[Trigeminal autonomic headache, hemicrania continua and hypnic headache. A review of rare primary headache forms]

Tension-type headache and migraine are the most common types of primary headaches. Apart from these well known diseases, the group of primary headaches includes other relatively rare headache disorders. Some of these seldom syndromes have been described for the first time within the last twenty years and have been newly included in the revised IHS classification from 2004. Their typical symptomatic is less known, but offers an excellent opportunity to diagnose these syndromes. The importance of recognising these disorders is underlined by the fact, that rare primary headaches response often complete and rapid to a specific treatment. This review summarizes the current knowledge on the clinical presentation and treatment of cluster headache, paroxysmal hemicrania, SUNCT syndrome, hemicrania continua and hypnic headache.

Non-lateralized pain in a case of chronic paroxysmal hemicrania?

We describe a man with chronic paroxysmal hemicrania, who remained free of headaches on indomethacin, 25 mg once or twice daily. However, in this case, in contrast to typical cases of paroxysmal hemicrania, the pain of the headaches was nonlateralized and was located in the centre of the forehead. The headaches were not associated with local autonomic symptoms or signs involving the eyes or nose. Initially, the pain of the headaches lasted for seconds only and was brought on by coughing.

Chronic short-lasting headaches: clinical features and differential diagnosis

Chronic short-lasting headaches are relatively rare, poorly recognized syndromes. The chronic short-lasting headaches are a group of chronic disorders in which the headaches occur for one year or more, either without remission or with remission periods less than two weeks; each attack lasts less than 4 hours. These headache syndromes are divided into those with autonomic activation and those without autonomic activation. This article presents the clinical features and differential diagnosis of the relatively rare and clinically challenging trigeminal autonomic cephalgias (TACs). The article also focuses on the clinical features and differential diagnosis of hypnic headache, a chronic shortlasting, non-unilateral headache of moderate intensity in which there is no autonomic involvement, in order to differentiate this from chronic cluster headache, with which it is often confused.

[Idiopathic facial pain other than vascular pain]

Cluster Headache associates a severe pain generally unilateral and autonomic symptoms with a remarkable periodicity. In the first part we tried to explain the conception of physiopathology of these short lasting headache syndromes and in the second part we described the clinical features. The short lasting primary headaches are divided into two groups: those with marked autonomic activation which comprise chronic and episodic paroxysmal hemicrania, short lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT syndrome) and cluster headache. The second group includes two entities, one without autonomic activation: Hypnic Headache and one with mild autonomic features: Hemicrania Continua. The paroxysmal hemicranias are characterized by attack frequency ranges from 15 to 20 per day of short lasting attacks of unilateral pain that typically last 2 to 10 minutes, the severe pain is associated with autonomic symptoms and responds to treatment with indomethacin. The SUNCT syndrome has a less severe pain but marked autonomic activation during attacks, this syndrome is actually resistant to proposed therapy. The Hypnic Headache and the Hemicrania Continua have yet less severe pain with very mild or without autonomic features.

[The so-called stroke headache]

Sudden violent headache occurring for the first time in life suggests subarachnoid haemorrhage and requires diagnostic management. In 20 cases the authors failed to find blood in cerebrospinal fluid, but in 8 cases the protein level was raised. The patients were examined again after 2-10 years, and had control neurological examination and CT of the brain. In half the cases similar headaches returned after various time periods, and haemorrhage was again ruled out. In all patient chronic headaches of lower intensity developed. Control CT examination showed in 7 cases scars or atrophy of brain tissue. It is difficult to qualify such headaches as migraine and other known types of headache. Recently in the literature a new name has been coined for them--thunderclap headaches, and some authors regard them as a sign of minor intracranial haemorrhage. CT changes, raised protein level in cerebrospinal fluid, and the type of pain may suggest haemorrhage. The usefulness of cerebral arteriography in such patients should be considered. We propose the name of stoke headache for suggesting the cause and special management.

A population-based study of migraine headaches in Olmsted County, Minnesota. Case ascertainment and classification

Using the unique resources of the Rochester Epidemiology Project for population-based studies, we identified 629 Olmsted County, Minn., residents who fulfilled the 1988 International Headache Society criteria for newly diagnosed migraine over a 3-year period. Over 6,400 patient records from several diagnostic rubrics were screened; a substantial proportion of cases had been 'signed-out' to diagnoses other than 'migraine headache'. Medical records were reviewed by two trained nurses who abstracted supporting data for two neurologists. The neurologists determined whether each case met eligibility requirements and assigned a headache diagnosis by consensus. The diagnostic criteria offered some flexibility and were adapted to retrospective record-based research. Most records contained enough information to effectively classify the headache, although information on the frequency and duration of attacks proved to be problematic. A validation re-abstraction of a 10% sample of cases was undertaken with acceptable reproducibility of symptoms and diagnosis. Our study shows that migraine headache can be studied retrospectively through existing detailed medical records.

[Clinical characteristics of cluster headache]

The authors describe in detail the clinical characteristics of 48 patients suffering from cluster headache. They investigate the question of nomenclature and survey the clinical forms of diagnosis. They deal with differential diagnosis comparing migraine, trigeminal neuralgia and headaches origin from systemic illness. They point out that the clinical characteristics of their patients co-responding to the data in the literature. They emphasize that the precise anamnesis can result the diagnosis of this type of headache which is the basis of the treatment.

[Surgical treatment of Horton's headache or neuralgia of the greater superficial petrosal nerve]

The authors report two cases of Horton's neuralgia treated surgically. In one patient the result is very good, in the other one it is poor. The pathophysiological mechanisms and anatomical-functional basis of this type of headache are discussed stressing the contribution to the knowledge of these mechanisms made by Professor Jerzy Choróbski. It seems that more patients should be referred for this treatment that it is done presently. The operation with sectioning of this nerve is not particularly troublesome and it may be a good supplementation of pharmacological treatment.

So-called "vascular headache of the migraine type": one or more nosological entities?

The dispute about whether migraine and cluster headache are one disorder--the "unified theory"--or two facets of a spectrum of "vascular headache" has not yet been settled. The author discusses various clinical features that unite or divide migraine and cluster headache in this respect: so-called "mixed forms" of vascular headache, corneal indentation pulse amplitudes, partial Horner's syndrome and possible aberrations in histamine metabolism. Evidence is presented showing that there may exist subunits of cluster headache, such as chronic paroxysmal hemicrania (C.P.H.) and a hitherto unreported type that co-exists with recurring bouts of retrobulbar neuritis and a partial factor XII deficiency.