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Sample records for dural puncture headache

  1. [Post-dural puncture headache].

    PubMed

    Radke, K; Radke, O C

    2013-02-01

    Headache following dural puncture is a typical complication of neuraxial analgesia and can impair the ability to perform activities of daily living up to incapacitation. The use of thin, atraumatic needles and special puncture techniques (e.g. reinsertion of the stylet) can prevent the majority of post-dural puncture headaches (PDPH). One of the most effective measures to prevent headache after accidental dural puncture is the intrathecal or epidural administration of morphine. When the diagnosis of PDPH is confirmed after excluding relevant differential diagnoses, some of which are potentially life-threatening, caffeine, theophylline and non-opioid analgesics are effective agents to reduce the severity of the symptoms. Traditional measures, such as strict bed rest and hyperhydration can no longer be recommended. If invasive treatment of the headache is warranted an epidural blood patch is still the method of choice with a high rate of success. PMID:23400710

  2. Differentiating the headache of cerebral venous thrombosis from post-dural puncture: A headache for anaesthesiologists

    PubMed Central

    Sherfudeen, Khaja Mohideen; Ramasamy, Gurumoorthi; Kaliannan, Senthil Kumar; Dammalapati, Pavan Kumar

    2016-01-01

    Cerebral venous thrombosis (CVT) is a rare complication of lumbar puncture. Occasionally, the clinical picture of CVT may mimic post-dural puncture headache (PDPH) resulting in delayed diagnosis. A case of PDPH progressing to CVT is presented and the pathophysiology, diagnostic challenges and management options discussed in this article. PMID:27212724

  3. Does preoperative gabapentin affects the characteristics of post-dural puncture headache in parturients undergoing cesarean section with spinal anesthesia?

    PubMed Central

    Nofal, Walid Hamed; Mahmoud, Mohamed Sidky; Al Alim, Azza Atef Abd

    2014-01-01

    Background: Gabapentin is effective for treating different types of headache including post-dural puncture headache (PDPH), also used for prophylaxis against migraine. We studied the effect of pre-operative administration of gabapentin on the characteristics of PDPH in parturients undergoing cesarean section (CS) under spinal anesthesia. Materials and Methods: Women undergoing elective cesarean section under spinal anesthesia were randomized to receive preoperative gabapentin 600 mg or placebo. Spinal anesthesia was achieved with 12.5 mg hyperbaric bupivacaine plus 25 μg fentanyl. Babies were followed up by Apgar scores, umbilical artery blood gases, breastfeeding difficulties, and need for NICU admission. The mothers were followed up for any side-effects of gabapentin for 24 h. Patients with PDPH were re-admitted and onset and duration of the headache were reported and severity was assessed using a visual analog scale (VAS) for 4 days from diagnosis. Paracetamol with caffeine and diclofenac were given for treatment, and the doses were adjusted according to VAS; also number of doses given for each group was recorded. Results: Eighty eight patients were randomized, and 2 were excluded. The incidence of headache and co-existing symptoms were similar in both groups. The onset of headache was significantly delayed in gabapentin group (P < 0.05). Also, severity and duration of headache were significantly less in gabapentin group (P < 0.05). The incidence of sedation was more in gabapentin group 11 (26.19%) versus placebo group 3 (6.81%). Neonatal outcomes were statistically insignificant between both groups. Conclusion: Pre-operative administration of gabapentin has no effect on incidence of (PDPH) but delays its onset and reduces its severity and duration in parturients undergoing cesarean section with spinal anesthesia without significant adverse effects on the mother or the baby. PMID:25191187

  4. Accidental dural puncture rates in UK obstetric practice.

    PubMed

    Gleeson, C M; Reynolds, F

    1998-10-01

    Headache following epidural analgesia is a common cause of complaint, but accidental dural puncture rates vary among hospitals and with techniques. We were therefore interested to discover the extent of audit of dural puncture, the dural puncture rates in those UK centres that kept reliable records, and the techniques they used for detecting the epidural space. Consultants in charge of anaesthetic services to all 257 obstetric units in the UK were sent a questionnaire requesting numbers of obstetric epidurals, techniques used to detect the epidural space and the numbers of accidental dural punctures in the years 1991-1995. Replies were received from 191 respondents (74%) of whom 104 were able to provide some information about dural puncture rates. Dural puncture rate was inversely related to the number of epidurals performed; the highest recorded rate was 3.6% in a unit with < 300 epidurals annually, and the lowest 0.19% in a unit with > 1000. Most respondents did not record the loss of resistance technique used but among those who did, the dural puncture rate using mainly saline was 0.69% and using mainly air was 1.11% (P<0.001). Since accurate patient information is crucial for informed consent, audit needs to be improved in many centres. Though the accidental dural puncture rate may be under-reported in this survey, our data are in agreement with other findings that loss of resistance to saline is safer than loss of resistance to air. PMID:15321187

  5. A new approach using high volume blood patch for prevention of post-dural puncture headache following intrathecal catheter pump exchange

    PubMed Central

    Abdulla, Susanne; Vielhaber, Stefan; Heinze, Hans-Jochen; Abdulla, Walied

    2015-01-01

    Background: In an observational study, complications of intrathecal catheter pumps necessitating surgical exchange were analyzed. Also the use of a high-volume prophylactic epidural blood patch (EBP) during surgery for preventing post-dural puncture headache (PDPH) with a follow-up for 1 year is described. Materials and Methods: In 22 patients with refractory chronic pain of cancer/noncancer origin or severe spasticity, who were receiving intrathecal morphine including adjuvants or baclofen for symptom relief, catheter exchange with or without pump was performed. In patients with documented symptoms of PDPH following initial intrathecal catheter implantation, a prophylactic EBP with a high blood volume was used for PDPH prevention during surgery. Catheters were replaced using 40 mL EBP before entering dural space at a speed of 5mL/min into the epidural space. Patients were asked to quantify pain experience and functional ability. Results: From a sample of 72 patients admitted for catheter exchange with or without pump, 22 patients (33%) (12 male, 10 female) had a history of PDPH following initial implantation. Diagnostic and therapeutic measures occurring with malfunction of intrathecal catheter pump systems were described. Twenty-one patients were successfully treated with prophylactic EBP, while one patient could not be properly evaluated because of intracranial bleeding as the underlying disease. Conclusions: A new approach using a high-volume prophylactic EBP for preventing PDPH following catheter exchange is presented. The efficacy and safety of this technique for 1 year follow-up have been evaluated and was found to be safe and potentially effective. PMID:26157652

  6. Cranial nerve VI palsy after dural-arachnoid puncture.

    PubMed

    Hofer, Jennifer E; Scavone, Barbara M

    2015-03-01

    In this article, we provide a literature review of cranial nerve (CN) VI injury after dural-arachnoid puncture. CN VI injury is rare and ranges in severity from diplopia to complete lateral rectus palsy with deviated gaze. The proposed mechanism of injury is cerebrospinal fluid leakage causing intracranial hypotension and downward displacement of the brainstem. This results in traction on CN VI leading to stretch and neural demyelination. Symptoms may present 1 day to 3 weeks after dural-arachnoid puncture and typically are associated with a postdural puncture (spinal) headache. Resolution of symptoms may take weeks to months. Use of small-gauge, noncutting spinal needles may decrease the risk of intracranial hypotension and subsequent CN VI injury. When ocular symptoms are present, early administration of an epidural blood patch may decrease morbidity or prevent progression of ocular symptoms. PMID:25695579

  7. [Subdural hematoma after dural puncture: fateful complication of epidural anesthesia].

    PubMed

    Schott, M; Gehrke, A; Gaab, M; Jantzen, J-P

    2013-05-01

    Subdural hematoma may occur as rare, although intervention- specific complications of accidental dural puncture by neuroaxial block. Bleeding may be caused by rapid cerebrospinal fluid loss related to traction on fragile intracranial bridging veins. This article reports a case of postdural puncture headache in a 43-year-old woman after accidental dural puncture during attempted placement of an epidural catheter for induction of abortion. Bed rest, analgesics, theophylline and hydration were to no avail and only a blood patch improved the headaches. The patient presented 7 weeks later with headache and left-sided hemiplegia. Magnetic resonance imaging showed a right frontoparietal subdural intracranial hematoma which had to be surgically evacuated. The patient recovered completely. Intracranial hematoma is a rare but serious complication of central neuroaxial block. According to current German jurisdiction this risk must be addressed when informed consent is obtained. Intracranial hematoma should be considered in the differential diagnosis of atypical headache and neurological signs (e.g. focal motor and sensory deficits and seizures) following neuroaxial block and adequate image diagnostics should be carried out without delay. PMID:23558719

  8. [Unknown intracerebral tumour presenting as brainstem compression following unintentional dural puncture].

    PubMed

    Castro-Castro, J; Figueiredo-González, O; Río-Gómez, A; Carballo-Loureiro, N; Castro-Bouzas, D

    2014-01-01

    A 36-year old primigravid of 41 weeks gestation was admitted to the labour ward. Her past medical history included hyperemesis gravidarum and migraine. An accidental dural puncture occurred during labour epidural analgesia. In the postpartum period she presented with continuous headache, and was treated with oral analgesics, oral caffeine, fluid therapy, and tetracosactide. She refused an epidural blood patch. On the seventh day postpartum, the patient was re-admitted to the Emergency Department with decreased level of consciousness and signs of brainstem compression. Cranial computed tomography and magnetic resonance imaging showed a posterior fossa tumour. An emergency craniotomy was performed with complete neurological recovery. This case emphasises the need to consider the differential diagnoses of post-dural puncture headache and to highlight the warning signs in patients who do not respond despite treatment with conventional therapy. PMID:24041454

  9. Visualization of extradural blood patch for post lumbar puncture headache by magnetic resonance imaging.

    PubMed

    Griffiths, A G; Beards, S C; Jackson, A; Horsman, E L

    1993-02-01

    We describe a case of post lumbar puncture headache treated by extradural blood patch. Magnetic resonance imaging (MRI) demonstrated a large extradural haematoma extending over four spinal segments and extending out through the neural outlet foramina. There was significant compression of the thecal sac, supporting the theory that extradural blood patch causes tamponade at the site of dural puncture. The spread of clot was predominantly upwards from the injection site and subarachnoid extension of blood was also demonstrated. PMID:8435271

  10. Cerebrospinal fluid leakage and headache after lumbar puncture: a prospective non-invasive imaging study.

    PubMed

    Wang, Yen-Feng; Fuh, Jong-Ling; Lirng, Jiing-Feng; Chen, Shih-Pin; Hseu, Shu-Shya; Wu, Jaw-Ching; Wang, Shuu-Jiun

    2015-06-01

    The spatial distribution and clinical correlation of cerebrospinal fluid leakage after lumbar puncture have not been determined. Adult in-patients receiving diagnostic lumbar punctures were recruited prospectively. Whole-spine heavily T2-weighted magnetic resonance myelography was carried out to characterize post-lumbar puncture spinal cerebrospinal fluid leakages. Maximum rostral migration was defined as the distance between the most rostral spinal segment with cerebrospinal fluid leakage and the level of lumbar puncture. Eighty patients (51 female/29 male, mean age 49.4 ± 13.3 years) completed the study, including 23 (28.8%) with post-dural puncture headache. Overall, 63.6% of periradicular leaks and 46.9% of epidural collections were within three vertebral segments of the level of lumbar puncture (T12-S1). Post-dural puncture headache was associated with more extensive and more rostral distributions of periradicular leaks (length 3.0 ± 2.5 versus 0.9 ± 1.9 segments, P = 0.001; maximum rostral migration 4.3 ± 4.7 versus 0.8 ± 1.7 segments, P = 0.002) and epidural collections (length 5.3 ± 6.1 versus 1.0 ± 2.1 segments, P = 0.003; maximum rostral migration 4.7 ± 6.7 versus 0.9 ± 2.4 segments, P = 0.015). In conclusion, post-dural puncture headache was associated with more extensive and more rostral distributions of periradicular leaks and epidural collections. Further, visualization of periradicular leaks was not restricted to the level of dural defect, although two-thirds remained within the neighbouring segments. PMID:25688077

  11. Inadvertent Dural Puncture during Caudal Approach by the Introducer Needle for Epidural Adhesiolysis Caused by Anatomical Variation

    PubMed Central

    Kim, Si Gon; Kim, Do Wan; Lee, Yeon Ju

    2013-01-01

    There have been reports of abnormalities in the lumbosacral region involving a lower-than-normal termination of the dural sac, which is caused by disease or anatomical variation. Inadvertent dural puncture or other unexpected complications can occur during caudal epidural block or adhesiolysis in patients with these variations, but only a small number of case reports have described this issue. We report a case of dural puncture by the introducer needle before attempting caudal epidural adhesiolysis, which occurred even though the needle was not advanced upward after penetrating the sacrococcygeal ligament. Dural puncture was caused by a morphological abnormality in the lumbosacral region, with no pathological condition; the dural sac terminal was located more distally than normal. However, dural puncture could have been prevented if we had checked for such an abnormality in the magnetic resonance imaging (MRI) taken before the procedure. PMID:23614088

  12. Intravenous theophylline rapidly decreases post-lumbar puncture headaches.

    PubMed

    Ergün, Ufuk; Ünal-Artık, H Aybüke; İnan, Leven E; Yoldaş, Tahir

    2016-09-01

    When managing therapy for the post-lumbar puncture headaches (PLPHs), an efficacious, fast-acting, practical and safe method is preferred. Invasive methods have known complications and oral medications might be problematic when nausea and vomiting occurs with severe headaches. The aim of this study was to highlight the brief initial time for a remarkable decrease of PLPH pain levels after the administration of IV theophylline infusion. We observed that IV theophylline infusion has a rapid and marked effect on decreasing pain in PLPHs. At 30 min of theophylline infusion, mean VAS levels were decreased by 47.1 % and at 60 min of infusion, the decrease of pain was 61.9 %. We conclude that IV theophylline infusion is a rapidly effective, noninvasive, practical and low-cost way to treat PLPHs. To the best of our knowledge, this is the first study to highlight both the efficacy and the speed of the effect of pain relief in PLPHs. PMID:26563407

  13. ACTIVATION OF TRPA1 ON DURAL AFFERENTS: A POTENTIAL MECHANISM OF HEADACHE PAIN

    PubMed Central

    Edelmayer, Rebecca M.; Le, Larry N.; Yan, Jin; Wei, Xiaomei; Nassini, Romina; Materazzi, Serena; Preti, Delia; Appendino, Giovanni; Geppetti, Pierangelo; Dodick, David W.; Vanderah, Todd W.; Porreca, Frank; Dussor, Gregory

    2012-01-01

    Activation of transient receptor potential ankyrin-1 (TRPA1) on meningeal nerve endings has been suggested to contribute to environmental irritant-induced headache but this channel may also contribute to other forms of headache such as migraine. The preclinical studies described here examined functional expression of TRPA1 on dural afferents and investigated whether activation of TRPA1 contributes to headache-like behaviors. Whole-cell patch-clamp recordings were performed in vitro using two TRPA1 agonists, mustard oil (MO) and the environmental irritant umbellulone (UMB), on dural-projecting trigeminal ganglion neurons. Application of MO and UMB to dural afferents produced TRPA1-like currents in approximately 42% and 38% of cells, respectively. Using an established in vivo behavioral model of migraine-related allodynia, dural application of MO and UMB produced robust time-related tactile facial and hindpaw allodynia that was attenuated by pretreatment with the TRPA1 antagonist HC-030031. Additionally, MO or UMB were applied to the dura and exploratory activity was monitored for 30 minutes using an automated open-field activity chamber. Dural MO and UMB decreased the number of vertical rearing episodes and the time spent rearing in comparison to vehicle treated animals. This change in activity was prevented in rats pretreated with HC-030031 as well as sumatriptan, a clinically effective anti-migraine agent. These data indicate that TRPA1 is expressed on a substantial fraction of dural afferents and activation of meningeal TRPA1 produces behaviors consistent with those seen in patients during migraine attacks. Further, they suggest that activation of meningeal TRPA1 via endogenous or exogenous mechanisms can lead to afferent signaling and headache. PMID:22809691

  14. Cavernous Sinus Dural Arteriovenous Fistula Patients Presenting With Headache as an Initial Symptom

    PubMed Central

    Nomura, Motohiro; Mori, Kentaro; Tamase, Akira; Kamide, Tomoya; Seki, Syunsuke; Iida, Yu; Kawabata, Yuichi; Nakano, Tatsu; Shima, Hiroshi; Taguchi, Hiroki

    2016-01-01

    Cavernous sinus (CS) dural arteriovenous fistula (dAVF) patients presenting with only headache as an initial symptom are not common. Patients with CS-dAVF commonly present with symptoms related to their eyes. In all three patients, headache was the initial symptom. Other symptoms related to the eyes developed 1 - 7 months after headache. In one patient, headache was controlled by sumatriptan succinate, but not diclofenac sodium or loxoprofen sodium. In another patient, headache was controlled by loxoprofen sodium. In the third patient, headache was improved by stellate ganglion block. In all patients, magnetic resonance angiography (MRA) in the early stage of the clinical course showed abnormal blood flow in the CS. However, reflux to the superior ophthalmic vein (SOV) was not detected. As treatment, transarterial and transvenous embolizations were necessary for one patient, and transvenous embolization was performed for another patient with significant blood flow to the SOV and cortical veins. On the other hand, manual compression of the bilateral carotid arteries at the neck resulted in disappearance of the fistula in the third patient. In all patients, the symptoms improved after the disappearance of blood reflux to the CS. The refluxed blood to the CS might cause elevation of the CS pressure and stimulate the trigeminal nerve in the dural membrane, resulting in headache before developing reflux in an anterior direction. CS-dAVF could induce both migraine and common headache. In cases with blood reflux to the CS on magnetic resonance imaging and/or MRA even without eye symptoms, a differential diagnosis of CS-dAVF should be taken into consideration. PMID:26985257

  15. Cavernous Sinus Dural Arteriovenous Fistula Patients Presenting With Headache as an Initial Symptom.

    PubMed

    Nomura, Motohiro; Mori, Kentaro; Tamase, Akira; Kamide, Tomoya; Seki, Syunsuke; Iida, Yu; Kawabata, Yuichi; Nakano, Tatsu; Shima, Hiroshi; Taguchi, Hiroki

    2016-04-01

    Cavernous sinus (CS) dural arteriovenous fistula (dAVF) patients presenting with only headache as an initial symptom are not common. Patients with CS-dAVF commonly present with symptoms related to their eyes. In all three patients, headache was the initial symptom. Other symptoms related to the eyes developed 1 - 7 months after headache. In one patient, headache was controlled by sumatriptan succinate, but not diclofenac sodium or loxoprofen sodium. In another patient, headache was controlled by loxoprofen sodium. In the third patient, headache was improved by stellate ganglion block. In all patients, magnetic resonance angiography (MRA) in the early stage of the clinical course showed abnormal blood flow in the CS. However, reflux to the superior ophthalmic vein (SOV) was not detected. As treatment, transarterial and transvenous embolizations were necessary for one patient, and transvenous embolization was performed for another patient with significant blood flow to the SOV and cortical veins. On the other hand, manual compression of the bilateral carotid arteries at the neck resulted in disappearance of the fistula in the third patient. In all patients, the symptoms improved after the disappearance of blood reflux to the CS. The refluxed blood to the CS might cause elevation of the CS pressure and stimulate the trigeminal nerve in the dural membrane, resulting in headache before developing reflux in an anterior direction. CS-dAVF could induce both migraine and common headache. In cases with blood reflux to the CS on magnetic resonance imaging and/or MRA even without eye symptoms, a differential diagnosis of CS-dAVF should be taken into consideration. PMID:26985257

  16. The "temporalis-inhibitory reflex" in post-lumbar puncture headache.

    PubMed

    Wallasch, T M; Niemann, U; Strenge, H

    1992-01-01

    Nausea and rigidity of the neck muscles, typical symptoms of post-lumbar puncture syndrome (PPS), may also be found in patients suffering from chronic headache of the tension-type. A decreased duration of the late suppression period of temporal muscle activity indicating a central disturbance of pericranial muscle control, can be observed in these patients. We have studied the temporalis-inhibitory reflex in 47 neurological inpatients requiring lumbar puncture. There were no significant differences of latencies or durations of temporalis silent periods between patients with and without PPS before, and 48 h following, lumbar puncture. PMID:1292957

  17. Acupuncture for the Management of Postdural Puncture Headache: A Case Report

    PubMed Central

    Chang, Alexandra; Acquah, Joseph; Reddy, Sanjay

    2016-01-01

    Postdural puncture headache (PDPH) is a recognized complication of neuraxial anesthesia. This case report documents 1 patient who developed PDPH following epidural anesthesia for postoperative pain control. The patient declined conventional treatments, including an epidural blood patch and intravenous caffeine. This report documents successful use of adjunct acupuncture for the management of PDPH. Additional research on acupuncture as a potential adjunctive therapy for PDPH is needed, particularly for patients who are reluctant to receive more invasive treatments. PMID:26937320

  18. [Effect of the continuous epidural saline infusion for patients with postdural puncture headache after pulmonary resection].

    PubMed

    Katayama, Tatsuya; Hirai, Shinji; Hamanaka, Yoshiharu; Fukui, Takayuki; Itou, Shimon; Hatooka, Shunzou; Mitsudomi, Tetsuya

    2011-11-01

    The dual puncture is one of the diseaseful complications at the induction of the epidural anesthesia, which causes severe symptoms of intracranial hypotension such as headache and nausea. The clinical courses of 3 patients with the dual puncture symptoms after pulmonary resections were retrospectively reviewed, and the effect of the continuous epidural saline infusion treatment (CESI) for the dual puncture was evaluated. Pneumococcal empyema developed in 1 patient who had been treated with conservative management. In contrast, the symptoms of the others who were treated with the CESI were quickly recovered or were effectively prevented. This report strongly suggested that the CESI was convenient and effective treatment for dual punctune symptoms by suppressing the cerebrospinal fluid leakage by elevation of the fluid pressure in the extradural space. PMID:22187867

  19. Failure rate and complications associated with the use of spinal catheters for the management of inadvertent dural puncture in the parturient: a retrospective comparison with re-sited epidural catheters.

    PubMed

    Tien, Michael; Peacher, Dionne F; Franz, Amber M; Jia, Shawn Y; Habib, Ashraf S

    2016-05-01

    Objective To report on the failure rate of spinal catheters placed following inadvertent dural puncture (IDP) compared with re-sited epidural catheters in the obstetric population. Research design and methods Patients who experienced IDP during epidural or combined spinal epidural placement with 17 or 18 gauge Tuohy needles for labor analgesia between 2003 and 2014 were identified using our post-dural puncture headache (PDPH) database. Patients were categorized into two groups: those who had spinal catheters inserted and those who had epidural catheters re-sited. Main outcome measure Failure rate associated with spinal or re-sited epidural catheters (defined as need for repeat block or alternative analgesic modality). Secondary outcomes were incidence of PDPH, need for epidural blood patch (EBP), and adverse events. Results A total of 109 patients were included in the final analysis; 79 ultimately had spinal catheters and 30 ultimately had re-sited epidural catheters. There were no differences between spinal catheters and re-sited epidural catheters in failure rate (22% vs. 13%, P = 0.33), incidence of PDPH (73% vs. 60%, P = 0.24), need for EBP (42% vs. 30%, P = 0.28), number of headache days, or maximum headache scores. There was also no difference in the rate of adverse events including high block levels, hypotension, and fetal bradycardia (9% vs. 7%, P = 1.0) between the two groups. Conclusions There were no differences in failure rates, PDPH outcomes, or adverse events between spinal catheters and re-sited epidural catheters following IDP in parturients receiving labor analgesia. Limitations of the study include its single-center retrospective non-randomized design, and the uneven number of patients in the two groups with a relatively small number in the re-sited epidural catheter group. PMID:26818623

  20. [Epidural blood patch to treat severe postdural puncture headache after ambulatorysurgery].

    PubMed

    Galindo Palazuelos, M; Díaz Setién, N

    2010-04-01

    We report a case of postdural puncture headache (PDPH) after outpatient hysteroscopy under spinal anesthesia in which a 25-gauge Whitacre needle was used. Symptoms of PDPH appeared 6 hours after surgery. The headache improved with oral caffein and intravenous corticosteroids and the patient was discharged after 24 hours. Later, she was attended twice in the emergency departments of 2 hospitals, where she received conventional treatment (analgesics and corticosteroids). Eleven days after the surgical procedure, an epidural blood patch was performed. Within 12 hours the incapacitating symptoms had improved markedly and resolution was complete 2 months after surgery. PDPH worthy of blood patch treatment is a rare complication of spinal anesthesia with pencil-point needles. Clear diagnostic protocols are required if satisfactory treatment is not to be delayed and unnecessary suffering is to be prevented. PMID:20499802

  1. The prevalence of anatomical variations that can cause inadvertent dural puncture when performing caudal block in Koreans: a study using magnetic resonance imaging.

    PubMed

    Joo, J; Kim, J; Lee, J

    2010-01-01

    The purpose of this study was to investigate the prevalence of the anatomical abnormalities that can induce inadvertent dural puncture when performing caudal block. The anatomy of the lumbo-sacral area was evaluated using magnetic resonance imaging. In 2462 of the 2669 patients imaged, the dural sac terminal was located between the upper half of the 1st sacral vertebra and the lower half of the 2nd sacral vertebra. In 22 cases (0.8%), the dural sac terminal and the spinal canal were located at or below the 3rd sacral vertebra, and these were cases of simple anatomical variations. As regards pathologic conditions, there was one case of sacral meningocoele and 46 cases of sacral perineural cyst. In 21 cases (0.8%) out of the 46 perineural cyst cases, the cyst could be found at or below the 3rd sacral vertebra level. Inadvertent dural puncture may happen when performing caudal block in patients with such abnormal anatomy. PMID:19922508

  2. [Posterior reversible encephalopathy syndrome and cerebrovascular constriction syndrome in the differential diagnosis of post-partum headaches].

    PubMed

    Ruiz López, N; Cano Hernández, B; Balbás Álvarez, S

    2016-02-01

    Postpartum headache can be due to many causes. In a patient with previous epidural analgesia, the headache can be attributed to post-dural puncture headache, even if the symptoms are not typical of this clinical entity. We report a case of a post-partum with accidental dural tap during the insertion of an epidural catheter for labour analgesia, and who referred to headaches in the third post-partum day. Initially, a post-dural puncture headache was suspected, but the subsequent onset of seizures and visual impairment meant that the diagnosis had to be reconsidered. In this case report, the clinical and pathophysiological features of posterior reversible encephalopathy syndrome and reversible cerebral vasoconstriction syndrome, as well as the differential diagnosis of post-partum headaches are described. PMID:26056067

  3. Idiopathic intracranial hypertension presenting as postpartum headache.

    PubMed

    Mathew, Mariam; Salahuddin, Ayesha; Mathew, Namitha R; Nandhagopal, Ramachandiran

    2016-01-01

    Postpartum headache is described as headache and neck or shoulder pain during the first 6 weeks after delivery. Common causes of headache in the puerperium are migraine headache and tension headache; other causes include pre-eclampsia/eclampsia, post-dural puncture headache, cortical vein thrombosis, subarachnoid hemorrhage, posterior reversible leukoencephalopathy syndrome, brain tumor, cerebral ischemia, meningitis, and so forth. Idiopathic intracranial hypertension (IIH) is a rare cause of postpartum headache. It is usually associated with papilledema, headache, and elevated intracranial pressure without any focal neurologic abnormality in an otherwise healthy person. It is more commonly seen in obese women of reproductive age group, but rare during pregnancy and postpartum. We present a case of IIH who presented to us 18 days after cesarean section with severe headache and was successfully managed. PMID:26818168

  4. Effect of venous dexamethasone, oral caffeine and acetaminophen on relative frequency and intensity of postdural puncture headache after spinal anesthesia

    PubMed Central

    Masoudifar, Mehrdad; Aghadavoudi, Omid; Adib, Sajjad

    2016-01-01

    Background: Postdural puncture headache (PDPH) is a relatively common complication after regional anesthesia, especially in younger people, bothersome to patients and needs prophylaxis to prevent this complication. This study was conducted aiming to determine the preventive effect of dexamethasone plus caffeine and acetaminophen on relative frequency and intensity of PDPH after spinal anesthesia. Materials and Methods: In a clinical trial study, 90 candidates for the lower extremities orthopedic elective operation were divided into two groups of 45 individuals each. Intervention group received the compound of 500 mg acetaminophen +65 mg oral caffeine +8 mg venous dexamethasone an hour before spinal blocking, and the control group received placebo tablets + a dexamethasone equivalent volume of venous normal saline. The level of postoperative headache at the time of entrance to recovery and discharge, 6, 12, 24, 48, and 72 h postoperatively were measured based on Visual Analog Scale criterion in the two groups and then compared with each other. Results: During the study, 24 patients in the control group and 17 patients in the intervention group were afflicted with headache; however, with no significant difference (P = 0.14). Total frequency of headache incidence was 35 times in the control group and 27 times in the intervention group (P = 0.32). Conclusions: Though the taking of acetaminophen + caffeine + dexamethasone is associated with a decrease in headache intensity and duration and decrease in PDPH incidence, compared with placebo, however, no essentially and statistically significant effect was produced. PMID:27169097

  5. Headache

    MedlinePlus

    ... headache (not caused by another medical condition) is migraine. Migraine headaches are usually characterized by severe pain on ... Women are more likely than men to have migraine headaches. Is there any treatment? When headaches occur ...

  6. Headache

    MedlinePlus

    Almost everyone has had a headache. Headache is the most common form of pain. It's a major reason people miss days at work or school or visit the doctor. The most common type of headache is a tension headache. Tension headaches are due ...

  7. Headache

    MedlinePlus

    A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are rare. Most ... The most common type of headache is tension headache. It is likely caused by tight muscles in your shoulders, neck, scalp, and jaw. A tension headache : May ...

  8. Headache

    MedlinePlus

    ... of headache is tension headache. It is likely caused by tight muscles in your shoulders, neck, scalp, and jaw. A tension headache : May be related to stress, depression, anxiety, a head injury, or holding your head ...

  9. [Headache].

    PubMed

    Godin, O

    1976-01-01

    Headache is an alarm symptom, whether there is an organic disease (lesional headache) or a perturbation of one of the various functions of the head (functional headache). Lesional headaches follow a sinusitis or an arthrosis, or accompany a "temporal arteritis of Horton". Functional headaches include several varieties. 1. Trigemellar neuralgia. 2. Vascular algia originating from the basal arteries, the large cerebral venous sinuses or the branches of the external carotid. Among these are: a) headaches due to a dilatation of the internal wall, causing "Horton headache", migrain-like psychosomatic migraine and hormonal migraines (premenstrual, menstrual, menopausal or linked to the use of contraceptive pills); b) headaches caused by an angiospasm of the arteriole, which is the case in exposure to the cold, in traumatic headaches (malfunction of temporomandibular articulation, dry alveolitis), in psychosomatic angiospastic algias and in ethmoidal artery algias previously described by the author in 1949 (Godin's disease). 3. Headaches due to psychic hypertension. 4. Postconcussional psychogenic headaches. 5. Neurotic headaches. The author gives a detailed description of the subjective symptoms in each case, including localisation, form, intensity, duration course and associated phenomenons. This facilitates greatly the differential diagnosis and the choice of complementary examinations. Necessary biological investigations should be performed (e.g. hormonal balance). One should however avoid to increase the number of complementary examinations which would only delay treatment and would expose patients to somatisation. Furthermore, in each case drug treatment, periarterial infiltration technics of the temporal, internal frontal, facial, mastoid and occipital arteries are described. The necessity of questioning the patient at length and to listen to him to enable him to verbalise conscious conflicts is emphasized. A serious medicopsychological examination and a relaxation

  10. [Headache].

    PubMed

    Godin, O

    1976-03-01

    Headache is an alarm sympton, whether there is an organic disease (lesional headache) or a perturbation of one of the various functions of the head (functional headache). Lesional headaches follow a sinusitis or an arthrosis, or accompany a "temporal arteritis of Horton". Funstional headaches include several varieties. 1. Trigemellar neuralgia. 2.Vascular algi originating from the basal arteries, the large cerebral venous sinuses or the branches of the external carotid. Among these are: a) headaches due to a dilatation of the internal wall, causing "Horton headache", migraine-like psychosomatic migraine and hormonal migraines (premenstrual, menstrual, menopausal or linked to the use of contraceptive pills); b) headaches caused by an angiospasm of the arteriole, which is the case in exposure to the cold, in traumatic headaches (malfunction of temporomandibular articulation, dry alveolitis), in psychosomatic angiospastic algias and in ethmoidal artery algias preciously described by the author in 1949 (Godin's disease).3. Headaches due to psychic hypertension. 4. Postconcussional psychogenic headaches. 5. Neurotic headaches. The author gives a detailed description of the subjective symptoms in each case, including localisation, from, intensity, duration course and associated phenomenons. This facilitates greatly the differential diagnosis and the choice of complementary examinations. Necessary biological investigations should be performed (e.g. hormonal balance). One should however avoid to increase the number of complementary examination which would only delay treatement and would expose patients to somatisation. Furthermore, in each case drug treatment, periarterial infiltration technics of the temporal, internal frontal, facial, mastoid and occipital arteries are described. The necessity of questioning the patient at lenght and to listen to him to enable him to verbalise conscious conflicts is emphasized. A serious medicopsychlogical examination and a relaxation

  11. Headaches

    MedlinePlus

    ... questions, ask your doctor or pharmacist. Keep in mind that children should not take aspirin. Aspirin can ... herbal health product for headache relief, keep in mind that these products aren't tested to be ...

  12. Headaches.

    PubMed

    Sutherland, J E

    1983-02-01

    Although classification can be difficult, determining the type of headache, such as tension, migraine or cluster, aids in the formulation of a therapeutic approach. Treatment involves regulation rather than cure. Acute and prophylactic pharmacotherapy and control of stress through behavior modification, relaxation training and biofeedback are methods of management. PMID:6829368

  13. Headaches

    MedlinePlus

    ... stress, changes in sleep patterns, or even the weather. Getting Relief Most headaches will go away if ... or she will probably want to do a physical examination and get your medical history to help figure out what might ... Getty Images, Corbis, Veer, Science Photo Library, Science Source Images, Shutterstock, and Clipart. ...

  14. Marsupialization and distal obliteration of a lumbosacral dural ectasia in a nonsyndromic, adult patient.

    PubMed

    Nguyen, Ha Son; Lozen, Andrew; Doan, Ninh; Gelsomin, Michael; Shabani, Saman; Maiman, Dennis

    2015-01-01

    Dural ectasia is frequently associated with connective tissue disorders or inflammatory conditions. Presentation in a patient without known risk factors is rare. Moreover, the literature regarding the treatment options for symptomatic dural ectasia is controversial, variable, and limited. A 62-year-old female presents with intractable, postural headaches for years. A lumbar puncture revealed opening pressure 3 cm of water. A computed tomography myelogram of the spine demonstrated erosion of her sacrum due to a large lumbosacral dural ectasia. An initial surgery was attempted to reduce the size of the expansile dura, and reconstruct the dorsal sacrum with a titanium plate (Depuy Synthes, Westchester, PA, USA) to prevent recurrence of thecal sac dilatation. Her symptoms initially improved, but shortly thereafter recurred. A second surgery was then undertaken to obliterate the thecal sac distal to the S2 nerve roots. This could not be accomplished through simple ligation of the thecal sac circumferentially as the ventral dura was noted to be incompetent and attempts to develop an extradural tissue plane were unsuccessful. Consequently, an abundance of fibrin glue was injected into the thecal sac distal to S2, and the dural ectasia was marsupialized rostrally, effectively obliterating the distal thecal sac while further reducing the size of the expansile dura. This approach significantly improved her symptoms at 5 months follow-up. Treatment of dural ectasia is not well-defined and has been variable based on the underlying manifestations. We report a rare patient without risk factors who presented with significant lumbosacral dural ectasia. Moreover, we present a novel method to treat postural headaches secondary to dural ectasia, where the thecal sac is obliterated distal to the S2 nerve roots using an abundance of fibrin glue followed by marsupialization of the thecal sac rostally. This method may offer an effective therapy option as it serves to limit the expansile

  15. Treatment of Refractory Postdural Puncture Headache after Intrathecal Drug Delivery System Implantation with Epidural Blood Patch Procedures: A 20-Year Experience.

    PubMed

    Bendel, Markus A; Moeschler, Susan M; Qu, Wenchun; Hanley, Eugerie; Neuman, Stephanie A; Eldrige, Jason S; Hoelzer, Bryan C

    2016-01-01

    A recent publication reported the incidence of postdural puncture headache (PDPH) in conjunction with intrathecal drug delivery system (IDDS) implantation to be nearly 23 percent. Many patients responded to conservative measures but a percentage needed invasive treatment with an epidural blood patch (EBP). There is limited data to describe the technical details, success rates, and complications associated with EBP in this population. This study aims to provide a retrospective report of EBP for patients suffering from PDPH related to IDDS implantation. A chart review established a cohort of patients that required EBP in relation to a PDPH after IDDS implantation. This cohort was evaluated for demographic data as well as details of the EBP including technical procedural data, success rates, and complications. All patients received a trial of conservative therapy. Standard sterile technique and skin preparation were utilized with no infectious complications. The EBP was placed below the level of the IDDS catheter in 94% of procedures. Fluoroscopy was utilized in each case. The mean EBP volume was 18.6 cc and median time of EBP was day 7 after implant. There were no complications associated with EBP. EBP appears to be an effective intervention in this subset of PDPH patients. PMID:27597897

  16. Treatment of Refractory Postdural Puncture Headache after Intrathecal Drug Delivery System Implantation with Epidural Blood Patch Procedures: A 20-Year Experience

    PubMed Central

    Moeschler, Susan M.; Qu, Wenchun; Hanley, Eugerie; Neuman, Stephanie A.; Eldrige, Jason S.; Hoelzer, Bryan C.

    2016-01-01

    A recent publication reported the incidence of postdural puncture headache (PDPH) in conjunction with intrathecal drug delivery system (IDDS) implantation to be nearly 23 percent. Many patients responded to conservative measures but a percentage needed invasive treatment with an epidural blood patch (EBP). There is limited data to describe the technical details, success rates, and complications associated with EBP in this population. This study aims to provide a retrospective report of EBP for patients suffering from PDPH related to IDDS implantation. A chart review established a cohort of patients that required EBP in relation to a PDPH after IDDS implantation. This cohort was evaluated for demographic data as well as details of the EBP including technical procedural data, success rates, and complications. All patients received a trial of conservative therapy. Standard sterile technique and skin preparation were utilized with no infectious complications. The EBP was placed below the level of the IDDS catheter in 94% of procedures. Fluoroscopy was utilized in each case. The mean EBP volume was 18.6 cc and median time of EBP was day 7 after implant. There were no complications associated with EBP. EBP appears to be an effective intervention in this subset of PDPH patients. PMID:27597897

  17. Successful treatment of spontaneous cerebrospinal fluid leak headache with fluoroscopically guided epidural blood patch: a report of four cases.

    PubMed

    Hayek, Salim M; Fattouh, Maher; Dews, Teresa; Kapural, Leonardo; Malak, Osama; Mekhail, Nagy

    2003-12-01

    Spontaneous cerebrospinal fluid (CSF) leak is a rare clinical entity that may result in disabling headaches. It occurs as a result of dural defects, and the initial symptoms resemble those of postdural puncture headache. However, the positional headache can later evolve into a persistent chronic daily headache. The diagnosis of spontaneous CSF leak can be very challenging, but increasing awareness and improved diagnostic techniques are yielding ever more cases. When conservative management fails, the pain management clinician is called upon to administer an epidural blood patch. The success of this technique is dependent upon accurate diagnosis of the site of leakage and targeted epidural administration of the blood patch to this area. In this report, we describe four consecutive cases that were referred to our pain management department over an 18-month period and were successfully treated with site-directed epidural blood patches. PMID:14750917

  18. The Wiley Spinal Catheter-Over-Needle System for Continuous Spinal Anesthesia: A Case Series of 5 Cesarean Deliveries Complicated by Paresthesias and Headaches.

    PubMed

    McKenzie, Christine P; Carvalho, Brendan; Riley, Edward T

    2016-01-01

    Intrathecal catheter devices using a catheter-over-needle design and softer flexible material have been introduced to clinical practice with the aim of reducing some of the complications such as postdural puncture headaches and paresthesias seen with previous versions of intrathecal catheters. We present a case series of 5 cesarean deliveries using the Wiley Spinal intrathecal system (Epimed, Johnstown, New York), which was recently approved by the US Food and Drug Administration. The intrathecal catheter system consists of a flexible 23-gauge intrathecal cannula over a 27-gauge pencil-point spinal needle. The placement of the intrathecal catheter was successful in all 5 cases; however, paresthesias in 3 cases and postdural puncture headaches in 2 cases complicated the placement and use of the device. Although the unique catheter-over-needle design facilitates the use of smaller-gauge spinal needles for dural puncture and larger-gauge catheters for medication administration, this case series using the Wiley Spinal suggests that paresthesias and postdural puncture headaches may still limit its widespread utilization. Future studies are needed to determine the true incidence of complications and to determine the role of continuous spinal anesthesia in the obstetric population. PMID:26909488

  19. Lumbar puncture-related cerebrospinal fluid leakage on magnetic resonance myelography: is it a clinically significant finding?

    PubMed Central

    2013-01-01

    Background Post-dural puncture headache (PDPH) due to excessive cerebrospinal fluid (CSF) leakage is a well-known complication of lumbar puncture. Although various factors, especially the type of spinal needle, have been demonstrated to be associated with PDPH, the clinical implications of CSF leakage detected on magnetic resonance myelography (MRM) images remain unclear. The objective of this case–control study was to evaluate the association between radiologically visualized CSF leakage and PDPH. Methods Clinical data including patients’ age and gender, types of spinal needle, duration of bed rest, interval between lumbar puncture procedures and MRM studies, and incidence of PDPH were compared between patients who were radiologically-positive and -negative for CSF leakage. Results Of the 22 patients with definite CSF leakage on MRM images, most were asymptomatic (86%, 19/22). The remaining three patients, who were suffering from PDPH, only complained of headaches and were treated conservatively. In a review of patients’ clinical data, there were no significant differences in any parameter including the incidence of PDPH between the 22 patients who were radiologically-positive for CSF leakage and the 31 radiologically-negative patients. Conclusion The significance of radiologically visualized CSF leakage should not be overestimated, as most such incidents are not associated with PDPH and do not require any treatment. PMID:24160550

  20. Characterization of a mouse model of headache.

    PubMed

    Huang, Dongyue; Ren, Lynn; Qiu, Chang-Shen; Liu, Ping; Peterson, Jonathan; Yanagawa, Yuchio; Cao, Yu-Qing

    2016-08-01

    Migraine and other primary headache disorders affect a large population and cause debilitating pain. Establishing animal models that display behavioral correlates of long-lasting and ongoing headache, the most common and disabling symptom of migraine, is vital for the elucidation of disease mechanisms and identification of drug targets. We have developed a mouse model of headache, using dural application of capsaicin along with a mixture of inflammatory mediators (IScap) to simulate the induction of a headache episode. This elicited intermittent head-directed wiping and scratching as well as the phosphorylation of c-Jun N-terminal kinase in trigeminal ganglion neurons. Interestingly, dural application of IScap preferentially induced FOS protein expression in the excitatory but not inhibitory cervical/medullary dorsal horn neurons. The duration of IScap-induced behavior and the number of FOS-positive neurons correlated positively in individual mice; both were reduced to the control level by the pretreatment of antimigraine drug sumatriptan. Dural application of CGRP(8-37), the calcitonin gene-related peptide (CGRP) receptor antagonist, also effectively blocked IScap-induced behavior, which suggests that the release of endogenous CGRP in the dura is necessary for IScap-induced nociception. These data suggest that dural IScap-induced nocifensive behavior in mice may be mechanistically related to the ongoing headache in humans. In addition, dural application of IScap increased resting time in female mice. Taken together, we present the first detailed study using dural application of IScap in mice. This headache model can be applied to genetically modified mice to facilitate research on the mechanisms and therapeutic targets for migraine headache. PMID:27058678

  1. Effects of Voluntary Locomotion and Calcitonin Gene-Related Peptide on the Dynamics of Single Dural Vessels in Awake Mice

    PubMed Central

    Gao, Yu-Rong

    2016-01-01

    The dura mater is a vascularized membrane surrounding the brain and is heavily innervated by sensory nerves. Our knowledge of the dural vasculature has been limited to pathological conditions, such as headaches, but little is known about the dural blood flow regulation during behavior. To better understand the dynamics of dural vessels during behavior, we used two-photon laser scanning microscopy (2PLSM) to measure the diameter changes of single dural and pial vessels in the awake mouse during voluntary locomotion. Surprisingly, we found that voluntary locomotion drove the constriction of dural vessels, and the dynamics of these constrictions could be captured with a linear convolution model. Dural vessel constrictions did not mirror the large increases in intracranial pressure (ICP) during locomotion, indicating that dural vessel constriction was not caused passively by compression. To study how behaviorally driven dynamics of dural vessels might be altered in pathological states, we injected the vasodilator calcitonin gene-related peptide (CGRP), which induces headache in humans. CGRP dilated dural, but not pial, vessels and significantly reduced spontaneous locomotion but did not block locomotion-induced constrictions in dural vessels. Sumatriptan, a drug commonly used to treat headaches, blocked the vascular and behavioral the effects of CGRP. These findings suggest that, in the awake animal, the diameters of dural vessels are regulated dynamically during behavior and during drug-induced pathological states. SIGNIFICANT STATEMENT The vasculature of the dura has been implicated in the pathophysiology of headaches, but how individual dural vessels respond during behavior, both under normal conditions and after treatment with the headache-inducing peptide calcitonin gene-related peptide (CGRP), is poorly understood. To address these issues, we imaged individual dural vessels in awake mice and found that dural vessels constricted during voluntary locomotion, and

  2. The effect of Valsalva maneuver in attenuating skin puncture pain during spinal anesthesia: a randomized controlled trial

    PubMed Central

    Gautam, Sujeet Kumar Singh; Gupta, Devendra; Agarwal, Anil; Dhirraj, Sanjay; Khuba, Sandeep

    2016-01-01

    Background Valsalva maneuver reduces pain by activating sinoaortic baroreceptor reflex arc. We planned this study to evaluate the role of valsalva in attenuating spinal needle-puncture pain. Methods Ninety American Society of Anesthesiologists (ASA) grade I and II enrolled patients undergoing elective surgery were randomized into 3 groups of 30 each. Group I (Control): didn't blow; group II (Distraction): patients blew into rubber tube; Group III (Valsalva): blew into sphygmomanometer tube and raise mercury column up to 30 mmHg for at least 20 seconds. During above procedures, spinal puncture was performed with 25-gauge spinal needle. Results Eighty-two patient data were analyzed. Incidence of spinal puncture pain was reduced to 10% (3 of 27) in Valsalva group as compared to 100% (28 of 28 in control group and 27 of 27 in Distraction group) observed in other two groups (P < 0.05). Severity of lumbar puncture pain as assessed by visual analog scale (0−10; where 0 is no pain and 10 is the worst imaginable pain) presented as Median (Interquartile range) were significantly reduced in the Valsalva group (0.0 [0.0] as compared to other 2 groups 2.0 [0.0] in the Distraction group and 3.0 [0.8] in Control group) (P < 0.05). Regarding time taken by CSF to fill spinal needle hub, there was no difference among the three groups (P > 0.05). None patient of all groups had post dural puncture headache (P > 0.05). Conclusions Valsalva can be performed routinely in ASA I and II patients undergoing spinal anesthesia as it is safe, painless and non-pharmacological method of pain attenuation. PMID:26885298

  3. [Headache disorders].

    PubMed

    Takeshima, Takao; Kikui, Shoji

    2013-09-01

    Primary headache disorders such as migraine, tension-type headache, and cluster headache are prevalent and disabling neurological disorders. Although most headache disorders are largely treatable, they are under-recognized, under-diagnosed, and under-treated. Many headache sufferers in Japan do not receive appropriate and effective health care; hence, the illness, which should be relieved, persists and acts as an individual and societal burden. One of the barriers most responsible for this is poor awareness of the disorders. For lifting the burden, health care must be improved. Education is an essential way to resolve these issues at multiple levels. We have a Japanese version of the international headache classification and diagnostic criteria II (ICHD-II) and guidelines for the management of chronic headaches. Utilization of these resources is key for the improvement of headache management in our country. Not only neurologists, but also neurosurgeons and other medical specialists are participating in headache care in Japan. The Japanese Headache Society and the Japanese Society for Neurology should play major roles in health care service, education programs, as well as clinical and basic research for headache disorders. The road map for realizing our aim on headache treatment is as follows: (1) increase the number of units concerning headache in lectures for medical students, implement training programs for residents and neurologists, and offer continuous medical educations for physicians and neurologists; (2) secure more funding for headache research; (3) propagate medical care for headache in primary care settings and regional fundamental hospitals; (4) reform the health care system for headache and incentivize appropriate compensation for headache care in public health insurance; and (5) spread appropriate information on medical and socio-ethical issues related to headache for the sufferers and citizens. The authors expect that many neurologists have an

  4. Secondary Headaches

    MedlinePlus

    ... Pinterest Follow us on Instagram DONATE TODAY About Migraine Patient Registry Corporate Roundtable Info for Residents & Fellows Living With Migraines Types of Headache/Migraine Life with Headache/Migraine ...

  5. Headache (image)

    MedlinePlus

    Headaches are usually caused by either muscle tension, vascular problems, or both. Migraines are vascular in origin, ... disturbances, loss of peripheral vision, and fatigue. Most headaches can be relieved or ameliorated by over-the- ...

  6. Secondary Headaches

    MedlinePlus

    ... Patients American Headache & Migraine Association Articles Patient Handouts Kids Help Patient to Patient Podcasts for Patients Videos Links Find a Healthcare Professional Other Websites & Information ...

  7. Emergency airway puncture

    MedlinePlus

    Emergency airway puncture is the placement of a hollow needle through the throat into the airway. It ... Emergency airway puncture is done in an emergency situation, when someone is choking and all other efforts ...

  8. Dural-Based Cavernoma of the Posterior Cranial Fossa Mimicking a Meningioma: A Case Report

    PubMed Central

    Cruz, Aurora S; Jeyamohan, Shiveindra; Tubbs, R. Shane; Page, Jeni; Chamiraju, Parthasarathi; Tkachenko, Lara; Rostad, Steven; Newell, David W.

    2016-01-01

    Cavernous angiomas usually occur in the parenchyma of both the supra and infratentorial compartments. At times, they can both clinically and radiologically mimic other dural-based lesions. We present a case of a patient with chronic occipital headaches, initially thought to have a meningioma, but proven to be a cavernoma with histological analysis. PMID:27190725

  9. Headaches - danger signs

    MedlinePlus

    Migraine headache - danger signs; Tension headache - danger signs; Cluster headache - danger signs; Vascular headache - danger signs ... and bleeding in the brain can cause a headache. These problems include: Abnormal connection between the arteries ...

  10. Tension headache

    MedlinePlus

    ... headaches occur when neck and scalp muscles become tense, or contract. The muscle contractions can be a ... and practice stress management . Some people find relaxation exercises or meditation helpful. Biofeedback may help you improve ...

  11. Dural port therapy

    PubMed Central

    Farmer, John A.; Blum, Charles L.

    2002-01-01

    Abstract Introduction Dural port therapy (DPT) is a chiropractic procedure which can be used effectively with Sacro-Occipital Technique (SOT) procedures and which uses the sacrum as a lever to influence and balance the spine and cranium by way of the meningeal system. Discussion Rationale and research is presented to explain the basis behind DPT's method of affecting the craniospinal system and its relationship to the meninges. Though the procedure can be used with most conditions, DPT appears to be safe to use with osteoporotic conditions, fractured vertebrae, and other conditions where a “thrust” to the spine may be contraindicated. Basic methods of using DPT are presented along with alternative methods which can be applied when the basic methods are not sufficient. Conclusion DPT reduces sacral, spinal, and cranial dura meningeal tension, lesions, torque and stress, as well as dural sleeve vasomotor interference. The possibility that the doctor can influence the nervous system directly in such a powerful manner warrants further investigation. PMID:19674561

  12. Cluster headache

    MedlinePlus

    ... the body released during an allergic response) or serotonin (chemical made by nerve cells). A problem in a small area at the base of the brain called the hypothalamus may be involved. More men than women are affected. The headaches can occur at any ...

  13. Allergies and Headache

    MedlinePlus

    ... vasoactive or neuroactive amino acids such as tyramine , dopamine, phenylethylamine or monosodium glutamate that can trigger a ... Headache Fact Sheets Tags: allergy , allergy and headache , dopamine , headache , migraine , sinus headache , tyramine More Posts ← Tension- ...

  14. National Headache Foundation

    MedlinePlus

    ... Headache War Veterans Health Resource Initiative National Headache Foundation Brochures For Professionals Learn About CAQ Get More ... 45 years, our mission at the National Headache Foundation has been to further awareness of headache and ...

  15. Traumatic Dural Venous Sinus Injury

    PubMed Central

    Kim, You-Sub; Jung, Seung-Hoon; Lim, Dong-Ho; Kim, Tae-Sun; Kim, Jae-Hyoo

    2015-01-01

    Objective The importance of traumatic dural venous sinus injury lies in the probability of massive blood loss at the time of trauma or emergency operation resulting in a high mortality rate during the perioperative period. We considered the appropriate methods of treatment that are most essential in the overall management of traumatic dural venous sinus injuries. Methods We conducted a retrospective review of all cases involving patients with dural venous sinus injury who presented to our hospital between January 1999 and December 2014. Results Between January 1999 and December 2014, 20 patients with a dural venous sinus injury out of the 1,200 patients with severe head injuries who had been operated upon in our clinic were reviewed retrospectively. There were 17 male and 3 female patients. In 11 out of the 13 patients with a linear skull fracture crossing the dural venous sinus, massive blood loss from the injured sinus wall could be controlled by simple digital pressure using Gelfoam. All 5 patients with a linear skull fracture parallel to the sinus over the venous sinus developed massive sinus bleeding that could not be controlled by simple digital pressure. Conclusion When there is a linear skull fracture parallel to the sinus over the dural venous sinus or a depressed skull fracture penetrating the sinus, the surgeon should be prepared for the possibility of potentially fatal venous sinus injury, even in the absence of a hematoma. PMID:27169076

  16. Acoustic puncture assist device: A novel technique to identify the epidural space

    PubMed Central

    Al-Mokaddam, MA; Al-Harbi, MK; El-Jandali, ST; Al-Zahrani, TA

    2016-01-01

    Background: Acoustic puncture assist device (APAD) is designed to detect and signal the loss of resistance during the epidural procedure. We aimed to evaluate this device in terms of successful identification of the epidural space and the incidence of accidental dural puncture. Patients and Methods: Following Institutional Review Board approval and written informed consent obtained from all patients, 200 adult patients (107 males) American Society of Anesthesiologists I-III who underwent lower limb orthopedic surgery under lumbar epidural anesthesia using APAD were enrolled in the study. APAD system was connected to the epidural needle using normal saline prefilled extension tube. Numbers of successful epidural attempts and accidental dural tap were documented. Results: The mean values of the depth of epidural space and the time to perform epidural puncture were 5.8 ± 1.0 cm and 3.3 ± 1.4 min, respectively. In 63% of patients, epidural puncture was successful from the first attempt and in 1% it was successful from the fourth attempt. Epidural anesthesia by APAD was successful in 198 cases (99 %). Dural tap occurred in 2 cases (1%). Conclusions: Using APAD, the success of identifying the epidural space was high and reliable. PMID:27051369

  17. pH-evoked dural afferent signaling is mediated by ASIC3 and is sensitized by mast cell mediators

    PubMed Central

    Yan, Jin; Wei, Xiaomei; Bischoff, Christina; Edelmayer, Rebecca M.; Dussor, Gregory

    2013-01-01

    Background Prior studies have shown that decreased meningeal pH activates dural afferents via opening of acid-sensing ion channels (ASICs) suggesting one pathophysiological mechanism for the generation of headaches. The studies described here further examined the ASIC subtype mediating pH-induced dural-afferent activation and examined whether sensitization influences pH responses. Objective Given the potential importance of meningeal mast cells to headache, the goal of this study was to evaluate dural afferent responses to pH following sensitization with mast cell mediators. Methods Cutaneous allodynia was measured in rats following stimulation of the dura with decreased pH alone or in combination with mast cell mediators. Trigeminal ganglion neurons retrogradely-labeled from the dura were stained with an ASIC3 antibody using immunohistochemistry. Currents and action potentials evoked by changes in pH alone or in combination with mast cell mediators were measured in retrogradely-labeled dural afferents using patch-clamp electrophysiology. Results pH-sensitive dural afferents generated currents in response to the ASIC3 activator 2-guanidine-4-methylquinazoline (GMQ), approximately 80% of these neurons express ASIC3 protein, and pH-evoked behavioral responses were inhibited by the ASIC3 blocker APETx2. Following exposure to mast cell mediators, dural afferents exhibited increased pH-evoked excitability and cutaneous allodynia was observed at higher pH than with pH stimuli alone. Conclusion These data indicate that the predominant ASIC subtype responding to decreased meningeal pH is ASIC3. Additionally, they demonstrate that in the presence of inflammation, dural afferents respond to even smaller decreases in pH providing further support for the ability of small pH changes within the meninges to initiate afferent input leading to headache. PMID:23808707

  18. Managing tension headaches at home

    MedlinePlus

    Tension-type headache - self-care; Muscle contraction headache - self-care; Headache - benign - self-care; Headache - tension- self-care; Chronic headaches - tension - self-care; Rebound headaches - tension - self- ...

  19. Managing tension headaches at home

    MedlinePlus

    Tension-type headache - self-care; Muscle contraction headache - self-care; Headache - benign - self-care; Headache - tension- self-care; Chronic headaches - tension - self-care; Rebound headaches - ...

  20. Chronic daily headaches

    PubMed Central

    Ahmed, Fayyaz; Parthasarathy, Rajsrinivas; Khalil, Modar

    2012-01-01

    Chronic Daily Headache is a descriptive term that includes disorders with headaches on more days than not and affects 4% of the general population. The condition has a debilitating effect on individuals and society through direct cost to healthcare and indirectly to the economy in general. To successfully manage chronic daily headache syndromes it is important to exclude secondary causes with comprehensive history and relevant investigations; identify risk factors that predict its development and recognise its sub-types to appropriately manage the condition. Chronic migraine, chronic tension-type headache, new daily persistent headache and medication overuse headache accounts for the vast majority of chronic daily headaches. The scope of this article is to review the primary headache disorders. Secondary headaches are not discussed except medication overuse headache that often accompanies primary headache disorders. The article critically reviews the literature on the current understanding of daily headache disorders focusing in particular on recent developments in the treatment of frequent headaches. PMID:23024563

  1. Spontaneous intracranial hypotension secondary to anterior thoracic osteophyte: Resolution after primary dural repair via posterior approach

    PubMed Central

    Veeravagu, Anand; Gupta, Gaurav; Jiang, Bowen; Berta, Scott C.; Mindea, Stefan A.; Chang, Steven D.

    2012-01-01

    INTRODUCTION Spontaneous intracranial hypotension (SIH) is an uncommon syndrome widely attributed to CSF hypovolemia, typically secondary to spontaneous CSF leak. Although commonly associated with postural headache and variable neurological symptoms, one of the most severe consequences of SIH is bilateral subdural hematomas with resultant neurological deterioration. PRESENTATION OF CASE We present the case of a patient diagnosed with SIH secondary to an anteriorly positioned thoracic osteophyte with resultant dural disruption, who after multiple attempts at nonsurgical management developed bilateral subdural hematomas necessitating emergent surgical intervention. The patient underwent a unilateral posterior repair of his osteophyte with successful anterior decompression. At 36 months follow up, the patient reported completely resolved headaches with no focal neurological deficits. DISCUSSION We outline our posterior approach to repair of the dural defect and review the management algorithm for the treatment of patients with SIH. We also examine the current hypotheses as to the origin, pathophysiology, diagnosis and treatment of this syndrome. CONCLUSION A posterior approach was utilized to repair the dural defect caused by an anterior thoracic osteophyte in a patient with severe SIH complicated by bilateral subdural hematomas. This approach minimizes morbidity compared to an anterior approach and allowed for removal of the osteophyte and repair of the dural defect. PMID:23108168

  2. Recurrent unilateral headache associated with SAPHO syndrome.

    PubMed

    Tsugawa, Jun; Ouma, Shinji; Fukae, Jiro; Tsuboi, Yoshio

    2014-01-01

    A 57-year-old woman was admitted with recurrent episodes of right frontal headache. Head magnetic resonance imaging (MRI) revealed extensive thickening and enhancement of the right frontal dura, muscle and fascia, as well as abnormal signal intensity and enhancement of bone marrow at the lesions. Synovitis-acne-pustulosis-hyperostosis osteomyelitis (SAPHO) syndrome was diagnosed based on the patient's 8-year history of treatment of palmoplantar pustulosis and abnormal accumulations in the right temporal, sternum, and left medial clavicula on bone scintigraphy. SAPHO syndrome may be associated with skull lesions, which can contribute to the onset of repeated headache or dural thickening, thus these symptoms should be recognized as manifestations of this syndrome. PMID:25030573

  3. Headaches (For Parents)

    MedlinePlus

    ... migraines. Migraines Often triggered by things like stress, sleep deprivation, and menstruation, migraine headaches can cause the following ... your child headache following a head injury or loss of consciousness headache accompanied by seizures visual changes ...

  4. [Headache can be caused by spontaneous intracranial hypotension.

    PubMed

    Hansen, Lasse Berg; Bjarkam, Carsten Reidies

    2014-06-01

    Spontaneous intracranial hypotension (SIH) is an uncommon condition associated with postural headache, nausea and dizziness. It is believed to be secondary to a dural tear with resultant cerebrospinal fluid (CSF) leak. This is a case report of a pregnant woman (gestational age 31 weeks) who contacted an obstetric department because of severe headache. Pre-eclamp-sia was suspected, but not found. An MRI showed a CSF leak at C1-C2 level and intracranial signs of SIH. The woman was treated with an autologous blood patch and recovered quickly. Focus on subjective symptoms and MRI findings seem to be important in the diagnostic procedure of SIH. PMID:25352082

  5. Cuts and puncture wounds

    MedlinePlus

    ... cuts and puncture wounds can be treated at home. Take the following steps. FOR MINOR CUTS Wash your hands with soap or antibacterial ... and scissors safely. Make sure you and your child are up to date on vaccinations . A tetanus vaccine is generally recommended every 10 ... Snake bite Minor cut - first aid Sewing a wound closed - series ...

  6. Looking at "thunderclap headache" differently? Circa 2016.

    PubMed

    Ravishankar, K

    2016-01-01

    The term "thunderclap headache" (TCH) was first coined in 1986 by Day and Raskin to describe headache that was the presenting feature of an underlying unruptured cerebral aneurysm. The term is now well established to describe the abrupt onset headache seen with many other conditions and is also now included in The International Classification of Headache Disorders 3(rd) edition beta version rubric 4.4. An essential to label an acute headache as "TCH" and differentiate it from other "sudden onset, severe headaches" is the arbitrary time frame of 1 min from onset to peak intensity for "TCH." What happens in practice, however, is that even those "sudden onset, severe headaches" that do not strictly fulfill the definition criteria are also labeled as "TCH" and investigated with the same speed and in the same sequence and managed based on the underlying cause. This article begins by questioning the validity and usefulness of this "one minute" arbitrary time frame to define "TCH," particularly since this time frame is very difficult to assess in practice and is usually done on a presumptive subjective basis. The article concludes with suggestions for modification of the current investigation protocol for this emergency headache scenario. This proposal for "a change in practice methodology" is essentially based on (1) the fact that in the last two decades, we now have evidence for many more entities other than just subarachnoid hemorrhage that can present as "TCH" or "sudden onset, severe headache" and (2) the evidence from literature which shows that advances in imaging technology using higher magnet strength, better contrast, and newer acquisition sequences will result in a better diagnostic yield. It is therefore time now, in our opinion, to discard current theoretical time frames, use self-explanatory terminologies with practical implications, and move from "lumbar puncture (LP) first" to "LP last!" PMID:27570377

  7. Headache in divers.

    PubMed

    Cheshire, W P; Ott, M C

    2001-03-01

    The increasing popularity of scuba diving has added a new category to the differential diagnosis of headache. Headache in divers, while uncommon and generally benign, can occasionally signify serious consequences of hyperbaric exposure such as arterial gas embolism, decompression sickness, and otic or paranasal sinus barotrauma. Inadequate ventilation of compressed gases can lead to carbon dioxide accumulation, cerebral vasodilatation, and headache. Other types of headache encountered in divers include exertional headache, cold stimulus headache, migraine, tension-type headache, acute traumatic headache, cervicogenic headache, carbon monoxide poisoning headache, and headache associated with envenomation. Correct diagnosis and appropriate treatment require a careful history and neurologic examination as well as an understanding of the unique physiologic stresses of the subaquatic environment. PMID:11264683

  8. Headaches and exercise.

    PubMed

    McCrory, P

    2000-09-01

    Exercise-related headache is one of the most common medical problems affecting the modern-day athlete. Despite the high prevalence of headache in community populations, the epidemiology of sports-related headache is unclear. In certain collision sports, up to 50% of athletes report regular headaches as a consequence of their athletic participation. The classification of the different types of sport-related headache by the International Headache Society (IHS) and in previously published articles does not adequately encompass the clinical problem faced by team physicians. Confusion exists where terms such as 'effort headache' and 'exertional headache' may be used to describe similar entities. In this review, the specific headache entities discussed include benign exertional headache, effort headache, acute post-traumatic headache and cervicogenic headache. For the sports physician, an understanding of the variety of specific headache syndromes that occur with particular sports is necessary for everyday clinical practice. This article reviews the common exercise-related headache syndromes and attempts to provide a framework for their overall management. Team physicians also need to be cognisant that many of the standard preparations used to treat headaches may be banned drugs under International Olympic Committee (IOC) rules. PMID:10999425

  9. Tinnitus and Headache

    PubMed Central

    Langguth, Berthold; Hund, Verena; Busch, Volker; Jürgens, Tim P.; Lainez, Jose-Miguel; Landgrebe, Michael; Schecklmann, Martin

    2015-01-01

    Background. Tinnitus and headache are frequent disorders. Here, we aimed to investigate whether the occurrence of headache among tinnitus patients is purely coincidental or whether tinnitus and headache are pathophysiologically linked. We investigated a large sample of patients with tinnitus and headache to estimate prevalence rates of different headache forms, to determine the relationship between tinnitus laterality and headache laterality, and to explore the relationship between tinnitus and headache over time. Method. Patients who presented at a tertiary referral center because of tinnitus and reported comorbid headache were asked to complete validated questionnaires to determine the prevalence of migraine and tension-type headache and to assess tinnitus severity. In addition, several questions about the relationship between headache and tinnitus were asked. Results. Datasets of 193 patients with tinnitus and headache were analysed. 44.6% suffered from migraine, 13% from tension-type headache, and 5.7% from both. Headache laterality was significantly related to tinnitus laterality and in the majority of patients fluctuations in symptom severity of tinnitus and headache were interrelated. Conclusion. These findings suggest a significant relationship between tinnitus and headache laterality and symptom interaction over time and argue against a purely coincidental cooccurrence of tinnitus and headache. Both disorders may be linked by common pathophysiological mechanisms. PMID:26583133

  10. Sleep and primary headaches.

    PubMed

    Aguggia, Marco; Cavallini, M; Divito, N; Ferrero, M; Lentini, A; Montano, V; Tinebra, M C; Saracco, M G; Valfrè, W

    2011-05-01

    The relationship between sleep and primary headaches has been known for over a century, particularly for headaches occurring during the night or early morning. Migraine, tension-tyre headache, and cluster headache may cause sleep fragmentation, insomnia, and hypersomnia, causing considerable social and economical costs and several familial problems. By contrast, sleep disorders may themselves trigger headache attacks. Finally, headaches and sleep disorders can also be symptoms of other underlying pathologies. Despite this background, there is still no clarity about the mechanism that links these two entities and their interdependence remains to be defined. Patients with primary headache should undergo a careful assessment of sleep habits. PMID:21533713

  11. [Headache and migraine].

    PubMed

    Diener, H C; Slomke, M A; Limmroth, V

    2007-09-01

    Headaches are one of the most common disorders and symptoms in daily medical practice. There has been dramatic progress of knowledge in the fields of epidemiology, pathophysiology, acute treatment, and preventive therapy over the past 100 years. Triptans have been the breakthrough in the treatment of acute migraine attacks. Beta blockers, calcium antagonists, and neuromodulators are available for preventive migraine therapy. Treatment for chronic tension headache is still unsatisfying. Cluster headache is part of the group of trigemino-autonomic headaches. Headache from medication overuse plays an increasingly important role. New medical care structures such as integrated headache care provide better support for patients with chronic headache disorders. PMID:17687534

  12. Sleep-related headaches.

    PubMed

    Rains, Jeanetta C; Poceta, J Steven

    2012-11-01

    Irrespective of diagnosis, chronic daily, morning, or "awakening" headache patterns are soft signs of a sleep disorder. Sleep apnea headache may emerge de novo or may present as an exacerbation of cluster, migraine, tension-type, or other headache. Insomnia is the most prevalent sleep disorder in chronic migraine and tension-type headache, and increases risk for depression and anxiety. Sleep disturbance (e.g., sleep loss, oversleeping, schedule shift) is an acute headache trigger for migraine and tension-type headache. Snoring and sleep disturbance are independent risk factors for progression from episodic to chronic headache. PMID:23099138

  13. Other primary headaches

    PubMed Central

    Bahra, Anish

    2012-01-01

    The ‘Other Primary Headaches’ include eight recognised benign headache disorders. Primary stabbing headache is a generally benign disorder which often co-exists with other primary headache disorders such as migraine and cluster headache. Primary cough headache is headache precipitated by valsalva; secondary cough has been reported particularly in association with posterior fossa pathology. Primary exertional headache can occur with sudden or gradual onset during, or immediately after, exercise. Similarly headache associated with sexual activity can occur with gradual evolution or sudden onset. Secondary headache is more likely with both exertional and sexual headache of sudden onset. Sudden onset headache, with maximum intensity reached within a minute, is termed thunderclap headache. A benign form of thunderclap headache exists. However, isolated primary and secondary thunderclap headache cannot be clinically differentiated. Therefore all headache of thunderclap onset should be investigated. The primary forms of the aforementioned paroxysmal headaches appear to be Indomethacin sensitive disorders. Hypnic headache is a rare disorder which is termed ‘alarm clock headache’, exclusively waking patients from sleep. The disorder can be Indomethacin responsive, but can also respond to Lithium and caffeine. New daily persistent headache is a rare and often intractable headache which starts one day and persists daily thereafter for at least 3 months. The clinical syndrome more often has migrainous features or is otherwise has a chronic tension-type headache phenotype. Management is that of the clinical syndrome. Hemicrania continua straddles the disorders of migraine and the trigeminal autonomic cephalalgias and is not dealt with in this review. PMID:23024566

  14. Nitric oxide synthase inhibitors can antagonize neurogenic and calcitonin gene-related peptide induced dilation of dural meningeal vessels

    PubMed Central

    Akerman, S; Williamson, D J; Kaube, H; Goadsby, P J

    2002-01-01

    The detailed pathophysiology of migraine is beginning to be understood and is likely to involve activation of trigeminovascular afferents. Clinically effective anti-migraine compounds are believed to have actions that include peripheral inhibition of calcitonin gene-related peptide (CGRP) release from trigeminal neurones, or preventing dural vessel dilation, or both. CGRP antagonists can block both neurogenic and CGRP-induced dural vessel dilation. Nitric oxide (NO) can induce headache in migraine patients and often triggers a delayed migraine. The initial headache is thought to be caused via a direct action of the NO–cGMP pathway that causes vasodilation by vascular smooth muscle relaxation, while the delayed headache is likely to be a result of triggering trigeminovascular activation. Nitric oxide synthase (NOS) inhibitors are effective in the treatment of acute migraine. The present studies used intravital microscopy to examine the effects of specific NOS inhibitors on neurogenic dural vasodilation (NDV) and CGRP-induced dilation. The non-specific and neuronal NOS (nNOS) inhibitors were able to partially inhibit NDV, while the non-specific and endothelial NOS (eNOS) inhibitors were able to partially inhibit the CGRP induced dilation. There was no effect of the inducible NOS (iNOS) inhibitor. The data suggest that the delayed headache response triggered by NO donors in humans may be due, in part, to increased nNOS activity in the trigeminal system that causes CGRP release and dural vessel dilation. Further, eNOS activity in the endothelium causes NO production and smooth muscle relaxation by direct activation of the NO–cGMP pathway, and may be involved in the initial headache response. PMID:12183331

  15. Rizatriptan has central antinociceptive effects against durally evoked responses.

    PubMed

    Cumberbatch, M J; Hill, R G; Hargreaves, R J

    1997-06-01

    The 5-HT(1B/1D) receptor agonist rizatriptan constricts intracranial, extracerebral blood vessels, inhibits neurogenic vasodilation and extravasation in the meninges and is effective clinically against migraine. The present study has investigated whether rizatriptan may also have activity at 5-HT(1B/1D) receptors within the central nervous system (CNS) that contributes to its antimigraine effects. Action potentials evoked by electrical stimulation of the dura-mater were recorded extracellularly from single neurones in the trigeminal nucleus caudalis in anaesthetized rats. Rizatriptan dose dependently inhibited these nociceptive dural responses by up to 63 +/- 9% after 3 mg/kg, i.v. Rizatriptan therefore has central activity which may contribute to its efficacy against migraine headache. PMID:9203565

  16. [Headache and sleep disorders].

    PubMed

    Miyamoto, Masayuki; Suzuki, Keisuke; Miyamoto, Tomoyuki; Hirata, Koichi

    2014-01-01

    Headache and sleep problems are both some of the most commonly reported symptoms in clinical practice. There is a clear association between chronic headache and sleep disorders, especially headaches occurring during the night or early morning. Identification of sleep problems in chronic headache patients is worthwhile because treatment of sleep disorders among chronic headache patients may be followed by improve of the headache. Morning headache has been recognised as an obstructive sleep apnoea related symptom. Treatment with continuous positive airway pressure usually reduced headache, however, we often encounter obstructive sleep apnoea patients who present various characteristics of morning headache that often do not fulfil the criteria for "sleep apnoea headache" according to the International Classification of Headache Disorders: 2nd edition (ICHD-2) criteria. The pathophysiologic background for a relation between obstructive sleep apnoea and morning headache is multifactorial. We should also be noted that tension-type headache and migraine might be coexisted in obstructive sleep apnoea patients. In addition, we review the relationship between migraine and sleep disorders such as restless legs syndrome, narcolepsy and parasomnia (dream enacting behaviour) including our studies. PMID:25672689

  17. Headaches and Migraines: Understanding Headaches, From Mild to Migraine

    MedlinePlus

    ... not all headaches are the same. From mild tension headaches to crippling migraines, there are steps you ... The most common type of headache is a tension headache. These usually are due to tight muscles ...

  18. American Headache Society

    MedlinePlus

    ... Marriott Camelback Inn READ MORE Jan 20 2017 International Headache Academy Los Angeles, CA , UCLA Meyer & Renee ... Symposium JW Marriott Camelback Inn Jan 20 2017 International Headache Academy UCLA Meyer & Renee Luskin Conference Center ...

  19. Ice Pick Headache.

    PubMed

    Chua, Abigail L; Nahas, Stephanie

    2016-05-01

    Ice pick headache, also called idiopathic or primary stabbing headache, is a unique headache type associated with ultra-brief stabs of pain, most commonly in the frontal or temporal area. It occurs predominantly in women and is estimated to affect 2-35 % of the population. Unlike other headache types of short duration, such as short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT), ice pick headache is not associated with any cranial autonomic symptoms but has been known to occur with nausea, vomiting, photophobia, and dizziness. It exists in two forms: primary and secondary, with examples of secondary causes being herpes zoster meningoencephalitis, meningiomas, stroke, and multiple sclerosis. Ice pick headache is one of the "indomethacin responsive headaches," but up to 35 % of patients fail to show significant benefit with that treatment. Other treatment options include gabapentin, cyclooxygenase-2 inhibitors, melatonin, and external hand warming. PMID:27038969

  20. Headache Sufferers' Diet

    MedlinePlus

    ... of sensitivities (for example, people who find red wine to be a headache trigger often find chocolate ... headaches from alcohol . Others react mostly to red wine (especially Chianti), which is a sensitivity to chemicals, ...

  1. Managing Chronic Headache Disorders.

    PubMed

    Forde, Grace; Duarte, Robert A; Rosen, Noah

    2016-01-01

    Headaches are a very common disorder, more common than asthma and diabetes combined. Migraine is the most common headache disorder, but it remains underdiagnosed and therefore undertreated. The treatment of migraines is divided into acute and prophylaxis. Patients who are experiencing 8 or more headaches a month or those who experience disability with their headaches as determined by the Migraine Disability Assistance Score or MIDAS should be placed on prophylaxis. PMID:26614723

  2. [Cluster headache differential diagnosis].

    PubMed

    Guégan-Massardier, Evelyne; Laubier, Cécile

    2015-11-01

    Cluster headache is characterized by disabling stereotyped headache. Early diagnosis allows appropriate treatment, unfortunately diagnostic errors are frequent. The main differential diagnoses are other primary or essential headaches. Migraine, more frequent and whose diagnosis is carried by excess, trigeminal neuralgia or other trigemino-autonomic cephalgia. Vascular or tumoral underlying condition can mimic cluster headache, neck and brain imaging is recommended, ideally MRI. PMID:26549687

  3. [Pathophysiology of cluster headache].

    PubMed

    Donnet, Anne

    2015-11-01

    The aetiology of cluster headache is partially unknown. Three areas are involved in the pathogenesis of cluster headache: the trigeminal nociceptive pathways, the autonomic system and the hypothalamus. The cluster headache attack involves activation of the trigeminal autonomic reflex. A dysfunction located in posterior hypothalamic gray matter is probably pivotal in the process. There is a probable association between smoke exposure, a possible genetic predisposition and the development of cluster headache. PMID:26470883

  4. New Classification of Headache

    PubMed Central

    Gawel, Marek J.

    1992-01-01

    The Headache Classification Committee of the International Headache Society has developed a new classification system for headache, cranial neuralgia, and facial pain. The value of the classification for the practising clinician is that it forces him or her to take a more careful history in order to determine the nature of the headache. This article reviews the classification system and gives examples of case histories and subsequent diagnoses. PMID:21221276

  5. Headache management: pharmacological approaches

    PubMed Central

    Sinclair, Alex J; Sturrock, Aaron; Davies, Brendan; Matharu, Manjit

    2015-01-01

    Headache is one of the most common conditions presenting to the neurology clinic, yet a significant proportion of these patients are unsatisfied by their clinic experience. Headache can be extremely disabling; effective treatment is not only essential for patients but is rewarding for the physician. In this first of two parts review of headache, we provide an overview of headache management, emerging therapeutic strategies and an accessible interpretation of clinical guidelines to assist the busy neurologist. PMID:26141299

  6. Methacholine induced headache.

    PubMed Central

    Carratala, C.; Gea, J. G.; Aguar, M. C.; Grau, S.; Espadaler-Medina, J. M.; Broquetas, J. M.

    1995-01-01

    A lung function technician developed episodes of headache, probably related to the use of methacholine. The headache disappeared with breathing 100% oxygen. Cholinergic agents are known to induce headaches but the mechanism remains unclear. Vascular factors could be implicated. PMID:7660351

  7. Methacholine induced headache.

    PubMed

    Carratala, C; Gea, J G; Aguar, M C; Grau, S; Espadaler-Medina, J M; Broquetas, J M

    1995-03-01

    A lung function technician developed episodes of headache, probably related to the use of methacholine. The headache disappeared with breathing 100% oxygen. Cholinergic agents are known to induce headaches but the mechanism remains unclear. Vascular factors could be implicated. PMID:7660351

  8. Primary dural non-hodgkin's lymphoma mimicking meningioma: A case report and review of literature.

    PubMed

    Kudrimoti, Jyoti K; Gaikwad, Manish J; Puranik, Shaila C; Chugh, Ashish P

    2015-01-01

    A 42-year-old immunocompetent female presented with headache, vomiting and diminished unilateral vision. Computed tomography and magnetic resonance imaging were suggestive of high-grade meningioma. Neurological examination and routine hematological parameters were within normal limits. Craniotomy was performed; the tumor was arising from the dura mater, which was completely resected. Hematoxylin and eosin showed lesion comprising a tumor mass with monomorphic population of tumor cells arranged in sheets and small follicles. The tumor cells were immunoreactive for leukocyte common antigen and CD20 and immunonegative for glial fibrillary acid protein, epithelial membrane antigen, cytokeratin, CD3 and CD30. Rest of the body scan was normal. A diagnosis of primary dural non-Hodgkin's lymphoma was made. We report this exceedingly rare case of primary dural non-Hodgkin's lymphoma, which mimicked clinically and radiologically as meningioma. PMID:26458614

  9. Hijab (headscarf) headache.

    PubMed

    Ansari, Huma N; Solomon, Glen D

    2015-03-01

    Hijab (headscarf) headache is well known among wearers and is a common topic of discussion. It has never previously been reported in the medical literature. Five women described bilateral headache either prompted by or worsened by donning the hijab, or headscarf. The headache always resolved soon after removal of the headscarf. Hijab headache may also be alleviated by minimal modifications in style while allowing women to maintain their moral conviction. It likely represents an extracranial etiology of headache, and recognition may prevent unnecessary evaluation and suffering in hijab wearers. PMID:25711501

  10. Causality and headache triggers

    PubMed Central

    Turner, Dana P.; Smitherman, Todd A.; Martin, Vincent T.; Penzien, Donald B.; Houle, Timothy T.

    2013-01-01

    Objective The objective of this study was to explore the conditions necessary to assign causal status to headache triggers. Background The term “headache trigger” is commonly used to label any stimulus that is assumed to cause headaches. However, the assumptions required for determining if a given stimulus in fact has a causal-type relationship in eliciting headaches have not been explicated. Methods A synthesis and application of Rubin’s Causal Model is applied to the context of headache causes. From this application the conditions necessary to infer that one event (trigger) causes another (headache) are outlined using basic assumptions and examples from relevant literature. Results Although many conditions must be satisfied for a causal attribution, three basic assumptions are identified for determining causality in headache triggers: 1) constancy of the sufferer; 2) constancy of the trigger effect; and 3) constancy of the trigger presentation. A valid evaluation of a potential trigger’s effect can only be undertaken once these three basic assumptions are satisfied during formal or informal studies of headache triggers. Conclusions Evaluating these assumptions is extremely difficult or infeasible in clinical practice, and satisfying them during natural experimentation is unlikely. Researchers, practitioners, and headache sufferers are encouraged to avoid natural experimentation to determine the causal effects of headache triggers. Instead, formal experimental designs or retrospective diary studies using advanced statistical modeling techniques provide the best approaches to satisfy the required assumptions and inform causal statements about headache triggers. PMID:23534872

  11. Yom Kippur headache.

    PubMed

    Mosek, A; Korczyn, A D

    1995-11-01

    Fasting is frequently mentioned by patients and in textbooks as a trigger for headache. In this study, we attempted to define the role of fasting as a possible precipitator of headache. Headache history was documented in 370 hospital employees (60% female) before and immediately after a 25-hour fast for the 1993 Day of Atonement (Yom Kippur). The population included 211 who fasted; 39% of fasters developed headache, compared with only 7% of nonfasters (p < 0.000001). Headache was usually of a nonpulsating quality, mild to moderate in intensity, and bilateral and frontal in location. Subjects with a history of headache were more likely to develop fasting-induced headache than were those without such history (66% versus 29%, p < 0.000002). The number of headache sufferers increased in direct relation to the duration of the fast. Caffeine and nicotine withdrawal and oversleeping did not appear to have an influence on headache development. We conclude that fasting is a strong headache precipitator, especially among chronic headache sufferers. It is usually nonpulsating and nonlateralized. PMID:7501139

  12. Dural arteriovenous fistula discovered in patient presenting with recent head trauma

    PubMed Central

    Cooper, Chad J.; Said, Sarmad; Nunez, Angelica; Quansah, Raphael; Khalillullah, Sayeed; Hernandez, German T.

    2013-01-01

    Patient Male, 32 Final Diagnosis: Dural arterio-venous fistula Symptoms: Eye redness • post-trauma headache • tinnitus Medication: — Clinical Procedure: Fistula embolization Specialty: Neurology Objective: Mistake in diagnosis Background: A dural arteriovenous fistula (DAVF), is an abnormal direct connection (fistula) between a meningeal artery and a meningeal vein or dural venous sinus. The pathogenesis of DAVF still remains unclear. Sinus thrombosis, head trauma, chronic central nervous system, hypercoagulable state, surgery, and hormonal influence are the pre-disposing factors that initiate this disease. The symptoms experienced by the patient will depend on the location of the fistula. Case Report: Thirty-two year old Hispanic male who presented one day after a rear ended motor vehicle collision (MVC) with a severe throbbing headache in the left parietal region, left eye redness but no retro-orbital pain and tinnitus in the left ear. He was initially misdiagnosed to have a carotid-cavernous fistula but upon cerebral angiogram was actually diagnosed with a dural arterio-venous fistula in the posterior fossa venous system followed by successful embolization of the fistula. Conclusions: A cerebral angiography is the gold standard for detection and characterization of a DAVF and will distinguish it from a CCF. Endovascular surgery involves a catheter-based technique for embolization of the lumen of arteries feeding the DAVF, or directly into the vein draining the DAVF. It is very important to recognize the typical findings of patients presenting with a DAVF then quickly proceeding with a cerebral angiogram to determine the exact location of the fistula and the appropriate treatment plan. By diagnosing and treating a DAVF as early as possible, the associated fatal complications can be averted. PMID:24194975

  13. Role of opioid receptors in neurogenic dural vasodilation and sensitization of trigeminal neurones in anaesthetized rats

    PubMed Central

    Williamson, D J; Shepheard, S L; Cook, D A; Hargreaves, R J; Hill, R G; Cumberbatch, M J

    2001-01-01

    Migraine headache is thought to be caused by a distension of meningeal blood vessels, the activation of trigeminal sensory neurones and the the development of a central sensitization within the trigeminal nucleus caudalis (TNC). It has been proposed that clinically effective 5-HT1B/1D agonists act peripherally to inhibit the release of calcitonin gene-related peptide (CGRP) and neurogenic dural vasodilation, and to attenuate nociceptive neurotransmission within the TNC. Since opioids are also effective anti-migraine agents the present studies investigated the role of opioids within the trigemino-vascular system in anaesthetised rats. Electrical stimulation of the dura mater evoked neurogenic dural vasodilation which was significantly inhibited by morphine (1 mg kg−1) the selective μ-opioid agonist DAGO (10 μg kg−1) and the mixed agonist/antagonist butorphanol (1 mg kg−1) but not by the κ- and δ-opioid agonists (±) U50488H (100 μg kg−1) and DPDPE (1 mg kg−1). Morphine had no effect on CGRP-evoked dural vasodilation. In electrophysiological studies morphine (1 – 10 mg kg−1) significantly attenuated brainstem neuronal activity in response to electrical stimulation of the dura by 65% at 10 mg kg−1. Morphine (3 mg kg−1) also inhibited the TNC neuronal sensitization following CGRP-evoked dilation. The present studies have demonstrated that opioids block the nociceptive neurotransmission within the trigeminal nucleus caudalis and in addition inhibit neurogenic dural vasodilation via an action on μ-opioid receptors located on trigeminal sensory fibres innervating dural blood vessels. These peripheral and central actions are similar to those of the ‘triptan' 5-HT1B/1D agonists and could account for the anti-migraine actions of opioids. PMID:11454653

  14. The effects of needle deformation during lumbar puncture

    PubMed Central

    Özdemir, Hasan Hüseyin; Demir, Caner F.; Varol, Sefer; Arslan, Demet; Yıldız, Mustafa; Akil, Eşref

    2015-01-01

    Objective: The aim of this study is to assess deformation of the tip and deflection from the axis of 22-gauge Quincke needles when they are used for diagnostic lumbar puncture (LP). Thus, it can be determined whether constructional alterations of needles are important for predicting clinical problems after diagnostic LP. Materials and Methods: The 22-gauge Quincke needles used for diagnostic LP were evaluated. A specially designed protractor was used for measurement and evaluation. Waist circumference was measured in each patient. Patients were questioned about headaches occurring after LP. Results: A total of 115 Quincke-type spinal needles used in 113 patients were evaluated. No deflection was detected in 38 (33.1%) of the needles. Deflection between 0.1° and 5° occurred in 43 (37.3%) of the needles and deflection ≥ 5.1° occurred in 34 patients (29.6%). Forty-seven (41.5%) patients experienced post lumbar puncture headache (PLPH) and 13 (11.5%) patients experienced intracranial hypotension (IH). No statistically significant correlation between the degree of deflection and headache was found (P > 0.05). Epidural blood patch was performed for three patients. Deformity in the form of bending like a hook occurred in seven needles and IH occurred in six patients using these needles. Two of the needles used in three patients requiring blood patch were found to be bent. Conclusion: Deformation of needles may increase complications after LP. Needle deformation may lead to IH. In case of deterioration in the structure of the needle, termination of the puncture procedure and the use of a new needle could reduce undesirable clinical consequences, especially IH. PMID:25883480

  15. Sexuality and headache.

    PubMed

    Del Bene, E; Conti, C; Poggioni, M; Sicuteri, F

    1982-01-01

    Ten percent of 362 headache sufferers reported sexual arousal during migraine attack. Clinical investigations on sexuality in 16 headache sufferers, according to some studies showing correlations between idiopathic headache and sexual behavior, were performed. Patients responding by questionnaire listed each sexual experience, headache attack, and number of sleeping hours every day for 1 month. In both men and women, the number of coiti, erotic dreams, and sleeping hours were similar in headache sufferers and controls, while the frequency of masturbation was significantly reduced in the former. Sexual excitement and fantasies appeared more often in female headache sufferers than in controls, while the opposite occurred in the male group. Among the clinical analogies between the crises of migraine and morphine abstinence, sexual arousal may be included. PMID:7054999

  16. [Electrotherapy for headaches].

    PubMed

    Lutters, B; Koehler, P J

    2016-01-01

    Neuromodulation is being applied increasingly for the treatment of drug resistant headache. Although these techniques are often considered high-tech, electrotherapy for headache has a long history; electric fish have been used for headache treatment since the first century CE. During the eighteenth and nineteenth century, static electricity was a treatment for a wide variety of neuropsychiatric disorders including headache. The efficacy of electrotherapy, however, has been disputed continuously, since opponents were of the opinion that the positive results could be attributed to suggestion. At the beginning of the twentieth century, the electric treatment of headache gradually disappeared. In recent years, there has been a resurgence in the use of electrotherapy, along with the efficacy debate. With this historical review we wish to emphasize the importance of placebo-controlled studies, not only in terms of electrotherapy of headache, but also for the evaluation of neuromodulation for other disorders. PMID:27353158

  17. High-altitude headache.

    PubMed

    Marmura, Michael J; Hernandez, Pablo Bandres

    2015-05-01

    High-altitude headache is one of many neurological symptoms associated with the ascent to high altitudes. Cellular hypoxia due to decreased barometric pressure seems to be the common final pathway for headache as altitude increases. Susceptibility to high-altitude headache depends on genetic factors, history of migraine, and acclimatization, but symptoms of acute mountain sickness are universal at very high altitudes. This review summarizes the pathophysiology of acute mountain sickness and high-altitude headache as well as the evidence for treatment and prevention with different drugs and devices which may be useful for regular and novice mountaineers. This includes an examination of other headache disorders which may mimic high-altitude headache. PMID:25795155

  18. Pain. Part 10: Headaches.

    PubMed

    Chong, M S; Renton, Tara

    2016-06-01

    This last in a series of 10 papers aims to provide the dental and medical teams with an update in headache conditions relevant to dentistry and medicine. Headache is the most common presenting symptom for patients presenting to A&E departments. CPD/Clinical Relevance: Most of the dental team take for granted their knowledge and ability to manage acute dental pain. However, the education and preparation in managing patients with headache conditions remains poor. Dentists are in a privileged position to be able to advise their patients about common conditions including headaches. PMID:27529913

  19. Pregnancy and chronic headache.

    PubMed

    Marcus, Dawn A

    2002-04-01

    Headache patterns in women change in relation to fluctuations in oestrogen levels. Increasing oestrogen levels in early pregnancy offer a protective effect against headache, particularly for women with migraine. However, some women continue to experience troublesome headache throughout pregnancy. Headache persisting at the end of the first trimester will usually continue without improvement for the remainder of pregnancy and should be treated. Safe and effective acute care treatment options include paracetamol, opioids and anti-emetics. The use of triptans during pregnancy is controversial and not broadly recommended. Safe and effective preventive treatments include relaxation, biofeedback, beta-blockers, some antidepressants and gabapentin in early pregnancy. PMID:11934341

  20. Headaches and Migraines: Headache Symptoms, Diagnosis, and Treatment

    MedlinePlus

    ... Bar Home Current Issue Past Issues Headaches and Migraines Headache Symptoms, Diagnosis, and Treatment Past Issues / Spring ... of headache. Each has distinct symptoms and treatments. Migraine and Other Vascular Headaches—Symptoms and Diagnosis Migraine: ...

  1. Headaches and Migraines: Headache Symptoms, Diagnosis, and Treatment

    MedlinePlus

    ... Home Current Issue Past Issues Headaches and Migraines Headache Symptoms, Diagnosis, and Treatment Past Issues / Spring 2009 ... turn Javascript on. There are several types of headache. Each has distinct symptoms and treatments. Migraine and ...

  2. Management of cluster headache.

    PubMed

    Tfelt-Hansen, Peer C; Jensen, Rigmor H

    2012-07-01

    The prevalence of cluster headache is 0.1% and cluster headache is often not diagnosed or misdiagnosed as migraine or sinusitis. In cluster headache there is often a considerable diagnostic delay - an average of 7 years in a population-based survey. Cluster headache is characterized by very severe or severe orbital or periorbital pain with a duration of 15-180 minutes. The cluster headache attacks are accompanied by characteristic associated unilateral symptoms such as tearing, nasal congestion and/or rhinorrhoea, eyelid oedema, miosis and/or ptosis. In addition, there is a sense of restlessness and agitation. Patients may have up to eight attacks per day. Episodic cluster headache (ECH) occurs in clusters of weeks to months duration, whereas chronic cluster headache (CCH) attacks occur for more than 1 year without remissions. Management of cluster headache is divided into acute attack treatment and prophylactic treatment. In ECH and CCH the attacks can be treated with oxygen (12 L/min) or subcutaneous sumatriptan 6 mg. For both oxygen and sumatriptan there are two randomized, placebo-controlled trials demonstrating efficacy. In both ECH and CCH, verapamil is the prophylactic drug of choice. Verapamil 360 mg/day was found to be superior to placebo in one clinical trial. In clinical practice, daily doses of 480-720 mg are mostly used. Thus, the dose of verapamil used in cluster headache treatment may be double the dose used in cardiology, and with the higher doses the PR interval should be checked with an ECG. At the start of a cluster, transitional preventive treatment such as corticosteroids or greater occipital nerve blockade can be given. In CCH and in long-standing clusters of ECH, lithium, methysergide, topiramate, valproic acid and ergotamine tartrate can be used as add-on prophylactic treatment. In drug-resistant CCH, neuromodulation with either occipital nerve stimulation or deep brain stimulation of the hypothalamus is an alternative treatment strategy

  3. Headache Hygiene -- What Is It?

    MedlinePlus

    ... is it? Print Email Headache Hygiene - What is it? ACHE Newsletter Sign up for our newsletter by ... e-mail address below. Headache Hygiene - What is it? Headache hygiene is the practice of taking care ...

  4. Treatment of headache.

    PubMed

    Diamond, S; Freitag, F G

    1989-01-01

    Headache is the most common complaint encountered in clinical practice. Approximately 45 million people in the United States experience chronic headaches. The management of migraine headache involves both pharmacologic and nondrug therapy. Drug therapy for migraine involves the use of abortive and prophylactic agents. Abortive agents, such as ergotamine tartrate and ketoprofen, may be used to relieve the acute attack. Prophylactic therapy is focused on reducing the frequency and severity of the attacks. beta-Adrenergic blocking agents, such as propranolol, remain the primary agents for many migraine patients, although other drugs, such as nonsteroidal anti-inflammatory drugs (NSAIDs), including ketoprofen, or calcium-channel blocking agents, such as verapamil, may be beneficial for many patients. For cluster headache and its variants, methysergide and corticosteroids are usually the drugs of choice. Patients with chronic cluster headache may achieve good results from long-term treatment with other therapies, including lithium carbonate, verapamil, and ketoprofen. PMID:2520442

  5. Headache yesterday in Europe

    PubMed Central

    2014-01-01

    Background Surveys enquiring about burden of headache over a prior period of time (eg, 3 months) are subject to recall bias. To eliminate this as far as possible, we focused on presence and impact of headache on the preceding day (“headache yesterday”). Methods Adults (18-65 years) were surveyed from the general populations of Germany, Italy, Lithuania, Luxembourg and the Netherlands, from a work-force population in Spain and from mostly non-headache patient populations of Austria, France and UK. A study of non-responders in some countries allowed detection of potential participation bias where initial participation rates were low. Results Participation rates varied between 11% and 59% (mean 27%). Non-responder studies suggested that, because of participation bias, headache prevalence might be overestimated in initial responders by up to 2% (absolute). Across all countries, 1,422 of 8,271 participants (15-17%, depending on correction for participation bias) had headache yesterday lasting on average for 6 hours. It was bad or very bad in 56% of cases and caused absence from work or school in 6%. Among those who worked despite headache, 20% reported productivity reduced by >50%. Social activities were lost by 24%. Women (21%) were more likely than men (12%) to have headache yesterday, but impact was similar in the two genders. Conclusions With recall biases avoided, our findings indicate that headache costs at least 0.7% of working capacity in Europe. This calculation takes into account that most of those who missed work could make up for this later, which, however, means that leisure and social activities are even more influenced by headache. PMID:24884765

  6. Acute aggravation of subdural fluid collection associated with dural metastasis of malignant neoplasms: case report and review of the literature.

    PubMed

    Kimura, Shigeyoshi; Kotani, Akio; Takimoto, Toshiro; Yoshino, Atsuo; Katayama, Yoichi

    2014-10-01

    A 63-year-old woman was admitted to our hospital with serious headache and vomiting. Five months before admission, she had undergone surgery for a primary advanced gastric cancer. Neuroradiological examinations revealed subdural fluid collection. We twice performed evacuation of the subdural fluid collection. However, aggravation of her state of consciousness progressed and she passed away. Histological examinations demonstrated that the dural veins were infiltrated by numerous tumor cells that produced mucus; however, ruptured vessels were not found. Furthermore, the subdural fluid collection increased shortly after the initial operation. We infer that the cause of the collection, which was associated with the dural metastasis of malignant tumors, was not only mucin secretion by tumor cells but also a rapid increase in perfusion pressure in the vessels of the dura mater, resulting in extravasation of plasma components into the subdural space. Our case demonstrates that the pathogenetic mechanism that is specific for subdural fluid collection caused by dural metastasis of malignant tumors differs from the mechanism of production of subdural hematoma associated with dural metastasis. PMID:24036578

  7. Mast cell degranulation activates a pain pathway underlying migraine headache

    PubMed Central

    Levy, Dan; Burstein, Rami; Kainz, Vanessa; Jakubowski, Moshe; Strassman, Andrew M.

    2007-01-01

    Intracranial headaches such as that of migraine are generally accepted to be mediated by prolonged activation of meningeal nociceptors but the mechanisms responsible for such nociceptor activation are poorly understood. In this study, we examined the hypothesis that meningeal nociceptors can be activated locally through a neuroimmune interaction with resident mast cells, granulated immune cells that densely populate the dura mater. Using in vivo electrophysiological single unit recording of meningeal nociceptors in the rat we observed that degranulation of dural mast cells using intraperitoneal administration of the basic secretagogue agent compound 48/80 (2 mg/kg) induced a prolonged state of excitation in meningeal nociceptors. Such activation was accompanied by increased expression of the phosphorylated form of the extracellular signal-regulated kinase (pERK), an anatomical marker for nociceptor activation. Mast cell - induced nociceptor interaction was also associated with downstream activation of the spinal trigeminal nucleus as indicated by an increase in c-fos expression. Our findings provide evidence linking dural mast cell degranulation to prolonged activation of the trigeminal pain pathway believed to underlie intracranial headaches such as that of migraine. PMID:17459586

  8. Headaches -- danger signs

    MedlinePlus

    ... chap 398. Garza I, Schwedt TJ, Robertson CE, Smith JH. Headache and other craniofacial pain. In: Daroff ... commercial use must be authorized in writing by ADAM Health Solutions. About MedlinePlus Site Map FAQs Contact ...

  9. [Treatment of tension headache].

    PubMed

    Schoenen, J

    2000-01-01

    The scientific basis of tension- type headache suffers from the lack of precise pathophysiological knowledge and the heterogenecity of this disorder. Treatment of acute tension-type headache episodes is more effective with an NSAIDs (ibuprofen 400-800mg, naproxen 550-825mg, ketoprofen 50-75mg) than with aspirin or paracetamol. Caffein containing preparations of NSAIDs are slightly superior, but should not be taken frequently to avoid headache chronification. For chronic tension-type headache, relaxation therapies with EMG biofeedback and tricyclics have about the same efficacy rate of 40-50p.100. Physical therapy and acupuncture are in general less effective. There is thus clearly a need for better strategies, e.g. combination of available therapies and novel approaches. PMID:11139755

  10. Headaches in Children

    MedlinePlus

    ... include the doubling of images or words, blurred vision, fatigue, and headaches which worsen with prolonged reading. At home eye exercises, sometimes with the help of computer software, can help treat convergence insufficiency. Glasses are ...

  11. A Clinical Pitfall: Optimal Management of Single Dural-based Metastatic Carcinoma of the Breast Mimicking Meningioma.

    PubMed

    Li, Chiao-Zhu; Li, Chiao-Ching; Lin, Meng-Chi; Chih-Chuan, Hsieh; Chen, Nan-Fu; Chen, Chun-Lin; Tang, Chi-Tun

    2015-11-01

    Meningioma is the most common benign brain lesion in adults. Conservative treatment is suggested if there is no obvious neurological symptom or mass effect, but cerebral metastases require aggressive therapy. Single dural-based metastatic carcinoma mimicking meningioma is uncommon. Here is a case of clinical dilemma between meningioma and metastatic carcinoma mimicking meningioma. A woman with a history of invasive ductal carcinoma of the breast presented with headache and blurred vision. Brain computed tomography and magnetic resonance imaging (MRI) both gave the impression of meningioma. After surgical resection of the brain lesion, histopathology revealed that it was a metastatic lesion from the breast. This report discussed the optimal management of single dural-based metastatic carcinoma mimicking meningioma. PMID:26566041

  12. Management of Headaches in Children

    PubMed Central

    Haslam, Robert H.A.

    1988-01-01

    Headache is a common complaint in children. Although in most cases it does not require medical attention, a thorough evaluation is mandatory for the child with severe, recurring, or unconventional headaches. Recurrent episodes of headache over a prolonged period with normal behaviour, intellectual function, and a negative physical examination suggest migraine or psychogenic headaches. Headache in a child may be indicative of a systemic illness or an intracranial process causing increased intracranial pressure. This review discusses the three most common types of headache in children, highlighting the characteristic symptoms, investigation, and management of migraine, organic, and psychogenic headaches. PMID:21253182

  13. Cluster headache after orbital exenteration.

    PubMed

    Evers, S; Sörös, P; Brilla, R; Gerding, H; Husstedt, I W

    1997-10-01

    A 37-year-old man developed an ipsilateral headache which fulfilled the criteria for cluster headache after orbital extenteration because of a traumatic lesion of the bulb. The headache could be treated successfully by drugs usually applied in the therapy of cluster headache. Six similar cases of cluster headache after orbital exenteration could be identified in the literature suggesting that the eye itself is not necessarily part of the pathogenesis of cluster headache. We hypothesize that orbital exenteration can cause cluster headache by lesions of sympathetic structures. Possibly, these mechanisms are similar to those of sympathetic reflex dystrophy (Sudeck-Leriche syndrome) causing pain of the limbs. PMID:9350391

  14. Medical management of adult headache.

    PubMed

    Freitag, Frederick G; Schloemer, Fallon

    2014-04-01

    We review the therapies for primary headache disorders: migraine, chronic migraine, tension-type headache, and cluster headache. Recommendations follow the evidence-based treatments so far as is possible with expert opinion to give clinical guidance. Headache has 2 levels of care: acute treatments designed to stop a headache from progressing and alleviate all symptoms associated with the headache and preventive therapies for patients whose headache frequency is such that by itself produces significant disability and impact on quality of life, or where the frequency of use of acute medications, regardless of efficacy, poses risks in terms of overuse or adverse events. PMID:24680490

  15. Abrupt-Onset Severe Headaches

    PubMed Central

    Ju, Yo-El S.; Schwedt, Todd J.

    2013-01-01

    Thunderclap headache, a severe headache which is maximal in intensity at onset, is associated with numerous underlying disorders, including subarachnoid hemorrhage, unruptured intracranial aneurysm, cervical artery dissection, cerebral venous sinus thrombosis, stroke, intracranial hemorrhage, reversible cerebral vasoconstriction syndrome, and reversible posterior leukoencephalopathy. After exclusion of all possible causes, thunderclap headache may be considered a primary headache. This review summarizes the diagnostic considerations and clinical approach to thunderclap headache, with particular emphasis on the reversible cerebral vasoconstriction syndromes. PMID:20352589

  16. Wine and headache.

    PubMed

    Jarisch, R; Wantke, F

    1996-05-01

    Headache can be induced by histamine in wine in patients suffering from histamine intolerance, a disease characterized by impaired histamine degradation based on reduced diamine oxidase activity or a lack of the enzyme. Diamine oxidase is localized in the jejunal mucosa and is the most important enzyme metabolising histamine. It is competitively inhibited by alcohol and numerous drugs. In preliminary investigations, assessment of diamine oxidase levels gave decreased activity (0.03 nKat/l) in patients with histamine intolerance compared to healthy controls (0.07 nKat/l). In pregnancy, diamine oxidase levels are known to be about 500-fold elevated, giving mean levels of 25.0 nKat/l. Other biogenic amines such as phenylethylamine or serotonin may be causative for wine/food-induced headache. In experimental models, headache has been induced by histamine infusion as well as red wine provocation. Histamine-induced headache is a vascular headache likely to be caused by nitric oxide which probably represents a key molecule in vascular headaches. A histamine-free diet is the treatment of choice for patients with histamine intolerance and chronic headache. To start treatment, an antihistamine (H1 blocker) for 14 days as well as a histamine-free diet for at least 4 weeks are recommended. Clinical improvement to the diet as well as in vitro tests for plasma histamine and diamine oxidase in the serum as well as vitamin B6 levels have to confirm the diagnosis. As supportive treatment, a vitamin B6 (pyridoxal phosphate) substitution appears useful in histamine-intolerant patients as pyridoxal phosphate seems to be crucial for diamine oxidase activity. Histamine intolerance, based on reduced diamine oxidase activity or a lack in the enzyme is causative for wine/food-induced chronic headache. According to the localization of diamine oxidase in the jejunal mucosa, histamine intolerance is primarily a disease of intestinal origin. A histamine-free diet is the treatment of choice in

  17. [Headaches in the emergency context].

    PubMed

    Gauvrit, J-Y; Leclerc, X; Moulin, T; Oppenheim, C; Savage, J; Pruvo, J-P; Meder, J-F

    2004-09-01

    Headaches constitute one of the most frequent reason of consultation. Their causes are extremely varied. The first step consists in the analysis of the characteristics of the pain and the associated signs in order to distinguish primary and secondary headaches. Primary headaches, including migraines and tension-type headaches are the most frequent types and do not require imaging evaluation. Secondary headaches are related to an organic cause and require specific investigations. In case of suspected symptomatic or secondary headaches, brain imaging plays an important role in the etiologic work-up. The main purpose of imaging in an emergency setting is to diagnose a life-threatening disease. PMID:15545938

  18. Temporomandibular Disorders and Headache.

    PubMed

    Graff-Radford, Steven B; Abbott, Jeremy J

    2016-08-01

    Temporomandibular disorders (TMD) and primary headaches can be perpetual and debilitating musculoskeletal and neurological disorders. The presence of both can affect up to one-sixth of the population at any one time. Initially, TMDs were thought to be predominantly musculoskeletal disorders, and migraine was thought to be solely a cerebrovascular disorder. The further understanding of their pathophysiology has helped to clarify their clinical presentation. This article focuses on the role of the trigeminal system in associating TMD and migraine. By discussing recent descriptions of prevalence, diagnosis, and treatment of headache and TMD, we will further elucidate this relationship. PMID:27475510

  19. Endovascular Treatment of Dural Arteriovenous Fistulas: Single Center Experience

    PubMed Central

    Oh, Jae-Sang; Oh, Hyuk-Jin; Shim, Jai-Joon; Bae, Hack-Gun; Lee, Kyeong-Seok

    2016-01-01

    Objective Treatment of intracranial dural arteriovenous fistulas (dAVFs) remains a challenge. However, after introduction of Onyx, transarterial approach is the preferred treatment option in many centers. We report our experience of dAVFs embolization with special emphasis on transarterial approach. Methods Seventeen embolization procedures were performed in 13 patients with dAVFs between Jan 2009 and Oct 2014. Clinical symptoms, location and type of fistulas, embolization methods, complications, radiological and clinical outcomes were evaluated using charts and PACS images. Results All 13 patients had symptomatic lesions. The locations of fistulas were transverse-sigmoid sinus in 6, middle fossa dura in 4, cavernous sinus in 2, and superior sagittal sinus in 1 patient. Cognard types were as follows : I in 4, IIa in 2, IIa+IIb in 5, and IV in 2. Embolization procedures were performed ≥2 times in 3 patients. Nine patients were treated with transarterial Onyx embolization alone. One of these required direct surgical puncture of middle meningeal artery. Complete obliteration of fistulas was achieved in 11/13 (85%) patients. There were no complications except for 1 case of Onyx migration in cavernous dAVF. Modified Rankin scale score at post-operative 3 months were 0 in 11, and 3 in 2 patients. Conclusion Transarterial Onyx embolization can be a first line therapeutic option in patients with dAVFs. However, transvenous approach should be tried first in cavernous sinus dAVF because of the risk of intracranial migration of liquid embolic materials. Furthermore, combined surgical endovascular approach can be considered as a useful option in inaccessible route. PMID:26885282

  20. Causes of secondary headache (image)

    MedlinePlus

    Temporomandibular joint, or TMJ, dysfunction, can be a cause of secondary headache. Secondary headaches result from underlying disorders which produce pain as a symptom. The TMJ may become painful and dysfunctional as a result ...

  1. The patient with daily headaches.

    PubMed

    Maizels, Morris

    2004-12-15

    The term "chronic daily headache" (CDH) describes a variety of headache types, of which chronic migraine is the most common. Daily headaches often are disabling and may be challenging to diagnose and treat. Medication overuse, or drug rebound headache, is the most treatable cause of refractory daily headache. A pathologic underlying cause should be considered in patients with recent-onset daily headache, a change from a previous headache pattern, or associated neurologic or systemic symptoms. Treatment of CDH focuses on reduction of headache triggers and use of preventive medication, most commonly anti-depressants, antiepileptic drugs, and beta blockers. Medication overuse must be treated with discontinuation of symptomatic medicines, a transitional therapy, and long-term prophylaxis. Anxiety and depression are common in patients with CDH and should be identified and treated. Although the condition is challenging, appropriate treatment of patients with CDH can bring about significant improvement in the patient's quality-of-life. PMID:15617293

  2. Tension-type headaches.

    PubMed

    Semenov, Irene A

    2015-06-01

    TTH are very common in general population and may be under diagnosed. They are more common in patients suffering from migraine headaches. In general underlying psychiatric conditions, such as anxiety and depression, are prevalent in TTH sufferers. For acute therapy NSAIDs are the main treatment option. Tricyclic antidepressant, SSRI, and cognitive behavioral therapy have been proven to be effective for prophylactic purposes. PMID:25882693

  3. Medical Comorbidities in Pediatric Headache.

    PubMed

    Jacobs, Howard; Singhi, Samata; Gladstein, Jack

    2016-02-01

    Comorbid conditions frequently occur in pediatric headaches and may significantly affect their management. Comorbidities that have been associated with pediatric headaches include attention-deficit or hyperactivity disorder, autism, developmental disabilities, depression, anxiety, epilepsy, obesity, infantile colic, atopic disorders, inflammatory bowel disease, and irritable bowel syndrome. The goal of this article is to review these comorbidities associated with pediatric headache, thereby empowering child neurologists to identify common triggers and tailor management strategies that address headache and its comorbidities. PMID:27017024

  4. Direct transcranial puncture for Onyx embolization of a cerebellar hemangioblastoma.

    PubMed

    Ding, Dale; Starke, Robert M; Evans, Avery J; Liu, Kenneth C

    2014-06-01

    Intracranial hemangioblastomas are benign but hypervascular tumors, most commonly located in the cerebellum, which are difficult to resect without significant operative blood loss. While preoperative embolization may decrease the amount of operative bleeding, the vascular supply of cerebellar hemangioblastomas frequently precludes safe embolization by an endovascular route due to the risk of thromboembolic vertebrobasilar infarction. Direct puncture embolization overcomes many of the limitations of endovascular embolization but its safety and feasibility for intracranial tumors is unknown. We report a 48-year-old man who was diagnosed with a large cerebellar mass after presenting with headaches and gait ataxia. Based on diagnostic angiography, which demonstrated a highly vascular tumor supplied by the posterior inferior cerebellar and posterior meningeal arteries, we decided to embolize the tumor by a direct transcranial puncture approach. After trephinating the skull in a standard fashion, a catheter-needle construct, composed of an Echelon 10 microcatheter (ev3 Endovascular, Plymouth, MN, USA) placed into a 21-gauge spinal needle, was inserted into the tumor under biplanar angiographic guidance. Using continuous angiographic monitoring, 9cc of Onyx 34 (ev3 Endovascular) was injected through the catheter, resulting in 75% tumor devascularization without evidence of complications. The patient was taken directly to surgery where a gross total resection of the hemangioblastoma was achieved with an acceptable operative blood loss. At his 2 year follow-up, the patient was neurologically intact without neuroimaging evidence of residual tumor. We describe, to our knowledge, the first case of direct transcranial puncture for preoperative embolization of a cerebellar hemangioblastoma. PMID:24370504

  5. Headache - what to ask your doctor

    MedlinePlus

    ... Migraine - what to ask your doctor; Tension-type headache - what to ask your doctor; Cluster headache - what to ask your doctor ... How can I tell if the headache I am having is dangerous? What are ... headache ? A migraine headache ? A cluster headache ? What medical ...

  6. Headaches due to vascular disorders.

    PubMed

    Rothrock, John F

    2004-02-01

    The association between stroke and headache is complex, ranging from highly nonspecific, wherein headache is largely irrelevant to diagnosis and therapeutic management, to highly specific and even causative. In short, acute headache may accompany the acute stroke process, chronically complicate stroke, or, in rare instances, serve as the primary cause of stroke. With the first instance, the incidence of acute headache is highly dependent on the stroke sub-type and etiology. In this article, the headaches accompanying or causing acute stroke are addressed in some detail. PMID:15062526

  7. Primary varicella infection presenting with headache and elevated intracranial pressure.

    PubMed

    Gilad, Oded; Shefer-Averbuch, Noa; Garty, Ben Zion

    2015-05-01

    Primary varicella infection may be associated with neurologic complications, such as cerebritis and meningoencephalitis. Several cases of varicella infection with elevated intracranial pressure have been reported. We describe a 13-year-old immunocompetent girl who presented with a clinical picture of headaches and elevated intracranial pressure as the only manifestation of primary varicella zoster infection. The working diagnosis at first was pseudotumor cerebri based on complaints of headache of 2 weeks' duration, in addition to vomiting and papilledema, without fever or skin eruption. On lumbar puncture, opening pressure was 420 mmH2O, but mild pleocytosis and mildly elevated protein level ruled out the diagnosis of pseudotumor cerebri. Our patient had no history of previous varicella infection, and she did not receive the varicella zoster vaccine. Serology tests, done on admission and repeated 2 months later, suggested primary varicella infection. The literature on varicella infection associated with pseudotumor cerebri or elevated intracranial pressure is reviewed. PMID:24846901

  8. Vestibular schwannoma surgery and headache.

    PubMed

    Levo, H; Blomstedt, G; Pyykkö, I

    2000-01-01

    The aim of the study was to evaluate aetiological factors for postoperative headache after vestibular schwannoma (VS) surgery with respect to asymmetric activation of vestibular reflexes. After surgery, 27 VS patients with persistent postoperative headache, 16 VS patients without headache and 9 healthy controls were examined. The vestibular, cervicocollic and cervicospinal reflexes were evaluated to study whether asymmetric activation of vestibular reflexes could cause headache. The effect of neck muscle and occipital nerve anaesthesia and the effect of sumatriptan on headache were also evaluated. The vestibular function of VS patients with headache did not differ from that of VS patients without headache, but was abnormal when compared to that of normal controls. The cervicospinal and cervicocollic reflexes did not differ in the patient groups. Injection of lidocaine around the operation scar gave pain relief to two patients, and one of them had occipital nerve entrapment. Infiltration of lidocaine deep in the neck muscles in the vicinity of the C2 root did not alleviate headache, but caused vertigo. Nine patients with musculogenic headache got pain relief from supportive neck collars, and two patients with cervicobrachial syndrome got pain relief from manual neck traction. The study shows that asymmetric activation of cervicocollic reflexes does not seem to be the reason for headache. Headache seems to be linked to neuropathic pain, allegedly caused by trigeminal irritation of the inner ear and the posterior fossa, which has recently been linked to vascular pain. PMID:10908966

  9. Imaging of Headache in Pregnancy.

    PubMed

    Skliut, Maryna; Jamieson, Dara G

    2016-10-01

    Pregnant women are most likely to have primary headaches, such as migraine and tension-type headaches, which can be diagnosed and treated without brain imaging. Primary headaches may even start de novo during pregnancy, especially in the first few months. However, when the headache occurs late in pregnancy or in the peripartum period, secondary causes of headaches need to be considered and evaluated by brain and/or vascular imaging, generally using magnetic resonance techniques. There is considerable overlap between the cerebrovascular complications of pregnancy, including preeclampsia/eclampsia, posterior reversible encephalopathy syndrome (PRES), reversible cerebral vasoconstriction syndrome (RCVS), and both hemorrhagic and ischemic strokes; although, their imaging may be distinctive. Imaging is necessary to distinguish between arterial and venous pathology causing headache in the peripartum patient, as there can be similar presenting symptoms. Mass lesions, both neoplastic and inflammatory, can enlarge and produce headaches and neurological symptoms late in pregnancy. PMID:27562782

  10. Headache and sferics.

    PubMed

    Vaitl, D; Propson, N; Stark, R; Walter, B; Schienle, A

    2001-10-01

    Many patients with migraine believe weather is a trigger for their headaches. The objective of this study was to determine if very low frequency sferics, pulse-shaped electromagnetic fields originating from atmospheric discharges (lightning), are precipitating factors. The occurrence of sferics impulses is characterized by a daily, as well as an annual, periodicity and is thought to be associated with various pathological processes. The diaries of 37 women suffering from migraine and tension-type headaches were analyzed over a period of 6 months and correlated with daily sferics activity and other weather phenomena in the area of Giessen, Germany. From October through December (autumn), sferics activity was correlated with the occurrence of migraine (r = 0.33, P<.01); however, there was no correlation in July and August (summer), when the thunderstorm activity had been very intense. In summer, tension-type headaches were associated with other weather parameters such as temperature (r = 0.36, P<.01) and vapor pressure (r = 0.27, P<.05). PMID:11703470

  11. Solitaire FR device for treatment of dural sinus thrombosis

    PubMed Central

    Pukenas, Bryan Anthony; Kumar, Monisha; Stiefel, Michael; Smith, Michelle; Hurst, Robert

    2012-01-01

    Dural venous sinus thrombosis is a rare and potentially devastating disease. Several predisposing factors exist, including oral contraceptive therapy and colitis. First-line therapy consists of systemic anticoagulation. If first-line therapies fail, more aggressive endovascular therapies may be performed. We report our initial experience with the Solitaire FR device for treatment of refractory symptomatic dural venous sinus thrombosis. PMID:23257943

  12. [Pulmonary hemorrhage complicating transthoracic puncture].

    PubMed

    Febvre, M; de Fenoyl, O; Capron, F; Vadrot, D; Rochemaure, J

    1989-01-01

    Fine needle transthoracic aspiration (FNTA) of pulmonary opacities under guidance of computerized tomography (CT) is a simple procedure yielding conclusive results in many patients with malignant lung tumours. The small caliber of the needles utilized and the CT control make this increasingly popular procedure both accurate and safe. Yet a number of complications have occurred; most of them were benign (e.g. pneumothorax) but some were potentially dangerous (e.g. pulmonary haemorrhage), so that the pros and cons of the procedure must carefully be weighed. We report the case of a patient in whom FNTA was complicated by copious haemoptysis and a pulmonary haematoma clearly visible at CT. The literature concerning the potential complications of transthoracic puncture is reviewed. PMID:2633295

  13. Epidural insertion simulator of higher insertion resistance & drop rate after puncture.

    PubMed

    Naemura, K; Sakai, A; Hayashi, T; Saito, H

    2008-01-01

    Accidents such as dural puncture remain one of the problems of epidural anesthesia, and unskilled doctors can repeat such accidents. The purpose of the current research was to provide a new simulator for epidural insertion training. No reference data regarding the resistance force used when inserting a needle into patients have been reported. A comparative study was conducted to aid in the development of a new simulator. Pork loin (n=5) were employed as a substitute for patients. Thickness was set at 2 cm so as to improve the reproducibility. The authors took the conventional simulator apart, and picked a block as an analogue of muscle and ligamentum flavum. A new simulator was made of a melamine foam resin block and a latex rubber sheet. An epidural needle fixed on a motorized stage was inserted at the speed of 2 mm per second. The reaction force was measured while the needle was inserted into each specimen. Waveform of the pork loin exhibited two slopes of different inclines up to peaks and then falls after puncture. The conventional simulator showed a simple increase up to peak and a slow fall after puncture. In contrast, the new simulator showed two slopes up to peak and then a sudden fall after puncture. The insertion resistances were 2.5 N/s for the porcine, 0.8 N/s for the conventional and 2.1 N/s for the new simulator. The drop rates were 5 N/s for the porcine, 0.6 N/s for the conventional and 24 N/s for the new simulator. The higher insertion resistance and drop rate for the new simulator than the conventional simulator will be suitable for epidural insertion training. PMID:19163400

  14. Spontaneous closure of a dural arteriovenous fistula

    PubMed Central

    Al-Afif, Shadi; Nakamura, Makoto; Götz, Friedrich; Krauss, Joachim K

    2014-01-01

    Spontaneous closure of a dural arteriovenous fistula (dAVF) is a rare condition and only a few cases have been reported since its first description in 1976. We report delayed and progressive spontaneous closure of a dAVF after massive intracerebral hemorrhage documented by angiographic studies before and after bleeding. To our knowledge, this is the first report to document gradual closure of a dAVF by serial angiographic studies. The mechanism of spontaneous closure of dAVFs has not been fully elucidated. We suggest different factors for consideration from previously published data and show how each of these factors can influence the others. PMID:25053666

  15. Temporomandibular disorders and headaches.

    PubMed

    Graff-Radford, Steven B; Bassiur, Jennifer P

    2014-05-01

    Headache and temporomandibular disorders should be treated together but separately. If there is marked limitation of opening, imaging of the joint may be necessary. The treatment should then include education regarding limiting jaw function, appliance therapy, instruction in jaw posture, and stretching exercises, as well as medications to reduce inflammation and relax the muscles. The use of physical therapies, such as spray and stretch and trigger point injections, is helpful if there is myofascial pain. Tricyclic antidepressants and the new-generation antiepileptic drugs are effective in muscle pain conditions. Arthrocentesis and/or arthroscopy may help to restore range of motion. PMID:24703543

  16. Headaches prior to earthquakes

    NASA Astrophysics Data System (ADS)

    Morton, L. L.

    1988-06-01

    In two surveys of headaches it was noted that their incidence had increased significantly within 48 h prior to earthquakes from an incidence of 17% to 58% in the first survey using correlated samples and from 20.4% to 44% in the second survey using independent samples. It is suggested that an increase in positive air ions from rock compression may trigger head pain via a decrease in brain levels of the neurotransmitter serotonin. The findings are presented as preliminary, with the hope of generating further research efforts in areas more prone to earthquakes.

  17. [Neurostimulation for treatment of headaches].

    PubMed

    Diener, H C; Rabe, K; Gerwig, M; Müller, O; Sure, U; Gaul, C

    2012-08-01

    Only a small portion of patients with primary headaches are refractory to treatment concerning relief of headache episodes and prophylactic therapy of headaches. New methods of central and peripheral neurostimulation have been developed for these patients during the last few years and experience was mostly gained in small case series. The following overview gives a description of new stimulation methods, such as deep brain stimulation, occipital nerve stimulation, vagal nerve stimulation, neurostimulation of the sphenopalatine ganglion and transcranial magnetic stimulation. PMID:22801664

  18. Autonomic dysregulation in headache patients.

    PubMed

    Gass, Jason J; Glaros, Alan G

    2013-12-01

    To analyze autonomic nervous system activity in headache subjects, measurements of heart rate variability (HRV), skin temperature, skin conductance, and respiration were compared to a matched control group. HRV data were recorded in time and frequency domains. Subjects also completed self-report questionnaires assessing psychological distress, fatigue, and sleep dysfunction. Twenty-one headache and nineteen control subjects participated. In the time domain, the number of consecutive R-to-R intervals that varied by more than 50 ms and the standard deviation of the normalized R-to-R intervals, both indices of parasympathetic nervous system activity, were significantly lower in the headache group than the control group. Groups did not differ statistically on HRV measures in the frequency domain. Self-report measures showed significantly increased somatization, hostility, anxiety, symptom distress, fatigue, and sleep problems in the headache group. The results suggest headache subjects have increased sympathetic nervous system activity and decreased parasympathetic activity compared to non-headache control subjects. Headaches subjects also showed greater emotional distress, fatigue, and sleep problems. The results indicate an association between headaches and cardiovascular functioning suggestive of sympathetic nervous system activation in this sample of mixed migraine and tension-type headache sufferers. PMID:23912525

  19. Neurostimulation for chronic cluster headache

    PubMed Central

    Kaube, Holger

    2012-01-01

    Neurostimulation techniques for the treatment of primary headache syndromes, particularly of chronic cluster headache, have received much interest in recent years. Occipital nerve stimulation (ONS) has yielded favourable clinical results and, despite the limited numbers of published cases, is becoming a routine treatment for refractory chronic cluster headache in specialized centres. Meanwhile, other promising techniques such as spinal cord stimulation (SCS) or sphenopalate ganglion stimulation have emerged. In this article the current state of clinical research for neurostimulation techniques for chronic cluster headache is reviewed. PMID:22590481

  20. Neuromodulation in cluster headache.

    PubMed

    Fontaine, Denys; Vandersteen, Clair; Magis, Delphine; Lanteri-Minet, Michel

    2015-01-01

    Medically refractory chronic cluster headache (CH) is a severely disabling headache condition for which several surgical procedures have been proposed as a prophylactic treatment. None of them have been evaluated in controlled conditions, only open studies and case series being available. Destructive procedures (radiofrequency lesioning, radiosurgery, section) and microvascular decompression of the trigeminal nerve or the sphenopalatine ganglion (SPG) have induced short-term improvement which did not maintain on long term in most of the patients. They carried a high risk of complications, including severe sensory loss and neuropathic pain, and consequently should not be proposed in first intention.Deep brain stimulation (DBS), targeting the presumed CH generator in the retro-hypothalamic region or fibers connecting it, decreased the attack frequency >50 in 60 % of the 52 patients reported. Complications were infrequent: gaze disturbances, autonomic disturbances, and intracranial hemorrhage (2).Occipital nerve stimulation (ONS) was efficient (decrease of attack frequency >50 %) in about 70 % of the 60 patients reported, with a low risk of complications (essentially hardware related). Considering their respective risks, ONS should be proposed first and DBS only in case of ONS failure.New on-demand chronically implanted SPG stimulation seemed to be efficient to abort CH attacks in a pilot controlled trial, but its long-term safety needs to be further studied. PMID:25411142

  1. Allergy, Rhinitis and Migraine Headache

    MedlinePlus

    ... play no role in provoking attacks of migraine headache. Recent research suggests this may not be correct. Confirming allergy - ... might lead to sleep apnea that could cause headache. Third, allergy worsens symptoms ... Research shows that patients with depression compared to those ...

  2. What Are Nerve Blocks for Headache?

    MedlinePlus

    ... nerve blocks for headache? Print Email What are nerve blocks for headache? ACHE Newsletter Sign up for ... entering your e-mail address below. What are nerve blocks for headache? A nerve block is the ...

  3. Altitude, Acute Mountain Sickness and Headache

    MedlinePlus

    ... Mountain Sickness, and Headache Print Email Altitude, Acute Mountain Sickness, and Headache ACHE Newsletter Sign up for ... entering your e-mail address below. Altitude, Acute Mountain Sickness, and Headache David W. Dodick, MD, FAHS, ...

  4. Management of migraine headaches.

    PubMed

    Graves, Barbara W

    2006-01-01

    With 17% to 18% of women suffering from migraine headaches, clinicians will often be asked by their patients to prescribe medication. Migraine is an episodic chronic disease that is best managed with an overall treatment plan, rather than treated as an acute illness that is managed with sporadic medications. Realistic goals for the long-term management of migraine are based on patient education and an ongoing discussion between patient and provider. This article reviews the clinical presentation of migraine and recommendations for both acute and preventive treatment, including complementary therapies. "Red flags" that could be signs of more serious neurologic illness are presented. The management of migraine in pregnancy is also reviewed. PMID:16647669

  5. Headaches in patients with shunts.

    PubMed

    Rekate, Harold L; Kranz, Dory

    2009-03-01

    Headache is one of the most common afflictions suffered by humans. Headache in patients with a shunt triggers a series of events that includes utilization of expensive technologies and often potentially dangerous surgical intervention. The purpose of this study was to determine the incidence of headaches in patients with shunts and, hopefully, the relationship of those headache disorders to the treatment of hydrocephalus. The Hydrocephalus Association maintains a self-reporting database recorded from individuals treated for hydrocephalus and their families. This database was mined to determine the incidence of severe headaches requiring treatment and interfering with normal life in patients who have been treated for hydrocephalus. There were 1,242 responders between the ages of 19 months and 45 years of age. Of these, 1,233 answered the question, "Do you or your family member suffer from (does your child complain of) frequent or chronic headaches?" This subset forms the basis of this study. Three groups were defined by age: children (19 months-12 years), adolescents (13 years-19 years), and young adults (20 years-45 years). Most respondents were initially treated during infancy (before 18 months of age); 84% of children and 69% of both adolescents and young adults were treated very early in life. Severe headaches became a more frequent problem as the age of the population treated for hydrocephalus increased. In terms of frequency and severity of headaches, direct comparisons with epidemiologic studies of normal populations are difficult because of the limitations of data available in the database. However, it is likely that this population has a higher incidence of severe headaches than normal populations. The cost of management of headaches in this population is very high, and the patients are at risk throughout life. Early treatment decisions have a significant effect on later quality of life. Strategies that lead to normalization of cerebrospinal fluid dynamics

  6. Probing the puncture for black hole simulations

    SciTech Connect

    Brown, J. David

    2009-10-15

    With the puncture method for black hole simulations, the second infinity of a wormhole geometry is compactified to a single 'puncture point' on the computational grid. The region surrounding the puncture quickly evolves to a trumpet geometry. The computational grid covers only a portion of the trumpet throat. It ends at a boundary whose location depends on resolution. This raises the possibility that perturbations in the trumpet geometry could propagate down the trumpet throat, reflect from the puncture boundary, and return to the black hole exterior with a resolution-dependent time delay. Such pathological behavior is not observed. This is explained by the observation that some perturbative modes propagate in the conformal geometry, others propagate in the physical geometry. The puncture boundary exists only in the physical geometry. The modes that propagate in the physical geometry are always directed away from the computational domain at the puncture boundary. The finite difference stencils ensure that these modes are advected through the boundary with no coupling to the modes that propagate in the conformal geometry. These results are supported by numerical experiments with a code that evolves spherically symmetric gravitational fields with standard Cartesian finite difference stencils. The code uses the Baumgarte-Shapiro-Shibata-Nakamura formulation of Einstein's equations with 1+log slicing and gamma-driver shift conditions.

  7. Repair of spinal dural defects. An experimental study.

    PubMed

    Keller, J T; Ongkiko, C M; Saunders, M C; Mayfield, F H; Dunsker, S B

    1984-05-01

    The search for an ideal substance for duraplasty has stimulated clinical and experimental investigations. To date a large number of materials have been employed for dural repair, although there is as yet no unanimity regarding the ideal material. Most of these studies have been concerned with cranial dura, and spinal duraplasty has received less attention. This study was designed to examine the repair of spinal dural defects in the dog. The materials chosen for this experiment were autologous fat, a polyester fiber mesh (Mersilene) and silicone-coated Dacron (Dura Film). Nineteen dogs were used in this study. Following lumbar laminectomy and the excision of elliptical pieces of dura (1.0 X 0.5 cm) at three noncontiguous levels, each of the defects was repaired using one of the three materials. Groups of animals were sacrificed at each of 3, 6, 12, and 24 weeks after dural repair. The lumbar region was removed en bloc and prepared for histological examination. Repair of the dural opening was achieved in all cases. The polyester fiber mesh was quite effective for dural repair, serving as a scaffold through which a neomembrane grew and united the dural edges. The results with autologous fat were similarly favorable. On the other hand, results with silicone-coated Dacron showed encapsulation by connective tissue, with the ventral aspect of the graft frequently compressing the underlying cord. PMID:6232352

  8. Headaches related to sexual activity.

    PubMed Central

    Lance, J W

    1976-01-01

    Twenty-one patients experienced headache related to sexual activity. Two varieties of headache could be distinguished from the clinical histories. The first, developing as sexual excitement mount, had the characteristics of muscle contraction headache. The second, severe, throbbing or 'explosive' in character, occurring at the time of orgasm, was presumably of vascular origin associated with a hyperdynamic circulatory state. Two of the patients with the latter type of headache had each experienced episodes of cerebral vascular insufficiency on one occasion which subsequently resolved. A third patient in this category had a past history of drop attacks. No evidence of any structural lesion was obtained on clinical examination or investigation, including cerebral angiography in seven patients. Eighteen patients have been followed up for periods of two to seven years without any serious intracranial disorder becoming apparent. While the possibility of intracranial vascular or other lesions must always be borne in mind, there appears to be a syndrome of headache associated with sexual excitement where no organic change can be demonstrated, analogous to benign cough headache and benign exertional headache. PMID:1011034

  9. [Clinical characteristics of cluster headache].

    PubMed

    Jelencsik, I; Kovács, K; Csanda, E

    1989-05-28

    The authors describe in detail the clinical characteristics of 48 patients suffering from cluster headache. They investigate the question of nomenclature and survey the clinical forms of diagnosis. They deal with differential diagnosis comparing migraine, trigeminal neuralgia and headaches origin from systemic illness. They point out that the clinical characteristics of their patients co-responding to the data in the literature. They emphasize that the precise anamnesis can result the diagnosis of this type of headache which is the basis of the treatment. PMID:2503799

  10. A boy with sudden headache.

    PubMed

    Norbedo, Stefania; Naviglio, Samuele; Murru, Flora Maria; Cavallin, Roberta; Giurici, Nagua; Rabusin, Marco; Barbi, Egidio

    2014-03-01

    Headache is a common presenting complaint in pediatric emergency departments. The goal of emergent evaluation is to identify those children with potentially life-threatening conditions. We present the case of an adolescent boy presenting with headache and hypertension who was diagnosed with a catecholamine-secreting abdominal paraganglioma. Genetic testing eventually led to the diagnosis of SDHB-related hereditary paraganglioma-pheochromocytoma syndrome. Alarm features ("red flags") in children presenting with headache are reviewed, as well as the main features of paragangliomas and the indications for genetic testing. PMID:24589807

  11. Aerosol can puncture device operational test plan

    SciTech Connect

    Leist, K.J.

    1994-05-03

    Puncturing of aerosol cans is performed in the Waste Receiving and Processing Facility Module 1 (WRAP 1) process as a requirement of the waste disposal acceptance criteria for both transuranic (TRU) waste and low-level waste (LLW). These cans have contained such things as paints, lubricating oils, paint removers, insecticides, and cleaning supplies which were used in radioactive facilities. Due to Westinghouse Hanford Company (WHC) Fire Protection concerns of the baseline system`s fire/explosion proof characteristics, a study was undertaken to compare the baseline system`s design to commercially available puncturing devices. While the study found no areas which might indicate a risk of fire or explosion, WHC Fire Protection determined that the puncturing system must have a demonstrated record of safe operation. This could be obtained either by testing the baseline design by an independent laboratory, or by substituting a commercially available device. As a result of these efforts, the commercially available Aerosolv can puncturing device was chosen to replace the baseline design. Two concerns were raised with the system. Premature blinding of the coalescing/carbon filter, due to its proximity to the puncture and draining operation; and overpressurization of the collection bottle due to its small volume and by blinding of the filter assembly. As a result of these concerns, testing was deemed necessary. The objective of this report is to outline test procedures for the Aerosolv.

  12. Headaches and Complementary Health Approaches

    MedlinePlus

    ... training of investigators in the basic and clinical neurosciences, and seeks better understanding, diagnosis, treatment, and prevention ... type headache in adults: are they beneficial? CNS Neuroscience & Therapeutics. 2009;15(2):183–205. Vickers AJ, ...

  13. A standard optometric headache history.

    PubMed

    Kairys, D J; Tibbetts, C; Saliba, K

    1983-02-01

    Many optometric patients present with headache as their chief complaint, or as an ancillary symptom. Since most cases of head pain are associated with few or inconstant physical signs, the key to an accurate diagnosis lies largely in a careful, systematic history. This article provides a scheme by which the busy optometric clinician can expeditiously obtain an incisive and relevant profile of every headache patient, and thereby determine the appropriate mode of management, and referral. PMID:6341437

  14. [Cluster headache and brain imagery].

    PubMed

    Giraud, Pierric; Demarquay, Geneviève

    2015-11-01

    Cluster headache is defined on clinical international criteria developed by International Headache Society (IHS, 2013). The realization of a brain MRI with arterial angio-MRI is required according to the French recommendations (Donnet et al., 2014) based on recent the literature. Numerous causes or diseases can mimic typical or atypical AVF (Edvardsson, 2014). Identification of these causes allows an appropriate treatment in addition with symptomatic treatment. PMID:26585270

  15. Higher-dimensional puncture initial data

    SciTech Connect

    Zilhao, Miguel; Ansorg, Marcus; Cardoso, Vitor; Gualtieri, Leonardo; Herdeiro, Carlos; Sperhake, Ulrich; Witek, Helvi

    2011-10-15

    We calculate puncture initial data, corresponding to single and binary black holes with linear momenta, which solve the constraint equations of D-dimensional vacuum gravity. The data are generated by a modification of the pseudospectral code presented in [M. Ansorg, B. Bruegmann, and W. Tichy, Phys. Rev. D 70, 064011 (2004).] and made available as the TwoPunctures thorn inside the Cactus computational toolkit. As examples, we exhibit convergence plots, the violation of the Hamiltonian constraint as well as the initial data for D=4,5,6,7. These initial data are the starting point to perform high-energy collisions of black holes in D dimensions.

  16. PUNCTURE TEST CHARACTERIZATION OF GLOVEBOX GLOVES

    SciTech Connect

    Korinko, P.; Chapman, G.

    2012-02-29

    An experiment was conducted to determine the puncture resistance of 15 gloves that are used or proposed for use in the Tritium Facility at Savannah River Site (SRS). These data will serve as a baseline for characterization and may be incorporated into the glove procurement specification. The testing was conducted in agreement with ASTM D120 and all of the gloves met or exceeded the minimum requirements. Butyl gloves exhibited puncture resistance nearly 2.5 times the minimum requirements at SRS while Polyurethane was nearly 7.5x the minimum.

  17. Dural opening/removal for combined petrosal approach: technical note.

    PubMed

    Terasaka, Shunsuke; Asaoka, Katsuyuki; Kobayashi, Hiroyuki; Sugiyama, Taku; Yamaguchi, Shigeru

    2011-03-01

    Detailed descriptions of stepwise dural opening/removal for combined petrosal approach are presented. Following maximum bone work, the first dural incision was made along the undersurface of the temporal lobe parallel to the superior petrosal sinus. Posterior extension of the dural incision was made in a curved fashion, keeping away from the transverse-sigmoid junction and taking care to preserve the vein of Labbé. A second incision was made perpendicular to the first incision. After sectioning the superior petrosal sinus around the porus trigeminus, the incision was extended toward the posterior fossa dura in the middle fossa region. The tentorium was incised toward the incisura at a point just posterior to the entrance of the trochlear nerve. A third incision was made longitudinally between the superior petrosal sinus and the jugular bulb. A final incision was initiated perpendicular to the third incision in the presigmoid region and extended parallel to the superior petrosal sinus connecting the second incision. The dural complex consisting of the temporal lobe dura, the posterior fossa dura, and the freed tentorium could then be removed. In addition to extensive bone resection, our strategic cranial base dural opening/removal can yield true advantages for the combined petrosal approach. PMID:22451813

  18. Dural Opening/Removal for Combined Petrosal Approach: Technical Note

    PubMed Central

    Terasaka, Shunsuke; Asaoka, Katsuyuki; Kobayashi, Hiroyuki; Sugiyama, Taku; Yamaguchi, Shigeru

    2010-01-01

    Detailed descriptions of stepwise dural opening/removal for combined petrosal approach are presented. Following maximum bone work, the first dural incision was made along the undersurface of the temporal lobe parallel to the superior petrosal sinus. Posterior extension of the dural incision was made in a curved fashion, keeping away from the transverse-sigmoid junction and taking care to preserve the vein of Labbé. A second incision was made perpendicular to the first incision. After sectioning the superior petrosal sinus around the porus trigeminus, the incision was extended toward the posterior fossa dura in the middle fossa region. The tentorium was incised toward the incisura at a point just posterior to the entrance of the trochlear nerve. A third incision was made longitudinally between the superior petrosal sinus and the jugular bulb. A final incision was initiated perpendicular to the third incision in the presigmoid region and extended parallel to the superior petrosal sinus connecting the second incision. The dural complex consisting of the temporal lobe dura, the posterior fossa dura, and the freed tentorium could then be removed. In addition to extensive bone resection, our strategic cranial base dural opening/removal can yield true advantages for the combined petrosal approach. PMID:22451813

  19. Spinal Dural Arteriovenous Fistula: A Review.

    PubMed

    Maimon, Shimon; Luckman, Yehudit; Strauss, Ido

    2016-01-01

    Spinal dural arteriovenous fistula (SDAVF) is a rare disease, the etiology of which is not entirely clear. It is the most common vascular malformation of the spinal cord, comprising 60-80 % of the cases. The clinical presentation and imaging findings may be nonspecific and misleading, often mistaking it for other entities like demyelinating or degenerative diseases of the spine.This chapter describes the imaging findings, clinical signs, and symptoms of this disease and also the available treatment options according to the current literature.Angiography is still considered the gold standard for diagnosis; however, MRI/MRA is increasingly used as a screening tool. Modern endovascular techniques are becoming increasingly more effective in treating SDAVF offering a less invasive treatment option; however, they still lag behind surgical success rates which approach 100 %. The outcome of both treatment options is similar if complete obliteration of the fistula is obtained and depends mainly on the severity of neurological dysfunction before treatment.Heightened awareness by radiologists and clinicians to this rare entity is essential to make a timely diagnosis of this treatable disease. A multidisciplinary treatment approach is required in order to make appropriate treatment decisions. PMID:26508408

  20. [Endovascular treatment for dural arteriovenous fistula].

    PubMed

    Miyachi, Shigeru

    2008-08-01

    Intracranial dural arteriovenous fistulas (DAVFs) are acquired abnormal epidural arteriovenous shunts, particularly at the sinus wall. Most of the DAVFs are associated with progressive sinus occlusion. They are located in the cavernous sinus, lateral (transverse-sigmoid) sinus, superior-sagittal sinus, anterior condylar confluence, tentorial sinus, craniocervical junction, and anterior skull base (ethmoidal sinus). The treatment strategy differs based on the etiology and drainage pattern of DAVFs. The most effective treatment for DAVFs at the sinus wall is transvenous embolization (TVE) with coils. The target coil packing is effective if the sinus point is identified. Certain cases that are difficult to approach transvenously are treated with transarterial embolization (TAE) by using liquid materials like such glue. In particular cases with sinus occlusive lesion sinus reconstruction with sinoplasty is effective. The cases with failed or impossible endovascular approach should be treated with surgical interruption of shunts or by radiosurgery. The most frequent complication of TAE is brain and nerve ischemia due to the overembolization or migration, and that in TVE is the bleeding due to obstruction of the drainage route and nerve compression due to overpacking of coils. PMID:18717194

  1. A hundred years of lumbar puncture.

    PubMed

    Dugacki, V

    1992-01-01

    In the years 1991 and 1992 the 100th anniversary of the announcement of the lumbar puncture method (1891) and 150th anniversary of the birth of its inventor Heinrich Irenaeus Quincke (1842) are celebrated. In the article a short review is given of the development of this method. PMID:1463808

  2. European Headache Federation consensus on technical investigation for primary headache disorders.

    PubMed

    Mitsikostas, D D; Ashina, M; Craven, A; Diener, H C; Goadsby, P J; Ferrari, M D; Lampl, C; Paemeleire, K; Pascual, J; Siva, A; Olesen, J; Osipova, V; Martelletti, P

    2015-12-01

    The diagnosis of primary headache disorders is clinical and based on the diagnostic criteria of the International Headache Society (ICHD-3-beta). However several brain conditions may mimic primary headache disorders and laboratory investigation may be needed. This necessity occurs when the treating physician doubts for the primary origin of headache. Features that represent a warning for a possible underlying disorder causing the headache are new onset headache, change in previously stable headache pattern, headache that abruptly reaches the peak level, headache that changes with posture, headache awakening the patient, or precipitated by physical activity or Valsalva manoeuvre, first onset of headache ≥50 years of age, neurological symptoms or signs, trauma, fever, seizures, history of malignancy, history of HIV or active infections, and prior history of stroke or intracranial bleeding. All national headache societies and the European Headache Alliance invited to review and comment the consensus before the final draft. The consensus recommends brain MRI for the case of migraine with aura that persists on one side or in brainstem aura. Persistent aura without infarction and migrainous infarction require brain MRI, MRA and MRV. Brain MRI with detailed study of the pituitary area and cavernous sinus, is recommended for all TACs. For primary cough headache, exercise headache, headache associated with sexual activity, thunderclap headache and hypnic headache apart from brain MRI additional tests may be required. Because there is little and no good evidence the committee constructed a consensus based on the opinion of experts, and should be treated as imperfect. PMID:26857820

  3. Headache and sleep disorders: review and clinical implications for headache management.

    PubMed

    Rains, Jeanetta C; Poceta, J Steven

    2006-10-01

    Review of epidemiological and clinical studies suggests that sleep disorders are disproportionately observed in specific headache diagnoses (eg, migraine, tension-type, cluster) and other nonspecific headache patterns (ie, chronic daily headache, "awakening" or morning headache). Interestingly, the sleep disorders associated with headache are of varied types, including obstructive sleep apnea (OSA), periodic limb movement disorder, circadian rhythm disorder, insomnia, and hypersomnia. Headache, particularly morning headache and chronic headache, may be consequent to, or aggravated by, a sleep disorder, and management of the sleep disorder may improve or resolve the headache. Sleep-disordered breathing is the best example of this relationship. Insomnia is the sleep disorder most often cited by clinical headache populations. Depression and anxiety are comorbid with both headache and sleep disorders (especially insomnia) and consideration of the full headache-sleep-affective symptom constellation may yield opportunities to maximize treatment. This paper reviews the comorbidity of headache and sleep disorders (including coexisting psychiatric symptoms where available). Clinical implications for headache evaluation are presented. Sleep screening strategies conducive to headache practice are described. Consideration of the spectrum of sleep-disordered breathing is encouraged in the headache population, including awareness of potential upper airway resistance syndrome in headache patients lacking traditional risk factors for OSA. Pharmacologic and behavioral sleep regulation strategies are offered that are also compatible with treatment of primary headache. PMID:17040332

  4. [The secondary headache in dentistry].

    PubMed

    Watanabe, Nagaoki; Shimohira, Masayuki

    2005-10-01

    This report summarizes the secondary headache attributed to dental disease. Among a lot of dental diseases, the temporomandibular disorder(TMD) is the most important for understanding the mechanism of this type of headache. Our recent study showed that TMD patients had the following symptoms: dysdiadochokinesia, abnormal induced-rigidity in forearms, abnormal circadian rhythm, tension-type headache and mental torment. All these abnormal symptoms were relieved by the improvement of the patient's sleep-quality. The brain monoaminergic systems are known to be related to muscle tonus, sleep problems and mental symptoms. Our studies of a serotonin transporter(5-HTT) gene promoter polymorphism showed that the L and XL alleles were more frequent and S allele was less frequent in the TMD compared to the controls. We speculate the brain monoaminergic systems play the important pathophysiological roles on the TMD. PMID:16218390

  5. Dural lucent line: characteristic sign of hyperostosing meningioma en plaque

    SciTech Connect

    Kim, K.S.; Rogers, L.F.; Lee, C.

    1983-12-01

    Hyperostosis of the skull associated with en plaque form of meningioma may present a diagnostic challenge, since the intracranial part of the tumor is not visualized by skull radiography, computed tomography (CT), or other neuroradiologic methods. The authors report four cases of hyperostosing meningioma en plaque demonstrating a characteristic feature: a subdural layer of ossification along the hyperostotic bone with a dural lucent interface. Polytomography or high-resolution CT at bone window settings is necessary to identify the dural lucent line. The absence of this sign does not exclude meningioma en plaque.

  6. Brain Herniations into the Dural Venous Sinuses or Calvarium: MRI of a Recently Recognized Entity

    PubMed Central

    Battal, Bilal; Castillo, Mauricio

    2014-01-01

    Summary Brain herniations into dural venous sinuses (DVS) are rare findings recently described and their etiology and clinical significance are controversial. We describe five patients with brain herniations into the DVS or calvarium identified on MRI, and discuss their imaging findings, possible causes, and relationship to the patient's symptoms. All patients were examined with MRI including high resolution pre- and post-contrast T1- and T2-weighted sequences. With respect to brain herniations we documented their locations, signal intensities in different sequences, and size. We then reviewed clinical records in an attempt to establish if any symptoms were related to the presence of these herniations. Three males and two females were examined (age range, 11-68 years). Three patients had unilateral temporal lobe herniations into transverse sinuses, one had a cerebellar herniation into the skull, and one had bilateral temporal lobe herniations into the transverse sinuses as well as a cerebellar herniation into the sigmoid sinus. In all, the herniated brain and surrounding cerebrospinal fluid (CSF) had normal signal intensity on all MRI sequences. When correlated with clinical symptoms, brain herniations were thought to be incidental and asymptomatic in three patients and two patients had histories of headaches. Brain herniations with surrounding CSF into the DVS/skull should be considered potential sources of filling defects in the DVS. We believe that they are probably incidental findings that may be more common than previously recognized and should be not confused with the more common arachnoid granulations, clots, or tumors. Two patients had headaches, but their relation to the presence of herniated brain was uncertain. PMID:24571834

  7. Fatal progression of posttraumatic dural arteriovenous fistulas refractory to multimodal therapy. Case report.

    PubMed

    Friedman, J A; Meyer, F B; Nichols, D A; Coffey, R J; Hopkins, L N; Maher, C O; Meissner, I D; Pollock, B E

    2001-05-01

    The authors report the case of a man who suffered from progressive, disseminated posttraumatic dural arteriovenous fistulas (DAVFs) resulting in death, despite aggressive endovascular, surgical, and radiosurgical treatment. This 31-year-old man was struck on the head while playing basketball. Two weeks later a soft, pulsatile mass developed at his vertex, and the man began to experience pulsatile tinnitus and progressive headaches. Magnetic resonance imaging and subsequent angiography revealed multiple AVFs in the scalp, calvaria, and dura, with drainage into the superior sagittal sinus. The patient was treated initially with transarterial embolization in five stages, followed by vertex craniotomy and surgical resection of the AVFs. However, multiple additional DAVFs developed over the bilateral convexities, the falx, and the tentorium. Subsequent treatment entailed 15 stages of transarterial embolization; seven stages of transvenous embolization, including complete occlusion of the sagittal sinus and partial occlusion of the straight sinus; three stages of stereotactic radiosurgery; and a second craniotomy with aggressive disconnection of the DAVFs. Unfortunately, the fistulas continued to progress, resulting in diffuse venous hypertension, multiple intracerebral hemorrhages in both hemispheres, and, ultimately, death nearly 5 years after the initial trauma. Endovascular, surgical, and radiosurgical treatments are successful in curing most patients with DAVFs. The failure of multimodal therapy and the fulminant progression and disseminated nature of this patient's disease are unique. PMID:11354419

  8. Headaches and Migraines: Migraine 101 Quiz

    MedlinePlus

    ... Bar Home Current Issue Past Issues Headaches and Migraines Migraine 101 Quiz Past Issues / Spring 2009 Table of ... the facts when it comes to headaches and migraines? Test your knowledge with this quick quiz. True/ ...

  9. Altitude, Acute Mountain Sickness and Headache

    MedlinePlus

    ... Pinterest Follow us on Instagram DONATE TODAY About Migraine Patient Registry Corporate Roundtable Info for Residents & Fellows Living With Migraines Types of Headache/Migraine Life with Headache/Migraine ...

  10. Persistent unilateral mydriasis and headache

    PubMed Central

    Alkhalil, Mohammad; Lewis, Simon; Hawker, Matthew; Dick, David

    2009-01-01

    A 50-year-old white Caucasian woman with previously diagnosed migraine was admitted with unilateral headache and anisocoria. An initial assessment revealed no cause for this abnormality and she was thought to have mydriasis in the context of migraine. However, failure of her symptoms and signs to resolve prompted further investigation and demonstrated the diagnosis of intermittent angle-closure glaucoma. PMID:21686386

  11. Acute treatment of migraine headaches.

    PubMed

    Taylor, Frederick R

    2010-04-01

    Optimum acute treatment of migraine requires prevention of headache as a top priority. Recognition of the multitude of migraine presentations, the frequency of total headache attacks, and number of days of headache disability are critical. Successful treatment requires excellent patient-clinician communication enhancing confidence and mutual trust based on patient needs and preferences. Optimum management of acute migraine nearly always requires pharmacologic treatment for rapid resolution. Migraine-specific triptans, dihydroergotamine, and several antiinflammatories have substantial empirical clinical efficacy. Older nonspecific drugs, particularly butalbital and opioids, contribute to medication overuse headache and are to be avoided. Clinicians should utilize evidence-based acute migraine-specific therapy stressing the imperative acute treatment goal of early intervention, but not too often with the correct drug, formulation, and dose. This therapy needs to provide cost-effective fast results, meaningful to the patient while minimizing the need for additional drugs. Migraine-ACT evaluates 2-hour pain freedom with return to normal function, comfort with treatment, and consistency of response. Employ a thoroughly educated patient, formulary, testimonials, stratification, and rational cotherapy against the race to central sensitization for optimum outcomes. PMID:20352584

  12. [Therapeutic neuromodulation in primary headaches].

    PubMed

    May, A; Jürgens, T P

    2011-06-01

    Neuromodulatory techniques have developed rapidly in the therapeutic management of refractory headaches. Invasive procedures comprise peripheral nerve stimulation (particularly occipital nerve stimulation), vagus nerve stimulation, cervical spinal cord stimulation and hypothalamic deep brain stimulation. Transcutaneous electrical nerve stimulation, repetitive transcranial magnetic stimulation and transcranial direct current stimulation are noninvasive variants. Based on current neuroimaging, neurophysiological and clinical studies occipital nerve stimulation and hypothalamic deep brain stimulation are recommended for patients with chronic cluster headache. Less convincing evidence can be found for their use in other refractory headaches such as chronic migraine. No clear recommendation can be given for the other neuromodulatory techniques. The emerging concept of intermittent stimulation of the sphenopalatine ganglion is nonetheless promising. Robust randomized and sham-controlled multicenter studies are needed before these therapeutic approaches are widely implemented. Due to the experimental nature all patients should be treated in clinical studies. It is essential to confirm the correct headache diagnosis and the refractory nature before an invasive approach is considered. Patients should generally be referred to specialized interdisciplinary outpatient departments which closely collaborate with neurosurgeons who are experienced in the implantation of neuromodulatory devices. It is crucial to ensure a competent postoperative follow-up with optimization of stimulation parameters and adjustment of medication. PMID:20972665

  13. Higher-dimensional puncture initial data

    NASA Astrophysics Data System (ADS)

    Zilhão, Miguel; Ansorg, Marcus; Cardoso, Vitor; Gualtieri, Leonardo; Herdeiro, Carlos; Sperhake, Ulrich; Witek, Helvi

    2011-10-01

    We calculate puncture initial data, corresponding to single and binary black holes with linear momenta, which solve the constraint equations of D-dimensional vacuum gravity. The data are generated by a modification of the pseudospectral code presented in [M. Ansorg, B. Bruegmann, and W. Tichy, Phys. Rev. DPRVDAQ1550-7998 70, 064011 (2004).10.1103/PhysRevD.70.064011] and made available as the TwoPunctures thorn inside the Cactus computational toolkit. As examples, we exhibit convergence plots, the violation of the Hamiltonian constraint as well as the initial data for D=4,5,6,7. These initial data are the starting point to perform high-energy collisions of black holes in D dimensions.

  14. Dural diverticulum with a symptomatic cerebrospinal fluid leak.

    PubMed

    Armstrong, Nicholas; Williamson, Clinton; Williamson, Natalie; Fortes, Manuel; Tjauw, Iwan; Vij, Vikas; Trojan, Ryan

    2016-03-01

    A case report of a 63-year-old female patient with a cervical spinal dural diverticulum and intracranial hypotension secondary to a symptomatic CSF leak after minor trauma. The patient responded well after the cervical approach epidural blood patch procedure. PMID:26973722

  15. Headache - Multiple Languages: MedlinePlus

    MedlinePlus

    ... Headaches (Arabic) الصداع - العربية Bilingual PDF Health Information Translations Chinese - Simplified (简体中文) Headaches 头痛 - 简体中文 (Chinese - Simplified) Bilingual PDF Health Information Translations Chinese - Traditional (繁體中文) Headaches 頭痛 - 繁體中文 (Chinese - Traditional) ...

  16. [The problems of migraine headache treatment].

    PubMed

    Vilionskis, Aleksandras; Vaitkus, Antanas

    2002-01-01

    The acute treatment and prophylaxis of migraine headache are discussed in this article. The medications for acute treatment, their doses, indications, contraindications and adverse effects are compared. The special attention for migraine headache prophylaxis is paid. The migraine diagnostic criteria and triggers of migraine headache are noted. PMID:12474651

  17. Psychiatric Symptoms in Children with Primary Headache

    ERIC Educational Resources Information Center

    Anttila, Pirjo; Sourander, Andre; Metsahonkala, Liisa; Aromaa, Minna; Helenius, Hans; Sillanpaa, Matti

    2004-01-01

    Objective: To examine the association of psychiatric symptoms with migraine and tension-type headache in children. Method: A questionnaire completed by 1,135 Finnish children in the sixth grade identified 154 children with migraine, 138 with tension-type headache, and 407 children who were headache-free. Seventy children were randomly selected…

  18. Use of an Intrathecal Catheter for Analgesia, Anesthesia, and Therapy in an Obstetric Patient with Pseudotumor Cerebri Syndrome.

    PubMed

    Gragasin, Ferrante S; Chiarella, Angelo B

    2016-03-15

    Pseudotumor cerebri syndrome (PTCS) is a rare disorder chiefly observed in obese women of childbearing age. We describe a case of a parturient with PTCS managed successfully with an intrathecal catheter, after inadvertent dural puncture, for labor analgesia, surgical anesthesia, and treatment of headache because of intracranial hypertension during the peripartum period. Prolonged placement of the intrathecal catheter (i.e., >24 hours) may have contributed to the absence of postdural puncture headache symptoms and an uneventful postpartum period. Intrathecal catheter placement may therefore be a viable option in patients with PTCS should inadvertent dural puncture occur. PMID:26825990

  19. Tension-type headache: one or more headaches?

    PubMed

    Sjaastad, Ottar

    2011-01-01

    In this context, the focus will be on the homogeneity of tension-type headache (T-TH): is it a disease? Or: is it more likely to be a syndrome? A multiplicity of disorders from as drastically different fields of medicine as disorders caused by environmental gases, intra-psychic conflicts, and nuchal/cervical disorders can putatively fake T-TH. T-TH is in all probability a conglomerate of disorders and not one solid, homogeneous disorder. PMID:22152438

  20. Tension-type headache: one or more headaches?

    PubMed Central

    Sjaastad, Ottar

    Summary In this context, the focus will be on the homogeneity of tension-type headache (T-TH): is it a disease? Or: is it more likely to be a syndrome? A multiplicity of disorders from as drastically different fields of medicine as disorders caused by environmental gases, intra-psychic conflicts, and nuchal/cervical disorders can putatively fake T-TH. T-TH is in all probability a conglomerate of disorders and not one solid, homogeneous disorder. PMID:22152438

  1. Recurrent paroxysmal headache associated with facial ecchymosis.

    PubMed

    Comabella, M; Titus, F; Huguet, P

    1996-08-01

    The case of a 58-year-old man with chronic paroxysmal headache and facial ecchymosis is described. The headache was pulsating, of short duration, without nausea or vomiting, and occasionally associated with flashing lights. Ecchymoses were mainly located in the middle forehead region and their appearance was associated with a reduction in intensity of the headache. Blood coagulation tests were within normal limits, and a skin biopsy of the ecchymotic lesion ruled out an underlying vasculitis. These attacks were difficult to include in any particular type of headache, although some aspects were similar to migraine headache. The possible mechanism of hemorrhages is discussed. PMID:8869770

  2. Cough, exertional, and other miscellaneous headaches.

    PubMed

    Sands, G H; Newman, L; Lipton, R

    1991-05-01

    We have discussed several miscellaneous headache disorders not associated with structural brain disease. The first group included those headaches provoked by "exertional" triggers in various forms. These include benign cough headache, BEH, and headache associated with sexual activity. The IHS diagnostic criteria were discussed. Benign exertional headache and cough headache were discussed together because of their substantial similarities. In general, BEH is characterized by severe, short-lived pain after coughing, sneezing, lifting a burden, sexual activity, or other similar brief effort. Structural disease of the brain or skull was the most important differential diagnosis for these disorders, with posterior fossa mass lesions being identified as the most common organic etiology. Magnetic resonance imaging with special attention to the posterior fossa and foramen magnum is the preferred method for evaluating these patients. Indomethacin is the treatment of choice. The headache associated with sexual activity is dull in the early phases of sexual excitement and becomes intense at orgasm. This headache is unpredictable in occurrence. Like BEH, the headache associated with sexual activity can be a manifestation of structural disease. Subarachnoid hemorrhage must be excluded, by CT scanning and CSF examination, in patients with the sexual headache. Benign headache associated with sexual activity has been successfully treated with indomethacin and beta-blockers. The second miscellaneous group of headache disorders includes those provoked by eating something cold or food additives, and by environmental stimuli. Idiopathic stabbing headache does not have a known trigger and appears frequently in migraineurs. Its occurrence may also herald the termination of an attack of cluster headache. Indomethacin treatment provides significant relief. Three headaches triggered by substances that are eaten were reviewed: ingestion of a cold stimulus, nitrate/nitrite-induced headache

  3. Posttraumatic headaches in civilians, soldiers, and athletes.

    PubMed

    Evans, Randolph W

    2014-05-01

    Posttraumatic headaches are one of the most common and controversial secondary headache types. After mild head injury, more than 50% of people develop a postconcussion syndrome which has been controversial for more than 150 years. Headache is estimated as present in 30% to 90% of patients after mild head injury. Most headaches are of the tension type, although migraines can increase in frequency or occur acutely or chronically de novo. A review is provided of headaches in civilians, soldiers after blast trauma, athletes, and post-craniotomy including pathogenesis. The treatments are the same as for the primary phenotypes. PMID:24703532

  4. Post-traumatic headaches: a clinical overview.

    PubMed

    Russo, A; D'Onofrio, F; Conte, F; Petretta, V; Tedeschi, G; Tessitore, A

    2014-05-01

    Headache attributed to head and/or neck trauma or injury, the so-called post-traumatic headache (PTH), is the most common secondary headache disorder and one of the most controversial clinical entities in the headache field, due to its unclear pathophysiological mechanisms and the unsolved role of associated psychological and medico-legal aspects. PTH, as a significant cause of morbidity after traumatic brain injury, may occur as an isolated symptom or as one of a constellation of symptoms known as post-concussive syndrome. However, in many cases, PTH might also represent an accentuation of non-disabling, remote or infrequent pre-existing primary headaches rather than a new onset headache strictly related to the trauma. Recently, the International Classification of Headache Disorders attempted to classify PTH; however, many unsolved issues are still to be clarified. In this brief review, we will focus on PTH clinical aspects and diagnostic criteria. PMID:24867854

  5. Sunrise-related headache: case report.

    PubMed

    Ulas, U H; Korkmaz, A; Karadas, O; Odabasi, Z; Reiter, R J

    2010-01-01

    A male, 34 years of age, suffers from headaches, red and watery eyes. The headaches began in childhood; the frequency of headaches has increased over the years and in the last decade headaches have occurred on a daily basis. If he wakes up before sunrise he feels much better and free of a headache; however, once he continues to sleep during and after sunrise, he suffers from tiredness, headache and nervousness. On magnetic resonance imaging (MRI), benign neuroepithelial cysts or a chronic infarct area was reported at the junction of the left medio-lateral zone of hypothalamus. After repeated MRI examinations, it was decided that the lesion on the left medio-lateral zone of hypothalamus may have disrupted the pineal gland and changed melatonin secretion. It was decided to treat him with 3 mg melatonin daily before going to bed. After a week of treatment, the patient reported that he felt very fresh and was virtually free of headaches. PMID:19473198

  6. [Tension headache--a review].

    PubMed

    Pfaffenrath, V; Wermuth, A; Pöllmann, W

    1988-12-01

    Tension headache (TH) is an ill-defined headache syndrome, characterized by bilateral, daily headaches with fronto-occipital localisation. TH is often accompanied by a migraine and an abuse of analgesics and/or ergotamine. In the etiology of TH vascular, muscular and psychogenic factors are assumed. Floating transitions to common migraine are discussed. The increased muscle tension is not specific for TH, but more probably a consequence of TH. In addition a decrease of the pain threshold with a deficiency of the antinociceptive system is supposed. The efficacy of tricyclic antidepressives in TH is based on potentiation of serotonergic and noradrenergic mechanisms and - besides their analgetic potencies - upon an increase of the pain threshold. TH prophylaxis is indicated if patients suffer from TH more than ten times per month. Medication are tricyclic antidepressives of the amitriptyline-type. Prophylaxis of TH can only be successful if a simultaneous abuse of analgesics and/or ergotamine is discontinued. In addition, EMG-biofeedback, as well as relaxation - and vasoconstriction training might be helpful in specific cases. PMID:3069680

  7. [Genetics of primary headache syndromes].

    PubMed

    Freilinger, T

    2014-08-01

    Migraine has an important genetic component. The prototypic monogenic form of migraine is hemiplegic migraine, a rare subtype of migraine with aura, for which three causative genes have been identified. Studies of transgenic animal models have substantially improved our understanding of the molecular pathophysiology of this monogenic model disease as well as of migraine in general. Beyond this, there are other (rarer) monogenic forms of migraine, e.g., in the context of hereditary mostly vascular syndromes such as CADASIL. By contrast, the common types of migraine with and without aura are genetically complex. With the identification of the first robust genetic risk variants in large genome-wide association studies, our knowledge in this still dynamically expanding field has substantially increased. This review summarizes the current status of migraine genetics, with a special focus on hemiplegic migraine as well as the most recent findings in complex migraine genetics. In addition, the first preliminary findings on the genetics of other types of primary headache disorders (cluster headache, tension-type headache) are briefly reviewed. PMID:25012921

  8. Intracranial Chronic Subdural Hematoma Presenting with Intractable Headache after Cervical Epidural Steroid Injection.

    PubMed

    Kim, Myungsoo; Park, Ki-Su

    2015-08-01

    Postdural punctural headache (PDPH) following spinal anesthesia is due to intracranial hypotension caused by cerebrospinal fluid (CSF) leakage, and it is occasionally accompanied by an intracranial hematoma. To the best of our knowledge, an intracranial chronic subdural hematoma (CSDH) presenting with an intractable headache after a cervical epidural steroid injection (ESI) has not been reported. A 39-year-old woman without any history of trauma underwent a cervical ESI for a herniated nucleus pulposus at the C5-6 level. One month later, she presented with a severe headache that was not relieved by analgesic medication, which changed in character from being positional to non-positional during the preceding month. Brain magnetic resonance imaging revealed a CSDH along the left convexity. Emergency burr-hole drainage was performed and the headache abated. This report indicates that an intracranial CSDH should be considered a possible complication after ESI. In addition, the event of an intractable and changing PDPH after ESI suggests further evaluation for diagnosis of an intracranial hematoma. PMID:26361532

  9. Hybrid surgery for dural arteriovenous fistula in the neurosurgical hybrid operating suite

    PubMed Central

    Shen, Shih-Chieh; Tsuei, Yuang-Seng; Chen, Wen-Hsien; Shen, Chiung-Chyi

    2014-01-01

    Treatment of a dural arteriovenous fistula (AVF), which is difficult to access by either the surgical or endovascular approach, is challenging. A hybrid technique, combining a microsurgical approach and endovascular embolization, can provide less invasive management of dural AVFs in a modern neurosurgical hybrid operating suite. We present a case of intracerebral hemorrhage in the left cerebellum secondary to dural AVF, Cognard type IV with numerous tiny feeders from the ascending pharyngeal artery branches. No adequate arterial or venous route for endovascular embolization was found by neuroangiography. The hybrid technique, combining keyhole pterional craniotomy and embolization with n-butyl cyanoacrylate glue injection via direct cannulation of the periclival venous plexus, succeeded in obliterating the dural AVF. Intraoperative angiography showed successful embolization of the dural AVF without any complication. This report illustrates the usefulness of the neurosurgical hybrid operating suite for the treatment of difficult dural AVFs. PMID:24459222

  10. Direct puncture angiography in congenital venous malformations

    SciTech Connect

    Boxt, L.M.; Levin, D.C.; Fellows, K.E.

    1983-01-01

    Angiodysplasia of the extremities is a broad group of vascular lesions of arterial, capillary, and venous origin. They are generally detected initially during late childhood or early adulthood. Although they may cause swelling and pain, they are often asymptomatic and are discovered incidentally on physical examination performed for other reasons. One of the most troublesome diagnostic aspects of these lesions is the fact that while they consist of enlarged venous channels, standard venographic techniques may fail to demonstrate them. Three cases are described in which the diagnosis of venous angioma was made by direct needle puncture and contrast material injection, after arteriographic and/or venographic examination was either negative or nondiagnostic.

  11. Endovascular treatment of posterior condylar canal dural arteriovenous fistula.

    PubMed

    Maus, Volker; Söderman, Michael; Rodesch, Georges; Kabbasch, Christoph; Mpotsaris, Anastasios

    2016-01-01

    Posterior condylar canal dural arteriovenous fistulas (PCC DAVFs) are rare lesions that may present with pulse-synchronous bruit. In cases with venous reflux there is a risk of haemorrhage or even dementia. Diagnosis and endovascular treatment require a profound knowledge of the vascular anatomy of the craniocervical junction and comprehensive neurovascular imaging. We describe the clinical presentation, angiographic imaging and endovascular treatment of a PCC DAVF in a female patient with pulse-synchronous bruit as the presenting symptom. The fistula drained almost exclusively into the sigmoid sinus and internal jugular vein. There was no intracranial reflux. The PCC DAVF was treated with transvenous coil occlusion of the fistulous pouch in the condylar canal. Symptoms resolved immediately after intervention and the patient recovered quickly without any neurological deficits. MR angiography confirmed occlusion of the DAVF. The dural sinus was patent with normal blood flow. PMID:27247204

  12. Primary dural lymphoma: Complete remission after treatment with radiation therapy.

    PubMed

    Jones, Jeremy; Gupta, Arjun; Naina, Harris

    2015-01-01

    Central nervous system (CNS) involvement in sarcoidosis is rare and typically occurs in 5-10% of patients. Neurological symptoms in a patient with known sarcoidosis can be attributed to neurosarcoidosis without thorough evaluation. Primary Dural Lymphoma (PDL) is an extremely rare form of non-Hodgkin lymphoma. Although PDL is technically a subtype of primary CNS lymphoma, the two entities vary markedly in their histological grade, clinical course, prognosis and treatment. The most common dural- based lesion found on CNS imaging is meningioma. It shares many imaging, clinical and epidemiologic features of PDL which often leads to misdiagnosis of PDL as meningioma. We present a case where a PDL was diagnosed after CNS symptoms failed to resolve after steroid therapy for presumed neurosarcoidosis. PMID:26237359

  13. C6 plate puncture testing report.

    SciTech Connect

    Vangoethem, Douglas J.; Cordova, Theresa Elena; Reu, Phillip L.

    2013-04-01

    There are numerous scenarios where critical systems could be subject to penetration by projectiles or fixed objects (e.g., collision, natural disaster, act of terrorism, etc.). It is desired to use computational models to examine these scenarios and make risk-informed decisions; however, modeling of material failure is an active area of research, and new models must be validated with experimental data. The purpose of this report is to document the experimental work performed from FY07 through FY08 on the Campaign Six Plate Puncture project. The goal of this project was to acquire experimental data on the puncture and penetration of metal plates for use in model validation. Of particular interest is the PLH failure model also known as the multilinear line segment model. A significant amount of data that will be useful for the verification and validation of computational models of ductile failure were collected during this project were collected and documented herein; however, much more work remains to be performed, collecting additional experimental data that will further the task of model verification.

  14. Headaches

    MedlinePlus

    ... brain and spinal cord, or intracranial hemorrhage, bleeding inside the brain. EMERGENCY See your doctor or go ... relieve pain. You can also rest in a dark room and apply ice packs and gentle pressure ...

  15. Headache

    MedlinePlus

    ... decisions about when and where they should receive healthcare. Unfortunately, most people lack the medical knowledge needed to make these decisions safely. FreeMD.com is powered by a computer program that performs symptom triage. The goal of ...

  16. Analysis of Internet sites for headache.

    PubMed

    Peroutka, S J

    2001-02-01

    The Internet is capable of providing an unprecedented amount of information to both physicians and patients interested in headache. To assess the status of headache information on the Internet (as of January 2000), a search for 'headache' was performed using 10 leading Internet search engines. The number of web pages identified ranged from 4419 (WebCrawler) to 506 426 (Northern Light). The 'average' search yielded nearly 150 000 web page listings for 'headache'. The content was then reviewed of the top 10 listed web pages for each search (i.e. a total of 100 page listings). The results demonstrate that, at the present time, Internet-based information on headache is extensive but poorly organized. Editorial review of this potential valuable resource is required in order to maximize its utility in headache education and management. PMID:11298659

  17. Acetate Causes Alcohol Hangover Headache in Rats

    PubMed Central

    Maxwell, Christina R.; Spangenberg, Rebecca Jay; Hoek, Jan B.; Silberstein, Stephen D.; Oshinsky, Michael L.

    2010-01-01

    Background The mechanism of veisalgia cephalgia or hangover headache is unknown. Despite a lack of mechanistic studies, there are a number of theories positing congeners, dehydration, or the ethanol metabolite acetaldehyde as causes of hangover headache. Methods We used a chronic headache model to examine how pure ethanol produces increased sensitivity for nociceptive behaviors in normally hydrated rats. Results Ethanol initially decreased sensitivity to mechanical stimuli on the face (analgesia), followed 4 to 6 hours later by inflammatory pain. Inhibiting alcohol dehydrogenase extended the analgesia whereas inhibiting aldehyde dehydrogenase decreased analgesia. Neither treatment had nociceptive effects. Direct administration of acetate increased nociceptive behaviors suggesting that acetate, not acetaldehyde, accumulation results in hangover-like hypersensitivity in our model. Since adenosine accumulation is a result of acetate formation, we administered an adenosine antagonist that blocked hypersensitivity. Discussion Our study shows that acetate contributes to hangover headache. These findings provide insight into the mechanism of hangover headache and the mechanism of headache induction. PMID:21209842

  18. Cerebral venous thrombosis in post-lumbar puncture intracranial hypotension: case report and review of literature

    PubMed Central

    Kate, Mahesh P.

    2014-01-01

    The spectrum of presentation of intracranial hypotension is clinically perplexing. We report a case of 31-year-old post-partum woman who underwent an uneventful caesarean section under spinal anesthesia. From the second day of surgery she developed postural headache, the headache lost its postural character after few days. She then developed seizures and ataxic hemiparesis. Magnetic resonance imaging showed features of severe intracranial hypotension in the brain and the spinal cord, and magnetic resonance venography showed cortical vein and partial superior sagittal sinus thrombosis. Prothrombotic (etiological) work-up showed Protein C and S deficiency. She responded to anticoagulation therapy and recovered completely. On review of literature two distinct groups could be identified obstetric and non-obstetric. The non-obstetric group included patients who underwent diagnostic lumbar puncture, intrathecal injection of medications and epidural anesthesia for non-obstetric surgeries. Poor outcome and mortality was noted in non-obstetric group, while obstetric group had an excellent recovery. PMID:24627803

  19. [Orofacial pain and secondary headaches].

    PubMed

    Bodéré, C; Pionchon, P

    2005-07-01

    Recent studies have improved our knowledge of the mechanisms underlying orofacial pain. This review presents the most relevant aspects of such mechanisms according to the different clinical features of the various entities in orofacial pain: odontogenic pain, atypical facial pain and other idiopathic orofacial pain conditions and musculoskeletal pain characterized by pain in the temporomandibular joint and/or the associated muscles of mastication. The link between the muscular temporomandibular disorders and tension type headache is particularly considered in the light of the different possible mechanisms. PMID:16141969

  20. [Headache. Current status of research and treatment].

    PubMed

    Straube, A; Gaul, C

    2015-10-01

    The starting point for German headache research and clinical education was the engagement of D. Soyka in the 1970s, which enabled the foundation of the German Headache Society (DMKG) on 28 June 1979 and, some years later, the founding congress of the International Headache Society (IHS) in Munich 1982. As a result of these activities, in 1988 the first international classification of headache disorders was published. This classification was one of the major milestones in the development of basic as well as clinical headache research. In the following years, epidemiological studies all over the world showed a 1-year prevalence for headache of approximately 60%, making headaches one of the most frequent medical complaints. Basic research showed an involvement of serotonergic mechanisms in migraine pain and triptans were one of the first drugs designed to influence these mechanisms. Functional brain imaging studies in migraine patients further showed a cyclic modulation of the activity of brainstem areas independent of the current pain state. Various research groups were involved in the clarification of the role of calcitonin gene-related peptide (CGRP) in migraine and cluster headache. A specific development in the German headache scene is the establishment of integrated headache centers and reflects the primarily multimodal treatment approach in Germany which contrasts with the settings in other countries. These successful developments are increasingly being undermined by the fact that the low financial support of headache research, for example, by the German science council is causing a decreasing interest in headache research, with the consequence that the clinical education of students as well as young medical doctors shows increasing deficits. The consequence for the future will be a deficit in the clinical care of the population. PMID:26264901

  1. Headache and facial pain in scuba divers.

    PubMed

    Cheshire, William P

    2004-08-01

    Headache occasionally occurs during or after scuba diving. Although its significance often is benign, headache may signal a serious neurological disorder in some circumstances. In addition to the usual causes of headache, the diagnostic evaluation should consider otic and paranasal sinus barotrauma, arterial gas embolism, decompression sickness, carbon dioxide retention, carbon monoxide toxicity, hyperbaric-triggered migraine, cervical and temporomandibular joint strain, supraorbital neuralgia, carotid artery dissection, and exertional and cold stimulus headache syndromes. Focal neurologic symptoms, even in the migraineur, should not be ignored, but rather treated with 100% oxygen acutely and referred without delay to a facility with a hyperbaric chamber. PMID:15228893

  2. Injection Therapy for Headache and Facial Pain.

    PubMed

    Kleen, Jonathan K; Levin, Morris

    2016-08-01

    Peripheral nerve blocks are an increasingly viable treatment option for selected groups of headache patients, particularly those with intractable headache or facial pain. Greater occipital nerve block, the most widely used local anesthetic procedure in headache conditions, is particularly effective, safe, and easy to perform in the office. Adverse effects are few and infrequent. These procedures can result in rapid relief of pain and allodynia, and effects last for several weeks or months. Use of nerve block procedures and potentially onabotulinum toxin therapy should be expanded for patients with intractable headache disorders who may benefit, although more studies are needed for efficacy and clinical safety. PMID:27475516

  3. Flat plate puncture test convergence study.

    SciTech Connect

    Snow, Spencer; Ammerman, Douglas James; Molitoris, David; Tso, Chi-Fung; Yaksh, Mike

    2010-10-01

    The ASME Task Group on Computational Mechanics for Explicit Dynamics is investigating the types of finite element models needed to accurately solve various problems that occur frequently in cask design. One type of problem is the 1-meter impact onto a puncture spike. The work described in this paper considers this impact for a relatively thin-walled shell, represented as a flat plate. The effects of mesh refinement, friction coefficient, material models, and finite element code will be discussed. The actual punch, as defined in the transport regulations, is 15 cm in diameter with a corner radius of no more than 6 mm. The punch used in the initial part of this study has the same diameter, but has a corner radius of 25 mm. This more rounded punch was used to allow convergence of the solution with a coarser mesh. A future task will be to investigate the effect of having a punch with a smaller corner radius. The 25-cm thick type 304 stainless steel plate that represents the cask wall is 1 meter in diameter and has added mass on the edge to represent the remainder of the cask. The amount of added mass to use was calculated using Nelm's equation, an empirically derived relationship between weight, wall thickness, and ultimate strength that prevents punch through. The outer edge of the plate is restrained so that it can only move in the direction parallel to the axis of the punch. Results that are compared include the deflection at the edge of the plate, the deflection at the center of the plate, the plastic strains at radius r=50 cm and r=100 cm , and qualitatively, the distribution of plastic strains. The strains of interest are those on the surface of the plate, not the integration point strains. Because cask designers are using analyses of this type to determine if shell will puncture, a failure theory, including the effect of the tri-axial nature of the stress state, is also discussed. The results of this study will help to determine what constitutes an adequate

  4. Clinical aspects of perimenstrual headaches.

    PubMed

    Taylor, Frederick R

    2009-02-01

    Menstrual migraine (MM) is either pure, if attacks are limited solely during the perimenstrual window (PMW), or menstrually related (MRM), if two of three PMWs are associated with attacks with additional migraine events outside the PMW. Acute migraine specific therapy is equally effective in MM and non-MM. Although the International Classification of Headache Disorders-II classifies MM without aura, data suggest this needs revision. The studies on extended-cycle oral contraceptives suggest benefits for headache-prone individuals. Triptan mini-prophylaxis outcomes are positive, but a conclusion of "minimal net benefit compared to placebo" is not entirely unwarranted. In a 2008 evidence-based review, grade B recommendations exist for sumatriptan (50 and 100 mg), mefenamic acid (500 mg), and riza-triptan (10 mg) for the acute treatment of MRM. For the preventive mini-prophylactic treatment of MRM, grade B recommendations are provided for transcutaneous estrogen (1.5 mg), frovatriptan (2.5 mg twice daily), and naratriptan (1 mg twice daily). PMID:19126376

  5. Delay in hospital admission of patients with cerebral vein and dural sinus thrombosis.

    PubMed

    Ferro, José M; Lopes, M G; Rosas, M J; Fontes, J

    2005-01-01

    Factors influencing early hospital admission have been described for several stroke types but not for cerebral vein and dural sinus thrombosis (CVT). CVT is more difficult to diagnose than arterial stroke; delay in hospital admission may postpone CVT treatment. The purposes of this study were: (1) to describe the delay between the onset of symptoms and hospital admission of patients with CVT, and (2) to identify the variables that influence that delay. We registered the interval (days) between the onset of symptoms and hospital admission in 91 consecutive patients admitted to 20 Portuguese hospitals between June 1995 and June 1998. We also studied the impact of admission delay on treatments (prescription of anticoagulants and the number of days elapsed between the onset of symptoms and start of anticoagulation and admission). Median admission delay was 4 days. Twenty-two (25%) patients were admitted within 24 h. Two thirds of the patients were admitted within 7 days and 75% within 13 days. In multiple logistic regression analysis, admission within 24 h was positively associated with mental status disorder (delirium or abulia; OR = 4.59; 95% CI = 1.41-14.89) and negatively associated with headache (OR = 0.03; 95% CI = 0.00-0.32). Presentation as isolated intracranial hypertension was associated with admission delay of more than 4 days (OR = 2.63; 95% CI = 0.97-7.14). Papilloedema was associated with an admission delay of more than 13 days (OR = 4.69; 95% CI = 1.61-13.61). There was no association between admission delay and the proportion of anticoagulated patients. The interval between onset of symptoms and start of anticoagulation was shorter in patients admitted earlier (p = 0.0001, for either admission within 24 h, 4 or 13 days). There is a considerable delay until the clinical picture associated with CVT is recognised as justifying hospital admission, especially when patients present with symptoms identical to isolated intracranial hypertension syndrome. PMID

  6. Sport and exercise headache: Part 2. Diagnosis and classification.

    PubMed Central

    Williams, S J; Nukada, H

    1994-01-01

    A group of 129 subjects (67 men and 62 women) experiencing sports headache was established using a questionnaire. A wide range of information was gathered, focusing on the mode of onset, time course, characteristic features and associated symptoms of sports-related headache. Criteria for the varieties of sports headaches were established using head trauma and then migraine to divide subgroups of sports headaches. Cases were classified into four categories: effort migraine, trauma-triggered migraine, effort-exertion headache, and post-traumatic headache. The percentages of each sports-related headache found were: effort migraine 9%, trauma-triggered migraine 6%, effort-exertion headache 60%, post-traumatic headache 22% and miscellaneous 3%. Sports migraine accounted for 15% of the total sports headache sample. Effort-exertion headache was the most common type of sports headache. Although effort-exertion headache could be separated into subjects who had an acute severe headache induced by anaerobic exercise (exertion headache) from those having a substantial headache lasting hours initiated by aerobic exercise (effort headache), most subjects with effort-exertion headache in this study appeared not to fall into any discrete subgroups. Trauma-related headaches were experienced mainly by men in contact sports, while women more commonly had non-trauma-related headache in running and jogging. PMID:7921916

  7. [Management of transient radicular pain after receiving an epidural blood patch for headaches due to spontaneous intracranial hypotension].

    PubMed

    Melo, M C; Revuelta, M E; Santeularia, T; Genové, M; Català, E

    2015-11-01

    Spontaneous intracranial hypotension headache is an uncommon disease that resolves spontaneously in most of the cases and in a short period of time. The initial treatment should be symptomatic. In some patients the symptomatology is extremely disabling, and in these cases both the diagnosis and treatment may be performed by an epidural blood patch. A 49-year-old Caucasian woman, with no previous record of epidural or intrathecal puncture, consulted in the Emergency Department complaining of a 9-day history of frontal headache and diplopia, along with nausea and vomiting. The patient was diagnosed with spontaneous intracranial hypotension headache. Considering the symptomatology and the uncontrolled pain, the Pain Unit of our hospital performed an epidural blood patch. In the first 24h the patient reported a remarkable relief of both headache and diplopia but developed a left lumbar radiculopathy that was treated successfully with supportive measures. Transient lumbar radiculopathy is a common and acceptable event secondary to the use of epidural blood patch as a treatment for spontaneous intracranial hypotension headache. PMID:25698607

  8. [Consensus paper of the German Migraine and Headache Society on the structure of headache care facilities in Germany].

    PubMed

    Marziniak, M; Malzacher, V; Förderreuther, S; Jürgens, T; Kropp, P; May, A; Straube, A

    2014-04-01

    This consensus paper introduces a classification of headache care facilities on behalf of the German Migraine and Headache Society. This classification is based on the recommendations of the International Association for the Study of Pain (IASP) and the European Headache Federation (EHF) and was adapted to reflect the specific situation of headache care in Germany. It defines three levels of headache care: headache practitioner (level 1), headache outpatient clinic (level 2) and headache centers (level 3). The objective of the publication is to define and establish reliable criteria in the field of headache care in Germany. PMID:24718744

  9. Post-epileptic headache and migraine.

    PubMed Central

    Schon, F; Blau, J N

    1987-01-01

    One hundred epileptic patients were questioned about their headaches. Post-ictal headaches occurred in 51 of these patients and most commonly lasted 6-72 hours. Major seizures were more often associated with post-epileptic headaches than minor attacks. Nine patients in this series of 100 also had migraine: in eight of these nine a typical, albeit a mild, migraine attack was provoked by fits. The post-ictal headache in the 40 epileptics who did not have migraine was accompanied by vomiting in 11 cases, photophobia in 14 cases and vomiting with photophobia in 4 cases. Furthermore, post-epileptic headache was accentuated by coughing, bending and sudden head movements and relieved by sleep. It is, therefore, clear that seizures provoke a syndrome similar to the headache phase of migraine in 50% of epileptics. It is proposed that post-epileptic headache arises intracranially and is related to the vasodilatation known to follow seizures. The relationship of post-epileptic headache to migraine is discussed in the light of current ideas on migraine pathogenesis, in particular the vasodilation which accompanies Leao's spreading cortical depression. PMID:3117978

  10. Athletes' Headaches: Not Necessarily 'Little' Problems.

    ERIC Educational Resources Information Center

    McCarthy, Paul

    1988-01-01

    Headaches experienced by athletes are categorized (exertional, effort, and trauma-triggered migraines), and treatment methods related. Consequences of misdiagnosis, lack of reporting, and poor monitoring are discussed as well as categories of athletes most likely to suffer sports-related headaches. (IAH)

  11. Harry Potter and the curse of headache.

    PubMed

    Sheftell, Fred; Steiner, Timothy J; Thomas, Hallie

    2007-06-01

    Headache disorders are common in children and adolescents. Even young male Wizards are disabled by them. In this article we review Harry Potter's headaches as described in the biographical series by JK Rowling. Moreover, we attempt to classify them. Regrettably we are not privy to the Wizard system of classifying headache disorders and are therefore limited to the Muggle method, the International Classification of Headache Disorders, 2nd edition (ICHD-II). Harry's headaches are recurrent. Although conforming to a basic stereotype, and constant in location, throughout the 6 years of his adolescence so far described they have shown a tendency to progression. Later descriptions include a range of accompanying symptoms. Despite some quite unusual features, they meet all but one of the ICHD-II criteria for migraine, so allowing the diagnosis of 1.6 Probable migraine. PMID:17578544

  12. Interventional Treatment for Post-traumatic Headache.

    PubMed

    Conidi, Francis X

    2016-06-01

    Post-traumatic headache (migraine) is the most common symptom of concussion and traumatic brain injury. An expert opinion-based review along with a literature review (PubMed) was conducted looking at known interventional procedures for post-traumatic headache using the keywords post-traumatic headache, post-traumatic migraine headache, concussion, mild traumatic brain injury, and traumatic brain injury and the following categories: mechanism, pathophysiology, treatment, physical therapy, neurostimulation, Botox@/Onabotulinum toxin, and surgical intervention. The results returned a total of 181 articles of which 52 were selected. None of the articles included randomized placebo-controlled studies, and most were either prospective or retrospective case analysis and/or review articles or consensus opinion papers, with most studies yielding positive results. Despite a lack of hard evidence, interventional procedures, alone or in combination, appear to be an effective treatment for post-traumatic headaches. PMID:27130542

  13. Cluster headache management and beyond.

    PubMed

    Martelletti, Paolo

    2015-01-01

    The therapeutic management of cluster headache is based on a very stable triad of drugs. Acute treatment has, in subcutaneous sumatriptan, its gold standard if compared to pure oxygen or indomethacin. Preventative treatment is based on verapamil at high doses (≥ 360 mg) and is a gold standard if compared to lithium carbonate or topiramate. Transitional treatments, based on the short-term use of corticosteroids with either systemic or local administration (GON), can be useful for the suppression of most resistant cluster periods, but with a well-known carry-over phenomenon related to the length of the cluster period itself. The role of invasive or noninvasive neuromodulation approaches must still be determined on a large scale; therefore, its use is not recommended as of yet. Lifestyle changes, including alcohol avoidance during the active phase of the disease, sleep hygiene and use of vasodilation drugs, should be carefully considered and the patients should be fully informed. PMID:26027515

  14. Cluster headache in childhood: case series from a pediatric headache center.

    PubMed

    Mariani, Rosanna; Capuano, Alessandro; Torriero, Roberto; Tarantino, Samuela; Properzi, Enrico; Vigevano, Federico; Valeriani, Massimiliano

    2014-01-01

    Childhood-onset cluster headache is an excruciatingly painful and distressing condition. A retrospective study was conducted on charts of patients referring to our Headache Center. Those diagnosed as cluster headache were selected. We identified 11 children (6 males and 5 females). The mean age of cluster headache onset was 10 years (range: 5-16). All children had episodic cluster headache. All children had unilateral orbital pain; 7 patients had throbbing pain, whereas 4 children complained stabbing pain. The mean duration of the attack was 86 minutes (ranging from 30 to 180 minutes). The frequency of episodes was between 1 and 4 per day. All children had the typical cluster headache autonomic features, such as lacrimation, conjunctival injection, ptosis, and nostril rhinorrhea. Steroids showed a good clinical efficacy in interrupting cluster headache recurrence. As symptomatic drugs, acetaminophen as well as ibuprofen were ineffective; indomethacin was effective in 1 case. PMID:23307881

  15. [Idiopathic headache in childhood and adolescence].

    PubMed

    Karwautz, A; Wöber-Bingöl, C; Wöber, C

    1993-12-01

    This review of the literature covers classification, epidemiology and clinical aspects of idiopathic headache in childhood and adolescence. In addition, pathogenetic models taking into account the complex involvement of organic, psychological and psychosocial factors are critically reviewed. A general pathogenetic model of migraine may be characterized by a given predisposition, various co-factors which enhance the tendency, and finally, trigger mechanisms which induce an attack. No generally accepted model exists for tension-type headache. In assessing the importance of various factors thought to be related to idiopathic headache, it is necessary to differentiate between causal relation, unspecific association, and coincidence. The aim of this review is to present potential factors influencing headache in childhood and adolescence and to discuss these factors critically with regard to their etiopathogenetic importance. Organic factors seem to be most important in migraine, whereas psychological and (psycho)social factors may influence any type of headache. Briefly, migraine in childhood and adolescence seems to be definitively associated with vegetative dysfunction, abdominal symptoms and hormonal factors and possibly with allergic reactions, whereas a relation to epilepsy can be excluded. There is absolutely no evidence for a typical personality of migraine patients. Various psychic reactions, however, are important in all types of headache. Depression and anxiety in young headache patients seem to be related generally to pain, but not specifically to headache. However, school problems, learning disabilities and stress coping behaviour seem to be related directly to recurrent headache. Additionally, there is evidence that the prevalence of headache is associated with low economic status. PMID:8114976

  16. [Headache, general malaise and left-side ptosis].

    PubMed

    Kissling, S; Nützi, E; Magun, J G; Frauchiger, B

    1998-08-26

    A 82-year-old female was admitted to hospital because of deteriorated general condition, severe diffuse headache and complete left-sided ptosis. A computed tomography scan of the head revealed no subarachnoid haemorrhage. Based on the hypothesis that the symptoms resulted from an infarction in the brain stem, the previous medication with Aspirin was continued. After repeated vomitus hypotensive dehydration developed and was adequately treated. Because of confusion, elevated white blood counts and signs of meningism, a spinal puncture was performed. Only the serology for Borrelia-IgG was positive, therefore the patient received Rocephin. During treatment only the ptosis persisted, therefore the substitution with sodium and the medication with Prednisone were stopped. Afterwards the symptoms reappeared and the laboratory results showed insufficiency of the pituitary. A magnetic resonance scan showed a microadenoma of the pituitary with local bleeding. Nine months after pituitary apoplexy, with hormonal substitution only a divergent strabism on the left side persisted. Clinical findings, course and therapy of pituitary apoplexy are discussed. PMID:9782750

  17. Anti-migraine action of triptans is preceded by transient aggravation of headache caused by activation of meningeal nociceptors.

    PubMed

    Burstein, Rami; Jakubowski, Moshe; Levy, Dan

    2005-05-01

    Consistent with previous accounts, some of the patients visiting our pain clinic during the course of a migraine attack have indicated-without solicitation-that sumatriptan injection initially intensified their headache before they were able to appreciate any pain relief. In this study, those patients who came forward complaining about pain exacerbation were asked to rate their headache intensity every 5 min. Within 5-15 min of sumatriptan injection, 17 of the 31 patients studied (55%) reported that their migraine pain intensified for 10-15 min before they started to notice any pain relief. Similar pattern of pain exacerbation was also observed in migraine attacks treated with oral formulation of almotriptan, eletriptan, rizatriptan, and zolmitriptan. To investigate the possible mechanism underlying this transient exacerbation of pain, we examined whether intravenous administration of sumatriptan can alter the response properties of C- and Adelta-meningeal nociceptors in the rat. Five to twenty minutes after intravenous administration of 300 microg/kg sumatriptan, 8/10 C-units and 2/8 Adelta-units increased their firing rate, and 6/10 C-units and 7/8 Adelta-units developed mechanical hyper-responsiveness to dural indentation. The minimal effective dose for activation and sensitization of meningeal nociceptors by sumatriptan was 3 microg/kg, suggesting that relatively low levels of triptans entering the circulation shortly after their administration can alter the physiological properties of meningeal nociceptors and produce a transient exacerbation of headache. PMID:15836966

  18. Cavernous Sinus Dural Fistula Treated by Transvenous Facial Vein Approach

    PubMed Central

    Prochazka, V.; Cizek, V.; Kacirova, R.

    2004-01-01

    Summary We report on the endovascular treatment of the spontaneous indirect dural carotid cavernous sinus type D fistula in a 60-year-old woman, in whom ipsilateral facial, angular and superior ophthalmic veins catheterization was performed to get access to the fistula site for embolization treatment. Approach via the facial vein is helpful after inferior petrosal sinus treatment failure. Although this technique requires caution in the angular vein region it allows a safe and effective treatment of these lesions. 3D rotational digital angiography can obtain more information of the angioarchitecture of the cavernous plexus and venous outflow for the catheter navigation. PMID:20587267

  19. Facial palsy following embolization of a dural arteriovenous fistula.

    PubMed

    Ozluoglu, Levent N; Koycu, A; Jafarov, S; Hizal, E; Boyvat, F

    2016-09-01

    Intracranial arteriovenous malformations are infrequent. Advances in endovascular treatment techniques have promoted the use of endovascular embolization in management of intracranial arteriovenous malformations. Transvenous or transarterial embolization procedures are effective options in the treatment of the arteriovenous fistulas. However, complications such as cranial nerve palsies may occur. Here, we present a case of right-sided lower motor neuron facial paralysis due to embolization of an intracranial dural arteriovenous fistula that have presented with clinical findings on the left eye. Facial functions of the patient improved from total weakness to House-Brackmann grade II, following facial nerve decompression surgery. PMID:26329900

  20. Tentorial dural arteriovenous fistula of the medial tentorial artery.

    PubMed

    Liu, Syrone; Lee, Dane C; Tanoura, Tad

    2016-09-01

    The medial tentorial artery arises from the meningohypophyseal trunk, a branch of the cavernous internal carotid artery, and it is poorly visualized on angiography in the absence of pathologically increased blood flow. We present the case of a 38-year-old man with intraventricular hemorrhage from a tentorial dural arteriovenous fistula (DAVF) singularly supplied by a robust medial tentorial artery. Tentorial DAVFs comprise a rare but high-risk subset of DAVFs. The diagnosis was suggested by computed tomography and magnetic resonance imaging findings and confirmed with digital subtraction angiography. PMID:27594958

  1. Endovascular Management of Anterior Cranial Fossa Dural Arteriovenous Malformations

    PubMed Central

    Mack, W.J; Gonzalez, N.R.; Jahan, R.; Vinuela, F.

    2011-01-01

    Summary Dural arteriovenous fistulas (dAVFs) of the anterior cranial fossa have traditionally been treated by open surgical disconnection. Safe navigation through the ophthalmic artery or fragile cortical veins has historically provided a barrier to effective endovascular occlusion of these lesions. Using current microcatheter technology and embolic materials, safe positioning within the distal ophthalmic artery, beyond the origin of the central retinal artery, is achievable. We describe two cases in which anterior cranial fossa dAVFs were treated by exclusively endovascular strategies, and highlight the pertinent technical and anatomic considerations. We discuss the clinical symptoms resulting from the differing venous drainage patterns. PMID:21561565

  2. Novalis Stereotactic Radiosurgery for Spinal Dural Arteriovenous Fistula

    PubMed Central

    Sung, Kyoung-Su; Song, Young-Jin

    2016-01-01

    The spinal dural arteriovenous fistula (SDAVF) is rare, presenting with progressive, insidious symptoms, and inducing spinal cord ischemia and myelopathy, resulting in severe neurological deficits. If physicians have accurate and enough information about vascular anatomy and hemodynamics, they achieve the good results though the surgery or endovascular embolization. However, when selective spinal angiography is unsuccessful due to neurological deficits, surgery and endovascular embolization might be failed because of inadequate information. We describe a patient with a history of vasospasm during spinal angiography, who was successfully treated by spinal stereotactic radiosurgery using Novalis system. PMID:27446527

  3. Rare dural arteriovenous fistula of the lesser sphenoid wing sinus.

    PubMed

    Khadavi, Nicole M; Mancini, Ronald; Nakra, Tanuj; Tsirbas, Angelo C; Douglas, Raymond S; Goldberg, Robert A; Duckwiler, Gary R

    2009-01-01

    A fistula of the lesser sphenoid wing sinus is a rare dural arteriovenous fistula resulting from a connection between the middle meningeal artery and recipient vein in the sinus of the lesser sphenoid wing. In this report, MRI/magnetic resonance angiography of a 54-year-old man who presented with sudden-onset glaucoma and proptosis revealed a fistula in this anatomic location. Drainage patterns here may account for the absence of serious complications and optimistic prognosis following embolization. Care in diagnosis is required to avoid superfluous procedures, because classic signs of the more common carotid-cavernous fistula are absent. PMID:19966661

  4. Medication-overuse headache: a review

    PubMed Central

    Kristoffersen, Espen Saxhaug; Lundqvist, Christofer

    2014-01-01

    Medication-overuse headache (MOH) is a worldwide health problem with a prevalence of 1%–2%. It is a severe form of headache where the patients often have a long history of headache and of unsuccessful treatments. MOH is characterized by chronic headache and overuse of different headache medications. Through the years, withdrawal of the overused medication has been recognized as the treatment of choice. However, currently, there is no clear consensus regarding the optimal strategy for management of MOH. Treatment approaches are based on expert opinion rather than scientific evidence. This review focuses on aspects of epidemiology, diagnosis, pathogenesis, prevention, and treatment of MOH. We suggest that information and education about the risk of MOH is important since the condition is preventable. Most patients experience reduction of headache days and intensity after successful treatment. The first step in the treatment of MOH should be carried out in primary care and focus primarily on withdrawal, leaving prophylactic medication to those who do not manage primary detoxification. For most patients, a general practitioner can perform the follow-up after detoxification. More complicated cases should be referred to neurologists and headache clinics. Patients suffering with MOH have much to gain by an earlier treatment-focused approach, since the condition is both preventable and treatable. PMID:25061336

  5. Direct access to the middle meningeal artery for embolization of complex dural arteriovenous fistula: a hybrid treatment approach

    PubMed Central

    Lin, Ning; Brouillard, Adam M; Mokin, Maxim; Natarajan, Sabareesh K; Snyder, Kenneth V; Levy, Elad I; Siddiqui, Adnan H

    2014-01-01

    Endovascular embolization has become increasingly favored over microsurgical resection for treatment of complex dural arteriovenous fistulas (DAVFs). However, endovascular treatment can be restricted by tortuous transarterial access and a transvenous approach is not always feasible. We present a Borden III DAVF treated by direct access to the middle meningeal artery (MMA) and Onyx embolization performed in a hybrid operating room–angiography suite. A middle-aged patient with pulsatile headaches was found to have left transverse sinus occlusion and DAVF with retrograde cortical venous drainage fed by multiple external carotid artery (ECA) feeders. Endovascular attempts via conventional transvenous and transarterial routes were unsuccessful, and the major MMA feeder was accessed directly after temporal craniotomy was performed under neuronavigation. Onyx embolization was performed; complete occlusion of the fistula was achieved. Three-month follow-up angiography showed no residual filling; the patient remains complication-free. A combined surgical–endovascular technique in a hybrid operating room–angiography suite can be an effective treatment for DAVFs complicated by inaccessible arterial and transvenous approaches. PMID:24903968

  6. Iatrogenic brainstem injury during cerebellomedullary cistern puncture.

    PubMed

    Luján Feliu-Pascual, Alejandro; Garosi, Laurent; Dennis, Ruth; Platt, Simon

    2008-01-01

    Cerebrospinal fluid collection is fundamental to the investigation of central nervous system disorders although it carries potential risks. Herein we report the clinical signs and magnetic resonance (MR) imaging findings associated with needle injury to the brainstem during cerebellomedullary cistern puncture in four dogs. Three dogs were nonambulatory tetraparetic with cranial nerve deficits and one dog had unexplained left thoracic limb paresis. In MR images, there were conspicuous T2 hyperintensities in the myelencephalon in all dogs. In T2* gradient echo images, the lesions were hypointense in two dogs with multiple cranial nerve deficits, and hyperintense in another dog. One dog was euthanized due to sudden neurologic deterioration 12 days later, one died shortly after MR imaging, and a third was euthanized due to concurrent cervical spondylomyelopathy. The fourth dog recovered gradually. Diagnosis was confirmed histopathologically in one dog and was presumptive based on clinical signs and MR findings in three dogs. None of the dogs with cranial nerve deficits recovered, only the one dog with left thoracic limb paresis and concurrent syringomyelia. PMID:18833957

  7. Lumbar puncture refusal in febrile convulsion.

    PubMed

    Ling, S G; Boey, C C

    2000-10-01

    A descriptive study was carried out on patients admitted for febrile convulsion over a two-year period to determine rate of lumbar puncture (LP) refusal, factors associated with LP refusal and outcome of such patients. From 77 patients indicated and requested for LP, 19 (25%) patients refused the procedure. Refusal of LP was significantly more common among the Malay ethnic group (p = 0.01) but not significantly associated with age,gender or whether the patient was admitted for a first or recurrent febrile convulsion. Half of the patients who refused LP had to be started empirically on antibiotics for meningitis. Patients who refused LP were also 8.5 times more likely to discharge themselves "at own risk" (AOR), compared to other patients with febrile convulsion (p = 0.004). In conclusion, LP refusal is a common problem in the local setting and is a hindrance to the proper management of patients with fever and seizure. Appropriate measures must be carried out to educate the public, particularly those from the Malay ethnic group on the safety and usefulness of the procedure. Reasons for patients discharging AOR following LP refusal also need to be addressed and problems rectified. PMID:11281439

  8. Websites offer helpful information concerning consultation with headache specialists.

    PubMed

    Imai, N; Yagi, N; Konishi, T; Serizawa, M; Kobari, M

    2010-04-01

    Patients with severe primary headache may benefit from consultation with headache specialists, but doctor attendance rates in Japan are very low. More headache patients might consult headache specialists if these specialists were more widely recognized by the public. To determine what information prompted patients to seek consultation with a headache specialist, we questioned 256 primary headache patients about the source of the helpful information concerning consultation with headache specialists. From 191 patients, a total of 235 responses to the questionnaire were obtained. The most common response was 'websites' (33.2%), followed by 'professionals' (23.8%), 'acquaintances' (20.9%), 'print media' (6.8%) and 'TV/radio' (3.4%). Patients who indicated websites showed the most severe pain and highest impact of headache, and accounted for 52.4% of those with cluster headaches. Development of websites concerning headache specialists would seem likely to increase doctor attendance rates for patients with primary headache. PMID:19515123

  9. Migraine headache and labor market outcomes.

    PubMed

    Rees, Daniel I; Sabia, Joseph J

    2015-06-01

    While migraine headache can be physically debilitating, no study has attempted to estimate its effects on labor market outcomes. Using data drawn from the National Longitudinal Study of Adolescent Health, we estimate the effect of being diagnosed with migraine headache on labor force participation, hours worked, and wages. Ordinary least squares (OLS) estimates suggest that migraines are associated with reduced labor force participation and lower wages among females. A negative association between migraine headache and the wages of female respondents is also obtained using an instrumental variables (IV) approach, although the IV estimates are imprecise relative to the OLS estimates. PMID:24711105

  10. Primary Headache Disorders: Focus on Migraine

    PubMed Central

    2011-01-01

    Migraine is the most common disabling headache disorder. Most patients with disabling tension-type headache are likely to have migraine and accordingly respond to treatments efficacious in migraine. Individuals are genetically predisposed to experiencing recurrent migraine. Evidence supports migraine to be a primarily neural and not vascular mediated disorder. 1–2% of the population have chronic daily headache associated with acute-relief medication overuse; the majority are migraineurs. The presence of acute-relief medication overuse renders preventative medication less adequately efficacious. PMID:26525886

  11. Foramen magnum dural arteriovenous fistula presenting with epilepsy.

    PubMed

    Pop, Raoul; Manisor, Monica; Aloraini, Ziad; Chibarro, Salvatore; Proust, Francois; Quenardelle, Véronique; Wolff, Valérie; Beaujeux, Rémy

    2015-12-01

    Intracranial dural arteriovenous fistulas (dAVFs) with perimedullary drainage represent a rare subtype of intracranial dAVF. Patients usually experience slowly progressive ascending myelopathy and/or lower brainstem signs. We present a case of foramen magnum dural arteriovenous fistula with an atypical clinical presentation. The patient initially presented with a generalised tonic-clonic seizure and no signs of myelopathy, followed one month later by rapidly progressive tetraplegia and respiratory insufficiency. The venous drainage of the fistula was directed both to the left temporal lobe and to the perimedullary veins (type III + V), causing venous congestion and oedema in these areas and explaining this unusual combination of symptoms. Rotational angiography and overlays with magnetic resonance imaging volumes were helpful in delineating the complex anatomy of the fistula. After endovascular embolisation, there was complete remission of venous congestion on imaging and significant clinical improvement. To our knowledge, this is the first report of a craniocervical junction fistula presenting with epilepsy. PMID:26472637

  12. Lumbar puncture in patients using anticoagulants and antiplatelet agents.

    PubMed

    Domingues, Renan; Bruniera, Gustavo; Brunale, Fernando; Mangueira, Cristóvão; Senne, Carlos

    2016-08-01

    The use of anticoagulants and antiplatelet agents has largely increased. Diagnostic lumbar puncture in patients taking these drugs represents a challenge considering the opposing risks of bleeding and thrombotic complications. To date there are no controlled trials, specific guidelines, nor clear recommendations in this area. In the present review we make some recommendations about lumbar puncture in patients using these drugs. Our recommendations take into consideration the pharmacology of these drugs, the thrombotic risk according to the underlying disease, and the urgency in cerebrospinal fluid analysis. Evaluating such information and a rigorous monitoring of neurological symptoms after lumbar puncture are crucial to minimize the risk of hemorrhage associated neurological deficits. An individualized patient decision-making and an effective communication between the assistant physician and the responsible for conducting the lumbar puncture are essential to minimize potential risks. PMID:27556380

  13. Evolving a Puncture Black Hole with Fixed Mesh Refinement

    NASA Technical Reports Server (NTRS)

    Imbiriba, Breno; Baker, John; Choi, Dae-II; Centrella, Joan; Fiske. David R.; Brown, J. David; vanMeter, James R.; Olson, Kevin

    2004-01-01

    We present a detailed study of the effects of mesh refinement boundaries on the convergence and stability of simulations of black hole spacetimes. We find no technical problems. In our applications of this technique to the evolution of puncture initial data, we demonstrate that it is possible to simulaneously maintain second order convergence near the puncture and extend the outer boundary beyond 100M, thereby approaching the asymptotically flat region in which boundary condition problems are less difficult.

  14. The pipeline in headache therapy.

    PubMed

    Vollbracht, Sarah; Rapoport, Alan M

    2013-09-01

    Migraine is a common, disabling, neurovascular disorder characterized by episodic attacks of head pain and associated disability plus systemic autonomic and neurologic symptoms. The advent of the triptan class of medication in the 1990s revolutionized the acute treatment of migraine, but many migraineurs do not respond optimally or at all to triptans, have intolerable adverse effects, or have contraindications to their use. Preventive pharmacotherapy has advanced mostly through serendipity, with new drugs being found effective while being used for other indications. There remains a significant need for new medications and devices that can provide effective, rapid, and sustained pain relief without adverse effects or recurrence. Several new acute and preventive therapies for the treatment of migraine and cluster headaches have shown promise and are currently under investigation. This article covers innovative delivery mechanisms, calcitonin gene-related peptide receptor antagonists, antibodies to calcitonin gene-related peptide and its receptor, 5-HT1F receptor agonists, transient receptor potential vanilloid receptor modulators, orexin receptor antagonists, glial cell modulators, and neurostimulation. PMID:23839594

  15. The novel anti-migraine agent rizatriptan inhibits neurogenic dural vasodilation and extravasation.

    PubMed

    Williamson, D J; Shepheard, S L; Hill, R G; Hargreaves, R J

    1997-06-01

    These studies in anaesthetised rats showed, using intravital microscopy, that the novel anti-migraine agent, rizatriptan, significantly reduced electrically stimulated dural vasodilation but had no effect on increases in dural vessel diameter produced by exogenous substance P or calcitonin gene-related peptide (CGRP). Rizatriptan also significantly inhibited dural plasma protein extravasation produced by high intensity electrical stimulation of the trigeminal ganglion. We suggest that rizatriptan inhibits the release of sensory neuropeptides from perivascular trigeminal nerves to prevent neurogenic vasodilation and extravasation in the dura mater. These prejunctional inhibitory effects may be involved in the anti-migraine action of rizatriptan. PMID:9203569

  16. Response of cotton squares to various boll weevil oviposition puncture types

    Technology Transfer Automated Retrieval System (TEKTRAN)

    In an earlier laboratory study, estimates for boll weevil oviposition in unsealed punctures, punctures sealed with frass (frass-sealed), punctures sealed with a wax film (wax-sealed), and punctures sealed with a wax film plus frass (wax-sealed plus frass) were determined. However, the traditional p...

  17. What Are Nerve Blocks for Headache?

    MedlinePlus

    ... at the Montefiore Headache Center, Department of Neurology, Albert Einstein College of Medicine, Bronx, NY. Matthew S. Robbins, MD, ... is an assistant professor of neurology at the Albert Einstein College of Medicine, and the current chair of ...

  18. Neurostimulation for neck pain and headache.

    PubMed

    Hong, Jennifer; Ball, Perry A; Fanciullo, Gilbert J

    2014-03-01

    Patients with medically refractory headache disorders are a rare and challenging-to-treat group. The introduction of peripheral neurostimulation (PNS) has offered a new avenue of treatment for patients who are appropriate surgical candidates. The utility of PNS for headache management is actively debated. Preliminary reports suggested that 60-80% of patients with chronic headache who have failed maximum medical therapy respond to PNS. However, complications rates for PNS are high. Recent publication of 2 large randomized clinical trials with conflicting results has underscored the need for further research and careful patient counseling. In this review, we summarize the current evidence for PNS in treatment of chronic migraine, trigeminal autonomic cephalagias and occipital neuralgia, and other secondary headache disorders. PMID:24527699

  19. Cerebral venous sinus thrombosis and dural arteriovenous fistula in a 75-year-old man primarily presenting with repeated transient visual obscurations.

    PubMed

    Sato, Takeo; Matsuno, Hiromasa; Omoto, Shusaku; Sakuta, Kenichi; Terasawa, Yuka; Iguchi, Yasuyuki

    2016-04-28

    A 75-year-old man was admitted to our hospital because of repeated transient visual obscurations of greying vision. The transient visual obscurations were caused by rotating his neck or the Valsalva manoeuver, and they recovered in about 30 seconds. A few weeks later, pulsatile tinnitus of the right ear and a dull headache developed. Both ocular fundi showed papilledema, and there was significant intracranial hypertension on cerebrospinal fluid examination. He was diagnosed as having right sigmoid sinus thrombosis and a dural arteriovenous fistula with a rapid arteriovenous shunt from the right ascending pharyngeal artery and the right occipital artery to the right transverse sinus. Anticoagulant therapy was started, and coil embolization was performed. The transient visual obscurations, headache, and tinnitus improved dramatically after the procedure. We hypothesized that the transient visual obscurations were triggered by rotating the neck or performing the Valsalva manoeuver as they both increase the pressure of cerebrospinal fluid, inducing transient optic nerve ischemia and visual obscurations under mild intracranial hypertension. Transient visual obscurations are an important initial symptom of intracranial hypertension. PMID:27010097

  20. Regional cerebral blood flow in childhood headache

    SciTech Connect

    Roach, E.S.; Stump, D.A.

    1989-06-01

    Regional cerebral blood flow (rCBF) was measured in 16 cranial regions in 23 children and adolescents with frequent headaches using the non-invasive Xenon-133 inhalation technique. Blood flow response to 5% carbon dioxide (CO2) was also determined in 21 patients, while response to 50% oxygen was measured in the two patients with hemoglobinopathy. Included were 10 patients with a clinical diagnosis of migraine, 4 with musculoskeletal headaches, and 3 with features of both types. Also studied were 2 patients with primary thrombocythemia, 2 patients with hemoglobinopathy and headaches, 1 patient with polycythemia, and 1 with headaches following trauma. With two exceptions, rCBF determinations were done during an asymptomatic period. Baseline rCBF values tended to be higher in these young patients than in young adults done in our laboratory. Localized reduction in the expected blood flow surge after CO2 inhalation, most often noted posteriorly, was seen in 8 of the 13 vascular headaches, but in none of the musculoskeletal headache group. Both patients with primary thrombocythemia had normal baseline flow values and altered responsiveness to CO2 similar to that seen in migraineurs; thus, the frequently reported headache and transient neurologic signs with primary thrombocythemia are probably not due to microvascular obstruction as previously suggested. These data support the concept of pediatric migraine as a disorder of vasomotor function and also add to our knowledge of normal rCBF values in younger patients. Demonstration of altered vasomotor reactivity to CO2 could prove helpful in children whose headache is atypical.

  1. Stabbing headache in an 8-year-old girl: primary or drug induced headache?

    PubMed

    Biedroł, Agnieszka; Kaciłski, Marek; Skowronek-Bała, Barbara

    2014-04-01

    The occurrence of stabbing headaches in children requires a thorough diagnostic approach that excludes secondary headaches. The organic background should be taken into consideration when alarming symptoms occur, such as a purely 1-sided location, a change in the character of the headache, or possibly a link to physical activity. The current study describes the case of an 8-year-old girl who suffered short-lasting stabbing headache attacks. The headaches with increasing intensity and frequency started 1 month before her hospitalization and were usually preceded by physical activity (dancing, running). The pain, which was located in the right supraorbital region, lasted 1 second and occurred several times during the day. No associated symptoms were observed. In addition, the girl suffered from allergic rhinitis and was on antiallergic treatment (levocetirizine, fluticasone nasal spray). On admission she was in good general condition, and a pediatric and neurologic examination revealed no abnormalities. Her brain MRI was normal. The initial diagnosis was that the patient was suffering from primary stabbing headaches. However, during a follow-up visit 4 months later, a relationship was observed between the cessation of the headache attacks and the discontinuation of an antihistaminic drug. Six months later, the girl remained headache free. In cases involving differential diagnoses of stabbing headaches, it is important to consider the adverse reactions of the drugs used. PMID:24664098

  2. Weekly headache periodicity and the effect of weather changes on headache

    NASA Astrophysics Data System (ADS)

    Osterman, P. O.; Lövstrand, K. G.; Lundberg, P. O.; Lundquist, S.; Muhr, C.

    1981-03-01

    A weekly periodicity in the occurrence of headache was found in 53 patients with migraine and in 20 with tension headache during an observation period of four weeks. In the migraine group the frequency was highest on Thursday and on Saturday and lowest on Sunday Monday, and in patients with tension headache it was lowest on Sunday Tuesday and highest on Friday. During the observation period several climatic factors were recorded. After correction for the weekly periodicity a highly significant correlation was found in the migraine group between headache frequency, on the one hand, and atmospheric pressure and outdoor temperature recorded 1 3 days later, on the other.

  3. Diagnosis and management of migraine headaches.

    PubMed

    Lawrence, Elizabeth C

    2004-11-01

    Migraine headaches afflict approximately 6% of men and 18% of women in the United States, and cost billions of dollars each year in lost productivity, absenteeism, and direct medical expendi tures. Despite its prevalence and the availability of therapeutic op tions, many patients do not seek treatment, and among those who do, a significant portion are misdiagnosed. Correct diagnosis can be made by identifying the historic and physical examination finding that distinguish primary headache disorders from secondary head ache disorders, as well as the key clinical features that distinguis migraine headaches from other types. Once diagnosis is made, im proper or inadequate management of headache pain, related symp toms such as nausea, and the possible aggravating side-effects of pharmacologic therapies represent further obstacles to effective ther apy. Dissatisfaction with migraine therapy on the basis of these factors is common. Among abortive therapy options there are de livery methods available which may avoid aggravating symptom such as nausea. Recommended pharmacologic agents include non steroidal anti-inflammatory drugs, intranasal butorphanol, ergota mine and its derivatives, and the triptans. Indications for prophylac tic in addition to abortive therapy include the occurrence o headaches that require abortive therapy more than twice a week, tha do not respond well to abortive therapy, and which are particularly severe. Research is ongoing in the pathophysiology of migraines evaluation of nonpharmacologic treatment modalities, assessment of new drug therapies, and validation of headache guidelines. PMID:15586597

  4. Sphenopalatine Ganglion Stimulation in Neurovascular Headaches.

    PubMed

    Schoenen, Jean

    2015-01-01

    The interest for the sphenopalatine ganglion (SPG) in neurovascular headaches dates back to 1908 when Sluder presented his work on the role of the SPG in 'nasal headaches', which are now part of the trigeminal autonomic cephalalgias and cluster headache (ICHD-III-beta). Since then various interventions with blocking or lesional properties have targeted the SPG (transnasal injection of lidocaine and other agents, alcohol or steroid injections, radiofrequency lesions, or even ganglionectomy); success rates vary, but benefit is usually transient. Here we briefly review some anatomophysiological characteristics of the SPG and hypotheses about its pathophysiological role in neurovascular headaches before describing recent therapeutic results obtained with electrical stimulation of the SPG. Based on results of a prospective randomized controlled study, SPG stimulation appears to be an effective treatment option for patients with chronic cluster headaches; efficacy data indicate that acute electrical stimulation of the SPG provides significant attack pain relief and in many cases pain freedom compared to sham stimulation. Moreover, in some patients SPG stimulation has been associated with a significant and clinically meaningful reduction in cluster headache attack frequency; this preventive effect of SPG stimulation warrants further investigation. For migraine attacks, the outcome of a proof-of-concept study using a temporary electrode implanted in the pterygopalatine fossa was less encouraging; however, an ongoing multicenter trial is evaluating the efficacy of long-term SPG stimulation against sham stimulation for acute and preventive treatment in patients with frequent migraine. PMID:26394372

  5. Fasting headache, weight loss, and dehydration.

    PubMed

    Mosek, A; Korczyn, A D

    1999-03-01

    Recently, we showed that fasting is a strong headache precipitator unrelated to coffee, tea, or smoking withdrawal or to oversleeping. In the current study, we evaluated the role of dehydration as a possible precipitator of fasting headache. The effects of a 25-hour fast of the Jewish Yom Kippur (Day of Atonement) were studied in women who participated in our previous Yom Kippur study. We asked the subjects to weigh themselves at the beginning and at the end of the Yom Kippur fast, assuming that the weight loss would largely reflect dehydration. In all but 1 of the 56 participants, the fast resulted in weight loss but only 28 (50%) reported headache. The average weight loss was 1.4 +/- 0.8 kg in those who developed headache and 1.2 +/- 0.5 kg in those who did not. This small difference was not statistically significant. We conclude that dehydration, as reflected by acute weight loss, is an unlikely cause of headache during a single day of fasting. The mechanism of fasting headache remains unclear. PMID:15613218

  6. Functioning of Women with Migraine Headaches

    PubMed Central

    Zgorzalewicz-Stachowiak, Małgorzata; Czajkowska, Agrypina; Hudaś, Karolina

    2014-01-01

    Background. Migraines are one of the most commonly occurring ailments affecting the nervous system. The aim of this research paper was to evaluate the effect migraines have on the everyday functioning of women. Method. The study involved women with diagnosed migraine headaches (IHS-2004) undergoing treatment at a neurological clinic. In order to evaluate the influence of headaches on the everyday functioning of women, a MSQ v.2 questionnaire was used, whereas pain severity was assessed on a linear VAS scale. Results. Among the clinical factors, the most influential was the frequency of headaches. Headache duration was particularly significant for women below the age of 40. Pain severity cited at 8–10 pts on the VAS significantly disrupted and limited everyday functioning. On the emotional function subscale, the most influential factors were age, education, and the frequency of headaches. Conclusions. On account of headache frequency emerging as the most significant influencing factor, it is of the utmost importance to inform patients of the value of taking prophylactic measures. Central to this is the identification of factors that trigger the onset of migraines. This approach would greatly aid the individual in choosing the appropriate treatment, either pharmacological or others. PMID:25133238

  7. [Pharmacotherapy of headache apart from self-medication].

    PubMed

    Evers, Stefan

    2015-11-01

    The pharmacotherapy of headache differentiates between self-medication and prescribed medication. Furthermore, pharmacotherapy has to consider the different headache disorders. In this article, the evidence-based treatment recommendations of the German Migraine and Headache Society for the different idiopathic headache disorders including trigeminal neuralgia are described. In addition, for most headache disorders acute and preventive medication has to be differentiated. It has to be noted that acute mediation against headache should not be taken too frequently and that in chronic headache disorders most often only a multimodal treatment results in a sufficient pain reduction. PMID:26742211

  8. A Practical Approach to Autonomic Dysfunction in Patients with Headache.

    PubMed

    Ailani, Jessica

    2016-05-01

    The presence of autonomic symptoms can make the diagnosis of headache challenging. While commonly seen with the trigeminal autonomic cephalalgias, autonomic dysfunction can also be present in patients with migraine, or with a variety of secondary headaches. The pathophysiology of cranial autonomic symptoms in headache is based between the trigeminal system and the hypothalamus. This article will review the pathophysiology and presence of autonomic dysfunction in headache and will provide techniques to help in headache diagnosis in patients with autonomic dysfunction. PMID:27021770

  9. Headache and Chiari I Malformation in Children and Adolescents.

    PubMed

    Victorio, M Cristina; Khoury, Chaouki K

    2016-02-01

    Headache is a common problem in children and adolescents. Its recurrent and disabling nature may lead to use of neuroimaging to exclude secondary causes of headache such as Chiari I malformation (CM I). CM I has a variety of presentation with headache being the most common symptom. CM I can be asymptomatic and is also often found incidentally in neuroimaging done for conditions other than headache. This article reviews the spectrum of headache in patients with CM I. PMID:27017020

  10. [Relationship between lupus headache and headache due to internal injury in traditional Chinese medicine].

    PubMed

    Shen, Si-yu; Fu, Xiao-dong; Zhang, Yong-wen; Dong, Xiao-lei; Zhao, Ling-jie; Cai, Hui

    2009-05-01

    In 1999, the nomenclature and case definitions for neuropsychiatric lupus syndromes were published by American College of Rheumatology (ACR), and the cognition of neuropsychiatric damage of systemic lupus erythematosus (SLE) was gradually unified and standardized. Lupus headache is an intractable problem in SLE, especially in SLE patients complicated with multiple organ injury. In general, vascular headache is common in most SLE patients, and a small number of SLE patients complicated with nervous headache are found in clinic. Moreover, its pathophysiological mechanism is far from being understood. Although early diagnosis is essential for good outcomes, the diagnosis method is rather confused in the world. There still exist some limitations in the proposal of clinical classification of headache from ACR and International Headache Society (IHS), and the proposal does not mention the classification of headache related to psychiatric damage. Current therapeutic regimens are almost exclusively based on empirical evidence. Treatment approaches include symptomatic treatment, immunosuppressive, anticoagulant and anti-aggregant therapies. It provides enormous and hopeful space in research of combined therapy strategy, especially in the field of traditional Chinese medicine. The authors discussed the relationship between lupus headache and headache due to internal injury in the view of integrated traditional Chinese and Western medicine, and suggested that the treatment strategy for lupus headache should be made in argument with the headache due to internal injury. Syndrome differentiation treatment according to deficiency in the root and excess in the branch and the therapy for activating blood to dredge collaterals maybe have great advantages in treatment of the headache in SLE. PMID:19435552