Ponytail headache: a pure extracranial headache.

Fifty of 93 females experienced headache from wearing a ponytail. Pain was experienced only at the site of the hair tie in 10 subjects, extending in others, forwards to the vertex (n = 5) or forehead (n = 7), laterally to the parietal region (n = 8) or temples (n = 3), downwards to the neck (n = 5), or to other areas (n = 12). Loosening the hair relieved pain immediately in 4 subjects, within half an hour in 32, and within an hour in 5 subjects; the remaining 9 subjects were uncertain of pain duration. This headache was preventable by wearing the ponytail more loosely tied. Ponytail headache, well known to females, is not described in the medical literature because the remedy is obvious, therefore those affected do not seek medical advice. This seemingly common headache provides an example of a pure extracranial headache arising from pericranial muscle fascia and tendon traction. Males almost certainly have similar experiences, but were not questioned in this study. Distinguishing intracranial from extracranial headache is essential in diagnosis and treatment. Further research on ponytail and other extracranial headaches could shed light on the mechanism of tension-type headache.

A new cluster headache precipitant: increased body heat.

Exercise, a hot bath, or elevated environmental temperature provoked cluster headaches, within 1 h, in 75 out of 200 patients. This new observation accords with recognised precipitants--alcohol, histamine, and gyceryl trinitrate--perhaps via generalised vasodilatation or hypothalamic activation.

Premonitory and prodromal symptoms in cluster headache.

Warning symptoms in 150 cluster headache patients were studied by focusing on attacks occurring during waking hours. Warnings were divided into prodromes that started minutes before the pain of individual attacks (122 patients) and premonitory symptoms preceding the onset of cluster periods by days to weeks (12 patients). Pathogenetic and therapeutic implications are discussed.

The effect of national lifestyles.

Epidemiological surveys show that migraine is global, although not so far reported in Eskimos. Where studied, countries show the usual age variations, but adult national prevalence figures range between 2 and 35%, indicating that data-gathering methods need scrutiny. National and religious lifestyles affect eating at different times, in varying quantities and types of food; the drinking of alcohol and non-alcoholic fluids, as well as climate may also affect migraine. More questions than answers are raised to stimulate thinking, observations, and further research. Knowledge can derive from seeking and studying differences, contradictions, and questioning current beliefs. Can national lifestyles influence migraine and what can we learn from such variations?

Is abdominal pain a feature of adult migraine?

Recurrent abdominal pain in children, frequently diagnosed as "abdominal migraine," is thought to evolve into more typical migraine headache during the teens and twenties. If this transformation occurred, we would expect some adult migraineurs to retain abdominal pain; but we could not recall this symptom being mentioned by patients. However, without direct questioning the absence cannot be assumed. We, therefore, asked 100 migraineurs about abdominal symptoms during migraine attacks: only one experienced unexplained abdominal pain. We conclude that abdominal pain is not a feature in adult migraineurs, leading us to support the notions that: (1) recurrent abdominal pain of childhood has a number of causes; (2) abdominal migraine may be an incorrect attribution and is liable to be over diagnosed; (3) abdominal migraine requires more precise definition; (4) the transition from childhood abdominal migraine to adult migraine needs precise prospective study.