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Cuneo A, Murinova N. Headache Management in Individuals with Brain Tumor. Semin Neurol 2024; 44:74-89. [PMID: 38183973 DOI: 10.1055/s-0043-1777423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2024]
Abstract
Headache occurs commonly in individuals diagnosed with cerebral neoplasm. Though the features of a brain tumor-associated headache may vary, a progressive nature of headache and a change in headache phenotype from a prior primary headache disorder often are identified. Pathophysiologic mechanisms proposed for headache associated with brain tumor include headache related to traction on pain-sensitive structures, activation of central and peripheral pain processes, and complications from surgical, chemotherapeutic and/or radiotherapy treatment(s). Optimization of headache management is important for an individual's quality of life. Treatments are based upon patient-specific goals of care and may include tumor-targeted medical and surgical interventions, as well as a multimodal headache treatment approach incorporating acute and preventive medications, nutraceuticals, neuromodulation devices, behavioral interventions, anesthetic nerve blocks, and lifestyles changes.
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Affiliation(s)
- Ami Cuneo
- Department of Neurology, University of Washington, Seattle, Washington
| | - Natalia Murinova
- Department of Neurology, University of Washington, Seattle, Washington
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2
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Jeon CW, Lim GY, Moon JU. Dedicated neuroimaging analysis in children with primary headaches: prevalence of lesions and a comparison between patients with and without migraines. BMC Med Imaging 2023; 23:152. [PMID: 37817100 PMCID: PMC10563304 DOI: 10.1186/s12880-023-01122-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/05/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND This study evaluated the prevalence and types of intracranial lesions through dedicated imaging analysis of primary headaches in children and compared them between patients with and without migraine. METHODS This study included 190 children diagnosed with primary headache who underwent neuroimaging, including brain computed tomography (CT), CT angiography (CTA), and brain magnetic resonance imaging (MRI). All patients with primary headaches was divided into two groups, namely, the migraine and non-migraine groups, on the basis of data from electronic medical records. Clinical characteristics and imaging findings were evaluated and compared between the two groups. RESULTS Patients with migraine were old and had a longer period from symptom onset to diagnosis. CT was normal in 71 of 95 patients, whereas 7 of 29 patients who underwent CTA had vascular lesions; the migraine group (n = 6/20, [30%]) had higher incidence of vascular lesions than the non-migraine group (n = 1/9, [11.1%]); however, there was no statistically significant difference (p = 0.382). Furthermore, 57.5% (61/106) of children showed normal brain MRI. The most common brain MRI finding was dilated perivascular space (n = 18, [16.8%]). Most perivascular spaces were located in the basal ganglia (n = 72, [75.8%]) and were in linear patterns (n = 58, [63.0%]). There was no statistically significant difference between the two groups. CONCLUSION A low prevalence of significant abnormalities was found in children with primary headaches. Dilated perivascular space was the most common finding in both groups on MRI. CTA showed more vascular lesions in the migraine group than in the non-migraine group. Therefore, further evaluations are needed to reveal the relationship between vascular lesions or dilated perivascular space and pediatric primary headaches.
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Affiliation(s)
- Cha Woong Jeon
- Department of Radiology & Pediatrics, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, 63- ro, Yeongdeungpo-gu, Seoul, 07345, Republic of Korea
| | - Gye Yeon Lim
- Department of Radiology & Pediatrics, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, 63- ro, Yeongdeungpo-gu, Seoul, 07345, Republic of Korea.
| | - Ja Un Moon
- Department of Radiology & Pediatrics, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, 63- ro, Yeongdeungpo-gu, Seoul, 07345, Republic of Korea
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3
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Utukuri PS, Shih RY, Ajam AA, Callahan KE, Chen D, Dunkle JW, Hunt CH, Ivanidze J, Ledbetter LN, Lee RK, Malu O, Pannell JS, Pollock JM, Potrebic SX, Setzen M, Shih RD, Soares BP, Staudt MD, Wang LL, Burns J. ACR Appropriateness Criteria® Headache: 2022 Update. J Am Coll Radiol 2023; 20:S70-S93. [PMID: 37236753 DOI: 10.1016/j.jacr.2023.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Headache is an ancient problem plaguing a large proportion of the population. At present, headache disorders rank third among the global causes of disability, accounting for over $78 billion per year in direct and indirect costs in the United States. Given the prevalence of headache and the wide range of possible etiologies, the goal of this document is to help clarify the most appropriate initial imaging guidelines for headache for eight clinical scenarios/variants, which range from acute onset, life-threatening etiologies to chronic benign scenarios. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Robert Y Shih
- Panel Chair, Uniformed Services University, Bethesda, Maryland
| | | | - Kathryn E Callahan
- Wake Forest School of Medicine, Winston Salem, North Carolina; American Geriatrics Society
| | - Doris Chen
- Stanford University, Stanford, California, Primary care physician
| | - Jeffrey W Dunkle
- Indiana University School of Medicine, Indianapolis, Indiana; Committee on Emergency Radiology-GSER
| | - Christopher H Hunt
- Mayo Clinic, Rochester, Minnesota; Commission on Nuclear Medicine and Molecular Imaging
| | | | | | - Ryan K Lee
- Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Omojo Malu
- Fort Belvoir Community Hospital, Fort Belvoir, Virginia; American Academy of Family Physicians
| | | | | | - Sonja X Potrebic
- Southern California Permanente Medical Group, Pasadena, California; American Academy of Neurology
| | - Michael Setzen
- Weill Cornell Medical College, New York, New York; American Academy of Otolaryngology-Head and Neck Surgery
| | - Richard D Shih
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida; American College of Emergency Physicians
| | - Bruno P Soares
- The University of Vermont Medical Center, Burlington, Vermont
| | - Michael D Staudt
- Oakland University William Beaumont School of Medicine, Rochester, Michigan; American Association of Neurological Surgeons/Congress of Neurological Surgeons
| | - Lily L Wang
- University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Judah Burns
- Specialty Chair, Montefiore Medical Center, Bronx, New York
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4
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Abstract
Headache is a common presenting symptom in the ambulatory setting that often prompts imaging. The increased use and associated health care money spent in the setting of headache have raised questions about the cost-effectiveness of neuroimaging in this setting. Neuroimaging for headache in most cases is unlikely to reveal significant abnormality or impact patient management. In this article, reasons behind an observed increase in neuroimaging and its impact on health care expenditures are discussed. The typical imaging modalities available and various imaging guidelines for common clinical headache scenarios are presented, including recommendations from the American College of Radiology.
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Prevalence and Risk Factors Associated with Tumors and Other Structural Anomalies in Brain MRI Performed to Rule out Secondary Headache: A Multicenter Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063521. [PMID: 35329206 PMCID: PMC8956087 DOI: 10.3390/ijerph19063521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 02/01/2023]
Abstract
Headache disorders (HDs) are among the most common conditions of the central nervous system, with an estimated prevalence of 50% in adult population. The aim of this work is to analyze the prevalence of structural anomalies that may explain HDs in MRI exams performed to rule out secondary headache in real-world practice, as well as risk factors associated with these lesions. We conducted a retrospective observational study based on a consecutive case series of all patients that underwent brain MRI due to headache from 1 January 2019 to 31 May 2019. We included patients from six MRI diagnostic centers accounting for four provinces of Andalusia (southern Spain). Bivariate and multivariate logistical regression models were performed to identify risk factors associated with the outcomes (1) presence of a structural finding potentially explaining headache, (2) presence of intracranial space-occupying lesions (SOLs), and (3) presence of intracranial tumors (ITs). Of the analyzed sample (1041 patients), a structural finding that could explain headache was found in 224 (21.5%) patients. SOLs were found in 50 (6.8%) patients and ITs in 12 (1.5%) patients. The main factors associated with structural abnormalities were female sex (OR, 1.35; 95% CI, 1.02–1.85), accompanying symptoms (OR, 1.34; 95% CI, 1.05–1.89), use of gadolinium-based contrast agents (OR, 1.89; 95% CI, 1.31–2.72) and previously known conditions potentially explaining headache (OR, 2.44; 95% CI, 1.55–3.84). Female sex (p = 0.048) and accompanying symptoms (p = 0.033) were also associated with ITs in bivariate analyses. Our results may be relevant for different medical specialists involved in the diagnosis, management and prevention of headache. Moreover, the risk factors identified in our study might help the development of public health strategies aimed at early diagnosis of brain tumors. Future studies are warranted to corroborate our findings.
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Serousova OV, Karpova MI. [Trigeminal autonomic cephalgias: features of diagnosis and treatment]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:105-112. [PMID: 34874664 DOI: 10.17116/jnevro2021121101105] [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: 11/17/2022]
Abstract
Trigeminal autonomic cephalgias is a group of primary headaches, including cluster headache, paroxysmal hemicrania and hemicrania continua, as well as two forms of short- lasting unilateral neuralgiform headache attacks, the complexity of diagnosis of which is determined by the low prevalence and some similarity of clinical manifestations both among themselves and with other diseases in particular with migraine and trigeminal neuralgia. Despite the rather short duration of headache attacks, the intensity of the pain syndrome reaches a severe and very severe degree, and the high frequency of paroxysms per day significantly complicates abortion treatment and leads to a pronounced professional and social maladjustment. At the same time, the possibility of using effective specific prophylactic therapy determines the importance of accurate diagnosis and, therefore, the knowledge of neurologists on this issue.
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Affiliation(s)
- O V Serousova
- South Ural State Medical University, Chelyabinsk, Russia
| | - M I Karpova
- South Ural State Medical University, Chelyabinsk, Russia
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Findings of Brain Magnetic Resonance Imaging in Girls with Central Precocious Puberty Compared with Girls with Chronic or Recurrent Headache. J Clin Med 2021; 10:jcm10102206. [PMID: 34069752 PMCID: PMC8160955 DOI: 10.3390/jcm10102206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/04/2021] [Accepted: 05/15/2021] [Indexed: 11/29/2022] Open
Abstract
In the present study, the results of brain magnetic resonance imaging (MRI) in girls with central precocious puberty (CPP) were compared those in with girls evaluated for headaches. A total of 295 girls with CPP who underwent sellar MRI were enrolled. A total of 205 age-matched girls with chronic or recurrent headaches without neurological abnormality who had brain MRI were included as controls. The positive MRI findings were categorized as incidental non-hypothalamic–pituitary (H–P), incidental H–P, or pathological. Positive MRI findings were observed in 39 girls (13.2%) with CPP; 8 (2.7%) were classified as incidental non-H–P lesions, 30 (10.2%) as incidental H–P lesions, and 1 (0.3%) as a pathological lesion (tuber cinereum hamartoma). The prevalence of positive MRI findings in girls with CPP did not differ from girls with headaches (13.2% vs. 12.2%, p = 0.74). The prevalence of incidental H–P lesions in girls with CPP <6 years of age, 6–6.9 years of age, and 7–7.9 years of age was 21.2%, 13.5%, and 9.6%, respectively (p = 0.21). Known pathological lesions were detected in only one (3.0%) girl with CPP aged <6 years and in no girls with CPP aged 6–7.9 years. Microadenomas were detected in no girls with CPP aged <6 years and in 5 (1.9%) girls with CPP aged of 6–7.9 years. Our findings call into question the routine use of brain MRI in girls with CPP, especially in girls 6 years or older. Current guidelines recommend a follow-up MRI in cases of microadenoma, but few data exist to support this recommendation for children.
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Yayıcı Köken Ö, Danış A, Yüksel D, Aksoy A, Öztoprak Ü, Aksoy E. Pediatric headache: Are the red flags misleading or prognostic? Brain Dev 2021; 43:372-379. [PMID: 33187753 DOI: 10.1016/j.braindev.2020.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/14/2020] [Accepted: 10/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Symptoms and findings called orange or red flags may indicate the etiology of pediatric headaches and may point to a life-threatening situation requiring urgent treatment and thus can alter patient management. These findings can be either misleading or prognostic for clinicians. We aimed to identify the etiology and prognostic value of orange/red flags in pediatric patients. METHODS This study included 810 children with headaches who underwent neuroimaging due to the existence of orange/red flags. Their hospital records were examined to obtain demographical, clinical, laboratory data, and re-classify the headaches and determine orange/red flags on admission. RESULTS Secondary causes were identified in 17.0% (n: 138) of patients, however, those who were diagnosed with a life-threatening headache that required emergency treatment were 5.2% of all patients and 30.4% of the patients diagnosed with a secondary headache. Those with secondary headaches and with life threatening secondary headaches which required urgent treatment were younger (p = 0,018, p = 0,022), had more emergency department visits (p < 0,001), and acute onsets (p < 0,001). Red flags, like systemic symptoms (p < 0,001), sudden onset (p = 0,023, p = 0.039), papilledema (p < 0,001), and progressive headaches (p = 0,048, p = 0.006), were more common with secondary headaches and its subgroup, while headache awakening from sleep (p = 0.009) and family history of primary headache (P > 0,001) were more common in primary headaches. No correlation existed between the number of red flags and etiology. However, older age (p = 0,001) and a shorter duration between symptoms and admission (p = 0,032), and the number of emergency service visits (p = 0,020) increased with increasing red flags. CONCLUSIONS Physicians always look for flags when they encounter patients with headaches, which is a common symptom, so as not to overlook anything. However, red flags do not always mean that the underlying cause requires emergency treatment and the severity of the cause is not correlated with the number of flags.
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Affiliation(s)
- Özlem Yayıcı Köken
- Department of Pediatric Neurology, Ankara City Hospital, Children's Hospital, Ankara, Turkey.
| | - Ayşegül Danış
- Deparment of Pediatric Neurology, SBU, Dr. Sami Ulus Research and Training Hospital, Ankara, Turkey
| | - Deniz Yüksel
- Deparment of Pediatric Neurology, SBU, Dr. Sami Ulus Research and Training Hospital, Ankara, Turkey
| | - Ayşe Aksoy
- Deparment of Pediatric Neurology, Ondokuz Mayıs University, Faculty of Medicine, Samsun, Turkey
| | - Ülkühan Öztoprak
- Deparment of Pediatric Neurology, SBU, Dr. Sami Ulus Research and Training Hospital, Ankara, Turkey
| | - Erhan Aksoy
- Deparment of Pediatric Neurology, SBU, Dr. Sami Ulus Research and Training Hospital, Ankara, Turkey
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Whitehead MT, Cardenas AM, Corey AS, Policeni B, Burns J, Chakraborty S, Crowley RW, Jabbour P, Ledbetter LN, Lee RK, Pannell JS, Pollock JM, Powers WJ, Setzen G, Shih RY, Subramaniam RM, Utukuri PS, Bykowski J. ACR Appropriateness Criteria® Headache. J Am Coll Radiol 2020; 16:S364-S377. [PMID: 31685104 DOI: 10.1016/j.jacr.2019.05.030] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 12/20/2022]
Abstract
Headache is one of the most common human afflictions. In most cases, headaches are benign and idiopathic, and resolve spontaneously or with minor therapeutic measures. Imaging is not required for many types of headaches. However, patients presenting with headaches in the setting of "red flags" such as head trauma, cancer, immunocompromised state, pregnancy, patients 50 years or older, related to activity or position, or with a corresponding neurological deficit, may benefit from CT, MRI, or noninvasive vascular imaging to identify a treatable cause. This publication addresses the initial imaging strategies for headaches associated with the following features: severe and sudden onset, optic disc edema, "red flags," migraine or tension-type, trigeminal autonomic origin, and chronic headaches with and without new or progressive features. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | | | - Amanda S Corey
- Panel Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
| | - Bruno Policeni
- Panel Vice-Chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | | | - Santanu Chakraborty
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada, Canadian Association of Radiologists
| | - R Webster Crowley
- Rush University Medical Center, Chicago, Illinois, Neurosurgery expert
| | - Pascal Jabbour
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, Neurosurgery expert
| | | | - Ryan K Lee
- Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Jeffrey S Pannell
- University of California San Diego Medical Center, San Diego, California
| | | | - William J Powers
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, American Academy of Neurology
| | - Gavin Setzen
- Albany ENT & Allergy Services, PC, Albany, New York, American Academy of Otolaryngology-Head and Neck Surgery
| | - Robert Y Shih
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | | | - Julie Bykowski
- Specialty Chair, University of California San Diego Health Center, San Diego, California
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Kim BS, Kim SK, Kim JM, Moon HS, Park KY, Park JW, Sohn JH, Song TJ, Chu MK, Cha MJ, Kim BK, Cho SJ. Factors Associated with Incidental Neuroimaging Abnormalities in New Primary Headache Patients. J Clin Neurol 2020; 16:222-229. [PMID: 32319238 PMCID: PMC7174120 DOI: 10.3988/jcn.2020.16.2.222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/24/2019] [Accepted: 10/24/2019] [Indexed: 12/12/2022] Open
Abstract
Background and Purpose Deciding whether or not to perform neuroimaging in primary headache is a dilemma for headache physicians. The aim of this study was to identify clinical predictors of incidental neuroimaging abnormalities in new patients with primary headache disorders. Methods This cross-sectional study was based on a prospective multicenter headache registry, and it classified 1,627 consecutive first-visit headache patients according to the third edition (beta version) of the International Classification of Headache Disorders (ICHD-3β). Primary headache patients who underwent neuroimaging were finally enrolled in the analysis. Serious intracranial pathology was defined as serious neuroimaging abnormalities with a high degree of medical urgency. Univariable and multivariable logistic regression analyses were conducted to identify factors associated with incidental neuroimaging abnormalities. Results Neuroimaging abnormalities were present in 170 (18.3%) of 927 eligible patients. In multivariable analysis, age ≥40 years [multivariable-adjusted odds ratio (aOR)=3.37, 95% CI=2.07–6.83], male sex (aOR=1.61, 95% CI=1.12–2.32), and age ≥50 years at headache onset (aOR=1.86, 95% CI=1.24–2.78) were associated with neuroimaging abnormalities. In univariable analyses, age ≥40 years was the only independent variable associated with serious neuroimaging abnormalities (OR=3.37, 95% CI=1.17–9.66), which were found in 34 patients (3.6%). These associations did not change after further adjustment for neuroimaging modality. Conclusions Incidental neuroimaging abnormalities were common and varied in a primary headache diagnosis. A small proportion of the patients incidentally had serious neuroimaging abnormalities, and they were predicted by age ≥40 years. These findings can be used to guide the performing of neuroimaging in primary headache disorders.
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Affiliation(s)
- Byung Su Kim
- Department of Neurology, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea
| | - Soo Kyoung Kim
- Department of Neurology, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jae Moon Kim
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Heui Soo Moon
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Yeol Park
- Department Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jeong Wook Park
- Department of Neurology, Uijeongbu St.Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Jong Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Tae Jin Song
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myoung Jin Cha
- Department of Neurology, National Police Hospital, Seoul, Korea
| | - Byung Kun Kim
- Department of Neurology, Eulji Hospital, Eulji University, Seoul, Korea
| | - Soo Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.
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Abstract
Migraine affects over a billion people worldwide in any year and is the second most common cause of years lost due to disability. Not "just a headache", morbidity washes though society and carries a substantial economic and social cost. Understanding of migraine pathophysiology has progressed significantly. Animal models and functional neuroimaging have yielded significant insight into brain structures that mediate migraine symptoms. The role of small peptides as neurotransmitters within this network has been elucidated, allowing the generation of novel therapeutic approaches that have been validated by randomised placebo-controlled trials. Migraine is underdiagnosed and undertreated. Treatment of migraine should be proactive. An acute and, when indicated, preventive strategy should be formulated with the patient. Comorbid medication overuse must be supportively managed. Migraine-specific medications are making their way from bench to bedside. They promise an improved safety profile and ease of use in comparison to older, repurposed medications. Devices promise a non-drug alternative should patients prefer. The migraine understanding and treatment landscape is changing rapidly.
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12
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Peres MF, Valença MM, Amaral FG, Cipolla-Neto J. Current understanding of pineal gland structure and function in headache. Cephalalgia 2019; 39:1700-1709. [PMID: 31370669 DOI: 10.1177/0333102419868187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The pineal gland plays an important role in biological rhythms, circadian and circannual variations, which are key aspects in several headache disorders. OVERVIEW Melatonin, the main pineal secreting hormone, has been extensively studied in primary and secondary headache disorders. Altered melatonin secretion occurs in many headache syndromes. Experimental data show pineal gland and melatonin both interfere in headache animal models, decreasing trigeminal activation. Melatonin has been shown to regulate CGRP and control its release. DISCUSSION Melatonin has been used successfully as a treatment for migraine, cluster headaches and other headaches. There is a rationale for including the pineal gland as a relevant brain structure in the mechanisms of headache pathophysiology, and melatonin as a treatment option in primary headache.
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Affiliation(s)
- Mario Fp Peres
- Hospital Israelita Albert Einstein, Sao Paolo, Brazil.,Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da USP, Pernambuco, Brazil
| | | | | | - José Cipolla-Neto
- Instituto de Ciencias Biomédicas, Universidade de São Paulo, São Paulo, Brazil
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13
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Do TP, Remmers A, Schytz HW, Schankin C, Nelson SE, Obermann M, Hansen JM, Sinclair AJ, Gantenbein AR, Schoonman GG. Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list. Neurology 2019; 92:134-144. [PMID: 30587518 PMCID: PMC6340385 DOI: 10.1212/wnl.0000000000006697] [Citation(s) in RCA: 174] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 08/27/2018] [Indexed: 01/03/2023] Open
Abstract
A minority of headache patients have a secondary headache disorder. The medical literature presents and promotes red flags to increase the likelihood of identifying a secondary etiology. In this review, we aim to discuss the incidence and prevalence of secondary headaches as well as the data on sensitivity, specificity, and predictive value of red flags for secondary headaches. We review the following red flags: (1) systemic symptoms including fever; (2) neoplasm history; (3) neurologic deficit (including decreased consciousness); (4) sudden or abrupt onset; (5) older age (onset after 65 years); (6) pattern change or recent onset of new headache; (7) positional headache; (8) precipitated by sneezing, coughing, or exercise; (9) papilledema; (10) progressive headache and atypical presentations; (11) pregnancy or puerperium; (12) painful eye with autonomic features; (13) posttraumatic onset of headache; (14) pathology of the immune system such as HIV; (15) painkiller overuse or new drug at onset of headache. Using the systematic SNNOOP10 list to screen new headache patients will presumably increase the likelihood of detecting a secondary cause. The lack of prospective epidemiologic studies on red flags and the low incidence of many secondary headaches leave many questions unanswered and call for large prospective studies. A validated screening tool could reduce unneeded neuroimaging and costs.
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Affiliation(s)
- Thien Phu Do
- From the Headache Diagnostic Laboratory (T.P.D., H.W.S.), Danish Headache Center and Department of Neurology (J.M.H.), Rigshospitalet-Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark; Department of Neurology (A.R., G.G.S.), Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Department of Neurology (C.S.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Neurology and Anesthesiology/Critical Care Medicine (S.E.N.), Johns Hopkins University, Baltimore, MD; Center for Neurology (M.O.), Asklepios Hospitals Schildautal, Seesen; Department of Neurology (M.O.), University Hospital Essen, University of Duisburg-Essen, Germany; Neurometabolism (A.J.S.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, UK; and Neurorehabilitation (A.R.G.), RehaClinic Bad Zurzach and University of Zürich, Switzerland
| | - Angelique Remmers
- From the Headache Diagnostic Laboratory (T.P.D., H.W.S.), Danish Headache Center and Department of Neurology (J.M.H.), Rigshospitalet-Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark; Department of Neurology (A.R., G.G.S.), Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Department of Neurology (C.S.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Neurology and Anesthesiology/Critical Care Medicine (S.E.N.), Johns Hopkins University, Baltimore, MD; Center for Neurology (M.O.), Asklepios Hospitals Schildautal, Seesen; Department of Neurology (M.O.), University Hospital Essen, University of Duisburg-Essen, Germany; Neurometabolism (A.J.S.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, UK; and Neurorehabilitation (A.R.G.), RehaClinic Bad Zurzach and University of Zürich, Switzerland
| | - Henrik Winther Schytz
- From the Headache Diagnostic Laboratory (T.P.D., H.W.S.), Danish Headache Center and Department of Neurology (J.M.H.), Rigshospitalet-Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark; Department of Neurology (A.R., G.G.S.), Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Department of Neurology (C.S.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Neurology and Anesthesiology/Critical Care Medicine (S.E.N.), Johns Hopkins University, Baltimore, MD; Center for Neurology (M.O.), Asklepios Hospitals Schildautal, Seesen; Department of Neurology (M.O.), University Hospital Essen, University of Duisburg-Essen, Germany; Neurometabolism (A.J.S.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, UK; and Neurorehabilitation (A.R.G.), RehaClinic Bad Zurzach and University of Zürich, Switzerland
| | - Christoph Schankin
- From the Headache Diagnostic Laboratory (T.P.D., H.W.S.), Danish Headache Center and Department of Neurology (J.M.H.), Rigshospitalet-Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark; Department of Neurology (A.R., G.G.S.), Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Department of Neurology (C.S.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Neurology and Anesthesiology/Critical Care Medicine (S.E.N.), Johns Hopkins University, Baltimore, MD; Center for Neurology (M.O.), Asklepios Hospitals Schildautal, Seesen; Department of Neurology (M.O.), University Hospital Essen, University of Duisburg-Essen, Germany; Neurometabolism (A.J.S.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, UK; and Neurorehabilitation (A.R.G.), RehaClinic Bad Zurzach and University of Zürich, Switzerland
| | - Sarah E Nelson
- From the Headache Diagnostic Laboratory (T.P.D., H.W.S.), Danish Headache Center and Department of Neurology (J.M.H.), Rigshospitalet-Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark; Department of Neurology (A.R., G.G.S.), Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Department of Neurology (C.S.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Neurology and Anesthesiology/Critical Care Medicine (S.E.N.), Johns Hopkins University, Baltimore, MD; Center for Neurology (M.O.), Asklepios Hospitals Schildautal, Seesen; Department of Neurology (M.O.), University Hospital Essen, University of Duisburg-Essen, Germany; Neurometabolism (A.J.S.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, UK; and Neurorehabilitation (A.R.G.), RehaClinic Bad Zurzach and University of Zürich, Switzerland
| | - Mark Obermann
- From the Headache Diagnostic Laboratory (T.P.D., H.W.S.), Danish Headache Center and Department of Neurology (J.M.H.), Rigshospitalet-Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark; Department of Neurology (A.R., G.G.S.), Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Department of Neurology (C.S.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Neurology and Anesthesiology/Critical Care Medicine (S.E.N.), Johns Hopkins University, Baltimore, MD; Center for Neurology (M.O.), Asklepios Hospitals Schildautal, Seesen; Department of Neurology (M.O.), University Hospital Essen, University of Duisburg-Essen, Germany; Neurometabolism (A.J.S.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, UK; and Neurorehabilitation (A.R.G.), RehaClinic Bad Zurzach and University of Zürich, Switzerland
| | - Jakob Møller Hansen
- From the Headache Diagnostic Laboratory (T.P.D., H.W.S.), Danish Headache Center and Department of Neurology (J.M.H.), Rigshospitalet-Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark; Department of Neurology (A.R., G.G.S.), Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Department of Neurology (C.S.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Neurology and Anesthesiology/Critical Care Medicine (S.E.N.), Johns Hopkins University, Baltimore, MD; Center for Neurology (M.O.), Asklepios Hospitals Schildautal, Seesen; Department of Neurology (M.O.), University Hospital Essen, University of Duisburg-Essen, Germany; Neurometabolism (A.J.S.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, UK; and Neurorehabilitation (A.R.G.), RehaClinic Bad Zurzach and University of Zürich, Switzerland
| | - Alexandra J Sinclair
- From the Headache Diagnostic Laboratory (T.P.D., H.W.S.), Danish Headache Center and Department of Neurology (J.M.H.), Rigshospitalet-Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark; Department of Neurology (A.R., G.G.S.), Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Department of Neurology (C.S.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Neurology and Anesthesiology/Critical Care Medicine (S.E.N.), Johns Hopkins University, Baltimore, MD; Center for Neurology (M.O.), Asklepios Hospitals Schildautal, Seesen; Department of Neurology (M.O.), University Hospital Essen, University of Duisburg-Essen, Germany; Neurometabolism (A.J.S.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, UK; and Neurorehabilitation (A.R.G.), RehaClinic Bad Zurzach and University of Zürich, Switzerland
| | - Andreas R Gantenbein
- From the Headache Diagnostic Laboratory (T.P.D., H.W.S.), Danish Headache Center and Department of Neurology (J.M.H.), Rigshospitalet-Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark; Department of Neurology (A.R., G.G.S.), Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Department of Neurology (C.S.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Neurology and Anesthesiology/Critical Care Medicine (S.E.N.), Johns Hopkins University, Baltimore, MD; Center for Neurology (M.O.), Asklepios Hospitals Schildautal, Seesen; Department of Neurology (M.O.), University Hospital Essen, University of Duisburg-Essen, Germany; Neurometabolism (A.J.S.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, UK; and Neurorehabilitation (A.R.G.), RehaClinic Bad Zurzach and University of Zürich, Switzerland
| | - Guus G Schoonman
- From the Headache Diagnostic Laboratory (T.P.D., H.W.S.), Danish Headache Center and Department of Neurology (J.M.H.), Rigshospitalet-Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark; Department of Neurology (A.R., G.G.S.), Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Department of Neurology (C.S.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Neurology and Anesthesiology/Critical Care Medicine (S.E.N.), Johns Hopkins University, Baltimore, MD; Center for Neurology (M.O.), Asklepios Hospitals Schildautal, Seesen; Department of Neurology (M.O.), University Hospital Essen, University of Duisburg-Essen, Germany; Neurometabolism (A.J.S.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, UK; and Neurorehabilitation (A.R.G.), RehaClinic Bad Zurzach and University of Zürich, Switzerland.
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14
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Yang Q, Wang Z, Yang L, Xu Y, Chen LM. Cortical thickness and functional connectivity abnormality in chronic headache and low back pain patients. Hum Brain Mapp 2017; 38:1815-1832. [PMID: 28052444 DOI: 10.1002/hbm.23484] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 11/11/2016] [Accepted: 11/22/2016] [Indexed: 12/27/2022] Open
Abstract
This study aims to characterize the psychological wellbeing of chronic headache (CH) patients, to identify cortical structural abnormalities and any associations of those abnormalities with resting state functional connectivity (rsFC), and to determine whether such rsFC abnormality is specific to CH patients. Compared with healthy controls (CONCH ), CH patients suffered from mild depression, sleep disturbances, and relatively poor quality of life. CH patients also exhibited widespread cortical thickness (CT) abnormalities in left premotor (BA6), right primary somatosensory (S1) and right prefrontal (BA10) cortices, as well as in regions of default mode and executive control networks. Using cortical regions with thickness abnormality as seeds, we found cortical region pairs showed strengthened rsFC in CH patients. Using the same seeds, rsFC analysis from chronic low back pain (CLBP) patients and their controls (CONCLBP ) identified abnormalities in non-overlapping cortical region pairs. Direct comparison of rsFC between CH and CLBP patients revealed significantly differences in thirteen cortical region pairs, including the four identified in CH and CONCH comparison. Across all three groups (CH, CLBP and CON), the rsFC between left multisensory association area (BA39) and left posterior cingulate cortex (BA23) differed significantly. Eight regions showed CT abnormality in CLBP patients, two of which overlapped with those of CH patients. Our observations support the notion that CH and CLBP pain are pathological conditions, under which the brain develops distinct widespread structural and functional abnormalities. CH and CLBP groups share some similar structural abnormalities, but rsFC abnormalities in several cortical region pairs appear to be pathology-specific. Hum Brain Mapp 38:1815-1832, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Qing Yang
- Center for Biomedical Imaging Research, Shanghai Clinical Research Center/Xuhui Central Hospital, Chinese Academy of Sciences, People's Republic of China
| | - Zewei Wang
- School of Mechatronic Engineering and Automation, Shanghai University, People's Republic of China
| | - Lixia Yang
- Center for Biomedical Imaging Research, Shanghai Clinical Research Center/Xuhui Central Hospital, Chinese Academy of Sciences, People's Republic of China
| | - Yonghua Xu
- Center for Biomedical Imaging Research, Shanghai Clinical Research Center/Xuhui Central Hospital, Chinese Academy of Sciences, People's Republic of China
| | - Li Min Chen
- Center for Biomedical Imaging Research, Shanghai Clinical Research Center/Xuhui Central Hospital, Chinese Academy of Sciences, People's Republic of China.,Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee.,Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee
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15
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Abstract
"Do I have a tumor?" This is a question in every person's mind when first confronted with a new-onset headache, a question that causes considerable anxiety among patients, leading them to seek medical evaluation. This publication reviews the current literature with respect to the epidemiology, pathophysiology presentation, and treatment of headaches in association with intracranial neoplasm.
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