Cefalea de tipo tensional / Tension-Type headache: an update

This study describes the tensio-type headache with an update on mechanisms and treatment (AU)

Hemicrania continua is not that rare.

BACKGROUND: Hemicrania continua is an indomethacin-responsive headache disorder characterized by a continuous, moderate to severe, unilateral headache. More than 90 cases of hemicrania continua have been reported, but there is still uncertainty about its clinical features. METHODS: The authors compared 34 new cases (24 women, 10 men) with previously reported cases. All the patients met Goadsby and Lipton's proposed criteria. The authors compared baseline (continuous background headache) and exacerbation (attacks of severe periods of headaches). RESULTS: The baseline headache was typically mild to moderate in intensity and usually not associated with severe disability. In contrast, the headache exacerbations were severe and associated with photophobia, phonophobia, nausea, and disability. At least one autonomic symptom was present in 25 patients (74%). Jabs and jolts were present in 14 patients (41%). The mean indomethacin dose was 136.7 +/- 60 mg (range 25 to 225 mg). Twenty-four patients (70.6%) met International Headache Society criteria for migraine in their exacerbation period. Occipital tenderness was observed in 23 patients (67.6%). The temporal pattern was remitting in four patients (11.8%), continuous from onset in 18 (52.9%), and continuous evolving from remitting in 12 (35.3%). CONCLUSION: Hemicrania continua is not a rare disorder. All cases of chronic unilateral daily headaches should receive an indomethacin trial early if not first in treatment.

[Characteristics of headache associated with cerebral arteriovenous malformations]. / Caractéristiques des céphalées associées aux malformations artério-veineuses cérébrales.

BACKGROUND: and purposes. The purpose of this study was to identify the specific characteristics of headaches associated with cerebral arteriovenous malformations in order to differentiate them from other known entities of headaches such as migraine, cluster headache, and trigeminal neuralgia. This differentiation allows an early diagnosis of cAVM and a treatment to be administrated before any cerebral hemorrhage. PATIENTS AND METHODS: The study included 700 patients with cAVM and treated by radiosurgery. Out of this series, only 109 (48 males, 61 females, mean age of 33) presented with headaches. Headaches were studied as a possible revelation mode of a cAVM, either as an isolated sign, preceding an epileptic seizure, a cerebral hemorrhage, or associated with a neurological deficit. Analysis concerned 13 clinical parameters and 30 anatomic parameters based on angiography. RESULTS: Headaches were found in 15.6%; they were isolated in 6%. They preceded a cerebral hemorrhage in 12.6%, constituting an early alarm signal when increasing in intensity, frequency and duration. They were associated with seizures or a neurological deficit in 9.6%. We found a predominant female sex-ratio (0.78) and occurrence at a young age (72.3% between 10 and 40 years). Headaches were non-pulsating in 95.3%; nausea, vomiting, light or sound phobia were only found in 4.7%. Headaches were unilateral and homolateral to the malformation in 80%, corresponding to the malformation topography in 97.4% in posterior location and 80% in anterior location. Associated neurological symptoms existed in 20.2%; related to the malformation and lasting 5 to 30 minutes. Duration of pain episodes was less than 3 hours in 77% with a frequency of 1 to 2 per month in 82.5%. Pain was mild and responded to simple analgesics. A family migraine was found in only 3 patients. The angiographic characteristics of the malformations were meningeal afferences, superficial venous drainage and posterior location. CONCLUSIONS: Headaches associated with cerebral arterio-venous malformations form a distinct category that can be determined from specific characteristics; this should help an early diagnosis of cerebral arterio-venous malformations in order to start a treatment before the occurrence of cerebral hemorrhage.

Primary vascular-type craniofacial pain.

Primary vascular-type craniofacial pain comprises a group of pain disorders that share common diagnostic features. These are unilateral, episodic, pulsatile, severe pain. Accompanying phenomena include local autonomic (e.g., tearing, rhinorrhea) and systemic signs (e.g., nausea, photophobia). Primary vascular-type craniofacial pain includes migraine, cluster headache, and paroxysmal hemicrania. A new diagnostic entity, vascular orofacial pain, is suggested. Treatment of primary vascular-type craniofacial pain depends on its more specific diagnosis, and may be abortive or prophylactic. Diagnostic features, common pathophysiological mechanisms, and treatment modalities are discussed.

Cefalea en el niño: utilidad de la clasificación internacional (IHS) 1988 / Headache in children: the utility of the international classification of headache (IHS) 1988

El objetivo de este estudio prospectivo de cefalea en el niño fue conocer la prevalencia de consultas por cefalea en el policlínico de Neurología del Hospital Roberto del Río, las características clínicas, el tipo de cefalea y la utilidad en niños de la clasificación internacional de cefalea dadapor la Internacional Headache Society 1988. Entre enero y junio 1994, tuvimos 114 consultas por cefalea, de un total de 5 612, al policlínico de Neurología del Hospital de Niños Roberto del Río, lo que dio una prevalencia de 2 por ciento. Hubo 68 mujeres y 46 hombres, edades entre 3,5 y 14,8 años. Todos sufrían cefaleas recurrentes. La aplicación de la clasificación internacional nos permitió clasificar el 75 por ciento de los casos, con una distribución de 66 por ciento vascular, 8 por ciento tensional y 26 por ciento no definida

A population-based study of migraine headaches in Olmsted County, Minnesota. Case ascertainment and classification.

Using the unique resources of the Rochester Epidemiology Project for population-based studies, we identified 629 Olmsted County, Minn., residents who fulfilled the 1988 International Headache Society criteria for newly diagnosed migraine over a 3-year period. Over 6,400 patient records from several diagnostic rubrics were screened; a substantial proportion of cases had been 'signed-out' to diagnoses other than 'migraine headache'. Medical records were reviewed by two trained nurses who abstracted supporting data for two neurologists. The neurologists determined whether each case met eligibility requirements and assigned a headache diagnosis by consensus. The diagnostic criteria offered some flexibility and were adapted to retrospective record-based research. Most records contained enough information to effectively classify the headache, although information on the frequency and duration of attacks proved to be problematic. A validation re-abstraction of a 10% sample of cases was undertaken with acceptable reproducibility of symptoms and diagnosis. Our study shows that migraine headache can be studied retrospectively through existing detailed medical records.

Cluster headache in black patients. A report of 7 cases.

Cluster headache is an uncommon form of headache syndrome. It is characterised by paroxysms of severe unilateral head pain typically involving the orbit. There are often associated autonomic changes on the affected side such as lacrimation, nasal congestion and Horner's syndrome. Apart from episodic cluster headache, various subtypes such as chronic cluster headache, cluster headache variant and chronic paroxysmal hemicrania have been identified. There have been few reports of the incidence and clinical features of cluster headache in blacks; 7 black patients with various types of cluster headache are described.

Cluster headache in the Republic of San Marino.

The prevalence of cluster headache (CH) in the Republic of San Marino (21,792 inhabitants; 10,893 men and 10,899 women) was studied, reviewing the past 15 years' medical records of neurological, ophthalmological, and otorhinolaryngological services. Further cases were searched for by means of a letter sent to each inhabitant. Control of the case collection method was performed on a random sample of 1314 inhabitants over 7 years, interviewed for possible past or present cluster headache. We found 15 cases of CH (14 men, 1 woman), for an estimated prevalence ratio of 69 cases per 100,000 population. No previous reports have been published on the prevalence of CH in the general population.

[Nervous system diseases in large-city population. II. Effect of occupational factors]. / Choroby ukladu nerwowego w populacji wielkomiejskiej. II. Wplyw czynników zawodowych.

The patients of a local outpatient department in a half--million population town have been examined. The rate of organic angiogenic encephalopathies, vasomotor headaches and epilepsy has been three times greater in those performing light work than in the hard-working group. No dependency between the hard work and rate of ischias and lumbago has been found. Operations of productive machines, similarly as the working place microclimatic conditions do not pose a risk of nervous system diseases, except ischias and lumbago which occur more frequently in an occupational group working at low temperature and considerable humidity or at an open air. Likewise, the body position at work significantly affects the rate of ischias and lumbago. Our findings prove that hard work does not pose an additional risk of nervous system diseases. Another conclusion of those investigations is that advantageous microclimate and body position at the working place, possibly accompanied by corrective physical training, are significant in the prevention of ischias and lumbago.

Headache in a random sample of 200 persons: a clinical study of a population in northern Finland.

Two hundred persons, randomly chosen out of 3,067 who had answered a headache questionnaire modified from Waters, were summoned to an interview and an examination performed by a neurologist. The aim was to obtain prevalence readings for different types of headaches in an unselected population. Simple blood studies and plain skull and cervical spine radiography were performed. The occurrence of headache was 77%, and the prevalence of migraine 9% in men and 28% in women. There was a higher prevalence of headache in women, accounted for solely by their higher frequency of vascular headaches, while the figure for tension headache was 35% for both sexes. Demographic factors did not influence the distribution of the headache types, except for a concentration of vascular headaches in women working in service occupations. A positive family history of migraine was reported significantly more often by persons with migraine than by others. The physical neurological examination, and the laboratory and X-ray investigations performed generally did not contribute to the diagnosis of the headache.

[Nervous system diseases in workers of a large metallurgic plant]. / Choroby ukladu nerwowego w populacji duzego zakladu metalurgicznego

Epidemiological investigations were carried out in an industrial plant in a population of about 16 000 people. The overall morbidity was 1 241.8 cases of nervous system diseases per 100 000 of population and the annual prevalence of neurological diseases was 473.7 per 100 000. The most frequent disease was sciatic pain, followed in order of frequency by epilepsy, vasomotor headaches, subjective symptoms after craniocerebral trauma, Parkinson's disease, clinically evident cerebral atherosclerosis and disseminated sclerosis. No significant effect of the type of occupation on the development of nervous system diseases was observed.