[The impact of migraine and other primary headaches on the health system and in social and economic terms]. / Impacto social, económico y en el sistema de salud de la migraña y otras cefaleas primarias.

INTRODUCTION: Primary headaches are characterised by their high rates of prevalence and incidence among the general population. DEVELOPMENT: The main types of primary headaches that produce a significant social and economic impact as well as an important effect on the health system are migraine and tension-type headaches. Migraine is a condition that gives rise to a high percentage of visits to different health professionals and leads to a large number of prescriptions for medication, which in turn produces an increase in costs. Moreover, general practitioners and other specialists -even from the field of neurology- very often have scant knowledge about primary headaches, especially as regards topics concerning new therapies, the use of the International Headache Society's diagnostic criteria, epidemiology and comorbidities. Furthermore, many of these professionals seldom attend accredited courses in education in headaches and this means that the follow-up of the patients is often inadequate. CONCLUSIONS: The appearance of new pharmaceuticals for the abortive and preventive treatment of headaches, together with the creation of specialised headache centres, has allowed improvements to be made in the treatment of patients with lower overall costs for the health system. At the same time, occupational and personal productivity and quality of life have also been enhanced. Nevertheless, because the number of specialised headache centres is low and their implementation is more complex, there is a need for the creation and dissemination of programmes to educate general practitioners and other health care specialists in matters concerning headaches. Some of these programmes currently being run have obtained statistically significant positive results (p < 0.0001).

Impacto social, económico y en el sistema de salud de la migraña y otras cefaleas primarias / The impact of migraine and other primary headaches on the health system and in social and economic terms

Introducción. Las cefaleas primarias se caracterizan porpresentar altos índices de prevalencia e incidencia en la poblacióngeneral. Desarrollo. Las principales cefaleas primarias causantesde un significante impacto social, económico y sobre el sistema desalud son la migraña y la cefalea de tipo tensional. La migraña esuna entidad que representa un alto porcentaje de las consultas adiferentes profesionales de salud y que desencadena una alta prescripciónde medicamentos, lo que repercute en altos costes. Porotro lado, el conocimiento existente sobre cefaleas primarias pormédicos generales y otros especialistas –incluso del área neurológica–es pobre, en especial en tópicos relacionados con nuevos tratamientos,utilización de criterios diagnósticos de la Sociedad Internacionalde Cefaleas, epidemiología y comorbilidades. Adicionalmente,la asistencia de muchos de estos profesionales a cursosacreditados de educación en cefaleas es baja, por lo que propiciaun inadecuado seguimiento de los pacientes. Conclusiones. El surgimientode nuevos fármacos para el tratamiento abortivo y preventivode las cefaleas, y la creación de centros especializados decefalea ha permitido mejorar el tratamiento de los pacientes conmenores costes globales para el sistema de salud, con una mejoraen la productividad laboral y personal, y en la calidad de vida. Sinembargo, debido a que el número de centros especializados de cefaleaes bajo y su implementación es más compleja, se hace necesariala creación y difusión de programas de educación en cefaleaspara médicos generales y otros especialistas de la salud. Algunosde estos programas actualmente en desarrollo han obtenido resultadospositivos estadísticamente significativos (p < 0,0001)

Introduction. Primary headaches are characterised by their high rates of prevalence and incidence among thegeneral population. Development. The main types of primary headaches that produce a significant social and economicimpact as well as an important effect on the health system are migraine and tension-type headaches. Migraine is a conditionthat gives rise to a high percentage of visits to different health professionals and leads to a large number of prescriptions formedication, which in turn produces an increase in costs. Moreover, general practitioners and other specialists –even from thefield of neurology– very often have scant knowledge about primary headaches, especially as regards topics concerning newtherapies, the use of the International Headache Society’s diagnostic criteria, epidemiology and comorbidities. Furthermore,many of these professionals seldom attend accredited courses in education in headaches and this means that the follow-up ofthe patients is often inadequate. Conclusions. The appearance of new pharmaceuticals for the abortive and preventivetreatment of headaches, together with the creation of specialised headache centres, has allowed improvements to be made inthe treatment of patients with lower overall costs for the health system. At the same time, occupational and personalproductivity and quality of life have also been enhanced. Nevertheless, because the number of specialised headache centres islow and their implementation is more complex, there is a need for the creation and dissemination of programmes to educategeneral practitioners and other health care specialists in matters concerning headaches. Some of these programmes currentlybeing run have obtained statistically significant positive results (p < 0.0001)

[Cluster headache: its diagnosis, pathophysiology and treatment]. / Cefalea en racimos: diagnóstico, fisiopatología y tratamiento.

INTRODUCTION: Cluster headache (CH) is the most frequent subtype of trigeminal headache with autonomic symptoms (THAS); yet, despite its characteristic clinical profile it remains poorly understood and badly controlled. AIMS: To identify the correct diagnostic criteria of CH and the respective differential diagnoses, as well as to gain an understanding of the pathophysiology of CH, its treatment and prognosis by means of a review of the literature. DEVELOPMENT AND CONCLUSIONS: CH is a condition that is characterised by the presence of sharp, or extremely sharp, unilateral pain that is short-lasting and usually located in the retroocular and/or temporal region; it is also accompanied by ipsilateral autonomic symptoms (mainly conjunctival injection). CH can be differentiated from other THAS by the frequency with which it appears and the amount of time the pain lasts (the average is less than five attacks a day lasting from 30 minutes to 3 hours), as well as the response to treatment. A number of neuronal pathways are involved in the pathophysiology of CH. It has been suggested that the activation of the trigeminovascular and the parasympathetic systems, together with the dysfunction of the cranial sympathetic system, are involved in this condition. Moreover, there is evidence to support the role of functional and structural alterations in the hypothalamus. Treatment of CH is based on the proper pharmacological implementation of abortive, transitional and prophylactic therapies. Surgical interventions are recommended in patients with strictly unilateral pain in the ophthalmic division of the trigeminal nerve who are resistant to multiple therapies, and/or offer a poor response and/or contraindications to pharmacological treatment. Factors related to genetics, brain functioning or the environment, as well as the way the symptoms present (episodic or chronic), determine the prognosis of CH.

Cefalea en racimos: diagnóstico, fisiopatología y tratamiento / Cluster headache: its diagnosis, pathophysiology and treatment

Introducción. La cefalea en racimos (CR) es el subtipo decefalea trigeminal con síntomas autonómicos (CTA) más frecuente; sin embargo, a pesar de su característico perfil clínico continúa siendo pobremente reconocida y mal controlada. Objetivos. Aprender a identificar los correctos criterios diagnósticos de la CR y los diagnósticos diferenciales respectivos; comprender la fisiopatología de la CR, su tratamiento y pronóstico mediante la revisión de la literatura. Desarrollo y conclusiones. La CR es una entidad caracterizada por la presencia de dolor agudo o extremadamente agudo, unilateral, de corta duración, generalmente de ubicación retrooculary/o temporal, acompañada de síntomas autonómicos ipsilaterales (principalmente inyección conjuntival). La CR se puede diferenciar de otras CTA por la frecuencia de presentación y duración del dolor (promedio de menos de cinco crisis por día de más de 30 minutos a 3 horas), así como por la respuesta a los tratamientos. La fisiopatología de la CR involucra múltiples vías neuronales. Se sugiere la activación del sistema trigéminovascular y del sistema parasimpático, y disfunción del sistema simpático craneal. Por otro lado, hay evidencias de alteración funcional y estructural en el hipotálamo. El tratamiento de la CR se basa en la correcta implementación farmacológica de terapias abortiva, de transición y profiláctica. Los procedimientos quirúrgicos se recomiendan en pacientes con dolor estrictamente unilateral en la división oftálmica del nerviotrigémino refractarios a múltiples terapias, y/o con mala respuesta y/o contraindicaciones al tratamiento farmacológico. Factores genéticos, de funcionamiento cerebral, medioambientales, al igual que la forma de presentación (episódica o crónica), determinan el pronóstico de la CR (AU)

Introduction. Cluster headache (CH) is the most frequent subtype of trigeminal headache with autonomic symptoms (THAS); yet, despite its characteristic clinical profile it remains poorly understood and badly controlled. Aims. To identify the correct diagnostic criteria of CH and the respective differential diagnoses, as well as to gain an understanding of the pathophysiology of CH, its treatment and prognosis by means of a review of the literature. Development and conclusions. CHis a condition that is characterised by the presence of sharp, or extremely sharp, unilateral pain that is short-lasting and usually located in the retroocular and/or temporal region; it is also accompanied by ipsilateral autonomic symptoms (mainly conjunctival injection). CH can be differentiated from other THAS by the frequency with which it appears and the amount of time the pain lasts (the average is less than five attacks a day lasting from 30 minutes to 3 hours), as well as the response to treatment. A number of neuronal pathways are involved in the pathophysiology of CH. It has been suggested that the activation of the trigemino vascular and the parasympathetic systems, together with the dysfunction of the cranial sympathetic system, are involved in this condition. Moreover, there is evidence to support the role of functional and structural alterations in the hypothalamus. Treatment of CH is based on the proper pharmacological implementation of abortive, transitional and prophylactic therapies. Surgical interventions are recommended in patients with strictly unilateral pain in the ophthalmic division of the trigeminal nerve who are resistant to multiple therapies, and/or offer a poor response and/or contraindications to pharmacological treatment. Factors related to genetics, brain functioning or the environment (AU)

[Chronic daily headache: II. Treatment]. / Cefalea crónica diaria: II. Tratamiento.

INTRODUCTION: The difficulty involved in treating chronic daily headache (CDH), a frequent pathology with a multifactorial aetiology, makes it a challenging disorder for clinicians. CDH is a disease that causes significant impact on patients, employers and the health system. DEVELOPMENT: The treatment of CDH is based on the implementation of three therapies. The first is to establish a pharmacological treatment, with medication such as antidepressants, antiepileptic agents, muscle relaxants, and antihypertensive and antiserotoninergic drugs, either in mono or in polytherapy. The second measure is to stop the analgesic overuse. This is achieved by suddenly withdrawing the drugs or, in a combined manner, by stopping the analgesic intake and establishing bridge therapy (steroids or triptans), which, in addition to reducing the severity and frequency of seizures and the consumption of drugs, also help to lower the occurrence and duration of withdrawal symptoms. Hospital treatment is needed in cases of patients who are refractory to multiple therapies, with frequent visits to the emergency department, in presence of associated symptoms or comorbidities, and low tolerance to medication. The third measure is to implement non-pharmacological therapies, which are used to modify inappropriate behaviour as regards pain treatment, to promote proper medication consumption and to allow the patient comprehend the prognosis of the disease with and without treatment. CONCLUSIONS: Implementing these three therapies makes possible to reduce the severity, frequency and socioeconomic impact caused by headache and thereby improve patients' quality of life and capabilities.

[Chronic daily headache: I. Diagnosis and pathophysiology]. / Cefalea crónica diaria: I. Diagnóstico y fisiopatología.

INTRODUCTION: Chronic daily headache (CDH), or headache more than 15 days/month or over 180 days/year, is one of the main reasons for visits to specialised headache centres and accounts for up to 5% of primary headaches. AIMS: Our objective was to determine the classification, epidemiology, risk factors and pathophysiology of CDH by reviewing the literature. DEVELOPMENT: CDH has a prevalence of 2 to 3% in the general population and is subdivided into two groups according to the headache duration. The first group (more than four hours) represents over 90% patients; includes chronic migraine (60 to 87.4%), chronic tension-type headache (0.9 to 28.8%), new daily persistent headache (0.8 to 20%) and hemicrania continua (2.2%), which represents over 90% of patients. The second group (less than four hours) is made up of cluster, chronic paroxysmal hemicranial, idiopathic stabbing-type headache and cranial neuralgias. The pathophysiology of CDH is multifactorial; it has been suggested that genetic factors, peripheral and central neuronal dysfunction derived from the alteration of protein and receptor synthesis, inadequate release of inhibitory and excitatory neuropeptides, imbalance, excitatory and inhibitory neuropeptides concentration imbalance, in association with abuse of analgesics, high comorbidity with psychiatric disorders (anxiety, depression and panic) and sleep disorders may all be involved. CONCLUSIONS: CDH is a frequent cause of headache and chronic migraine is the main presenting symptom. Pathophysiology is multifactorial; there is a strong association with analgesic abuse, high comorbidity with psychiatric disorders and sleep disorders.

Cefalea crónica diaria: II. Tratamiento / Chronic daily headache: II. Treatment

Introducción. La cefalea crónica diaria (CCD), patología frecuente de etiología multifactorial, representa un reto clínico por su difícil manejo. La CCD es una enfermedad que genera un significativo impacto socioeconómico en los pacientes, los empleadores y el sistema de salud. Desarrollo. El tratamiento de la CCD se basa en la implementación de tres modalidades terapéuticas. La primera es la instauración de un tratamiento farmacológico, con medicamentos como antidepresivos, antiepilépticos, relajantes musculares, antihipertensivos y antiserotoninérgicos en monoterapia o politerapia. La segunda medida es la suspensión del abuso de analgésicos que se realiza suprimiendo abruptamente el consumo de medicamentos o, de manera combinada, con la suspensión del consumo de analgésicos y el inicio de terapias de enlace (esteroides o triptanes), que, además, de reducir la gravedad y frecuencia de crisis y el consumo de medicamentos, ayudan a reducir la presentación y duración de síntomas de abstinencia. El tratamiento hospitalario se requiere en pacientes refractarios a múltiples terapias, con frecuentes consultas a los servicios de urgencias, en presencia de síntomas asociados o comorbilidades, con pobre tolerancia a medicamentos. La tercera medida es la implementación de terapias no farmacológicas con las que se busca modificar conductas inapropiadas en torno al manejo del dolor, promover el correcto consumo de medicamentos y facilitar la comprensión del pronóstico de la enfermedad. Conclusión. La implementación de estas tres modalidades terapéuticas permite reducir la gravedad, la frecuencia y el impacto socioeconómico causado por la cefalea, lo cual mejora la calidad de vida y la funcionalidad de los pacientes

Introduction. The difficulty involved in treating chronic daily headache (CDH), a frequent pathology with a multifactorial aetiology, makes it a challenging disorder for clinicians. CDH is a disease that causes significant impact on patients, employers and the health system. Development. The treatment of CDH is based on the implementation of three therapies. The first is to establish a pharmacological treatment, with medication such as antidepressants, antiepileptic agents, muscle relaxants, and antihypertensive and antiserotoninergic drugs, either in mono or in polytherapy. The second measure is to stop the analgesic overuse. This is achieved by suddenly withdrawing the drugs or, in a combined manner, by stopping the analgesic intake and establishing bridge therapy (steroids or triptans), which, in addition to reducing the severity and frequency of seizures and the consumption of drugs, also help to lower the occurrence and duration of withdrawal symptoms. Hospital treatment is needed in cases of patients who are refractory to multiple therapies, with frequent visits to the emergency department, in presence of associated symptoms or comorbidities, and low tolerance to medication. The third measure is to implement non-pharmacological therapies, which are used to modify inappropriate behaviour as regards pain treatment, to promote proper medication consumption and to allow the patient comprehend the prognosis of the disease with and without treatment. Conclusions. Implementing these three therapies makes possible to reduce the severity, frequency and socioeconomic impact caused by headache and thereby improve patients’ quality of life and capabilities

Cefalea crónica diaria: I. Diagnóstico y fisiopatología / Chronic daily headache: I. Diagnosis and pathophysiology

Introducción. La cefalea crónica diaria (CCD) o cefalea de más de 15 días/mes o más de 180 días/año es una de las principales causas de consulta en los centros especializados de cefalea y representa hasta el 5% de las cefaleas primarias. Objetivos. Recoger la clasificación, la epidemiología, los factores de riesgo y la fisiopatología de la CCD mediante la revisión de la literatura. Desarrollo. La CCD tiene una prevalencia del 2 al 3% en la población general y se subdivide en dos subgrupos según la duración del dolor. En el primer grupo (más de cuatro horas) se encuentran la migraña crónica (60 al 87,4%), la cefalea tipo tensional crónica (0,9 al 28,8%), la cefalea crónica diaria de novo (0,8 al 20%) y la hemicránea continua (2,2%), que representan más del 90% de los pacientes. El segundo grupo (menos de cuatro horas) está constituido por la cefalea en racimo, la hemicránea paroxística crónica, la cefalea tipo punzada idiopática y las neuralgias craneales. La fisiopatología de la CCD es multifactorial; se sugiere la participación de factores genéticos, disfunción neuronal periférica y central derivada de una alteración de la síntesis proteica y de receptores, inadecuada liberación de neuropéptidos, desequilibrio, concentración de neuropéptidos inhibidores y excitadores –en asociación con el abuso de analgésicos–, alta comorbilidad con trastornos psiquiátricos (ansiedad, depresión y pánico) y trastornos del sueño. Conclusión. La CCD es una causa frecuente de cefalea, y la migraña crónica es la principal forma de presentación. La fisiopatología es multifactorial; existe una alta asociación con el abuso de analgésicos, alta comorbilidad con trastornos psiquiátricos y trastornos del sueño

Introduction. Chronic daily headache (CDH), or headache more than 15 days/month or over 180 days/year, is one of the main reasons for visits to specialised headache centres and accounts for up to 5% of primary headaches. Aims. Our objective was to determine the classification, epidemiology, risk factors and pathophysiology of CDH by reviewing the literature. Development. CDH has a prevalence of 2 to 3% in the general population and is subdivided into two groups according to the headache duration. The first group (more than four hours) represents over 90% patients; includes chronic migraine (60 to 87.4%), chronic tension-type headache (0.9 to 28.8%), new daily persistent headache (0.8 to 20%) and hemicrania continua (2.2%), which represents over 90% of patients. The second group (less than four hours) is made up of cluster, chronic paroxysmal hemicranial, idiopathic stabbing-type headache and cranial neuralgias. The pathophysiology of CDH is multifactorial; it has been suggested that genetic factors, peripheral and central neuronal dysfunction derived from the alteration of protein and receptor synthesis, inadequate release of inhibitory and excitatory neuropeptides, imbalance, excitatory and inhibitory neuropeptides concentration imbalance, in association with abuse of analgesics, high comorbidity with psychiatric disorders (anxiety, depression and panic) and sleep disorders may all be involved. Conclusions. CDH is a frequent cause of headache and chronic migraine is the main presenting symptom. Pathophysiology is multifactorial; there is a strong association with analgesic abuse, high comorbidity with psychiatric disorders and sleep disorders

[Headaches in idiopathic intracranial hypertension. A review of ten years in a Columbian hospital]. / Cefaleas en hipertensión intracraneal idiopática. Revisión de diez años en un hospital colombiano.

INTRODUCTION: Different patterns of headache have been reported in idiopathic intracranial hypertension. PATIENTS AND METHODS: We conducted a retrospective study to evaluate patients in a Columbian hospital who satisfied Friedman and Jacobson criteria for idiopathic intracranial hypertension. Two groups of patients, with throbbing headaches (TH) and heaviness/oppressive headaches (HOH), were correlated with International Headache Society classification criteria. RESULTS: We found 16 patients, 14 of whom were females (87.5%), with a mean age of 27 years. Patients had a history of two months or more (43.7%), 1-2 months (25%) and 2 weeks (18.7%). Six patients were found to be suffering from TH and nine had HOH. In the TH group, headaches were hemicranial (50%), frontal (33.3%), moderate (33.3%), severe (66.6%), got worse with activity (100%), with sickness/vomiting (83.3%), and photophobia (33.3%). All of them had clinical parameters similar to those of migraine. In the HOH group headaches were global (33.3%), hemicranial (22.2%), frontal and occipital (22.2%), moderate (66.6%), severe (33.3%), and with sickness/vomiting (55.5%). 66.6% of them had clinical parameters similar to those of de novo chronic daily headache (NCDH). On carrying out a physical examination in all the patients, paresis of the abducent nerve was found in 31.2% and papilloedema in 93.7%. The average opening pressure was 27 cmH2O. Computerised axial tomography scanning revealed unspecific anomalies in 18.7% and they were also observed with magnetic resonance imaging in 31.2%. Associated pathologies were found in six patients (37%). Pharmacological treatment was effective in 93.8%. There were no relapses or sequelae. CONCLUSIONS: Idiopathic intracranial hypertension is a malady affecting young people, mainly females, with subacute headaches and symptoms similar to those of migraine and NCDH. A neurological abnormality suggestive of intracranial hypertension was found in 31.2-93.7% of patients.

[The effectiveness and safety of botulinum toxin in the treatment of chronic primary headaches]. / Eficacia y seguridad del tratamiento con toxina botulínica en las cefaleas primarias crónicas.

INTRODUCTION: Primary headaches (PH), which are highly prevalent pathologies, are linked to high morbidity and disability rates and high costs for the health care system. Due to the partial effectiveness of prophylactic treatments, especially in chronic headaches, or the existence of contraindications that make them unsuitable for prescription, the use of botulinum toxin (BTX) arises as a promising preventive therapy. AIMS: The purpose of this study was to determine the usefulness and the mechanism of action of BTX in PH through a review of the literature. DEVELOPMENT: Recent results of BTX use in PH are contradictory and, although controlled studies with placebos are scarce, it has been suggested that it could have a grade II-III evidence level of effectiveness and safety, with greater benefits in refractory chronic migraine and chronic tension-type headache, together with the absence of analgesic abuse and psychiatric illness. The probable mechanism of action in PH is through a peripheral antinociceptive effect related to a decreased release of neuropeptides and to the transmission of impulses with indirect inhibition of nociceptive centres in the brain stem, which is an effect that is apparently intensified with repeated applications. A correlation has been claimed between the use of BTX and a reduction in the intensity, severity, number of headaches per month, diminished use of analgesics per month and lowered total management costs. Side effects of the treatment are infrequent (< 1%) and transient. CONCLUSIONS: Despite findings that have proved BTX to be effective and safe as prophylactic therapy in PH, it is still not considered to be the first choice preventive treatment. Further studies are needed to establish sites, doses and application schemas (fixed vs. mobile), as well as a subtype of patients who can benefit from its use.

Cefaleas en la hipertensión intracraneal idiopática. Revisión de diez años en un hospital colombiano / Headaches in idiopathic intracranial hypertension. A review of ten years in a Columbian hospital

Introducción. Se han descrito diversos patrones de cefalea en la hipertensión intracraneal idiopática. Pacientes y métodos. Se realizó un estudio retrospectivo en el que se evaluaron pacientes de un hospital colombiano que cumplieran los criterios de Friedman y Jacobson de hipertensión intracraneal idiopática. Dos grupos de pacientes, con cefalea pulsátil (CP) y cefalea opresiva/pesadez (COP), se correlacionaron con los criterios de clasificación de la Sociedad Internacional de Cefaleas. Resultados. Se encontraron 16 pacientes, 14 mujeres (87,5 por ciento), con una edad promedio de 27 años. La evolución fue dos meses o más (43,7 por ciento), de 1-2 meses (25 por ciento) y de 2 semanas (18,7 por ciento). Se encontraron seis pacientes con CP y nueve con COP. En el grupo CP, la cefalea fue hemicraneal (50 por ciento), frontal (33,3 por ciento), moderada (33,3 por ciento), grave (66,6 por ciento), empeoraba con la actividad en el 100 por ciento, con náuseas/vómito (83,3 por ciento) y con fotofobia (33,3 por ciento). Todos los pacientes tenían parámetros clínicos similares a la migraña. En el grupo COP la cefalea fue global (33,3 por ciento), hemicraneal (22,2 por ciento), frontal y occipital (22,2 por ciento), moderada (66,6 por ciento), grave (33,3 por ciento), con náuseas/vómito (55,5 por ciento). El 66,6 por ciento presentaban parámetros clínicos similares a los de cefalea crónica diaria de novo (CCDN). En el examen físico de todos los pacientes se encontró paresia del VI par en el 31,2 por ciento y papiledema en el 93,7 por ciento. El promedio de presión de apertura fue de 27 cmH2O. Se observaron anormalidades inespecíficas en la tomografía axial computarizada en el 18,7 por ciento y en la resonancia magnética en el 31,2 por ciento. En seis pacientes (37 por ciento) se encontraron patologías asociadas. El tratamiento farmacológico fue efectivo en el 93,8 por ciento. No hubo recaídas ni secuelas. Conclusión. La hipertensión intracraneal idiopática es una entidad de personas jóvenes, principalmente mujeres, con cefalea subaguda, con sintomatología similar a la de la migraña y la CCDN. En el 31,2-93,7 por ciento se encuentra alguna anormalidad neurológica sugestiva de hipertensión intracraneal (AU)

Introduction. Different patterns of headache have been reported in idiopathic intracranial hypertension. Patients and methods. We conducted a retrospective study to evaluate patients in a Columbian hospital who satisfied Friedman and Jacobson criteria for idiopathic intracranial hypertension. Two groups of patients, with throbbing headaches (TH) and heaviness/ oppressive headaches (HOH), were correlated with International Headache Society classification criteria. Results. We found 16 patients, 14 of whom were females (87.5%), with a mean age of 27 years. Patients had a history of two months or more (43.7%), 1-2 months (25%) and 2 weeks (18.7%). Six patients were found to be suffering from TH and nine had HOH. In the TH group, headaches were hemicranial (50%), frontal (33.3%), moderate (33.3%), severe (66.6%), got worse with activity (100%), with sickness/vomiting (83.3%), and photophobia (33.3%). All of them had clinical parameters similar to those of migraine. In the HOH group headaches were global (33.3%), hemicranial (22.2%), frontal and occipital (22.2%), moderate (66.6%), severe (33.3%), and with sickness/vomiting (55.5%). 66.6% of them had clinical parameters similar to those of de novo chronic daily headache (NCDH). On carrying out a physical examination in all the patients, paresis of the abducent nerve was found in 31.2% and papilloedema in 93.7%. The average opening pressure was 27 cmH2O. Computerised axial tomography scanning revealed unspecific anomalies in 18.7% and they were also observed with magnetic resonance imaging in 31.2%. Associated pathologies were found in six patients (37%). Pharmacological treatment was effective in 93.8%. There were no relapses or sequelae. Conclusions. Idiopathic intracranial hypertension is a malady affecting young people, mainly females, with subacute headaches and symptoms similar to those of migraine and NCDH. A neurological abnormality suggestive of intracranial hypertension was found in 31.2-93.7% of patients (AU)

Eficacia y seguridad del tratamiento con toxina botulínica en las cefaleas primarias crónicas / The effectiveness and safety of botulinum toxin in the treatment of chronic primary headaches

Introducción. Las cefaleas primarias (CP), patologías con alta prevalencia, se asocian a altas tasas de morbilidad e incapacidad y altos costos para el sistema de salud. Debido a la efectividad parcial de los tratamientos profilácticos, especialmente en las cefaleas crónicas o por contraindicaciones para la prescripción, el uso de toxina botulínica (TXB) surge como una terapia preventiva prometedora. Objetivo. Determinar la utilidad y el mecanismo de acción de la TXB en la CP mediante la revisión de la literatura. Desarrollo. Los resultados del reciente uso de la TXB en la CP son contradictorios y, aunque se carece de suficientes estudios controlados con placebo, se sugiere que podría tener un nivel de evidencia de eficacia y seguridad II-III, con un mayor beneficio en la migraña crónica y la cefalea del tipo tensional crónica refractarias, en ausencia de abuso de analgésicos y de enfermedad psiquiátrica. El probable mecanismo de acción en la CP se debe a un efecto antinociceptivo periférico relacionado con la disminución de la liberación de neuropéptidos y de la transmisión de impulsos, con una inhibición indirecta de los centros nociceptivos situados en el tallo cerebral, efecto que, aparentemente, se intensifica con aplicaciones repetidas. El uso de la TXB se ha correlacionado con una reducción de la intensidad de la cefalea, de su gravedad, del número de cefaleas/mes, del uso de analgésicos/mes y de los costos totales de manejo. Los efectos adversos del tratamiento son mínimos (< 1 por ciento) y transitorios. Conclusión. A pesar de los resultados que han demostrado la eficacia y seguridad de la TXB como terapia profiláctica en la CP, no se considera aún como tratamiento preventivo de primera elección. Se requieren más estudios para establecer los sitios, las dosis y los esquemas de aplicación (fijo frente a móvil), así como el subtipo de pacientes beneficiarios (AU)

Introduction. Primary headaches (PH), which are highly prevalent pathologies, are linked to high morbidity and disability rates and high costs for the health care system. Due to the partial effectiveness of prophylactic treatments, especially in chronic headaches, or the existence of contraindications that make them unsuitable for prescription, the use of botulinum toxin (BTX) arises as a promising preventive therapy. Aims. The purpose of this study was to determine the usefulness and the mechanism of action of BTX in PH through a review of the literature. Development. Recent results of BTX use in PH are contradictory and, although controlled studies with placebos are scarce, it has been suggested that it could have a grade II-III evidence level of effectiveness and safety, with greater benefits in refractory chronic migraine and chronic tension-type headache, together with the absence of analgesic abuse and psychiatric illness. The probable mechanism of action in PH is through a peripheral antinociceptive effect related to a decreased release of neuropeptides and to the transmission of impulses with indirect inhibition of nociceptive centres in the brain stem, which is an effect that is apparently intensified with repeated applications. A correlation has been claimed between the use of BTX and a reduction in the intensity, severity, number of headaches per month, diminished use of analgesics per month and lowered total management costs. Side effects of the treatment are infrequent (< 1%) and transient. Conclusions. Despite findings that have proved BTX to be effective and safe as prophylactic therapy in PH, it is still not considered to be the first choice preventive treatment. Further studies are needed to establish sites, doses and application schemas (fixed vs. mobile), as well as a subtype of patients who can benefit from its use (AU)

[Mesial temporal lobe epilepsy: its physiopathology, clinical characteristics, treatment and prognosis]. / Epilepsia del lobulo temporal mesial: fisiopatologia, caracteristicas clinicas, tratamiento y pronostico.

INTRODUCTION: The prevalence of epilepsy in the population is between 15 and 18 per 1000. About 60 to 80% of the people affected are considered to have an appropriate long term prognosis (from 5 to 10 years), while between 20 and 40% respond partially to pharmacological therapy. Temporal lobe epilepsy (TLE) is the main cause of refractory epilepsies and is associated to atrophy and sclerosis of the hippocampus. Aims. To determine the physiopathology, clinical characteristics, modes of therapy and prognosis of TLE through a survey of the literature. DEVELOPMENT: The physiopathology of this disease is unknown but early brain injury, with ensuing neuronal death and loss, triggered by mechanisms of excitotoxicity has been put forward as an explanation. TLE presents a clinical picture, which is heterogeneous in childhood and homogeneous in adulthood, that is characterised by the presence of simple partial seizures and complex partial seizures. These seizures can become generalised. Diagnosis is based on the results from the electroencephalogram and from the cranial magnetic resonance, which is currently considered to be the standard diagnostic method. The pharmacological treatment of TLE only achieves complete control over the seizures in less than 20% of patients. Surgical methods, such as anterior temporal lobectomy and amygdalohippocampectomy, reach control rates in 67 85% of patients, with low morbidity and mortality rates. Although prognosis depends on a number of factors, surgical treatment improves the quality of life of these patients.

[Thrombosis of the cerebral venous sinuses: a description of its clinical features, risk factors and treatment in a hospital of Colombia]. / Trombosis de senos venosos cerebrales: descripción de las características clínicas, factores de riesgo y tratamiento en un hospital de Colombia.

INTRODUCTION: Thrombosis of the cerebral venous sinuses (TCVS) is an infrequent entity that still represents a challenge in health care. PATIENTS AND METHODS: A descriptive study involving the evaluation of the medical records of patients that met the following criteria: over 18 years of age with a diagnosis of TCVS confirmed by CAT scan or cranial MRI, the absence of a history of intracranial surgery in the previous six months and absence of a history of intracranial infection. RESULTS: A total of 15 patients (14 females and one male) were found with an average age of 28.6 years. The time required for the development of the most frequent symptoms was 1 10 days (60%). The usual presentation was a syndrome of intracranial hypertension with focalisation and encephalopathy. Risk factors were identified in 13 patients (87%). TCVS was diagnosed by cranial MRI in the case of 14 patients (93%), by CAT scanning in one (7%) and this was also used to orient diagnosis in 12 cases (80%). The most frequently affected sinuses were the superior longitudinal and transverse, in 10 cases each (66%), and venous infarctions were also detected in 10 patients (66%). In the patients in whom we were able to evaluate clotting disorders, it was found that the only individual who displayed activated protein C resistance was positive, three out of four patients had a protein C deficiency and four out of six had an antithrombin III deficiency. CONCLUSION: TCVS presents as an intracranial hypertension syndrome and it is possible to find risk factors in as many as 85% of the cases.

Trombosis de senos venosos cerebrales: descripción de las características clínicas, factores de riesgo y tratamiento en un hospital de Colombia / Thrombosis of the cerebral venous sinuses: a description of its clinical features, risk factors and treatment in a hospital of Colombia

Introducción. La trombosis de senos venosos cerebrales (TSVC) es una entidad poco frecuente que todavía es un reto. Pacientes y métodos. Estudio descriptivo en el que se evaluaron las historias clínicas que cumplieran con los siguientes criterios: mayores de 18 años con diagnóstico confirmado de TSVC por TAC o RM craneal, ausencia de antecedente de cirugía intracraneal en los seis meses previos y ausencia de antecedente de infección intracraneal. Resultados. Se encontraron 15 pacientes, 14 mujeres y un hombre, con una edad promedio de 28,6 años. El intervalo de evolución de los síntomas más frecuentes fue de 1-10 días (60 por ciento). La presentación habitual fue un síndrome de hipertensión intracraneal con focalización y encefalopatía. Se identificaron factores de riesgo en 13 pacientes (87 por ciento). El diagnóstico de TSVC se realizó por RM craneal en 14 pacientes (93 por ciento), por TAC en uno (7 por ciento), y ésta orientó al diagnóstico en 12 (80 por ciento). Los senos más comúnmente afectados fueron el longitudinal superior y transverso, en 10 casos cada uno (66 por ciento), y se detectaron infartos venosos en 10 (66 por ciento). En los pacientes en que se lograron evaluar alteraciones de la coagulación, se encontró que el único paciente en el que se determinó resistencia a la proteína C activada fue positivo, tres de cuatro pacientes tenían déficit de proteína C y cuatro de seis tenían déficit de antitrombina III. Conclusión. La TSVC se manifiesta como un síndrome de hipertensión intracraneal y es posible encontrar factores de riesgo hasta en el 85 por ciento de los casos (AU)

Introduction. Thrombosis of the cerebral venous sinuses (TCVS) is an infrequent entity that still represents a challenge in health care. Patients and methods. A descriptive study involving the evaluation of the medical records of patients that met the following criteria: over 18 years of age with a diagnosis of TCVS confirmed by CAT scan or cranial MRI, the absence of a history of intracranial surgery in the previous six months and absence of a history of intracranial infection. Results. A total of 15 patients (14 females and one male) were found with an average age of 28.6 years. The time required for the development of the most frequent symptoms was 1-10 days (60%). The usual presentation was a syndrome of intracranial hypertension with focalisation and encephalopathy. Risk factors were identified in 13 patients (87%). TCVS was diagnosed by cranial MRI in the case of 14 patients (93%), by CAT scanning in one (7%) and this was also used to orient diagnosis in 12 cases (80%). The most frequently affected sinuses were the superior longitudinal and transverse, in 10 cases each (66%), and venous infarctions were also detected in 10 patients (66%). In the patients in whom we were able to evaluate clotting disorders, it was found that the only individual who displayed activated protein C resistance was positive, three out of four patients had a protein C deficiency and four out of six had an antithrombin III deficiency. Conclusion. TCVS presents as an intracranial hypertension syndrome and it is possible to find risk factors in as many as 85% of the cases (AU)