The coexistence of paroxysmal hemicrania and temporomandibular disorder: Importance of multidisciplinary approach.

Paroxysmal hemicrania (PH) is a trigeminal autonomic cephalalgia, a rare primary headache characterized by unilateral periorbital and/or temporal attacks of severe intensity and short duration. In this situation, the determination of a correct diagnosis is crucial for the establishment of a proper management strategy. In the case of head and facial pain, this step is usually a big challenge since many conditions share the same features, as some primary headaches and temporomandibular disorders (TMD). The relationship between PH and TMD has not been determined. This paper describes a case of a female patient diagnosed with TMD and presenting concomitant headache attacks fulfilling the International Headache Society's criteria for PH. It is also emphasized the importance of dentist in this scenario, for many times responsible for the initial diagnosis of facial/head pain. Moreover, it is presented an integrated and simultaneously approach of both conditions, PH and TMD.

Manejo analgésico y anestésico en la mastocitosis sistémica: a propósito de un caso / Analgesic and anesthetic management in systemic mastocytosis: a case report

Las mastocitosis son un grupo heterogéneo de enfermedades que se caracterizan por la proliferación de mastocitos en uno o más órganos o tejidos. Se denomina mastocitosis sistémica (MS) cuando hay afectación de un tejido distinto a la piel. La MS es una enfermedad poco frecuente, cuya incidencia y prevalencia se desconocen. El manejo anestésico de estos pacientes debe considerar que muchos de los fármacos empleados pueden causar una liberación masiva de mediadores químicos mastocitarios. Se presenta el caso de una mujer con MS programada para una histerectomía total, valorando la importancia del correcto estudio preoperatorio así como la técnica anestésica y el tipo de analgesia elegida en este caso. Se presenta nuestro protocolo de actuación de cara a la cirugía en estos pacientes.

Mastocytoses are a heterogeneous group of entities characterized by mast cell proliferation in one or more organs or tissues. When tissues other than the skin are involved, the disease is called systemic mastocytosis (SM). SM is a highly infrequent disease, whose incidence and prevalence are unknown. The anesthetic management of these patients must consider the fact that many drugs can trigger massive release of chemical mediators of mast cells. We report the case of a patient diagnosed with SM who underwent total hysterectomy and discuss the importance of thorough preoperative study, as well as the anesthetic technique and type of analgesia chosen. We also report our protocol for anesthetic management in this disease.

Cefaleas trigémino autonómicas: 3 casos de localización dentomaxilar / Trigeminal autonomic cephalalgias: 3 cases of dentomaxillar location

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.

Probable Paroxysmal Hemicrania Associated with Holmes-Adie Syndrome

No abstract available.

Hemicránea paroxística de localización dentomaxilar: reporte deun Caso / Dento maxilar paroxysmal hemialgia: case report

La hemicránea paroxística es un cuadro de cefalea primaria, agrupada dentro de las Cefaleas Trigémino Autonómicas(CTAs), junto con la cefalea cluster y el SUNCT, caracterizada por la presencia de dolor unilateral en la distribución somática del nervio trigeminal y asociada a características autonómicas craneofaciales ipsilaterales. A pesar de sus elementos comunes, de forma individual, difieren con respecto a su duración, frecuencia y la respuesta a indometacina. Se presenta un caso de hemicránea paroxística de localización primaria dentomaxilar, sus características comunes y particulares respecto de las demás CTAs, y la necesidad del diagnóstico diferencial con cuadros dolorosos provenientes de estructuras estomatognáticas.

Paroxysmal hemialgia is a primary cephalea of the AutonomousTrigeminus Cephaleas type (ATCs) along with cluster cephalea and SUNCT characterized by the presence of unilateral pain in the somatic distribution of the trigeminal nerve associated to autonomous craniofacial ipsilateral characteristics. Despite the common elements, individually they differ with respect to the length, frequency and response to indomethacin. We present a primary location dento maxilar paroxysmal hemialgia case, its common and particular characteristics with respect to all other ATCs and the need to a differential diagnose with pain coming from stomatognathic structures.

Cefaleas crónicas diarias: características clínicas y tratamiento / Chronic daily hedaches: clinical characteristics and treatment

El 5% de la población general sufre cefaleas más de 15 días por mes. Dentro de este grupo denominado “cefaleas crónicas diarias”, la mayor parte son migrañas crónicas y si bien una causa común es el abuso de fármacos, se ha podido establecer que estas personas tienen un sistema nervioso más vulnerable a los factores precipitantes de la migraña y que habría una alteración estructural en el funcionamiento neuroquímico cerebral que favorecería el establecimiento de esta situación. Otro hecho importante es la comorbilidad con depresión, pánico, enfermedad bipolar, trastornos obsesivo-compulsivos, síndrome de vejiga irritable, trastornos del sueño o fibromialgia. Al estudiar a estos pacientes, se deben descartar otras posibles causas utilizando los adecuados estudios complementarios. El tratamiento debería contemplar también el manejo de la comorbilidad antes descripta que suele confluir en estos pacientes.

Five percent of the overall population suffer from headaches over 15 days a month. Within this group called "chronic daily headaches", chronic migraines form the largest part, and despite a common cause of them is medication abuse, it has been possible to establish that people suffering from them have a nervous system which is more vulnerable to the factors that may bring about this situation. Another significant fact is the comorbility with depression, panic, bipolar disorder, obsessive-compulsive disorders, irritable bladder syndrome, sleep disorders or fibromyalgia. When studyng these patients, other possible causes must be dismissed, performing the proper complementary studies. Treatment should also provide for the previously described comorbility that usually converges among these patients.

Bilateral paroxysmal hemicrania with autonomic features in a child: A case report / 소아과

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.

Trigeminal Autonomic Cephalalgia by Neurogenic Palatine Compression: A Clinical Report and Review / Cefalea Autonómica Trigeminal por Compresión Neurogénica Palatina: Reporte de Caso y Revisión

This clinical report presents the evolution of a possible intraoral traumatic trigeminal autonomic cephalalgia simulating a probable cluster headache. A 50-year-old female patient had severe right-hand side pain for 7 years with autonomic signs and symptoms, such as lacrimation, conjunctival injection, rhinorrhoea, nasal congestion, forehead perspiration, myosis and eyelid edema. The episodes of pain lasted 4 or 5 months with 3- or 4-month remission periods between the painful onsets. The headaches presented an episodic pattern (1 to 3 attacks daily) lasting three to six hours. The patient had used five prosthetic sets continuously (24 h) for 20 years and the current prosthesis was 7 years old. Accidentally, after the alleviation of the maxillary denture due to it rested on a marked irritated incisive papilla the symptoms disappear. The patient has been periodically checked over a 5 year period since, without recurrence of her pain and autonomic symptomatology. The possible pathophysiology is discussed.

Se presenta un caso de cefalea autonómica trigeminal que simula una cefalea en cluster probable con potencial origen traumático intraoral. Mujer de 50 años que reportaba dolor derecho de intensidad severa con 7 años de evolución. El dolor se presenta con síntomas vegetativos como epifora, irritación de la conjuntiva ocular, rinorea, congestión nasal, sudoración frontal, miosis y edema palpebral. Los episodios de dolor se presentaban intermitentemente en el año, con duración de 4 a 5 meses y periodos de remisión de 3 a 4 meses. Las cefaleas se presentaban de manera episódica en el día (1 a 3 episodios) que duraban de 3 a 6 horas. Se observa prótesis intraoral en mal estado, con 7 años de realizada. La paciente reporta la elaboración de 5 juegos protésicos hasta la fecha y que usa constantemente en el día y la noche. Accidentalmente, y antes de la remisión a otro especialista, los síntomas desaparecen después del alivio mecánico en la zona anterior de la prótesis, que comprimía e irritaba la papilla incisiva. La paciente ha estado bajo controles periódicos durante 5 años y medio, sin recurrencia de los síntomas. La posible fisiopatología es discutida.

Headache: Response to Lamotrigine.

A number of patients attending a psychiatry out patient department present with headache and cranial autonomic symptoms (CAS) which include cluster headache (CH), shortlasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) or cranial autonomic features (SUNA) and paroxismal hemicrania (PH). The present case reports describe two cases of SUNCT which showed response to lamotrigine. In a day-today practice SUNCT should be kept in mind as effective therapy is available.

Black, white and shades of grey: SUNCT or short-lasting chronic paroxysmal hemicrania? / Preto, branco e tons de cinza: SUNCT ou hemicrania paroxística crônica de curta duração?

AIM OF THE STUDY: To report a case of unilateral headache with two possibilities of diagnosis. METHOD: Case report. RESULTS: Patient with unilateral, intense, stabbing periocular headache with conjuntival injection and tearing. Although the duration of attacks was typical of SUNCT, there was complete remission of the pain with indomethacin, suggesting that this was a case of chronic paroxysmal hemicrania with unusually short attack duration. CONCLUSION: Therapeutic trials of indomethacin on younger patients presenting clinical diagnosis of SUNCT could be tried on a more regular basis.

MOTIVO DO ESTUDO: Relatar um caso de cefaléia unilateral com duas possibilidades diagnósticas. MÉTODOS: Relato de caso. RESULTADOS: Paciente com cefaléia unilateral, intensa, em pontadas em região periocular, com congestão conjuntival e lacrimejamento. Embora a duração das crises fosse típica de SUNCT, houve remissão completa da dor com indometacina, sugerindo que se trate de um caso de hemicramia paroxística crônica com crises de duração atipicamente muito curta. CONCLUSÃO: Testes terapêuticos com indometacina em pacientes mais jovens com diagnóstico clínico de SUNCT poderiam ser tentados de forma mais regular.

Two Cases of Paroxysmal Hemicrania with Response to Rofecoxib

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.

Verapamil-responsive SUNCT Syndrome

SUNCT syndrome is characterized by short-lasting, unilateral, neuralgiform headache attacks, with conjuntival injec-tion and tearing. Distinct from trigeminal neuralgia, cluster headache, or paroxysmal hemicrania, this rare syndrome is SUNCT syndrome is characterized by short-lasting, unilateral, neuralgiform headache attacks, with conjuntival injec-tion and tearing. Distinct from trigeminal neuralgia, cluster headache, or paroxysmal hemicrania, this rare syndrome is generally refractory to various medications. We report a 63-year-old man diagnosed with SUNCT syndrome, whose symptoms were relieved by verapamil. The therapeutic effects of verapamil on SUNCT syndrome remain to be verified by further experiences. (J Korean Neurol Assoc 19(4):407~409, 2001)