ABSTRACT
Hypertrophic pachymeningitis is a rare inflammatory condition characterized by the thickening of the dura mater. We describe a patient who presented with intractable headache and complex cranial nerve palsy. Hypertrophy of the frontal dura was accompanied by pleocytosis and detection of Epstein-Barr virus (EBV) by PCR in cerebrospinal fluid. Clinical symptoms gradually improved after acyclovir and corticosteroid treatment, whereas dural pathology remained unchanged on neuroimaging. This case points at an expansion of the spectrum of neurological manifestations for EBV.
Subject(s)
Epstein-Barr Virus Infections/virology , Meningitis/virology , Acyclovir/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Antiviral Agents/therapeutic use , Epstein-Barr Virus Infections/drug therapy , Epstein-Barr Virus Infections/pathology , Herpesvirus 4, Human/physiology , Humans , Male , Meningitis/drug therapy , Meningitis/pathology , Middle Aged , Virus ActivationABSTRACT
Medication overuse in primary headache disorders is a worldwide phenomenon and has a role in the chronification of headache disorders. The burden of disease on individuals and societies is significant due to high costs and comorbidities. In the Third Edition of the International Classification of Headache Disorders, medication-overuse headache is recognized as a separate secondary entity next to mostly primary headache disorders, although many clinicians see the disease as a sole complication of primary headache disorders. In this review, we explore the historical background of medication-overuse headache, its epidemiology, phenomenology, pathophysiology and treatment options. The review explores relevant unanswered questions and summarizes the current debates in medication-overuse headache.
