Tension-type headaches

Tension-type headaches are generally characterized by slowly progressive, dull, constant, nonpulsatile pain in the occipital and posterior neck or in a "headband" distribution. Episodic tension-type headaches occur fewer than 15 times a month, and chronic tension-type headaches occur more than 15 times a month for at least six months. Cranial radiography, computed tomographic scanning, electroencephalography and other adjunctive tests are unnecessary if the presentation is typical and the headache is not associated with seizure activity, mental status changes, neurologic deficits and other markers of potentially serious underlying disease. Treatment of episodic tension-type headaches may include topical heat or cold packs, exercise and other stress-reduction techniques, mild analgesics, muscle relaxants and trigger-point injections. Some patients may benefit from antidepressants and individual or family counseling.     

Hyperprolactinemia and headaches

We investigated the frequency of headaches in women with menstrual abnormalities and hyperprolactinemia. Twenty-seven of 46 (58%) women with hyperprolactinemia indicated that headache episodes occur once or more per week; patients with sellar abnormalities (macroadenoma) or previous cranial or pituitary operation were excluded from this group of hyperprolactinemic patients. The headache episodes occurred significantly more frequently than in the control group (N = 56), where 27% indicated one or more headaches per week (p less than 0.01). In the vast majority of the women with hyperprolactinemia, headaches had preceded the finding of elevated prolactin levels for years and had not developed after the patients had become concerned about the pituitary gland. The clinical impression was that the headaches of these patients typically lack features of prodromal signs and unilaterality and resemble, in general, tension headaches; they may last for hours and often require medication. We could not demonstrate a relationship between prolactin levels and frequency or severity of these headache episodes. The etiology of these headaches is unclear. The therapeutic effect of bromocriptine deserves further investigation. In conclusion, we present data to suggest that headaches are commonly an associated finding in hyperprolactinemic women who have no evidence of significant pituitary enlargement.     

Reducing headaches after a myelogram

Presented here is the first report of a pregnancy complicated by symptomatic polycystic liver disease. Associated abdominal pain necessitated transcutaneous hepatic cyst aspiration at 5, 13, 20, 24, 30, and 34 weeks' gestation. Labor was induced at 35 weeks' gestation after confirmation of fetal pulmonary maturity.     

Clinical assessment of posttraumatic headaches

The evaluation of the person with posttraumatic headache remains a difficult clinical task. The rehabilitation clinician seeing the person with posttraumatic headache may encounter a large spectrum of potential etiologies for cephalgia. We believe an ordered approach to the history, physical, and laboratory examination may lead to a more accurate and focused diagnosis in some cases. In an attempt to provide a directed approach to posttraumatic headaches, this discussion is divided into extracranial and intracranial sources. A brief table guide to the etiology of pain by site is presented, and the key eight steps of examination are reviewed.     

Thermal sensitivity in unilateral headaches

Thermal thresholds were measured in the face (first and second trigeminal area), over the mastoid process (C2-3 area), and in the hands in patients with migraine (n=17), cluster headache (n=22), and cervicogenic headache (n=20). Significant symptomatic versus nonsymptomatic side differences were generally not found for any headache group. Cluster headache patients had significantly higher warm thresholds than controls (n=24) for most of the cephalic points. Cervicogenic headache patients had significantly higher warm and cold thresholds than controls (n=56) at several cephalic and noncephalic points. Warm thresholds over the mastoid process on the symptomatic side were higher in cervicogenic headache patients compared to the other groups. In migraine patients, thermal thresholds were similar to those in controls. Thus, we found no evidence of focal or unilateral peripheral somatic nerve dysfunction involving C or A-delta fibers in any of the studied headache groups, although a C2-3 root dysfunction in cervicogenic headache could not be excluded. A bilateral central sensory dysfunction in cluster headache and cervicogenic headache may be hypothesized but a generalized peripheral dysfunction can also explain our results.     

Chronic headaches and sleep disorders

BACKGROUND: Headaches and sleep problems are common complaints in the daily practice of the general practitioner. Since the relationship between headaches and sleep complaints is complex, clear models of interaction are needed for adequate diagnosis and treatment. METHODS: All subjects, successively seen in a headache clinic during a defined period, were subdivided based on the time of onset of cephalalgia. Subjects who reported onset of headache on a long-term basis, during the nocturnal or early morning (before final awakening) period, were systematically studied by a headache clinic and a sleep disorders center. This subgroup represented 17% of the total headache group. RESULTS: Although the results of the headache clinic study did not differentiate this subgroup from the other patients, the sleep disorders center's interviews and questionnaires demonstrated a significant impact of the sleep disorders on headache and daytime function. Nocturnal monitoring during sleep identified specific sleep disorders in 55% of the subjects with onset of headache during the nocturnal sleep period. Follow-up after treatment of the sleep disorder showed that all subjects with an identifiable sleep disorder reported either an improvement or absence of their headache. The subjects identified with periodic limb movement syndrome were mostly those who reported only an improvement in their sleep and still needed treatment for their headaches. The question of the interaction and association of sleep-related headache and periodic limb movement syndrome is unresolved. CONCLUSION: Headaches occurring during the night or early morning are often related to a sleep disturbance.     

Treating headaches. A conceptual framework

BACKGROUND: Similar medications are effective in migraine and muscle contraction headache therefore the term recurrent headache is used to cover the spectrum of classic migraine and muscle contraction headache. OBJECTIVE: The concept of a threshold to headache triggers is proposed. Treatment for chronic headaches is directed at raising the threshold or removing triggers. DISCUSSION: The most important factors that lower the threshold to headaches are hormones, mood and sleep disturbance. Therapeutic strategies for raising the threshold and treatment of the acute headache are discussed.     

Factors contributing to so-called idiopathic headaches]

The interest in factors that may trigger in some cases idiopathic headache has increased in recent years. This problem has not been discussed in Polish literature up to now. An analysis of precipitating factors in a group of 116 patients: 70 with migraine, 30 with tension type of headache and 16 with cluster headache was conducted. In these groups: 60 patients (87%) with migraine, 24 patients (80%) with tension type headache and 15 patients (94%) with cluster headache confirmed activity of precipitating factors was shown. Stress was the most frequently cited precipitant in all types of idiopathic headaches (migraine-58%; tension type headache-53%; cluster headache-50%). Weather changes were in the second place. Excessive environmental factors, oversleep, some foods were also prominent factors.     

Unusual aneurysms

Cerebral aneurysms can present in a variety of special circumstances. Aneurysmal subarachnoid hemorrhage (SAH) can complicate systemic or neoplastic disease, head injuries, arterial dissection, and other cerebrovascular conditions. Aneurysms associated with non-saccular configuration or giant size can make surgical or endovascular intervention difficult if not impossible. This article will review these uncommon aneurysms and their management.     

Atypical cases of acute headaches of cerebrovascular origin

Acute headaches can be an important signal of a cerebrovascular event. In some cases, as illustrated in this article, such headaches may have the same characteristics as migraine or be the main feature of unusual types of cerebrovascular disease. Headache should not be underestimated since misdiagnosis of cerebrovascular disease can lead to serious consequences.     

Childhood headaches: discrete entities or continuum?

The aims of this study were to investigate the signs and symptoms of recurrent headaches in children and to identify if there are any discrete groups of children whose headaches corresponded to the World Federation of Neurology (1969) definition of migraine. One-hundred and fifty children recruited from the neurology clinics at Royal Manchester, Booth Hall, and Birmingham Children's Hospitals were interviewed to complete a standardized questionnaire. The data were examined using cluster analysis followed by comparative analysis of the headache signs and symptoms in the different groups identified. No stable groups were identified (i.e., no group was reliably identified by different methods of cluster analysis) which corresponded to the World Federation of Neurology definition of migraine. This would suggest that this definition is not appropriate for the sample investigated. Three groups of children evolved after cluster analysis. None of these groups was in agreement with the International Headache Society classification of headaches. The groups were neither 'stable' clusters nor 'useful' in predicting prognosis. This outcome supports the continuum theory of headache syndromes.     

The clinical link between migraine and cluster headaches

We describe seven patients with vascular headaches. Five of them had cluster headaches, which were preceded by migrainous scotamata (two patients), weakness contralateral to the pain (one), accompanied by ipsilateral photopsias (one), or by contralateral paresthesias (one). The other two patients had "clusters" of daily common migraine headaches separated by long free intervals. The symptoms of these patients suggest a common root for cluster and migraine headaches.     

Exploration of extra-cephalic pain induced in essential headaches

The deep pain threshold and migrainous patient's tolerance were investigated by different methods such as: the post-ischemic stasis, muscular exercise in an ischemic condition, sural pressure, comparing them with the cold pain test employed to assess the superficial pain threshold. The tests were carried out simultaneously and symmetrically to both extremities in order to check the possible asymmetry of the pain threshold. Migrainous patients showed a reduced threshold and a lower tolerance to deep pain, while this is not evident when testing the superficial threshold. The simultaneous measurement of both extremities showed higher differences in migrainous patients than in control patients. The meaning of the change of systemic pain is discussed, with special reference to the possible correlation with the hypothesis of a central origin of pain in essential headaches.     

Attempt at the classification of chronic and recurrent headaches

The authors describe a proposal of classification of chronic and recurrent headaches based on criteria different from those used as yet. The initial criterion of headache classification was its extent and location: 1) diffuse, 2) partial, 3) posterior, b) anterior, 3)localized. Another element is: 1) unequivical or 2) non-unequivical clinical pattern. Definite clinical entities, probable aetiological factors, or possible pathological mechanisms are referred to definite extent and localization, and unequivocal or non-unequivocal clinical patterns.