[Spontaneous intracranial hypotensioncan be confused with subdural haematoma].

Spontaneous intracranial hypotension is a rare condition, but due to increased awareness and better diagnostics it is more frequently reported. This is a case report of a 52-year-old male with sudden onset of vertigo and orthostatic headache. Initial workup was negative, but over the following six months symptoms progressed and bilateral hygromas were identified. Complete recovery was noted after two autologous blood patches. The importance of clinical presentation and differential diagnoses of spontaneous intracranial hypotension is emphasized.

Diagnosis of idiopathic intracranial hypertension - the importance of excluding secondary causes: A systematic review.

BACKGROUND: Idiopathic intracranial hypertension is characterized by increased intracranial pressure without any pathological findings on neuroimaging, except for signs of high intracranial pressure. Before diagnosing idiopathic intracranial hypertension secondary causes of increased intracranial pressure should be excluded. OBJECTIVE: to characterize the phenotype of patients with secondary intracranial hypertension and to identify possible risk factors for secondary intracranial hypertension. METHODS: We have systematically searched the PubMed database. The publications were analyzed according to the patient phenotype, age, gender, comorbidities, body mass index/weight status, and additional medication. The results are summarized in four categories: medication, infection, hormonal induced intracranial hypertension and miscellaneous groups of diseases related to sIH. RESULTS: We identified 105 eligible papers which included 272 cases. There were 49.6% pediatric cases. Among the adult group,70.9% were women. A total of 40.4% of all cases were obese or overweight, 27% among adults and 13.4% among pediatric cases. Increased BMI and recent weight gain, anemia, renal diseases and hypertension were the most frequent comorbidities related to sIH. CONCLUSION: Among sIH patients, 40.4% were obese or overweight; two thirds were women. We recommend that even patients with a typical IIH phenotype should be screened for secondary causes.

[Idiopathic intracranial hypertension].

Idiopathic intracranial hypertension (IIH) is a challenging disease characterized by an increase in intracranial pressure which occurs without any known cause. The disease is mainly seen in obese females of child-bearing age. While originally described as rare, the incidence is increasing in parallel with pandemic obesity, and clinicians in all fields are increasingly likely to meet patients with IIH. The condition causes major morbidity due to chronic headache and visual loss if untreated. In the past ten years new diagnostic criteria and guidelines for management have been published.

[Intracranial hypertension secondary to systemic lupus erythematosus].

Systemic lupus erythematosus (SLE) is a diagnostically challenging autoimmune multisystem disease with intracranial hypertension as a rare initial clinical manifestation. This is a case report of a 27-year-old woman with a prior history of psychogenic non-epileptic attacks, intracranial hypertension, headache, visual impairment, papilloedema, and a BMI of 24 kg/m2. Upon acetazolamide treatment for intracranial hypertension and before the diagnosis of SLE was reached, the patient developed respiratory distress and metabolic acidosis, due to underlying SLE glomerulonephritis.

Prevalence and clinical characteristics of headache in adolescents: a Croatian epidemiological study.

BACKGROUND: Headaches are often under-diagnosed in adolescents. The aim of this study was to examine the one-year prevalence of primary headaches among high school students in the city of Zagreb, the capital of Croatia. METHODS: This was a population-based, cross-sectional study. A total of 2350 questionnaires consisting of questions on demographic data, the presence and clinical characteristics of headaches were distributed among students in eight high schools; 2057 (87.5%) questionnaires were eligible for analysis. RESULTS: The mean age of the students was 17.2 ± 1.2 years; 50.2% were female. The prevalence of recurrent headache was 30.1% (620/2057), girls 35.1%, boys 25.2%. Among students with headache, 291 (46.9%) had migraine, and 329 (53.1%) had tension-type headaches (TTHs). The mean frequency of headaches was 5.66 per month in girls and 4.42 in boys; mean duration of a headache attack was 8.94 hours in girls and 8.37 hours in boys (NS). Unilateral headache was present in 31.6%, throbbing quality in 22.6%, dull in 34.4% of students; 22.4% had severe intensity and 70.3% moderate. Nausea was present in 4.0% always and in 14.7% frequently (girls 18.8%), photophobia in 41.3%, phonophobia in 63.2%, osmophobia in 23.9% (NS among genders). Almost 30% of students were disabled and stayed at home, more frequently boys. Girls (33.4%) were more likely to take drugs for every attack; number per month was 3.7. The results of this study showed that the prevalence of migraine among adolescents in Croatia was 16.5% for girls and 11.8% for boys; the prevalence of TTH was 18.4% for girls and 13.4% for boys. CONCLUSIONS: The prevalence of self-reported headache among high school students in Zagreb is relatively high. Significant gender differences in frequency and clinical characteristics were observed. Primary headaches among adolescents are an important public health problem and should receive more attention from school and health authorities.

Analysis of headache management in emergency room.

The aim of this study was to analyze the management of headache patients presenting to the emergency room (ER) at a university hospital in Zagreb. Retrospective analysis of all patients with headache was carried out during 2007. Patients were analyzed according to the diagnoses, diagnostic procedures, treatment and further referral. Among 6225 patients, 1385 (22.3%) complained of headache; there were 894 (64.5%) women and 491 (35.5%) men. Migraine with or without aura, tension-type headache or "cervicogenic headache" had 1004 (72.5%) patients (women 67.5% and men 32.5%); secondary headache had 381 (27.5%) patients: 89 (6.4%) stroke or intracranial hemorrhage, 33 (2.4%) primary tumor, 54 (3.9%) metastatic tumor, 200 (14.4%) head trauma with or without hemorrhage, and 5 (0.4%) had an infectious disease. Diagnostic procedure was performed in 413 (29.8%) patients: 314 (22.7%) underwent computerized tomography scan of the brain, 85 (6.1%) electroencephalography and 70 (5%) ultrasound examination. Nonsteroidal antiinflammatory drugs (NSAIDs) and diazepam were the most commonly prescribed medications, followed by fluids, simple analgesics and antiemetics, whereas opioids were prescribed to 3.0% of patients. Among patients with primary headaches, diagnostic procedure was performed in 235 (23.2%) patients, while 40 (4.0%) patients were hospitalized. In conclusion, one-fifth of the patients presenting to neurological ER complain of headache and approximately three-quarters have primary headache. The majority of patients are treated with NSAIDs and a minority with opioids. Better treatment for these patients should be provided by general practitioners and neurologists in outpatient headache clinics.

[Is the management of migraine and tension headache in Croatia satisfactory?]. / Je li lijecenje migrene i tenzijske glavobolje u Hrvatskoj zadovoljavajuce?

According to the epidemiological study conducted in Croatia, 15% of the population suffer from migraine, 20.6% from tension-type headache and 2.4% from chronic headache. Although migraine is a frequent primary headache and poses a major problem to both the affected individuals and the society, it is considered that migraine is underdiagnosed. The study revealed half of patients with headache and even 36.3% of respondents with migraine to have never visited a doctor. Migraine and tension-type headache are not satisfactorily treated; in the study, one-quarter of the respondents were fully satisfied with the treatment of their headaches, approximately half were partially satisfied, one-fifth were mostly unsatisfied, and 10% were completely unsatisfied. It should be noted that specific therapy for migraine attacks, i.e. triptans, are available on the market and can be administered for moderate and severe headache attacks. Triptans are prescribed rarely, not only in Croatia but also in the world, although studies have shown that the use of triptans increases productivity at work and improves the quality of life in migraineurs. Prophylaxis may significantly improve the quality of life; the Croatian epidemiological study showed only 14% of respondents with migraine to have ever used prophylactic therapy. Considering that migraine is an 'expensive disorder', appropriate treatment of patients with migraine will decrease the costs that include visits to general practitioners, emergency departments and cost of hospitalization. Even indirect costs will decrease as well, including the costs caused by absenteeism from work and costs caused by reduced efficiency at work. It is necessary to educate the population about migraine and therapeutic options. Lack of time, unrecognized patients and insufficient knowledge about current treatment of migraine and other primary headaches are probably the reasons why patients do not receive appropriate therapy. Continuous campaigns, which should include lectures and workshops for physicians and inclusion of media for better spread of information about primary headaches among the population should be encouraged.