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Ferretti A, Velardi M, Fanfoni C, Di Nardo G, Evangelisti M, Foiadelli T, Orsini A, Del Pozzo M, Terrin G, Raucci U, Striano P, Parisi P. Pediatric hypnic headache: a systematic review. Front Neurol 2023; 14:1254567. [PMID: 37638182 PMCID: PMC10457117 DOI: 10.3389/fneur.2023.1254567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/02/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Hypnic headache (HH) is a primary headache, and it is considered a rare condition in children. The underlying mechanisms of HH are not yet fully understood. This systematic review aims to provide a comprehensive description of the clinical features of all published cases of pediatric HH. It will also discuss the differences in headache features between children and adults, the increased diagnostic sensitivity of the new diagnostic criteria (ICHD-3), potential pathophysiological hypotheses explaining the higher incidence in adults, differential diagnoses, and therapeutic options for children. Methods A systematic search was conducted to identify and analyze articles reporting cases of HH in patients under the age of 18. The search was performed in major medical databases including Cochrane Library, EBSCO, Embase, Medline, PubMed, Science Direct, Scopus, and Web of Science. The search covered the period from 1988 to April 2023. Relevant studies were screened for eligibility, and data extraction was performed using a standardized approach. Results Seven children with HH were included in the analysis. The mean age of onset for headache attacks was 10 ± 4.3 years (range 3-15 years). The average time from the start of headaches to diagnosis was 15.8 ± 25.0 months (range 1-60 months). Headache features in children differed from those observed in adult HH patients. Children experienced throbbing/pulsating pain, while adults reported dull/pressure-like pain. Children also had lower frequency and shorter duration of attacks compared to adults. The use of ICHD-3 criteria appeared to be more sensitive and inclusive for diagnosing HH in children compared to the previous ICHD-2 criteria. The association of headache attacks with sleep suggests that HH may be a primary disorder with a chronobiological origin. Hypothalamic dysfunction and melatonin dysregulation, which are more prevalent in older individuals, could potentially explain the higher incidence of HH in adults. Other primary headaches and secondary causes should be ruled out. Melatonin prophylactic therapy may be considered for pediatric patients. Discussion Further evaluation of the clinical features of HH in children is needed. The development of specific diagnostic criteria for pediatric cases could improve diagnostic rates and enhance the management of children with HH.
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Affiliation(s)
- Alessandro Ferretti
- Pediatrics Unit, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, S. Andrea Hospital, Rome, Italy
| | - Margherita Velardi
- General and Emergency Department, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico, Rome, Italy
| | - Claudia Fanfoni
- Pediatrics Unit, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, S. Andrea Hospital, Rome, Italy
| | - Giovanni Di Nardo
- Pediatrics Unit, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, S. Andrea Hospital, Rome, Italy
| | - Melania Evangelisti
- Pediatrics Unit, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, S. Andrea Hospital, Rome, Italy
| | - Thomas Foiadelli
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandro Orsini
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Marco Del Pozzo
- Pediatrics Unit, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, S. Andrea Hospital, Rome, Italy
| | - Gianluca Terrin
- Department of Mother and Child, Gynecological and Urological Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Umberto Raucci
- General and Emergency Department, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico, Rome, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Pasquale Parisi
- Pediatrics Unit, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, S. Andrea Hospital, Rome, Italy
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Lindner D, Scheffler A, Nsaka M, Holle-Lee D. Hypnic Headache - What do we know in 2022? Cephalalgia 2023; 43:3331024221148659. [PMID: 36786376 DOI: 10.1177/03331024221148659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND Hypnic Headache, also known as "alarm clock headache", is a rare primary headache disorder. It is characterized by frequently recurring headache attacks, which only develop during sleep, especially nighttime sleep. OBJECTIVE This article gives a narrative review on the current knowledge about Hypnic Headache with a focus on secondary Hypnic Headache. METHODS Based on literature research, using Pubmed and Google Scholar, latest case reports, studies, and systematic reviews about Hypnic Headache were analyzed and summarized focusing on therapeutic options and causes of secondary Hypnic Headache. CONCLUSION Hypnic Headache mainly occurs in elderly patients. However, younger patients and children may also suffer from Hypnic Headache. Many different causes of secondary Hypnic Headache are described in the literature and ought to be ruled out before diagnosing primary Hypnic Headache. The pathophysiology of primary Hypnic Headache remains unclear, but a dysfunction of the hypothalamus seems to play a key role.
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Affiliation(s)
- Diana Lindner
- Department of Neurology, Westgerman Headache Center Essen, University Hospital Essen, Essen, Germany
| | - Armin Scheffler
- Department of Neurology, Westgerman Headache Center Essen, University Hospital Essen, Essen, Germany
| | - Michael Nsaka
- Department of Neurology, Westgerman Headache Center Essen, University Hospital Essen, Essen, Germany
| | - Dagny Holle-Lee
- Department of Neurology, Westgerman Headache Center Essen, University Hospital Essen, Essen, Germany
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Umana GE, Alberio N, Graziano F, Fricia M, Tomasi SO, Corbino L, Nicoletti GF, Cicero S, Scalia G. Vertebrobasilar Dolichoectasia, Hypoplastic Third Ventricle, and Related Biventricular Hydrocephalus: Case Report and Review of the Literature. J Neurol Surg A Cent Eur Neurosurg 2023; 84:206-211. [PMID: 34077981 DOI: 10.1055/s-0041-1725049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Vertebrobasilar dolichoectasia (VBDE) is defined as a symptomatic dilatation and tortuosity of the vertebrobasilar arteries. The risk of hydrocephalus development is due to direct compression of the third ventricle outflow or brainstem compression and related aqueduct stenosis. We present an uncommon case of a patient with symptomatic VBDE with the uniqueness of a hypoplastic third ventricle associated with biventricular hydrocephalus. A literature review concerning diagnosis and management of patients affected by biventricular hydrocephalus caused by VBDE was also performed. CASE ILLUSTRATION We report a case of a 54-year-old man who presented with headache, ideomotor apraxia, and gait disorder. A head computed tomography (CT) scan showed a biventricular hydrocephalus and a subsequent CT angiography documented the presence of a VBDE compressing the anterior part of the third ventricle that also appeared hypoplastic. The patient also presented a clinical history of arterial hypertension for which he was given a proper pharmacologic treatment with symptom relief. A surgical treatment of ventriculoperitoneal shunt along with endoscopic septostomy was proposed, but the patient refused, probably due to the slightly positive response to medical treatment. CONCLUSIONS The natural clinical history of patients affected by VBDE is unfavorable with 7.8 years of median survival. The therapeutic strategy is usually conservative and the role of antiplatelets or oral anticoagulants is still debated. In selected patients, ventriculoperitoneal shunt to resolve intracranial hypertension caused by biventricular hydrocephalus is the most effective treatment. In our opinion, chronic third ventricle compression could lead to anatomic-pathologic alterations like the third ventricle hypoplasia documented in our report.
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Affiliation(s)
| | - Nicola Alberio
- Department of Neurosurgery, Cannizzaro Hospital, Catania, Italy
| | - Francesca Graziano
- Department of Neurosurgery, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi, Catania, Sicilia, Italy
| | - Marco Fricia
- Department of Neurosurgery, Cannizzaro Hospital, Catania, Italy
| | | | - Leonardo Corbino
- Department of Neurosurgery, Azienda Ospedaliera Cannizzaro, Catania, Sicilia, Italy
| | | | | | - Gianluca Scalia
- Department of Neurosurgery, National Specialist Hospital Garibaldi, Catania, Sicilia, Italy
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Fortes YML, Erudilho E, Silva TSD, Souza WPDO, Silva-Neto R. Secondary hypnic headache: A literature review in the last 34 years. HEADACHE MEDICINE 2022. [DOI: 10.48208/headachemed.2022.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction: Hypnic headache is a rare primary headache disorder that occurs during sleep. Its pathophysiology is uncertain, but hypothalamic dysfunction is hypothesized. It is usually a primary headache, but it can have secondary causes.
Objectives: We aimed was to review articles published in the last 34 years on hypnic headache and analyze secondary cases.
Methods: Based on a literature search in the major medical databases and using the descriptor “hypnic headache” we included articles published between 1988 and 2020. Of the 359 patients found, only 18 met the inclusion criteria and were analyzed.
Results: We found 18 patients (6 men and 12 women) with secondary hypnic headache. The mean age of patients was 58.7±15.0 years, ranging from 20 to 84 years. The causes of hypnic headache were attributed to cranial vascular disorder (five), to non-vascular intracranial disorder (six), to a substance or its withdrawal (three) and to disorder of homoeostasis (four).
Conclusions: Although most cases of hypnic headache are primary, some symptomatic cases are described in the literature.
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Xu SY, Wang RJ, Zhang L, Li CX. Basilar dolichoectasia with intermural hematoma accompanied by cerebral microbleeds and white matter hyperintensities: A case report. Medicine (Baltimore) 2021; 100:e27022. [PMID: 34414996 PMCID: PMC8376391 DOI: 10.1097/md.0000000000027022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/05/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE The clinical manifestations of basilar dolichoectasia (BD) are variable. The diagnosis is based on imaging measurements. Digital subtraction angiography displays only the dilated vascular lumen and lacks visualization of the arterial wall. High-resolution Magnetic resonance imaging (MRI) can identify intramural hematoma; therefore, it may be more suitable for the imaging evaluation of BD. However, most of the existing literature pertaining to BD lacks vascular wall assessment. PATIENT CONCERNS A 65-year-old Chinese man perceived weakness of the left upper and lower limb, double vision, dizziness, nausea, and vomiting was admitted to the emergency department. Fifteen years prior to this admission, he began taking levamlodipine besylate inconsistently for hypertension, but the level of blood pressure control was uncertain. The patient's father had a family history of hypertension. DIAGNOSES An emergency axial computed tomography scan of the brain showed basilar artery (BA) dilation. Computed tomography angiography further indicated a maximum BA diameter of 38.94 mm. The length was >182 mm. MRI revealed acute infarctions of the right medulla oblongata and pons. Meanwhile, the patient had evidence of cerebral small vessel disease, including cerebral microbleeds and white matter hyperintensities. Whole-exome sequencing eliminated significant genetic variations consistent with clinical phenotypes. BD and intramural hematoma were further confirmed by high-resolution MRI of the arterial wall. INTERVENTIONS Atorvastatin was admitted according to the results of the high-resolution MRI of the arterial wall. Benidipine hydrochloride was selected as a long-term anti-hypertensive drug. OUTCOMES The patient had no symptoms of neurological damage during 3-month follow-up. LESSONS Current evidence shows that BD has no obvious correlation with atherosclerosis. BA dissection and uncontrolled hypertension may be important factors in the progression of BD. BD-related stroke is likely to recur, and there are no standard secondary prevention measures. BD is often accompanied by cerebral microbleeds, and bleeding risk must be assessed during secondary prevention. When the BA diameter is greater than 10 mm, anti-platelet medication should be used with caution, blood pressure should be strictly controlled, and endovascular treatment should be considered.
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Affiliation(s)
- Sui-yi Xu
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Ruo-jun Wang
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Lei Zhang
- Department of Radiology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Chang-xin Li
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, China
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Silva-Néto RP, Soares AA, Peres MFP. Hypnic Headache Due to Hypoglycemia: A Case Report. Headache 2019; 59:1370-1373. [PMID: 31498893 DOI: 10.1111/head.13627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2019] [Indexed: 01/24/2023]
Abstract
Hypnic headache (HH) is a rare primary headache disorder and pathophysiology is still poorly understood. It is considered a chronobiological disorder in almost all published cases. Few secondary cases have been described so far. We report a case of a 64-year-old woman presenting headaches exclusively during sleep and fulfilling the diagnostic criteria for HH, but a 72-hour glucose monitoring showed hypoglycemia episodes related to the onset of headaches. To our knowledge, this is the first report of symptomatic HHs associated with hypoglycemia and it suggests direct evidence of HH due to a metabolic disorder.
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Ebrahimzadeh K, Bakhtevari MH, Shafizad M, Rezaei O. Hydrocephalus as a rare compilation of vertebrobasilar dolichoectasia: A case report and review of the literature. Surg Neurol Int 2017; 8:256. [PMID: 29184707 PMCID: PMC5680668 DOI: 10.4103/sni.sni_162_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 08/17/2017] [Indexed: 11/28/2022] Open
Abstract
Background: Vertebrobasilar dolichoectasia (VBD) is a rare disease characterized by significant expansion, elongation, and tortuosity of the vertebrobasilar arteries. Hydrocephalus is a rare compilation of VBD. Case Description: In this study, we report a 68-year-old male presenting with headache, progressive decreased visual acuity, memory loss, imbalance while walking, and episodes of urinary incontinency. The patient was diagnosed with dolichoectasia of basilar artery causing compression of the third ventricular outflow and thus, presenting with hydrocephalus documented with brain computed tomography scan and brain magnetic resonance imaging. The patient underwent surgical operation and ventriculoperitoneal shunt placement. Conclusion: In the case of hydrocephalus or normal pressure hydrocephalous, VBD should be considered as a differential diagnosis.
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Affiliation(s)
- Keveh Ebrahimzadeh
- Department of Neurosurgery, Loghman e Hakim hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad H Bakhtevari
- Department of Neurosurgery, Loghman e Hakim hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Misagh Shafizad
- Department of Neurosurgery, Emam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Omidvar Rezaei
- Department of Neurosurgery, Loghman e Hakim hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Fonseca M, Teotónio P, Fonseca AC. An unsuspected cause of hypnic-like headache. J Neurol 2016; 264:404-406. [PMID: 28028625 DOI: 10.1007/s00415-016-8376-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 11/20/2016] [Accepted: 12/20/2016] [Indexed: 01/03/2023]
Affiliation(s)
- Mariana Fonseca
- Department of Neurosciences (Neurology), Hospital de Santa Maria, Lisbon, Portugal
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Pedro Teotónio
- Department of Neuroradiology, Hospital de Santa Maria, Lisbon, Portugal
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Ana Catarina Fonseca
- Department of Neurosciences (Neurology), Hospital de Santa Maria, Lisbon, Portugal.
- Department of Neuroradiology, Hospital de Santa Maria, Lisbon, Portugal.
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
- Serviço de Neurologia, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-035, Lisbon, Portugal.
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