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Recent anatomical studies demonstrated that the output of the cerebellum targets multiple non-motor areas in the prefrontal and posterior parietal cortex.

Neuro-anatomy and functions of the cerebellum will be reviewed as well as the evidence of cerebellar infarcts in migraineurs. During the last decades, the methods of neurophysiology proved to be very effective in disclosing subtle functional abnormalities of the brain of patients affected by primary headache disorders. These methods received several refinements during the last years, further improving our understanding of headaches pathophysiology.

Abnormal increased responsivity was several times revealed with almost all the sensory modalities of stimulation in migraine between attacks, with its normalization during the attacks. Recently, authors observed that the degree of some neurophysiological abnormalities might depends on the distance from the last attack, i.

Somatosensory cortex lateral inhibition, gating, and interhemispheric inhibition were altered in migraine, and may contribute to cortical hyperresponsivity and clinical features. Cluster headache patients are characterized by a deficient habituation of the brainstem blink reflex during the bout, outside of attacks, on the affected side.

Evidence for sensitization of pain processing was disclosed by studying temporal summation threshold of the nociceptive withdrawal reflex, which was less modulated by supraspinal descending inhibitory controls. In conclusion, much has been discovered and much more needs to be investigated to better understand what causes, how it triggers, keeps and runs out recurrent primary headaches.

Clarifying some of these mechanisms might help in the identification of new therapeutic targets. Within the brain, neuropeptides can modulate the strength of synaptic signaling even at a relatively large distance from their site of release. Given the evidence for CGRP in migraine and potential roles for other hypothalamic peptides, it seems likely that altered neuropeptide actions may be a general theme underlying the heightened sensory state of migraine.

Towards this point, I will briefly discuss our preclinical CGRP and optogenetic studies using light aversive behavior in mouse models as a surrogate for migraine-associated photophobia. I will describe how both the brain and the periphery are susceptible to elevated CGRP and how CGRP appears to act by distinct mechanisms in these sites. These ideas will be tied together in a speculative model that integrates peripheral and central CGRP actions in photophobia.

Classical trigeminal neuralgia TN is a unique neuropathic facial pain disorder. As there are no diagnostic tests to confirm the diagnosis, it relies on a thorough history and exam.

MRI is used to exclude symptomatic trigeminal neuralgia, not to confirm the diagnosis of TN. Knowing how to interpret MRI findings is of importance with respect to surgical treatment options and their expected chance of a successful outcome. TN is characterized by paroxysms of unilateral intense pain usually in the 2 nd and 3 rd trigeminal branch.

The pain quality is stabbing and the pain is typically evoked by sensory stimuli like light touch, brushing teeth, cold wind or eating. Up to half of the patients also have concomitant persistent pain. A smaller proportion of patients may have sporadic autonomic symptoms.

The average age of disease onset is in the early fifties and TN is slightly more prevalent in women than in men. As a general rule, the neurological exam is normal in TN patients. As objective signs of TN, patients may wince at pain paroxysms and may avoid shaving or brushing their teeth on the affected side. Some studies argue that a proportion of TN patients have subtle sensory abnormalities at bedside exam, primarily hypoesthesia. Studies using quantitative sensory testing also documented sensory changes in TN.

Rather than indicating nerve damage, the findings may be explained by functional changes of the nervous system in response to severe pain. There is widespread consensus that TN is associated to a neurovascular contact between the trigeminal nerve and a blood vessel in the prepontine course of the nerve.

Emerging advanced imaging studies confirms that at the site of a neurovascular contact on the ipsilateral side of pain, there is of demyelination — a process that seems to be reversible in some patients after successful surgery. Imaging studies also consistently show that TN is strongly associated to a neurovascular contact with morphological changes of the trigeminal nerve, i. Meanwhile, only half of TN patients have morphological changes of the trigeminal nerve and there may be other unknown etiological factors causing TN.

The pearls and pitfalls of TN diagnosis and neuroimaging is discussed from both a clinical and a scientific perspective. The first evidence for potential role of PACAP in pathomechanism of migraine was the intravenous administration of PACAP caused headache and vasodilatation in healthy subjects as well as in migraineurs, and lead to delayed-type migraine-like attacks [2]. Preclinical experiments revealed that both PACAP and PACAP were found elevated in the trigeminal nucleus caudalis of rats following electrical stimulation of the trigeminal ganglion or chemical stimulation by nitroglycerin of the trigeminovascular system [3].

A magnetic resonance imaging MRI angiographic study demonstrated that PACAPinduced headache was associated with prolonged dilatation of the middle meningeal arteries, but not of the middle cerebral arteries in healthy volunteers [4]. The recent functional imaging study pointed that intravenous PACAPinduced migraine attacks was associated with alterations in brain network connectivity [6].

Clinical investigation provided evidence of a clear association between migraine phases during a spontaneous migraine attack versus pain-free period and the alteration of plasma PACAP level [7].

The activation and sensitization of the trigeminovascular system by vasoactive neuropeptides might be crucial factors of the migraine pathogenesis [8]. The recent preclinical and clinical studies suggest the importance of PACAP as a future biomarker of migraine headache. Schytz, H. PACAP38 induces migraine-like attacks in patients with migraine without aura.

Tuka, B. Peripheral and central alterations of pituitary adenylate cyclase activating polypeptide-like immunoreactivity in the rat in response to activation of the trigeminovascular system.

Peptides ; Amin, F. Cephalalgia ; Investigation of the pathophysiological mechanisms of migraine attacks induced by pituitary adenylate cyclase-activating polypeptide Brain ; Neurology ; Alterations in PACAPlike immunoreactivity in the plasma during ictal and interictal periods of migraine patients.

Several studies are found a relationship between headache and psychiatric comorbidity in both children and adolescents []. The most frequently described comorbidities include anxiety, mood disorders [1], sleep disorder [2] and attention hyperactive disorder [3]. The association between headache and comorbidities has been interpreted in the light of different possible causal pathways. Psychiatric comorbidity may represent the consequence of a link between neurotransmitter systems involved in migraine and psychiatric disorder, such as depression and anxiety [4].

A central role is thought to be played by serotonergic receptors, adrenergic and dopaminergic D2 receptor genotype, that seem to be associated with migraine, major depression, generalized anxiety disorder, panic attacks and phobia [5]. It has been suggested that the patient’s vulnerability to anxiety disorders and affective disorders as well as migraine might be attributed to the dysregulation of the serotonergic system [6].

Furthermore, it is possible that each disorder increases the risk of the other [4;7]. Therefore, the relevance of other mediating factors for the co-occurrence of headache and psychiatric comorbidity has to be taken into consideration.

Recent research found that an insecure attachment may be a risk factor for an outcome of poor adaptation that includes chronic pain [9] and that pain perception may change in relation with specific attachment styles. The ambivalent attachment seems to be the most common style among patients reporting high attack frequency and severe pain intensity and in children with this attachment style there is a relationship between high attack frequency and high anxiety levels [10].

Barone et al. Although more studies are needed in order to detect the biological, genetic and environmental mechanisms underlying the relationship between headache and comorbidities, attachment styles can be regarded as one of the factors mediating this association [12].

Anxiety, depression and behavioral problems among adolescents with recurrent headache: the Young-HUNT study. The relationship between sleep and headache in children: implications for treatment. Headache and attention deficit and hyperactivity disorder in children: common condition with complex relation and disabling consequences. Epilepsy Behav. Migraine and psychiatric comorbidity: a review of clinical findings.

Mol Med. Association of 5-HTT gene polymorphisms with migraine: a systematic review and meta-analysis. J Neurol Sci ; : Headache and comorbidity in children and adolescents. J Headache Pain ; Genetic and environmental influences on migraine: a twin study across six countries. Twin Res. Pain and emotion: a biopsychological review of recent research. J Clin Psychol ; 67 9 : Attachment styles in children affected by migraine without aura.

Neuropsychiatr Dis Treat. Behavioural problems in children with headache and maternal stress: is children’s attachment security a protective factor? Dev ; DOI: The role of attachment insecurity in the emergence of anxiety symptoms in children and adolescents with migraine: an empirical study. J Headache Pain In Press. Metabolic syndrome and overweight are highly prevalent among migraineurs and the weight-loss was suggested as a useful strategy to improve both migraine and metabolic syndrome.

Recently, we have observed that a particular version of VLCD characterized by very low-carbohydrate intake and Ketone bodies KBs production, named very low-calorie ketogenic diet VLCKD , was able to induce a rapid improvement of headache in migraineurs. To assess if the favorable outcome on migraine was due to the caloric restriction, instead of KBs, we performed a double blind crossover study to compare headache modifications during a VLCD and a VLCKD in a population of overweighed and obese migraineurs.

Among patients referred to the Sapienza University Obesity Clinic, a neurologist specializing in headache recruited 35 migraineurs. To verify variations in headache frequency, we used as baseline the month before the first VLCD and the first transition diet. Headaches are one of the most disabling disorders [1]. Moreover, recent knowledge have suggested that physical examination for provocative procedures should be done on each patient with side- locked headaches as many of these headaches may closely mimic primary headaches [4].

There have been identified eleven physical tests to properly assess cervical disorders. When these dysfunctions are present, they support a reciprocal interaction between the trigeminal and the cervical systems as a trait symptom in migraine [6, 7]. In this presentation, an evidence based physical protocol of specific tests it will be provided by a physiotherapist to assess musculoskeletal disorders in the most common primary headaches as Migraine and Tension Type Headache.

Moreover, the integration of this examination in a multidisciplinary team it will be discussed. Stovner LJ. Migraine prophylaxis with drugs influencing the renin- angiotensin system. Eur J Neurol. Prevalence of neck pain in migraine and tension-type headache: a population study.

Temporomandibular disorders is more prevalent among patients with primary headaches in a tertiary outpatient clinic. Arq Neuropsiquiatr. Prakash S, Rathore C. Side-locked headache: an algorithm based approach. The Journal of Headache and Pain ; doi International consensus on the most useful physical examination tests used by physiotherapists for patients with headache: A Delphi study.

Man Ther. Musculoskeletal dysfunction in migraine patients. The International Classification of Headache Disorders, 3rd edition beta version Jul;33 9 Headache represents the most common neurological symptom in pediatric age.

Among the primary headaches, migraine is far more prevalent than tension-type headache and cluster headache. Though extremely rare at this age, also trigeminal autonomic cephalgias have been reported. The most frequent causes of pediatric secondary headaches are represented by respiratory tract infections, while potentially life-threatening diseases, such as brain tumors, are less common.

However, especially in the emergency setting, the possibility that a headache attack is due to a brain tumor must be always considered. To avoid missing these cases, some headache characteristics red flags have been identified [1]. However, while the most recent ICHD criteria improved the possibility to classify some patients, such as children with migraine with aura [2], they turned out to be unsuitable for others, such as young patients with primary headache.

Several studies have shown the primary role played by psychological factors in determining the severity of migraine in children [4]. Therefore, a psychological examination is often mandatory, as part of the initial assessment of the patient. Lastly, when assessing a child with primary headache, possible comorbidities should be never forgotten, since addressing them can represent a crucial point for the treatment [5]. Headache as an emergency in children and adolescents.

Curr Pain Headache Rep ; Cephalalgia, submitted. Diagnosis of primary headache in children younger than 6 years: A clinical challenge. Cephalalgia ; Chronic Migraine in Children and Adolescents. Headache and comorbidities in childhood and adolescence.

Springer, Whether medication-overuse headache MOH represents a distinct biological entity within the concept of chronic daily headache with specific neurobiological and genetic background is still a matter of debate. A great deal of interest has been directed at understanding the neurophysiological mechanisms that underlie MOH pathogenesis.

Currently, two main, non-mutually exclusive hypotheses have been proposed. The first, stems from the apparent compulsive use of headache medications by MOH patients, and considers this disorder a sort of addiction to symptomatic remedies.

The second shifts the focus from drug addiction to neural sensitization, claiming that triptan overuse triggers adaptations of the trigeminovascular system, thereby facilitating pain transmission and leading to a state of latent sensitization. Answering these questions might be relevant to better understand the neurochemical mechanisms prompted by acute headache medications that underlie the pathophysiology of MOH and of chronic headache in general.

In this presentation, preclinical data will be presented showing that chronic exposure to eletriptan or indomethacin alter trigeminal ganglion gene expression patterns broadly and to a similar extend. Remarkably, qualitative transcriptomic analysis reveals that prolonged exposure to the two different symptomatic drugs triggers almost identical, increased expression of various genes coding for proteins involved in headache pathogenesis such as neuropeptides, their cognate receptors, TRP channels, prostanoid and NO synthesizing enzymes.

These findings will be correlated with the clinical aspects of MOH. The dramatic caloric restriction promotes the fat metabolism, mimicking the starvation, even if meals replacements ad hoc developed accounts for essential nutrients, avoiding the malnutrition. Because of the extreme caloric restriction, this type of diet is very effective in weight loss, however, that characteristic also is the main limit of VLCD, since it is possible to follow this kind of dietetic regimen for a very limited period usually weeks.

Salads are allowed ad libitum dressed with a spoonful of olive oil. Also in this kind of diet, there are meals per day, mainly consisting in meal replacement products. There is a growing interest in the ketogenic form of the VLCD because several studies have shown a higher compliance of patients with this diet.

The reason of this higher adherence to the diet is still under scrutiny but several reasons are called in cause: an appetite suppression induced by proteins and maybe by ketone bodies KBs , or a modification in hormone secretion insulin, glucagon, ghrelin, adipokines. The real impact of ketogenic diets in weight loss is still disputed; in fact, on the long period there are not differences between low-carb and low-fat diets in terms of weight reduction and regain of lost weight after the diet.

However, thanks to the higher compliance and the drastic caloric restriction, the VLCKDs seem to be a promising approach in the early management of obesity and in the preparation phase for patients that must undergo to bariatric or other types of surgical procedures.

Temporomandibular disorders TMD represent the main cause of orofacial pain of non-dental origin and comprehend several disturbances of the masticatory system characterized by myofascial pain of masticatory muscles or articular pain localized in the pre-auricular area.

Moreover, TMD patients show temporomandibular joint sounds and deviation or limitation of the opening of the mouth. Myofascial pain is a probable consequence of central nervous system mechanisms of convergence and activation of second order neurons with enlargement of the receptive field, reduced pain threshold and allodinia. Often there are accompanying symptoms like facial pain and headaches.

Headache is the most prevalent neurologic disorder, third most diffused health disturbance and the seventh cause of disability in the world. It can be primary, without apparent organic cause, or secondary to other pathologies. Some epidemiological studies indicates that headache is more prevalent in TMD patients and TMD is more prevalent in subjects affected by headache.

A stronger association exists between TMD and chronic migraine in comparison with other types of headache. Nevertheless the methodological quality of the available studies is not optimal and many of them classify patients with anamnestic questionnaire that tend to overestimate the values of prevalence. A growing body of literature suggests that the association between headache and TMD may be a manifestation of a central sensitization mechanism.

Temporomandibular joint and muscles receive the sensitive innervation of the trigeminal nerve that supply also the cranial vascular structures likely involved in the etiology of the headache.

The sensitization of the trigeminal caudate nucleus by the TMD symptoms can favor the triggering of migraine episode. Beside the epidemiological studies and the neurophysiologic hypothesis, there are some initial clinical evidence that show how severity of TMD symptoms parallels an increase of frequency and intensity of migraine and the simultaneous treatment of both conditions results in better outcomes. From a clinical perspective, a comprehensive assessment based on a biopsychosocial approach can provide relevant information to plan a contemporaneous treatment of TMD and headache, together with an intervention targeted to the reduction of psychosocial conditions that can elicit and maintain mechanisms of central sensitization likely responsible of the comorbidity of TMD and headache.

The exact pathophysiology is still unknown, but evidence supporting both peripheral and central mechanisms i. In fact, the frequency of headache attacks has found to be related to the level of central sensitization [4]. However, not all TTH patients present with the same level of central sensitization and clinical presentation, but subgroups need to be identified in order to offer specific therapeutic programs [5]. Prolonged peripheral nociceptive input from the pericranial, neck, and shoulder regions e.

In fact, it has been found that sustained stimulation of TrPs may induce central sensitization in healthy participants [7]. The number of TrPs seems to be associated with the degree of widespread pressure pain hypersensitivity in TTH patients, supporting the role of TrPs on central sensitization: however the cross-sectional nature of the study does not allow to establish a cause and effect relationship between TrPs and central sensitization, as other variables may influence this association [9].

Physical therapy may be helpful for the management of TTH patients [10,11], as it may decrese the peripheral nociceptive input. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia ;— Tension type headache.

Curr Rheumatol Rev ; — Pressure pain thresholds assessed over temporalis, masseter, and frontalis muscles in healthy individuals, patients with tension- type headache, and those with migraine: A systematic review.

Pain ; — Frequency of headache is related to sensitization: a population study. Pain ; Identification of subgroups of patients with tension type headache with higher widespread pressure pain hyperalgesia.

J Headache Pain ; 18 1 The role of muscles in tension-type headache. Curr Pain Headache Rep. Sustained nociceptive mechanical stimulation of latent myofascial trigger point induces central sensitization in healthy subjects.

J Pain. Myofascial trigger points and sensitization: An updated pain model for tension-type headache. Trigger Points are associated with widespread pressure pain sensitivity in people with tension-type headache.

Cephalalgia [Epub ahead of print]. Muscle trigger point therapy in tension-type headache. Expert Rev Neurother ; 12 3 Effectiveneess of physical therapy in patients with tension-type headache: literature review. J Jpn Phys Ther Assoc ; 17 1 Migraine is related to the highest disability among headaches. Great efforts are faced to improve the outcome of forthcoming treatments.

However, still now, many patients regard as unsatisfactory the low responder rate about the half of patients and adverse effects that current treatments account. Therefore, waiting for innovative, more tolerated and effective treatments, there is a large request for non-pharmacological approaches that in many cases have specific pathophysiological targets. Among these treatments, nutraceuticals has a leading role.

Several nutraceutical products are proposed for migraine and sold around the world, but researchers adequately study only few compounds. Among studied nutraceuticals compounds, only few of them have studies of good quality in support. Moreover, also interactions among different molecules are not studied. We have reviewed literature data in order to find researches that support the use of nutraceutical molecules in migraine management.

Available good quality data support the use of certain nutraceuticals, in particular riboflavin, coenzyme Q10, magnesium, butterbur, feverfew, and omega-3 polyunsaturated fatty acids. Even if not supported by double blind studies, recently some prospective observational studies about fixed combination of nutraceuticals were performed.

For instance, it is the case of a combination of coenzyme Q10, feverfew and magnesium for migraine prophylaxis: a prospective observational study. A double blind versus placebo study about the effect of a fixed combination of riboflavin, coenzyme Q10, feverfew, andrographis and magnesium for migraine prophylaxis is currently in progress.

Usually patients appreciate nutraceuticals more than traditional drugs, since they are regarded as safe and of efficacy not inferior to other pharmacological products. Available data seem to support this widespread belief, but some concerns about the regulation of nutraceuticals and quality of some products, still remain. Contrary to what is generally thought of, headaches and algology pain therapy share many aspects. Headaches and chronic non-oncological pain are two paradigms of chronic illness capable of generating enormous individual and social impact by disabling the sick person not only in the biological, but also in the psychological, professional, social and relational spheres.

Both cause alterations in psychological equilibrium, secondary depression, loss of social and professional roles, which, in the most serious cases, can cause loss of work.

Literature documents in both cases, headaches and chronic pain, a rise in direct costs but above all of the indirect ones with a huge burden of disease. Both are capable of generating a marked drop in the quality of life associated with a serious bio-psycho-social disability.

Headaches and chronic pain, although distinct according to a topographical criterion, share many mechanisms and physiopathogenetic steps. One of the most current fields in which neurologists and pain therapists converge is the focus on neuroinflammation [3] and central sensitization[4], two key mechanism for triggering, maintaining, and subsequent perpetuation of pain: the pain as a symptom, filogenetically responsible for maintaining homeostasis of the organism against actual or potential damage, becomes unnecessary illness without any protective meaning.

Another important shared pathogenetic passage is that of neuroimmune mechanisms, which interlink the immune system with the central nervous system[4]. Furthermore, numerous contribution to the scientific international literature highlight the need to modify the therapeutic approach, directing it towards a semeiotic criterion pain phenothype: specific sign and symptoms of a certain type of pain in a specific moment , which is an epiphenomenon of underlyng pathogenetic mechanism, instead of basing it on a etiologic criterion[5].

This would enable a more appropriate prescription and greater efficiency, taking into primary consideration the possibility of getting back to everyday life rather than obtaining complete analgesia.

All the above mentioned aspects are equally important but one of them can prevail over the others depending on patient characteristics and background. In conclusion it can be stated that the aspects of sharing between headaches and chronic non-oncological pain are significantly greater than those that clearly divide them. World Health Organization. International classification of functioning, disability and health ICF. Geneva, World Health Organization, Steiner T.

J Lifting the burden: The global campaign against headache. Ru-Rong Ji Emerging targets in neuroinflammation-driven chronic pain. Nat Rev Drug Discov. Baron R Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol. Headache is a common clinical feature in neurological patients. Usually, neuroimaging is unnecessary in patients with episodic migraine or tension type headache with typical headache features and with a normal neurological examination.

These patients do not have a higher probability of a relevant brain pathology compared to the general population. A recent study, however, reported that neuroimaging is routinely ordered in outpatient headache even if guidelines specifically recommend against their use.

Brain MRI with detailed study of the pituitary area and cavernous sinus, is recommended for all trigeminal autonomic cephalalgias TACs. Neuroimaging should be considered in patients presenting with atypical headache features, a new onset headache, change in previously headache pattern, headache abruptly reaching the peak level, headache changing with posture, headache awakening the patient, or precipitated by physical activity or Valsalva manoeuvre and abnormal neurological examination.

A recent consensus recommends brain MRI for the case of migraine with aura that persists on one side or in brainstem aura. According the same consensus, fFor primary cough headache, exercise headache, headache associated with sexual activity, thunderclap headache and hypnic headache apart from brain MRI additional tests may be required [3].

Particularly in emergency room it is mandatory to exclude a secondary headache that requires special attention and further diagnostic workup. CT scan is the first line neuroimaging examination. MRI offers a greater resolution and discrimination and might therefore be the preferred method of choice in non acute headache.

In addition, radiation due to CT scanning may be avoided. Neuroimaging non conventional techniques are of little or no value in the clinical setting. Headache neuroimaging: Routine testing when guidelines recommend against them. European Headache Federation consensus on technical investigation for primary headachedisorders.

Migraine frequency fluctuates over time. In the literature, the most important recognized factors associated to chronic migraine are overuse of acute migraine medication, ineffective acute treatment, obesity, depression, presence of allodynia and stressful life events. Other factors reported in studies are age, female sex and low educational status. Very recently, a large population study suggested that the presence of additional noncephalic pain site is a risk factor for migraine chronification.

For many of these factors the relationship with migraine chronification may however be bi-directional. For instance, in the case of depression, it is possible that depression may negatively affect the response of migraine to acute and prophylactic treatments, but it is also true the opposite: i. In the case of obesity, the association with chronic migraine may simply be ascribed to the effect of fat tissue in drug distribution.

Beside and beyond the putative biological factors that may cause a worsening of disease, several lines of evidence suggest that the progression from episodic to chronic migraine is associated to a progressive increase and stabilization of functional and anatomical changes associated to chronic sensitization.

In this frame, it appears obvious that an additional cause for chronic migraine is quite likely represented by the low rate of prescription of preventive medications. The underutilization of preventive drugs has several explanations ranging from drug-associated issues limited efficacy, poor tolerability profile to education of practitioners, pharmacists and patients, and it also involve the limited access to qualified care.

Underutilization of preventative drugs also translate into a higher recourse to acute drugs, thus feeding on a vicious cycle that leads to negative consequences.

CT has participated in advisory boards for Allergan and electroCore; she has lectured at symposia sponsored by Allergan; she is PI or collaborator in clinical trials sponsored by Alder, electroCore, Eli-Lilly and Teva. Prevalence of migraine sufferers who are candidates for preventive therapy: results from the American migraine study AMPP study.

Headache ; — The added value of an electronic monitoring and alerting system in the management of medication-overuse headache: A controlled multicentre study. To date, the majority of clinical studies concerning primary headaches and their comorbidities are focused on migraine. Comorbidities of migraine may include neurological and psychiatric conditions, as mood disorders depression, mania, anxiety, panic attacks , epilepsy, essential tremor, stroke, and the presence of white matter abnormalities [2].

Particularly, a complex and bidirectional relation between migraine and stroke has been described, including migraine as a risk factor for cerebral ischemia, migraine caused by cerebral ischemia, migraine mimicking cerebral ischemia, migraine and cerebral ischemia sharing a common cause, and migraine associated with subclinical vascular brain lesions [2].

A recent meta-analysis pointed out that migraine is associated with increased ischemic stroke risk [3], and according to a systematic review and meta-analysis [4] the risk of hemorrhagic stroke in migraineurs is increased with respect to non-migraineurs. Besides, the risk of transient ischemic attack seems to be increased in migraineurs, although this issue has not been extensively investigated [5].

A recent systematic review and meta-analysis also describes an increased risk of myocardial infarction and angina in migraineurs compared to non-migraineurs [6]. Concerning the association between migraine and vascular risk factors arterial hypertension, diabetes mellitus, dyslipidemia, obesity, alcohol consumption, family history of cardiovascular disease , a recent review [7] showed no solid evidence of an increased burden of conventional vascular risk factors in migraineurs, with the only exceptions of dyslipidemia and cigarette smoking, while a systematic review and meta-analysis regarding migraine and body mass index categories [8] found an increased risk of having migraine in underweight subjects and in obese women as compared with normal-weight subjects.

Few studies investigated the comorbidities of tension-type headache TTH , despite the fact that tension-type headache TTH is highly prevalent, and may be as debilitating as migraine [9].

It is noteworthy that, according to a review, TTH is associated with increased rate of affective distress [9]. Furthermore, some medical disorders may worsen a preexisting TTH, and it has been described the comorbidity of TTH with psychiatric disorders and fibromyalgia [10]. The International Classification of Headache Disorders, 3 rd edition beta version. Comorbid neuropathologies in migraine. Migraine headache and ischemic stroke risk: an updated meta-analysis. Am J Med. Migraine and hemorrhagic stroke: a meta-analysis.

Sacco S, Kurth T. Migraine and the risk for stroke and cardiovascular disease. Curr Cardiol Rep. Migraine and risk of ischaemic heart disease: a systematic review and meta-analysis of observational studies. Conventional vascular risk factors: Their role in the association between migraine and cardiovascular diseases.

Migraine and body mass index categories: a systematic review and meta-analysis of observational studies. Tension-type headache and psychiatric comorbidity. Tension-type headache and systemic medical disorders. Differentiating patients with life-threatening headaches from the overwhelming majority with primary headaches eg migraine, tension or cluster headache is an important issue in emergency department ED.

Patients with non-traumatic headaches are up to 4. These numbers seem to remain constant in Western countries Ramirez-Lassepas, ; Kowalski, ; Cvetkovic, ; Gaughran, Primary headaches still pose an open challenge in the ED because the failure to recognize a secondary headache could cause potentially fatal consequences.

Unfortunately, to date, there is still no a standard diagnostic procedure for headache in emergency conditions; although according to the diagnostic guidelines there are red flags that could help in the process, the positive predictive value of each severity indicator is not yet determined.

The problem of poor diagnostic sensitivity was attributed to IHCD-3 criteria rigidity in relation to primary headache diagnosis in emergency setting Dutto, , Swadron, Alternatively, a different standardized work-up has been proposed for the most frequent headache scenarios in ED Cortelli, ; Dutto, A careful history and physical examination remain the most important part of the assessment of the headache patient; they enable the clinician to determine whether the patient is at significant risk for a dangerous cause of their symptoms and what additional workup is necessary.

This presentation will discuss how to approach adults with headache in ED with an emphasis on those features that characterize high-risk headaches. Thus, the muscolokeletal contribution in Primary Headaches is still debate in the literature [5]. Moreover, recent knowledge suggests that different clinical headache phenotypes arising from a common pathophysiology rather than an independent disorder [6].

That is, in the most prevalent headaches disorders i. In this presentation, the role of the musculoskeletal inputs in primary headaches it will be provided.

Moreover, evidences of the effectiveness of a manual therapy management provided by a physiotherapist and its integration in a multidisciplinary team it will be discussed. Migraine prophylaxis with drugs influencing the renin-angiotensin system.

The impact of headache in Europe: principal results of the Eurolight project. Pietrobon D, Striessnig J. Neurobiology of migraine. Nat Rev Neurosci. Cady RK. The convergence hypothesis. Noseda R, Burstein R. Migraine pathophysiology: anatomy of the trigeminovascular pathway and associated neurological symptoms, CSD, sensitization and modulation of pain.

Migraine pathophysiology: anatomy of the trigeminovascular pathway and associated neurological symptoms, cortical spreading depression, sensitization, and modulation of pain. The European Headache Federation recognized the value of OnabotulinumtoxinA suggesting that, before labeling a patient as affected by refractory CM, a proper treatment with this drug needs to be completed [1].

In the last years several real-life prospective studies provided further evidence in clinical setting of OnabotulinumtoxinA U efficacy for the headache prophylaxis in CM complicated by medication overuse headache MOH [2]. Recently we published the results of a prospective study on the long-term 2 years efficacy and safety of a single dose of OnabotulinumtoxinA or U in patients with CM plus MOH had failed previous preventative drugs and detoxification attempts [3].

Both the doses were effective and equally safe, but U was more effective than U in reducing headache days, migraine days, pain medication intake days and Headache Impact Test HIT -6 score. Even more, the U dose superior efficacy was evident since the first injection and maintained over all the study period of 24 months. Interestingly we observed a progressive improvement in all the efficacy measures during the 2 years of follow-up with both the doses and significantly more with U.

Sometime a response appears only after the second or third injections. For this reason in selected cases can be useful to temporarily continue an oral preventative agent. The NICE guidelines recommend OnabotulinumtoxinA only for patients who have already tried at least three different preventative drug treatments that have not worked.

The chance to use it as first-line preventative treatment may shorten the period of chronicity and eventually prevent the developing of MOH. Several studies conducted before OnabotulinumtoxinA approval shown that it is ineffective in patients with episodic migraine [4].

Those studies had important limitations as range doses and injection paradigm. Furthermore, the population enrolled was represented in the majority by patients with low frequency episodic migraine an average of attacks per month. Refractory chronic migraine: a consensus statement on clinical definition from the European headache federation.

J Headache Pain ;28; A critical evaluation on MOH current treatments. Curr Treat Options Neurol. A two years open-label prospective study of OnabotulinumtoxinA U in medication overuse headache: a real-world experience. J Headache Pain ; Efficacy of botulinum toxin type A for the prophylaxis of episodic migraine headaches: a meta-analysis of randomized, double-blind, placebo-controlled trials.

Pharmacotherapy ;— Trigeminal autonomic cephalalgias TACs are a group of primary headaches comprehending the following syndromes: episodic and chronic cluster headache CH , episodic and chronic paroxysmal hemicrania PH , short-lasting unilateral neuralgiform headache attacks, and hemicrania continua HC [1].

Their phenotypes are similar and attack duration is the main feature distinguishing the first three TACs. An accurate diagnosis is important because of their different response to treatments. CH typically occurs at the same time of the day, from once to eight times per day, and in the same period of the year. Trigger factors can include alcohol, volatile chemicals or a warm environment 3. Controlled trials have investigated the efficacy of subcutaneous sumatriptan, nasal sumatriptan, and nasal zolmitriptan.

When a preventive medication is required, verapamil is the reference treatment. PH attack features are characterized by unilateral, often stabbing, headaches, shorter and more frequent than in cluster headaches. PH is responsive to treatment with indomethacin. Indomethacin dosages ranges from 25 to 75 mg, three times a day. SUNCT-SUNA attacks are very short in duration seconds to minutes , triggered by touching the face or chewing, with associated autonomic features and occur up to hundreds of times per day.

In HC, clinical attack features have been reported as unilateral, side-locked continuous pain although interrupted by frequent severe exacerbations , associated with autonomic symptoms and responsive to indomethacin.

Therapeutic options in TACs are limited. In many patients the preventive treatment does not help to control attack frequency, or the acute drugs are not well tolerated or are contraindicated.

For these reasons, after the discovery of the central role of the hypothalamus in TACs pathogenesis, neuromodulation techniques started. After the results obtained with hypothalamic deep brain stimulation in CH, other peripheral neuromodulation targets occipital nerves, spinal cord, sphenopalatine ganglion, vagus nerve were tried in the management of refractory CH and other TACs.

Headache Classification Committee of the International Headache Society: The international classification of headache disorders: 3th edition beta version. Cephalalgia , Headache ; Chronic headaches are a relevant health problem characterized by significant disability, poor quality of life and high economic burden 1.

The most common forms include chronic migraine CM and medication overuse headache MOH , which are frequently associated, given that the majority of CM sufferers do overuse acute medications CM with MO. Chronic headaches represent a challenge for physicians, given their frequent resistance to therapies, risk of relapse and associated comorbidities. Their management includes several steps aimed to: 1 make a proper diagnosis excluding secondary forms; 2 identify exacerbating factors; 3 treat comorbidities; 4 identify and address medication overuse; 5 establish a therapeutic agreement with patient; 6 define an integrated care approach.

Patient-history collection is crucial for defining headache onset and its life-long course, chronicization factors, and outcomes of previous therapies acute and prophylactic.

Overused drug discontinuation is the first approach for MOH and it can be achieved via multiple modalities – in-patient or out-patient withdrawal procedures, advice alone — depending on several headache-associated or patient-associated factors.

During withdrawal, adequate care is required to help the patient to go through the treatment phases, given the frequent occurrence of headache recrudescence. Headache diaries represent useful tools in monitoring attacks frequency, detecting medication overuse, checking therapies outcomes, and assessing disability improvements.

A relevant problem in MOH is the risk of relapse into overuse after successful withdrawal. There are only few controlled pharmacological trials on the management of MO in CM, which does not allow to derive precise figures on the risk of relapse into MO associated to specific therapies.

Furthermore, the relapse risk is also influenced by psychological and clinical comorbidities. For instance, mood and personality disorders e. Psychological factors indeed seem to play a crucial role in predicting the outcome e. The presence of other pain-syndrome comorbidities e.

Such a management is not limited to the earliest stages of treatment diagnosis, therapies, detoxification , being very important also when the patients resume their everyday life 4. It is important to prevent unrealistic expectations e. The cost of headache disorders in Europe: the Eurolight project. Changes in anxiety and depression symptoms associated to the outcome of MOH: A post-hoc analysis of the Comoestas Project.

Psychological factors associated to failure of detoxification treatment in chronic headache associated with medication overuse. A consensus protocol for the management of medication-overuse headache: Evaluation in a multicentric, multinational study. Headache prevalence is age-dependent and decreases progressively over time, especially starting from the age of The incidence of primary headaches declines, whereas secondary headaches tend to occur more frequently with increasing age [1].

Although the prevalence of headache in the elderly is relevant, few studies have been conducted in patients over 65 so far. The clinical records of consecutive outpatients aged over 18 referred to our Headache Centre from to were reviewed. Patients were diagnosed based on The International Classification of Headache Disorders, 3rd edition beta version criteria [2].

Out of patients, a total of 5. Primary headaches were diagnosed in patients In the primary headache group the most common disorders were migraine without aura As for patients with migraine and chronic tension-type headache, the onset of headache occurred in most cases before 45, in particular in chronic migraine Secondary headaches were represented above all by cervicogenic headache, frequently associated with tension-type headache.

Among cranial neuropathies, trigeminal neuralgia was by far the most commonly diagnosed headache. In our population of elderly headache patients, migraine without aura, chronic tension-type headache and chronic migraine accounted for There was a large majority of females in all the subgroups of headaches. In cluster headache, considered as a typical disorder of young men, we found indeed a slight preponderance of females. Migraine with aura not infrequently occurs in the elderly; this headache, as well as cluster headache, can even start, even rarely, over 65 and in such cases a differential diagnosis with a possible secondary disorder is mandatory.

Among patients with chronic headaches, a medication overuse was found more frequently in chronic migraine The choice of headache treatment is challenging, since specific guidelines are lacking and also because elderly patients commonly present with comorbidities. Previously when you received a link to a shared file, you would be directed to a browser and prompted to re-authenticate. Today, we are announcing universal link support, which will open the document directly in the Word, Excel, or PowerPoint iOS apps.

OneDrive lets you open, view, and share all of your files without leaving the app. For example, you can use the built-in rotor on iOS to navigate line-by-line or word-by-word and change the speed at which VoiceOver speaks.

The new Office-specific rotors also let people with vision impairments navigate more efficiently in Word across tables and links, slides in PowerPoint, and sheets in Excel. Users can also leverage larger text options in accessibility settings to modify the text size in the core Office apps.

Visit the support pages for Excel, Word, and PowerPoint to learn more. On April 17th Microsoft announced that Attack Simulator is now generally available. With Attack Simulator, customers can launch simulated attacks on their end users, determine how end users behave in the event of an attack, and update policies and ensure that appropriate security tools are in place to protect the organization from threats.

Also, two spear-phishing templates are available for immediate use in the spear phishing simulation. Attack Simulator includes the three attack scenarios from our public preview. Display Name Spear Phishing Attack: Phishing is the generic term for socially engineered attacks designed to harvest credentials or personally identifiable information PII.

Spear phishing is a subset of this phishing and is more targeted, often aimed at a specific group, individual, or organization. These attacks are customized and tend to leverage a sender name that generates trust with the recipient.

Password Spray Attack: To prevent bad actors from constantly guessing the passwords of user accounts, often there are account lockout policies. For example, an account will lockout after a certain number of bad passwords are guessed for a user.

However, if you were to take a single password and try it against every single account in an organization, it would not trigger any lockouts.

The password spray attack leverages commonly used passwords and targets many accounts in an organization with the hope that one of the account holder uses a common password that allows a hacker to enter the account and take control of it.

From this compromised account, a hacker can launch more attacks by assuming the identity of account holder. Brute Force Password Attack: This type of attack consists of a hacker trying many passwords or passphrases with the hope of eventually guessing correctly.

The attacker systematically checks all possible passwords and passphrases until the correct one is found. This video demonstrates how Attack Simulator can help organizations educate users to become more secure from cyber threats. With Attack Simulator, admins can train all their end users, and especially those who are attacked most often. This proactive training is a powerful way to ensure that your organization can prevent the impact from advanced threats.

Over the coming months, more threat simulations will be added to Attack Simulator so organizations can simulate the most prevalent threat types from the modern threat landscape. Also, learn more about how Microsoft leverages threat intelligence and the value of threat intelligence Take a few minutes to try out these tips, and your machine will be zippier and less prone to performance and system issues.

Even desktop PCs typically have a Power saver plan. Changing your power plan from Power saver to High performance or Balanced will give you an instant performance boost. Depending on your make and model, you might see other plans here as well, including some branded by the manufacturer. To see the High performance setting, click the down arrow by Show additional plans. To change your power setting, simply choose the one you want, then exit Control Panel.

High performance gives you the most oomph, but uses the most power; Balanced finds a median between power use and better performance; and Power saver does everything it can to give you as much battery life as possible. Desktop users have no reason to choose Power saver, and even laptop users should consider the Balanced option when unplugged and High performance when connected to a power source.

Stop them from running, and your PC will run more smoothly. The Task Manager will then appear in all of its full-tabbed glory. Click the Startup tab. But you may not recognize many of them. No fair Googling it first. The Task Manager helps you get information about unfamiliar programs. Right-click an item and select Properties for more information about it, including its location on your hard disk, whether it has a digital signature, and other information such as the version number, the file size and the last time it was modified.

Bing will then launch with links to sites with information about the program or service. Turn off search indexing Windows 10 indexes your hard disk in the background, allowing you — in theory — to search your PC more quickly than if no indexing were being done.

But slower PCs that use indexing can see a performance hit, and you can give them a speed boost by turning off indexing. Even if you have an SSD disk, turning off indexing can improve your speed as well, because the constant writing to disk that indexing does can eventually slow down SSDs.

To get the maximum benefit in Windows 10, you need to turn indexing off completely. To do so, first type services. The Services app then appears. Scroll down to either Indexing Service or Windows Search in the list of services. Double-click it, and from the screen that appears, click Stop. Then reboot. Your searches may be slightly slower, although you may not notice the difference. But you should get an overall performance boost.

To do this, first type index in the Start Menu search box, and click the Indexing Options result that appears. The Indexing Options page of Control Panel appears. Uncheck the boxes next to any location, and it will no longer be indexed. Cleaning it out can give you a speed boost. Windows 10 has a surprisingly useful built-in tool for doing this called Storage Sense.

You can customize how Storage Sense works and also use it to free up even more space than it normally would. And you can also set how long to wait to delete files in the Recycle Bin automatically. You can also delete old versions of Windows that might be hogging space. Clean out your Registry Under the Windows hood, the Registry tracks and controls just about everything about the way Windows works and looks. That includes information about where your programs are stored, which DLLs they use and share, what file types should be opened by which program or just about everything else.

But the Registry is a very messy thing. So over time, it can get filled with countless outdated settings of all types. And that can lead to system slowdowns. To do it, you need a Registry Cleaner. There are plenty available, some free and some paid. Before using Auslogics or any other Registry Cleaner, you should back up your Registry so you can restore it if anything goes wrong. To do your own Registry backup, type regedit. That runs the Registry editor. From the File menu, select Export.

Then choose a file location and file name and click Save. To restore the Registry, open the Registry editor, select Import from the File menu, then open the file you saved.

Now download, install and run Auslogics Registry Cleaner. On the left-hand side of the screen you can select the kinds of Registry issues you want to clean up — for example, File Associations, Internet or Fonts. I generally select them all. Next tell it to scan the Registry for problems.

That lets you first examine the Registry problems it finds. It now scans your Registry for errors, then shows you what it found. It ranks the errors according to their severity, to help you decide which to fix. Disable shadows, animations and visual effects Windows 10 has some nice eye candy — shadows, animations and visual effects. But on slower and older PCs, they can exact a performance hit. In the Windows 10 search box type sysdm.

That launches the System Properties dialog box. That brings you to the Performance Options dialog box. If you have time on your hands and love to tweak, you can turn individual ones on and off.

Windows 10 will then turn off the effects that slow down your system. Launch the Windows troubleshooter Windows 10 has a very useful, little-known tool that can sniff out performance problems and solve them. Click Next. The Resource and Performance Monitor launches and gathers information about your system.

When the Monitor finishes, it will launch an interactive report. Your best bet is to first look at the Warnings section, which details the biggest issues if any it found on your PC, such as problems with Windows, with drivers and so on.

It also tells you how to fix each problem — for example, how to turn on a device that has been disabled. Each result is color-coded, with green meaning no problems, yellow meaning potential issues, and red showing a problem. Beyond that, the Resource Overview also reports performance metrics and explanatory details. First, run a system scan to find adware and malware.

Windows Defender will look for malware and remove any it finds. The free version scans for malware and removes what it finds; the paid version offers always-on protection to stop infections in the first place. Now you can check for bloatware and get rid of it. Several free programs will do this for you; your best bet is to run several of them, because no single one will find all the bloatware on your PC. It also kills processes that you might have set in motion and are no longer needed, but that continue running and slow your system.

If your Windows 10 PC has turned sluggish over time for no apparent reason, you may be surprised at how much more quickly it will run when you do this. How to access Compliance Manager? This new compliance solution is designed to help organizations meet their data protection and regulatory requirements while using Microsoft cloud services. Compliance Manager enables users to perform on-going risk assessments, gain actionable insights to improve data protection capabilities, and simplifies compliance processes through its built-in control management and audit-ready reporting tools.

Compliance Manager is now generally available for Azure, Dynamics , and Office Business and Enterprise subscribers in public clouds. Note that Office GCC customers can access Compliance Manager, however, you should evaluate whether to use the document upload feature of compliance manager, as the storage for document upload is currently compliant with Office Tier C only. What do I need to do to prepare for this change? By default, everyone in your organization with an Office , Dynamics or Azure user account has access to Compliance Manager and can perform any action in Compliance Manager.

To change the default permissions, at least one user must be added to each Compliance Manager role see the instructions on our support page linked from Additional Information below. After a user is added to a role, the default permissions are removed and only users that have been added to a role will be able to access Compliance Manager and perform the actions allowed by that role.

Once you log into Compliance Manager you will see a number of assessments and what Microsoft has completed for the various assessments. You will also see what controls your organization are responsible for. You can export the assessment to excel if you need to provide it for an auditor or wish to save it for retention purposes. Once in an assessment, you can update what your organization is doing to meet the requirements for the various supported standards.

This gives you the ability to track your compliance activities. Some organization may already have GRC tracking software but they will find this tool useful if for no other reason to see the results of Microsoft Managed controls. If Microsoft allowed you to have an assessment for your on-premises systems. Like a blank questionnaire, clients could use it might be able to replace a GRC app for some companies.

When updating the Customer Managed Controls you have the ability to upload documents, lookup the related controls, assign an assessor, a test date and document the test results. Microsoft provides you with detailed guidance for customer actions and allows you to document your control implementation details along with a test plan and any response to the assessment.

Compliance Manager analyzes controls for their the impact to the confidentiality, availability, and integrity of protected data, as well as external drivers in order to weigh controls based on their impact.

This tool could help them develop those processes. We also see this as a great tool or internal auditors to use. It gives businesses a place to document the testing methods and results. The chipmaker, working with partners and rivals, says it has already issued updates to protect most processor products introduced in the past five years, but the news sparked concern about this fundamental building block of the internet, PCs and corporate networks.

That makes everything from supercomputers to smartphones operate very fast. Unfortunately, as Google researchers discovered, it also provides a way for bad actors to read data stored in memory that had been thought to be secure. In a worst-case scenario, that would let someone access your passwords. How bad is it? More broadly, though, the new fears could undermine longtime assurances that hardware and chip-level security is more tamper-proof than software.

How was it discovered? The weakness was discovered last year by folks Google employs to find such issues before the bad guys do. Usually, solutions are developed in private and announced in a coordinated way. This time the news leaked before the companies involved had a chance to get a fix in place.

Chipmakers and operating system providers, such as Alphabet Inc. Intel said that it expects to have issued updates for more than 90 percent of recently introduced processor products. Some customers of Android devices, Google Chromebook laptops and its cloud services still need to take steps to patch security holes, the company said. Patches for Windows devices are out now and the company is securing its cloud services, Microsoft said in a statement.

Is this just an Intel problem? No, though that seems to be what panicky investors initially thought. But rival Advanced Micro Devices Inc. Google fingered all three companies.

What will the fallout be? Some computers, mostly older ones, could be slowed down by the software patches that will make them more secure. Intel said that in common situations software might be slowed down by as much as 3 percent or not at all. But in other rare situations, performance might be reduced as much as 30 percent. Intel has only done lab tests Microsoft finally retired a version of Windows 10, marking 29 months of support for the untitled feature upgrade, nearly as long a stretch as the time between the releases of Windows 8 and Windows Windows 10 — Microsoft labels its feature upgrades in a yymm format — received a final set of security patches on April The retirement date had originally been slated for Oct.

Customers running Windows 10 Enterprise or Windows 10 Education were given the support reprieve; those operating lesser SKUs stock-keeping units , including Windows 10 Home and Windows 10 Pro, had their support curtailed last October. Earlier this year, Microsoft added six months of support to all versions of Enterprise and Education, raising the support roof from 18 months to 24 for not only , but also for , and The less expensive, less expansive, Home and Pro, however, retained the month support timeline.

Also destined for an April 10 retirement party was Windows 10 , the mid feature upgrade that received its last security patches that day on Windows 10 Home and Windows 10 Pro. Meanwhile, version on Enterprise and Education will continue receiving fixes until Oct. The company has extended the lifespan of other software previously, including the original version of Windows 10, tagged as In February , it added six weeks to the timetable. Generally, however, Microsoft has been hard-nosed about support deadlines, and for good reason.

Microsoft on Tuesday said that some million enterprise workers now run Windows 10, a sign that corporations and other businesses are close to schedule to scrub Windows 7 from their machines before that older OS retires in about 20 months, an analyst argued.

In actuality, because Microsoft typically sells licenses on a per user basis, with multiple devices allowed for each user, million people may be using more than that number of Windows 10 devices. According to other metrics, there may be a considerable number of them. Estimates from analytics vendors, including U. The million touted by Belfiore this week will be quite different a year from now, Kleynhans was certain.

Windows 10 deployment is, like previous iterations of the OS, on a timetable not of its own making. Get answers from Microsofts Cloud Solutions Partner! Contact for More Information. An Authentication error has occurred. The function requested is not supported. A reboot was not needed.

To read this article in its entirety click here This server has been disconnected from other partners for days, which is longer than the time allowed by the MaxOfflineTimeInDays parameter. DFS Replication considers the data in this folder to be stale, and this server will not replicate the folder until this error is corrected. To resume replication of this folder, use the DFS Management snap-in to remove this server from the replication group, and then add it back to the group.

This causes the server to perform an initial synchronization task, which replaces the stale data with fresh data from other members of the replication group. More Information If setting the authoritative flag on one DC, you must non-authoritatively synchronizeall other DCs in the domain. For example, if all logon scripts were accidentally deleted and a manual copy of them was placed back on the PDC Emulator role holder, making that server authoritative and all other servers non-authoritative would guarantee success and prevent conflicts.

The use of the authoritative flag is only necessary if you need to force synchronization of all DCs. If only repairing one DC, simply make it non-authoritative and do not touch other servers. This article is designed with a 2-DC environment in mind, for simplicity of description.

It also assumes you have the ability to restore data that was deleted, overwritten, damaged, etc. Event Medical Staffing Solutions EMSS has a nationwide network of emergency medical professionals focusing on special events, sporting events, construction sites, medical escort services and the television and film industry. Event Medical Staffing Solutions specialize in on-site medical needs for any duration at any location, and any type of event.

In the past, Ring Central has not been enforcing licenses for employees that are using the system on mobile devices without a digital line. That is about to change. Mobile Users without a digital line can make and receive calls and have access to many of the same capabilities as users with digital lines. With this advanced functionality, these users have begun using the product the same way they would a digital line.

Will I be charged for using the Mobile App? Mobile Users with a digital line are not affected, and can continue to use the Mobile App for no additional charge.

This change only affects Mobile Only Users without a digital line. When does this take effect? Please refer to the email notification for the timing of this change for your account. What will be the cost?

The cost for each Mobile User without a digital line will be the same as users who have a digital line. If you want to add digital lines for your Mobile Users at no additional cost excluding taxes and fees , please contact your RingCentral account manager. What are the benefits to Mobile Users of adding a digital line? If you are interested, please contact your account manager by calling How do I know which Mobile Users without a digital line will be billed at any given time?

System administrators can log into their RingCentral account and see this information under the billing tab. See more details here. If a mobile user without a digital line is inactive or is only used for internal company calls, within a given month, there will be no charge. Microsoft released an update that addresses the issue yesterday. Addresses an issue in which some USB devices and onboard devices, such as a built-in laptop camera, keyboard, or mouse, stop working.

This may occur when the Windows Update servicing stack incorrectly skips installing the newer version of some critical drivers in the cumulative update and uninstalls the currently active drivers during maintenance. Known issues in this update Symptom Workaround Windows Update History reports that KB failed to install because of error 0x Even though the update was successfully installed, Windows Update incorrectly reports that the update failed to install.

Select Check for Updates to verify that there are no additional updates available. You can also type About your PC in the search box on the taskbar to verify that your device is using the expected OS build. Microsoft is working on a resolution and will provide an update in an upcoming release. This issue occurs when the windows update servicing stack incorrectly skips installing the newer version of some critical drivers in the cumulative update and uninstalls the currently active drivers during maintenance.

Workaround steps are available in KB There is no way to undo the database corruption. To return your AD FS server to a functional state, you must restore it from a backup. How to get this update This update will be downloaded and installed automatically from Windows Update. To get the stand-alone package for this update, go to the Microsoft Update Catalog website.

File information For a list of the files that are provided in this update, download the file information for cumulative update Have any questions? New Website Design — W. The most recent website developed by our team is for W. Wallace Paving in Delanco, NJ. Wallace Paving is a trusted asphalt paving company serving in South Jersey. Wallace Paving has been consistently providing exceptional value, superior customer service and the highest workmanship in South Jersey for over 30 years.

Wallace Paving is a name you can trust and rely on. Wallace Paving carries full liability insurance and workers compensation insurance on all employees with one of the best experience modifiers in our industry for safety.

Press OK once done. Step 9 You will be prompted for your username and password for your VPN. Enter them as provided. Step 10 You can also check the VPN status in the Network applet the icon in your system tray at the bottom right. Connecting the SSTP on Windows 10 Find the network connections icon in the bottom right corner of the screen near the clock.

The icon can be in the shape of computer display or wireless signal meter you can see it on Step Click on that icon. In the appeared list click on any network connection. After that you will see another window with the connection list, click on theVPN connection the connection name can be different, you have set it up on Step 5.

Disconnecting the SSTP on Windows 10 Find the network connections icon in the bottom right corner of the screen near the clock. Contact for More Information Your reviews are public, so anyone can see what you write. To leave us a review click here Note: Google has a zero tolerance policy for fake reviews.

Why we want you to leave a review on Google? At South Jersey Techies, we recognize the challenges businesses face and can help you improve your technology with affordable professional Managed IT Services and Website Maintenance Plans. By contributing to Google Maps, you can earn points and get a special badge next to your reviews.

For more info and answers to your other questions, check out the Local Guides forum. Search for a place. To read all the reviews for the place, to the right of the rating, click on the total number of reviews. Tip: If you want to see a translated review in another language, go to your languages on the right, click Edit choose a language.

Click Write a review. In the window that appears, click the stars to score the place. If you want, you can also write a review. At the top, tap Reviews. To share a review, go to the bottom of the review and tap Share. A star means a Local Guide wrote the review. Add a rating or review On your Android phone or tablet, open the Google Maps app. Search for a place or tap it on the map. At the top, tap Reviews scroll down until you see 5 empty stars.

Tap the stars to score a place or write a review. Scroll down until you see reviews. A star means the review was written by a Local Guide. Scroll down until you see 5 empty stars. On your iPhone or iPad, open the Google Maps app.

In the top left, tap the Menu Your contributions. To see places you might want review, choose Contribute. In the top left, tap the Menu Your contributions Reviews.

Find the review you want to share, edit, or delete. Share your review: Tap on your review scroll down until you see your review at the bottom of your review, tap Share. Edit your review: Tap More Edit review. Delete your review: Tap More Delete review. Next to the review, tap More Report review. Oh, plus a promise to crowdfund the upcoming console. This week Atari further detailed the Ataribox to GamesBeat, and the plan seems even weirder than before.

Best of luck to them. Is that enough? Probably not. The problem, as always, is the games. Linux gaming is worlds better than it was a few years ago, especially if Atari focuses on the indie scene. Hell, for all we know Atari will be buying Steam Controllers in bulk and packaging them with the system. Might as well. Plans are for an Indiegogo campaign later this fall, with a release scheduled for Spring Mark Kaelin explains how.

Microsoft has been slowly and methodically rolling out the Windows 10 Creators Update to customers throughout If you are one of the lucky ones to receive the update already, you have likely noticed more than a few changes to how Windows 10 looks and works.

Some of the changes are good, some are a little annoying. Microsoft is migrating the interface for configuring the operating system to the new Settings screen, but some of us, especially IT pros who have been doing this for a long time, prefer the old Control Panel interface.

Figure A Fortunately, the old Control Panel is still available; it is just lurking in the background. We can bring it back to the forefront with a few clicks, tweaks, and tricks, and this tutorial will show you how they work. In general, that means acquiring a link from a version of Windows that is not the Creators Update. It is possible with the help of a third-party app, but it is complicated, convoluted, and not really necessary.

If you want to go through the process, you can check out this website for the details. But before you do, I have some simple solutions that might work better for you. Now, what you can and should do For those of us who want to keep things simple, here are a couple of ways to access the traditional Control Panel in Microsoft Windows 10 Creators Update. Search for it Figure C If you just want to access the control panel occasionally and not add more icons to your desktop, the simplest way to access the Control Panel is by typing control panel in the Cortana search box.

Control Panel should be the first entry in the search results Figure C. You can left-click the link to start the app or right-click it and add the link to the Start Menu or to your Taskbar for easy future access.

Adding the Control Panel to the Start Menu is handy if you are using a touch screen interface. Adding it to the Taskbar works well if you find yourself accessing configuration settings on a regular basis. Click the Personalization icon to open the next screen and drill down to the Themes screen. Scroll down until you see the Desktop Icon Settings item under the Related Settings area and click it.

A dialog box will pop open and you can check the Control Panel radio button to add that link to your Desktop Figure D. Click OK and the icon will be added as a primary system link on your Desktop. Here are the best features that came with it. Get ready to back up your iPhone and iPad: iOS 11 is here.

Apple released the latest version of its mobile operating system on Tuesday, introducing us to a handful of brand-new features. In fact, this version of iOS feels like the most ambitious version of iOS that Apple has launched in a while. This time, Siri gets a new voice, plus a super-helpful visual interface that lets you even edit your voice request with text input. Apple said that it will add more languages in the months to come.

Customizable Control Center Currently, Control Center in iOS 10 takes up two panels, so you have to navigate to the second panel to access volume controls. However, iOS 11 brings everything back to a single screen and relies more on 3D Touch. In iOS 11, you can add effects to your Live Photos after you take them.

Find a Live Photo on your camera roll and then swipe up. You can also make it a long exposure shot for better photos of low-lit scenarios.

Drag-and-drop on iPad iOS 11 makes for better multitasking on iPad. Now you can drag-and-drop images, links, and files between apps that are open side-by-side, either in Split View or Side Bar mode.

In fact, you can drag-and-drop an app from Dock onto Side Bar mode, and drag that secondary app from the right to the left side of the screen.

Markup your screenshots Everytime you take a screenshot in iOS 11, it will automatically remain floating on the lower left. You can swipe it offscreen to save it to your camera roll as per usual, or you can tap on it to go into Markup. Taking a page from Spotify, Apple Music members now have a profile on the streaming app. However, there is currently no way to listen to music on private or secret mode, so be ready for your Apple Music followers to get a glimpse at all your guilty pleasures.

You can scan several documents at once and apply different filters. The scans can be saved inside your Notes, and you can also export them as PDF files that are Markup-friendly, so you can add your signature and send it back.

If you prefer to take notes using your finger or your Apple Pencil on iPad Pro, they are now searchable. QuickType keyboard improvements iOS 11 also makes significant improvements to the software keyboard. On iPhone, you can press-down on the globe icon and choose one-handed mode.

This will bring all the keys closer to either the left or right side of the screen to make it easier to type with one hand. You can also make one-handed mode your default keyboard by going into Settings. For iPad, you can now type numbers, symbols, and punctuation marks without switching to a secondary keyboard.

Simply flick down on the key to insert the character you need. Apple Pay Cash for sending or receiving cash within Messages 2. Indoor maps for Apple Maps to help you navigate popular shopping centers and major airports worldwide. Use promo code rsa5 in your cart when you order. Offer expires Wednesday, September 27, at midnight Mountain Time.

Did you know? Mac Office support conks out on Oct. Support ends for Office for Mac on Oct. As of that date, the Redmond, Wash. The individual applications — Excel, PowerPoint, Outlook and Word — will continue to operate after support ends, but companies will be taking a risk, however small, that malware exploiting an unpatched flaw will surface and compromise systems.

To receive security and non-security updates after Oct. Unlike the Windows version of Office, which receives 10 years of security support, those that run on macOS are allotted half that. The latter will be upgraded with new features, Microsoft said in April, twice each year for enterprise subscribers to Office ProPlus, with each release supported for 18 months before giving way to a pair of successors. Mac editions, however, are refreshed with new tools at irregular intervals, often long after the same feature debuts in the same Windows application.

And because there are no regular, large-scale feature upgrades to Office for Mac, support is not curtailed by the release schedule as with Windows. The difference between Offices — the behemoth Windows on one side, the niche Mac on the other — has been put into even starker relief recently: Microsoft has adopted March and September dates for launching new upgrades to Windows 10, Office ProPlus, and last week, Windows Server, but made no similar promises for Office for Mac Offer expires Wednesday, September 13, at midnight Mountain Time.

I deleted Google from my life, and I can show you how to do it, too. After being a devoted Googler for many years, I realized putting all my data on one platform had its downsides. A couple of factors in particular drove me to make a clean break. Deleting Google for privacy and security The appeal of escaping Google comes down to privacy. Google collects an alarming amount of data about you. Security goes hand-in-hand with that.

How to delete your Google data to protect yourself. Deleting Google for social impact Another reason to get rid of Google is make your choice as a consumer for a healthier, more responsible media.

The importance of search discovery means that publishers and journalists must write stories to match the queries typed in by readers. How my Google-free experiment started When I decided to drop Google, I had just left a full-time job at a company that used Google mail and other apps. I stopped using all Google products while I freelanced. Everyone uses Google differently, but I focused on forgoing the services that are core to the experience: Gmail, Docs, Drive, Calendar, Maps, and Search.

Dropping Gmail was easier than expected. I tried Yahoo! Mail, but there were too many ads for my taste. The web interface for Apple Mail at icloud. I liked them both better than Docs because I prefer native apps to web apps, and because I think both have more elegant designs—especially iCloud. It also has a mobile app. It was also pretty easy to kick Drive to the curb.

Cloud storage competitors abound. Google Calendar has plenty of competition. This is a more personal choice, and people can get very attached—consider the furor when Microsoft shuttered Sunrise Calendar. On the other hand, it inspired us to find third-party alternative calendars, which could also replace Google Calendar. I tried Waze. Google Maps is still the best. Google Maps alternatives were a challenge.

Unlike Apple Maps, Waze has a web app, and powerful community-sourced data is its biggest selling point. But guess what? Google Search rules for a reason. Bing is a strong competitor. Some features, like video search, are even better than what Google offers. Both search options were passable, but Google has nailed semantic search with a precision that no one else can touch. Then I was hired at a new job that required me to use Google.

I considered the experiment a success, to the point that I was dismayed to abandon it at the new gig. Google has us in its grasp for good reason.

Your mileage may vary based on which services you value most. If you decide to delete Google from your life, too, let us know how it goes on our Facebook page. But what makes the S8 so amazing is how unique it is. For the first time in a while, Samsung is standing alone on the cutting edge with a phone that needs to be seen to be believed. From its barely there bezels to its brilliant wraparound screen, the Galaxy S8 truly gives Apple a run for its money.

No joke, it actually makes the iPhone 7 look pretty stale. According to rumors, the lineup this year will consist of the usual S models along with a fantabulous iPhone 8, which looks to adopt a similar aesthetic to the Galaxy S8, with an edge-to-edge OLED display and the removal of the physical home button. The iPhone 7 Plus is already a step ahead here, with 2X optical zoom and the sublime Portrait Mode, but the iPhone 8 could really separate itself from the S8 by taking it even further.

Along with a megapixel bump, Apple could add optical image stabilization to the second lens, which will go a long way toward increasing photo and zoom quality. But what would really set it apart would be a larger sensor and greater ISO range to make it a low-light leader. And that could be one of the features that sets the iPhone 8 apart. An AR-fueled iPhone 8 could connect us to the world in fun new ways without separating us from reality.

Well-placed fingerprint sensor While the Galaxy S8 is one of the best smartphones ever made, one tragic flaw prevented it from being perfect: the placement of the fingerprint sensor. For some god-awful reason, Samsung put it right next to the camera, all but ensuring your finger will not only miss it, but also repeatedly smudge the lens.

If the rumors are correct that Apple will also be removing the home button in the iPhone 8, it has two options: under the screen or on the back. Samsung integrated Bixby deep into the interface to let it access apps, fetch information, and cut down on how often we need to touch our phones. It might be time to rethink iOS for modern times and give it more than new features and a fresh coat of pixels.

True wireless charging While Samsung has had wireless charging in the Galaxy S since the S6, Apple has been slow to adopt it for the iPhone. That alone would be an S8 killer. The Galaxy S8 includes a pretty great pair of earbuds. Inside the S8 box is a pair of premium AKG-tuned earbuds that are a few steps above the usual build and sound quality you get for free—certainly better than what Apple gives us. But if Apple really wants to embrace the wireless future of the iPhone, it needs to stop including a wired set of EarPods, even if they are Lightning.

A pair of AirPods in the box or a cheaper Beats alternative would really set it apart from the 3. Use promo code rsa3 in your cart when you order. Offer expires Wednesday, August 30, at midnight Mountain Time. These include a host of new enterprise-useful features — especially for the iPad — as well as a variety of tweaks that will almost any user.

That commitment to privacy means Apple has been crafting smart solutions that work on a device rather than by sharing data with the less secure cloud. Apple also introduced Core ML, a general-purpose machine-learning framework that developers can use to integrate machine learning inside their apps.

Here are some of the ways Apple has applied A. The People folder in Photos becomes more accurate, and information about your friends will sync across all your Apple ID logged-in devices. Based on what you are doing in other apps, iOS 11 can provide personalized recommendations in Safari, Maps, Messages and News.

Siri Kit improvements: Developers can use the SiriKit framework to integrate Siri support inside apps for ride scheduling, bill payments, banking, messaging, image search, VoIP calls, workouts, car controls and to-do lists.

Type to Siri: You can now choose to type your Siri requests rather than speak them. Then toggle Type to Siri to On green. The Dock: The new, customizable Dock holds up to 15 apps or folders containing apps. Three additional slots to the right of the Dock show a trio of the most recently used apps. You get to the Dock by swiping up from within any application.

Drag and drop: You can select a single item by tapping it, and if you continue to hold it — and then tap one or more additional items — you can select a number of items. This feature also works with the newly introduced Files browser see below. Together, Files and drag-and-drop make working on an iPad feel much more like working on a computer than on a giant iPhone. It works like this: Summon the Dock by swiping up the screen from within any app ; you can then tap an app icon and drag it to the right side of the screen to open a narrow version of it.

This makes it easy to switch between apps using the Dock and Split View. If you have a keyboard, you can switch apps using the Mac-familiar Command-Tabbuttons.

Apple Pencil: Tap the screen to instantly open Notes and begin writing. Locations lets you access files held in iCloud Drive, on your device or the trash if they were recently deleted. You can also bring in files held in third-party services such as Dropbox.

Tap this and you can assign a new tag to the file. Sort files by name, date, size and tags. Skip between list and icon-based views. Drag items to other apps. Enterprise deployment — simplified iOS 11 brings changes designed to make it easier to deploy Apple devices across the enterprise. You can add any device to the Device Enrollment Program. MDM commands can be set to execute only when a device has a wired connection — saving on corporate bandwidth.

A new restriction forbids enterprise users from adding their own VPN. You can now enable signing and encryption in Mail and Exchange separately; before you could only enable signing and encryption at once.

Sysadmins can now configure home screen layout and app installs on Apple TV. The security enhancements will likely have the biggest effect on users. These include better, easier cookie blocking and Intelligent Tracking Prevention, which uses built-in machine A. This will mean higher-quality video at much lower file sizes compared to the older H. This opens the doors to cross-platform, browser-based video collaboration.

This will enable new breeds of A. Swipe up and you can invoke numerous items for quick access. Mightier Maps Maps continues to improve, with features such as the introduction of new AR-like city flyover views. To explore these views, search for a major city and look for a Flyover button. Tap this to access the view. It also includes these key items: A Do Not Disturb When Driving feature designed to keep you from getting distracted by incoming Notifications while behind the wheel.

A new Lane Guidance feature that shows you the correct highway lane to be in to make the turns you need to stay on course. A speed limit display in Maps, beginning with those posted for U. A new way to access zoom mode: Just double tap a Map and, while keeping your finger pressed into the display, move your finger up and down to zoom in and out.

Many of your personal settings, preferences and iCloud Keychain passwords will be carried over to your new device, so it is ready to use, fast. Instant Wi-Fi: iOS 11 users can approve others to use their Wi-Fi network by holding the devices close together, authorizing them, and transferring the password automatically. This should help schools and enterprises more easily manage routine Wi-Fi password changes.

Point your device at the code, tap to focus, and a notification box will let you respond to that code. Apple has also added new filters to improve images, including one designed to make skin tones appear more natural. Live Photos gains several improvements.

Not only can you now share these live moments with others as GIF files or as an mp4 on Android , but you get to choose the key image and can apply three new effects: loop, bounce and long exposure.

By the time iOS 10 arrived, Notes had already become a sort of low-budget replacement for Evernote, but it gets much more versatility in iOS Certainly, for business users it has become an excellent tool to keep receipts and other expenses in one place when traveling: You can scan documents from within a Note; just tap the plus sign and choose Scan Documents, then point your device until the document is in focus and highlighted by a yellow tint.

You can then keep, share or even sign the scan the latter on the iPad Pro using an Apple Pencil. Apple has added the capacity to draw inside Notes using the familiar sketch tools interface from the iPad. You can pin notes to the top of your list, more easily search through your notes, and quickly place notes within subject folders.

When you need it, just download the app again to use that data. Otherwise, wait until the final version arrives, when the bugs should have been ironed out. To read this article in its entirety click here. If your home or business is in need of anything from a few minor updates, a complete overhaul or a brand new building, Cobalt Electric will provide unparalleled quality and service, and work with you to get the job done right.

Whether you want a surround-sound audio system, wired security cameras,motion sensors or ethernet jacks, choose Cobalt Electric for the highest quality cabling available in your area, making your home safer, simpler and more enjoyable.

Here are 10 tips for getting the most out of the OS. Windows 10 faced a controversial roll-out, with privacy concerns, bugs, and other issues plaguing many users. Here are 10 articles with Windows 7 tips that will help enterprise users operate the machines more effectively.

The OS also contains certain features that users can take advantage of to improve overall performance. Here, we outline 10 steps business users can take to enhance the performance of your Windows 7 system. Newly mapped addresses are saved in an ARP cache, which is usually fine, but can sometimes cause issues with internet connections and web page loading times. Here, are the necessary steps to clear the ARP cache, and how to manage it going forward. In this article, we highlight 13 services that users can disable if they so choose on Windows 7 systems that will likely not have any impact on business operations, including IP Helper, offline files, and Network Access Protection.

This article walks users through how to modify the boot config data using this tool. Here, we offer a tutorial on doing so.

Change the Processor Affinity setting in Windows 7 to gain a performance edge Most applications have been designed for multi-core processors, and work with an OS to distribute their operations evenly across cores to enhance performance. However, you can sometimes achieve better overall performance from certain applications by configuring them to run on different processor cores, which Windows 7 allows via the Processor Affinity setting.

In this article, we explain two ways to change the Processor Affinity setting in Windows 7. Use Windows 7 Event Viewer to track down issues that cause slower boot times Experiencing a slow Windows 7 boot time?

Here, we explain how it is possible to find out how long it took to boot up your system every time, since the day Windows 7 was first installed, along with instances where boot time slowed down, all through these logs.

The ability to more easily find files is a boon for business users who want to enhance their productivity. If you have a multi-core processor, chances are good that on the Performance tab in Windows Task Manager, you have noticed that the CPU Usage History graphs look about the same for each core, as shown in Figure A.

The reason for this is that most applications you run these days have been designed with multi-core processors in mind and will work with the operating system to distribute their operations as evenly as possible across all the available cores. In most cases this even distribution provides you with the best performance possible.

For instance, older applications that were designed for single-core processors can behave irrationally — they may all of a sudden begin maxing out the CPU usage at percent and appear to be locked up. In other circumstances, you might be able to achieve better overall performance from certain applications by configuring each of them to run on different processor cores. Fortunately, Windows 7 allows you to configure applications to use only one, or several, of the processor cores in a multi-core system by using the Processor Affinity setting.

From Task Manager Changing the Processor Affinity setting from within Task Manager is a pretty straightforward operation once you know how to do it.

Once Task Manager is up and running, select the Applications tab, right-click on the application that you want to work with, and select the Go to Process command, as shown in Figure B. When you get to the Processes tab, right-click on the process and from that context menu, select the Set Affinity command, as shown in Figure C. Figure B Right-click on an application and select the Go to Process command.

Figure C Right-click on the process and select the Set Affinity command. At this point, you can clear the All Processors check box and then select the CPU on which you want the process to run. Figure D The Processor Affinity dialog box allows you to choose which processor s you want to use. An example To take a look at the effects of using the Set Affinity command, we launched two applications: Microsoft Security Essentials and Disk Defragmenter.

We then started each application running — Microsoft Security Essentials performing a full scan and Disk Defragmenter defragging a GB disk. When we did, we could see that each graph was showing different measurements, as shown in Figure E. Again, we could see that each CPU core was showing different usage measurements, as shown in Figure F.

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Their goal is to get your money, access to your computer, or both. They may even access sensitive data like passwords, customer records, or credit card information. Social Engineering, Phishing and Ransomware Cyber scammers can trick employees into giving up confidential or sensitive information, such as passwords or bank information.

It often starts with a phishing email, social media contact, or a call that seems to come from a trusted source, such as a supervisor or other senior employee, but creates urgency or fear.

Scammers tell employees to wire money or provide access to sensitive company information. Other emails may look like routine password update requests or other automated messages but are actually attempts to steal your information. Business Promotion and Coaching Scams Some scammers sell bogus business coaching and internet promotion services. Using fake testimonials, videos, seminar presentations, and telemarketing calls, the scammers falsely promise amazing results and exclusive market research for people who pay their fees.

They also may lure you in with low initial costs, only to ask for thousands of dollars later. In reality, the scammers leave budding entrepreneurs without the help they sought and with thousands of dollars of debt. Changing Online Reviews Some scammers claim they can replace negative reviews of your product or service, or boost your scores on ratings sites. However, posting fake reviews is illegal. FTC guidelines say endorsements — including reviews — must reflect the honest opinions and experiences of the endorser.

Credit Card Processing and Equipment Leasing Scams Scammers know that small businesses are looking for ways to reduce costs.

Some deceptively promise lower rates for processing credit card transactions, or better deals on equipment leasing. Some unscrupulous sales agents ask business owners to sign documents that still have key terms left blank. Others have been known to change terms after the fact. Fake Check Scams Fake check scams happen when a scammer overpays with a check and asks you to wire the extra money to a third party. The new dialing procedures will be in effect on August 18th.

New phone lines will begin to be issued the area code on September 17th Chrome currently displays a neutral information icon, but starting with version 68, the browser is warning users with an extra notification in the address bar. Google has been nudging users away from unencrypted sites for years, but this is the most forceful nudge yet. Google search began down-ranking unencrypted sites in , and the following year, the Chrome team instituted a similar warning for unencrypted password fields.

Eighty-one of the top sites on the web default to HTTPS, and a strong majority of Chrome traffic is already encrypted. Without that encryption, someone with access to your router or ISP could intercept information sent to websites or inject malware into otherwise legitimate pages. Offer expires Wednesday, August 15, at midnight Mountain Time. In SharePoint Online and on office. Another user will see different results than you, even when you both search for the same words.

The results update as you start typing. Or, if the site you searched from is associated with another site, but you want to search all the associated sites. When you exit a search results page, you return to the page where you started your search Dictate in Word or PowerPoint 1 Turn on your microphone and make sure it works. As you talk, text appears in your document or slide. Insert punctuation by saying the name of the punctuation mark you want to add. No need to turn off the microphone.

Dictate in Outlook 1 Turn on your microphone and make sure it works. As you talk, text appears in your email message. Insert punctuation, by saying the name of the punctuation mark you want to add. Important information about Dictate Dictate is one of the Office Intelligent Services, bringing the power of the cloud to Office apps to help save you time and produce better results. Your speech utterances will be sent to Microsoft to provide you with this service, and may also be used to improve speech recognition services.

For more information see, What are Intelligent Services? OLD folder in the root of C:. This folder will have a backup of your old program files, appdata and Windows folder… just in case you need to revert back or recover something that might have been lost during the upgrade.

Just a small point here, it is generally not recommended to do in-place upgrades on servers. In fact there are some products e. Exchange, ConfigMgr that explicitly state they do not support upgrading the Operating System. OLD folder of several GB in size sitting there. If all is well, then you might as well just delete it. Command line tools to take ownership and delete the folder. To delete, it is necessary to take ownership of the folder, give administrators full control, then delete.

Click on Add role and Feature Click on add role and feture to launch the add role and feature wizard. Choose installation Type Choose rolebase or feature based installation to install to local machine. Proceed with the installation and Reboot Make it sure that you reboot the system 6. Verify that the Utility is indeed installed Ready to run diskcleanup. See screen shot below. Disk Cleanup in Action Below is a sample snapshot of disk cleanup in action Foreign cybercriminals have compromised hundreds of thousands of home and office routers and other networked devices worldwide, the FBI said in a May 25 announcement.

This may temporarily disrupt the malware and potentially help identify already-infected devices. Secure the device with a strong, unique, new password. Upgrade firmware to the latest available version. Windows 10 Pro is a dead end for enterprises, a prominent Gartner analyst has argued.

Because Enterprise versions of Windows have never been available to computer makers, Pro — sometimes, as in Windows 7, tagged Professional instead — has been the most popular pre-installed OS on new business PCs.

Corporations typically re-image new personal computers with Enterprise upon receipt of the devices. But although Pro or Professional has a long history in business settings, Microsoft has made numerous decisions in its Windows 10 migration campaign to separate Pro and Enterprise even more, pushing them apart. Last year, the Redmond, Wash. There was a catch: Only Windows 10 Enterprise and Windows 10 Education, a similar version for public and private school districts and universities qualified for the extra six months of support.

Users running Windows 10 Pro were still required to upgrade to a successor SKU stock-keeping unit within 18 months to continue receiving security patches and other bug fixes. But Windows 10 Pro runs out of support on April 9, I think that this telegraphed the fact that, for businesses, Pro is being dead-ended. The extra support, which Microsoft will sell at an undisclosed price, is available only to Enterprise and Education customers.

Paid supplemental servicing adds 12 months to the 18 months provided free of charge. In this way, Microsoft is further reinforcing that it expects enterprise customers to move to the Enterprise edition of Windows As business goals and team structures evolve, so too must your sites and the content that lives within them.

Ideas must flourish and grow, not become rigid or stale. SharePoint hub sites bring flexible, dynamic building blocks to your company intranet — connecting collaboration and communication. Associating sites together in a hub site enhances discovery and engagement with content, while creating a complete and consistent representation of your project, department or region.

Microsoft first disclosed SharePoint hub sites during Ignite And recently they announced that they are now rolling out to Targeted Release customers in Office They are easy for admins to establish and bring efficiencies for people who work inside and across the sites on a day-to-day basis. And when managing change within the business, it is easy to move a site from one hub site to another.

Getting started with SharePoint hub sites in Office You can convert an existing communication site or modern team time into a hub site, or you can start with a brand-new modern site. We recommend selecting a communication site as the hub site. You can associate multiple team sites and communication sites to model and promote an intranet that reflects the way your people organize.

It is easy for admins to create one or more hub sites. After a hub site is created, approved site owners can associate existing team sites and communication sites with the hub site. You then will assign a unique security group to designate approved site owners that can associate sites to this new hub.

You simply create a mail-enabled security group and add the users. You then run an additional PowerShell command to give that group permissions to associate their sites to the hub site. Site owners, however, can associate a SharePoint site with a hub site that already exists. Learn more how admins create and manage hub sites.

As the site owner, go to the site you want to have associated to the hub site. And then click Save. You will see the hub navigation appear above. The site itself will inherit the hub theme, and news and activities will begin to flow up to the hub site home page — along with a search crawl of content for any site associated to the hub site.

And at any time, per a reorg or change in business direction, you can easily move sites between hub sites. This is the power of a dynamic intranet, one that can change and adapt with the ebb and flow of your ever-changing business landscape. Note: individual sites can only be associated to one hub site at a time. Each site, including the hub site, will retain their current permission settings. And as easy as it is to associate a site to a hub site, you, too, can dissaciate from one.

Learn more how to associate and dissociate your sites to and from hub sites. And all will re-flow and present beautifully within the SharePoint mobile apps.

The SharePoint mobile apps will display hub sites, and their pages, news, and content, with smooth navigation between associated sites and the scoped search experience. Find what you need on the go and get going! Install or update the SharePoint mobile app today: aka. This new portal will offer a unified experience to manage both Teams and Skype for Business and will also include Call Analytics and the Call Quality Dashboard.

Admins can also get end-to-end insights and the ability to manage Teams settings on a user level in this new portal. Following features are available in this release: Microsoft Teams messaging policy: Create custom policies for messaging scenarios for your users. User management: Assign policies and configure your users. Microsoft Teams guest messaging settings: Control the messaging capabilities for guest accounts in Microsoft Teams.

Please note that federation for Microsoft Teams and Skype for Business will roll out in stages and this setting might not be visible for you during the initial rollout. Audio conferencing: Configure dial-in numbers and settings for Microsoft Teams and Skype for Business Besides, there are numerous feature updates available in Office threat protection service to address the evolution and advances in the threat landscape.

The addition of enhanced Anti-Spoofing capability in Office ATP for protecting against spoofed emails from external domains further strengthens this security framework. Anti-spoofing in Office Advanced Threat Protection The newest anti-spoof features help protect organizations from external domain spoof. This normal process is however challenged when external domains do not have these settings properly configured.

Without enforcement of these settings, domains show a high likelihood of being manipulated and maliciously spoofed, leaving customers vulnerable to phishing or spam attacks. The new external domain anti-spoofing capabilities help detect and block emails from external domains that do not have the following features, Correct authentication configuration An email infrastructure source with an unknown history How does it work?

If not, the filter thoroughly checks for historical sending patterns of that domain and associated infrastructure. If any suspicious behavior is noted, ATP assumes the sender does not bear a good reputation and as such, proceeds to junk the message. Also, a feature worth noticing about Anti-spoofing — The filter constantly evolves and enhances itself based on mail flow patterns it observes.

ATP subscribers can access the spoof intelligence report in their Antispam Policy and take necessary actions if required Our services include lawn maintenance, installation of retaining walls, brick walkways and patios, pruning, mulching, drainage, irrigation, and chemical fertilization. To view the Website Have questions? Use promo code rsa6 in your cart when you order. Offer expires Friday, July 13, at midnight Mountain Time. In essence, it is reshaping the way corporations handle personal data by controlling its collection, use, and storage.

The data subject: This is any individual that can be directly or indirectly identified or uniquely singled out in a group of individuals, from any stored data. Personal data: This is any information relating to an individual, whether in reference to their private, professional, or public life.

The data controller: This is the person who, alone or jointly with others, determines the purposes for, and means of, processing personal data.

A data controller is not responsible for the act of processing this falls to the data processor ; they can be defined as the entity that determines motivation, condition, and means of processing. That is, a business is the controller for the customer data it processes in relation to its sales, and an employer is the controller for the employee data they process in connection with the employment relationship.

Data processors: This is the person who processes personal data on behalf of the controller. Typical processors are IT service providers including hosting providers and payroll administrators. The GDPR does not allow data processors to use the personal data for other purposes beyond providing the services requested by the controller. Processing must be fair and lawful, although transparency is significantly strengthened.

The processor may not use the personal data for their own purposes. There are four more important elements to consider with GDPR as you become ready. Any data breaches must be documented.

This requires you to ensure that the purpose in which the data is agreed and the purpose in which the data was collected are materially similar.

Although similar, anonymization and pseudonymization are two distinct techniques that permit data controllers and processors to use de-identified data. The difference between the two techniques rests on whether the data can be re-identified. Generally, only the level and type of data collected should be limited to the minimum amount of data necessary see data minimization above.

There are a number of methods in which the data may be processed, including: express consent which may be withdrawn at any time , legitimate interest basis the subject of which legitimacy may be challenged by the data subject , honoring obligations under the agreement with the data subject, or any other legal basis that may apply. What We Can Do to Help We know this information can be overwhelming, but taking the proper steps now will save you headaches later.

SolarWinds provides products that can help you with getting ready. As they work across their PCs, Macs and mobile devices, they expect an uncompromising experience that is familiar yet optimized for the device they are using. Microsoft is committed to providing best in class experiences on all devices, and today, we are proud to share with you a set of new Office capabilities across Word, Excel, PowerPoint, and OneDrive on iOS that will delight and make iPad and iPhone users more productive than ever before.

Using real-time co-authoring, colleagues, friends, and family can contribute to and edit documents simultaneously in the Word, Excel and PowerPoint iOS apps. Drag and drop files anywhere with OneDrive — Sometimes your files can get scattered between different folders or even services and applications.

You can drag files in between folders in OneDrive and, if your teammates use SharePoint to work together, you can even drag OneDrive files to a SharePoint site giving them immediate access. On iPad, you can also drag files from other apps, such as iMessage, into your OneDrive and drag files out of your OneDrive to other apps. Drag and drop content between Word, Excel, PowerPoint, and OneDrive on iPad — One of the most common and powerful tasks when creating content is pulling in text, photos, graphs, and other objects from different sources.

Now you can pull in content with ease on your iPad with drag and drop support in Office and OneDrive. Easily drag and drop objects from OneDrive or from one Office app to another.

OneDrive integration with the Files app allows you to access, upload, edit, and save your content to OneDrive or SharePoint from apps that support Files app integration. OneDrive redesigned to find the files that matter — The OneDrive iOS app has been redesigned from the ground up with a new layout that uses your screen space more efficiently allowing you to find your files faster.

New metadata is visible in the list view, so you can easily identify new files and files that have been shared. Universal link support for shared files — Being able to seamlessly share and securely access files is essential for teamwork. Previously when you received a link to a shared file, you would be directed to a browser and prompted to re-authenticate.

Today, we are announcing universal link support, which will open the document directly in the Word, Excel, or PowerPoint iOS apps. OneDrive lets you open, view, and share all of your files without leaving the app. For example, you can use the built-in rotor on iOS to navigate line-by-line or word-by-word and change the speed at which VoiceOver speaks. The new Office-specific rotors also let people with vision impairments navigate more efficiently in Word across tables and links, slides in PowerPoint, and sheets in Excel.

Users can also leverage larger text options in accessibility settings to modify the text size in the core Office apps. Visit the support pages for Excel, Word, and PowerPoint to learn more.

On April 17th Microsoft announced that Attack Simulator is now generally available. With Attack Simulator, customers can launch simulated attacks on their end users, determine how end users behave in the event of an attack, and update policies and ensure that appropriate security tools are in place to protect the organization from threats. Also, two spear-phishing templates are available for immediate use in the spear phishing simulation.

Attack Simulator includes the three attack scenarios from our public preview. Display Name Spear Phishing Attack: Phishing is the generic term for socially engineered attacks designed to harvest credentials or personally identifiable information PII.

Spear phishing is a subset of this phishing and is more targeted, often aimed at a specific group, individual, or organization. These attacks are customized and tend to leverage a sender name that generates trust with the recipient. Password Spray Attack: To prevent bad actors from constantly guessing the passwords of user accounts, often there are account lockout policies.

For example, an account will lockout after a certain number of bad passwords are guessed for a user. However, if you were to take a single password and try it against every single account in an organization, it would not trigger any lockouts.

The password spray attack leverages commonly used passwords and targets many accounts in an organization with the hope that one of the account holder uses a common password that allows a hacker to enter the account and take control of it.

From this compromised account, a hacker can launch more attacks by assuming the identity of account holder. Brute Force Password Attack: This type of attack consists of a hacker trying many passwords or passphrases with the hope of eventually guessing correctly. The attacker systematically checks all possible passwords and passphrases until the correct one is found. This video demonstrates how Attack Simulator can help organizations educate users to become more secure from cyber threats. With Attack Simulator, admins can train all their end users, and especially those who are attacked most often.

This proactive training is a powerful way to ensure that your organization can prevent the impact from advanced threats. Over the coming months, more threat simulations will be added to Attack Simulator so organizations can simulate the most prevalent threat types from the modern threat landscape. Also, learn more about how Microsoft leverages threat intelligence and the value of threat intelligence Take a few minutes to try out these tips, and your machine will be zippier and less prone to performance and system issues.

Even desktop PCs typically have a Power saver plan. Changing your power plan from Power saver to High performance or Balanced will give you an instant performance boost. Depending on your make and model, you might see other plans here as well, including some branded by the manufacturer. To see the High performance setting, click the down arrow by Show additional plans.

To change your power setting, simply choose the one you want, then exit Control Panel. High performance gives you the most oomph, but uses the most power; Balanced finds a median between power use and better performance; and Power saver does everything it can to give you as much battery life as possible.

Desktop users have no reason to choose Power saver, and even laptop users should consider the Balanced option when unplugged and High performance when connected to a power source.

Stop them from running, and your PC will run more smoothly. The Task Manager will then appear in all of its full-tabbed glory. Click the Startup tab. But you may not recognize many of them. No fair Googling it first. The Task Manager helps you get information about unfamiliar programs. Right-click an item and select Properties for more information about it, including its location on your hard disk, whether it has a digital signature, and other information such as the version number, the file size and the last time it was modified.

Bing will then launch with links to sites with information about the program or service. Turn off search indexing Windows 10 indexes your hard disk in the background, allowing you — in theory — to search your PC more quickly than if no indexing were being done.

But slower PCs that use indexing can see a performance hit, and you can give them a speed boost by turning off indexing. Even if you have an SSD disk, turning off indexing can improve your speed as well, because the constant writing to disk that indexing does can eventually slow down SSDs.

To get the maximum benefit in Windows 10, you need to turn indexing off completely. To do so, first type services. The Services app then appears.

Scroll down to either Indexing Service or Windows Search in the list of services. Double-click it, and from the screen that appears, click Stop. Then reboot. Your searches may be slightly slower, although you may not notice the difference. But you should get an overall performance boost.

To do this, first type index in the Start Menu search box, and click the Indexing Options result that appears. The Indexing Options page of Control Panel appears. Uncheck the boxes next to any location, and it will no longer be indexed.

Cleaning it out can give you a speed boost. Windows 10 has a surprisingly useful built-in tool for doing this called Storage Sense. You can customize how Storage Sense works and also use it to free up even more space than it normally would. And you can also set how long to wait to delete files in the Recycle Bin automatically.

You can also delete old versions of Windows that might be hogging space. Clean out your Registry Under the Windows hood, the Registry tracks and controls just about everything about the way Windows works and looks.

That includes information about where your programs are stored, which DLLs they use and share, what file types should be opened by which program or just about everything else. But the Registry is a very messy thing. So over time, it can get filled with countless outdated settings of all types.

And that can lead to system slowdowns. To do it, you need a Registry Cleaner. There are plenty available, some free and some paid. Before using Auslogics or any other Registry Cleaner, you should back up your Registry so you can restore it if anything goes wrong.

To do your own Registry backup, type regedit. That runs the Registry editor. From the File menu, select Export. Then choose a file location and file name and click Save. To restore the Registry, open the Registry editor, select Import from the File menu, then open the file you saved. Now download, install and run Auslogics Registry Cleaner. On the left-hand side of the screen you can select the kinds of Registry issues you want to clean up — for example, File Associations, Internet or Fonts.

I generally select them all. Next tell it to scan the Registry for problems. That lets you first examine the Registry problems it finds. It now scans your Registry for errors, then shows you what it found.

It ranks the errors according to their severity, to help you decide which to fix. Disable shadows, animations and visual effects Windows 10 has some nice eye candy — shadows, animations and visual effects. But on slower and older PCs, they can exact a performance hit. In the Windows 10 search box type sysdm.

That launches the System Properties dialog box. That brings you to the Performance Options dialog box. If you have time on your hands and love to tweak, you can turn individual ones on and off. Windows 10 will then turn off the effects that slow down your system. Launch the Windows troubleshooter Windows 10 has a very useful, little-known tool that can sniff out performance problems and solve them.

Click Next. The Resource and Performance Monitor launches and gathers information about your system. When the Monitor finishes, it will launch an interactive report. Your best bet is to first look at the Warnings section, which details the biggest issues if any it found on your PC, such as problems with Windows, with drivers and so on.

It also tells you how to fix each problem — for example, how to turn on a device that has been disabled. Each result is color-coded, with green meaning no problems, yellow meaning potential issues, and red showing a problem. Beyond that, the Resource Overview also reports performance metrics and explanatory details. First, run a system scan to find adware and malware. Windows Defender will look for malware and remove any it finds.

The free version scans for malware and removes what it finds; the paid version offers always-on protection to stop infections in the first place. Now you can check for bloatware and get rid of it. Several free programs will do this for you; your best bet is to run several of them, because no single one will find all the bloatware on your PC. It also kills processes that you might have set in motion and are no longer needed, but that continue running and slow your system. If your Windows 10 PC has turned sluggish over time for no apparent reason, you may be surprised at how much more quickly it will run when you do this.

How to access Compliance Manager? This new compliance solution is designed to help organizations meet their data protection and regulatory requirements while using Microsoft cloud services.

Compliance Manager enables users to perform on-going risk assessments, gain actionable insights to improve data protection capabilities, and simplifies compliance processes through its built-in control management and audit-ready reporting tools. Compliance Manager is now generally available for Azure, Dynamics , and Office Business and Enterprise subscribers in public clouds.

Note that Office GCC customers can access Compliance Manager, however, you should evaluate whether to use the document upload feature of compliance manager, as the storage for document upload is currently compliant with Office Tier C only.

What do I need to do to prepare for this change? By default, everyone in your organization with an Office , Dynamics or Azure user account has access to Compliance Manager and can perform any action in Compliance Manager.

To change the default permissions, at least one user must be added to each Compliance Manager role see the instructions on our support page linked from Additional Information below. After a user is added to a role, the default permissions are removed and only users that have been added to a role will be able to access Compliance Manager and perform the actions allowed by that role.

Once you log into Compliance Manager you will see a number of assessments and what Microsoft has completed for the various assessments. You will also see what controls your organization are responsible for. You can export the assessment to excel if you need to provide it for an auditor or wish to save it for retention purposes. Once in an assessment, you can update what your organization is doing to meet the requirements for the various supported standards.

This gives you the ability to track your compliance activities. Some organization may already have GRC tracking software but they will find this tool useful if for no other reason to see the results of Microsoft Managed controls. If Microsoft allowed you to have an assessment for your on-premises systems.

Like a blank questionnaire, clients could use it might be able to replace a GRC app for some companies. When updating the Customer Managed Controls you have the ability to upload documents, lookup the related controls, assign an assessor, a test date and document the test results. Microsoft provides you with detailed guidance for customer actions and allows you to document your control implementation details along with a test plan and any response to the assessment.

Compliance Manager analyzes controls for their the impact to the confidentiality, availability, and integrity of protected data, as well as external drivers in order to weigh controls based on their impact.

This tool could help them develop those processes. We also see this as a great tool or internal auditors to use. It gives businesses a place to document the testing methods and results. The chipmaker, working with partners and rivals, says it has already issued updates to protect most processor products introduced in the past five years, but the news sparked concern about this fundamental building block of the internet, PCs and corporate networks.

That makes everything from supercomputers to smartphones operate very fast. Unfortunately, as Google researchers discovered, it also provides a way for bad actors to read data stored in memory that had been thought to be secure. In a worst-case scenario, that would let someone access your passwords.

How bad is it? More broadly, though, the new fears could undermine longtime assurances that hardware and chip-level security is more tamper-proof than software. How was it discovered? The weakness was discovered last year by folks Google employs to find such issues before the bad guys do. Usually, solutions are developed in private and announced in a coordinated way. This time the news leaked before the companies involved had a chance to get a fix in place.

Chipmakers and operating system providers, such as Alphabet Inc. Intel said that it expects to have issued updates for more than 90 percent of recently introduced processor products. Some customers of Android devices, Google Chromebook laptops and its cloud services still need to take steps to patch security holes, the company said.

Patches for Windows devices are out now and the company is securing its cloud services, Microsoft said in a statement. Is this just an Intel problem? No, though that seems to be what panicky investors initially thought.

But rival Advanced Micro Devices Inc. Google fingered all three companies. What will the fallout be? Some computers, mostly older ones, could be slowed down by the software patches that will make them more secure. Intel said that in common situations software might be slowed down by as much as 3 percent or not at all. But in other rare situations, performance might be reduced as much as 30 percent. Intel has only done lab tests Microsoft finally retired a version of Windows 10, marking 29 months of support for the untitled feature upgrade, nearly as long a stretch as the time between the releases of Windows 8 and Windows Windows 10 — Microsoft labels its feature upgrades in a yymm format — received a final set of security patches on April The retirement date had originally been slated for Oct.

Customers running Windows 10 Enterprise or Windows 10 Education were given the support reprieve; those operating lesser SKUs stock-keeping units , including Windows 10 Home and Windows 10 Pro, had their support curtailed last October.

Earlier this year, Microsoft added six months of support to all versions of Enterprise and Education, raising the support roof from 18 months to 24 for not only , but also for , and The less expensive, less expansive, Home and Pro, however, retained the month support timeline.

Also destined for an April 10 retirement party was Windows 10 , the mid feature upgrade that received its last security patches that day on Windows 10 Home and Windows 10 Pro.

Meanwhile, version on Enterprise and Education will continue receiving fixes until Oct. The company has extended the lifespan of other software previously, including the original version of Windows 10, tagged as In February , it added six weeks to the timetable.

Generally, however, Microsoft has been hard-nosed about support deadlines, and for good reason. Microsoft on Tuesday said that some million enterprise workers now run Windows 10, a sign that corporations and other businesses are close to schedule to scrub Windows 7 from their machines before that older OS retires in about 20 months, an analyst argued. In actuality, because Microsoft typically sells licenses on a per user basis, with multiple devices allowed for each user, million people may be using more than that number of Windows 10 devices.

According to other metrics, there may be a considerable number of them. Estimates from analytics vendors, including U. The million touted by Belfiore this week will be quite different a year from now, Kleynhans was certain. Windows 10 deployment is, like previous iterations of the OS, on a timetable not of its own making.

Get answers from Microsofts Cloud Solutions Partner! Contact for More Information. An Authentication error has occurred. The function requested is not supported. A reboot was not needed. To read this article in its entirety click here Peter Erdi. Book Title : Complexity Explained. Authors : Peter Erdi. Publisher : Springer Berlin, Heidelberg. Edition Number : 1. Number of Pages : XV, Skip to main content. Search SpringerLink Search. Authors: Peter Erdi 0. Buying options eBook EUR Price includes VAT Finland.

Softcover Book EUR Hardcover Book EUR Learn about institutional subscriptions. Table of contents 10 chapters Search within book Search. History of Complex Systems Research Pages Pages From Models to Decision Making Pages How Many Cultures We Have? Back Matter Pages Back to top. About this book This book is, of course about complexity. The goal of this book is to explain how various types of complexity emerge due to the interaction among constituents.

Therefore, the relevance of other mediating factors for the co-occurrence of headache and psychiatric comorbidity has to be taken into consideration. Recent research found that an insecure attachment may be a risk factor for an outcome of poor adaptation that includes chronic pain [9] and that pain perception may change in relation with specific attachment styles.

The ambivalent attachment seems to be the most common style among patients reporting high attack frequency and severe pain intensity and in children with this attachment style there is a relationship between high attack frequency and high anxiety levels [10]. Barone et al. Although more studies are needed in order to detect the biological, genetic and environmental mechanisms underlying the relationship between headache and comorbidities, attachment styles can be regarded as one of the factors mediating this association [12].

Anxiety, depression and behavioral problems among adolescents with recurrent headache: the Young-HUNT study. The relationship between sleep and headache in children: implications for treatment.

Headache and attention deficit and hyperactivity disorder in children: common condition with complex relation and disabling consequences. Epilepsy Behav. Migraine and psychiatric comorbidity: a review of clinical findings. Mol Med. Association of 5-HTT gene polymorphisms with migraine: a systematic review and meta-analysis.

J Neurol Sci ; : Headache and comorbidity in children and adolescents. J Headache Pain ; Genetic and environmental influences on migraine: a twin study across six countries. Twin Res. Pain and emotion: a biopsychological review of recent research. J Clin Psychol ; 67 9 : Attachment styles in children affected by migraine without aura.

Neuropsychiatr Dis Treat. Behavioural problems in children with headache and maternal stress: is children’s attachment security a protective factor? Dev ; DOI: The role of attachment insecurity in the emergence of anxiety symptoms in children and adolescents with migraine: an empirical study. J Headache Pain In Press. Metabolic syndrome and overweight are highly prevalent among migraineurs and the weight-loss was suggested as a useful strategy to improve both migraine and metabolic syndrome.

Recently, we have observed that a particular version of VLCD characterized by very low-carbohydrate intake and Ketone bodies KBs production, named very low-calorie ketogenic diet VLCKD , was able to induce a rapid improvement of headache in migraineurs. To assess if the favorable outcome on migraine was due to the caloric restriction, instead of KBs, we performed a double blind crossover study to compare headache modifications during a VLCD and a VLCKD in a population of overweighed and obese migraineurs.

Among patients referred to the Sapienza University Obesity Clinic, a neurologist specializing in headache recruited 35 migraineurs.

To verify variations in headache frequency, we used as baseline the month before the first VLCD and the first transition diet. Headaches are one of the most disabling disorders [1]. Moreover, recent knowledge have suggested that physical examination for provocative procedures should be done on each patient with side- locked headaches as many of these headaches may closely mimic primary headaches [4]. There have been identified eleven physical tests to properly assess cervical disorders.

When these dysfunctions are present, they support a reciprocal interaction between the trigeminal and the cervical systems as a trait symptom in migraine [6, 7]. In this presentation, an evidence based physical protocol of specific tests it will be provided by a physiotherapist to assess musculoskeletal disorders in the most common primary headaches as Migraine and Tension Type Headache.

Moreover, the integration of this examination in a multidisciplinary team it will be discussed. Stovner LJ.

Migraine prophylaxis with drugs influencing the renin- angiotensin system. Eur J Neurol. Prevalence of neck pain in migraine and tension-type headache: a population study. Temporomandibular disorders is more prevalent among patients with primary headaches in a tertiary outpatient clinic. Arq Neuropsiquiatr. Prakash S, Rathore C. Side-locked headache: an algorithm based approach. The Journal of Headache and Pain ; doi International consensus on the most useful physical examination tests used by physiotherapists for patients with headache: A Delphi study.

Man Ther. Musculoskeletal dysfunction in migraine patients. The International Classification of Headache Disorders, 3rd edition beta version Jul;33 9 Headache represents the most common neurological symptom in pediatric age.

Among the primary headaches, migraine is far more prevalent than tension-type headache and cluster headache. Though extremely rare at this age, also trigeminal autonomic cephalgias have been reported.

The most frequent causes of pediatric secondary headaches are represented by respiratory tract infections, while potentially life-threatening diseases, such as brain tumors, are less common. However, especially in the emergency setting, the possibility that a headache attack is due to a brain tumor must be always considered. To avoid missing these cases, some headache characteristics red flags have been identified [1]. However, while the most recent ICHD criteria improved the possibility to classify some patients, such as children with migraine with aura [2], they turned out to be unsuitable for others, such as young patients with primary headache.

Several studies have shown the primary role played by psychological factors in determining the severity of migraine in children [4]. Therefore, a psychological examination is often mandatory, as part of the initial assessment of the patient.

Lastly, when assessing a child with primary headache, possible comorbidities should be never forgotten, since addressing them can represent a crucial point for the treatment [5]. Headache as an emergency in children and adolescents. Curr Pain Headache Rep ; Cephalalgia, submitted. Diagnosis of primary headache in children younger than 6 years: A clinical challenge.

Cephalalgia ; Chronic Migraine in Children and Adolescents. Headache and comorbidities in childhood and adolescence. Springer, Whether medication-overuse headache MOH represents a distinct biological entity within the concept of chronic daily headache with specific neurobiological and genetic background is still a matter of debate. A great deal of interest has been directed at understanding the neurophysiological mechanisms that underlie MOH pathogenesis.

Currently, two main, non-mutually exclusive hypotheses have been proposed. The first, stems from the apparent compulsive use of headache medications by MOH patients, and considers this disorder a sort of addiction to symptomatic remedies.

The second shifts the focus from drug addiction to neural sensitization, claiming that triptan overuse triggers adaptations of the trigeminovascular system, thereby facilitating pain transmission and leading to a state of latent sensitization.

Answering these questions might be relevant to better understand the neurochemical mechanisms prompted by acute headache medications that underlie the pathophysiology of MOH and of chronic headache in general. In this presentation, preclinical data will be presented showing that chronic exposure to eletriptan or indomethacin alter trigeminal ganglion gene expression patterns broadly and to a similar extend. Remarkably, qualitative transcriptomic analysis reveals that prolonged exposure to the two different symptomatic drugs triggers almost identical, increased expression of various genes coding for proteins involved in headache pathogenesis such as neuropeptides, their cognate receptors, TRP channels, prostanoid and NO synthesizing enzymes.

These findings will be correlated with the clinical aspects of MOH. The dramatic caloric restriction promotes the fat metabolism, mimicking the starvation, even if meals replacements ad hoc developed accounts for essential nutrients, avoiding the malnutrition.

Because of the extreme caloric restriction, this type of diet is very effective in weight loss, however, that characteristic also is the main limit of VLCD, since it is possible to follow this kind of dietetic regimen for a very limited period usually weeks.

Salads are allowed ad libitum dressed with a spoonful of olive oil. Also in this kind of diet, there are meals per day, mainly consisting in meal replacement products. There is a growing interest in the ketogenic form of the VLCD because several studies have shown a higher compliance of patients with this diet. The reason of this higher adherence to the diet is still under scrutiny but several reasons are called in cause: an appetite suppression induced by proteins and maybe by ketone bodies KBs , or a modification in hormone secretion insulin, glucagon, ghrelin, adipokines.

The real impact of ketogenic diets in weight loss is still disputed; in fact, on the long period there are not differences between low-carb and low-fat diets in terms of weight reduction and regain of lost weight after the diet. However, thanks to the higher compliance and the drastic caloric restriction, the VLCKDs seem to be a promising approach in the early management of obesity and in the preparation phase for patients that must undergo to bariatric or other types of surgical procedures.

Temporomandibular disorders TMD represent the main cause of orofacial pain of non-dental origin and comprehend several disturbances of the masticatory system characterized by myofascial pain of masticatory muscles or articular pain localized in the pre-auricular area. Moreover, TMD patients show temporomandibular joint sounds and deviation or limitation of the opening of the mouth. Myofascial pain is a probable consequence of central nervous system mechanisms of convergence and activation of second order neurons with enlargement of the receptive field, reduced pain threshold and allodinia.

Often there are accompanying symptoms like facial pain and headaches. Headache is the most prevalent neurologic disorder, third most diffused health disturbance and the seventh cause of disability in the world. It can be primary, without apparent organic cause, or secondary to other pathologies. Some epidemiological studies indicates that headache is more prevalent in TMD patients and TMD is more prevalent in subjects affected by headache. A stronger association exists between TMD and chronic migraine in comparison with other types of headache.

Nevertheless the methodological quality of the available studies is not optimal and many of them classify patients with anamnestic questionnaire that tend to overestimate the values of prevalence. A growing body of literature suggests that the association between headache and TMD may be a manifestation of a central sensitization mechanism.

Temporomandibular joint and muscles receive the sensitive innervation of the trigeminal nerve that supply also the cranial vascular structures likely involved in the etiology of the headache. The sensitization of the trigeminal caudate nucleus by the TMD symptoms can favor the triggering of migraine episode.

Beside the epidemiological studies and the neurophysiologic hypothesis, there are some initial clinical evidence that show how severity of TMD symptoms parallels an increase of frequency and intensity of migraine and the simultaneous treatment of both conditions results in better outcomes.

From a clinical perspective, a comprehensive assessment based on a biopsychosocial approach can provide relevant information to plan a contemporaneous treatment of TMD and headache, together with an intervention targeted to the reduction of psychosocial conditions that can elicit and maintain mechanisms of central sensitization likely responsible of the comorbidity of TMD and headache.

The exact pathophysiology is still unknown, but evidence supporting both peripheral and central mechanisms i. In fact, the frequency of headache attacks has found to be related to the level of central sensitization [4]. However, not all TTH patients present with the same level of central sensitization and clinical presentation, but subgroups need to be identified in order to offer specific therapeutic programs [5].

Prolonged peripheral nociceptive input from the pericranial, neck, and shoulder regions e. In fact, it has been found that sustained stimulation of TrPs may induce central sensitization in healthy participants [7].

The number of TrPs seems to be associated with the degree of widespread pressure pain hypersensitivity in TTH patients, supporting the role of TrPs on central sensitization: however the cross-sectional nature of the study does not allow to establish a cause and effect relationship between TrPs and central sensitization, as other variables may influence this association [9]. Physical therapy may be helpful for the management of TTH patients [10,11], as it may decrese the peripheral nociceptive input.

The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia ;— Tension type headache. Curr Rheumatol Rev ; — Pressure pain thresholds assessed over temporalis, masseter, and frontalis muscles in healthy individuals, patients with tension- type headache, and those with migraine: A systematic review. Pain ; — Frequency of headache is related to sensitization: a population study. Pain ; Identification of subgroups of patients with tension type headache with higher widespread pressure pain hyperalgesia.

J Headache Pain ; 18 1 The role of muscles in tension-type headache. Curr Pain Headache Rep. Sustained nociceptive mechanical stimulation of latent myofascial trigger point induces central sensitization in healthy subjects. J Pain. Myofascial trigger points and sensitization: An updated pain model for tension-type headache.

Trigger Points are associated with widespread pressure pain sensitivity in people with tension-type headache. Cephalalgia [Epub ahead of print]. Muscle trigger point therapy in tension-type headache. Expert Rev Neurother ; 12 3 Effectiveneess of physical therapy in patients with tension-type headache: literature review.

J Jpn Phys Ther Assoc ; 17 1 Migraine is related to the highest disability among headaches. Great efforts are faced to improve the outcome of forthcoming treatments. However, still now, many patients regard as unsatisfactory the low responder rate about the half of patients and adverse effects that current treatments account.

Therefore, waiting for innovative, more tolerated and effective treatments, there is a large request for non-pharmacological approaches that in many cases have specific pathophysiological targets.

Among these treatments, nutraceuticals has a leading role. Several nutraceutical products are proposed for migraine and sold around the world, but researchers adequately study only few compounds.

Among studied nutraceuticals compounds, only few of them have studies of good quality in support. Moreover, also interactions among different molecules are not studied. We have reviewed literature data in order to find researches that support the use of nutraceutical molecules in migraine management.

Available good quality data support the use of certain nutraceuticals, in particular riboflavin, coenzyme Q10, magnesium, butterbur, feverfew, and omega-3 polyunsaturated fatty acids. Even if not supported by double blind studies, recently some prospective observational studies about fixed combination of nutraceuticals were performed.

For instance, it is the case of a combination of coenzyme Q10, feverfew and magnesium for migraine prophylaxis: a prospective observational study. A double blind versus placebo study about the effect of a fixed combination of riboflavin, coenzyme Q10, feverfew, andrographis and magnesium for migraine prophylaxis is currently in progress.

Usually patients appreciate nutraceuticals more than traditional drugs, since they are regarded as safe and of efficacy not inferior to other pharmacological products. Available data seem to support this widespread belief, but some concerns about the regulation of nutraceuticals and quality of some products, still remain.

Contrary to what is generally thought of, headaches and algology pain therapy share many aspects. Headaches and chronic non-oncological pain are two paradigms of chronic illness capable of generating enormous individual and social impact by disabling the sick person not only in the biological, but also in the psychological, professional, social and relational spheres.

Both cause alterations in psychological equilibrium, secondary depression, loss of social and professional roles, which, in the most serious cases, can cause loss of work. Literature documents in both cases, headaches and chronic pain, a rise in direct costs but above all of the indirect ones with a huge burden of disease.

Both are capable of generating a marked drop in the quality of life associated with a serious bio-psycho-social disability. Headaches and chronic pain, although distinct according to a topographical criterion, share many mechanisms and physiopathogenetic steps. One of the most current fields in which neurologists and pain therapists converge is the focus on neuroinflammation [3] and central sensitization[4], two key mechanism for triggering, maintaining, and subsequent perpetuation of pain: the pain as a symptom, filogenetically responsible for maintaining homeostasis of the organism against actual or potential damage, becomes unnecessary illness without any protective meaning.

Another important shared pathogenetic passage is that of neuroimmune mechanisms, which interlink the immune system with the central nervous system[4]. Furthermore, numerous contribution to the scientific international literature highlight the need to modify the therapeutic approach, directing it towards a semeiotic criterion pain phenothype: specific sign and symptoms of a certain type of pain in a specific moment , which is an epiphenomenon of underlyng pathogenetic mechanism, instead of basing it on a etiologic criterion[5].

This would enable a more appropriate prescription and greater efficiency, taking into primary consideration the possibility of getting back to everyday life rather than obtaining complete analgesia.

All the above mentioned aspects are equally important but one of them can prevail over the others depending on patient characteristics and background. In conclusion it can be stated that the aspects of sharing between headaches and chronic non-oncological pain are significantly greater than those that clearly divide them. World Health Organization. International classification of functioning, disability and health ICF. Geneva, World Health Organization, Steiner T.

J Lifting the burden: The global campaign against headache. Ru-Rong Ji Emerging targets in neuroinflammation-driven chronic pain. Nat Rev Drug Discov. Baron R Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol. Headache is a common clinical feature in neurological patients.

Usually, neuroimaging is unnecessary in patients with episodic migraine or tension type headache with typical headache features and with a normal neurological examination.

These patients do not have a higher probability of a relevant brain pathology compared to the general population. A recent study, however, reported that neuroimaging is routinely ordered in outpatient headache even if guidelines specifically recommend against their use.

Brain MRI with detailed study of the pituitary area and cavernous sinus, is recommended for all trigeminal autonomic cephalalgias TACs. Neuroimaging should be considered in patients presenting with atypical headache features, a new onset headache, change in previously headache pattern, headache abruptly reaching the peak level, headache changing with posture, headache awakening the patient, or precipitated by physical activity or Valsalva manoeuvre and abnormal neurological examination.

A recent consensus recommends brain MRI for the case of migraine with aura that persists on one side or in brainstem aura. According the same consensus, fFor primary cough headache, exercise headache, headache associated with sexual activity, thunderclap headache and hypnic headache apart from brain MRI additional tests may be required [3]. Particularly in emergency room it is mandatory to exclude a secondary headache that requires special attention and further diagnostic workup. CT scan is the first line neuroimaging examination.

MRI offers a greater resolution and discrimination and might therefore be the preferred method of choice in non acute headache. In addition, radiation due to CT scanning may be avoided. Neuroimaging non conventional techniques are of little or no value in the clinical setting.

Headache neuroimaging: Routine testing when guidelines recommend against them. European Headache Federation consensus on technical investigation for primary headachedisorders. Migraine frequency fluctuates over time.

In the literature, the most important recognized factors associated to chronic migraine are overuse of acute migraine medication, ineffective acute treatment, obesity, depression, presence of allodynia and stressful life events.

Other factors reported in studies are age, female sex and low educational status. Very recently, a large population study suggested that the presence of additional noncephalic pain site is a risk factor for migraine chronification. For many of these factors the relationship with migraine chronification may however be bi-directional.

For instance, in the case of depression, it is possible that depression may negatively affect the response of migraine to acute and prophylactic treatments, but it is also true the opposite: i. In the case of obesity, the association with chronic migraine may simply be ascribed to the effect of fat tissue in drug distribution.

Beside and beyond the putative biological factors that may cause a worsening of disease, several lines of evidence suggest that the progression from episodic to chronic migraine is associated to a progressive increase and stabilization of functional and anatomical changes associated to chronic sensitization. In this frame, it appears obvious that an additional cause for chronic migraine is quite likely represented by the low rate of prescription of preventive medications.

The underutilization of preventive drugs has several explanations ranging from drug-associated issues limited efficacy, poor tolerability profile to education of practitioners, pharmacists and patients, and it also involve the limited access to qualified care. Underutilization of preventative drugs also translate into a higher recourse to acute drugs, thus feeding on a vicious cycle that leads to negative consequences.

CT has participated in advisory boards for Allergan and electroCore; she has lectured at symposia sponsored by Allergan; she is PI or collaborator in clinical trials sponsored by Alder, electroCore, Eli-Lilly and Teva. Prevalence of migraine sufferers who are candidates for preventive therapy: results from the American migraine study AMPP study. Headache ; — The added value of an electronic monitoring and alerting system in the management of medication-overuse headache: A controlled multicentre study.

To date, the majority of clinical studies concerning primary headaches and their comorbidities are focused on migraine. Comorbidities of migraine may include neurological and psychiatric conditions, as mood disorders depression, mania, anxiety, panic attacks , epilepsy, essential tremor, stroke, and the presence of white matter abnormalities [2]. Particularly, a complex and bidirectional relation between migraine and stroke has been described, including migraine as a risk factor for cerebral ischemia, migraine caused by cerebral ischemia, migraine mimicking cerebral ischemia, migraine and cerebral ischemia sharing a common cause, and migraine associated with subclinical vascular brain lesions [2].

A recent meta-analysis pointed out that migraine is associated with increased ischemic stroke risk [3], and according to a systematic review and meta-analysis [4] the risk of hemorrhagic stroke in migraineurs is increased with respect to non-migraineurs. Besides, the risk of transient ischemic attack seems to be increased in migraineurs, although this issue has not been extensively investigated [5].

A recent systematic review and meta-analysis also describes an increased risk of myocardial infarction and angina in migraineurs compared to non-migraineurs [6]. Concerning the association between migraine and vascular risk factors arterial hypertension, diabetes mellitus, dyslipidemia, obesity, alcohol consumption, family history of cardiovascular disease , a recent review [7] showed no solid evidence of an increased burden of conventional vascular risk factors in migraineurs, with the only exceptions of dyslipidemia and cigarette smoking, while a systematic review and meta-analysis regarding migraine and body mass index categories [8] found an increased risk of having migraine in underweight subjects and in obese women as compared with normal-weight subjects.

Few studies investigated the comorbidities of tension-type headache TTH , despite the fact that tension-type headache TTH is highly prevalent, and may be as debilitating as migraine [9]. It is noteworthy that, according to a review, TTH is associated with increased rate of affective distress [9]. Furthermore, some medical disorders may worsen a preexisting TTH, and it has been described the comorbidity of TTH with psychiatric disorders and fibromyalgia [10].

The International Classification of Headache Disorders, 3 rd edition beta version. Comorbid neuropathologies in migraine. Migraine headache and ischemic stroke risk: an updated meta-analysis. Am J Med. Migraine and hemorrhagic stroke: a meta-analysis. Sacco S, Kurth T.

Migraine and the risk for stroke and cardiovascular disease. Curr Cardiol Rep. Migraine and risk of ischaemic heart disease: a systematic review and meta-analysis of observational studies.

Conventional vascular risk factors: Their role in the association between migraine and cardiovascular diseases. Migraine and body mass index categories: a systematic review and meta-analysis of observational studies. Tension-type headache and psychiatric comorbidity.

Tension-type headache and systemic medical disorders. Differentiating patients with life-threatening headaches from the overwhelming majority with primary headaches eg migraine, tension or cluster headache is an important issue in emergency department ED. Patients with non-traumatic headaches are up to 4. These numbers seem to remain constant in Western countries Ramirez-Lassepas, ; Kowalski, ; Cvetkovic, ; Gaughran, Primary headaches still pose an open challenge in the ED because the failure to recognize a secondary headache could cause potentially fatal consequences.

Unfortunately, to date, there is still no a standard diagnostic procedure for headache in emergency conditions; although according to the diagnostic guidelines there are red flags that could help in the process, the positive predictive value of each severity indicator is not yet determined.

The problem of poor diagnostic sensitivity was attributed to IHCD-3 criteria rigidity in relation to primary headache diagnosis in emergency setting Dutto, , Swadron, Alternatively, a different standardized work-up has been proposed for the most frequent headache scenarios in ED Cortelli, ; Dutto, A careful history and physical examination remain the most important part of the assessment of the headache patient; they enable the clinician to determine whether the patient is at significant risk for a dangerous cause of their symptoms and what additional workup is necessary.

This presentation will discuss how to approach adults with headache in ED with an emphasis on those features that characterize high-risk headaches. Thus, the muscolokeletal contribution in Primary Headaches is still debate in the literature [5]. Moreover, recent knowledge suggests that different clinical headache phenotypes arising from a common pathophysiology rather than an independent disorder [6]. That is, in the most prevalent headaches disorders i. In this presentation, the role of the musculoskeletal inputs in primary headaches it will be provided.

Moreover, evidences of the effectiveness of a manual therapy management provided by a physiotherapist and its integration in a multidisciplinary team it will be discussed. Migraine prophylaxis with drugs influencing the renin-angiotensin system. The impact of headache in Europe: principal results of the Eurolight project. Pietrobon D, Striessnig J. Neurobiology of migraine. Nat Rev Neurosci. Cady RK. The convergence hypothesis.

Noseda R, Burstein R. Migraine pathophysiology: anatomy of the trigeminovascular pathway and associated neurological symptoms, CSD, sensitization and modulation of pain. Migraine pathophysiology: anatomy of the trigeminovascular pathway and associated neurological symptoms, cortical spreading depression, sensitization, and modulation of pain.

The European Headache Federation recognized the value of OnabotulinumtoxinA suggesting that, before labeling a patient as affected by refractory CM, a proper treatment with this drug needs to be completed [1]. In the last years several real-life prospective studies provided further evidence in clinical setting of OnabotulinumtoxinA U efficacy for the headache prophylaxis in CM complicated by medication overuse headache MOH [2].

Recently we published the results of a prospective study on the long-term 2 years efficacy and safety of a single dose of OnabotulinumtoxinA or U in patients with CM plus MOH had failed previous preventative drugs and detoxification attempts [3].

Both the doses were effective and equally safe, but U was more effective than U in reducing headache days, migraine days, pain medication intake days and Headache Impact Test HIT -6 score. Even more, the U dose superior efficacy was evident since the first injection and maintained over all the study period of 24 months.

Interestingly we observed a progressive improvement in all the efficacy measures during the 2 years of follow-up with both the doses and significantly more with U. Sometime a response appears only after the second or third injections. For this reason in selected cases can be useful to temporarily continue an oral preventative agent.

The NICE guidelines recommend OnabotulinumtoxinA only for patients who have already tried at least three different preventative drug treatments that have not worked. The chance to use it as first-line preventative treatment may shorten the period of chronicity and eventually prevent the developing of MOH.

Several studies conducted before OnabotulinumtoxinA approval shown that it is ineffective in patients with episodic migraine [4].

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