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Calcified Neurocysticercosis and Headache in an Endemic Village: A Case–Control Study Nested to a Population-Based Cohort

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  • 1 School of Medicine, Universidad Espíritu Santo—Ecuador, Guayaquil, Ecuador;
  • 2 Universidad Central del Este, San Pedro de Macorís, Dominican Republic;
  • 3 Vanderbilt University Medical Center, Nashville, Tennessee;
  • 4 School of Medicine, Stony Brook University, New York, New York;
  • 5 Imaging Department, Hospital-Clínica Kennedy, Guayaquil, Ecuador;
  • 6 Department of Neurology, University of Chicago, Chicago, Illinois;
  • 7 Community Center, The Atahualpa Project, Atahualpa, Ecuador

Headache in patients with calcified neurocysticercosis (NCC) is probably common but has been largely overlooked. We aimed to assess the presence, characteristics, and diagnosis of headache across patients with calcified NCC and their matched controls. In this case–control study nested to a population-based cohort, Atahualpa residents aged ≥ 20 years with calcified NCC were identified as case patients and paired 1:1 to age- and gender-matched randomly selected controls. A culturally adapted questionnaire was derived from the EUROLIGHT. Headache diagnosis was established according to the International Classification of Headache Disorders, 3rd edition. Conditional logistic regression models for matched paired data were fitted to assess the independent association between calcified NCC (as the exposure) and headache variables, after adjusting for education, alcohol intake, depression, and epilepsy. The selection process generated 106 case patients and their matched controls. Lifetime headache prevalence (odds ratio [OR]: 4.18; 95% Confidence Interval [CI]: 1.79–9.75; P = 0.001), current headaches (OR: 4.19; 95% CI: 1.92–9.16; P < 0.001), and intense headaches (OR: 9.47; 95% CI: 2.88–31.19; P < 0.001) were more frequent among cases than in controls. In addition, migraine (but not other forms of headache) was more frequent among subjects with calcified NCC (OR: 4.89; 95% CI: 2.36–11.39; P < 0.001). This study shows a robust epidemiological association between headache—particularly migraine—and calcified NCC.

Author Notes

Address correspondence to Oscar H. Del Brutto, School of Medicine, Universidad Espíritu Santo—Ecuador, Km 2.5 Vía Puntilla - Samborondon, Samborondón, Ecuador. E-mail: oscardelbrutto@hotmail.com

Financial support: This study was partly supported by Universidad Espíritu Santo, Ecuador.

Authors’ addresses: Oscar H. Del Brutto and Aldo F. Costa, School of Medicine, Universidad Espíritu Santo—Ecuador, Guayaquil, Ecuador, E-mails: oscardelbrutto@hotmail.com and aldocosva_01@hotmail.com. Ana M. Robles, Universidad Central del Este, Avenida Francisco Alberto Caamaño, San Pedro de Macorís, República Dominicana, E-mail: anaroblesg@gmail.com. Robertino M. Mera, Vanderbilt University Medical Center, Nashville, TN, E-mail: rmm17189@gmail.com. Elizabeth Darsan, Lucía Milla, Jessica Montes, and Mark J. Sedler, School of Medicine, Stony Brook University, Stony Brook, NY, E-mails: elizabeth.darsan@stonybrookmedicine.edu, lucia.milla@stonybrookmedicine.edu, jessica.montes@stonybrookmedicine.edu, and mark.sedler@stonybrookmedicine.edu. Julio Lama, Imaging Department, Hospital-Clínica Kennedy, Guayaquil, Ecuador, E-mail: julama54@hotmail.com. Victor J. Del Brutto, Department of Neurology, University of Chicago, Chicago, IL, E-mail: vjdelbrutto@gmail.com. Mauricio Zambrano, Community Center, The Atahualpa Project, Atahualpa, Ecuador, E-mail: zamaleon@hotmail.com.

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