy; however, the pharmacological mechanism underlying this pain relief is unclear. Previous studies by other groups have demonstrated that BCP produces antinociception via cannabinoid and opioid mechanisms following local administration into the hindpaw. As such, we hypothesized that BCP produces analgesia via opioid mechanisms following systemic administration. To test this hypothesis, we administered varying doses of BCP and evaluated their antinociceptive effects on the hot plate and tail-flick tests in adult male Sprague-Dawley rats. The hot plate test identifies pain relief mediated by supraspinal mechanisms. The tail-flick test identifies pain relief mediated by spinal mechanisms. One intraperitoneal injection of 30 mg/kg BCP produced antinociception on the hot plate test and the tail-flick test approximately 15 minutes after injection. Vehicle and doses of 3 mg/kg and 10 mg/kg were ineffective at producing pain relief on the hot plate and tail-flick tests. In order to test the contribution of opioid receptors, a subset of rats received a 30 min pretreatment of the opioid receptor antagonist naltrexone. The effect of naltrexone on BCP-induced antinociception varied depending on both dose and time. These results indicate that low doses of BCP may effectively alleviate acute pain and that BCP-induced antinociception may be mediated, in part, by opioid receptors. Further studies are needed to fully understand the relationship between BCP and opioid receptors to determine their therapeutic potential.