ABSTRACT
Introduction: In Brazil there is only one case report of a patient diagnosed with Paroxysmal Hemicrania-Trigeminal (PH-Tic) syndrome reported, however it was observed in a patient with Chiari I malformation. Objective: Here, we describe the first case of primary PH-Tic syndrome in the country. Method: Case report. CARE guideline was used to guide the structuring of this article. This case report was approved by the ethics committee and has been registered under the protocol number 70705623.7.0000.5440 on "Plataforma Brasil". Results:A 72-year-old woman with a five-month history of headaches was admitted at our headache outpatient clinic. The pain was sharp, intense, localized in the periorbital and left temporal regions. Blood counts, liver, renal and thyroid function were normal, as well as brain magnetic resonance imaging. Despite using carbamazepine, the patient had pain in only the left side of the face. Indomethacin was added until the dose of 100 mg a day and resulted in improvement of headache frequency. Conclusion: PH-Tic should be hypothesized in patients with short-lasting headaches associated with facial pain that partially improve with carbamazepine or indomethacin.
Introdução: No Brasil há apenas um relato de caso de paciente com diagnóstico de síndrome Paroxística Hemicrania-Trigeminal (PH-Tic), porém foi observado em um paciente com malformação de Chiari I. Objetivo: Descrevemos aqui o primeiro caso de síndrome PH-Tic primária no país. Método: Relato de caso. A diretriz CARE foi utilizada para orientar a estruturação deste artigo. Este relato de caso foi aprovado pelo comitê de ética e registrado sob o número de protocolo 70705623.7.0000.5440 na "Plataforma Brasil". Resultados: Uma mulher de 72 anos com história de cefaleias há cinco meses foi internada em nosso ambulatório de cefaleias. A dor era aguda, intensa, localizada nas regiões periorbital e temporal esquerda. Os hemogramas, as funções hepática, renal e tireoidiana estavam normais, assim como a ressonância magnética cerebral. Apesar do uso de carbamazepina, o paciente apresentava dor apenas no lado esquerdo da face. A indometacina foi adicionada até a dose de 100 mg ao dia e resultou em melhora da frequência da cefaleia. Conclusão: O PH-Tic deve ser hipotetizado em pacientes com cefaleias de curta duração associadas a dores faciais que melhoram parcialmente com carbamazepina ou indometacina.
ABSTRACT
Las cefaleas trigemino autonómicas (CTAs: cefalea tipo cluster, hemicránea paroxística y el SUNCT) son un grupo de cefaleas primarias, caracterizadas por la presencia de dolor unilateral en la distribución somática del nervio trigémino, asociada a características autonómicas cráneofaciales ipsilaterales. A pesar de sus elementos comunes, de forma individual, difieren con respecto a su duración, frecuencia y la respuesta a indometacina. Se presentan tres casos de CTAs de localización primaria dentomaxilar, sus características comunes y particulares, y la necesidad del diagnóstico diferencial con cuadros dolorosos provenientes de estructuras estomatognáticas.
The Trigeminal Autonomic Cephalalgias (TACs: Cluster headache, paroxysmal hemicrania and SUNCT) are a primary headache grouped characterized by the presence of unilateral pain in the somatic distribution of the trigeminal nerve, associated with craniofacial ipsilateral autonomic features. Despite their common elements, individually these headaches differ with respect to attack duration, frequency, and response to indomethacin.A three cases of TACs of dentomaxilar location is presented, common and particular characteristics, and the need for differential diagnosis with pain from stomatognathic structures.
Subject(s)
Humans , Male , Adult , Female , Middle Aged , Trigeminal Autonomic Cephalalgias/diagnosis , Analgesics/therapeutic use , Trigeminal Autonomic Cephalalgias/drug therapy , Diagnosis, Differential , Paroxysmal Hemicrania/diagnosis , Jaw , SUNCT Syndrome/diagnosisABSTRACT
Patent foramen ovale (PFO), a relatively common abnormality in adults, has been associated with migraine. Few studies also linked PFO with cluster headache (CH). To verify whether right-to-left shunt (RLS) is related to headaches other than migraine and CH, we used transcranial Doppler following microbubbles injection to detect shunts in 24 CH, 7 paroxysmal hemicrania (PH), one SUNCT, two hemicrania continua (HC) patients; and 34 matched controls. RLS was significantly more frequent in CH than in controls (54 percent vs. 25 percent, p=0.03), particularly above the age of 50. In the HC+PH+SUNCT group, RLS was found in 6 patients and in 2 controls (p=0.08). Smoking as well as the Epworth Sleepiness Scale correlated significantly with CH, smoking being more frequent in patients with RLS. PFO may be non-specifically related to trigeminal autonomic cephalalgias and HC. The headache phenotype in PFO patients probably depends on individual susceptibility to circulating trigger factors.
O forame oval patente (FOP), uma anormalidade cardíaca relativamente comum em adultos, tem sido associado à enxaqueca, mas raramente às cefaléias trigêmino-autonômicas (TACs). Utilizamos o Doppler transcraniano (DTC) para detecção de shunt direito-esquerdo (SDE) em 24 pacientes com cefaléia em salvas (CS), sete com hemicrania paroxística (HP), dois com hemicrania continua (HC) e um com SUNCT; alem de 34 controles. O SDE foi mais frequente nos pacientes com CS do que nos controles (54 por cento vs. 25 por cento p=0,03), particularmente acima de 50 anos. No grupo HP+HC+SUNCT, o SDE foi encontrado em seis pacientes e dois controles (p=0,08). O hábito de fumar, bem como sonolência excessiva diurna foram mais frequentes em paciente com CS. O FOP pode ter importância inespecífica na fisiopatologia das TACs e HC, na dependência da susceptibilidade individual a fatores desencadeantes.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Foramen Ovale, Patent/complications , Headache/etiology , Trigeminal Autonomic Cephalalgias/etiology , Case-Control Studies , Foramen Ovale, Patent/physiopathology , Foramen Ovale, Patent , Headache/physiopathology , Headache , Trigeminal Autonomic Cephalalgias/physiopathology , Trigeminal Autonomic Cephalalgias , Ultrasonography, Doppler, TranscranialABSTRACT
Paroxysmal hemicrania (PH) is rare in children and not widely recognized. It is characterized by pain attacks and associated symptoms and signs similar to those experiencing cluster headaches, but the features have a shorter effect, are more frequent, and respond completely to indomethacin. Some patients with PH may experience slight pain across the midline. There are only four cases of bilateral PH in the literature and it is very rare in children. Here, I report the case of a 10-year-old female with bilateral PH diagnosed by the typical symptoms along with the favorable response to indomethacin therapy.
Subject(s)
Child , Female , Humans , Cluster Headache , Hydrogen-Ion Concentration , Indomethacin , Paroxysmal HemicraniaABSTRACT
Aunque la migraña y los dolores de cabeza de tipo tensión son las cefalalgias más frecuentes en la práctica clínica, es muy importante el reconocimiento de otros síndromes dolorosos menos comunes como la cefalea en salvas, la hemicránea paroxística crónica y otros síndromes autonomotrigeminales. Estos síndromes dolorosos comparten algunos rasgos clínicos. El diagnóstico diferencial se basa en el número y la frecuencia de los episodios y la intensidad del dolor, así como en la respuesta a medicamentos específicos. La cefalea en salvas, las hemicráneas paroxísticas, la hemicránea continua y otros síndromes se incluyeron en la clasificación internacional de dolor de cabeza modificada por la IHS en el 2004. Esta revisión muestra los aspectos epidemiológicos, fisiopatológicos y clínicos y el tratamiento de estas cefaleas.
Although migraine and tension type headaches are the most frequent disorders in clinical practice, it is very important to recognize other painful syndromes such as cluster, paroxysmal hemicranias and trigeminal autonomic cephalgias wich are less common. These painful syndromes share some clinical features, and the main differential diagnoses are based on the number and the frequency of the episodes, and the intensity of pain, as well as in the response to specific medications. Cluster headache, paroxysmal hemicranias, hemicrania continua and other syndromes were included in the International Classification of Headache modified by the IHS in 2004. This review shows the epidemic aspects, pathophysiopatology, clinical manifestations and treatment of these headaches.
Subject(s)
Humans , Headache , Neurology , SUNCT SyndromeABSTRACT
Paroxysmal hemicrania (PH) has been recently defined as an uncommon primary headache. PH is characterized by frequent attacks of severe unilateral pain associated with autonomic symptoms. The attack frequency usually ranges from 5 to 40 attacks per day. PH is characterized by its absolute responsiveness to indomethacin. However, indomethacin is not often well tolerated because of its gastric side effects. We report two patients with PH who could not tolerate indomethacin due to its severe gastric side effects but dramatically responded to rofecoxib.
Subject(s)
Humans , Headache , Hydrogen-Ion Concentration , Indomethacin , Paroxysmal HemicraniaABSTRACT
This paper introduces the classification of trigeminal autonomic cephalalgias (TAC) and their clinical manifestation,diagnostic criteria and therapy of main type.TAC share the clinical features of headache and prominent cranial parasympathetic autonomic features.The most effective therapy for acute cluster headache is oxygen inhalation and Sumatriptan subcutaneous injection.Ergotamine is the first choice drug for the preventive treatment of episodic cluster headache and Verapamil coupled with Lithium salt is preventive treatment for chronic cluster headache.Indomethacin is specific treatment for paroxysmal hemicrania.Lamotrigine,Topiramate and Gabapentin are all useful to SUNCT.