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.     

Side-locked unilaterality and pain localization in long-lasting headaches: migraine, tension-type headache, and cervicogenic headache

Side-locked unilaterality and specific localization of pain are not as well-defined clinical characteristics in long-lasting headaches (duration more than 4 hours) as they are in short-lasting forms. We examined side-locked unilaterality and pain distribution at onset and at peak headache in 74 patients with different forms of long-lasting headache: migraine and tension-type headache (IHS) and cervicogenic headache (according to Sjaastad et al). Side-locked unilaterality of pain was found in all forms, but to differing extents - 20.8% in migraine, 12.5% in tension-type headache, while it was a mandatory criterion for cervicogenic headache. The pain tended to localize anteriorly, particularly at onset, in migraine; was more diffuse in tension-type headache; and always began in the occipitonuchal region in cervicogenic headache. Our results may contribute to a better clinical definition of long-lasting headaches.     

A new type of headache of ocular origin: ophthalmotonic headache. Diagnosis and treatment

INTRODUCTION: In some patients it was seen that chronic headaches disappeared after laser iridectomies had been done to prevent glaucoma, in persons with normal intra-ocular pressure (IOP). OBJECTIVE: To make a study of patients with headache, some of whom were treated with topical beta-blockers (carteolol) and others by Yag-laser iridectomies. The effect on headache and IOP was analyzed. MATERIAL AND METHODS: A survey, ophthalmological examination and headache provocation test were carried out in patients with headaches, and the changes in IOP determined by pharmacologically inducing miosis and mydriasis were recorded. Three treatment groups were formed and the results analyzed statistically. RESULTS: In the 12 patients treated pharmacologically, 62% improved and in 14% the headaches disappeared. In the 16 treated using laser 94% were cured and 6% improved. When both types of treatment were used on 9 patients, 22% improved and 78% were cured. The validity of the ocular pressure curve was checked in the diagnosis of blockage of the pupil. CONCLUSIONS: Some headaches of ocular origin (ophthalmotonic), not previously described, occur due to abrupt changes in intraocular pressure, and improve significantly when the IOP is reduced by beta-blockers or Yag-laser iridectomies are done. A valid provocation tests for diagnosis of this type of headache is described. We consider that blockage of the pupil and/or of the angle of the anterior chamber are possible etiopathogenic mechanisms.     

Response to prophylactic treatment of benign headache in children

INTRODUCTION: Common childhood headaches seldom require prophylactic treatment which, nevertheless, is quite often unsatisfactory. OBJECTIVE: To study drug and non-drug related factors that may influence the therapeutic response. MATERIAL AND METHODS: A four-month follow-up study of all patients attended during a year at the neuropediatric, outpatient hospital-based clinic, with > or = 2 monthly migraine without aura attacks, > or = 10 tension-type headaches, or both types of headaches. Patients were randomized to be treated on an open basis, placebo controlled, with flunarizine or piracetam. Headache frequency was evaluated according to treatment and patients' basal characteristics. RESULTS: 98 patients studied (56 migraine without aura, 24 tension-type headache, 18 mixed). 33% dropped out; they were school underachievers more frequently than those that completed the protocol. Of those completing the protocol and treated with placebo as the first choice of therapy, 27% reported total remission of symptomatology; those not remitting with placebo were high achievers at school significatively more frequently. At the end of the trial, 43% of the initially randomized patients still complained of headaches, regardless of treatment, showing a seasonal relationship. CONCLUSIONS: Prophylaxis of benign childhood headaches is needed in less than half of those reporting a high headache frequency; school achievement should be taken into consideration as another clue to compliance and headache persistence. On a short-term basis only the seasonal influence and the placebo effect can be held responsible for amelioration of symptomatology.     

Perioperative ingestion of caffeine and postoperative headache

The interruption of daily consumption of caffeine-containing beverages can cause headache and other symptoms within 8 hours. Resumption of caffeine alleviates these symptoms. Surgical patients routinely fast preoperatively and may have postoperative symptoms from caffeine withdrawal. In the current study, we determined whether perioperative caffeine consumption altered the incidence of postoperative headache. After institutional approval of the study design, 233 surgical outpatients were surveyed about history of headaches, caffeine consumption, and the presence and severity of headaches postoperatively. Of the 233 patients, 190 (82%) drank caffeinated beverages daily (mean daily consumption, 290 mg of caffeine). Postoperative headaches occurred in 22% of patients who routinely drank caffeinated beverages but in only 7% of those who did not (P < 0.03). Other factors associated with postoperative headaches included a history of frequent headaches (P < 0.0001), age of 50 years or younger (P < 0.002), and amount of daily caffeine ingested (P < 0.01). Among daily caffeine drinkers, those who drank caffeinated beverages on the day of the surgical procedure had a lower incidence of postoperative headaches than did those who abstained (17% versus 28%; P < 0.04). Postoperative headaches may be related to several factors. Perioperative intake of caffeine altered postoperative well-being. Caffeine given preoperatively may limit postoperative withdrawal headaches among the millions of daily drinkers of caffeinated beverages. A randomized, prospective, and blinded trial to test this hypothesis is warranted.     

Headache and neck pain in spontaneous internal carotid and vertebral artery dissections

We studied the characteristics of headaches in 161 consecutive symptomatic patients with spontaneous dissections of the internal carotid artery (n = 135) or the vertebral artery (n = 26). For patients with internal carotid artery dissection (ICAD), the mean age was 47 years and for those with vertebral artery dissection (VAD), 40.7 years. A history of migraine was present in 18% of the ICAD group and in 23% of the VAD group. Headache was reported by 68% of the patients with ICAD and by 69% of those with VAD, and, when present, it was the initial manifestation in 47% of those with ICAD and in 33% of those with VAD. Ten percent of patients with ICAD had eye, facial, or ear pain without headache. The median interval from onset of headache to development of other neurologic manifestations was 4 days for the ICAD group and 14.5 hours for the VAD group. For all dissections, headaches typically were ipsilateral to the side of dissection. In the ICAD group, headaches were limited to the anterior head in 60% of patients and were steady in 73% and pulsating in 25%. In the VAD group, headaches were distributed posteriorly in 83% of patients and were steady in 56% and pulsating in 44%. Neck pain was present in 26% of patients with ICAD (anterolateral) and in 46% of those with VAD (posterior). The median duration of the headache in patients with VAD and ICAD was 72 hours, but headaches became prolonged, persisting for months to years, in four patients with ICAD.     

Acute headache

Sudden, explosive headache is rather rare. Though dramatic for the patient and the physician, it does not necessarily herald an intracranial catastrophe. Benign and dangerous thunderclap headaches cannot be distinguished from the features of headache itself, but rather on the basis of the situation, the additional symptoms and the findings. This means that every sudden headache should be considered potentially dangerous and be investigated immediately. The dangerous forms comprise intermittent hydrocephalus, acute bacterial meningitis and above all vascular complications. Subarachnoid hemorrhage frequently must be ruled out by computed tomography and lumbar puncture. Intracerebral, especially cerebellar hemorrhage, as well as hypertensive crisis require immediate treatment. Fatal cerebral embolism complicating spontaneous dissection of craniocervical arteries (carotid or vertebral arteries) can be prevented by early anticoagulant therapy. To confirm diagnosis, additional investigations such as CT, lumbar puncture or cerebrovascular ultrasound, and in rare cases MRI, should be performed early as the available time for effective therapy in many situations is short. Many of the benign forms of sudden headache can be diagnosed with a focused interview (cold or drug induced and food dependent headaches, sinusitis, glaucoma). Others, such as neuralgia, cough and coital headache, can be diagnosed as benign only when additional investigations have ruled out symptomatic forms.     

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.     

Ocular adnexal oncocytoma: a case series and clinicopathologic review of the literature

OBJECTIVE: Headache is a common complaint in children and brain imaging has become widely used to evaluate this clinical condition. We studied the value of neuroimaging in children with chronic headaches. PATIENTS AND METHODS: A retrospective chart review was conducted of all children referred to the pediatric outpatient clinic for evaluation of headache over a 3-year period. The charts were reviewed for headache characteristics, clinical indications for performing neuroimaging, and imaging results. Special attention was paid to evidence of space-occupying lesions. RESULTS: A total of 160 records were studied, with subjects ranging in age from 4 to 14 years. Most patients were diagnosed as having migraine headaches (60%) or chronic tension headaches (29.5%). Other diagnoses were post-traumatic (6%) and unclassified (4%). Sixty-six patients (41%) had computed tomography imaging performed. In most cases, brain imaging studies were performed because of clinical data (41%) like atypical pattern, sleep-related headache or increase of headache, because of the parents' concerns about brain lesions (38%) and because of an age less than 5 years (14%). Structural changes were found on brain imaging in 4 patients, but none indicated the presence of a treatable space-occupying lesion and all were deemed unrelated to the headache. Our findings of no relevant abnormalities in a series of 66 neuroimaging studies indicate that the maximal rate at which such abnormalities might appear in this population is 4.4%. CONCLUSIONS: These results indicate that neuroimaging studies have very limited value in the clinical evaluation of pediatric patients with chronic headache and should be reserved for those patients with clinical evidence suggestive of underlying structural lesion.     

Headaches associated with nasal obstruction due to deviated nasal septum

A deviated nasal septum not only can cause a blocked nose, but may also be associated with headaches. This study evaluates the nature of these headaches, the effect of submucous resection of the nasal septum, and the factors associated with postoperative headache relief. Deviated nasal septa were corrected by submucous resection in 99 men and 17 women. Patients were studied at 4 to 48 months (mean 18 months) postoperatively. Fifty-five of the 116 patients studied (47.4%) had preoperative recurring headaches. Thirty-five of the 55 patients with headaches (63.6%) experienced relief (complete or partial) of their headaches at a mean follow-up period of 18 months. Patients were more likely to be relieved of their headaches following submucous resection if the headaches were most intense over the frontal region, pressurelike in nature, and if the submucous resection resulted in relief of nasal obstruction. It is possible that headaches recur in the long term, and it is postulated that central mechanisms play a role.     

Methylergonovine maleate as a cluster headache prophylactic: a study and review

Methylergonovine maleate (Methergine), an ergot derivative with vasoconstrictive properties, has been cited as an effective treatment for vascular headaches. Few studies are available to support its use in headache management. An uncontrolled pilot study of 20 episodic cluster headache patients confirmed its effectiveness and tolerability as an adjunct cluster headache prophylactic. Decreased headache frequency was reported by 19 of 20 patients (95%), and 15 of 20 patients (75%) reported decreased intensity of headaches within 1 week of initiating therapy. A review of methylergonovine's pharmacokinetic, molecular, and tolerability profile clarifies its mechanisms and clinical role in headache management.     

Diagnosis and investigation of headache

BACKGROUND: Headache is one of the commonest medical complaints. It is usually benign but may be the first presentation of serious disease. OBJECTIVE: This article reviews the symptoms and signs that suggest the diagnosis of the common headaches and discusses which headache presentations require investigation. DISCUSSION: An accurate clinical history is the key to diagnosing the cause of a headache. A new headache of acute onset or progressing over days to weeks or associated with abnormal neurological signs requires investigation.     

Bacterial causes of bovine mastitis in Wondogenet, Ethiopia

This community study on headache in Malaysia was based on IHS diagnostic criteria and showed the last-year prevalence of migraine was 9.0%. Migraine with aura accounted for only 10.6% of the migrainous population. The last-year prevalence of tension headache was 26.5% (94.4% episodic, 5.6% chronic) and 28.2% for other types of headache. No case of cluster headache was found. Almost two thirds of the migraine subjects graded their headaches as severe, while almost 60% of the tension headache subjects and almost 70% of the other headache subjects graded their headaches as mild. Overall, there was higher prevalence in females for migraine and tension headache, and in males for the other types of headache. The prevalence of headache was lower among those younger than 15 and older than 65 years of age. No significant differences were found in the prevalence of headache among the different racial groups nor among the urban versus the rural population. All the headache types shared the same triggering factors suggesting that different physiological characteristics are responsible for the type of pain suffered. In the location of this community with its tropical climate, headache was attributed to sun exposure in 51.9% of the migraine subjects, 55.7% of the tension headache subjects, and 36.6% of the group with other headaches.     

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.     

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.     

Headache during pregnancy

A questionnaire was submitted to 430 women 3 days after delivery, asking mainly about features of headache before and during pregnancy, and their possible modification or recurrence; moreover, delivery modalities and the condition of the newborn were evaluated. One-hundred-and-twenty-six (29.3%) were found to be primary headache sufferers (IHS criteria, 1988), 81 of whom had migraine without aura (MO), 12 migraine with aura (MA), and 33 tension-type headache (TH). In all three groups, about 80% showed complete remission or a higher than 50% decrease in the number of attacks. The improvement was more evident after the end of the first trimester; this trend was common to the three primary headaches considered. In our series of primary headaches, there was only one case (MO) which began during pregnancy. In a subgroup of pluripara, headache maintained the improvement presented in the first pregnancy also during the following gravidic periods in about 50% of cases, whereas in the remaining 50% a worsening in parallel with successive pregnancies was found. Primary headaches "per se" do not seem to increase the pregnancy or delivery risks, nor the vitality of the newborn. During pregnancy, drug use was very much reduced and was restricted to a limited number of compounds.     

Biofeedback and relaxation training with three kinds of headache: Treatment effects and their prediction.

After a 4-wk baseline period during which daily ratings of headache activity were made and all participants took several psychological tests, 91 18–68 yr old patients with chronic headache (tension, migraine, and combined tension and migraine) were given a 10-session relaxation-training regimen. Ss who did not show substantial reductions in headache activity from the relaxation therapy were given a 12-session regimen of biofeedback (thermal biofeedback for vascular headaches and frontal EMG biofeedback for tension headaches). Relaxation therapy alone led to significant improvement for all groups, with a trend for the tension headache group to respond the most favorably. Biofeedback therapy led to further significant reduction in headache activity for all who received it, with a trend for combined migraine and tension headache patients to respond the most favorably. Multiple regression analyses revealed that approximately 32% of the variance in end-of-treatment headache diary scores could be predicted after relaxation and that 44% of the variance after biofeedback could be predicted using standard psychological tests. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Management of primary headache in emergency services of Santos and surrounding towns

OBJECTIVES: Primary headaches are often seen by Clinicians on duty at Emergency Services. We have investigated the treatment of such patients by 43 medical doctors who have been working at Emergency Services in the city of Santos and surrounding towns for many years. RESULTS: We confirmed the high prevalence of primary headaches in Emergency Services. There seem to be diagnosis difficulties concerning differentiating attacks of migraine and tension type headache. We also observed that IV dipirone was the most frequently prescribed treatment for patients with primary headaches in this study. There is no protocol in the literature which recommends IV dipirone for the treatment of migraine attacks or other primary headaches. CONCLUSION: It would be advisable to perform controlled double blind studies in order to verify the advantages of IV dipirone in the treatment of intense attacks primary headaches. We concluded that headache management recycling programs could be of interest for doctors who regularly work at Emergency Services.     

Clinical experience on headache in children: analysis of 92 cases

We analyzed, retrospectively, 92 patients with headache to determine the changes in the order of frequency of causes with the development of neuroimaging studies and its efficacy in the investigation of patients with headache. The type of headache was redefined according to the International Headache Society (IHS) diagnostic criteria. Migraine was the most frequent cause of headache and the rest in decreasing order were: tension-type headache, sinusitis, and epilepsy. The percentage of the findings relevant to headache in computed tomographic (CT) scans, magnetic resonance images (MRIs), Waters' projection (radiographs), and electroencephalograms (EEGs) were respectively 4.2%, 33.3%, 16%, and 25%. Neuroimaging studies are not necessary in the routine evaluation of patients with headache unless there is an abnormality in the findings. When it is needed, MRI, which has higher yield, can take the place of CT scanning. The most important point is taking a proper history of headache and making a thorough physical and neurologic examination of the patient.     

Clinical features of daily chronic headache

INTRODUCTION: Although the International Headache Society considers chronic tension headache to be a chronic headache, patients with daily chronic headache may have pain which is not only due to tension but also has migrainous features. OBJECTIVE: To evaluate the clinical differences and abuse of drugs in a group of patients with chronic daily headache who were consecutively evaluated in the Neurology Clinic. MATERIAL AND METHODS: We consider the patients to have daily chronic headache when they have had pain at least 6 days a week for the past 6 months. Using this criterion, we studied 112 patients, of whom 90 (80.4%) were women and 22 (19.6%) men. Results. Sixty nine (61.6%) had transformed migraine and 43 (38.4%) tension headache. There were no differences in their current ages but the age of onset of the headaches varied (p = 0.000,t). Unilateral pain, trigger factors and a family history were more frequent in the cases of transformed migraine. Eighty four patients (75%) abused analgesics. Although we found different pain intensities (p = 0.000, chi 2) there was no difference in the weekly consumption of analgesics (p = 0.64, t) in the mg/week of ergotamine (p = 0.96, t) nor in absence from work between the two types of headache. CONCLUSIONS: In spite of clinical differences between transformed migraine and tension headache, which may help diagnosis, in our series abuse of analgesics (including ergotamine) was a common characteristic.