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Rabah K, Rabah N, Deeb H, Haidar G, Kudsi M. Prevalence, types, and characteristics of headache in Behcets disease without involvement of the central nervous system in the Syrian population: a case-cohort study. Ann Med Surg (Lond) 2024; 86:2549-2554. [PMID: 38694392 PMCID: PMC11060300 DOI: 10.1097/ms9.0000000000001903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 02/24/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction Oral ulcers, genital ulcers, and uveitis represent the typical trial of Behcet's disease (BD). It is well common on the Old Silk Road. The mucocutaneous lesions are the hallmark of BD, but neurological involvement is one of the severe symptoms. Headaches may be an early sign of BD neurological involvement. This study aims to investigate the headache prevalence and its types, and characteristics in a Syrian sample of BD patients. Methods BD patients were clinically interviewed and examined to collect their information, symptoms, and signs. the International Study Group for Behcet's Disease diagnosis criteria was used to confirm the BD diagnosis. The International Classification of headaches was used when classifying the headaches. Results One hundred twenty participants were included in the study. half of them were BD patients and the control group was also 60 participants. Among Syrian BD patients, 36.7% suffer from primary headaches and 36.7% suffer from secondary headaches. These findings were not significantly different between the BD patients and the healthy population. Our results showed that there was no statistically significant difference between the two groups. Conclusion Headache should not be considered a predictor for neurological involvement among BD patients. Additional attention to BD patients or the specific treatment for headaches is not required and does not differ from the general population.
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Affiliation(s)
- Karam Rabah
- Faculty of Medicine, Syrian Private University
| | - Nour Rabah
- Faculty of Medicine, Syrian Private University
| | | | - Ghina Haidar
- Department of Rheumatology, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Maysoun Kudsi
- Department of Rheumatology, Faculty of Medicine, Damascus University, Damascus, Syria
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Mirac UA, Tugrul A. The effect of anesthetic blockade of greater occipital nerve during the withdrawal period of the medication overuse headache treatment. Ideggyogy Sz 2024; 77:103-110. [PMID: 38591927 DOI: 10.18071/isz.77.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Background and purpose Discontinuation of medication still remains a key element in the treatment of medication overuse headache (MOH), but there is no consensus on the withdrawal procedure. We aimed to share the promising results of anesthetic blockade of greater occipital nerve (GON), which can be an alternative to existing treatments during the early withdrawal period of MOH treatment. . Methods This study was conducted using regular electronic medical records and headache diaries of patients diagnosed with MOH and treated with anesthetic GON blockade with 0.5% bupivacaine solution in a specialized headache outpatient clinic. A total of 86 patients who developed MOH while being followed up for chronic migraine were included in the study. . Results The treatment schemes for MOH are based on expert consensus and withdrawal strategies are the most challenging part of treatment. In our study, numerical rating scale for headache intensity, overused medication consumption per month, headache frequency (day/month) and the duration of each attack (hour/day) decreased significantly in the first month compared to pre-treatment (p < 0.01). . Conclusion Conclusion – Our study suggests that GON blockade can be used as a good alternative therapy in the treatment of MOH. .
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Affiliation(s)
- Unsal Aysen Mirac
- Sultan II. Abdulhamid Han Training Hospital, Neurology Department, Istanbul, Turkey
| | - Aydin Tugrul
- Prof. Dr. Cemil Tascioglu City Hospital, Neurology Department, Istanbul, Turkey
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3
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Abstract
BACKGROUND The distinction between a pre-existing primary headache and a secondary headache at the onset of a disorder is important and has not been taken into account in the International Classification of Headache Disorders-3. This study aimed to improve the general diagnostic criteria for secondary headaches using results of our previous studies. MATERIALS AND METHODS We analyzed characteristics of headaches including their changes in intensity, duration, frequency, localization and side, development of new accompanying symptoms, and therapeutic response at the onset of transient ischemic attacks (TIA) (n = 120, mean age 56.1, 55% females) and ischemic stroke (n = 550, mean age 63.1, 56% females) compared to the control group (n = 192, mean age 58.7, 64% females). RESULTS Headache of a new type occurred in 8.4% of ischemic stroke patients and 5% of TIA patients on the day of admission but did not occur at all in the control group. Pre-existing headache with a change of at least one characteristic occurred significantly more often in stroke (5.4%) and TIA (7.5%) than in the control group (1%) (p = 0.01 and p = 0.003 respectively). CONCLUSION The presence of a new type of headache and a pre-existing headache with altered characteristics in close temporal relation to a disorder indicates causality. Based on these data we propose revised general diagnostic criteria for secondary headaches.
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Affiliation(s)
- Elena R Lebedeva
- Department of Neurology, the Ural State Medical University, Yekaterinburg, Russia
- International Headache Centre "Europe-Asia", Yekaterinburg, Russia
| | - Jes Olesen
- Danish Headache Centre, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
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Navarro-Pérez MP, Santos-Lasaosa S, Olesen J. Evaluation of the ICHD-3 diagnostic criteria for cardiac cephalalgia and new proposal. Cephalalgia 2023; 43:3331024231202243. [PMID: 37917823 DOI: 10.1177/03331024231202243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND The current International Classification of Headache Disorders, 3rd edition (ICHD-3) diagnostic criteria for cardiac cephalalgia were established according to previous case reports and the opinion of experts. We aimed to assess the ICHD-3 diagnostic criteria for cardiac cephalalgia. METHODS We conducted a series of cases study and evaluated these criteria in 54 patients with cardiac cephalalgia. Next, we assessed whether the ICHD-3 diagnostic criteria B, C and D for migraine without aura were fulfilled by these patients. RESULTS ICHD-3 criteria A, B, C1, C2 and D for cardiac cephalalgia were met by 100% of patients, whereas criterion C3 was fulfilled by 81.5%. The least frequently fulfilled sub-criterion was C3b (accompanied by nausea) (18.5%). Moreover, we found that ICHD-3 criteria B, C and D for migraine without aura were met by a low proportion of patients: 11.1%, 46.3% and 25.9%, respectively, and no patient fulfilled the three criteria simultaneously. CONCLUSION Based on our results, we propose revised diagnostic criteria for cardiac cephalalgia. We suggest removing criterion C3 and C4. We also suggest removing the word "migraine-like" from its description.
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Affiliation(s)
- María Pilar Navarro-Pérez
- Neurology Department, Hospital Obispo Polanco, Teruel, Spain
- Aragon Institute for Health Research (IIS Aragón), Zaragoza, Spain
| | - Sonia Santos-Lasaosa
- Aragon Institute for Health Research (IIS Aragón), Zaragoza, Spain
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Jes Olesen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
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Krymchantowski A, Jevoux C, Krymchantowski AG, Ramos LB, Barbosa JSS, Silva-Neto RP. Medication-overuse headache-a review of different treatment strategies. Front Pain Res (Lausanne) 2023; 4:1103497. [PMID: 37881687 PMCID: PMC10597723 DOI: 10.3389/fpain.2023.1103497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/23/2023] [Indexed: 10/27/2023] Open
Abstract
Medication-overuse headache (MOH) can develop from primary headaches. MOH is usually the result of overuse of symptomatic medications. It is a noteworthy personal and societal burden. The identification and treatment of patients at risk for MOH is an essential component of MOH management. Medication overuse can be modifiable and can advance from episodic to chronic migraine. Treatment for MOH is complex, and experts in the field have varied views on the most appropriate strategy for MOH treatment. The objective of this review is to give a comprehensive synopsis of the literature for the management of MOH. Treatment strategies, such as detoxification and prevention, are the debatable issues. Medication withdrawal is the foundation for management. The available literature suggested abrupt withdrawal with preventive approaches for early management. Bridging therapy could be useful to get relief from withdrawal symptoms. Multidisciplinary choices proved beneficial in supporting withdrawal and preventing relapse. Worldwide, the termination of overused medications has been observed as a standard treatment strategy; however, patient-specific approaches should be taken.
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Khoromi S. Secondary headaches in pregnancy and the puerperium. Front Neurol 2023; 14:1239078. [PMID: 37840942 PMCID: PMC10569305 DOI: 10.3389/fneur.2023.1239078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/30/2023] [Indexed: 10/17/2023] Open
Abstract
Headache during pregnancy can be due to primary causes such as migraine but can also be a presenting symptom of secondary causes including life threatening conditions. This is a minireview of secondary causes of headache during pregnancy and the puerperium. Unique alterations in physiological and vascular functions as well as in the coagulation pathway which occur during pregnancy increase the risk of most of these secondary conditions which include preeclampsia, eclampsia, hemorrhagic stroke, cerebral venous, sinus thrombosis, reversible cerebral vascular syndrome, and posterior reversible encephalopathy. Marked increase in progesterone level in pregnancy is also associated with the growth of tumors such as meningiomas, as 70% of these tumors are positive for progesterone receptors and increase in size can lead to headache along with other neurological symptoms. Hemodynamic changes can lead to the growth of meningiomas as well. Although hormone producing pituitary tumors are usually not conducing to pregnancy, women with known pituitary tumors who do get pregnant may become symptomatic during pregnancy and develop secondary headache. Another rare cause of secondary headache during pregnancy is pituitary apoplexy. Although its occurrence is uncommon, it needs to be properly recognized and treated to avoid endocrine and visual complications. Other rare entities with increased incidence during the puerperium such postdural puncture headache will be also discussed. In summary, new onset headache during pregnancy deserves special attention because in the absence of proper recognition and treatment, secondary headache disorders can endanger the life of the mother and the fetus.
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Affiliation(s)
- Suzan Khoromi
- University of California, San Diego, La Jolla, CA, United States
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Boddu SP, Goodman BP, VanderPluym JH. Headache rounds: Postural headache in a patient with squamous cell carcinoma. Headache 2023; 63:1186-1192. [PMID: 37635384 DOI: 10.1111/head.14615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/20/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023]
Affiliation(s)
- Sayi P Boddu
- Mayo Clinic Alix School of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
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Evlice A, Genç H, Uluduz D, Baykan B, Bolay H, Unal-Cevik I, Kissani N, Luvsannorov O, Togha M, Ozge A. Secondary headache disorders in Turkey, the Middle East, Asia, and Africa: A cross-sectional, multicenter study. Cephalalgia 2023; 43:3331024231194024. [PMID: 37592903 DOI: 10.1177/03331024231194024] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
BACKGROUND This multicenter cross-sectional study aimed to determine the frequency and characteristics of secondary headaches in different geographic regions, including Turkey, the Middle East, Asia, and Africa. METHODS Patients were admitted to the study on a particular day each week for five consecutive weeks between 1 April and 16 May 2022. Before the study, all researchers underwent a constructed briefing about the use and code of the ICHD-3 criteria. The study was conducted in two stages. In the first stage, data on secondary headaches were compared between the regions. In the second stage, the sub-diagnoses of secondary headaches were analyzed only in Turkey. RESULTS A total of 4144 (30.0%) of the 13,794 patients reported headaches as the main symptoms at admission. A total of 422 patients were excluded from the study. In total, 1249 (33.4%) of 3722 patients were diagnosed as having secondary headaches (Turkey [n = 1039], Middle East [n = 80], Asia [n = 51], Africa [n = 79]). The frequency of secondary headaches (Turkey 33.6%, Africa 30.1%, Middle East 35.5%, Asia 35.4%) did not differ significantly between the regions (p > 0.05). The most common subtype of secondary headaches was headache attributed to substances or their withdrawal in all the studied regions. There was a female predominance in all regions, but it was lower in Africa than in Turkey. The severity and density of headaches differed significantly between the regions, with patients from Africa reporting milder pain than patients from other regions. In Turkey, the most common sub-diagnoses of secondary headaches were medication overuse headache, idiopathic intracranial hypertension, and cervicogenic headache. CONCLUSION In the present study, one in three patients with a headache had a secondary headache. Headache attributed to substances or their withdrawal was the most common subtype of secondary headaches in all the studied regions. The female predominance of secondary headaches was lower in Africa than in Turkey. The severity and density of headaches differed significantly between regions, with patients from Africa reporting milder pain.
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Affiliation(s)
- Ahmet Evlice
- Department of Neurology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Hamit Genç
- Department of Neurology, University of Health Sciences, Van Training and Research Hospital, Van, Turkey
| | - Derya Uluduz
- Department of Neurology, Istanbul University, Cerrahpasa Faculty of Medicine, İstanbul, Turkey
| | - Betul Baykan
- Istanbul University, Istanbul Faculty of Medicine, EMAR Medical Center, İstanbul, Turkey
| | - Hayrunnisa Bolay
- Department of Neurology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Isin Unal-Cevik
- Department of Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Najib Kissani
- Neuroscience Research Laboratory, Marrakesh Medical School, Cadi Ayyad University, Marrakech, Morocco
| | - Otgonbayar Luvsannorov
- Department of Neurology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Mansoureh Togha
- Department of Neurology, Tehran University of Medical Sciences, Tehran, Iran
| | - Aynur Ozge
- Department of Neurology, Mersin University Faculty of Medicine, Mersin, Turkey
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9
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Sharma S, Slade GD, Fillingim RB, Ohrbach R. A rose by another name? Characteristics that distinguish headache secondary to temporomandibular disorder from headache that is comorbid with temporomandibular disorder. Pain 2023; 164:820-830. [PMID: 36048529 PMCID: PMC9971346 DOI: 10.1097/j.pain.0000000000002770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/19/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Co-occurring pain conditions that affect overlapping body regions are complicated by the distinction between primary vs secondary pain conditions. We investigate the occurrence of headache and painful temporomandibular disorder (TMD) in a community-based, cross-sectional study of US adults in the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA-II) study. A specific goal was to determine whether headache attributed to TMD is separable from primary headache. Using DC/TMD and International Classification of Headache Disorders-third edition criteria, 3 groups of individuals were created: (a) headache without TMD; (b) headache comorbid with TMD; and (c) headache attributed to TMD. Regression models compared study groups according to demographic and comorbid characteristics, and post hoc contrasts tested for differences. Descriptive statistics and Cohen d effect size were computed, by group, for each predictor variable. Differences in continuous predictors were analyzed using one-way analysis of variance. Nearly all demographic and comorbid variables distinguished the combined headache and TMD groups from the group with headache alone. Relative to the reference group with primary headache alone, markers related to headache, TMD, somatic pain processing, psychosocial, and health conditions were substantially greater in both headache comorbid with TMD and headache attributed to TMD, attesting to their qualitative similarities. However, effect sizes relative to the reference group were large for headache comorbid with TMD and larger again for headache attributed to TMD, attesting to their separability in quantitative terms. In summary, the presence of overlapping painful TMD and headache adds substantially to the biopsychosocial burden of headache and points to the importance of comprehensive assessment and differential management.
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Affiliation(s)
- Sonia Sharma
- Department of Neurosurgery, Neuro Pain Management Center, University of Rochester Medical Center, Rochester, NY, United States
- Department of Oral Diagnostic Sciences, University at Buffalo School of Dental Medicine, Buffalo, NY, United States
| | - Gary D Slade
- Division of Pediatric and Population Health, UNC Adams School of Dentistry, Chapel Hill, NC, United States
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, United States
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo School of Dental Medicine, Buffalo, NY, United States
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10
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Navarro-Pérez MP, Espinosa-Rueda J, Ballesta-Martínez S, Revilla-Martí P, Olesen J, Bellosta-Diago E, Santos-Lasaosa S. Prevalence, clinical characteristics and associated factors of cardiac cephalalgia: A prospective study. Cephalalgia 2023; 43:3331024231160743. [PMID: 36918763 DOI: 10.1177/03331024231160743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND The prevalence of cardiac cephalalgia is unknown and there is limited information about its clinical features. We aimed to assess the prevalence of cardiac cephalalgia, its clinical characteristics and associated factors. METHODS We conducted a prospective study of patients with suspected acute coronary syndrome admitted to the Cardiology Service at Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain, over a one-year period. We interviewed patients within the first 24 hours of admission using a standardized case-report form to assess the presence of headache in relation to the acute coronary syndrome and its characteristics. RESULTS We included 438 patients, 381 with confirmed myocardial ischemia. Prevalence of cardiac cephalalgia was 14.2% (n = 54). The most common features were frontal location, pressing quality and moderate intensity. Pain referred to the jaws (aOR 2.61; 95% CI 1.33-5.12; p = 0.005), palpitations (aOR 3.65; 95% CI 1.57-8.50; p = 0.003) and circumflex coronary artery as the culprit artery for the myocardial ischemia (aOR 3.8; 95% CI 1.07-13.74; p = 0.021) were related to cardiac whereas history of hypertension was inversely associated (aOR 0.37: 95% CI 0.18-0.74; p = 0.005). CONCLUSION The prevalence of cardiac cephalalgia was 14.2%. Our study provides valuable information about cardiac cephalalgia characteristics that suggest revision of current diagnostic criteria.
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Affiliation(s)
- María Pilar Navarro-Pérez
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.,Aragon Institute for Health Research, Zaragoza, Spain
| | - Judit Espinosa-Rueda
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.,Aragon Institute for Health Research, Zaragoza, Spain
| | - Sara Ballesta-Martínez
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.,Aragon Institute for Health Research, Zaragoza, Spain
| | - Pablo Revilla-Martí
- Aragon Institute for Health Research, Zaragoza, Spain.,Cardiology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Jes Olesen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Elena Bellosta-Diago
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.,Aragon Institute for Health Research, Zaragoza, Spain
| | - Sonia Santos-Lasaosa
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.,Aragon Institute for Health Research, Zaragoza, Spain
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Martins BP, Mesquita I, Sousa JM, Abreu P, Costa A. Persistent headache attributed to past cervicocephalic artery dissection: clinical characteristics and contributors to headache persistence. Cephalalgia 2023; 43:3331024221144782. [PMID: 36751874 DOI: 10.1177/03331024221144782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Persistent headache/facial/neck pain attributed to past cervicocephalic arterial dissection is under-documented in literature. Our main goal was to evaluate clinical characteristics and contributors to this persistence. METHODS A retrospective cohort study which included patients with a radiologically confirmed cervicocephalic arterial dissection (2015-2020) in a Portuguese tertiary hospital. Headache persistence was identified through clinical records. A questionnaire aimed to characterize headache in three moments: previous, persistent, and headache at the time of the interview (on average 2.5 years post-event). RESULTS Ninety-two patients were identified; 24 (26.1%) had headache persistence ≥3 months, and 20 (22.2%) on average after 2.5 years post-event. There were no differences regarding demographics and vascular risk factors among patients with (n = 22) and without (n = 68) headache persistence. The first group had higher previous headache history (68.2% vs 4.4%, p < 0.001), delay in diagnosis (3.6 vs 1.9 days, p < 0.001), and headache/cervicalgia as the first symptom (81.8% vs 41.2%, p < 0.001). At the time of the interview, 20% still reported daily headache. A logistic regression model depicted headache history (OR = 59.8, p < 0.001), acute headache/cervicalgia (odds ratio, OR = 25.4, p = 0.005), posterior circulation dissection (OR = 7.6, p < 0.001), and less than 4 points by National Institutes of Health Stroke Scale score (OR = 5.0, p = 0.025) as contributors to headache persistence. CONCLUSION Headache persistence post-cervicocephalic arterial dissection is common, and frequently affects patients daily. As it potentially affects functional outcomes and quality of life, the contributors identified in this study may help clinicians manage patients after the acute event.
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Affiliation(s)
- Bárbara Pinto Martins
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal.,Clinical Neuroscience and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Inês Mesquita
- Clinical Neuroscience and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
| | - José Maria Sousa
- Neurorradiology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Pedro Abreu
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal.,Clinical Neuroscience and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Andreia Costa
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal.,Clinical Neuroscience and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
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12
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Bernstein CA. Evaluation of headache in patients with cancer. Cancer 2021; 127:4368-4375. [PMID: 34606085 DOI: 10.1002/cncr.33930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/19/2021] [Accepted: 07/02/2021] [Indexed: 11/07/2022]
Abstract
Headache is a common complaint and is often benign. When patients with cancer describe new headaches, it is important to ensure that there are no emergent or concerning etiologies, including metastatic disease. This review article details primary and secondary headaches. Red flags-the do-not-miss warning signs-are described. An initial approach to the evaluation, including suggestions for imaging, features to look for in a targeted examination, and when to request a consultation, is outlined. An overview of headache etiologies is described with a particular emphasis on the most common types: migraine and tension. The classification of headaches, based on criteria from the International Classification of Headache Disorders (3rd edition; beta version), is reviewed. Medications used for treatment, including newer biological agents, are described, and there are details about both abortive and preventive medication therapies. Suggestions for complementary and integrative therapies, some of which may be synergistic in treating other cancer symptoms, are outlined; they include mindfulness therapies, which are gaining traction in treating a variety of medical conditions. Readers should have an understanding of headache evaluation in patients with cancer and should know how to formulate a plan for a diagnosis. In addition, readers will gain familiarity with common treatments, both pharmacological and complementary/integrative.
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Pensato U, Matteo E, Cevoli S. The unforgivable curse of Harry Potter's thunderclap headaches. Headache 2021; 61:1287-1290. [PMID: 34510446 PMCID: PMC9293176 DOI: 10.1111/head.14205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/05/2021] [Accepted: 07/14/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Umberto Pensato
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Eleonora Matteo
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Sabina Cevoli
- UOC Clinica Neurologica NEUROMET, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italia
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Rimmele F, Janke J, Kropp P, Grossmann A, Hamann T, Walter U, Jürgens TP. Headache Characteristics in the Neurological Emergency Department: A Retrospective Study. Front Neurol 2021; 12:706074. [PMID: 34489852 PMCID: PMC8416997 DOI: 10.3389/fneur.2021.706074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/28/2021] [Indexed: 01/29/2023] Open
Abstract
Background: The care of patients with headache in the emergency department (ED) represents a diagnostic and clinical challenge. Data on the prevalence and characteristics of headache patients in purely neurological EDs are sparse. The aim of the present study is to examine patient profiles with the cardinal symptom of headache in an academic neurological ED, to analyze correlations between headache characteristics and search for differences compared to the interdisciplinary ED. Methods: This retrospective cross-sectional study assessed all patients who presented to the ED of the Department of Neurology at Rostock University Medical Center between November 2013 and November 2016 with the main symptom of headache. Epidemiological, clinical, diagnostic data as well as key data regarding the care structure were recorded. Correlations between headache characteristics and diagnosis at discharge were analyzed and risk profiles were identified using binary logistic regression analysis. Conclusion: This study comprehensively characterized a large collective of patients with the cardinal symptom of headache presenting to a purely neurology emergency department.
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Affiliation(s)
- Florian Rimmele
- Department of Neurology, Headache Center North-East, University Medical Center Rostock, Rostock, Germany
| | - Josephine Janke
- Department of Neurology, Headache Center North-East, University Medical Center Rostock, Rostock, Germany
| | - Peter Kropp
- Institute of Medical Psychology and Medical Sociology, University Medical Center Rostock, Rostock, Germany
| | - Annette Grossmann
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany
| | - Till Hamann
- Department of Neurology, Headache Center North-East, University Medical Center Rostock, Rostock, Germany
| | - Uwe Walter
- Department of Neurology, Headache Center North-East, University Medical Center Rostock, Rostock, Germany
| | - Tim P Jürgens
- Department of Neurology, Headache Center North-East, University Medical Center Rostock, Rostock, Germany
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15
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Barasa L, Salyani A, Bika J, Otieno F, Sokhi D. Takayasu arteritis: A rare cause of chronic headache. Clin Case Rep 2021; 9:e04860. [PMID: 34584719 PMCID: PMC8455962 DOI: 10.1002/ccr3.4860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 11/09/2022] Open
Abstract
Chronic headache can be a presenting manifestation of Takayasu arteritis, although patients usually have other characteristic features. A thorough clinical assessment remains key in the evaluation of chronic headache.
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Affiliation(s)
- Linda Barasa
- Department of MedicineAga Khan University Medical College of East Africa (Nairobi Campus)NairobiKenya
| | - Adil Salyani
- Department of MedicineAga Khan University Medical College of East Africa (Nairobi Campus)NairobiKenya
| | - Jillo Bika
- Department of RadiologyAga Khan University Medical College of East Africa (Nairobi Campus)NairobiKenya
| | - Fredrick Otieno
- Department of MedicineAga Khan University Medical College of East Africa (Nairobi Campus)NairobiKenya
| | - Dilraj Sokhi
- Department of MedicineAga Khan University Medical College of East Africa (Nairobi Campus)NairobiKenya
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16
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Abstract
AIM Headache attributed to temporomandibular disorders and myalgia are two diagnoses included in the diagnostic criteria for temporomandibular disorders (DC/TMD). However, it is not clear if these two diagnoses are different clinical entities given their similar presentation and way in which they are diagnosed, when the myalgia is within the temporalis muscle. The purpose of this retrospective study was to assess the overlap between headache attributed to temporomandibular disorders and myalgia of the temporalis muscle. METHODS The charts of 671 patients seeking treatment at the Section of Orofacial Pain and Jaw Function, Aarhus University, Denmark, between January 2015 and February 2020 were screened for a diagnosis of headache attributed to temporomandibular disorders, myalgia of the temporalis muscle, or both. RESULTS A total of 89 patients fulfilled the DC/TMD criteria for either headache attributed to TMD, myalgia of the temporalis or both. Of these, two had a diagnosis of headache attributed to TMD, 16 of myalgia of the temporalis, and 71 were diagnosed with both. In 97.3% of the times that headache attributed to temporomandibular disorders was diagnosed, the patient was also diagnosed with myalgia of the temporalis. The Jaccard index was 0.8, indicating a substantial overlap between the two diagnoses. Finally, the overlap of pain location between the two diagnoses was substantial, with a Jaccard index of 0.9. CONCLUSIONS In the present study, headache attributed to temporomandibular disorders was almost exclusively diagnosed together with myalgia of the temporalis. Therefore, we propose that headache attributed to temporomandibular disorders and myalgia of the temporalis muscle have more clinical similarities than differences and as such could be considered one single clinical entity. Further studies will be needed to address the clinical consequences of this proposal.
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Affiliation(s)
- Fernando G Exposto
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - Nicole Renner
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - Karina H Bendixen
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - Peter Svensson
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark.,Faculty of Odontology, Malmø University, Malmø, Sweden
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17
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Thomsen AV, Sørensen MT, Ashina M, Hougaard A. Symptomatic migraine: A systematic review to establish a clinically important diagnostic entity. Headache 2021; 61:1180-1193. [PMID: 34254302 DOI: 10.1111/head.14187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To determine if a clinical presentation indistinguishable from migraine can occur due to an underlying condition or pathology, that is, "symptomatic migraine." BACKGROUND It is currently not clear whether migraine truly can be caused by an underlying condition or pathology. Characterization of the etiology and clinical features of possible symptomatic migraine is of significant clinical importance and further may help elucidate the pathophysiology of migraine. METHODS We devised operational diagnostic criteria for "symptomatic migraine" and "possible symptomatic migraine" requiring strong evidence for a causal relation between underlying cause and migraine symptoms adhering strictly to diagnostic criteria. PubMed was searched for case reports of symptomatic migraine from inception to March 2020. Only articles published in English or German were included. No restrictions were placed on study design. Relevant references in the articles were also included. Papers were systematically reviewed by two independent reviewers for detailed clinical features of migraine as well as the proposed underlying conditions and the effects of treatment of these conditions. RESULTS Our search retrieved 1726 items. After screening, 109 papers comprising 504 cases were reviewed in detail. Eleven patients with migraine with aura (MWA) fulfilled our working criteria for symptomatic migraine, and 39 patients fulfilled our criteria for possible symptomatic migraine. The most common etiologies of symptomatic migraine were arteriovenous malformations, carotid stenosis, dissection or aneurysm, brain infarctions, meningioma, and various intra-axial tumors. CONCLUSIONS Symptomatic MWA, indistinguishable from idiopathic MWA, may occur due to cortical lesions or microembolization. We found no clear evidence supporting the existence of symptomatic migraine without aura although we did identify possible cases. Our findings are limited by the available literature, and we suggest that prospective studies are needed.
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Affiliation(s)
- Andreas Vinther Thomsen
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Morten Togo Sørensen
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Anders Hougaard
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
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18
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Zhao YJ, Lim JYX, Wong PS. Diagnosis and Management of Headaches in the Emergency Department (ED) in Adults and Children. Neurol India 2021; 69:S173-S182. [PMID: 34003163 DOI: 10.4103/0028-3886.315977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Headache accounts for a significant number of cases presenting to the Emergency Department (ED) and has a high societal cost, contributed by recurrent ED and clinic visits, and unnecessary diagnostic tests. Objective This review article covers the important clinical tools needed to evaluate headaches in both adults and children in the ED. Methods Medline/PubMed was searched using the keywords "Emergency department", "headache", "adult", "pediatric", "clinical assessment", "diagnosis" and "treatment", in the title or abstract. The search covers the period from 1 January 1990 to 31 December 2019. Results The articles selected were based on their relevancy to the objective of this review article. Additional relevant publications were identified from article references lists. Conclusion The emergency physician plays a key role in differentiating between primary and secondary headaches. Within the limited ED resources, appropriate diagnostic testing should be used to identify the life-threatening headaches. This will ensure patients are given the appropriate evidence-based pharmacological therapy and holistic management.
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Affiliation(s)
- Yi J Zhao
- Department of Neurology, National Neuroscience Institute -SGH Campus, Singapore
| | - Jocelyn Y X Lim
- KK Women and Children's Hospital, Neurology Service, Singapore
| | - Pei S Wong
- SGH Department of Pharmacy, NUS Dept of Pharmacy, Singapore
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19
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Kulkarni GB, Mathew T, Mailankody P. Medication Overuse Headache. Neurol India 2021; 69:S76-S82. [PMID: 34003151 DOI: 10.4103/0028-3886.315981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Medication overuse headache (MOH) is one of the highly disabling headache disorder and affects about 1% of the population of the world. It is associated with the development of headache for 15 days or more, with consumption of acute symptomatic medications for 10-15 days (depending on the class of drug, like, simple analgesics, triptans, and opioids) in a month, used for relief of headache for three or more months, in a known patient of primary headache disorder. Objective The aim of this study was to review the topic of MOH and present the details of this disorder with an emphasis on recent updates in the field of pathophysiology and treatment. Material and Methods Literature search was performed in the PubMed/MEDLINE and Cochrane database with appropriate keywords and relevant full-text articles were reviewed for writing this article. Results Over the years, the concept of MOH has evolved, although the exact pathophysiology is still being explored. In a susceptible individual interplay of genetics, change in pain pathways, changes in areas of the brain associated with the perception of pain, and changes in the neurotransmitters have been implicated. It has to be differentiated from other secondary chronic daily headache disorders, by a careful history, targeted examination, details of intake of medications. Treatment predominantly involves patient education, removal of the offending agent, and initiation of prophylactic medications for primary headache disorder in the outpatient or inpatient services. Conclusions MOH is a secondary headache disorder, which should be considered in any chronic headache patient. There are various pathophysiological mechanisms attributed to its development. Management includes educating the patients about the disorder, detoxification, and prophylactic therapy.
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Affiliation(s)
| | - Thomas Mathew
- Department of Neurology, St. Johns Medical College Hospital, Bengaluru, Karnataka, India
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20
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Caponnetto V, Ornello R, Frattale I, Di Felice C, Pistoia F, Lancia L, Sacco S. Efficacy and safety of greater occipital nerve block for the treatment of cervicogenic headache: a systematic review. Expert Rev Neurother 2021; 21:591-597. [PMID: 33709864 DOI: 10.1080/14737175.2021.1903320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Cervicogenic headache (CGH) is a secondary headache disorder caused by cervical spine or neck soft tissue lesions. Despite few available evidence-based pharmacological treatments are available, greater occipital nerve blocks (GONBs) are considered as therapeutic option. AREA COVERED In June 2020, we conducted a systematic review on Pubmed and Scopus, to summarize effectiveness and safety of GONBs in treating CGH. We included 5 observational studies and 3 nonrandomized trials reporting clinical outcomes of 140 CGH patients after GONBs. Authors performed unilateral GONBs during interictal phase (five studies) or during pain, injecting local anesthetic (four studies) or both local anesthetic and steroid (three studies) at variable timepoints. In 5 studies mean pain reduction ranged from -8.2 (at 2 weeks after the first block) to -0.1 (at 1 month after the third block); one study documented 66.6% reduction of pain intensity and another study documented a significant median reduction of pain intensity at 3 months (decreased from 5.5 to 2.3) and not at 9 months. Three studies reported minor adverse events. EXPERT OPINION Few available studies suggest that GONBs are effective and safe in treating CGH. GONB is a high tolerable, low cost and repeatable procedure. Larger and randomized studies are needed.
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Affiliation(s)
- Valeria Caponnetto
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila - L'Aquila, Italy.,Nursing Section, Department of Health, Life, and Environmental Sciences, University of L'Aquila - L'Aquila, Italy
| | - Raffaele Ornello
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila - L'Aquila, Italy
| | - Ilaria Frattale
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila - L'Aquila, Italy
| | - Chiara Di Felice
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila - L'Aquila, Italy
| | - Francesca Pistoia
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila - L'Aquila, Italy
| | - Loreto Lancia
- Nursing Section, Department of Health, Life, and Environmental Sciences, University of L'Aquila - L'Aquila, Italy
| | - Simona Sacco
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila - L'Aquila, Italy
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21
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Valença MM, de Azevedo Filho HRC, de Souza Ferreira MR, Valença MA, Krymchantowski AV, Valença MF, Andrade-Valença LPA. Secondary stabbing headache associated with intracranial tumors, aneurysms, and arteriovenous malformation: An alarming warning sign. Headache 2021; 61:80-89. [PMID: 33417245 DOI: 10.1111/head.14045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 10/19/2020] [Accepted: 10/30/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Stabbing headache (SH) is considered as a pure primary headache, but according to a few clinical observations it could also be secondary. Over the past decades, we have been observing the complaint of SH in patients with intracranial vascular and neoplastic lesions. OBJECTIVE To describe a series of patients with intracranial lesions who experienced SH. METHODS This is a cross-sectional, retrospective study of 34 patients with intracranial lesions associated with SH, admitted at Hospital das Clínicas, Federal University of Pernambuco, Brazil. RESULTS In this series of 34 patients [29 women, 44 ± 12 years (mean ± SD)] with secondary SH, the causes were intracranial neoplasms (n = 31), cerebral aneurysms (n = 2), or arteriovenous malformation (n = 1). Pituitary tumor (n = 18), meningioma (n = 6), and vestibular schwannomas (n = 4) were the most prevalent types of intracranial neoplasms. All these lesions had intimate contact with the dura mater, including an oligodendroglioma, the only intra-axial tumor in the series. A characteristic in the secondary SH is the crescendo pattern (12/34, 35%), progressing from infrequent attacks to recurrent crises occurring several times a day. The SH lasted from 5 days to 60 months (15 ± 18 months, mean ± SD) until the correct diagnosis [16/34 (47%) of the patients ≤6 months]. The SH was triggered by the movement of the head (5/34, 15%) or Valsalva maneuver (1/34). After surgery, suppression of the SH was observed. In a few of the patients to whom dexamethasone was prescribed, the SH subsided within a few days. CONCLUSION This study was able to identify clinical red flags associated with intracranial lesions and secondary SH, for example, recent onset of SH, exclusively unilateral (ipsilateral) at the same location, crescendo pattern, triggered by head movements, or Valsalva maneuver.
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Affiliation(s)
- Marcelo Moraes Valença
- Neurology and Neurosurgery Unit, Hospital das Clínicas, Federal University of Pernambuco, Recife, Brazil
| | | | | | - Marcelo Andrade Valença
- Neurology and Neurosurgery Unit, Hospital das Clínicas, Federal University of Pernambuco, Recife, Brazil
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Pohl H, Do TP, García-Azorín D, Hansen JM, Kristoffersen ES, Nelson SE, Obermann M, Sandor PS, Schankin CJ, Schytz HW, Sinclair A, Schoonman GG, Gantenbein AR. Green Flags and headache: A concept study using the Delphi method. Headache 2021; 61:300-309. [PMID: 33405273 DOI: 10.1111/head.14054] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/11/2020] [Accepted: 11/30/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to collect and rate Green Flags, that is, symptoms or pieces of information indicating that a patient is more likely to suffer from a primary than from a secondary headache. BACKGROUND When assessing headaches, a central question to be answered is whether the pain is primary or secondary to another disorder. To maximize the likelihood of a correct diagnosis, relevant signs and symptoms must be sought, identified, and weighed against each other. METHODS The project was designed as a Delphi study. In the first round, an expert panel proposed green flags that were rated anonymously in two subsequent rounds. Proposals with an average rating of 4.0 and higher on a scale from 0 to 5 reached consensus. RESULTS Five Green Flags reached consensus: (i) "The current headache has already been present during childhood"; (ii) "The headache occurs in temporal relationship with the menstrual cycle"; (iii) "The patient has headache-free days"; (iv) "Close family members have the same headache phenotype"; and (v) "Headache occurred or stopped more than one week ago." CONCLUSIONS We propose five Green Flags for primary headache disorders. None being a pathognomonic sign, we recommend searching for both Green Flags and Red Flags. If both are present, a secondary headache should be suspected. Overall, the application of the Green Flag concept in clinical practice is likely to increase diagnostic accuracy and improve diagnostic resource allocation. Prospective studies in clinical populations should be conducted to validate these Green Flags.
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Affiliation(s)
- Heiko Pohl
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Thien Phu Do
- The Danish Headache Center, Rigshospitalet-Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark
| | - David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Jakob Møller Hansen
- The Danish Headache Center, Rigshospitalet-Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark
| | - Espen Saxhaug Kristoffersen
- Department of Neurology, Akershus University Hospital, Oslo, Norway.,Department of General Practice, University of Oslo, Oslo, Norway
| | - Sarah E Nelson
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Mark Obermann
- Center for Neurology, Asklepios Hospitals Schildautal, Seesen, Germany.,Department of Neurology, University of Duisburg-Essen, Essen, Germany
| | - Peter S Sandor
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland.,Departement of Neurology and Neurorehabilitation, RehaClinic Group, Bad Zurzach, Switzerland
| | - Christoph J Schankin
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Henrik Winther Schytz
- The Danish Headache Center, Rigshospitalet-Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark
| | - Alexandra Sinclair
- Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Guus G Schoonman
- Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Andreas R Gantenbein
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland.,Departement of Neurology and Neurorehabilitation, RehaClinic Group, Bad Zurzach, Switzerland
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Lebedeva ER, Ushenin AV, Gurary NM, Tsypushkina TS, Gilev DV, Kislyak NV, Olesen J. Headache at onset of first-ever ischemic stroke: Clinical characteristics and predictors. Eur J Neurol 2021; 28:852-860. [PMID: 33331100 DOI: 10.1111/ene.14684] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/11/2020] [Accepted: 12/12/2020] [Indexed: 11/29/2022]
Abstract
No studies have prospectively investigated headache at onset of first-ever ischemic stroke along with a large concurrent control group. Our aims were to answer two important questions: (i) Are headaches at stroke onset causally related to the stroke, and what are their typical clinical characteristics? (ii) What etiology of stroke is associated with these headaches? The study population consisted of 550 patients (mean age = 63.1, 54% males) with first-ever ischemic stroke and 192 control patients (mean age = 58.7, 36% males) admitted to the emergency room without any acute neurological deficits or serious disorders. All data were collected prospectively, using a standardized case-report form during face-to-face interviews by neurologists. Headache at onset of ischemic stroke was present in 82 (14.9%) of 550 patients. More than half (56%) had a new type of headache (mainly migraine-like) simultaneously with stroke onset, and 36% had headache with altered characteristics (mainly tension-type-like headache). Headaches were associated with cardioembolism (p = 0.002, odds ratio [OR] = 2.4, 95% confidence interval [CI] = 1.4-4.1), posterior circulation stroke (p = 0.01, OR = 2.0, 95% CI = 1.2-3.5), infarcts >15 mm (p = 0.03, 95% CI = 1.1-2.7), infarcts of the cerebellum (p = 0.02, OR = 2.3, 95% CI = 1.1-4.8), good neurological status (p = 0.01, OR = 2.5, 95% CI = 1.2-4.9), and low frequency of large-artery atherosclerosis (p = 0.004, OR = 0.4, 95% CI = 0.2-0.8). At stroke onset, headache of a new type and headache with altered characteristics were related to ischemic stroke. They were associated with certain etiologies of stroke.
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Affiliation(s)
- Elena R Lebedeva
- Department of Neurology, The Ural State Medical University, Yekaterinburg, Russia.,International Headache Center "Europe-Asia", Yekaterinburg, Russia
| | - Anton V Ushenin
- Department of Neurology, The Ural State Medical University, Yekaterinburg, Russia
| | | | | | - Denis V Gilev
- Department of Economics, Ural Federal University, Yekaterinburg, Russia
| | - Nadezda V Kislyak
- Department of Economics, Ural Federal University, Yekaterinburg, Russia
| | - Jes Olesen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
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Abstract
Introduction: Headache is the fifth most common reason to visit an emergency department (ED). In most of the cases, headache is benign and has a primary origin, with migraine as the most common diagnosis. Inappropriate use of ED for non-emergency conditions causes overcrowding, unnecessary testing, and increased medical costs.Areas covered: All stages of headache management in ED, from the reasons to go there, the diagnosis that is made and the investigations necessary to make it, to get to the therapies administered and those prescribed at discharge, if there were any. Finally, the authors evaluated the habit of recommending medical follow-up and how often the headache is still present at discharge or returns within 24 hours.Expert Opinion: Primary headaches are underdiagnosed, misdiagnosed, and the majority do not receive drug therapy either in ED or on discharge, and in cases where the therapy is prescribed is not specific. Increase the number of primary care medical services, spread the 'headaches culture' among GPs and ED doctors, the adoption of ICHD in the diagnostic protocols used in EDs and a fast referral to a headache center could decrease the inappropriate use of ED and improve the headache management in the emergency units.
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Affiliation(s)
| | - Andrea Negro
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
| | - Valerio Spuntarelli
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Enrico Bentivegna
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
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Abstract
BACKGROUND/OBJECTIVE Post-traumatic headache is one of the most common and persistent symptoms following mild traumatic brain injury. The objective of this narrative review is to provide an update on the diagnostic criteria, clinical presentation, epidemiology, pathophysiology, and treatment of post-traumatic headache, and to identify future research priorities. METHODS This is a narrative review of the literature regarding post-traumatic headache attributed to mild traumatic brain injury. RESULTS Onset of post-traumatic headache within 7 days of injury is the only evidence for a causal relationship between the injury and the headache included in the diagnostic criteria. Post-traumatic headache often resolves within the first few days of onset, whereas it persists for at least 3 months in 30-50%. The majority of insights into post-traumatic headache pathophysiology come from pre-clinical animal studies and human imaging studies, which implicate structural, functional, metabolic, and neuroinflammatory mechanisms for post-traumatic headache. There is a paucity of quality evidence for how to best treat post-traumatic headache. CONCLUSIONS Although meaningful progress has been made in the post-traumatic headache field, priorities for future research are numerous, including the optimization of diagnostic criteria, a greater understanding of post-traumatic headache pathophysiology, identifying mechanisms and predictors for post-traumatic headache persistence, and identifying safe, well-tolerated, effective therapies.
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Pensato U, Cevoli S, Cirillo L. Vessel Wall Imaging in Thunderclap Headache: A Reversible Cerebral Vasoconstriction Syndrome (RCVS) Case. Headache 2020; 60:2633-2635. [PMID: 33112429 DOI: 10.1111/head.13992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/26/2020] [Accepted: 08/29/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Umberto Pensato
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Sabina Cevoli
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Luigi Cirillo
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
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Abstract
PURPOSE The purpose of this paper is to review some of the causes of secondary headache particularly focusing on the subcategories of secondary headache in the International Classification of Headache Disorders, 3rd edition, the clinical features of these headaches, and their associated features and management. OVERVIEW Headache attributed to trauma or injury to the head and/or neck, headache attributed to cranial or cervical vascular disorder, headache attributed to non-vascular intracranial disorder, headache attributed to a substance or its withdrawal, headache attributed to infection, headache attributed to disorder of homeostasis, and headache or facial pain attributed to disorder of the cranium, neck, eye, ears, nose, sinuses, teeth, mouth, or other facial or cervical structure are discussed in this paper. DISCUSSION Headache is a common symptom of multiple medical conditions. Although a minority of headache patients have a secondary basis for their headaches, it is important to identify clinical features of secondary headache disorders including both the headache and non-headache features of the condition, diagnose the secondary etiology correctly, and treat them appropriately.
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Affiliation(s)
- Kai Zhu
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Dawson W Born
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Esma Dilli
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
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28
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Moavero R, Stornelli M, Papetti L, Ursitti F, Ferilli MAN, Balestri M, Sforza G, Tarantino S, Vigevano F, Valeriani M. Medication Overuse Withdrawal in Children and Adolescents Does Not Always Improve Headache: A Cross-Sectional Study. Front Neurol 2020; 11:823. [PMID: 32973650 PMCID: PMC7466727 DOI: 10.3389/fneur.2020.00823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/30/2020] [Indexed: 12/14/2022] Open
Abstract
Background: MOH can be diagnosed in subjects with headache occurring 15 days/month in association with a regular medication overuse, but its existence is not universally accepted. ICHD-3 redefined criteria for MOH, removing the criterion associating drug suspension with headache course. The aim of our study was to compare the rate of patients diagnosed with medication overuse headache (MOH) according to ICHD-2 and ICHD-3 criteria, to verify the degree of concordance. The secondary aim was to verify if drug withdrawal was really associated with pain relief. Methods: In this cross-sectional study, we retrospectively analyzed a sample of 400 patients followed for primary chronic headache at the Headache Center of Bambino Gesù Children's Hospital. We then selected those presenting with a history of medication overuse, and we applied both ICHD-2 and ICHD-3 criteria to verify in which patients the criteria would identify a clinical diagnosis of MOH. Results: We identified 42 subjects (10.5%) with MOH; 23 of them (55%) presented a relief of headache withdrawing drug overuse. Regarding the applicability of the ICHD-2 criteria, 43% of patients (18/42) fulfilled all criteria, while all ICHD-3 diagnostic criteria were satisfied in 76% of patients (32/42). Eighteen patients (43%) satisfied both ICHD-2 and ICHD-3 criteria, while 10 patients (24%) did not satisfy either diagnostic criterion. Conclusions: Our study suggests that in children and adolescents, withdrawing medication overuse is not always associated with a clinical benefit. Therefore, though allowing a MOH diagnosis in a higher rate of patients as compared to ICHD-2, the application of ICHD-3 criteria does not guarantee a true a causal relationship between medication overuse and headache worsening.
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Affiliation(s)
- Romina Moavero
- Child Neurology Unit, Neuroscience and Neurorehabilitation Department, Headache Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Rome, Italy
| | - Maddalena Stornelli
- Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Rome, Italy
| | - Laura Papetti
- Child Neurology Unit, Neuroscience and Neurorehabilitation Department, Headache Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fabiana Ursitti
- Child Neurology Unit, Neuroscience and Neurorehabilitation Department, Headache Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Michela Ada Noris Ferilli
- Child Neurology Unit, Neuroscience and Neurorehabilitation Department, Headache Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Martina Balestri
- Child Neurology Unit, Neuroscience and Neurorehabilitation Department, Headache Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giorgia Sforza
- Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Rome, Italy
| | - Samuela Tarantino
- Child Neurology Unit, Neuroscience and Neurorehabilitation Department, Headache Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Federico Vigevano
- Child Neurology Unit, Neuroscience and Neurorehabilitation Department, Headache Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Massimiliano Valeriani
- Child Neurology Unit, Neuroscience and Neurorehabilitation Department, Headache Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Center for Sensory Motor Interaction, Aalborg University, Aalborg, Denmark
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Saengjaroentham C, Strother LC, Dripps I, Sultan Jabir MR, Pradhan A, Goadsby PJ, Holland PR. Differential medication overuse risk of novel anti-migraine therapeutics. Brain 2020; 143:2681-2688. [PMID: 32810212 PMCID: PMC7523700 DOI: 10.1093/brain/awaa211] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/07/2020] [Accepted: 05/03/2020] [Indexed: 01/16/2023] Open
Abstract
Medication overuse headache is estimated to affect 2% of the population, and is ranked in the top 20 most disabling disorders due to its high level of disability. Several therapies used in the treatment of acute migraine are thought to be associated with medication overuse headache, including opioids and triptans. With limited treatment options, it is critical to determine the risk profile of novel therapies prior to their widespread use. The current study explores the potential medication overuse risk of two novel therapeutic drug classes, namely the ditans: 5-HT1F receptor agonists, and the gepants: calcitonin gene-related peptide receptor antagonists, in a preclinical model of medication overuse. Persistent exposure of mice to the 5-HT1F agonist LY344864, but not olcegepant produced a significant reduction in hind paw and orofacial mechanical withdrawal thresholds as a surrogate readout of allodynia. In agreement, only LY344864 induced neuroplastic changes in trigeminal sensory afferents, increasing calcitonin gene-related peptide expression and basal trigeminal nociception. Our data highlight a differential medication overuse headache risk profile for the ditan and gepant classes of drugs that has important implications for their clinical use and patient education to help reduce the burden of medication overuse headache.
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Affiliation(s)
- Chonlawan Saengjaroentham
- Headache Group, Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Lauren C Strother
- Headache Group, Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Isaac Dripps
- Department of Psychiatry, University of Illinois at Chicago, Chicago, USA
| | - Mohammad Rayhan Sultan Jabir
- Headache Group, Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Amynah Pradhan
- Department of Psychiatry, University of Illinois at Chicago, Chicago, USA
| | - Peter J Goadsby
- Headache Group, Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Philip R Holland
- Headache Group, Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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30
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Abstract
BACKGROUND Secondary headaches attributed to exposure to or the overuse of a substance are classified under chapter eight in the International Classification of Headache Disorders 3rd edition. Three distinct sub-chapters consider: 1. Headache attributed to exposure to a substance, 2. Medication overuse headache, and 3. Headache attributed to substance withdrawal. Headache attributed to exposure to a substance refers to a headache with onset immediately or within hours after the exposure, while medication overuse headache is a headache occurring on 15 or more days per month that has developed as a consequence of regular usage of acute headache medication(s) for more than three consecutive months in a patient with a pre-existing primary headache disorder. The withdrawal of caffeine, oestrogen, and opioids is most often associated with the development of headache. DISCUSSION Despite the current headache classification, there is no certainty of a causal relationship between the use of any substance and the development of headache. Some substances are likely to provoke headache in patients that suffer from a primary headache disorder like migraine, tension-type headache or cluster headache, while others were described to cause headache even in people that generally do not get headaches. Toxic agents, such as carbon monoxide (CO) are difficult to investigate systematically, while other substances such as nitric oxide (NO) were specifically used to induce headache experimentally. If a patient with an underlying primary headache disorder develops a headache, in temporal relation to exposure to a substance, which is significantly worse than the usual headache it is considered secondary. This is even more the case if the headache phenotype is different from the usually experienced headache characteristics. Medication overuse headache is a well-described, distinct disease entity with only marginally understood pathophysiology and associated psychological factors. Managing medication overuse headache patients includes education, detoxification, prophylactic treatments and treating comorbidities, which is reflected in available guidelines. Viewing medication overuse headache as a separate entity helps clinicians and researchers better recognise, treat and study the disorder. CONCLUSION Identification of substances that may cause or trigger secondary headache is important in order to educate patients and health care professionals about potential effects of these substances and prevent unnecessary suffering, as well as deterioration in quality of life. Treatment in case of medication overuse and other chronic headache should be decisive and effective.
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Affiliation(s)
- Kati Toom
- Neurology Clinic, Tartu University Hospital, Tartu, Estonia.,Estonian Headache Society, Tartu, Estonia
| | - Mark Braschinsky
- Neurology Clinic, Tartu University Hospital, Tartu, Estonia.,Estonian Headache Society, Tartu, Estonia
| | - Mark Obermann
- Center for Neurology, Asklepios Hospitals Schildautal, Seesen, Germany.,Evangelical Hospital Unna, Unna, Germany
| | - Zara Katsarava
- Evangelical Hospital Unna, Unna, Germany.,Department of Neurology, University of Duisburg-Essen, Essen, Germany.,EVEX Medical Corporation, Tbilisi, Republic of Georgia.,IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
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31
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Fuino R, Raymond S, Shapiro R. Spontaneous Intracranial Hypotension Caused by Thoracic Disc Disease. Headache 2020; 60:1830-1831. [PMID: 32762048 DOI: 10.1111/head.13916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/26/2020] [Accepted: 06/27/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Robert Fuino
- Department of Neurological Sciences, University of Vermont Medical Center, Burlington, VT, USA
| | - Scott Raymond
- Department of Radiology, University of Vermont Medical Center, Burlington, VT, USA
| | - Robert Shapiro
- Department of Neurological Sciences, University of Vermont Medical Center, Burlington, VT, USA
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32
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Raucci U, Della Vecchia N, Ossella C, Paolino MC, Villa MP, Reale A, Parisi P. Management of Childhood Headache in the Emergency Department. Review of the Literature. Front Neurol 2019; 10:886. [PMID: 31507509 PMCID: PMC6716213 DOI: 10.3389/fneur.2019.00886] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 07/30/2019] [Indexed: 12/16/2022] Open
Abstract
Headache is the third cause of visits to pediatric emergency departments (ED). According to a systematic review, headaches in children evaluated in the ED are primarily due to benign conditions that tend to be self-limiting or resolve with appropriate pharmacological treatment. The more frequent causes of non-traumatic headache in the ED include primitive headaches (21.8–66.3%) and benign secondary headaches (35.4–63.2%), whereas potentially life-threatening (LT) secondary headaches are less frequent (2–15.3%). Worrying conditions include brain tumors, central nervous system infections, dysfunction of ventriculo-peritoneal shunts, hydrocephalus, idiopathic intracranial hypertension, and intracranial hemorrhage. In the emergency setting, the main goal is to intercept potentially LT conditions that require immediate medical attention. The initial assessment begins with an in-depth, appropriate history followed by a complete, oriented physical and neurological examination. The literature describes the following red flags requiring further investigation (for example neuroimaging) for recognition of LT conditions: abnormal neurological examination; atypical presentation of headaches: subjective vertigo, intractable vomiting or headaches that wake the child from sleep; recent and progressive severe headache (<6 months); age of the child <6 years; no family history for migraine or primary headache; occipital headache; change of headache; new headache in an immunocompromised child; first or worst headache; symptoms and signs of systemic disease; headaches associated with changes in mental status or focal neurological disorders. In evaluating a child or adolescent who is being treated for headache, physicians should consider using appropriate diagnostic tests. Diagnostic tests are varied, and include routine laboratory analysis, cerebral spinal fluid examination, electroencephalography, and computerized tomography or magnetic resonance neuroimaging. The management of headache in the ED depends on the patient's general conditions and the presumable cause of the headache. There are few randomized, controlled trials on pharmacological treatment of headache in the pediatric population. Only ibuprofen and sumatriptan are significantly more effective than placebo in determining headache relief.
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Affiliation(s)
- Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Nicoletta Della Vecchia
- Department of Pediatrics, University of "Studi della Campania Luigi Vanvitelli", Naples, Italy
| | - Chiara Ossella
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Chiara Paolino
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant' Andrea Hospital, Rome, Italy
| | - Maria Pia Villa
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant' Andrea Hospital, Rome, Italy
| | - Antonino Reale
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant' Andrea Hospital, Rome, Italy
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33
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Heijkoop TY, Hammer S, Koppen H. Cough Headache in a Patient With an Intradiploic Leptomeningeal Cyst: A Case Report. Headache 2019; 59:590-592. [PMID: 30756374 DOI: 10.1111/head.13483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Hille Koppen
- Department of Neurology, Haga Hospital, The Hague, The Netherlands
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34
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Ali AHA, Al-Ghamdi S, Karrar MH, Alajmi SA, Almutairi OS, Aldalbahi AM, Alotaibi YM, Alruwaili SA, Elamin AY. Is there a misuse of computed tomography in the diagnostic workup of headache? A retrospective record-based study in secondary health-care facility in Saudi Arabia. J Family Med Prim Care 2018; 7:357-361. [PMID: 30090777 PMCID: PMC6060924 DOI: 10.4103/jfmpc.jfmpc_338_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Introduction Headache disorders are one of the most prevalent global public-health problems that require placing high demand on health-care Services. Since it is one of the most frequent complaints in clinical practice worldwide, it causes a considerable burden in terms of the social cost. The study aimed to give a guide for the decision on the utilization of computed tomography (CT) in the diagnostic workup and identify if patients require neurological imaging (CT) for proper diagnosis or not. Materials and Methods The study was carried out in the Radiology Department in King Khalid Hospital, Al Kharj, Saudi Arabia from October 15, 2016, to February 15, 2017. A retrospective record-based study conducted using the documented CT reports in the files of patients whom were referred to the radiology department complaining of any type of a headache. Results The data included 210 patients 51% were males and 49% were females. The patients were distributed into age groups; the mean age was 38.46 standard deviation ± 13.56. Among Saudi population, the etiology of headache was varying; the most prevalent type of headache was tension headache 25.71% of the total headache patients followed by cluster 25.24% and the migraine with the lowest proportionality. The majority of the patients' headache pain was mild 60%. Moreover, the CT reports for most of the patients were normal. Spearman Correlation test was used to see if there is a significance in using the CT for any patient who comes with symptoms including headache, and the results have shown that there is no association and clinical significance in using the CT for patients with headache without suspecting other clinical condition (P = 0.177). Conclusion Headache disorders must be on the public-health agenda. Tension, migraine, and cluster-type headaches represent the majority of primary headaches. Statistically no significance or need to obtain CT if there are no life-threatening conditions expected or trauma presented.
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Affiliation(s)
- Ali Hassan A Ali
- Department of Anatomy, Prince Sattam Bin Abdulaziz University, Al Kharj, KSA.,Department of Anatomy, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Sameer Al-Ghamdi
- Department of Family Medicine, Prince Sattam Bin Abdulaziz University, Al Kharj, KSA
| | - Mohammed H Karrar
- Department of Anatomy, Prince Sattam Bin Abdulaziz University, Al Kharj, KSA
| | - Saud A Alajmi
- Department of College of Medicine, Prince Sattam Bin Abdulaziz University, Al Kharj, KSA
| | - Osama S Almutairi
- Department of College of Medicine, Prince Sattam Bin Abdulaziz University, Al Kharj, KSA
| | - Ahmed M Aldalbahi
- Department of College of Medicine, Prince Sattam Bin Abdulaziz University, Al Kharj, KSA
| | - Yazeed M Alotaibi
- Department of College of Medicine, Prince Sattam Bin Abdulaziz University, Al Kharj, KSA
| | - Sattam A Alruwaili
- Department of College of Medicine, Prince Sattam Bin Abdulaziz University, Al Kharj, KSA
| | - Abubaker Y Elamin
- Department of Histology and Embryology, College of Medicine, Ondokuz Maiz University, Samsun, Turkey.,Department of Emergency Medical Specialist, Al-Ghad International Colleges for Applied Medical Sciences, Al Madinah Al Munawarah, KSA
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Abstract
OBJECTIVE/BACKGROUND Headache in the elderly, defined as individuals aged 65 and older, although less prevalent than younger individuals, can present as a diagnostic challenge, given the increase in potentially fatal diseases within this population. METHODS These individuals require a complete history, neurological examination, and assessment of potential secondary causes of headaches. RESULTS Secondary causes include temporal or giant cell arteritis, subdural hematomas, central nervous system (CNS) tumors, strokes, and CNS infections. Once secondary conditions are ruled out, then primary causes of headache are considered such as tension-type headache, migraine, cluster headache, or hypnic headache. CONCLUSION This article reviews the distinguishing characteristics of the most common types of headache in patients over the age of 65 years old, along with potential diagnostic tests and treatment.
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Affiliation(s)
- Tara L Sharma
- Neurological Institute Cleveland Clinic, Cleveland, OH, USA
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36
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Abstract
Occipital headache is considered a risk factor for serious secondary headache pathology. The purpose of our study was to assess the etiology of occipital headaches among children visiting the emergency department. Subjects were children aged 5 to 18 years who were referred to the emergency department due to headaches during the years 2013 to 2014. A total of 314 patients with headaches were seen at our emergency department. Thirty-nine patients had occipital headaches. Viral infections were the most prevalent final diagnosis (97; 31%), followed by migraine (37; 11.8%). None of our patients had a brain tumor. There was no difference in final diagnosis between the occipital and nonoccipital groups. The most common causes of occipital headaches are viral infections and primary headaches. Serious intracranial disorders presenting solely as occipital headaches and not accompanied by other neurologic signs are uncommon. Thus, occipital headaches should be evaluated in the same manner as other headache locations.
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Affiliation(s)
- Jacob Genizi
- 1 Pediatric Neurology Unit, Haifa, Israel.,2 Department of Pediatrics, Bnai Zion Medical Center, Haifa, Israel.,3 Bruce and Ruth Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | | | - Nurit Assaf
- 2 Department of Pediatrics, Bnai Zion Medical Center, Haifa, Israel.,3 Bruce and Ruth Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Irena Chistyakov
- 2 Department of Pediatrics, Bnai Zion Medical Center, Haifa, Israel
| | - Isaac Srugo
- 2 Department of Pediatrics, Bnai Zion Medical Center, Haifa, Israel.,3 Bruce and Ruth Rappaport Faculty of Medicine, Technion, Haifa, Israel
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37
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Budhram A, Leung A, Sangle N, Khaw AV. Diffuse Large B-Cell Lymphoma of the Nasopharynx Presenting With Cluster-Like Headache. Headache 2017; 57:806-808. [PMID: 28295284 DOI: 10.1111/head.13065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 02/01/2017] [Accepted: 02/02/2017] [Indexed: 01/03/2023]
Affiliation(s)
- Adrian Budhram
- Department of Clinical Neurological Sciences, London Health Sciences Centre, London, Ontario, Canada
| | - Andrew Leung
- Department of Medical Imaging, London Health Sciences Centre, London, Ontario, Canada
| | - Nikhil Sangle
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Alexander V Khaw
- Department of Clinical Neurological Sciences, London Health Sciences Centre, London, Ontario, Canada
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38
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Stacey A, Lucas S, Dikmen S, Temkin N, Bell KR, Brown A, Brunner R, Diaz-Arrastia R, Watanabe TK, Weintraub A, Hoffman JM. Natural History of Headache Five Years after Traumatic Brain Injury. J Neurotrauma 2017; 34:1558-1564. [PMID: 27927072 DOI: 10.1089/neu.2016.4721] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Headache is one of the most frequently reported symptoms following traumatic brain injury (TBI). Little is known about how these headaches change over time. We describe the natural history of headache in individuals with moderate to severe TBI over 5 years after injury. A total of 316 patients were prospectively enrolled and followed at 3, 6, 12, and 60 months after injury. Individuals were 72% male, 73% white, and 55% injured in motor vehicle crashes, with an average age of 42. Pre-injury headache was reported in 17% of individuals. New or worse headache prevalence remained consistent with at least 33% at all time points. Incidence was >17% at all time points with first report of new or worse headache in 20% of participants at 60 months. Disability related to headache was high, with average headache pain (on 0-10 scale) ranging from 5.5 at baseline to 5.7 at 60 months post-injury, and reports of substantial impact on daily life across all time points. More than half of classifiable headaches matched the profile of migraine or probable migraine. Headache is a substantial problem after TBI. Results suggest that ongoing assessment and treatment of headache after TBI is needed, as this symptom may be a problem up to 5 years post-injury.
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Affiliation(s)
- Arthur Stacey
- 1 Department of Rehabilitation Medicine, University of Washington Medical Center , Seattle, Washington
| | - Sylvia Lucas
- 1 Department of Rehabilitation Medicine, University of Washington Medical Center , Seattle, Washington.,2 Department of Neurology, University of Washington , Seattle, Washington.,3 Department of Neurological Surgery, University of Washington , Seattle, Washington
| | - Sureyya Dikmen
- 1 Department of Rehabilitation Medicine, University of Washington Medical Center , Seattle, Washington.,3 Department of Neurological Surgery, University of Washington , Seattle, Washington.,4 Department of Psychiatry and Behavioral Medicine, University of Washington , Seattle, Washington
| | - Nancy Temkin
- 1 Department of Rehabilitation Medicine, University of Washington Medical Center , Seattle, Washington.,3 Department of Neurological Surgery, University of Washington , Seattle, Washington.,5 Department of Biostatistics, University of Washington , Seattle, Washington
| | - Kathleen R Bell
- 6 Department of Physical Medicine and Rehabilitation, UT Southwestern , Dallas, Texas
| | - Allen Brown
- 7 Department of Physical Medicine and Rehabilitation, Mayo Clinic , Rochester, Minnesota
| | - Robert Brunner
- 8 Department of Physical Medicine and Rehabilitation, University of Alabama Birmingham , UAB Spain Rehabilitation Center, Birmingham, Alabama
| | - Ramon Diaz-Arrastia
- 9 Department of Neurology, University of Pennsylvania , Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Thomas K Watanabe
- 10 MossRehab at Elkins Park, Einstein Medical Center , Elkins Park, Pennsylvania
| | - Alan Weintraub
- 11 Craig Hospital , CNS Medical Group, Englewood, Colorado
| | - Jeanne M Hoffman
- 1 Department of Rehabilitation Medicine, University of Washington Medical Center , Seattle, Washington
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39
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Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) is increasingly being recognized as a diagnosis in patients presenting with thunderclap headaches. In the vast majority of the cases, the syndrome follows a benign course and patients recover completely without any significant therapeutic intervention. In the rarest of cases, RCVS follows a monophasic course with rapid worsening, severe neurological deficits, and poor outcomes. We present the case of a 25-year-old female who presented with headaches which were worsening over 1 week. She was admitted to the hospital and rapidly worsened to develop severe neurological deficits over the next day. Initial computed tomography scan showed areas of hemorrhage and multiple ischemic strokes. Computed tomography angiogram and a conventional cerebral angiogram both revealed multifocal vasoconstriction, highly suggestive of RCVS. Despite aggressive medical and surgical management, the patient continued to worsen and eventually died. Autopsy findings did not show evidence of vasculopathy or any other underlying disorder, further supporting the diagnosis of RCVS. The RCVS is usually a benign self-remitting condition which commonly affects young females and presents with an insidious onset of headaches. Rarely, it can have a fulminant course with devastating outcomes. This case illustrates an exceptionally uncommon clinical course of RCVS and the challenges in its treatment.
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Affiliation(s)
- Kushak Suchdev
- Department of Neurology, Wayne State University, Detroit, MI, USA
| | - Gregory Norris
- Department of Neurology, Wayne State University, Detroit, MI, USA
| | - Imad Zak
- Department of Radiology, Wayne State University, Detroit, MI, USA
| | - Wazim Mohamed
- Department of Neurology, Wayne State University, Detroit, MI, USA
| | - Mohammed Ibrahim
- Department of Neurology, Wayne State University, Detroit, MI, USA
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40
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Schankin CJ, Kästele F, Gerdes LA, Winkler T, Csanadi E, Högen T, Pellkofer H, Paulus W, Kümpfel T, Straube A. New-Onset Headache in Patients With Autoimmune Encephalitis Is Associated With anti-NMDA-Receptor Antibodies. Headache 2016; 56:995-1003. [PMID: 27241874 DOI: 10.1111/head.12853] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/21/2016] [Accepted: 03/10/2016] [Indexed: 01/10/2023]
Abstract
OBJECTIVE We tested the hypotheses (i) that autoimmune encephalitis is associated with new-onset headache, and (ii) that the occurrence of headache is associated with the presence of anti-N-methyl-D-aspartate (NMDA)-receptor antibodies. BACKGROUND Autoimmune encephalitis presents with cognitive dysfunction as well as neuro-psychiatric symptoms. Its pathophysiology might involve antibody-mediated dysfunction of the glutamatergic system as indicated by the presence of anti-NMDA-receptor antibodies in some patients. METHODS In this cross-sectional study, patients with autoimmune encephalitis were assessed with a standardized interview for previous headache and headache associated with autoimmune encephalitis. Headache was classified according to the International Classification of Headache Disorders, second edition. Clinical and paraclinical findings were correlated with the occurrence of headache. RESULTS Of 40 patients with autoimmune encephalitis, 19 did not have a history of headache. Of those, nine suffered from encephalitis-associated headache. Seven of these nine had anti-NMDA-receptor antibodies in contrast to only two among the remaining 10 patients without new-onset headache (P = .023, odds ratio: 14, 95% confidence interval: 1.5; 127). In most patients headache occurred in attacks on more than 15 days/month, was severe, and of short duration (less than 4 hours). International Headache Society criteria for migraine were met in three patients. CONCLUSIONS New-onset headache is a relevant symptom in patients with autoimmune encephalitis who have no history of previous headache, especially in the subgroup with anti-NMDA-receptor antibodies. This indicates a thorough investigation for secondary headaches including anti-NMDA-R antibodies for patients with new-onset headache and neuropsychiatric findings. Glutamatergic dysfunction might be important for the generation of head pain but may only occasionally be sufficient to trigger migraine-like attacks in nonmigraineurs.
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Affiliation(s)
- Christoph J Schankin
- Department of Neurology, University of Munich Hospital, Großhadern, Munich, Germany (C.J. Schankin, F. Kästele, L. Ann Gerdes, T. Winkler, E. Csanadi, T. Högen, T. Kümpfel, and A. Straube).,Department of Neurology, University Hospital Bern - Inselspital, University of Bern, Bern, Switzerland (C.J. Schankin)
| | - Fabian Kästele
- Department of Neurology, University of Munich Hospital, Großhadern, Munich, Germany (C.J. Schankin, F. Kästele, L. Ann Gerdes, T. Winkler, E. Csanadi, T. Högen, T. Kümpfel, and A. Straube)
| | - Lisa Ann Gerdes
- Department of Neurology, University of Munich Hospital, Großhadern, Munich, Germany (C.J. Schankin, F. Kästele, L. Ann Gerdes, T. Winkler, E. Csanadi, T. Högen, T. Kümpfel, and A. Straube).,Institute of Clinical Neuroimmunology, University of Munich Hospital, Großhadern, Munich, Germany (L.A. Gerdes and T. Kümpfel)
| | - Tobias Winkler
- Department of Neurology, University of Munich Hospital, Großhadern, Munich, Germany (C.J. Schankin, F. Kästele, L. Ann Gerdes, T. Winkler, E. Csanadi, T. Högen, T. Kümpfel, and A. Straube)
| | - Endy Csanadi
- Department of Neurology, University of Munich Hospital, Großhadern, Munich, Germany (C.J. Schankin, F. Kästele, L. Ann Gerdes, T. Winkler, E. Csanadi, T. Högen, T. Kümpfel, and A. Straube)
| | - Tobias Högen
- Department of Neurology, University of Munich Hospital, Großhadern, Munich, Germany (C.J. Schankin, F. Kästele, L. Ann Gerdes, T. Winkler, E. Csanadi, T. Högen, T. Kümpfel, and A. Straube)
| | - Hannah Pellkofer
- Department of Neurology, University Medical Center, University of Göttingen, Göttingen, Germany (H. Pellkofer)
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center, University of Göttingen, Göttingen, Germany (W. Paulus)
| | - Tania Kümpfel
- Department of Neurology, University of Munich Hospital, Großhadern, Munich, Germany (C.J. Schankin, F. Kästele, L. Ann Gerdes, T. Winkler, E. Csanadi, T. Högen, T. Kümpfel, and A. Straube).,Institute of Clinical Neuroimmunology, University of Munich Hospital, Großhadern, Munich, Germany (L.A. Gerdes and T. Kümpfel)
| | - Andreas Straube
- Department of Neurology, University of Munich Hospital, Großhadern, Munich, Germany (C.J. Schankin, F. Kästele, L. Ann Gerdes, T. Winkler, E. Csanadi, T. Högen, T. Kümpfel, and A. Straube)
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41
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Abstract
BACKGROUND Headache is one of the most common and persistent symptoms following traumatic brain injury (TBI). The current study examines the prevalence and characteristics of headache following mild TBI (mTBI). METHODS We prospectively enrolled 212 subjects within one week of mTBI who were hospitalized for observation or other system injuries in a single level 1 US trauma center and followed by telephone at three, six, and 12 months after injury for evaluation of headache. Headaches were classified according to ICHD-2 criteria as migraine, probable migraine, tension-type, cervicogenic, or unclassifiable headache. RESULTS Subjects were 76% male and 75% white, and 58% were injured in vehicle-related crashes. A follow-up rate of 90% (190/212) occurred at 12 months post-injury. Eighteen percent (38/212) of subjects reported having a problem with headaches pre-injury while 54% (114/210) of subjects reported new or worse headaches compared to pre-injury immediately after injury, 62% (126/203) at three months, 69% (139/201) at six months, and 58% (109/189) at one year. Cumulative incidence was 91% (172/189) over one year. Up to 49% of headaches met criteria for migraine and probable migraine, followed by tension-type headaches (up to 40%). Age (≤ 60) was found to be a risk factor, but no significant difference was found in persistence of new or worse headache compared to pre-injury between males and females. More than one-third of the subjects reported persistent headache across all three follow-up time periods. CONCLUSIONS Headache after mTBI is very common and persistent across the first year after injury. Assertive, early treatment may be warranted to avoid chronicity and disability. Further research is needed to determine whether post-traumatic headache (PTH) responds to headache treatment used in the primary headache disorders and whether chronic PTH is preventable.
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Affiliation(s)
- Sylvia Lucas
- Department of Neurology, University of Washington, Seattle, WA, USA
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42
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Abstract
Cranial or cervical vascular disease is commonly associated with headaches. The descriptions may range from a thunderclap onset of a subarachnoid hemorrhage to a phenotype similar to tension type headache. Occasionally, this may be the sole manifestation of a potentially serious underlying disorder like vasculitis. A high index of clinical suspicion is necessary to diagnose the disorder. Prompt recognition and treatment is usually needed for many conditions to avoid permanent sequelae that result in disability. Treatments for many conditions remain challenging and are frequently controversial due to paucity of well controlled studies. This is a review of the recent advances that have been made in the diagnosis or management of these secondary headaches.
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43
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Abstract
Post-infectious disease syndrome includes both neurological and non-neurological disorders. However, headache as an isolated or a presenting complaint of post-infectious illness has not been well acknowledged in the literature. In this retrospective observation, patients having daily headache of more than 1 week and <4 weeks duration were included. We divided this group into patients having headache with preceding history of febrile illness in the recent past and patients without such history of febrile illness. We compared clinical features and therapeutic responses of various drugs between the groups. There were no significant differences in demographic features in these groups. However, associated neck pain, nausea, photophobia and meningeal signs were more prevalent in patients having history of preceding infection. A relatively lower proportion of subjects showed complete response to drugs at 3 months in post-infectious group. Good responses were noted to steroids in post-infectious group. In conclusion, a subset of patients with daily headache may be because of post-infectious pathology and treatment in the early stage may prevent it from becoming chronic. Large prospective studies are required to confirm these observations.
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Affiliation(s)
- Sanjay Prakash
- Department of Neurology, Medical College, SSG Hospital, O-19, Doctor's Quarter, Jail Road, Baroda 390001, Gujarat, India.
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