Primary headache and factors associated in university students: a cross sectional study / Cefaleia primária e fatores associados em estudantes universitários: um estudo transversal

INTRODUCTION: Primary headaches, defined as disorders in themselves caused by independent pathomechanisms and not by other disorders, are prevalent in university students and considered one important health problems in the world. OBJECTIVE: To investigate the prevalence of primary headaches and analyze associations with sociodemographic characteristics and the use of electronic devices by university students. METHODS: A cross-sectional observational study analysis was carried out with a sample of 1,143 students of both genders who responded to the questionnaire on demographic, socioeconomic aspects, use of electronic devices, and on the primary headaches. Descriptive analysis, bivariate analysis, and Poisson regression were performed. RESULTS: The overall prevalence of primary headache of 60.7%, being that, in relation to the type, 33.2% presented tension-type headache, 54.3% migraine, and 12.3% other types of headache. Regression analysis showed that female gender and income of up to two minimum wages were associated with primary headache and migraine type. The primary headache was associated with subjects of the white race; watching television and playing video games for more than 3 hours per day, for example. The sitting posture, semi-lying down, and distance from the eyes to the mobile phone and tablet longer than 20 cm were associated with primary headache and the three types of headaches. CONCLUSION: The results allow us to conclude that there is a high prevalence of primary headaches in college students and that socioeconomic factors related to the use of electronic devices are associated with the presence of primary headaches.

INTRODUÇÃO: As dores de cabeça primárias, definidas como perturbações em si mesmas, causadas por patomecanismos independentes e não por outras perturbações, são prevalentes em universitários e considerada um importante problema de saúde mundial. OBJETIVO: Investigar a prevalência de cefaleia primária e analisar associações com características sociodemográficas e uso de dispositivos eletrônicos em estudantes universitários. MÉTODOS: Foi realizado um estudo observacional transversal com uma amostra de 1143 estudantes de ambos os sexos, que responderam ao questionário sobre aspectos demográficos, socioeconômicos, uso de dispositivos eletrônicos e cefaleia primária. Foram realizadas análises descritivas, análises bivariadas e regressão de Poisson. RESULTADOS: A prevalência geral de cefaleia primária de 60,7%, sendo que, em relação ao tipo, 33,2% apresentavam cefaleia tensional, 54,3% enxaqueca e 12,3% outros tipos de cefaleia. A análise de regressão mostrou que o sexo feminino e a renda de até dois salários-mínimos estavam associados à cefaleia primária e a enxaqueca; a cefaleia primária está associada a indivíduos da raça branca; assistir televisão e jogar videogame por mais de 3 horas por dia foi associado ao tipo tensional, a enxaqueca e cefaleia primária; a postura sentada, semideitada e distância dos olhos ao telefone celular e tablet com mais de 20 cm com a cefaleia primária e aos três tipos específicos. CONCLUSÃO: Os resultados permitem concluir que existe alta prevalência de cefaleia primária em estudantes universitários e que fatores socioeconômicos e relacionados ao uso de dispositivos eletrônicos estão associados à presença de cefaleia primária.

Primary headache subtypes and thyroid dysfunction: Is there any association? / Subtipos de cefaleia primária e disfunção tireoidiana: existe alguma associação?

ABSTRACT Background: Primary headaches, and particularly migraine and tension-type headache (TTH) as well as hypothyroidism are common medical conditions. To date, numerous studies have suggested a possible bidirectional relationship between migraine and hypothyroidism, although certain studies had contradictory results. Objective: To investigate whether there is any association between primary headache subtypes and thyroid disorders. Methods: A retrospective study of consecutive patients aged ≥18 years referred to the Headache Outpatient Clinic of Aeginition Hospital and diagnosed with primary headache and any thyroid disorder. Results: Out of 427 patients (males/females=76/351), 253 (59.3%) were diagnosed with migraine without aura, 53 (12.4%) with TTH, 49 (11.5%) with migraine with aura, 29 (6.8%) with medication-overuse headache, 23 (5.4%) with mixed-type headache (migraine with/without aura and TTH), nine (2.1%) with cluster headache, and 11 (2.6%) with other types of primary headaches. The prevalence of any type of thyroid disorder was 20.8% (89/427 patients). In the total sample, 27 patients (6.3%) reported hypothyroidism, 18 (4.2%) unspecified thyroidopathy, 14 (3.3%) thyroid nodules, 12 (2.8%) Hashimoto thyroiditis, 12 (2.8%) thyroidectomy, three (0.7%) thyroid goiter, and three (0.7%) hyperthyroidism. Further statistical analysis between categorical variables did not reveal any significant association between headache subtypes and thyroid dysfunction. Conclusions: No specific association was found between primary headache subtypes and specific thyroid disorder. However, a high prevalence of thyroid dysfunction in general and specifically hypothyroidism was demonstrated among patients with primary headaches, which lays the foundation for further clarification in prospective longitudinal studies.

RESUMO Introdução: Cefaleias primárias e, particularmente, enxaqueca e cefaleia do tipo tensional (CTT), bem como hipotiroidismo, constituem condições médicas comuns. Até o momento, vários estudos sugeriram uma possível relação bidirecional entre enxaqueca e hipotireoidismo, embora alguns estudos tenham resultados contraditórios. Objetivo: Investigar se existe associação entre subtipos de cefaleia primária e distúrbios da tireoide. Métodos: Estudo retrospectivo de pacientes consecutivos com idade ≥18 anos encaminhados ao Ambulatório de Cefaleia do Hospital Aeginition, com diagnóstico de cefaleia primária e qualquer distúrbio da tireoide. Resultados: De 427 pacientes (homens/mulheres=76/351), 253 pacientes (59,3%) foram diagnosticados com enxaqueca sem aura, 53 (12,4%) com CTT, 49 (11,5%) com enxaqueca com aura, 29 (6,8 %) com cefaleia por uso excessivo de medicamentos, 23 (5,4%) com cefaleia mista (enxaqueca com/sem aura e CTT), nove (2,1%) com cefaleia em salvas e 11 (2,6%) com outros tipos de cefaleias primárias. A prevalência de qualquer tipo de distúrbio tireoidiano foi de 20,8% (89/427 pacientes). Na amostra total, 27 pacientes (6,3%) relataram hipotireoidismo, 18 (4,2%) tireoidopatia não especificada, 14 (3,3%) nódulos de tireoide, 12 (2,8%) tireoidite de Hashimoto, 12 (2,8%) tireoidectomia, três (0,7%) bócio da tireoide e três (0,7%) hipertireoidismo. Uma análise estatística posterior entre as variáveis categóricas não revelou qualquer associação significativa entre os subtipos de cefaleia e disfunção tireoidiana. Conclusões: Não encontramos associação entre subtipos de cefaleia primária e distúrbio específico da tireoide. No entanto, foi observada prevalência elevada de disfunção tireoidiana em geral e especificamente hipotireoidismo entre pacientes com cefaleia primária, o que estabelece base para maiores esclarecimentos em estudos longitudinais prospectivos.

Public policies in headache disorders: needs and possibilities / Políticas públicas em cefaleias: necessidades e possibilidades

Abstract Although headaches have recognized impact, there are no public policies in Brazil addressing this problem. The Brazilian Headache Society and the Brazilian Association of Cluster Headache and Migraine promoted a summit to discuss Public Policy and Advocacy for headache disorders. Professionals from various segments, representing various sectors of society, gathered in April 2019 in Brasília, defining the most important points for achieving advances in public policies in headache in Brazil, such as: inclusion in the chronic diseases surveillance agenda; improving public understanding and access to diagnosis and treatment; teaching in colleges and medical residences, structuring care networks, intervention models, clinical protocols and legislation supporting public policies in headache.

Resumo Embora as cefaleias tenham reconhecido impacto, não há no Brasil políticas públicas voltadas para este problema. A Sociedade Brasileira de Cefaleia e Associação Brasileira de Cefaleia e Enxaqueca promoveram um seminário para a discussão de Políticas Públicas e Advocacy (defesa dos direitos dos pacientes) em Cefaleias. Reuniram-se em abril de 2019 em Brasília, profissionais de vários segmentos, representando diversos setores da sociedade, definindo os pontos mais importantes para que se obtenham avanços nas políticas públicas em cefaleias no Brasil, tais como: inclusão na agenda de vigilância das doenças crônicas não transmissíveis; melhora do entendimento do público e seu acesso a diagnóstico e tratamento; ensino em faculdades e residências médicas, estruturação de redes de atendimento, modelos de intervenção, protocolos clínicos e legislação de apoio às políticas públicas em cefaleia.

A prevalência de cefaleia e fatores psicossociais associados em estudantes de medicina no Ceará / The prevalence of headache and psychosocial factors associated among medical students in a university of northeast Brazil

Introdução: A cefaleia é uma afecção que impacta negativamente a qualidade de vida da pessoa. O curso de medicina é reconhecidamente um gerador de esgotamento e, de acordo com a literatura, fatores estressantes são mais comuns em alunos de medicina que na população em geral, podendo desencadear a cefaleia. Esses fatores estressores podem ser intensificados em períodos que antecedem as provas devido a mudanças nos hábitos de sono e de estudo, havendo uma possível relação com o surgimento de cefaleias primárias. Objetivo: Avaliar a prevalência de cefaleia primária nos estudantes de medicina (EM) em períodos de provas e relacionar com fatores psicossociais. Métodos: Trata-se de um estudo transversal, baseado na aplicação de dois questionários a uma amostra de 219 EM do 1º ao 8º semestre de uma universidade no interior do Ceará. Um questionário relacionou a cefaleia com fatores psicossociais em períodos de provas. O segundo questionário: HSQ-DV, foi utilizado para o diagnóstico de enxaqueca e cefaleia do tipo tensional (CTT). Resultados: 98% dos EM relataram já ter sentido cefaleia. A prevalência de CTT e enxaqueca encontradas foi de 61,9% e 18,1%, respectivamente, dados maiores que a média para a população geral. Estudantes com enxaqueca têm mais crises antes de provas, se automedicam mais, ingerem mais psicoestimulantes, são mais ansiosos, mais depressivos, mais sedentários, mais estressados e dormem menos que aqueles com CTT. Conclusão: De fato, os EM são um grupo de risco para o desenvolvimento de cefaleias, merecendo, portanto, uma maior ênfase de pesquisas científicas sobre as cefaleias primárias neste grupo.

Introduction: Headache is a condition that impacts negatively the patients' quality of life. The medical course is a known generator of exhaustion and, according to the literature, stressors are more common in medical students (MS) than in the general population, which can trigger a headache. These stressors can be intensified in periods that precede the tests due to changes in sleep and in study habits, with a possible relation with the appearance of primary headache. Objective: To associate the presence of primary headache in MS during periods of tests and to relate to psychosocial factors. Methods: This is a cross-sectional study based on the application of two questionnaires to a sample of 219 MS from the 1st to the 8th semester of a university in Northeast Brazil. The first questionnaire related headache with psychosocial factors in periods of tests. The second questionnaire: HSQ-DV, was used for the diagnosis of migraine and tension-type headache (TTH). Results: 98% of MS reported having experienced headache. The prevalence of TTH and migraine was 61.9% and 18.1%, respectively, higher than the average for the general population. Students with migraine have more attacks before tests, self-medicate more, ingest more psychostimulants, are more anxious, more depressed, more sedentary, more stressed, and sleep less than those with TTH. Conclusion: In fact, MS are a risk group for the development of headache, thus deserving a greater emphasis of scientific research on primary headaches in this group

Reversible Cerebral Vasoconstriction Syndrome Misdiagnosed as Moyamoya Disease with Transient Ischemic Attack as Initial Manifestation

Reversible cerebral vasoconstriction syndrome (RCVS) is a disease characterized by reversible and multiple stenoses of cerebral blood vessels that improve within 3 months, accompanied by thunderclap headache. Here, we report an interesting case of RCVS initially misdiagnosed as Moyamoya disease with transient ischemic attack. A 45-year-old woman visited the Neurology Department of Eulji University Hospital. The patient was initially diagnosed with Moyamoya disease with transient ischemic attack. However, follow-up magnetic resonance angiography performed 12 months after the patient was appropriately diagnosed as having RCVS.

Development and Validation of the Cluster Headache Screening Questionnaire

BACKGROUND AND PURPOSE: Cluster headache (CH) is frequently either not diagnosed or the diagnosis is delayed. We addressed this issue by developing the self-administered Cluster Headache Screening Questionnaire (CHSQ). METHODS: Experts selected items from the diagnostic criteria of CH and the characteristics of migraine. The questionnaire was administered to first-visit headache patients at nine headache clinics. The finally developed CHSQ included items based on the differences in responses between CH and non-CH patients, and the accuracy and reliability of the scoring model were assessed. RESULTS: Forty-two patients with CH, 207 migraineurs, 73 with tension-type headache, and 18 with primary stabbing headache were enrolled. The CHSQ item were scored as follows: 3 points for ipsilateral eye symptoms, agitation, and duration; 2 points for clustering patterns; and 1 point for the male sex, unilateral pain, disability, ipsilateral nasal symptoms, and frequency. The total score of the CHSQ ranged from 0 to 16. The mean score was higher in patients with CH than in non-CH patients (12.9 vs. 3.4, p 8 points, the CHSQ had a sensitivity, specificity, positive predictive value, and negative predictive value of 95.2%, 96%, 76.9%, and 99.3%, respectively. CONCLUSIONS: The CHSQ is a reliable screening tool for the rapid identification of CH.

Prophylaxis with melatonin for primary stabbing headache in pediatrics: a case report / Profilaxis con melatonina para cefalea punzante primaria en pediatría: reporte de caso

Abstract Introduction: Primary stabbing headache (or "ice pick headache") is an alteration characterized by brief jabs (short stabs of pain, lasting ~3 seconds), which appear spontaneously, irregularly, and affecting unilaterally or bilaterally. Indomethacin has traditionally been used as the main therapeutic option. However, this drug is ineffective in a considerable percentage of patients and can generate multiple adverse effects that occur at therapeutic doses. Clinical case: A 7-year-old male patient with primary stabbing headache of mild to moderate intensity, lasting 3 to 4 seconds, without relevant history, with normal neurodevelopment, neurological examination and neuroimaging; no triggers were identified. It was started therapeutic trial with Coenzyme Q10; however, no improvement in the symptoms was identified. Treatment and outcomes: A therapeutic management was carried out with Melatonin, which led to complete remission of the symptoms; without adverse effects in the posterior follow-up months. Clinical and scientific relevance: There is little information regarding effective and safe treatments for primary stabbing headache in children. The present case identifies Melatonin as an innovative, effective and safe therapeutic alternative in the treatment of primary stabbing headache in children. This is a significant advance in the understanding of primary stabbing headache in the pediatric population. Conclusion: Melatonin may be an effective and safe therapeutic option for the treatment of primary stabbing headache in pediatric patients. It is necessary to deepen its research, in order to establish its use in a clinical practice guide.

Resumen Introducción: La cefalea punzante primaria, es una alteración que se caracteriza por punzadas breves (∼3 segundos), que aparecen espontáneamente, de forma irregular y afectación unilateral o bilateral. Tradicionalmente se ha utilizado Indometacina como opción terapéutica principal. Sin embargo, este medicamento es inefectivo en un porcentaje considerable de pacientes y puede generar múltiples efectos adversos que se presentan a dosis terapéuticas. Caso clínico: Paciente masculino de 7 años de edad con cefalea punzante primaria de intensidad leve a moderada con una duración entre 3 y 4 segundos sin antecedentes relevantes, con neurodesarrollo, examen neurológico y de neuroimagen normales; no se identificaron desencadenantes. Se inició prueba terapéutica con Coenzima Q10, sin embargo no se identificó mejoría en los síntomas. Tratamiento y resultados: Se realizó un manejo terapéutico con Melatonina que conllevó a remisión completa de la sintomatología y sin efectos adversos en los meses posteriores de seguimiento. Relevancia clínica y científica: Existe poca información respecto a tratamientos efectivos y seguros para cefalea punzante primaria en niños. El presente caso identifica la Melatonina como una alternativa terapéutica innovadora, efectiva y segura en el tratamiento de la cefalea punzante primaria en niños. Lo anterior constituye un avance significativo en la comprensión de la cefalea punzante primaria en la población pediátrica. Conclusión: La melatonina puede ser una opción terapéutica efectiva y segura para el tratamiento de la cefalea punzante primaria en pacientes pediátricos. Se requiere ahondar en su investigación para establecer su uso en una guía de práctica clínica.

Associação entre ponticulus, cefaleia primária e disfunção temporomandibular / Association among pontículos posticus, primary headches and temporomandibular dysfunction

Na primeira vértebra cervical (atlas) pode existir uma alteração anatômica caracterizada por um arco ósseo e diagnosticada por imagens radiográficas, chamada de Ponticulus Posticus (PP) e pode estar relacionada a cefaleias primárias e outras dores orofaciais. Objetivo: O objetivo deste estudo foi avaliar a associação entre PP, cefaleias primárias, disfunções temporomandibulares (DTMs) e maloclusão. Métodos: Todos pacientes foram voluntários e já possuíam documentação ortodôntica com telerradiografia odontológica e passaram antes das manutenções ortodônticas pelos questionários de Diagnóstico das Desordens Temporomandibulares (RDC/DTM) na versão em português, questionário clínico baseado nos critérios da CIC-2 (Classificação Internacional de Cefaleias) e exame clínico para avaliação das maloclusões. Todos os dados utilizados neste estudo foram coletados a partir destes documentos. As variáveis incluídas neste estudo foram: idade, tempo de tratamento, prevalência da maloclusão (quantitativas); gênero, tipo de disfunção temporomandibular (DTM), cefaleia primária e PP (qualitativas). Os dados foram organizados em uma planilha do programa SPSS 15.0, a relação entre as variáveis foram analisadas por meio de um modelo de regressão binária e foi calculado o odds ratio. As variávies gênero, tempo de tratamento ortodôntico, tipo de maloclusão e idade foram verificadas pelo teste qui-quadrado. Resultados: Mostraram não terem associação em relação à presença de PP, cefaleias primárias e DTM. Foi constatado que a presença de PP aumentou a chance do paciente em ter cefaleia primária e DTM tanto isoladamente como concomitantemente. Conclusão: Diante destes resultados, é importante que o diagnóstico por imagem dessa alteração torne-se uma prática comum entre os profissionais da saúde.

In the first cervical spine (Atlas) there may be an anatomical alteration characterized by a bone arch and diagnosed by radiographic images, called Ponticulus Posticus (PP) and may be related to primary headaches and other orofacial pains. Goal: The goal of this paper was to evaluate the association among PP, primary headaches, temporomandibular dysfunctions (TMDs) and malocclusion. Methods: All patients were voluntary and have already had the orthodontic documentation with the orthodontic tele radiography and went through orthodontic maintenance by Temporomandibular Disorder Diagnosis questionnaires (RDC/TMD) in the Portuguese version, clinical questionnaire based on some criteria of CIH-2 (international classification oh headaches) and clinical exam to evaluate the malocclusions. All the dada that were used in this research were collected from these documents. The variables included in this study were: age, time of treatment, prevalence of malocclusion (quantitative), sex, type of temporomandibular dysfunction (TMD), primary headache and PP (qualitative). The data were organized in a spreadsheet of SPSS 15.0 program and the relation among variables were analysed through the binary regression model, and the odds ration was calculated. The variables sex, time of the orthodontic treatment, type of malocclusion and age were checked by the chi-square test and the results obtained showed no association with the presence of PP, primary headache and TMD. Results: It was found that the presence of PP increased the patient's chance of having primary headache and TMD both individually and concomitantly. Conclusion: Considering these results, it is important that the diagnosis by image of this alteration becomes a common practice among health professional.

Series de Pediatría Garrahan. El niño con problemas neurológicos / Garrahan Pediatrics Series. The child with neurological problems

Las afecciones neurológicas son uno de los motivos de consulta más frecuentes en la práctica pediátrica ambulatoria y ocupan un alto índice de las camas en la internación. El papel del pediatra en este contexto es muy complejo, ya que es quien recibe a un paciente en la emergencia o en el consultorio y debe estar atento a si un determinado síntoma o signo neurológico puede ser transitorio o el indicio de una enfermedad grave. Así, son fundamentales tanto el conocimiento de las distintas entidades neurológicas y de sus aspectos epidemiológicos y patogénicos como también el examen semiológico y los primeros estudios por realizar para la orientación diagnóstica, el tratamiento inicial, las indicaciones de derivación, la prevención de riesgos y el asesoramiento a los padres. Este nuevo volumen aborda esta temática especial con énfasis en el trabajo interdisciplinario y entre sus características se destacan: El estudio de importantes temas clínicos, como las convulsiones febriles, que se presentan en el 2% al 5% de los niños; la epilepsia infantil, con una prevalencia del 1%; la cefalea, cuya incidencia ha aumentado en los últimos veinte años y es hoy el motivo de consulta más frecuente en los servicios de neurología; las crisis paroxísticas no epilépticas, que aparecen entre el 5% y el 20% de la población infantil; el desafío diagnóstico del lactante hipotónico; las encefalopatías agudas, y los trastornos de la marcha y del movimiento. La inclusión, en todos los capítulos, de casos clínicos con su evolución y desenlace, textos destacados con los principales conceptos, puntos claves para recordar, además de material complementario, como bibliografía adicional, videos y enlaces a sitios web de interés. Una obra sólida y práctica, que transmite las experiencias de los profesionales de una institución del prestigio internacional del Hospital de Pediatría Prof. Dr. Juan P. Garrahan ­a treinta años de su creación- dedicada a todos los pediatras, donde quiera que trabajen al servicio de la salud de los niños.

Clinical Reasoning: A 21-year-old Man Presenting with Thunderclap Headache

No abstract available.

Reversible Cerebral Vasoconstriction Syndrome with Concurrent Anterior Cerebral Artery Dissection

The pathophysiology of reversible cerebral vasoconstriction syndrome (RCVS) is not known but coexisting vascular lesion, such as carotid artery and vertebral artery dissection, has been reported. However, RCVS concurrent with anterior cerebral artery dissection has never been reported. We describe a 28-year old patient presenting with anterior cerebral artery dissection with RCVS associated with coughing. This case could support the causality between RCVS and arterial dissection.

Thunderclap Headache Due to Ruptured Intracranial Dermoid Cyst

No abstract available.

Diagnosis and treatment of acute rhinosinusitis in children

Acute rhinosinusitis is a common entity in children, most are due to viral infections, however up to over 80% children with rhinosinusitis are prescribed with antibiotics. Acute bacterial sinusitis should be diagnosed in when a child has 1) a severe onset with a fever over 39℃, purulent nasal discharge or facial pain for 3 to 4 days; 2) persistent illness with rhinorrhea, daytime cough or both for over 10 days with no clinical improvement; or 3) worsening course with symptoms aggravating or new onset symptoms including fever, headache, cough or rhinorrhea after clinical improvement. Radiographic imaging is not recommended for differentiation of viral and bacterial rhinosinusitis, however a contrast-enhanced computed tomography or magnetic resonance imaging may be done in cases with orbital or central nervous system complications. Antibiotics may be prescribed in cases with severe onset or worsening course. Antibiotics may be prescribed after additional observation for 3 days in children with persistent illness. Amoxicillin-clavulanate (amoxicillin 40 to 50 mg/kg/day, every 12 hours) is recommended for initial treatment and high dose amoxicillin-clavulanate (amoxicillin 90 mg/kg/day every 12 hours) may be considered in cases with severe infection, children in day care center, under 2 years of age, recent admission history, previous antibiotics within 1 month and immunocompromised children. Clinical response should be reassessed in cases of worsening or failure to improve within 72 hours of treatment.

A Case Report Reversible Cerebral Vasoconstriction Syndrome with Thunderclap Headache During Swimming

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by severe thunderclap headache with multifocal segmental vasoconstriction of the cerebral arteries. RCVS can be diagnosed if the cerebral angiogram shows segmental stenosis and spontaneously resolves within weeks to months. RCVS is reversible, but might cause brain lesions such as subarachnoid hemorrhage or cerebral infarction. We report a 45-year-old woman with severe sudden onset frontal headache who was identified with reversible cerebral vasoconstriction syndrome.

Bilateral Infarction of the Recurrent Arteries of Heubner Following Clipping of an Anterior Communicating Artery Aneurysm

A 50-year-old woman reported to the emergency department with thunderclap headache and vomiting. Non-enhanced brain computed tomography (CT) showed a subarachnoid hemorrhage of Hunt-Hess Grade II and Fisher Grade III. Brain angiography CT and transfemoral cerebral angiography (TFCA) revealed an aneurysm of the anterior communicating artery. A direct neck clipping was performed using the pterional approach. The post-operation CT was uneventful. Six days postoperatively, the patient became lethargic. The mean velocity (cm/s) of the middle cerebral artery peaked at 173 cm/s on the right side and 167 cm/s on the left. A TFCA revealed decreased perfusion in both recurrent arteries of Heubner (RAH), but no occlusion in either. Intra-arterial nimodipine injection was administered. On the 7th postoperative day, CT demonstrated a newly developed low-density lesion in the RAH territory bilaterally. The cause of the infarction was attributed to decreased perfusion caused by cerebral vasospasm. The patient was discharged with no definite neurologic deficit except for mild cognitive disorder.

Efficacy of neutrophil-lymphocyte ratio and clinical predicting indexes on differentiating subarachnoid hemorrhage from acute headache patients at emergency department

OBJECTIVE: This study evaluated the clinical usefulness of the neutrophil-lymphocyte ratio (NLR), Ottawa subarachnoid hemorrhage (SAH) rule and EMERALD (Emergency Medicine, Registry Analysis, Learning and Diagnosis) SAH rule for predicting SAH in patients with acute headache. METHODS: This clinical retrospective study was conducted at an urban emergency department between January 2008 and December 2017. Alert, neurologically intact adult patients with acute headache were included. All data were drawn from electrical medical charts. The Ottawa SAH rule (positive if any of age ≥40, neck pain, loss of consciousness, onset during exertion, thunderclap headache, and neck stiffness), EMERALD SAH rule (positive if any of systolic blood pressure >150 mmHg, diastolic blood pressure >90 mmHg, serum glucose >115 mg/dL, or serum potassium 2.1) was added to the last step to have achieve 99.0% sensitivity and 56.7% specificity. CONCLUSION: The stepwise application of the Ottawa, EMERALD SAH rule, and NLR increased the specificity compared to each application. On the other hand, further studies will be needed to increase the sensitivity.

Clinical Features of Cluster Headache Patients in Korea

Cluster headache (CH) is a rare underdiagnosed primary headache disorder with very severe unilateral pain and autonomic symptoms. Clinical characteristics of Korean patients with CH have not yet been reported. We analyzed the clinical features of CH patients from 11 university hospitals in Korea. Among a total of 200 patients with CH, only 1 patient had chronic CH. The average age of CH patients was 38.1 ± 8.9 years (range 19–60 years) and the average age of onset was 30.7 ± 10.3 years (range 10–57 years). The male-to-female ratio was 7:1 (2.9:1 among teen-onset and 11.7:1 among twenties-onset). Pain was very severe at 9.3 ± 1.0 on the visual analogue scale. The average duration of each attack was 100.6 ± 55.6 minutes and a bout of CH lasted 6.5 ± 4.5 weeks. Autonomic symptoms were present in 93.5% and restlessness or agitation was present in 43.5% of patients. Patients suffered 3.0 ± 3.5 (range 1–25) bouts over 7.3 ± 6.7 (range 1–30) years. Diurnal periodicity and season propensity were present in 68.5% and 44.0% of patients, respectively. There were no sex differences in associated symptoms or diurnal and seasonal periodicity. Korean CH patients had a high male-to-female ratio, relatively short bout duration, and low proportion of chronic CH, unlike CH patients in Western countries.

Cefalea... ¿y algo más?: Neuroimágenes en el estudio de la cefalea / Headache and something else? Neuroimaging in the study of headaches

Se revisa la iconografía de los hallazgos por tomografía computada (TC) y resonancia magnética (RM) de la cefalea, según nuestra experiencia. De acuerdo con la base MESH, esta entidad se define como un dolor craneano, que puede ser de ocurrencia benigna o la manifestación de una amplia gama de desórdenes. Las cefaleas se clasifican por su evolución temporal (aguda o crónica), presentación (en estallido, gravativa, etc.) o coexistencia de síntomas asociados, como auras, convulsiones o déficits focales. También se dividen en primarias o secundarias, según la existencia o no de una patología subyacente. Las primarias pueden tener manifestaciones clínicas definidas, pero en las secundarias ciertos signos y síntomas deben alertar sobre la presencia de una patología estructural. En este caso, las neuroimágenes tienen un rol esencial al detectar las causantes del cuadro. Nuestros hallazgos correspondieron a cefaleas primarias (p. ej: infarto migrañoso) y a etiologías orgánicas, entre las que se destacaron causas vasculares, como patología venosa (trombosis), vasoespasmo y leucoencefalopatía posterior reversible; hemorragias intraparen-quimatosas y extraaxiales; cefaleas postraumáticas y posquirúrgicas; y causas infecciosas y tumorales (apoplejía hipofisaria e hipertensión endocraneana). Además, hubo malformaciones (Arnold-Chiari, p.ej.) y otras como hipotensión endocraneana. En algunos casos inicialmente se realizó una TC y luego una RM, mientras que en otros la RM fue el método de elección. Las neuroimágenes facilitan el estudio de la cefalea, caracterizando la afección en primaria o secundaria. En el segundo caso permiten, a su vez, clasificar los hallazgos

A review is presented of the radiological findings (computed tomography -CT- and magnetic resonance imaging -MRI-) of headache, according to our experience. According to MESH database this entity is a skull based pain that can have a benign cause or be an expression of a wide spectrum of disorders. Headaches can be classified according to their temporal evolution (acute or chronic), presentation (blow up, aura, rapidly evolutionary, etc.), or according to associated symptoms, such as seizures or focal deficits. They could also be classified into primary or secondary, depending on the presence or absence of demonstrable disease. The primary headaches can have known symptoms (i.e. migraine), but in secondary ones certain symptoms and signs should alert on the existence of structural disease. At this point imaging methods have an outstanding role, as they allow detecting and identifying structural causes in patients with headache. Our findings corresponded to primary headaches (i.e.: migraine infarction) and organic aetiologies, such as vascular causes (venous thrombosis, vasospasm and posterior reversible leukoencephalopathy); intracerebral and extra-axial haemorrhage; post-surgical and post- traumatic headaches; and those due to infections and tumours (pituitary apoplexy or intracranial hypertension). Malformations, such as Arnold-Chiari's, and intracranial hypotension have also been found. In some cases a CT is initially performed and then an MR, whilst in others MR is the method of choice. Neuroimaging facilitates the study of headache, helping to characterise them into primary or secondary. In the latter case, the imaging also enables the findings to be classified

Cognitive functioning in adolescents with migraine / Funcionamento Cognitivo em Adolescentes com Migrânea

Although migraine is highly prevalent in children and teenagers, it often goes undetected in these patients, resulting in underdiagnosis and inadequate treatment. Several studies have investigated cognitive changes in adults with migraine. However, there are few studies focusing on children and adolescents. Objective : To investigate cognitive performance of adolescents with migraine. Methods : Twenty-eight adolescents diagnosed with migraine and twenty-six individuals without a history of headache were recruited for the study. All participants were evaluated using standardized neuropsychological tests. Results : Adolescents with migraine had worse performance on tests evaluating short- and long-term verbal memory, attention, executive function, and speed of processing information than controls. Conclusion : Cognitive dysfunction is common in adolescents with migraine. Since the cognitive deficits found in adolescents with migraine are similar to those reported in adults with migraine, cognitive impairment seems to persist throughout life.

Apesar de apresentar uma prevalência alta em crianças e adolescentes, nem sempre a migrânea é corretamente identificada nessa faixa etária, o que resulta em tratamentos inadequados e ineficazes. Vários estudos investigaram disfunções cognitivas associadas à migrânea em adultos. No entanto, poucos foram direcionados às crianças e aos adolescentes. Objetivo : Investigar o funcionamento cognitivo de adolescentes com migrânea. Métodos : Participaram do estudo 28 adolescentes diagnosticados com migrânea e 26 controles. Os participantes foram avaliados através de testes neuropsicológicos padronizados. Resultados : Os adolescentes com migrânea apresentaram pior desempenho que controles em testes que avaliaram memória verbal de curto e de longo prazo, atenção, funções executivas, velocidade de processamento. Conclusão : Disfunção cognitiva é comum em adolescentes com migrânea. Os resultados apontam para a persistência dos prejuízos cognitivos ao longo da vida, uma vez que os prejuízos encontrados nos adolescentes são semelhantes aos encontrados em adultos com migrânea.