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Sample records for dural puncture headache

  1. Prevention of post-dural puncture headache in parturients: a systematic review and meta-analysis.

    PubMed

    Bradbury, C L; Singh, S I; Badder, S R; Wakely, L J; Jones, P M

    2013-04-01

    Post-dural puncture headaches (PDPHs) present an important clinical problem. We assessed methods to decrease accidental dural punctures (ADPs) and interventions to reduce PDPH following ADP. Multiple electronic databases were searched for randomised clinical trials (RCTs) of parturients having labour epidurals, in which the studied intervention could plausibly affect ADP or PDPH, and the incidence of at least one of these was recorded. Forty RCTs (n = 11,536 epidural insertions) were included, studying combined spinal-epidurals (CSEs), loss of resistance medium, prophylactic epidural blood patches, needle bevel orientation, ultrasound-guided insertion, epidural morphine, Special Sprotte needles, acoustic-guided insertion, administration of cosyntropin, and continuous spinal analgesia. The RCTs for CSE, loss of resistance medium, and prophylactic epidural blood patches were meta-analysed. Five methods reduced PDPH: prophylactic epidural blood patch {four trials, median quality score = 2, risk difference = -0.48 [95% confidence interval (CI): -0.88 to -0.086]}, lateral positioning of the epidural needle bevel upon insertion (one trial, quality score = 1), Special Sprotte needles [one trial, quality score = 5, risk difference = -0.44 (95% CI: -0.67 to -0.21)], epidural morphine [one trial, quality score = 4, risk difference = -0.36 (95% CI -0.59 to -0.13)], and cosyntropin [one trial, quality score = 5, risk difference = -0.36 (95% CI -0.55 to -0.16)]. Several methods potentially reduce PDPH. Special Sprotte needles, epidural morphine, and cosyntropin are thus far each supported by a single, albeit good quality trial. Prophylactic blood patches are supported by three trials, but these had flawed methodology. Mostly, trials were of limited quality, and further well-conducted, large studies are needed.

  2. [Severe and prolonged post-dural puncture headache: from pathological basis to therapeutic role and correct timing for epidural blood patch].

    PubMed

    Wetzl, R G; Taglione, G; Ceresa, F; D'Agostino, R; Foresta, S; Guarnerio, C; Ladiana, N; Megaro, F; Zanesi, R; De Vietro, A; Pavani, M

    2001-09-01

    Believed to be due to unbalance between cerebrospinal fluid (CSF) production rate and its loss through the spinal dural puncture hole, post-dural puncture headache (PDPH) is often considered as a physiological syndrome, usually reversible without pathological sequelae after dural hole's closure. The clinical case here presented (incapacitating headache associated with diagnostic dural puncture in a leukaemic young female patient who underwent bone marrow transplantation) shows potentially fatal pathological sequelae following prolonged headache (untreated, due to the severe postransplant immunodeficiency and coagulopathy). The observed RMI lesions suggest interesting conclusions about the clinical indications and correct timing of autologous epidural blood patch (EBP). We also suggest the ways to preventing rebound intracranial hypertension following autologous epidural blood patch in patients suffering from incapacitating and prolonged headache.

  3. Timing of neuraxial pain interventions following blood patch for post dural puncture headache.

    PubMed

    Shaparin, Naum; Gritsenko, Karina; Shapiro, David; Kosharskyy, Boleslav; Kaye, Alan D; Smith, Howard S

    2014-01-01

    Post dural puncture headache (PDPH) is a common complication of interventional neuraxial procedures. Larger needle gauge, younger patients, low body mass index, women (especially pregnant women), and "traumatic" needle types are all associated with a higher incidence of PDPH. Currently, an epidural blood patch is the gold-standard treatment for this complication. However, despite the high PDPH cure rate through the use of this therapy, little is known about the physiology behind the success of the epidural blood patch, specifically, the time course of patch formation within the epidural space or how long it takes for the blood patch volume to be resorbed by the body. Of the many unanswered and debated topics related to PDPH and epidural blood patches, one additional specific question that may alter clinical management is when it is safe for patients who have experienced a disruption of the thecal space and have undergone this procedure to have a subsequent epidural or spinal procedure, such as a neuraxial anesthetic (i.e. a spinal anesthetic for an elective outpatient procedure) or an interventional pain procedure for chronic pain management. This question becomes more unclear if the new procedure includes a steroid medication. As an example, an older patient presents with a history of lumbar disc disease and during lumbar epidural steroid injection, an inadvertent wet tap occurs leading to PDPH. Following management with fluids, caffeine, medications, and a successful epidural blood patch, it remains unclear as to when would be the best time frame to consider a second lumbar epidural steroid injection. We identified the 3 main risk factors of subsequent interventional neuraxial procedures as (1) disruption of the epidural blood patch and ongoing reparative processes, (2) epidural procedure failure, and (3) infection. We looked at the literature, and summarized the existing literature in order to enable health care professionals to understand the time course of

  4. Recurrent psychogenic paresis after dural puncture in a parturient.

    PubMed

    Nguyen, J; Abola, R; Schabel, J

    2013-04-01

    We describe the case of a 29-year-old parturient who, after undergoing elective cesarean delivery, displayed symptoms of lower extremity weakness and sensory deficit. Her past medical history was significant for asymptomatic Arnold Chiari Type I malformation and asthma. She had received spinal anesthesia that failed to achieve an adequate surgical level requiring conversion to general anesthesia. After tracheal extubation, she exhibited bilateral leg weakness that did not resolve over the next 4-6h. An urgent magnetic resonance imaging scan revealed a normal spine with no evidence of hematoma. The lower extremity paresis persisted and a neurologist diagnosed psychogenic paresis, a type of conversion disorder. Interestingly, the patient's postoperative leg paresis was not her first occurrence of neurological dysfunction after dural puncture. At 27 weeks of gestation, she had similar lower extremity symptoms after a lumbar puncture, performed to exclude meningitis for severe headache symptoms. Psychogenic paresis is not commonly reported in the medical literature and we found no reports of psychogenic paresis after spinal anesthesia in a parturient or recurrent psychogenic paresis. We review the various risk factors, etiology, neurological signs and symptoms, types, therapy and future management of a patient with recurrent conversion disorder. PMID:23474280

  5. [Accidental dural puncture during epidural injection of corticosteroids: a different approach?].

    PubMed

    Galindo Palazuelos, M; González Fernández, I; Fernández Abascal, A; Díaz Setién, N; Manso Marín, F J; Castro Ugalde, A

    2006-04-01

    We report 6 cases diagnosed with accidental dural puncture after epidural injection of corticosteroids for low back pain. All the patients reported postdural puncture headache during their stay in the postanesthetic recovery unit. For 3 patients, pain resolved with treatment given in the recovery unit. Two other patients also required mild analgesics for 1 week. In the last patient, a blood patch was used to treat incapacitating headache 22 days after the epidural procedure and mild analgesics were needed for 4 more weeks. It is important to establish a protocol for treating postdural puncture headache in pain clinics to facilitate decision making. Good physician-patient communication is necessary to avoid refusals for permission for other epidural techniques and to facilitate management of symptoms.

  6. [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.

  7. A rational approach to the cause, prevention and treatment of postdural puncture headache.

    PubMed Central

    Morewood, G H

    1993-01-01

    OBJECTIVE: To review the current research and formulate a rational approach to the cause, prevention and treatment of postdural puncture headache (PDPH). DATA SOURCES: Articles published from January 1980 to April 1992 were obtained through a search of MEDLINE and Index Medicus. Key reference articles published before 1980 were also reviewed. STUDY SELECTION: All pertinent studies were included and critically analysed. DATA SYNTHESIS: PDPH occurs when a slow leak of cerebrospinal fluid leads to contraction of the subarachnoid space and compensatory expansion of the pain-sensitive intracerebral veins. Female sex and an age between 20 and 40 years have been shown to be independent risk factors for PDPH, but pregnancy has not. The rate of PDPH is directly proportional to the diameter of the needle used and also depends on the design of the needle tip. Prophylactic epidural blood patching or saline infusion after dural puncture can decrease the incidence of PDPH, but both are invasive procedures. Intravenous caffeine sodium benzoate therapy effectively relieves PDPH, but the headache may recur. An epidural blood patch is an invasive but effective, permanent treatment for PDPH in most cases; resistant cases may respond to epidural saline infusion. CONCLUSION: The rate of PDPH after lumbar puncture can be minimized through strict attention to technique and the employment of a 25-gauge needle with the bevel parallel to the dural fibres. A reliable diagnosis and stepwise approach to treatment will minimize complications. PMID:8221447

  8. Post-Lumbar Puncture Headache Etiology and Management

    PubMed Central

    Raymond, John R.; Raymond, Patrick A.

    1988-01-01

    Headache following a lumbar puncture is a common and often debilitating syndrome. Continued leakage of cerebrospinal fluid from a puncture site decreases intracranial pressure, which leads to traction on pain-sensitive intracranial structures. The headache is characteristically postural, often associated with nausea and optic, vestibular, or otic symptoms. Although usually self-limited after a few days, severe postural pain can incapacitate the patient. Management is mainly symptomatic, but definitive treatment with the epidural blood patching technique is safe and effective when done by an expert operator. PMID:3176458

  9. 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

  10. Transcranial direct middle meningeal artery puncture for the onyx embolization of dural arteriovenous fistula involving the superior sagittal sinus.

    PubMed

    Oh, Jae-Sang; Yoon, Seok-Mann; Shim, Jai-Joon; Bae, Hack-Gun

    2015-01-01

    A 66-year-old woman presented with intermittent paraparesis and generalized tonic-clonic seizure. Cerebral angiography demonstrated dural arteriovenous fistula (AVF) involving superior sagittal sinus (SSS), which was associated with SSS occlusion on the posterior one third. The dural AVF was fed by bilateral middle meningeal arteries (MMAs), superficial temporal arteries (STAs) and occipital arteries with marked retrograde cortical venous reflux. Transfemoral arterial Onyx embolization was performed through right MMA and STA, but it was not successful, which resulted in partial obliteration of dural AVF because of tortuous MMA preventing the microcatheter from reaching the fistula closely enough. Second procedure was performed through left MMA accessed by direct MMA puncture following small decortications of cranium overlying the MMA using diamond drill one week later. Microcatheter could be located far distally to the fistula through 5 F sheath placed into the MMA and complete obliteration of dural AVF was achieved using 3.9 cc of Onyx.

  11. [Accidental Dural Puncture and Post-dural Puncture Headache in the Obstetric Population: Eight Years of Experience].

    PubMed

    Antunes, Maria Vaz; Moreira, Adriano; Sampaio, Catarina; Faria, Aida

    2016-04-01

    Introdução: A punção acidental da dura é uma importante complicação da anestesia regional e a cefaleia pós-punção continua a ser causa de morbilidade na população obstétrica. O objetivo do nosso estudo foi calcular a incidência de punção acidental e cefaleia pós-punção no nosso Centro Hospitalar e avaliar a sua abordagem entre os anestesiologistas obstétricos. Material e Métodos: Realizámos uma auditoria retrospetiva, entre janeiro de 2007 e dezembro de 2014. Revimos as folhas de registo das doentes em que ocorreu punção inadvertida da dura ou cefaleia pós-punção. Excluímos as doentes submetidas a bloqueio subaracnoideu. Utilizámos o SPSS 22.0 no tratamento estatístico dos dados. Resultados: Obtivémos 18 497 bloqueios neuro-axiais e 58 punções acidentais da dura (0,3%). Após punção detetada, em 71,4% o cateter epidural foi re-posicionado e 21,4% tiveram cateteres intra-tecais. Quarenta e cinco (77,6%) desenvolveram cefaleia e a instituição de medidas profiláticas ocorreu em 76,1%. O tratamento conservador foi efetuado em todas as doentes. O blood patch epidural foi realizado em 32,8% com um sucesso de 84,2%. Discussão: A incidência de cefaleia pós-punção não está relacionada com o tipo de parto ou a inserção do cateter intra-tecal. A re-colocação do cateter epidural mantém-se a abordagem de eleição após punção. A instituição de medidas profiláticas é uma prática comum, apesar do baixo grau de eficácia. Realizámos blood patch epidural após falência do tratamento conservador. Conclusão: A incidência de punção inadvertida e cefaleia pós-punção foi semelhante à da literatura. Apesar de ser uma complicação comum, existe falta de consenso na sua abordagem.

  12. 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

  13. Epidural analgesia complicated by dural ectasia in the Marfan syndrome

    PubMed Central

    Gray, Chelsea; Hofkamp, Michael P.; Noonan, Patrick T.; McAllister, Russell K.; Pilkinton, Kimberly A.; Diao, Zhiying

    2016-01-01

    Patients with the Marfan syndrome are considered to be high risk during pregnancy and warrant a complete multidisciplinary evaluation. One goal is to minimize hemodynamic fluctuations during labor since hypertensive episodes may result in aortic dissection or rupture. Although they may prevent these complications, neuraxial techniques may be complicated by dural ectasia. The case of a parturient with the Marfan syndrome and mild dural ectasia is presented. During attempted labor epidural placement, unintentional dural puncture occurred. A spinal catheter was used for adequate labor analgesia, and a resultant postdural puncture headache was alleviated by an epidural blood patch under fluoroscopic guidance.

  14. Epidural analgesia complicated by dural ectasia in the Marfan syndrome

    PubMed Central

    Gray, Chelsea; Hofkamp, Michael P.; Noonan, Patrick T.; McAllister, Russell K.; Pilkinton, Kimberly A.; Diao, Zhiying

    2016-01-01

    Patients with the Marfan syndrome are considered to be high risk during pregnancy and warrant a complete multidisciplinary evaluation. One goal is to minimize hemodynamic fluctuations during labor since hypertensive episodes may result in aortic dissection or rupture. Although they may prevent these complications, neuraxial techniques may be complicated by dural ectasia. The case of a parturient with the Marfan syndrome and mild dural ectasia is presented. During attempted labor epidural placement, unintentional dural puncture occurred. A spinal catheter was used for adequate labor analgesia, and a resultant postdural puncture headache was alleviated by an epidural blood patch under fluoroscopic guidance. PMID:27695168

  15. Diagnosing and managing peripartum headache

    PubMed Central

    Wang, Jia; Gelpi, Brian; Wortman, Alison; Tao, Weike

    2015-01-01

    A 38-year-old gravida 7 para 5 Hispanic woman at 36 weeks and 4 days gestation presented with a postpartum headache following vaginal delivery complicated by an unintentional dural puncture for epidural analgesia. Due to the positional nature of the headache and its frontal and occipital origin, a postdural puncture headache was diagnosed. After failure of conservative treatment, an epidural blood patch was used, which offered immediate relief. However, shortly following the procedure, the parturient's neurological condition deteriorated due to an unrecognized intraparenchymal and subarachnoid hemorrhage requiring an emergent craniectomy. This case highlights the importance of diligence when evaluating and treating postpartum headache despite a classic presentation. PMID:26424942

  16. 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

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

    PubMed

    Chang, Alexandra; Acquah, Joseph; Reddy, Sanjay; Chao, Maria T

    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.

  18. Prevention of postdural puncture headache after spinal anaesthesia for extracorporeal shockwave lithotripsy. An assessment of prophylactic epidural blood patching.

    PubMed

    Sengupta, P; Bagley, G; Lim, M

    1989-01-01

    The prevention of postdural puncture headache after spinal anaesthesia for extracorporeal shockwave lithotripsy was investigated by a controlled clinical trial which compared epidural injection of 10 ml of autologous blood with 10 ml of normal saline immediately after intrathecal injection of local anaesthetic. The incidence of postdural puncture headache was 8.3% in the group that received blood compared with 45% in the group that received saline, a significant reduction (p less than 0.01). The incidences of backache and lower limb paraesthesiae were similar in both groups. No serious complications were reported.

  19. Chronic headache relief after section of suboccipital muscle dural connections: a case report.

    PubMed

    Hack, Gary D; Hallgren, Richard C

    2004-01-01

    The presence of a connective tissue bridge, attaching suboccipital muscles to the dura mater, is now recognized as a feature of normal human anatomy. The role that this myodural bridge may play in headache production is uncertain; however, a new conceptual model is emerging. Postsurgical myodural adhesions have been reported as a complication resulting from excision of acoustic tumors. Extensive research now exists implicating these myodural adhesions as a possible source of postoperative headache. Integrating these 2 types of myodural unions (anatomic and pathologic) into a unified theory of headache production, we report a single patient who experienced relief from chronic headache after surgical separation of the myodural bridge from the suboccipital musculature.

  20. [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.

  1. 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 ...

  2. Headache

    MedlinePlus

    ... The most common type of headache is a tension headache. Tension headaches are due to tight muscles in your ... or anxiety. You are more likely to get tension headaches if you work too much, don't ...

  3. [Prevention of headache from spinal anesthesia with the use of epidural cortisone].

    PubMed

    De Matteis, C; Pisana, G

    1991-04-01

    The Authors have analysed the etiopathogenetic factors of the post-dural puncture headache. To prevent this complication they have experimented an original method: in 74 patients they have injected 1.5 mg of betamethasone (diluted in physiological solution) into the epidural space after the anaesthetic infusion. They conclude supporting the validity of this method of prevention and its safety.

  4. [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

  5. [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

  6. Headache.

    PubMed

    Lance, J W

    1981-07-01

    Present views on the cause and treatment of temporal arteritis, trigeminal neuralgia, pain arising from the neck, benign intracranial hypertension, and other headaches of intracranial origin are summarized. The clinical components of migraine are correlated with recent studies of cerebral blood flow, monoamine changes, and the platelet release reaction. Psychological, physiological, and pharmacological management is based on the holistic concept of migraine as an uninhibited protective reaction. Cluster headache is subdivided into three varieties which respond preferentially to different medication. Tension headache may depend more on vascular mechanisms than excessive muscle contraction, but treatment is still directed at behavioral management and relaxation training with the aid of antidepressant therapy. PMID:7023351

  7. 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 ...

  8. Headache

    MedlinePlus

    ... hours How much you slept What you were doing and where you were right before the pain started How long the headache lasted and what made it stop Review your diary with your health care provider to identify ...

  9. 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. ...

  10. 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.

  11. 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

  12. 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

  13. Dural tear of unusual cause

    PubMed Central

    Kechna, Hicham; Loutid, Jaouad; Ouzzad, Omar; Hanafi, Sidi Mohamed; Hachimi, Moulay Ahmed

    2015-01-01

    Epidural analgesia is highly recommended in cancer anorectal surgery. In addition to the fight against pain it provides some benefit in allowing early rehabilitation of patients. One of the risks of this practice is the dural tear creating a cerebrospinal fluid leak (CSF) in the epidural space (EPD). Clinical features the typical positional headache, a procession of various more or less severe symptoms: nausea, vomiting, dizziness, visual or hearing impairment or radicular pain. We report a dural of unusual cause secondary of the obstruction of tuohy catheter by vertebral cartilage. PMID:26113920

  14. Two young women with chronic daily headache and cognitive impairment: why we need to ask about headache in the postpartum period

    PubMed Central

    Beams, Jennifer L; Rozen, Todd D

    2013-01-01

    Headache, which has a variety of causes, is a common and disabling complaint following childbirth. An important aetiology not to be missed is headache from epidural spinal anaesthesia, known as postdural puncture headache (PDPH), which has been reported in upwards of 85% of pregnant women and is a manifestation of intracranial hypotension from leakage of cerebrospinal (CSF) fluid through a dural tear. The common presenting symptom of PDPH is head pain occurring when a patient is in an upright position that resolves with recumbency. Other neurological issues associated with intracranial hypotension can include cranial nerve palsies, encephalopathy and Parkinsonism. We present two cases of persistent PDPH after pregnancy with secondary cognitive impairment. A review of the clinical manifestations, neuroimaging findings and treatment for PDPH will be presented. Better recognition of this disorder by obstetricians, physicians and anaesthetics will help to reduce the considerable morbidity this syndrome can produce in young mothers. PMID:27757163

  15. Cluster headache

    MedlinePlus

    Histamine headache; Headache - histamine; Migrainous neuralgia; Headache - cluster; Horton's headache; Vascular headache - cluster ... be related to the body's sudden release of histamine (chemical in the body released during an allergic ...

  16. 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

  17. 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

  18. Dural tears in spine surgery.

    PubMed

    Espiritu, Michael T; Rhyne, Alfred; Darden, Bruce V

    2010-09-01

    Dural tears are among the most commonly seen complications in spine surgery. Most studies in the literature indicate that long-term outcomes are not negatively affected, provided that the tears are diagnosed early and managed appropriately. Direct suture repair remains the preferred method for the management of durotomy caused by or found during surgery. However, recent literature reports encouraging results with sutureless repair. Understanding dural anatomy, dural healing, and cerebrospinal fluid dynamics is helpful in choosing among the available management options for dural tear.

  19. 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 ...

  20. 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

  1. The effects of gabapentin on severity of post spinal anesthesia headache.

    PubMed

    Vahabi, Sepideh; Nadri, Sedigheh; Izadi, Fatemeh

    2014-09-01

    Spinal anesthesia is a common anesthesia method and post dural puncture headache (PDPH) is one of its most common adverse effects. Gabapentin is a popular anticonvulsant drug that has been used as an oral nonopioid analgesic in recent years. In this placebo-controlled double-blind study, 120 patients were randomized in two equal groups (Placebo or gabapentin). The patients in the gabapentin group received gabapentin 300 mg orally one hour before the surgery and then every 12 hours for the first 24 hours after the surgery while the placebo group received placebos in the same way. Severity of headache and postoperative pain assessed by verbal rating score for pain (VRSP), morphine consumption, nausea, vomiting, somnolence, pruritus, dizziness in the first 48 hours, hypertension, hypotension, bradycardia and tachycardia in the first 24 hours after the surgery were recorded. In first 48 hour after surgery the mean of severity of headache in the gabapentin group was 0.20±0.05, and in the placebo group it was 0.93±0.01. The mean of postoperative pain in the gabapentin group was2.25±0.793, and in the placebo group it was3.77±0.813. In the first 24 hours post operative the mean of morphine consumptions were 0.20±0.030 and 0.32±0.0 30 mg in gabapentin and placebo groups. No significant differences were found between the two groups regarding incidence rate of the adverse effects. In this study, administration of gabapentin decreased the incidence and severity of post spinal anesthesia headache, postoperative pain and morphine consumption, without any significant differences in serious adverse effects.

  2. Cervicogenic headache: a real headache.

    PubMed

    Antonaci, Fabio; Sjaastad, Ottar

    2011-04-01

    Although theories regarding headache originating in the neck have existed for more than 150 years, the term "cervicogenic headache" originated in 1983. Early descriptions pinpoint the characteristic symptoms as dizziness, visual disturbances, tinnitus, and "posterior" headache, conceivably as a consequence of arthrosis, infliction upon the vertebral artery, or with a "migrainous" background and occurring in "advanced age." Cervicogenic headache (mean age of onset, 33 years) displays a somewhat different picture: unilateral headache, starting posteriorly, but advancing to the frontal area, most frequently the main site of pain; usually accompanied by ipsilateral arm discomfort, reduced range of motion in the neck, and mechanical precipitation of exacerbations (eg, through external pressure upon hypersensitive, occipital tendon insertions). Treatment options in treatment-resistant cases include cervical stabilization operations and extracranial electrical stimulation. In a personal, population-based study of 1,838 individuals (88.6% of the population), a prevalence of 2.2% "core" cases was found.

  3. Headache (image)

    MedlinePlus

    Headaches are usually caused by either muscle tension, vascular problems, or both. Migraines are vascular in origin, and may be preceded by visual disturbances, loss of peripheral vision, and fatigue. ...

  4. Tentorial meningioma encroaching the transverse sinuses and sigmoid sinus junction area associated with dural arteriovenous fistulous malformation: a case report.

    PubMed Central

    Chung, Y. G.; Lee, K. C.; Lee, H. K.; Lee, N. J.

    1999-01-01

    A 62-year-old woman was evaluated for tinnitis and headache. Magnetic resonance imaging and angiography revealed the coexistence of a tentorial tumor encroaching the junction of the right transverse-sigmoid sinuses, and dural arteriovenous fistulous malformation (AVFM) of the right transverse sinus. AVFM was not manipulated at all during the surgery. The pathology was fibroblastic meningioma. Postoperatively, the dural AVFM completely disappeared on follow-up angiography. The fistulas were occluded also after surgery, even though there was no manipulation of the AVFM. It is suggested that the right dominant transverse-sigmoid sinuses are partially occluded by tentorial meningioma, developing the dural arteriovenous fistula of the right transverse sinus. An acquired origin of the dural AVFM was suggested in this case. PMID:10485631

  5. Tentorial meningioma encroaching the transverse sinuses and sigmoid sinus junction area associated with dural arteriovenous fistulous malformation: a case report.

    PubMed

    Chung, Y G; Lee, K C; Lee, H K; Lee, N J

    1999-08-01

    A 62-year-old woman was evaluated for tinnitis and headache. Magnetic resonance imaging and angiography revealed the coexistence of a tentorial tumor encroaching the junction of the right transverse-sigmoid sinuses, and dural arteriovenous fistulous malformation (AVFM) of the right transverse sinus. AVFM was not manipulated at all during the surgery. The pathology was fibroblastic meningioma. Postoperatively, the dural AVFM completely disappeared on follow-up angiography. The fistulas were occluded also after surgery, even though there was no manipulation of the AVFM. It is suggested that the right dominant transverse-sigmoid sinuses are partially occluded by tentorial meningioma, developing the dural arteriovenous fistula of the right transverse sinus. An acquired origin of the dural AVFM was suggested in this case. PMID:10485631

  6. Indomethacin-responsive headaches.

    PubMed

    VanderPluym, Juliana

    2015-01-01

    Indomethacin-responsive headaches are a heterogeneous group of primary headache disorders distinguished by their swift and often absolute response to indomethacin. The epidemiology of these conditions is incompletely defined. Traditionally, indomethacin-responsive headaches include a subset of trigeminal autonomic cephalalgias (paroxysmal hemicrania and hemicrania continua), Valsalva-induced headaches (cough headache, exercise headache, and sex headache), primary stabbing headache, and hypnic headache. These headache syndromes differ in extent of response to indomethacin, clinical features, and differential diagnoses. Neuroimaging is recommended to investigate for various organic causes that may mimic these headaches. Case reports of other primary headache disorders that also respond to indomethacin, such as cluster headache, nummular headache, and ophthalmoplegic migraine, have been described. These "novel" indomethacin-responsive headaches beg the question of what headache characteristics are required to qualify a headache as an indomethacin-responsive headache. Furthermore, they challenge the concept of using a therapeutic intervention as a diagnostic criterion.

  7. 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

  8. Emergency airway puncture

    MedlinePlus

    Emergency airway puncture is the placement of a hollow needle through the throat into the airway. It ... efforts to assist with breathing have failed. A hollow needle or tube can be inserted into the ...

  9. 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- ...

  10. Cluster headache

    PubMed Central

    2010-01-01

    Introduction The revised International Headache Society (IHS) criteria for cluster headache are: attacks of severe or very severe, strictly unilateral pain, which is orbital, supraorbital, or temporal pain, lasting 15 to 180 minutes and occurring from once every other day to eight times daily. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to abort cluster headache? What are the effects of interventions to prevent cluster headache? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2009 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations, such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 23 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: baclofen (oral); botulinum toxin (intramuscular); capsaicin (intranasal); chlorpromazine; civamide (intranasal); clonidine (transdermal); corticosteroids; ergotamine and dihydroergotamine (oral or intranasal); gabapentin (oral); greater occipital nerve injections (betamethasone plus xylocaine); high-dose and high-flow-rate oxygen; hyperbaric oxygen; leuprolide; lidocaine (intranasal); lithium (oral); melatonin; methysergide (oral); octreotide (subcutaneous); pizotifen (oral); sodium valproate (oral); sumatriptan (oral, subcutaneous, and intranasal); topiramate (oral); tricyclic antidepressants (TCAs); verapamil; and zolmitriptan (oral and intranasal). PMID:21718584

  11. 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 - ...

  12. 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

  13. Pre-puncture ultrasound guided epidural insertion before vaginal delivery.

    PubMed

    Nassar, Mahmoud; Abdelazim, Ibrahim A

    2015-10-01

    Palpation method is widely used in clinical practice to identify the puncture site during combined spinal-epidural (CSE) blocks. Tuffier's line, is an anatomical landmark between two iliac crests (inter-cristal), which is widely used to identify the puncture site during CSE blocks is not always an indicator for specific vertebral level or inter-vertebral space. One hundred and Ten (110) women were scheduled for normal vaginal delivery and were randomized into two equal groups; palpation group and an ultrasound guided group to detect the efficacy of puncture ultrasound before CSE blocks to increase chances of successful CSE procedure on the first attempt and to reduce the number of attempts or punctures during insertion of CSE catheter. There were no significant differences between two studied groups regarding; maternal age, weight and height, while, there was a significant difference between two studied groups regarding; parity. Percentage of successful CSE procedure on the first attempt was significantly higher (67.27%) in ultrasound compared to palpation group (40%). Number of punctures (attempts) were significantly less in ultrasound (1.2 ± 0.6) compared to palpation group (2.3 ± 0.8) and the number of redirections was also significantly less in ultrasound (1.4 ± 0.5) compared to palpation group (2.8 ± 1.6). Although, time to identify puncture site was significantly longer in ultrasound compared to palpation group and total procedure time was longer in ultrasound (9.1 ± 1.5 min) compared to palpation group (6.2 ± 1.2 min), there was no significant difference between two studied groups regarding; time to identify puncture site and total procedure time. Two cases of dural puncture in palpation versus no cases in ultrasound group and two cases of intravascular catheter placement (one in each group), with no significant difference between two groups. Pre- puncture ultrasound guided epidural insertion before vaginal delivery, increases the chance of a

  14. 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 ...

  15. 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

  16. 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!"

  17. 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

  18. Dural invasion by pituitary tumours.

    PubMed

    Shaffi, O M; Wrightson, P

    1975-04-23

    In 12 cases of pituitary tumour the dura mater of the sella turcica or diaphragma sellae in contact with the tumour was examined histologically. In nine cases tumour cells were found lying deep in the substance of the dura. Dura from the sella of seven subjects without pituitary disease, obtianed at autopsy, showed no inclusions of pituitary tissue. Four of the cases studied were known before death to suffer from an invasive pituitary adenoma. Of eight surviving cases operated upon in the last two years, five showed dural invasion by tumour. The present report suggests that the condition may be more frequent than expected and that with more study it may provide an index of prognosis. It also defines a requirement for the surgeon aiming to prevent recurrence of tumour after operation or to achieve a complete endocrine ablation.

  19. 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.

  20. Dural enhancement and thickening in acute mastoiditis

    PubMed Central

    Shemesh, Shay; Marom, Tal; Raichman, Dominique Ben Ami

    2015-01-01

    Dural enhancement and thickening in imaging studies observed in acute mastoiditis patients is an uncommon phenomenon. It is infrequently seen in dural sinus thrombosis, and may be caused by infiltration of inflammatory cells and an increased number of thin-walled blood vessels. We present a three-year-old boy who presented with acute mastoiditis, complicated by subperiosteal abscess. Computerized tomography (CT) demonstrated subperiosteal abscess, and the child underwent mastoidectomy. Despite adequate treatment, symptoms worsened and neurological sequelae were suspected. CT and magnetic resonance imaging (MRI) studies demonstrated an atypical dural enhancement at the sigmoid perisinus and suboccipital abscess. The child underwent revision mastoidectomy and drainage of the abscess. Following the second procedure, resolution of symptoms was noted. Follow-up MRI did not demonstrate any dural pathologies. PMID:25963158

  1. 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

  2. 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

  3. [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.

  4. Modular headache theory.

    PubMed

    Young, W B; Peres, M F; Rozen, T D

    2001-10-01

    Many people experience headaches that do not fulfil the International Headache Society's criteria for a specific headache disorder yet behave biologically like that disorder. Others fulfil criteria for one headache disorder and yet have features of another disorder. To explain these observations, we propose that groups of neurones called modules become activated to produce each symptom of a primary headache disorder, and that each module is linked to other modules that together produce an individual's headache. This theory has implications for the classification, research and treatment of primary and secondary headache patients.

  5. Hemodialysis-related headache.

    PubMed

    Sav, Murat Yusuf; Sav, Tansu; Senocak, Elif; Sav, Nadide Melike

    2014-10-01

    Headache is one of the most frequently encountered neurological symptoms during hemodialysis. According to International Classification of Headache criteria dialysis-related headache was defined as the headache occurring during hemodialysis with no specific characteristic. It resolves spontaneously within 72 hours after the hemodialysis session ends. There are few studies in the literature investigating the clinical features of dialysis headache. The pathophysiology of hemodialysis-related headache is not known, but various triggering factors have been identified, including changes in blood pressure, serum sodium and magnesium levels during hemodialysis sessions, caffeine deprivation and stress. The aim of this article is to evaluate and analyze features of headache in patients undergoing hemodialysis.

  6. Primary headache disorders.

    PubMed

    Benoliel, Rafael; Eliav, Eli

    2013-07-01

    Primary headache disorders include migraine, tension-type headaches, and the trigeminal autonomic cephalgias (TACs). "Primary" refers to a lack of clear underlying causative pathology, trauma, or systemic disease. The TACs include cluster headache, paroxysmal hemicrania, and short-lasting neuralgiform headache attacks with conjunctival injection and tearing; hemicrania continua, although classified separately by the International Headache Society, shares many features of both migraine and the TACs. This article describes the features and treatment of these disorders.

  7. Technical advantages of the paramedian approach for lumbar epidural puncture and catheter introduction. A study using epiduroscopy in autopsy subjects.

    PubMed

    Blomberg, R G

    1988-10-01

    The lumbar epidural space of 14 autopsy subjects was examined by epiduroscopy. The aim was to compare the midline and paramedian approaches of locating the space, the estimated risk of accidental dural puncture, the course taken by the epidural catheter after introduction and with special attention to the influence of the dorsomedian connective tissue band. The paramedian needle passed a greater distance within the epidural space before contact with the dura mater and demonstrated a low risk of accidental dural puncture. The catheter passed by the paramedian approach did not cause any tenting of the dura and took a straight cephalad direction in all 14 cases. The midline catheter caused tenting of the dura in all 14 cases and the direction of travel was variable. Differences were statistically significant. Influence of the dorsomedian connective tissue band was greatest on the behaviour of the midline needle and catheter.

  8. Embryological Consideration of Dural Arteriovenous Fistulas.

    PubMed

    Tanaka, Michihiro

    2016-09-15

    The topographical distribution of dural arteriovenous fistulas (DAVFs) was analyzed based on the embryological anatomy of the dural membrane. Sixty-six consecutive cases of intracranial and spinal DAVFs were analyzed based on the angiography, and each shunt point was identified according to the embryological bony structures. The area of dural membranes was categorized into three different groups: a ventral group located on the endochondral bone (VE group), a dorsal group located on the membranous bone (DM group) and a falco-tentorial group (FT group) located in the falx cerebri, tentorium cerebelli, falx cerebelli, and diaphragm sellae. The FT group was designated when the dural membrane was formed only with the dura propria (meningeal layer of the dura mater) and not from the endosteal dura. Cavernous sinus, sigmoid sinus, and anterior condylar confluence was categorized to VE group, which had a female predominance, more benign clinical presentations, and a lower rate of cortical and spinal venous reflux. Transverse sinus, confluence, and superior sagittal sinus belonged to the DM group. Olfactory groove, falx, tent of the cerebellum, and nerve sleeve of spinal cord were categorized to the FT group, which presented later in life and which had a male predominance, more aggressive clinical presentations, and significant cortical and spinal venous reflux. The DAVFs was associated with the layers of the dural membrane characterized by the two different embryological bony structures. The FT group was formed only with the dura propria as an independent risk factor for aggressive clinical course and hemorrhage of DAVFs. PMID:27250699

  9. Embryological Consideration of Dural Arteriovenous Fistulas

    PubMed Central

    TANAKA, Michihiro

    2016-01-01

    The topographical distribution of dural arteriovenous fistulas (DAVFs) was analyzed based on the embryological anatomy of the dural membrane. Sixty-six consecutive cases of intracranial and spinal DAVFs were analyzed based on the angiography, and each shunt point was identified according to the embryological bony structures. The area of dural membranes was categorized into three different groups: a ventral group located on the endochondral bone (VE group), a dorsal group located on the membranous bone (DM group) and a falcotentorial group (FT group) located in the falx cerebri, tentorium cerebelli, falx cerebelli, and diaphragm sellae. The FT group was designated when the dural membrane was formed only with the dura propria (meningeal layer of the dura mater) and not from the endosteal dura. Cavernous sinus, sigmoid sinus, and anterior condylar confluence was categorized to VE group, which had a female predominance, more benign clinical presentations, and a lower rate of cortical and spinal venous reflux. Transverse sinus, confluence, and superior sagittal sinus belonged to the DM group. Olfactory groove, falx, tent of the cerebellum, and nerve sleeve of spinal cord were categorized to the FT group, which presented later in life and which had a male predominance, more aggressive clinical presentations, and significant cortical and spinal venous reflux. The DAVFs was associated with the layers of the dural membrane characterized by the two different embryological bony structures. The FT group was formed only with the dura propria as an independent risk factor for aggressive clinical course and hemorrhage of DAVFs. PMID:27250699

  10. Headaches and hormones.

    PubMed

    Pakalnis, Ann; Gladstein, Jack

    2010-06-01

    It is clear that hormones play an important role in modulating and exacerbating headaches. From an epidemiologic standpoint, we know that before puberty, incidence of new headache is similar for boys and girls. By age 18, however, most new cases of migraine occur in young women. The role of sex hormones in headache is described in the context of pubertal development. Obesity and Pseudotumor also impact headache through hormonal influences. Menstrual migraine will often present in the teenage years. Oral contraceptives may worsen or ameliorate headache. This article will introduce these concepts and help the reader become familiar with the role of hormones in headache.

  11. Headache care in China.

    PubMed

    Yu, Shengyuan; Zhang, Mingjie; Zhou, Jiying; Liu, Ruozhuo; Wan, Qi; Li, Yansheng

    2014-04-01

    Headache disorders are problematic worldwide. China is no different. A population-based door-to-door survey revealed that the 1-year prevalence of primary headache disorders in China was 23.8%, constituting a major societal burden. Many headache centers and clinics have been established in China, and headache disorders (and associated stress) are receiving an increased level of expert attention. This review summarizes the outcomes of the epidemiological survey and the progress of clinical and basic research in China, describes the present situation in terms of headache diagnosis and treatment, and discusses the future of headache care in China.

  12. [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

  13. Large capillary hemangioma of the temporal bone with a dural tail sign: A case report.

    PubMed

    Yang, Guang; Li, Chenguang; Chen, Xin; Liu, Yaohua; Han, Dayong; Gao, Xin; Kawamoto, Keiji; Zhao, Shiguang

    2014-07-01

    The present study reports a rare case of large capillary hemangioma of the temporal bone with a dural tail sign. A 57-year-old female presented with pulsatile tinnitus and episodic vertigo associated with a ten-year history of an intermittent faint headache. Magnetic resonance imaging revealed a mass in the right petrous bone, which was hypointense on T1-weighted images and heterogeneously hyperintense on T2-weighted images, and showed a dural tail sign following gadolinium administration. Pre-operatively, this tumor was believed to be a meningioma. During surgery, the vascular tumor was removed by a modified pterional approach. A histopathological examination indicated that the tumor was a capillary hemangioma. Although intraosseous capillary hemangiomas are rare, they most frequently affect the temporal bone. Hemangiomas of the temporal bone may mimic other more common basal tumors. The diagnosis is most often made during surgical resection. The dural tail sign is not specific for meningioma, as it also occurs in other intracranial or extracranial tumors. The treatment of intratemporal hemangiomas is complete surgical excision, with radiotherapy used for unresectable lesions. To the best of our knowledge, the present study is the fourth case of intraosseous intracranial capillary hemangioma, but the largest intratemporal hemangioma to be reported in the literature to date.

  14. Headaches - danger signs

    MedlinePlus

    ... KB. Headaches and other head pain. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 398. Garza I, Schwedt TJ, Robertson CE, Smith JH. Headache and other craniofacial pain. In: Daroff ...

  15. Chewing gum headaches.

    PubMed

    Blumenthal, H J; Vance, D A

    1997-01-01

    Aspartame, a popular dietetic sweetener, may provoke headache in some susceptible individuals. Herein, we describe three cases of young women with migraine who reported their headaches could be provoked by chewing sugarless gum containing aspartame.

  16. 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, ...

  17. 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

  18. 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

  19. 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

  20. 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

  1. Ultrasonography-guided punctures-with and without puncture guide.

    PubMed

    Desai, Mahesh

    2009-10-01

    The key requisite of any percutaneous nephrolithotomy technique is access to the collecting system. The kidney has a high degree of vascular network and is liable for vascular injury. Therefore, for an ideal puncture, a percutaneous tract would be developed that leads straight from the skin through a papilla and the target calix into the renal pelvis. Percutaneous renal access can be achieved under fluoroscopic control or using an ultrasonography (US)-guided puncture. The shortcomings and side effects of extensive radiation during therapeutic procedures are well known. The choice of method for the type of access depends on training and personal preference. The advantages of US-guided puncture are avoidance of radiation, avoiding adjacent and visceral injury and, most importantly, intrarenal vascular injury. US offers the shortest and straight access to the collecting system with minimal morbidity. US-guided access is of particular importance in the pediatric population and in special situations in which the procedure is performed with the patient in the supine position. I believe US-guided puncture has a significant reduction in complications. The available ultrasound probes come with a puncture attachment and, on US scanning, the puncture pathway is represented by an electronic dotted line on the scanner screen, which facilitates exact placement of the needle. US-guided access is optimal with a needle guide, because the electronic dotted line helps in assessing the depth and plane of the puncture needle. This helps in reaching the desired calix in the most accurate way. US access without a needle guide is useful in bedside procedures, in grossly hydronephrotic systems, and nonavailability of an electronic guide. We think the punctures with this technique are suboptimal. Both methods need a certain degree of training and orientation. The training in US should be structured.

  2. A review article on the diagnosis and treatment of cerebrospinal fluid fistulas and dural tears occurring during spinal surgery

    PubMed Central

    Epstein, Nancy E.

    2013-01-01

    Background: In spinal surgery, cerebrospinal fluid (CSF) fistulas attributed to deliberate dural opening (e.g., for tumors, shunts, marsupialization of cysts) or inadvertent/traumatic dural tears (DTs) need to be readily recognized, and appropriately treated. Methods: During spinal surgery, the dura may be deliberately opened to resect intradural lesions/tumors, to perform shunts, or to open/marsupialize cysts. DTs, however, may inadvertently occur during primary, but are seen more frequently during revision spinal surgery often attributed to epidural scarring. Other etiologies of CSF fistulas/DTs include; epidural steroid injections, and resection of ossification of the posterior longitudinal ligament (OPLL) or ossification of the yellow ligament (OYL). Whatever the etiology of CSF fistulas or DTs, they must be diagnosed utilizing radioisotope cisternography (RIC), magnetic resonance imaging (MRI), computed axial tomography (CT) studies, and expeditiously repaired. Results: DTs should be repaired utilizing interrupted 7-0 Gore-Tex (W.L. Gore and Associates Inc., Elkton, MD, USA) sutures, as the suture itself is larger than the needle; the larger suture occludes the dural puncture site. Closure may also include muscle patch grafts, dural patches/substitutes (bovine pericardium), microfibrillar collagen (Duragen: Integra Life Sciences Holdings Corporation, Plainsboro, NJ), and fibrin glues or dural sealants (Tisseel: Baxter Healthcare Corporation, Deerfield, IL, USA). Only rarely are lumbar drains and wound-peritoneal and/or lumboperitoneal shunts warranted. Conclusion: DTs or CSF fistulas attributed to primary/secondary spinal surgery, trauma, epidural injections, OPLL, OYL, and other factors, require timely diagnosis (MRI/CT/Cisternography), and appropriate reconstruction. PMID:24163783

  3. 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

  4. Symptomatic cervicogenic headache.

    PubMed

    Delfini, R; Salvati, M; Passacantilli, E; Pacciani, E

    2000-01-01

    Cervicogenic headache is a little-known clinical condition whose true importance has only recently been recognized. A number of causes may lie at the basis of the onset of headache (symptomatic cervicogenic headache). However, despite exhaustive attempts, sometimes it is not possible to identify a clear cause responsible for the onset of the syndrome (primitive cervicogenic headache). The genesis of symptomatic cervicogenic headaches sometimes may be easy to identify as a result of a close, pre-existing, cause-effect relationship (i.e. trauma). On other occasions it may be much more laborious to pinpoint the pathology responsible for headache (some cranio-cervical anomalies, etc.). Clinically, it is necessary to perform a thorough preliminary clinical and anamnestic evaluation which can orient subsequent investigations to achieve a diagnosis in the least time possible with the minimum discomfort to the patient and his relatives, not to mention lower costs for society. PMID:10824284

  5. [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

  6. Heredity, genes, and headache.

    PubMed

    Barbas, Nancy R; Schuyler, Erica A

    2006-11-01

    It is well recognized that headache, and especially migraine, runs in families. Recent studies into the heritability of primary headache subtypes, migraine, cluster and tension headache, and conditions in which headache is a prominent feature, such as the mitochondrial disease, mitochondrial encephalopathy, lactic acidosis, and strokelike episodes, and the arteriopathy, cerebral autosomal-dominant arteriopathy with subcortical infarctions and leukoencephalopathy, are improving our understanding of the genetic contribution to headache. Studies of the rare familial hemiplegic migraine are leading to advances in understanding the pathophysiological mechanisms of the more common migraine types. Current knowledge of hereditary and genetic features of headache subtypes is reviewed and the implications for understanding the pathophysiology of migraine are discussed.

  7. 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

  8. Headaches and sleep disorders.

    PubMed

    Freedom, Thomas

    2015-06-01

    Headaches and sleep disorders are associated in a complex manner. Both the disorders are common in the general population, but the relationship between the two is more than coincidental. Sleep disorders can exacerbate headache sand the converse is also true. Treatment of sleep disorders can have a positive impact on the treatment of headaches. Screening for sleep disorders should be considered in all patients with headaches. This can be accomplished with brief screening tools. Those who screen positively can be further evaluated or referred to asleep specialist.

  9. 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

  10. 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: ...

  11. [Validity of graphic headache diary for children having primary headaches].

    PubMed

    Fujita, Mitsue; Fujiwara, Junko

    2011-11-01

    We investigated whether the graphic headache diary is useful for diagnosing headache types in children, especially suffering from chronic daily headaches. Our study involved 109 children who completed the diaries for more than 3 weeks. The headache diary was a modified version of that used in the study by Sakai et al. Of 109, 84 had migraine, 15 had tension-type headache and 10 had both tension-type headache and migraine from the questionnaire and the first interview. The diary disclosed that 20 children, initially diagnosed as having migraine, had co-existing chronic tension-type headache with a variety of psychosocial problems. The graphic headache diary seems to be helpful for headache diagnosis and awareness of stress in children who suffered from strong and persistent headaches. Our study suggested that the graphic headache diary is useful not only for diagnosing headache types in children but also for finding out problems in school and/or family.

  12. 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

  13. Direct Superficial Temporal Vein Approach for Dural Carotid Cavernous Fistula

    PubMed Central

    Matsubara, S.; Kazekawa, K.; Aikawa, H.; Onizuka, M.; Tsutsumi, M.; Ikou, M.; Kodama, T.; Nii, K.; Nagata, S.; Tanaka, A.

    2007-01-01

    Summary We present an alternative endovascular approach to treat dural carotid cavernous fistulae (dural CCF) that drain only into the superior ophthalmic vein. Four cases of cavernous dural AVFs that could not be treated via the inferior petrosal vein were accessed via the direct superficial temporal vein approach through the superior ophthalmic vein. Successful embolization was documented radiographically and clinically in all patients. The trans-superficial temporal vein approach is safe and useful for inaccessible dural CCFs through the inferior petrosal sinus. PMID:20566079

  14. 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

  15. 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

  16. [Treatment of cluster headache].

    PubMed

    Fabre, N

    2005-07-01

    Remarkable therapeutic improvements have come forward recently for trigemino-autonomic cephalalgias. Attack treatment in cluster headache is based on sumatriptan and oxygen. Non-vasoconstrictive treatments are opening a new post-triptan era but are not yet applicable. Prophylactic treatment of cluster headache is based on verapamil and lithium. The efficacy of anti-epileptic drugs in cluster headache remains to be demonstrated. Surgical treatment aimed at the parasympathetic pathways and at the trigeminal nerve demonstrates a high rate of recurrence and adverse events and questions about the relevance of a "peripheral" target in cluster headache. The efficacy of continuous hypothalamic stimulation in patients with intractable headache constitutes a breakthrough, but must be demonstrated at a larger scale and the benefice/risk ratio must be carefully evaluated. Indomethacin still remains the gold standard in paroxysmal hemicrania treatment. Until recently SUNCT was considered an intractable condition. However there are some reports of complete relief with lamotrigine, topiramate and gabapentin.

  17. 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

  18. Spine fusion cross-link causing delayed dural erosion and CSF leak: case report.

    PubMed

    Rahmathulla, Gazanfar; Deen, H Gordon

    2015-04-01

    The past 2 decades have seen a considerable increase in the number of lumbar spinal fusion surgeries. To enhance spinal stabilization and fusion, make the construct resistant to or stiffer for axial stress loading, lateral bending, and torsional stresses, cross-links and connectors were designed and included in a rod-screw construct. The authors present the case of a 49-year-old woman who presented 11 years after undergoing an L4-5 decompression and fusion in which a pedicle screw-rod construct with an integrated cross-link was designed to attach onto the pedicle screws. The patient's response at the time to the initial surgery was excellent; however, at the time of presentation 11 years later, she had significant postural headaches, severe neurogenic claudication, and radiculopathy. Imaging revealed canal compression across the instrumented levels and a possible thickened adherent filum terminale. Reexploration of the level revealed a large erosive dural defect with a CSF leak, spinal canal compression, and a thickened filum at the level of the cross-link. To the author's knowledge, such complications have not been reported in literature. The authors discuss this rare complication of spinal fusion and the need to avoid dural compression when cross-links are used. PMID:25635637

  19. Headache - what to ask your doctor

    MedlinePlus

    ... about headaches; Migraine - what to ask your doctor; Tension-type headache - what to ask your doctor; Cluster ... is dangerous? What are the symptoms of a tension-type headache ? A migraine headache ? A cluster headache ? ...

  20. National Headache Foundation

    MedlinePlus

    ... has been to further awareness of headache and migraine as legitimate neurobiological diseases. Much has changed during this time, and with aid from advanced technology and clinical innovation, there are more treatment options than ever before. However, we understand that ...

  1. American Headache Society

    MedlinePlus

    ... Info for Residents & Fellows Int. Headache Academy Medical Student Resources New Investigators & Trainees Resources AHMA – For Patients ... pm #CMEP afternoon w @ranicholson & @SmithermanTodd talking patient engagement, communication & behavioral tools for managing #migraine h J ...

  2. Headache following parturition.

    PubMed

    Adinma, J I; Agbai, A O

    2000-01-01

    The incidence of headache following childbirth in 226 Nigerian women is 24.3% (n=55) or one in four births. Headache was more prevalent among women aged between 21 and 30 years (n=44); those of social class 3-5 (n=50); and also increased incidence with increasing parity, although these relationships did not reach significance. There is a highly significant association between the incidence of postparturition headache and evidence of stress (P=0.004), but not with a history of migraine (p=0.102). A highly significant association also exists between the incidence of postparturition headache and anaemia (Hb value less than 10 g/dl (68%), (p=0.004). Headache started on the day of delivery in the majority of cases (36.4%; n=20) although the median number of days of onset after delivery was 2 days. Post-natal headache may be associated with some underlying sociomedical factors which may be influenced by the fall in pregnancy hormones following parturition.

  3. 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

  4. [Recent new information on epidemiology of headache].

    PubMed

    Kavuk, I; Katsarava, Z; Stang, A; Agelink, M W; Diener, H C

    2004-04-01

    We reviewed the epidemiology of headache disorders for the most frequent primary headache-syndromes: migraine, tension-type headache and trigemino-autonomic headache syndromes. In the last years scientific data about headache disorders have increased. New studies investigated not only the prevalence of headaches, but also economic costs of this disorder. Epidemiologic headache research also investigates the quality of life.

  5. Sleep and Headache.

    PubMed

    Dosi, Claudia; Figura, Mariagrazia; Ferri, Raffaele; Bruni, Oliviero

    2015-06-01

    The interaction between sleep and headache or migraine is powerful and an elevated comorbidity between these 2 disorders has been reported in either adults or children. This comobidity is linked to common neurophysiological and neuroanatomical substrates that are genetically based strongly. The first reports on this relationship were related to the prevalence of parasomnias and sleep-disordered breathing in headache but recent research has expanded the comorbidity to several other sleep disorders, such as restless legs syndrome, periodic limb movements during sleep, and narcolepsy. The assessment of children with headache should always include an accurate anamnesis for the presence of sleep problems either in the child or in the relatives; no correct approach for treating children and adolescents is possible without an integrated method of evaluation and management.

  6. Headache and epilepsy.

    PubMed

    Bauer, P R; Carpay, J A; Terwindt, G M; Sander, J W; Thijs, R J; Haan, J; Visser, G H

    2013-08-01

    Headache and epilepsy often co-occur. Epidemiologic studies conducted in the past few years reinforce the notion of a bi-directional association between migraine and epilepsy. Data on an association between headache (in general) and epilepsy, however, are less clear. Peri-ictal headache often presents with migraine-like symptoms and can be severe. A correct diagnosis and management are paramount. It was demonstrated that cortical hyperexcitability may underlie both epilepsy and migraine. A recent study linked spreading depolarisation, the supposed underlying pathophysiological mechanism of migraine with aura, to epilepsy. Although this study was carried out in patients who had suffered a subarachnoid haemorrhage, the finding may shed light on pathophysiological mechanisms common to epilepsy and migraine.

  7. Pediatric Posttraumatic Headache.

    PubMed

    Kacperski, Joanne; Hung, Ryan; Blume, Heidi K

    2016-02-01

    Concussion and mild traumatic brain injury are common injuries in pediatrics, and posttraumatic headache is the most common complaint following them. Although most children and teens recover from a simple, isolated concussion without incidents within 1-2 weeks, some develop symptoms that can last for months. It is important to manage both acute and persistent posttraumatic headaches appropriately to speed recovery, minimize disability, and maximize function. In this article, we review the definitions, epidemiology, and current recommendations for the evaluation and treatment of acute and persistent posttraumatic headaches. Although this is still a developing field and there is much that we still need to learn about concussion and the best strategies to prevent and treat these injuries and their sequelae, we hope that this review will help providers to understand the current evidence and treatment recommendations to improve care for children with concussion and mild traumatic brain injury. PMID:27017019

  8. Pediatric Posttraumatic Headache.

    PubMed

    Kacperski, Joanne; Hung, Ryan; Blume, Heidi K

    2016-02-01

    Concussion and mild traumatic brain injury are common injuries in pediatrics, and posttraumatic headache is the most common complaint following them. Although most children and teens recover from a simple, isolated concussion without incidents within 1-2 weeks, some develop symptoms that can last for months. It is important to manage both acute and persistent posttraumatic headaches appropriately to speed recovery, minimize disability, and maximize function. In this article, we review the definitions, epidemiology, and current recommendations for the evaluation and treatment of acute and persistent posttraumatic headaches. Although this is still a developing field and there is much that we still need to learn about concussion and the best strategies to prevent and treat these injuries and their sequelae, we hope that this review will help providers to understand the current evidence and treatment recommendations to improve care for children with concussion and mild traumatic brain injury.

  9. 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

  10. Psychological Risk Factors in Headache

    PubMed Central

    Nicholson, Robert A.; Houle, Timothy T.; Rhudy, Jamie L.; Norton, Peter J.

    2008-01-01

    Headache is a chronic disease that occurs with varying frequency and results in varying levels of disability. To date, the majority of research and clinical focus has been on the role of biological factors in headache and headache-related disability. However, reliance on a purely biomedical model of headache does not account for all aspects of headache and associated disability. Using a biopsychosocial framework, the current manuscript expands the view of what factors influence headache by considering the role psychological (i.e., cognitive and affective) factors have in the development, course, and consequences of headache. The manuscript initially reviews evidence showing that neural circuits responsible for cognitive–affective phenomena are highly interconnected with the circuitry responsible for headache pain. The manuscript then reviews the influence cognitions (locus of control and self-efficacy) and negative affect (depression, anxiety, and anger) have on the development of headache attacks, perception of headache pain, adherence to prescribed treatment, headache treatment outcome, and headache-related disability. The manuscript concludes with a discussion of the clinical implications of considering psychological factors when treating headache. PMID:17371358

  11. Business management of headache centers.

    PubMed

    Nappi, G; Micieli, G; Cavallini, A; Rossi, G; Rossi, G; Rossi, F

    1998-02-01

    Economic evaluation of the costs and benefits of a headache center or unit has become very important for headache specialists. Many of the problems concerning this "financial" approach to headache derive from the model of organization of the Headache Unit, which is dependent on the various approaches to healthcare practiced in the country considered. So far there are two models of headache center that are generally considered: the hospital-based center and the independent center. An argument favoring hospital-based headache clinics is the lower costs, primarily because of their functional connection with the services of a general hospital, i.e., neuroradiology, neurophysiology, routine laboratory analysis, etc. Another is that the headache specialist has the possibility to visit the patients presenting to the emergency room in the acute phase of headache. Independent clinics have greater costs, but are equally as effective as hospital-based models. PMID:9533678

  12. Contraception and headache.

    PubMed

    MacGregor, E Anne

    2013-02-01

    Most women have used at least 1 method of contraception during their reproductive years, with the majority favoring combined oral contraceptives. Women are often concerned about the safety of their method of choice and also ask about likely effects on their pre-existing headache or migraine and restrictions on using their headache medication. While there should be no restriction to the use of combined hormonal contraceptives by women with migraine without aura, the balance of risks vs benefits for women with aura are debatable. Migraine with aura, but not migraine without aura, is associated with a twofold increased risk of ischemic stroke, although the absolute risk is very low in healthy, nonsmoking women. Although ethinylestradiol has been associated with increased risk of ischemic stroke, the risk is dose-dependent. Low-dose pills currently used are considerably safer than pills containing higher doses of ethinylestradiol but they are not risk-free. This review examines the evidence available regarding the effect that different methods of contraception have on headache and migraine and identifies strategies available to minimize risk and to manage specific triggers such as estrogen "withdrawal" headache and migraine associated with combined hormonal contraceptives. The independent risks of ischemic stroke associated with migraine and with hormonal contraceptives are reviewed, and guidelines for use of contraception by women with migraine are discussed in light of the current evidence. PMID:23432442

  13. Dural tears secondary to operations on the lumbar spine. Management and results after a two-year-minimum follow-up of eighty-eight patients.

    PubMed

    Wang, J C; Bohlman, H H; Riew, K D

    1998-12-01

    We reviewed the results of acute management of patients who had sustained a dural tear during an operation on the lumbar spine, and we attempted to determine the long-term sequelae of this complication. In the five years from July 1989 to July 1994, 641 consecutive patients had a decompression of the lumbar spine, performed by the senior one of us; of these patients, eighty-eight (14 percent) sustained a dural tear, which was repaired during the operation. The duration of follow-up ranged from two to eight years (average, 4.3 years). Postoperative management consisted of closed suction wound drainage for an average of 2.1 days and bed rest for an average of 2.9 days. Of the eighty-eight procedures that resulted in a dural tear, forty-five were revisions; these revisions were performed after an average of 2.2 previous operations on the lumbar spine, all of which resulted in a scar adherent to the dura. Only eight patients had headaches related to the spinal procedure and photophobia in the postoperative period; these symptoms resolved in all but two patients, both of whom had had a revision operation. Each of the two patients had symptoms of a persistent leak of spinal fluid and needed a reoperation for repair. Overall, seventy-six patients had a good or excellent result and twelve had a poor or satisfactory result with some residual back pain. One patient had arachnoiditis, and another had symptoms of viral meningitis one month postoperatively. A dural tear that occurs during an operation on the lumbar spine can be treated successfully with primary repair followed by bed rest. Such a tear does not appear to have any long-term deleterious effects or to increase the risk of postoperative infection, neural damage, or arachnoiditis. Closed suction wound drainage does not seem to aggravate the leak and can be used safely in the presence of a dural repair.

  14. Spontaneous Recanalization of Occluded Dural Venous Sinuses after Successful Trans Arterial Embolisation of a Dural Arteriovenous Shunt

    PubMed Central

    Brew, S.; Taylor, W.; Lasjaunias, P.

    2002-01-01

    Summary Dural arteriovenous shunts (DAVS) occur within the walls of dural venous sinuses or their tributaries. They may be related to previous episodes of sinus thrombosis. The presence of impediments to venous outflow results in venous congestion, predisposing to haemorrhage and cerebral parenchymal damage. Cerebral venous congestion is an indication for treatment. This case is unusual in some respects; firstly, the patient was relatively well despite worrisome features on imaging and secondly the occluded dural venous sinuses appeared to spontaneously recanalize after treatment of the DAVS. Anticoagulation may have had a role in avoiding thrombosis of the patient's precarious venous drainage after embolisation and in encouraging recanalization of the thrombosed dural venous sinuses. PMID:20594510

  15. 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

  16. Puncture mechanics of soft solids.

    PubMed

    Fakhouri, Sami; Hutchens, Shelby B; Crosby, Alfred J

    2015-06-21

    Gels and other soft elastic networks are a ubiquitous and important class of materials whose unique properties enable special behavior, but generally elude characterization due to the inherent difficulty in manipulating them. An example of such behavior is the stability of gels to large local deformations on their surface. This paper analyzes puncture of model soft materials with particular focus on the force response to deep indentation and the critical load for material failure. Large-strain behavior during deep indentation is described with a neo-hookean contact model. A fracture process zone model is applied to the critical load for puncture. It is found that the indenter geometry influences the size of the fracture process zone, resulting in two distinct failure regimes: stress-limited and energy-limited. The methods outlined in this paper provide a simple means for measuring Young's modulus, E, as well as the material's maximum cohesive stress, σ0, fracture energy, Γ0, and the intrinsic length scale linking the two, l0, all without requiring specialized sample preparation.

  17. Case studies of uncommon headaches.

    PubMed

    Evans, Randolph W

    2006-05-01

    The following interesting and uncommon headache disorders are presented through case studies: exploding head syndrome, hypnic headache, neck-tongue syndrome, "Alice in Wonderland" syndrome, nummular headache, red ear syndrome, burning mouth syndrome, spontaneous intracranial hypotension syndrome, and cardiac cephalalgia. PMID:16684636

  18. 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.

  19. 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.

  20. Headaches in medical school students.

    PubMed

    Monteiro, J M; Matos, E; Calheiros, J M

    1994-01-01

    Medical students of the Instituto de Ciências Biomédicas 'Abel Salazar' at the University of Oporto were interviewed using a structured headache questionnaire in order to assess the prevalence and characteristics of headaches in a young adult university population. This was the first population-based study of headaches in Portugal. 491 students were questioned. The parameters evaluated included age, sex, headache characteristics (frequency, localization, severity, duration), premonitory and associated symptoms and family history. Headaches were classified using the Ad Hoc Committee (1962) and the International Headache Society (1988) criteria. There was a high prevalence of overall headaches in this young population. The results of the application of these two types of criteria to the same population showed for the most prevalent forms, migraine and tension-type headaches, a prevalence that depends on the classification adopted and the number of criteria items considered. If all (9 items) were used, the statistics obtained for migraine were 6.9% (Ad Hoc) and 6.1% (IHS), an insignificant difference, and for tension-type headache 14.3% (Ad Hoc) and 16.0% (IHS), which corresponds to a significant difference (p = 0.0129, McNemar test). It is concluded that IHS classification criteria identify less cases of migraine and more cases of tension-type headaches, which means a higher specificity for migraine and a higher sensitivity for tension-type headache.

  1. Gastrointestinal Headache; a Narrative Review

    PubMed Central

    T Noghani, Majid; Rezaeizadeh, Hossein; Fazljoo, Sayed Mohammad Baqer; Keshavarz, Mansoor

    2016-01-01

    There are studies reporting primary headaches to be associated with gastrointestinal disorders, and some report resolution of headache following the treatment of the associated gastrointestinal disorder. Headache disorders are classified by The International Headache Society as primary or secondary; however, among the secondary headaches, those attributed to gastrointestinal disorders are not appreciated. Therefore, we aimed to review the literature to provide evidence for headaches, which originate from the gastrointestinal system. Gastrointestinal disorders that are reported to be associated with primary headaches include dyspepsia, gastro esophageal reflux disease (GERD), constipation, functional abdominal pain, inflammatory bowel syndrome (IBS), inflammatory bowel disorders (IBD), celiac disease, and helicobacter pylori (H. Pylori) infection. Some studies have demonstrated remission or improvement of headache following the treatment of the accompanying gastrointestinal disorders. Hypotheses explaining this association are considered to be central sensitization and parasympathetic referred pain, serotonin pathways, autonomic nervous system dysfunction, systemic vasculopathy, and food allergy. Traditional Persian physicians, namely Ebn-e-Sina (Avicenna) and Râzi (Rhazes) believed in a type of headache originating from disorders of the stomach and named it as an individual entity, the "Participatory Headache of Gastric Origin". We suggest providing a unique diagnostic entity for headaches coexisting with any gastrointestinal abnormality that are improved or cured along with the treatment of the gastrointestinal disorder. PMID:27800536

  2. 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

  3. Psychological factors in childhood headaches.

    PubMed

    Farmer, Kathleen; Dunn, David; Scott, Eric

    2010-06-01

    Recurrent headaches in children are most often migraines and are based in a genetic predisposition with a low headache threshold. As with any pain experience, there is a large emotional component associated with an attack of migraines that grows in amplitude as the headaches become more frequent and resistant to medicine, sleep, or other agents that used to work. Childhood headaches are especially complicated for 3 reasons: (1) the parents' fear (communicated to the child that serious medical pathology underlies the head pain), (2) the lack of evidence-based pharmacologic treatment, and (3) the belief that these headaches are largely psychological. This article addresses the mystery surrounding childhood headaches by delving into the influence of school, friends, and family; the impact of divorce; the coping skills required for a child to manage a migrainous nervous system; the potential secondary gain from headaches; psychiatric comorbidities and how to treat them; and the role of psychological intervention.

  4. The Management of Chronic Headaches

    PubMed Central

    Murray, T. J.

    1984-01-01

    Most patients who complain of recurrent headaches have migraine, muscle contraction headache, or both. At a patient's first office visit for headache, the family physician should carry out a physical and neurological examination. The type of headache and factors that can precipitate it may then be explained, and the patient should be advised to take only simple analgesics for pain, as soon as he recognizes the first symptom of headache. A daily diary can help reveal specific factors that precipitate the patient's headaches. He can also benefit from educational material, and be taught relaxation techniques to ease headache pain. At least one follow up office visit is necessary in order to emphasize and review instructions from the previous assessment, and to give the patient an opportunity to consider the explanation and problems and voice any remaining concerns or questions. PMID:21278963

  5. Psychological Aspects of Headache

    PubMed Central

    Sloane, R. Bruce

    1964-01-01

    Headache is considered as a non-specific syndrome illustrating the concept of pain as an emotion. Viewed in this way, its meaning looms larger than its site. Pain indicates dis-ease of the patient, sometimes with his body, but more often with his life. No pain is “imaginary”, nor can some pain be assigned to physiological and some to psychological pathways. Such a decision is often merely a judgmental one. Just as the “brain” cannot easily be separated from the “mind”, so to believe that some pain is “physical” and some “emotional” is a distortion. All painful syndromes are mixed and the problem is to decipher the meaning of the pain. Only rarely will headache respond to physical measures alone. PMID:14199822

  6. Tension Type Headache.

    PubMed

    de Tommaso, Marina; Fernández-de-Las-Penas, César

    2016-01-01

    Tension type headache (TTH) is the most common headache and it has been discussed for years without reaching consensus on its pathophysiology, or proper rationale management. This primary headache remains a challenge into its management for clinicians. This review aims to provide an updated and critical discussion on what is currently known and supported by scientific evidence about TTH and which gaps there still may be in our understanding of this condition. Clinical features of TTH resemble common manifestations of muscle referred pain. Episodic TTH may evolve into the chronic form by different aspects and several triggers may be involved at the same time. Both peripheral and central sensitization mechanisms seem to be clearly involved in this process. Individuals with episodic TTH exhibit higher levels of peripheral excitability whereas chronic TTH clearly show central sensitization manifestations. The role of associated muscle hyperalgesia seems to be important factors in TTH. Therapeutic management of individuals with TTH should be multimodal including appropriate use of pharmacological and non-pharmacological interventions to reduce the nociceptive peripheral drive to the central nervous system. If properly applied, treatment may not only reduce the number of TTH attacks but may also prevent or delay the transition from episodic to chronic TTH. Scientific evidence of pharmacological and nonpharmacological treatment is discussed in this review. PMID:26717946

  7. 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

  8. Dural cavernous sinus fistula: an unusual presentation.

    PubMed Central

    Procope, J. A.; Kidwell, E. D.; Copeland, R. A.; Perry, A. F.

    1994-01-01

    This article describes a 22-year-old man who presented to the Howard University Hospital emergency room with acute onset of swelling, proptosis, and decreased vision in the right eye preceded by 24 hours of nausea and vomiting. The patient's visual acuity was count fingers in the involved eye with marked proptosis and limitation of ocular motility. There was no history given of any ocular or head trauma. A computed tomography scan of the orbits showed diffuse symmetric enlargement of the extraocular muscles of the right eye, felt to be consistent with an orbital inflammatory pseudotumor. The patient was treated with intravenous steroids initially, then placed on oral prednisone. After minimal improvement on the steroids, a selective external carotid angiogram showed a moderate-sized dural cavernous sinus fistula. The patient underwent selective embolization of the fistula with rapid resolution of periorbital edema and proptosis. Visual acuity was stabilized at 20/200 in the right eye. The differential diagnosis and pathogenesis of carotid cavernous sinus fistulas and the likely pathogenesis of the fistula in this case are discussed. Images Figure 1 Figure 2 Figure 3 PMID:8046763

  9. Spinal dural ossification causing neurological signs in a cat.

    PubMed

    Antila, Johanna M; Jeserevics, Janis; Rakauskas, Mindaugas; Anttila, Marjukka; Cizinauskas, Sigitas

    2013-06-19

    A six-year-old Ragdoll cat underwent examination due to a six-month history of slowly progressive gait abnormalities. The cat presented with an ambulatory tetraparesis with a neurological examination indicating a C1-T2 myelopathy. Radiographs of the spine showed a radiopaque irregular line ventrally in the vertebral canal dorsal to vertebral bodies C3-C5. In this area, magnetic resonance imaging revealed an intradural extramedullary/extradural lesion compressing the spinal cord. The spinal cord was surgically decompressed. The cause of the spinal cord compression was dural ossification, a diagnosis confirmed by histopathological examination of the surgically dissected sample of dura mater. The cat gradually improved after the procedure and was ambulating better than prior to the surgery. The cat's locomotion later worsened again due to ossified plaques in the dura causing spinal cord compression on the same cervical area as before. Oral prednisolone treatment provided temporary remission. Ten months after surgery, the cat was euthanized due to severe worsening of gait abnormalities, non-ambulatory tetraparesis. Necropsy confirmed spinal cord compression and secondary degenerative changes in the spinal cord on cervical and lumbar areas caused by dural ossification. To our knowledge, this is the first report of spinal dural ossification in a cat. The reported cat showed neurological signs associated with these dural changes. Dural ossification should be considered in the differential diagnosis of compressive spinal cord disorders in cats.

  10. Spinal dural ossification causing neurological signs in a cat

    PubMed Central

    2013-01-01

    A six-year-old Ragdoll cat underwent examination due to a six-month history of slowly progressive gait abnormalities. The cat presented with an ambulatory tetraparesis with a neurological examination indicating a C1-T2 myelopathy. Radiographs of the spine showed a radiopaque irregular line ventrally in the vertebral canal dorsal to vertebral bodies C3-C5. In this area, magnetic resonance imaging revealed an intradural extramedullary/extradural lesion compressing the spinal cord. The spinal cord was surgically decompressed. The cause of the spinal cord compression was dural ossification, a diagnosis confirmed by histopathological examination of the surgically dissected sample of dura mater. The cat gradually improved after the procedure and was ambulating better than prior to the surgery. The cat’s locomotion later worsened again due to ossified plaques in the dura causing spinal cord compression on the same cervical area as before. Oral prednisolone treatment provided temporary remission. Ten months after surgery, the cat was euthanized due to severe worsening of gait abnormalities, non-ambulatory tetraparesis. Necropsy confirmed spinal cord compression and secondary degenerative changes in the spinal cord on cervical and lumbar areas caused by dural ossification. To our knowledge, this is the first report of spinal dural ossification in a cat. The reported cat showed neurological signs associated with these dural changes. Dural ossification should be considered in the differential diagnosis of compressive spinal cord disorders in cats. PMID:23777582

  11. [Different headache forms of chapter 4 of the International Headache Classification].

    PubMed

    Göbel, A; Heinze, A; Göbel, H

    2012-12-01

    Chapter 4 of the International Classification of Headaches contains a group of clinically very heterogeneous primary headache forms. Little is known about the pathogenesis of these headache types and therapy is usually based on isolated case reports and uncontrolled studies. The forms include primary stabbing headache, primary cough headache, primary exertional headache, primary headache associated with sexual activity, hypnic headache, primary thunderclap headache, hemicrania continua and the new daily persistent headache. Some of these headache forms may be of a symptomatic nature and require careful examination, imaging and further tests. Primary and secondary headache forms must be carefully distinguished.

  12. Creutzfeldt-Jakob disease via dural and corneal transplants.

    PubMed

    Lang, C J; Heckmann, J G; Neundörfer, B

    1998-10-01

    A review of all published cases of iatrogenic Creutzfeldt-Jakob disease (CJD) via dural (N=71) and corneal (N=4) transplants is given. All but three of the dural cases were obviously due to a commercial product recalled in 1996. Two of the corneal grafts were taken from patients who had died of sporadic CJD. These cases differed from CJD due to human growth hormone injections and the new variant. Instead. they were akin to sporadic cases, but memory loss, disorders of higher cerebral functions and extrapyramidal signs were fewer, while cerebellar abnormalities were more frequent. Progressive dysarthria and gait disorder/gait ataxia were prominent signs during the early stages, myocloni the most salient feature later. A nonperiodic EEG did not contradict the diagnosis. Using current diagnostic criteria the disease was underdiagnosed ante mortem. Utmost care is needed in selecting, harvesting and handling dural and corneal grafts to avoid inadvertent transmission of CJD.

  13. 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.

  14. 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

  15. 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

  16. Hormonal changes in headache patients.

    PubMed

    Elwan, O; Abdella, M; el Bayad, A B; Hamdy, S

    1991-11-01

    Seventy-three patients with headache underwent serum and cerebrospinal fluid (CSF) radioimmunoassays of follicle-stimulating hormone (FSH), luteinizing hormone (LH), cortisol and prolactin. Serum FSH showed significant increases in all headache patients while serum LH increased only in females. Such a rise of serum FSH and LH is attributed to disturbances of the sleep-wake cycle. On the other hand, serum cortisol was significantly decreased in the male headache patients, probably due to altered circadian rhythm. Serum prolactin remained within normal limits. CSF prolactin, FSH and LH showed detectable levels in all headache sufferers compared to undetectable levels in control subjects, while CSF cortisol was significantly reduced.

  17. Finger necrosis after accidental radial artery puncture

    PubMed Central

    Kang, Jun Sik; Lee, Tae Rim; Cha, Won Chul; Shin, Tae Gun; Sim, Min Seob; Jo, Ik Joon; Song, Keun Jeong; Rhee, Joong Eui; Jeong, Yeon Kwon

    2014-01-01

    Radial artery puncture, an invasive procedure, is frequently used for critical patients. Although considered safe, severe complications such as finger necrosis can occur. Herein, we review the clinical course of finger necrosis after accidental radial artery puncture. A 63-year-old woman visited the emergency department (ED) with left second and third finger pain after undergoing intravenous (IV) access in her wrist for procedural sedation. During the IV access, she experienced wrist pain, which increased during the 12 hours prior to her ED presentation. Emergency angiography revealed a pseudoaneurysm in her left radial artery and absence of blood flow to the proper palmar digital artery. Subsequent angiointervention and urokinase thrombolysis failed. The second finger was eventually amputated owing to gangrene. Radial artery puncture can occur accidentally during IV wrist access, resulting in severe morbidity. Providers should carefully examine the puncture site and collateral flow, followed by multiple examinations to ensure distal circulation.

  18. [Hemicrania: primary headache].

    PubMed

    Nattero, G; Allais, G; De Lorenzo, C

    1992-01-01

    Migraine is the commonest form among the so-called primary headaches and the description of its clinical picture is lost in the mists of time. On the contrary, headaches of organic origin have only recently received a proper nosological individuation thanks to the modern technological progress achieved in the field of medicine. The migraine crisis, both with and without aura, is so typical in its clinical features that it does not require subtle instrumental methodologies to be diagnosed. In most cases a careful anamnesis provides all the elements necessary to formulate a precise diagnosis: the positive family history, the time and mode of onset of crises, the nature of head pain, the chronological stages are quite constant whatever the trigger factor may be. Some other considerations add further evidence to the primitivity of migraine. First of all, migraine can be relieved by quite structurally different drugs with different mechanisms of action. In addition, no significant relationship has ever been found between migraine and other pathologies.

  19. 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.

  20. [Acupuncture in daily practice. Headache].

    PubMed

    Senta, A Q

    1976-11-24

    The aetiopathogenesis of headache is explained in a general review of this subject. Attention is directed the various forms of reflexotherapy that can be cmployed in its treatment. Acupuncture is examined in some detail, from both the general and the symptomatic standpoint. Stress is laid on the different picture presented by headache in different patients. PMID:1004762

  1. Tentorial Dural Arteriovenous Fistula Treated Using Transarterial Onyx Embolization.

    PubMed

    Kim, Hyun-Jung; Yang, Ji-Ho; Lee, Hong-Jae; Lee, Hyung-Jin

    2015-09-01

    Tentorial dural arteriovenous fistula (DAVF) is a rare vascular disease, which has high risk of intracranial hemorrhage. We present two cases of tentorial DAVF which were successfully treated with single trial of transarterial embolization using Onyx. We briefly reviewed the types of the tentorial DAVF and strategies of treatment. PMID:26539273

  2. 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

  3. The history of craniotomy for headache treatment.

    PubMed

    Assina, Rachid; Sarris, Christina E; Mammis, Antonios

    2014-04-01

    Both the history of headache and the practice of craniotomy can be traced to antiquity. From ancient times through the present day, numerous civilizations and scholars have performed craniotomy in attempts to treat headache. Today, surgical intervention for headache management is becoming increasingly more common due to improved technology and greater understanding of headache. By tracing the evolution of the understanding of headache alongside the practice of craniotomy, investigators can better evaluate the mechanisms of headache and the therapeutic treatments used today.

  4. 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.

  5. Modular headache theory: a new approach.

    PubMed

    Young, William B

    2002-03-01

    Many people experience headaches that do not fulfill the International Headache Society's criteria for a specific headache disorder, yet behave biologically like that disorder. Others fulfill criteria for one headache disorder but have features of another. To explain these observations, we propose that groups of neurons, called modules, become activated to produce each symptom of a primary headache disorder, and that each module is linked to other modules that together produce an individual's headache. Headaches develop phenotypic stability through a process referred to as learned stereotypy. This theory has implications for the classification, research, and treatment of primary and secondary headache patients.

  6. Steroid hormones in cluster headaches.

    PubMed

    Stillman, Mark

    2006-04-01

    For decades, glucocorticoid therapy has been a well-recognized abortive treatment for cluster headaches. However, the role of steroid hormones, including both glucocorticoids and sex steroids, in the pathophysiology and therapy of cluster headaches has been a topic of much debate and speculation. Current research now points to the importance of cortisol and testosterone in the pathogenesis of cluster headaches, and they appear to be linked mechanistically to another hormone, melatonin. Melatonin, unlike cortisol or testosterone, is not a product of the hypothalamic pituitary axis but of the retinohypothalamic pineal axis, and is the major biomarker of circadian rhythms. The regulation of steroids and melatonin in the pathogenesis of cluster headaches in turn depends on the sympathetic nervous system. Accumulated evidence suggests sympathetic dysfunction--embodied in the Horner sign so commonly seen in the cluster headache--as a necessary ingredient in the inception of the cluster headache. Sympathetic dysfunction now is thought to be associated with the hypercortisolism, hypotestosteronism, and lower-than-normal melatonin levels in the active cluster patient. Future research may hold the key to a fuller explanation of the complex interaction of hormonal systems in the cluster headache.

  7. Acupuncture in primary headache treatment.

    PubMed

    Schiapparelli, Paola; Allais, Gianni; Rolando, Sara; Airola, Gisella; Borgogno, Paola; Terzi, Maria Grazia; Benedetto, Chiara

    2011-05-01

    Acupuncture has a long tradition of use for the treatment of many pain conditions, including headache. Its effectiveness has been studied mainly for primary headaches, particularly for migraine and tension-type headache (TTH). Traditional Chinese Medicine (TCM) has two diagnostic frameworks for headaches: meridian diagnoses, based on the location of the pain and on the meridians (or channels) that pass through it; syndrome diagnoses, dependent on external or internal factors and on the characteristics of the pain. The four meridians involved in headache are Shaoyang (TE-GB channels, on the temporal sides of the head); Taiyang (SI-BL channels, occiput); Yangming (LI-ST channels, forehead) and Jueyin (PC-LR channels, vertex). The syndromes may be due to excess or deficit. Very generally, the excess syndromes correspond in the majority of cases to migraine and the deficit syndromes to TTH. Acupuncture is a complex intervention, which is also characterized by a close interaction between patient and therapist. The complicated system of TCM classification of headaches has frequently generated great diversity among the various therapeutic approaches used in the different studies on acupuncture in headache treatment. Despite these differences, the recent Cochrane systematic reviews on acupuncture in migraine and in TTH suggest that acupuncture is an effective and valuable option for patients suffering from migraine or frequent TTH. Moreover, acupuncture seems to be a cost-effective treatment.

  8. 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.

  9. [Iatrogenic after spinal puncture technique. Prevalence study of headache and associated factors].

    PubMed

    Bauset-Navarro, José Luis; Sánchez-Ortuño, Isabel M; Gómez-Cárdenas, Claudia; Sanz-Monllor, Ainara; Cinesi-Gómez, César; Piñera-Salmerón, Pascual

    2014-03-01

    Objetivo. Establecer la prevalencia existente de cefalea tras practicar una puncion lumbar transdural y los factores de riesgo. Pacientes y metodos. Estudio observacional prospectivo de cohortes. Se reclutaron pacientes del Servicio de Urgencias, del Servicio de Neurologia y del Hospital de Dia. Se recogio la experiencia del facultativo, el numero de punciones, la variacion de plano, la postura del paciente, el anestesico local, el calibre y bisel de la aguja, los grados de inclinacion, la cantidad de liquido, la sobrecarga de fluidoterapia y la indicacion o no de reposo tras la puncion. Tras 48 horas, se establecio la aparicion o no de cefalea. Resultados. Muestra de 59 pacientes, 31 (52,5%) de ellos hombres. Edad media: 47 años; 32 (54,2%) procedentes de Urgencias, 18 (30,5%) de Neurologia y 9 (15,3%) del Hospital de Dia. Hubo 41 (69,5%) en decubito lateral y 7 (11,9%) en sedestacion. Todos con agujas biseladas, 21 (35,6%) del calibre 20 y 38 (64,4%) del calibre 22. Sin reposo estuvieron 8 (13,56%) pacientes y 18 (33,3%) sin sobrecarga de fluidos. Veintitres (38,98%) con cefalea pospuncion lumbar, 12 (52,2%) mujeres, con una edad media de 38,3 ± 16,4 años. La mediana de intensidad de la cefalea fue de 2,6. El tiempo medio de aparicion fue de siete horas. Sin diferencias para ninguno de los factores estudiados, salvo la tendencia observada de mayor incidencia de cefalea a menor edad. Conclusiones. La cefalea pospuncion lumbar en nuestra serie es elevada, sin diferencias segun el servicio donde se practica o la experiencia. Tampoco influye la cantidad de liquido extraido, la posicion del paciente, la indicacion de reposo o la sobrecarga de fluidos.

  10. 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.

  11. 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.

  12. [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

  13. Aspartame and susceptibility to headache.

    PubMed

    Schiffman, S S; Buckley, C E; Sampson, H A; Massey, E W; Baraniuk, J N; Follett, J V; Warwick, Z S

    1987-11-01

    We performed a double-blind crossover trial of challenges with 30 mg of aspartame per kilogram of body weight or placebo in 40 subjects who reported having headaches repeatedly after consuming products containing aspartame. The incidence rate of headache after aspartame (35 percent) was not significantly different from that after placebo (45 percent) (P less than 0.50). No serious reactions were observed, and the incidence of symptoms other than headache following aspartame was also equivalent to that after placebo. No treatment-related effects were detected in vital signs, blood pressure, or plasma concentrations of cortisol, insulin, glucagon, histamine, epinephrine, or norepinephrine. Most of the subjects were well educated and overweight and had a family or personal history of allergic reactions. The subjects who had headaches had lower plasma concentrations of norepinephrine (P less than 0.0002) and epinephrine (P less than 0.02) just before the development of headache. We conclude that in this population, aspartame is no more likely to produce headache than placebo.

  14. [Headache from the neurological point of view].

    PubMed

    Krämer, G

    1984-08-01

    After a short review of the most important clinical signs of headaches including history and dynamic course as well as diagnostic management a systematic presentation of the most common neurological headache forms is given with the aid of tabular surveys. Considered are: psychogenic headache, tension headache, migraine including its special forms, cluster headache, headache associated with giant cell arteritis, meningeal irritation or space occupying cerebral lesions, trigeminal neuralgia and posttraumatic headache. Some less common special forms like the low spinal fluid pressure syndrome or the Tolosa Hunt syndrome are briefly discussed. PMID:6385099

  15. Dural arteriovenous fistula involving the anterior condylar canal.

    PubMed

    Cyril, Chivot; Ofélia, Marabotto; Hervé, Deramond

    2013-07-01

    Dural arteriovenous fistula (DAVF) of the anterior condylar canal is a rare subgroup of posterior fossa DAVF. Successful treatment of this DAVF requires an accurate image diagnosis and the knowledge of the anatomy of the anterior condylar confluent. We present the imaging features of angiography and MR angiography of a 54-year-old man, who presented progressive right synchronous tinnitus due to a DAVF of the anterior condylar confluent, successfully treated by transvenous embolization. PMID:22607489

  16. [Intracranial dural arteriovenous fistula draining into spinal cord veins: case report].

    PubMed

    Seda, Lauro Franco; Pieruccetti, Marco Antonio; Freitas, José Maria Modenesi; Listik, Sérgio; Pereira, Clemente Augusto Brito

    2002-09-01

    We present an usual case of intracranial dural arteriovenous fistula with perimedullary and spinal cord venous plexus drainage and discuss its etiological, physiopathological, diagnostic and therapeutic aspects.

  17. Headache during airplane travel ("airplane headache"): first case in Greece.

    PubMed

    Kararizou, Evangelia; Anagnostou, Evangelos; Paraskevas, George P; Vassilopoulou, Sofia D; Naoumis, Dimitrios; Kararizos, Grigoris; Spengos, Konstantinos

    2011-08-01

    Headache related to airplane flights is rare. We describe a 37-year-old female patient with multiple intense, jabbing headache episodes over the last 3 years that occur exclusively during airplane flights. The pain manifests during take-off and landing, and is located always in the left retro-orbital and frontotemporal area. It is occasionally accompanied by dizziness, but no additional symptoms occur. Pain intensity diminishes and disappears after 15-20 min. Apart from occasional dizziness, no other symptoms occur. The patient has a history of tension-type headache and polycystic ovaries. Blood tests and imaging revealed no abnormalities. Here, we present the first case in Greece. We review the current literature on this rare syndrome and discuss on possible pathophysiology and the investigation of possible co-factors such as anxiety and depression.

  18. [Evoked potentials in patients with secondary headaches].

    PubMed

    Iakupov, E Z; Kuznetsova, E A

    2010-01-01

    Characteristics of brain evoked activity were studied in patients with most frequent variants of secondary headaches: chronic posttraumatic headaches, cervicogenic headaches and vascular headaches in patients with arterial hypertension and chronic brain ischemia. The multimodal registration of evoked potentials (EP) (short-latency brainstem auditory, visual EPs to flash stimulation and cognitive EPs - P300) revealed signs of brainstem dysfunction, decrease of visual analyzer and diminished cognitive functions in most patients with secondary headaches. Based on results obtained, we can recommend a complex therapy of chronic secondary headaches with neuroprotectors and nootropics.

  19. Mind-body therapies for headache.

    PubMed

    Sierpina, Victor; Astin, John; Giordano, James

    2007-11-15

    Headache is one of the most common and enigmatic problems encountered by family physicians. Headache is not a singular entity, and different pathologic mechanisms are involved in distinct types of headache. Most types of headache involve dysfunction of peripheral or central nociceptive mechanisms. Mind-body therapies such as biofeedback, cognitive behavior therapy, hypnosis, meditation, and relaxation training can affect neural substrates and have been shown to be effective treatments for various types of headache. Meta-analyses of randomized controlled trials show that the use of mind-body therapies, alone or in combination, significantly reduces symptoms of migraine, tension, and mixed-type headaches. Side effects generally are minimal and transient.

  20. 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.

  1. Simple Systems for Detecting Spacecraft Meteoroid Punctures

    NASA Technical Reports Server (NTRS)

    Hall, Stephen B.

    2004-01-01

    A report describes proposed systems to be installed in spacecraft to detect punctures by impinging meteoroids or debris. Relative to other systems that have been used for this purpose, the proposed systems would be simpler and more adaptable, and would demand less of astronauts attention and of spacecraft power and computing resources. The proposed systems would include a thin, hollow, hermetically sealed panel containing an inert fluid at a pressure above the spacecraft cabin pressure. A transducer would monitor the pressure in the panel. It is assumed that an impinging object that punctures the cabin at the location of the panel would also puncture the panel. Because the volume of the panel would be much smaller than that of the cabin, the panel would lose its elevated pressure much faster than the cabin would lose its lower pressure. The transducer would convert the rapid pressure drop to an electrical signal that could trigger an alarm. Hence, the system would provide an immediate indication of the approximate location of a small impact leak, possibly in time to take corrective action before a large loss of cabin pressure could occur.

  2. The dural sheath of the optic nerve: descriptive anatomy and surgical applications.

    PubMed

    Francois, P; Lescanne, E; Velut, S

    2011-01-01

    The aim of this work was to clarify the descriptive anatomy of the optic dural sheath using microanatomical dissections on cadavers. The orbit is the rostral part of the extradural neural axis compartment; the optic dural sheath forms the central portion of the orbit.In order to describe this specific anatomy, we carefully dissected 5 cadaveric heads (10 orbits) up to the meningeal structure of the orbit and its contents. 1 cadaveric head was reserved for electron microscopy to add to our knowledge of the collagen structure of the optic dural sheath.In this chapter, we describe the anatomy of the interperiostal-dural concept and the anatomy of the orbit. The optic dural sheath contains three portions: the intracranial, the intracanalicular and the intraorbital segment. Each one has specific anatomic relations which result in particular surgical considerations.

  3. 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 ...

  4. 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/ ...

  5. 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

  6. Ryodoraku therapy for migraine headache.

    PubMed

    Okazaki, K; Sadove, M S; Kim, S I; Lee, M H; Cheng, D

    1975-01-01

    The authors discuss Ryodoraku electric acupuncture therapy in detail in Part I. The results of the treatment of migraine headache (20 cases) by Ryodoraku therapy were investigated in part II. In the present study 15 out of 20 patients achieved good to excellent responses to this type of therapy. PMID:1119438

  7. 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

  8. 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

  9. Onyx embolization of anterior condylar confluence dural arteriovenous fistula.

    PubMed

    Takemoto, Koichiro; Tateshima, Satoshi; Rastogi, Sachin; Gonzalez, Nestor; Jahan, Reza; Duckwiler, Gary; Vinuela, Fernando

    2014-03-01

    The anterior condylar confluence (ACC) is a small complex venous structure located medial to the jugular vein and adjacent to the hypoglossal canal. To our knowledge, this is the first report of transvenous Onyx embolization for ACC dural arteriovenous fistula (DAVF). Three patients with ACC DAVF were treated using the Onyx liquid embolic agent with or without detachable coils. Complete angiographic obliteration of the fistulas was achieved in all cases without permanent lower cranial neuropathy. This report suggests that the controlled penetration of Onyx is advantageous in order to obliterate ACC DAVFs with a small amount of embolic material.

  10. Onyx embolization of anterior condylar confluence dural arteriovenous fistula.

    PubMed

    Takemoto, Koichiro; Tateshima, Satoshi; Rastogi, Sachin; Gonzalez, Nestor; Jahan, Reza; Duckwiler, Gary; Vinuela, Fernando

    2013-01-01

    The anterior condylar confluence (ACC) is a small complex venous structure located medial to the jugular vein and adjacent to the hypoglossal canal. To our knowledge, this is the first report of transvenous Onyx embolization for ACC dural arteriovenous fistula (DAVF). Three patients with ACC DAVF were treated using the Onyx liquid embolic agent with or without detachable coils. Complete angiographic obliteration of the fistulas was achieved in all cases without permanent lower cranial neuropathy. This report suggests that the controlled penetration of Onyx is advantageous in order to obliterate ACC DAVFs with a small amount of embolic material.

  11. Dural arteriovenous fistula coexisting with a lumbar lipomeningocele. Case report.

    PubMed

    Rajeev, Kariyattil; Panikar, Dilip

    2005-11-01

    The authors describe the case of a 44-year-old woman who presented with recent onset of progressive paraparesis and bladder involvement; she had an asymptomatic lumbosacral lipomatous swelling that was present since birth. Magnetic resonance imaging confirmed the diagnosis of a lipomeningocele. It also revealed intramedullary hyperintensity on T2-weighted images and serpiginous flow voids suggestive of a dural arteriovenous fistula (DAVF) at the same level; the lesion was confirmed by spinal angiography. Both lesions were surgically managed, and the patient subsequently experienced neurological improvement. The coexistence of a DAVF and a lipomeningocele at the same level is unusual and can lead to treatment failure if missed.

  12. 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

  13. 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

  14. Aneurysmal Bone Cyst of the Temporal Bone Presenting with Headache and Partial Facial Palsy

    PubMed Central

    Kletke, Stephanie N.; Popovic, Snezana; Algird, Almunder; Alobaid, Abdullah; Reddy, Kesava K. V.

    2015-01-01

    Background Aneurysmal bone cysts (ABCs) are benign bony lesions that rarely affect the skull base. Very few cases of temporal bone ABCs have been reported. We describe the first case of a temporal bone ABC that was thought to be consistent with a meningioma based on preoperative magnetic resonance imaging (MRI) findings. Clinical Presentation An otherwise healthy 23-year-old woman presented with a pulsatile noise in her left ear and a 4-week history of throbbing headache with nausea. There was no associated emesis, visual or auditory changes, or other neurologic features. Neurologic examination revealed a left lower motor neuron facial paresis. Computed tomography and MRI studies demonstrated a large lesion in the left middle cranial fossa skull base with erosion of the petrous temporal bone. Based on the presence of a “dural tail” on preoperative contrast-enhanced T1-weighted imaging, the lesion was interpreted to likely be consistent with a meningioma. An orbitozygomatic approach was utilized for surgical excision. Histopathologic evaluation was consistent with an ABC. Conclusion Postoperatively the patient had improvement in the lower motor neuron facial paresis. It is important to consider ABC in the differential diagnosis of intracranial lesions accompanied by the dural tail sign on MRI. PMID:26251800

  15. 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…

  16. 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) ...

  17. [Integrated headache care network. Kiel Migraine and Headache Center and German National Headache Treatment Network].

    PubMed

    Göbel, H; Heinze-Kuhn, K; Petersen, I; Göbel, A; Heinze, A

    2013-04-01

    Migraine and other headaches affect 54 million people in Germany. They rank among the ten most severely disabling complaints and the three most expensive neurological disorders. Nevertheless, they are not adequately recognized in the healthcare system with sketchy diagnoses and inadequate treatment. This inadequate care is not primarily due to a lack of medical and scientific knowledge on the development and treatment of headaches but is predominantly due to organizational deficits in the healthcare system and in the implementation of current knowledge. To overcome the organizational barriers the national headache treatment network was initiated in Germany. For the first time it allows national cross-sectoral and multidisciplinary links between inpatient and outpatient care. A hand in hand treatment programme, better education, better information exchange between all partners and combined efforts using clearly defined treatment pathways and goals are the basis for state of the art and efficient treatment results. The treatment network is geared towards the specialized treatment of severely affected patients with chronic headache disorders. A national network of outpatient and inpatient pain therapists in both practices and hospitals works hand in hand to optimally alleviate pain in a comprehensive cross-sectoral and multidisciplinary manner. For therapy refractive disorders, a high-intensive supraregional fully inpatient treatment can be arranged. This concept offers for the first time a nationwide coordinated treatment without limitation by specialization and bureaucratic remuneration sectors.

  18. Intraoperative Brain Shift Compensation: Accounting for Dural Septa

    PubMed Central

    Chen, Ishita; Coffey, Aaron M.; Ding, Siyi; Dumpuri, Prashanth; Dawant, Benoit M.; Thompson, Reid C.

    2013-01-01

    Biomechanical models that describe soft tissue deformation provide a relatively inexpensive way to correct registration errors in image-guided neurosurgical systems caused by nonrigid brain shift. Quantifying the factors that cause this deformation to sufficient precision is a challenging task. To circumvent this difficulty, atlas-based methods have been developed recently that allow for uncertainty, yet still capture the first-order effects associated with deformation. The inverse solution is driven by sparse intraoperative surface measurements, which could bias the reconstruction and affect the subsurface accuracy of the model prediction. Studies using intraoperative MR have shown that the deformation in the midline, tentorium, and contralateral hemisphere is relatively small. The dural septa act as rigid membranes supporting the brain parenchyma and compartmentalizing the brain. Accounting for these structures in models may be an important key to improving subsurface shift accuracy. A novel method to segment the tentorium cerebelli will be described, along with the procedure for modeling the dural septa. Results in seven clinical cases show a qualitative improvement in subsurface shift accuracy making the predicted deformation more congruous with previous observations in the literature. The results also suggest a considerably more important role for hyperosmotic drug modeling for the intraoperative shift correction environment. PMID:21097376

  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. Case Studies of Uncommon and Rare Headache Disorders.

    PubMed

    Evans, Randolph W

    2016-08-01

    The following 6 case studies are presented: a 12-day migraine with recurring aura?; a migraineur with a new constant headache for 1 month; an orthostatic headache; a unilateral headache; migraine with aura and limb pain without headache; and nocturnal headaches. These cases illustrate the fascinating diversity and challenges of primary and secondary headaches that neurologists commonly encounter.

  2. Case Studies of Uncommon and Rare Headache Disorders.

    PubMed

    Evans, Randolph W

    2016-08-01

    The following 6 case studies are presented: a 12-day migraine with recurring aura?; a migraineur with a new constant headache for 1 month; an orthostatic headache; a unilateral headache; migraine with aura and limb pain without headache; and nocturnal headaches. These cases illustrate the fascinating diversity and challenges of primary and secondary headaches that neurologists commonly encounter. PMID:27445245

  3. Chronic daily headache in the elderly.

    PubMed

    Özge, Aynur

    2013-12-01

    Disabling headache disorders are ubiquitous in all age groups, including the elderly, yet they are under-recognized, underdiagnosed and undertreated worldwide. Surveys and clinic-based research reports on headache disorders in elderly populations are extremely limited in number. Chronic daily headache (CDH) is an important and growing subtype of primary headache disorders, associated with increased burden and disruption to quality of life. CDH can be divided into two forms, based on headache duration. Common forms of primary headache disorders of long duration (>4 hours) were comprehensively defined in the third edition of the International Classification of Headache Disorders (ICHD-3 beta). These include chronic migraine, chronic tension-type headache, new daily persistent headache, and hemicrania continua. Rarer short-duration (<4 hours) forms of CDH are chronic cluster headache, chronic paroxysmal hemicrania, SUNCT, and hypnic headache. Accurate diagnosis, management, and relief of the burden of CDH in the elderly population present numerous unique challenges as the "aging world" continues to grow. In order to implement appropriate coping strategies for the elderly, it is essential to establish the correct diagnosis at each step and to exercise caution in differentiating from secondary causes, while always taking into consideration the unique needs and limitations of the aged body.

  4. Cranial dural arteriovenous shunts. Part 1. Anatomy and embryology of the bridging and emissary veins.

    PubMed

    Baltsavias, Gerasimos; Parthasarathi, Venkatraman; Aydin, Emre; Al Schameri, Rahman A; Roth, Peter; Valavanis, Anton

    2015-04-01

    We reviewed the anatomy and embryology of the bridging and emissary veins aiming to elucidate aspects related to the cranial dural arteriovenous fistulae. Data from relevant articles on the anatomy and embryology of the bridging and emissary veins were identified using one electronic database, supplemented by data from selected reference texts. Persisting fetal pial-arachnoidal veins correspond to the adult bridging veins. Relevant embryologic descriptions are based on the classic scheme of five divisions of the brain (telencephalon, diencephalon, mesencephalon, metencephalon, myelencephalon). Variation in their exact position and the number of bridging veins is the rule and certain locations, particularly that of the anterior cranial fossa and lower posterior cranial fossa are often neglected in prior descriptions. The distal segment of a bridging vein is part of the dural system and can be primarily involved in cranial dural arteriovenous lesions by constituting the actual site of the shunt. The veins in the lamina cribriformis exhibit a bridging-emissary vein pattern similar to the spinal configuration. The emissary veins connect the dural venous system with the extracranial venous system and are often involved in dural arteriovenous lesions. Cranial dural shunts may develop in three distinct areas of the cranial venous system: the dural sinuses and their interfaces with bridging veins and emissary veins. The exact site of the lesion may dictate the arterial feeders and original venous drainage pattern.

  5. Cannabinoids and hallucinogens for headache.

    PubMed

    McGeeney, Brian E

    2013-03-01

    Hallucinogens and most cannabinoids are classified under schedule 1 of the Federal Controlled Substances Act 1970, along with heroin and ecstacy. Hence they cannot be prescribed by physicians, and by implication, have no accepted medical use with a high abuse potential. Despite their legal status, hallucinogens and cannabinoids are used by patients for relief of headache, helped by the growing number of American states that have legalized medical marijuana. Cannabinoids in particular have a long history of use in the abortive and prophylactic treatment of migraine before prohibition and are still used by patients as a migraine abortive in particular. Most practitioners are unaware of the prominence cannabis or "marijuana" once held in medical practice. Hallucinogens are being increasingly used by cluster headache patients outside of physician recommendation mainly to abort a cluster period and maintain quiescence for which there is considerable anecdotal success. The legal status of cannabinoids and hallucinogens has for a long time severely inhibited medical research, and there are still no blinded studies on headache subjects, from which we could assess true efficacy.

  6. An unusual presentation of spinal dural arteriovenous fistula: A case report

    PubMed Central

    Saadat, Payam; Adabi, Marzie

    2016-01-01

    Background: Spinal dural AVF is the most common type of spinal vascular malformation. However, presenting symptoms differ according to site of spinal involvement. This study described a case of arteriovenous malformation with paraparesis and incontinence. Case Presentation: Diagnosis of patient was confirmed by clinical and imaging examination using magnetic resonance image and ruling out other possibilities Result: A definitive diagnosis of arterio venous fistula was confirmed by clinical and MRI examination and demonstrated abnormalities compatible with dural arteriovenous fistula. Conclusion: Dural arteriovenous fistula should be considered in patients with paresis in both lower extremities. PMID:27757211

  7. 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

  8. 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.

  9. Stress and sleep duration predict headache severity in chronic headache sufferers.

    PubMed

    Houle, Timothy T; Butschek, Ross A; Turner, Dana P; Smitherman, Todd A; Rains, Jeanetta C; Penzien, Donald B

    2012-12-01

    The objective of this study was to evaluate the time-series relationships between stress, sleep duration, and headache pain among patients with chronic headaches. Sleep and stress have long been recognized as potential triggers of episodic headache (<15 headache days/month), though prospective evidence is inconsistent and absent in patients diagnosed with chronic headaches (≥15 days/month). We reanalyzed data from a 28-day observational study of chronic migraine (n=33) and chronic tension-type headache (n=22) sufferers. Patients completed the Daily Stress Inventory and recorded headache and sleep variables using a daily sleep/headache diary. Stress ratings, duration of previous nights' sleep, and headache severity were modeled using a series of linear mixed models with random effects to account for individual differences in observed associations. Models were displayed using contour plots. Two consecutive days of either high stress or low sleep were strongly predictive of headache, whereas 2 days of low stress or adequate sleep were protective. When patterns of stress or sleep were divergent across days, headache risk was increased only when the earlier day was characterized by high stress or poor sleep. As predicted, headache activity in the combined model was highest when high stress and low sleep occurred concurrently during the prior 2 days, denoting an additive effect. Future research is needed to expand on current findings among chronic headache patients and to develop individualized models that account for multiple simultaneous influences of headache trigger factors.

  10. Prevalence of Chronic Headache in Croatia

    PubMed Central

    Vuković-Cvetković, Vlasta; Lovrenčić-Huzjan, Arijana

    2013-01-01

    Background. Chronic headache describes the presence of headache for >15 days per month on average for >3 months and fulfills the rest of the IHS criteria. The prevalence of chronic headache is within the range of 0.5–7.3% worldwide. The aim of this study was to determine the 1-year prevalence of chronic headache in adult Croatian population. Methods. The data were collected from a cross-sectional survey of an adult population (>18 years of age) sample. Randomly selected patients from the general population in four Croatian cities were asked to fulfill a self-completed questionnaire. The prevalence of chronic headache was calculated in the sample representing 3 383 769 Croatian adults. Results. The total sample included 1542 responders among which 616 were with headache. The 1-year prevalence of chronic headache was 2.4%, and 0.9% of responders declared having headache 30 days per month. According to these results, 81 192 adult inhabitants in Croatia suffer from chronic headache. Conclusions. The prevalence of chronic headache in Croatia is comparable to other countries worldwide. These patients require special attention and should be offered multidisciplinary medical support. PMID:24078925

  11. Combined transarterial, transvenous, and direct puncture of the cavernous sinus to cure a traumatic carotid cavernous fistula.

    PubMed

    Lin, Chung-Jung; Luo, Chao-Bao; Chang, Feng-Chi; Teng, Michael Mu-Huo; Wang, Kao-Lun; Chu, Shu-Hsun

    2009-12-01

    Direct carotid cavernous fistulas (CCF) are generally well managed by simple endovascular treatment. We report an 8-year-old boy who required subsequent direct puncture of the cavernous sinus to completely obliterate the residual fistula after both transarterial and transvenous embolization had been performed. He presented with a mild right frontal headache, congestion of the right conjunctiva, blurred vision, and photophobia. Cerebral angiography demonstrated a right direct CCF. The patient underwent transarterial and transvenous embolization of the cavernous sinus (CS) with Gugliemi detached coils (GDCs), but a residual shunt persisted. Two days later, another session of embolization by direct puncture of the CS with GDCs was performed after failure to navigate through the superior ophthalmic vein which was partially occupied by previously deployed coils. Immediate control angiography showed complete obliteration of the fistula and the patient's symptoms rapidly resolved. This is the first report of a patient with a CCF who required three combined approaches - transarterial, transvenous, and direct puncture of the CS - to achieve complete closure of the complexed shunt.

  12. Case report: chronic sub-dural hematoma following high-speed ejection.

    PubMed

    Warburton, R

    1993-06-01

    This paper reports a case of chronic sub-dural hematoma occurring in a pilot after a high-speed ejection that was within the survival envelope of the Mark 10 Martin Baker ejection seat. The events leading up to the ejection, his subsequent hospitalization for treatment of immediate injuries and late development of neurological signs, 6 weeks after the ejection, are presented. (A thorough search of literature has failed to reveal any previously published account of chronic sub-dural hematoma as a post-ejection complication.) His surgical treatment, recovery, and final assessment are discussed together with the possible causes of his sub-dural hematoma. Flight surgeons should take careful note of the events in this case. Sub-dural hematoma is frequently difficult to diagnose but it should not be discounted as a potential late complication from an ejection which is within the parameters of survivability and which yields, initially, only signs of relatively minor injury. PMID:8338501

  13. [Volumetric valuation of dural sac by standard measurement on radiographs and saccoradiculographs (author's transl)].

    PubMed

    Surace, A; Balestra, R

    1979-08-01

    The Authors have planned to connect unexplained osphyalgias with dural pouch disease, through roentgenographic research. The Authors suggest a standard measurement primer to single out narrow pouches, in order to settle surgical operation.

  14. 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

  15. CD34 and dural fibroblasts: the relationship to solitary fibrous tumor and meningioma.

    PubMed

    Cummings, T J; Burchette, J L; McLendon, R E

    2001-10-01

    Intracranial solitary fibrous tumors (SFTs) are typically dural-based, CD34-positive neoplasms of uncertain histogenesis. We examined ten cases of meninges obtained at autopsy from patients with no history of neurological illness, head trauma, or neurosurgical intervention, and ten cases of typical meningiomas with attached dural margins not involved by tumor. All cases were immunostained with CD34. CD34 reactivity was noted in the long, thin delicate processes of dural fibroblasts preferentially located in the meningeal portion of the dura rather than the periosteal portion. No CD34 reactivity was identified in the arachnoid or pia mater, except in some endothelial cells. One supratentorial dural-based fibrous nodule and one SFT within the confines of the fourth ventricle showed strong and diffuse reactivity to CD34, bcl-2, and vimentin, and were negative for epithelial membrane antigen (EMA), S-100 protein, glial fibrillary acidic protein, smooth muscle actin, and desmin. We also describe a meningothelial meningioma within which a well circumscribed SFT-like nodule was embedded. The SFT-like nodule was strongly CD34 positive and EMA negative, and the meningioma was strongly EMA positive and CD34 negative. Fibroblasts of the dural border cell layer are attached to the underlying arachnoid, and their inclusion with arachnoidal stromal elements and pial-based tela choroidea during formation of choroid plexus interstitium may account for intraventricular SFTs. Our results suggest that SFTs and dural-based fibrous nodules derive from CD34-positive dural-based fibroblasts, and that CD34 reactivity in meningiomas may result from inclusion of dural fibroblasts within the neoplasm.

  16. Sepsis Induced by Cecal Ligation and Puncture

    PubMed Central

    Wen, Haitao

    2014-01-01

    Summary Despite advances in intensive care unit interventions, including the use of specific antibiotics and anti-inflammation treatment, sepsis with concomitant multiple organ failure is the most common cause of death in many acute care units. In order to understand the mechanisms of clinical sepsis and develop effective therapeutic modalities, there is a need to use effective experimental models that faithfully replicate what occurs in patients with sepsis. Several models are commonly used to study sepsis, including intravenous endotoxin challenge, injection of live organisms into the peritoneal cavity, establishing abscesses in the extremities, and the induction of polymicrobial peritonitis via cecal ligation and puncture (CLP). Here, we describe the surgery procedure of CLP in mice, which has been proposed to closely replicate the nature and course of clinical sepsis in humans. PMID:23824895

  17. 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.

  18. Development of a sutureless dural substitute from Bombyx mori silk fibroin.

    PubMed

    Flanagan, Kelly E; Tien, Lee W; Elia, Roberto; Wu, Julian; Kaplan, David

    2015-04-01

    Silk solvent casting, electrospinning, and electrogelation techniques were used to create a biodegradable, biocompatible silk fibroin dural substitute. The all-silk system was designed and produced to improve on currently available materials, grafts and tissue sealants used for dural closure in neurosurgery. The silk biomaterial was successfully fabricated as a dual layer adhesive system designed to seal durotomies while also functioning as a dural regeneration scaffold. The mechanical characteristics, biocompatibility, biodegradability, and hydrodynamic sealing capability of the material were evaluated. Results showed that the biomaterial was biocompatible with neural cells and fibroblasts, had mechanical properties mimicking the natural dura, was biodegradable with controllable degradation, and was able to seal against a hydrodynamic pressure of 205 mmHg, which greatly exceeds the maximum cerebrospinal fluid pressure seen in both cranial and spinal dural closures of 50 mmHg. Based on its design and experimental results, the adhesive silk dual layer composite biomaterial shows potential as a sutureless dural repair system that would improve on current dural closure techniques. PMID:24919581

  19. [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.

  20. 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

  1. Radiofrequency treatment of cervicogenic headache

    PubMed Central

    Peñarrocha, Miguel; Peñarrocha, Maria; Calvo, Ana; Jiménez, Alejandro; March, Rafael

    2013-01-01

    Objectives: In the clinical management of facial pain, a possible cervical origin must be considered. A clinical exploration is therefore essential. The disorder originates in the intimate connections between the cranial portion of the spinal cord and the trigeminal system. Although solid evidence supporting the use of radiofrequency (RF) treatment is lacking, it remains one of the management options to be taken into account. The present study evaluates the efficacy of RF in application to cervicogenic headache. Study design: We present three cases of severe facial pain arising from different cervical structures. Results: In two cases the pain originated in cervical roots C2 and C3, while in the third patient the trigger point was located at the level of the atlantoaxial joint. Pulsed RF was applied for 4 minutes at the dorsal ganglion of C2 and C3 in the first two cases, and for 8 minutes at intraarticular level in the third patient. The pain gradually subsided during the first month in all cases. The first two patients reported 70% improvement after one month, 60% improvement after 6 months, and 30-50% after one year, versus baseline. The third patient reported complete pain resolution lasting approximately 5 months, after which the pain reappeared with the same intensity as before. Conclusions: Radiofrequency is a satisfactory treatment option, affording adequate analgesia, though the effects are sometimes temporary. Key words:Cervicogenic headache, pulsed radiofrequency, analgesia. PMID:23229235

  2. 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)

  3. Aspartame as a dietary trigger of headache.

    PubMed

    Lipton, R B; Newman, L C; Cohen, J S; Solomon, S

    1989-02-01

    Many dietary factors have been implicated as possible precipitants of headache. There have been recent differences of opinion with regard to the effect of the artificial sweetener aspartame as a precipitant of headache. To assess the importance of aspartame as a dietary factor in headache, 190 consecutive patients of the Montefiore Medical Center Headache Unit were questioned about the effect of alcohol, carbohydrates and aspartame in triggering their headaches. Of the 171 patients who fully completed the survey, 49.7 percent reported alcohol as a precipitating factor, compared to 8.2 percent reporting aspartame and 2.3 percent reporting carbohydrates. Patients with migraine were significantly more likely to report alcohol as a triggering factor and also reported aspartame as a precipitant three times more often than those having other types of headache. The conflicting results of two recent placebo-control studies of aspartame and headache are discussed. We conclude that aspartame may be an important dietary trigger of headache in some people.

  4. Pain sensitivity and headache: an examination of the central theory.

    PubMed

    Marlowe, N I

    1992-01-01

    The central theory of headache was investigated by examining pain sensitivity in headache sufferers and headache-free controls. Headache subjects had lower pain threshold and tolerance levels than controls for electrical stimulation of the finger. Headache subjects also had a lesser tolerance for pain induced by the application of ice to the temporal region, but there was no significant difference between groups on temporal ice pain threshold. Sensitivity to finger pain was not affected by the presence or absence of headache at the time of testing. No significant differences between tension and migraine subjects were observed; neither were headache subjects, reporting unilateral headaches, significantly more sensitive to temporal ice pain on the side affected by headache. It was concluded that headache sufferers may be more sensitive to pain than headache-free persons but, that this heightened sensitivity is not specific to the head, and in itself, seems unable to account for the locus of headache. PMID:1538347

  5. 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.

  6. Complementary and Integrative Approaches for Pediatric Headache.

    PubMed

    Kedia, Sita

    2016-02-01

    In this article, the use of complementary and integrative medicine for the management of pediatric headache is reviewed. Despite limited numbers of studies for pediatric headaches, children and families seek these services. Integrative medicine focuses on treating the whole person, integrating conventional medicine with mind-body-spirit methods. Nutriceuticals include dietary supplements in the form of vitamins (vitamin D), minerals (magnesium), coenzyme Q, butterbur, and melatonin. Acupuncture, stimulation, physical therapy and Transcutaneous Electrical Nerve Stimulations (TENS) or Transcranial Magnetic Stimulation (TMS) may also be useful in selected patients. The efficacy of all these therapeutic alternatives in pediatric headache is presented here. Primary care providers, neurologists, and headache specialists alike need to be informed of such interventions and integrate these approaches, when appropriate, in the management of children with headaches. PMID:27017022

  7. 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

  8. Headaches after Concussion in Pediatrics: a Review.

    PubMed

    Blume, Heidi K

    2015-09-01

    Concussion and mild traumatic brain injury (TBI) are common pediatric injuries. Headaches are one of the most common and disabling complaints following concussion in the acute phase and are pervasive in those who have prolonged symptoms following concussion. The body of evidence regarding the epidemiology of and risk factors for pediatric concussion and post-traumatic headache is growing rapidly, but there still is a distinct lack of strong scientific evidence to support the best treatment strategies for post-traumatic headaches in either children or adults. In this article, we will review the current evidence regarding the epidemiology of acute and chronic headaches following concussion in the pediatric population, as well as current recommendations for the management of acute and chronic pediatric post-traumatic headaches.

  9. Neurogenic vascular headaches, food and chemical triggers.

    PubMed

    Trotsky, M B

    1994-04-01

    Recent evidence has demonstrated that neurogenic vascular headaches are a combination of neurological primary events and secondary vasomotor changes. The neurological events involve the hypothalamus and sensory cortex with sympathetic hypofunction and noradrenergic abnormalities. A platelet theory has been proposed but has not really been confirmed as a legitimate cause of the neurogenic vascular headaches. Food and chemicals in foods can act as a precipitating factor in the food-sensitive neurogenic vascular headache patient. In these patients evidence is now being demonstrated to confirm this, but larger patient studies are needed. The food-sensitive migraine patient and cluster headache patient must give a good history and food diary to go along with active challenges and provocative testing in order to determine the causative foods. Any concomitant allergies of inhalants or environmentals must also be treated. The treatment modalities of elimination and rotation diets or provocation neutralization may successfully control the headaches without the need for continuous medications.

  10. Behaviour during a cluster headache.

    PubMed

    Blau, J N

    1993-09-18

    Because cluster headache is short-lasting and tends to occur during the early morning hours, physicians rarely witness an attack. Accurate diagnosis is important because effective treatments are available. The diagnosis is made from the history of temporal pattern, reddening and tearing of the affected eye, and ipsilateral nasal congestion. An additional diagnostic aid is to invite patients to demonstrate how they respond to attacks. The pain, one of the worst known, causes extreme restlessness. 50 patients showed how they walk around, sit (or kneel) and rock, and clutch the affected side of the head. Diagnostic value apart, the patient will often be relieved to learn that bizarre behavioural responses are not a mark of insanity.

  11. [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

  12. Transarterial and Transvenous Embolization for Cavernous Sinus Dural Arteriovenous Fistulae

    PubMed Central

    Zhang, J.; Lv, X.; Jiang, C.; Li, Y.; Yang, X.; Wu, Z.

    2010-01-01

    Summary We report on the safety and efficacy of transarterial and transvenous Onyx embolization in the treatment of dural arteriovenous fistulae (DAVFs) of the cavernous sinus. We reviewed the findings from a retrospectively database for 22 patients with cavernous sinus DAVFs who were treated with either transarterial Onyx embolization alone (n = 8) or transarterial and transvenous Onyx embolization (n = 14) over a four year period. The mean follow-up period after endovascular treatment was 21.6 months (range 3-42 mths). Total number of embolizations was 27 for 22 patients. Two patients were treated transvenously after transarterial embolization. All 22 patients (100%) experienced improvement of their clinical symptoms. All 22 patients (100%) experienced total obliteration of their DAVFs, as documented by angiography performed at a mean follow-up of 5.8 months after the last treatment. No patient experienced a recurrence of symptoms after angiography showed DAVF obliteration. One patient exhibited temporary deterioration of ocular symptoms secondary to venous hypertension after near total obliteration; one had transient V cranial nerve deficit related to transarterial embolization, and two patients exhibited transient III and VI cranial nerve weakness related to transvenous embolization. Two patients experienced recurrent symptoms after incomplete transarterial embolization and underwent transvenous embolization at three and four months. Both patients achieved clinical and angiographic cures. Transarterial and transvenous embolization with Onyx, whenever possible, proved to be a safe and effective management for patients with cavernous sinus DAVFs. PMID:20977859

  13. Cervical Myelopathy Caused by Intracranial Dural Arteriovenous Fistula

    PubMed Central

    Kim, Won Young; Kim, Jin Bum; Nam, Taek Kyun; Kim, Young Baeg

    2016-01-01

    Intracranial dural arteriovenous fistula (dAVF) usually results in various problems in the brain. But it can be presented as a myelopathy, which may make early diagnosis and management to be difficult. We recently experienced a case of cervical myelopathy caused by intracranial dAVF. A 60-year-old man presented with a 3-year history of gait disturbance due to a progressive weakness of both legs. Neurological examination revealed spastic paraparesis (grade IV) and Babinski sign on both sides. Magnetic resonance imaging showed serpentine vascular signal voids at C2-T1 on T2-weighted image with increased signal intensity and swelling of spinal cord at C1-C4. We performed a brain computed tomography angiography and found intracranial dAVF with multiple arteriovenous shunts. Venous drainages were noted at tentorial veins and cervical perimedullary veins. After Onyx embolization, the patient showed gradual improvement in motor power and gait disturbance. The venous drainage pattern is a well-known prognostic factor of dAVF. In our case, the intracranial dAVF drained to spinal perimedullary vein, which seemed to result in the ischemic myelopathy. Although it is rare condition, it sometimes can cause serious complications. Therefore, we should keep in mind the possibility of intracranial dAVF when a patient presents myelopathy. PMID:27437016

  14. Cervical Myelopathy Caused by Intracranial Dural Arteriovenous Fistula.

    PubMed

    Kim, Won Young; Kim, Jin Bum; Nam, Taek Kyun; Kim, Young Baeg; Park, Seung Won

    2016-06-01

    Intracranial dural arteriovenous fistula (dAVF) usually results in various problems in the brain. But it can be presented as a myelopathy, which may make early diagnosis and management to be difficult. We recently experienced a case of cervical myelopathy caused by intracranial dAVF. A 60-year-old man presented with a 3-year history of gait disturbance due to a progressive weakness of both legs. Neurological examination revealed spastic paraparesis (grade IV) and Babinski sign on both sides. Magnetic resonance imaging showed serpentine vascular signal voids at C2-T1 on T2-weighted image with increased signal intensity and swelling of spinal cord at C1-C4. We performed a brain computed tomography angiography and found intracranial dAVF with multiple arteriovenous shunts. Venous drainages were noted at tentorial veins and cervical perimedullary veins. After Onyx embolization, the patient showed gradual improvement in motor power and gait disturbance. The venous drainage pattern is a well-known prognostic factor of dAVF. In our case, the intracranial dAVF drained to spinal perimedullary vein, which seemed to result in the ischemic myelopathy. Although it is rare condition, it sometimes can cause serious complications. Therefore, we should keep in mind the possibility of intracranial dAVF when a patient presents myelopathy. PMID:27437016

  15. 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

  16. Information computer program for laser therapy and laser puncture

    NASA Astrophysics Data System (ADS)

    Badovets, Nadegda N.; Medvedev, Andrei V.

    1995-03-01

    An informative computer program containing laser therapy and puncture methods has been developed. It was used successfully in connection with the compact Russian medical laser apparatus HELIOS-O1M in laser treatment and the education process.

  17. Cauda Equina Syndrome Associated with Dural Ectasia in Chronic Anlylosing Spondylitis

    PubMed Central

    Ha, Sang-woo

    2014-01-01

    Cauda equina syndrome (CES) associated with dural ectasia is a rare neurologic complication in patients with longstanding ankylosing spondylitis (AS). We report a 68-year-old male with a 30-year history of AS who presented a typical symptom and signs of progressive CES, urinary incontinence and neuropathic pain of the lumbosacral radiculopathy. Computed tomography (CT) and magnetic resonance imaging (MRI) findings showed the unique appearances of dural ectasia, multiple dural diverticula, erosion of posterior element of the lumbar spine, tethering of the conus medullaris and adhesion of the lumbosacral nerve roots to the posterior aspect of the dural ectasia. Considering the progressive worsening of the clinical signs, detethering of the conus medullaris through resection of the filum terminale was performed through a limited laminectomy. However, the urinary incontinence did not improve and there was a partial relief of the neuropathic leg pain only. The possible pathogenetic mechanism of CES-AS and the dural ectasia in this patient with longstanding AS are discussed with a literature review. PMID:25628815

  18. Bacterial cellulose membranes used as artificial substitutes for dural defection in rabbits.

    PubMed

    Xu, Chen; Ma, Xia; Chen, Shiwen; Tao, Meifeng; Yuan, Lutao; Jing, Yao

    2014-06-16

    To improve the efficacy and safety of dural repair in neurosurgical procedures, a new dural material derived from bacterial cellulose (BC) was evaluated in a rabbit model with dural defects. We prepared artificial dura mater using bacterial cellulose which was incubated and fermented from Acetobacter xylinum. The dural defects of the rabbit model were repaired with BC membranes. All surgeries were performed under sodium pentobarbital anesthesia, and all efforts were made to minimize suffering. All animals were humanely euthanized by intravenous injection of phenobarbitone, at each time point, after the operation. Then, the histocompatibility and inflammatory effects of BC were examined by histological examination, real-time fluorescent quantitative polymerase chain reaction (PCR) and Western Blot. BC membranes evenly covered the surface of brain without adhesion. There were seldom inflammatory cells surrounding the membrane during the early postoperative period. The expression of inflammatory cytokines IL-1β, IL-6 and TNF-α as well as iNOS and COX-2 were lower in the BC group compared to the control group at 7, 14 and 21 days after implantation. BC can repair dural defects in rabbit and has a decreased inflammatory response compared to traditional materials. However, the long-term effects need to be validated in larger animals.

  19. Bacterial Cellulose Membranes Used as Artificial Substitutes for Dural Defection in Rabbits

    PubMed Central

    Xu, Chen; Ma, Xia; Chen, Shiwen; Tao, Meifeng; Yuan, Lutao; Jing, Yao

    2014-01-01

    To improve the efficacy and safety of dural repair in neurosurgical procedures, a new dural material derived from bacterial cellulose (BC) was evaluated in a rabbit model with dural defects. We prepared artificial dura mater using bacterial cellulose which was incubated and fermented from Acetobacter xylinum. The dural defects of the rabbit model were repaired with BC membranes. All surgeries were performed under sodium pentobarbital anesthesia, and all efforts were made to minimize suffering. All animals were humanely euthanized by intravenous injection of phenobarbitone, at each time point, after the operation. Then, the histocompatibility and inflammatory effects of BC were examined by histological examination, real-time fluorescent quantitative polymerase chain reaction (PCR) and Western Blot. BC membranes evenly covered the surface of brain without adhesion. There were seldom inflammatory cells surrounding the membrane during the early postoperative period. The expression of inflammatory cytokines IL-1β, IL-6 and TNF-α as well as iNOS and COX-2 were lower in the BC group compared to the control group at 7, 14 and 21 days after implantation. BC can repair dural defects in rabbit and has a decreased inflammatory response compared to traditional materials. However, the long-term effects need to be validated in larger animals. PMID:24937688

  20. 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.

  1. [The myth of tension-type headache].

    PubMed

    Diaz-Insa, Samuel

    2014-03-10

    Tension-type headache is an entity recognised by the International Headache Society in its International Headache Classification. The limits of this condition, however, are somewhat fuzzy and poorly defined, and its diagnostic criteria are a sort of negation of the symptoms of migraine. In this review we are especially interested in highlighting the diagnostic vagueness in patients with chronic tension-type headache. This refers, above all, to those with a clear history of migraine and who continue to suffer a number of crises with symptoms of migraine, although they have headaches with tension-type features on a daily basis. Emphasis will be placed on the novel concept of chronic migraine which, today, can include these patients, and has not only diagnostic but also, and above all, therapeutic implications. Tension-type headache is a clinical syndrome that probably covers a series of entities with important aetiopathogenic differences from one to another and, perhaps sometime in the future, many patients who are now labelled as having been diagnosed with this condition will be classified further as having other better-defined diseases. In any case, although it might sound like a myth or just pie-in-the-sky, the tension-type headache is still needed to encompass these entities that are lacking any better-defined diagnoses.

  2. Endorphin patterns within the headache spectrum disorders.

    PubMed

    Nappi, G; Facchinetti, F; Martignoni, E; Petraglia, F; Manzoni, G C; Sances, G; Sandrini, G; Genazzani, A R

    1985-05-01

    The role of opioid peptides in modulating the nervous system adaptability has been demonstrated recently; proopiomelanocortin (POMC)-related peptides, in particular, serve in pain perception, in adaptation to stress, and in modulating higher brain functions. Primary headaches, besides pain, involve neuroendocrine/autonomic/adaptive processes as well as mood and personality factors. The view that primary headaches can be taken as a possible model of POMC-related peptides dysfunction led us to evaluate the resting plasma and CSF peptide levels and their plasma changes in response to various stimuli affecting their release. The data obtained from basal and dynamic studies agree with the concept that primary headaches are sustained by opioid system disturbance. In particular the reduced release of endogenous opioids by anterior pituitary in response to physical, endocrine or pharmacological stimuli agrees with a weak adaptive ability of headache sufferers. This impairment of endorphin responsiveness could play a key role in headache susceptibility to environmental stimuli. Primary headaches constitute a wide, intriguing field, including several subgroups bordering on "ischemic" and behavioral/affective disorders. The development of neuroendocrine techniques could be a useful means for supporting the clinical criteria identifying subpopulations of headache sufferers.

  3. History of headache research in Denmark.

    PubMed

    Tfelt-Hansen, P

    2001-09-01

    Headache research in Denmark started with the description in 1949 by Dalsgaard-Nielsen of the percutaneous nitroglycerin test. In 1976 Jes Olesen started The Copenhagen Acute Headache Clinic and from that time modern headache research began in Denmark. Specific changes in regional cerebral blood flow during attacks of migraine with aura, spreading oligaemia, were described for the first time in 1980. The first headache classification with operational diagnostic criteria was published in 1988 and used in a Danish population study from 1989. The lifetime prevalence of migraine was 8% in men and 25% in women. An intravenous nitroglycerin test was introduced in 1989 and has been developed as an experimental headache model. In 1993 it was suggested by Jes Olesen et al. that NO supersensitivity could be a possible molecular mechanism of migraine pain. Recent genetic studies have supported the distinction between migraine with aura and migraine without aura. From the middle of the 1980s the pathophysiology of tension-type headache has been investigated and recent results indicate central sensitization in patients with chronic tension-type headache.

  4. Self-healing flexible laminates for resealing of puncture damage

    NASA Astrophysics Data System (ADS)

    Beiermann, B. A.; Keller, M. W.; Sottos, N. R.

    2009-08-01

    A flexible self-healing system capable of healing puncture damage has been manufactured. Our material consists of three layers: a poly(dimethyl siloxane) (PDMS) composite, embedded with a self-healing microcapsule system, sandwiched between two layers of poly(urethane) coated nylon. The total structure thickness ranges between 0.84 and 1.5 mm. A protocol is established in which samples are damaged using a hypodermic needle or a razor blade, and a successful heal is defined as the ability to reseal the damage to withstand a pressure differential across the laminate of 103 kPa (~1 atm). Trends in healing success are analyzed as a function of microcapsule size, self-healing layer thickness, and puncture diameter. Healing varied significantly with microcapsule size, with the maximum healing success rate (100% successfully healed) occurring in samples with 220 µm microcapsules and a puncture diameter of 0.49 mm. For this puncture size, an increase in microcapsule diameter corresponds to a decrease in healing efficiency. However, samples with larger microcapsules (up to 500 µm avg.) demonstrate more effective healing for larger puncture diameters, up to 1.61 mm. Additionally, healing increased with composite layer thickness, and decreased with increasing puncture hole size.

  5. Clinical Evaluation of Cervicogenic Headache: A Clinical Perspective

    PubMed Central

    Hall, Toby; Briffa, Kathy; Hopper, Diana

    2008-01-01

    Headache is a common complaint that affects the majority of the population at some point in their lives. The underlying pathological bases for headache symptoms are many, diverse, and often difficult to distinguish. Classification of headache is principally based on the evaluation of headache symptoms as well as clinical testing. Although manual therapy has been advocated to treat a variety of different forms of headache, the current evidence only supports treatment for cervicogenic headache (CGH). This form of headache can be identified from migraine and other headache forms by a comprehensive musculoskeletal examination. Examination and subsequent diagnosis is essential not only to identify patients with headache where manual therapy is appropriate but also to form a basis for selection of the most appropriate treatment for the identified condition. The purpose of this paper is to outline, in clinical terms, the classification of headache, so that the clinician can readily identify those patients with headache suited to manual therapy. PMID:19119390

  6. Neurostimulation in the treatment of primary headaches.

    PubMed

    Miller, Sarah; Sinclair, Alex J; Davies, Brendan; Matharu, Manjit

    2016-10-01

    There is increasing interest in using neurostimulation to treat headache disorders. There are now several non-invasive and invasive stimulation devices available with some open-label series and small controlled trial studies that support their use. Non-invasive stimulation options include supraorbital stimulation (Cefaly), vagus nerve stimulation (gammaCore) and single-pulse transcranial magnetic stimulation (SpringTMS). Invasive procedures include occipital nerve stimulation, sphenopalatine ganglion stimulation and ventral tegmental area deep brain stimulation. These stimulation devices may find a place in the treatment pathway of headache disorders. Here, we explore the basic principles of neurostimulation for headache and overview the available methods of neurostimulation. PMID:27152027

  7. Neurostimulation in the treatment of primary headaches.

    PubMed

    Miller, Sarah; Sinclair, Alex J; Davies, Brendan; Matharu, Manjit

    2016-10-01

    There is increasing interest in using neurostimulation to treat headache disorders. There are now several non-invasive and invasive stimulation devices available with some open-label series and small controlled trial studies that support their use. Non-invasive stimulation options include supraorbital stimulation (Cefaly), vagus nerve stimulation (gammaCore) and single-pulse transcranial magnetic stimulation (SpringTMS). Invasive procedures include occipital nerve stimulation, sphenopalatine ganglion stimulation and ventral tegmental area deep brain stimulation. These stimulation devices may find a place in the treatment pathway of headache disorders. Here, we explore the basic principles of neurostimulation for headache and overview the available methods of neurostimulation.

  8. Neurostimulation in the treatment of primary headaches

    PubMed Central

    Miller, Sarah; Sinclair, Alex J; Davies, Brendan; Matharu, Manjit

    2016-01-01

    There is increasing interest in using neurostimulation to treat headache disorders. There are now several non-invasive and invasive stimulation devices available with some open-label series and small controlled trial studies that support their use. Non-invasive stimulation options include supraorbital stimulation (Cefaly), vagus nerve stimulation (gammaCore) and single-pulse transcranial magnetic stimulation (SpringTMS). Invasive procedures include occipital nerve stimulation, sphenopalatine ganglion stimulation and ventral tegmental area deep brain stimulation. These stimulation devices may find a place in the treatment pathway of headache disorders. Here, we explore the basic principles of neurostimulation for headache and overview the available methods of neurostimulation. PMID:27152027

  9. 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

  10. Psychiatric comorbidity in childhood and adolescence headache.

    PubMed

    Dyb, Grete; Stensland, Synne; Zwart, John-Anker

    2015-03-01

    Primary headaches among children and adolescents have a substantial impact on quality of life, daily activities, social interaction, and school performance in combination with psychopathological symptoms. The main purpose of the present paper is to summarize clinical and epidemiological evidence for psychiatric comorbidity among children and adolescents with headaches, to describe how evidence in headache research suggest different pathways involved in the development and maintenance of these comorbid conditions, and finally suggest some elements professionals may find helpful to assess the scope of complaints, related functional impairment, and potential precipitating factors in planning of more targeted treatments.

  11. 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

  12. Computed tomographic epidurography: an aid to understanding deformation of the lumbar dural sac by epidural injections.

    PubMed

    Fukushige, T; Kano, T; Sano, T; Irie, M

    1999-09-01

    Local anaesthetics injected into the epidural space may deform the dural sac to a variable degree, thereby contributing to variability in the extent of the block. We investigated deformation of the lumbar dural sac after injection into the lumbar epidural space. The subjects were 26 patients with low-back pain who underwent lumbar epidurography and computed tomographic (CT) epidurography, of whom seven also underwent myelography and computed tomographic myelography. The epidural space was entered via the sacral hiatus in 24 patients and through the L5/S1 interspace in two patients. Ten millilitres of local anaesthetic was then injected into the epidural space followed by 20 mL of contrast medium. Computed tomographic epidurography was undertaken approximately 30-min after the epidural injection at the mid-vertebral and mid-discal levels from the first lumbar through to the first sacral vertebrae. The dural sac usually showed an oval or hexagonal shape on the transverse views at the first and second lumbar vertebral levels, and the shape of an inverted triangle below the level of the third lumbar vertebra. A median line of translucency was also observed on the posteroanterior epidurographic view in 25 of the 26 patients. This line was though to be a manifestation of the dural deformation to the inverted triangle. Dural sac deformation usually shows a specific pattern, although there are individual variations. Dural deformability is an important consideration in any analysis of the spread of epidural block or of the changes of epidural pressure after epidural injection of local anaesthetics. PMID:10549463

  13. 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 ...

  14. New daily persistent headache: an update.

    PubMed

    Rozen, Todd D

    2014-07-01

    New daily persistent headache is a primary headache disorder marked by a unique temporal profile which is daily from onset. For many sufferers this is their first ever headache. Very little is known about the pathogenesis of this condition. It might be a disorder of abnormal glial activation with persistent central nervous system inflammation and it may be a syndrome that occurs in individuals who have a history of cervical hypermobility. At present there is no known specific treatment and many patients go for years to decades without any improvement in their condition despite aggressive therapy. This article will present an up-to-date overview of new daily persistent headache on the topics of clinical presentation, treatment, diagnostic criteria, and presumed pathogenesis. It will also provide some of the authors own treatment suggestions based on recognized triggering events and some suggestions for future clinical trials. PMID:24820732

  15. Acupuncture for tension-type headache

    PubMed Central

    Linde, Klaus; Allais, Gianni; Brinkhaus, Benno; Manheimer, Eric; Vickers, Andrew; White, Adrian R

    2011-01-01

    Background Acupuncture is often used for tension-type headache prophylaxis but its effectiveness is still controversial. This review (along with a companion review on ‘Acupuncture for migraine prophylaxis’) represents an updated version of a Cochrane review originally published in Issue 1, 2001, of The Cochrane Library. Objectives To investigate whether acupuncture is a) more effective than no prophylactic treatment/routine care only; b) more effective than ‘sham’ (placebo) acupuncture; and c) as effective as other interventions in reducing headache frequency in patients with episodic or chronic tension-type headache. Search strategy The Cochrane Pain, Palliative & Supportive Care Trials Register, CENTRAL, MEDLINE, EMBASE and the Cochrane Complementary Medicine Field Trials Register were searched to January 2008. Selection criteria We included randomized trials with a post-randomization observation period of at least 8 weeks that compared the clinical effects of an acupuncture intervention with a control (treatment of acute headaches only or routine care), a sham acupuncture intervention or another intervention in patients with episodic or chronic tension-type headache. Data collection and analysis Two reviewers checked eligibility; extracted information on patients, interventions, methods and results; and assessed risk of bias and quality of the acupuncture intervention. Outcomes extracted included response (at least 50% reduction of headache frequency; outcome of primary interest), headache days, pain intensity and analgesic use. Main results Eleven trials with 2317 participants (median 62, range 10 to 1265) met the inclusion criteria. Two large trials compared acupuncture to treatment of acute headaches or routine care only. Both found statistically significant and clinically relevant short-term (up to 3 months) benefits of acupuncture over control for response, number of headache days and pain intensity. Long-term effects (beyond 3 months) were not

  16. Gum-Chewing and Headache: An Underestimated Trigger of Headache Pain in Migraineurs?

    PubMed

    Lippi, Giuseppe; Cervellin, Gianfranco; Mattiuzzi, Camilla

    2015-01-01

    Tension-type headache and migraine are currently considered the second and third most frequent human diseases. Since a variety of conditions that involve the temporomandibular joint and chewing muscles are frequent causes of orofacial pain, the aim of this article was to review current published evidence about the potential relationship between gum-chewing and headache. A systematic electronic search performed on Medline, Scopus and Web of Science using the keywords "headache" or "migraine" and "chewing" allowed to finally identify 1 cross-sectional, 1 observational and 3 randomized studies, along with 3 case reports about the potential association between gum-chewing and headache. Despite the limited evidence, it seems reasonable to suggest that headache attacks may be triggered by gum-chewing in migraineurs and in patients with tension-type headache. Opposite results were obtained in non-migraineurs, since in none of these studies an increased prevalence of headache pain was reported after gum-chewing. Although larger randomized studies will be necessary to definitely establish the relationship between gum-chewing and headache across different populations, it seems cautionary to suggest that subjects with migraine or tension-type headache should avoid or limit gum-chewing in their lifestyle. PMID:25714969

  17. 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.

  18. 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.

  19. 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

  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. Epidemiology of headache in Arab countries.

    PubMed

    Benamer, Hani T S; Deleu, Dirk; Grosset, Donald

    2010-02-01

    The epidemiology of headache in Arab countries was systematically reviewed through Medline identification of four papers reporting headache prevalence in the Arab nations of Qatar, Saudi Arabia (2 papers) and Oman. The prevalence of headache varied from 8 to 12% in Saudi Arabia to 72.5% in Qatar and 83.6% in Oman. Headache was commoner in females and younger people. The prevalence of tension headache was 3.1-9.5% in Saudi Arabia and the 1-year prevalence in Qatar was 11.2%. The migraine prevalence was 2.6-5% in Saudi Arabia and 7.9% in Qatar, while the 1-year migraine prevalence was 10.1% in Oman. The results show a migraine prevalence within that estimated worldwide. However, it is clear that epidemiological data from Arab countries are lacking, and there is disparity in the reported prevalence from Saudi Arabia when compared with its two neighbours, Qatar and Oman. Wider study adopting the same methodology in the six Gulf countries (Saudi Arabia, Qatar, Oman, Bahrain, United Arab Emirates and Kuwait) is needed to examine variations in headache and migraine prevalence.

  2. 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

  3. Evaluation and management of "sinus headache" in the otolaryngology practice.

    PubMed

    Patel, Zara M; Setzen, Michael; Poetker, David M; DelGaudio, John M

    2014-04-01

    Patients, primary care doctors, neurologists and otolaryngologists often have differing views on what is truly causing headache in the sinonasal region. This review discusses common primary headache diagnoses that can masquerade as "sinus headache" or "rhinogenic headache," such as migraine, trigeminal neuralgia, tension-type headache, temporomandibular joint dysfunction, giant cell arteritis (also known as temporal arteritis) and medication overuse headache, as well as the trigeminal autonomic cephalalgias, including cluster headache, paroxysmal hemicrania, and hemicrania continua. Diagnostic criteria are discussed and evidence outlined that allows physicians to make better clinical diagnoses and point patients toward better treatment options.

  4. Management of migraine headache in the emergency department.

    PubMed

    Robertson, Carrie E; Black, David F; Swanson, Jerry W

    2010-04-01

    Headache is one of the more common reasons for adults to visit an emergency department. Most of these visits are for primary headache disorders, most commonly migraine headache. The authors discuss management options for patients presenting to the emergency department with prolonged, severe, or refractory migraine headaches. Particular attention is given to parenteral treatments and protocols that would not be options as an outpatient. The epidemiology, investigation, and outpatient management of migraine headache are discussed in other articles in this issue. PMID:20352590

  5. Guidelines for the organization of headache education in Europe: the headache school.

    PubMed

    Antonaci, Fabio; Láinez, José Miguel; Diener, Hans-Christoph; Couturier, Emile G M; Agosti, Reto; Afra, Judit; Färkkilä, Markus; Obelieniene, Diana; Valade, Dominique

    2005-01-01

    According to its mission statement, one of the goals of the European Headache Federation (EHF) is to "educate Europe" about headache through the teaching of the key health personnel, such as young physicians and all those involved in headache management, about the seriousness of headache disorders. The countries of Europe share a close geographical proximity that facilitates international exchanges, particularly between university faculties. In recent years, this has, indeed, been the working basis of European educational endeavours in the field of headache. For a number of years, annual summer schools were organized in different European countries and a permanent Summer Headache School was set up in Cambridge (to be held every alternate year). The last summer headache school was held in Vilnius in 2002. In the past decade, a patronage scheme was also set up, which, combining two or more countries (one developed, one or more developing), allowed international exchanges of doctors and students for training purposes. In some centres, participants were also able to gain clinical practice and research experience by staying at the host institutions for extended periods of time. As a result of all this activity there have emerged, in Europe, "clusters" of people with a particular interest in headache. However, the rapid growth of insight into headache (new molecules, new headache categories, etc.) has contributed to a widening of the scientific gap between developing and developed countries. Moreover, in the past four years, due to the relative restriction of national/international drug company budgets, it has proved possible to organize only relatively inexpensive teaching courses. As a result, countries whose medical communities had been developing a "headache culture" now find themselves destined to be increasingly held back. Therefore, the EHF, in order to promote education on headache in Europe at national level, felt there was a need for guidelines for the

  6. [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

  7. Relativistic hydrodynamics in the presence of puncture black holes

    SciTech Connect

    Faber, Joshua A.; Etienne, Zachariah B.; Shapiro, Stuart L.; Taniguchi, Keisuke; Baumgarte, Thomas W.

    2007-11-15

    Many of the recent numerical simulations of binary black holes in vacuum adopt the moving puncture approach. This successful approach avoids the need to impose numerical excision of the black hole interior and is easy to implement. Here we wish to explore how well the same approach can be applied to moving black hole punctures in the presence of relativistic hydrodynamic matter. First, we evolve single black hole punctures in vacuum to calibrate our Baumgarte-Shapiro-Shibata-Nakamura implementation and to confirm that the numerical solution for the exterior spacetime is invariant to any junk (i.e., constraint-violating) initial data employed in the black hole interior. Then we focus on relativistic Bondi accretion onto a moving puncture Schwarzschild black hole as a numerical test bed for our high-resolution shock-capturing relativistic hydrodynamics scheme. We find that the hydrodynamical equations can be evolved successfully in the interior without imposing numerical excision. These results help motivate the adoption of the moving puncture approach to treat the binary black hole-neutron star problem using conformal thin-sandwich initial data.

  8. Blunt atrial transseptal puncture using excimer laser in swine

    PubMed Central

    Elagha, Abdalla A.; Kim, Ann H.; Kocaturk, Ozgur; Lederman, Robert J.

    2009-01-01

    Objectives We describe a new approach that may enhance safety of atrial transseptal puncture, using a commercially available laser catheter that is capable of perforation only when energized. We test this approach in swine. Background Despite wide application, conventional needle transseptal puncture continues to risk inadvertent non-target perforation and its consequences. Methods We used a commercial excimer laser catheter (0.9mm Clirpath, Spectranetics). Perforation force was compared in vitro with a conventional Brockenbrough needle. Eight swine underwent laser transseptal puncture under X-ray fluoroscopy steered using a variety of delivery catheters. Results The 0.9mm laser catheter traversed in vitro targets with reduced force compared with a Brockenbrough needle. In vitro, the laser catheter created holes that were 25–30% larger than the Brockenbrough needle. Laser puncture of the atrial septum was successful and accurate in all animals, evidenced by oximetry, pressure, angiography, and necropsy. The laser catheter was steered effectively using a modified Mullins introducer sheath and using two different deflectable guiding catheters. The mean procedure time was 15 ± 6 minutes, with an average 3.0 ± 0.8 seconds of laser activation. There were no adverse sequelae after prolonged observation. Necropsy revealed discrete 0.9mm holes in all septae. Conclusion Laser puncture of the interatrial septum is feasible and safe in swine, using a blunt laser catheter that perforates tissues in a controlled fashion. PMID:17896413

  9. [Tinnitus during headache: clinical-instrumental evaluation].

    PubMed

    Farri, A; Enrico, A; Lacilla, M; Sartoris, A

    1999-04-01

    During the five years running from December 1993 to January 1998, 112 patients who had come to our University Clinic suffering from headache were examined. From this group 71 complaining of tinnitus during headache were recruited for the study: 19 patients suffered from migraine without aura, 8 migraine with aura, 15 tension headache, 21 mixed headache, 3 basic migraine and 5 cluster headache. The purpose of this work was to determine the incidence and to identify the frequency of the various types of tinnitus in the study sample. Once cardiovascular and metabolic pathologies, previous cranial or cervical traumas, barotrauma, chronic on-the-job noise exposure, cervical arthritis, ATM malocclusion, use of drugs that damage the hearing apparatus, morbose processes of the external and middle ear, otosclerosis, jugular tympanum paraganglioma, Meniere's disease, acoustic neurinoma were all ruled out, the patients underwent the following battery of instrumental tests: tonal audiometry, impedance measurement, vestibular examination, electronystagmography, ABR, simplified tinnitometry. Only those patients with normal hearing underwent the tinnitometry and, therefore, the type of tinnitus was established only for this group of 53 patients. Tinnitometry showed that 37% of these subjects had tinnitus at the higher frequency tones, 11% at the middle frequencies, 29% complained of tinnitus at the lower frequencies while 23% complained that the bothersome buzzing was a compound noise. In addition, the subjective intensity of the tinnitus was analyzed. The authors devised a tinnitus irritation scale covering a range from 0 (not irritating) to 10 (intolerable). The tinnitus was bilateral in 66% of the cases while it was limited to only one ear in the remaining 34%. In 15% of the cases tinnitus was present even when there was no headache. In the literature, the etiopathogenesis of tinnitus associated with migraine headache has been attributed to vascular and neuropeptide mechanisms

  10. Ice cream headache in students and family history of headache: a cross-sectional epidemiological study.

    PubMed

    Zierz, Antonia Maria; Mehl, Theresa; Kraya, Torsten; Wienke, Andreas; Zierz, Stephan

    2016-06-01

    Headache attributed to ingestion of a cold stimulus (ICHD-3 beta 4.5.1) is also known as ice cream headache (ICH). This cross-sectional epidemiological study included 283 students (10-14-year-olds) attending a grammar school in Germany, their parents (n = 401), and 41 teachers. A self-administered questionnaire was used to analyze the prevalence and characteristics of ICH based on the ICHD classification. Additionally, the association between ICH and other headaches was investigated in students and parents. Prevalence of ICH in students was 62 % without gender difference. In adults, only 36 % of females and 22 % of males reported ICH. There was an increased risk for ICH in students when mother (OR 10.7) or father (OR 8.4) had ICH. Other headaches in parents had no influence on the prevalence of ICH in students. However, in the groups of students and parents itself there was a highly significant association between ICH and other headaches (students: OR 2.4, mothers: OR 2.9, fathers: OR 6.8). There was a decreased risk for ICH when parents and students had no headache at all (OR < 0.4). ICH in students clearly shows a familial disposition by both father and mother. There was also an association between ICH and other headaches within the student and adult groups. The absence of headache history seems to be a protective factor for ICH.

  11. Neuromodulation of chronic headaches: position statement from the European Headache Federation.

    PubMed

    Martelletti, Paolo; Jensen, Rigmor H; Antal, Andrea; Arcioni, Roberto; Brighina, Filippo; de Tommaso, Marina; Franzini, Angelo; Fontaine, Denys; Heiland, Max; Jürgens, Tim P; Leone, Massimo; Magis, Delphine; Paemeleire, Koen; Palmisani, Stefano; Paulus, Walter; May, Arne

    2013-10-21

    The medical treatment of patients with chronic primary headache syndromes (chronic migraine, chronic tension-type headache, chronic cluster headache, hemicrania continua) is challenging as serious side effects frequently complicate the course of medical treatment and some patients may be even medically intractable. When a definitive lack of responsiveness to conservative treatments is ascertained and medication overuse headache is excluded, neuromodulation options can be considered in selected cases. Here, the various invasive and non-invasive approaches, such as hypothalamic deep brain stimulation, occipital nerve stimulation, stimulation of sphenopalatine ganglion, cervical spinal cord stimulation, vagus nerve stimulation, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, and transcutaneous electrical nerve stimulation are extensively published although proper RCT-based evidence is limited. The European Headache Federation herewith provides a consensus statement on the clinical use of neuromodulation in headache, based on theoretical background, clinical data, and side effect of each method. This international consensus further gives recommendations for future studies on these new approaches. In spite of a growing field of stimulation devices in headaches treatment, further controlled studies to validate, strengthen and disseminate the use of neurostimulation are clearly warranted. Consequently, until these data are available any neurostimulation device should only be used in patients with medically intractable syndromes from tertiary headache centers either as part of a valid study or have shown to be effective in such controlled studies with an acceptable side effect profile.

  12. Neuromodulation of chronic headaches: position statement from the European Headache Federation

    PubMed Central

    2013-01-01

    The medical treatment of patients with chronic primary headache syndromes (chronic migraine, chronic tension-type headache, chronic cluster headache, hemicrania continua) is challenging as serious side effects frequently complicate the course of medical treatment and some patients may be even medically intractable. When a definitive lack of responsiveness to conservative treatments is ascertained and medication overuse headache is excluded, neuromodulation options can be considered in selected cases. Here, the various invasive and non-invasive approaches, such as hypothalamic deep brain stimulation, occipital nerve stimulation, stimulation of sphenopalatine ganglion, cervical spinal cord stimulation, vagus nerve stimulation, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, and transcutaneous electrical nerve stimulation are extensively published although proper RCT-based evidence is limited. The European Headache Federation herewith provides a consensus statement on the clinical use of neuromodulation in headache, based on theoretical background, clinical data, and side effect of each method. This international consensus further gives recommendations for future studies on these new approaches. In spite of a growing field of stimulation devices in headaches treatment, further controlled studies to validate, strengthen and disseminate the use of neurostimulation are clearly warranted. Consequently, until these data are available any neurostimulation device should only be used in patients with medically intractable syndromes from tertiary headache centers either as part of a valid study or have shown to be effective in such controlled studies with an acceptable side effect profile. PMID:24144382

  13. Ice cream headache in students and family history of headache: a cross-sectional epidemiological study.

    PubMed

    Zierz, Antonia Maria; Mehl, Theresa; Kraya, Torsten; Wienke, Andreas; Zierz, Stephan

    2016-06-01

    Headache attributed to ingestion of a cold stimulus (ICHD-3 beta 4.5.1) is also known as ice cream headache (ICH). This cross-sectional epidemiological study included 283 students (10-14-year-olds) attending a grammar school in Germany, their parents (n = 401), and 41 teachers. A self-administered questionnaire was used to analyze the prevalence and characteristics of ICH based on the ICHD classification. Additionally, the association between ICH and other headaches was investigated in students and parents. Prevalence of ICH in students was 62 % without gender difference. In adults, only 36 % of females and 22 % of males reported ICH. There was an increased risk for ICH in students when mother (OR 10.7) or father (OR 8.4) had ICH. Other headaches in parents had no influence on the prevalence of ICH in students. However, in the groups of students and parents itself there was a highly significant association between ICH and other headaches (students: OR 2.4, mothers: OR 2.9, fathers: OR 6.8). There was a decreased risk for ICH when parents and students had no headache at all (OR < 0.4). ICH in students clearly shows a familial disposition by both father and mother. There was also an association between ICH and other headaches within the student and adult groups. The absence of headache history seems to be a protective factor for ICH. PMID:27039390

  14. Protective materials with real-time puncture detection capability

    SciTech Connect

    Hermes, R.E.; Stampfer, J.F.; Valdez-Boyle, L.S.; Ramsey, D.R.

    1996-08-01

    The protection of workers from chemical, biological, or radiological hazards requires the use of protective materials that can maintain their integrity during use. An accidental puncture in the protective material can result in a significant exposure to the worker. A five ply material has been developed that incorporates two layers of an electrically conductive polymer sandwiched between three layers of a nonconductive polymer. A normally open circuit that is connected between the conductive layers will be closed by puncturing the material with either a conductive or nonconductive object. This can be used to activate an audible alarm or visual beacon to warn the worker of a breach in the integrity of the material. The worker is not connected to the circuit, and the puncture can be detected in real-time, even when caused by a nonconductor.

  15. [Childhood transverse sinus dural arteriovenous fistula treated with endovascular and direct surgery: a case report].

    PubMed

    Niizuma, Kuniyasu; Sakata, Hiroyuki; Koyama, Shinya; Kon, Hiroyuki; Chonan, Masashi; Sasaki, Tatsuya; Nishijima, Michiharu; Ezura, Masayuki; Tominaga, Teiji

    2012-11-01

    Infantile dural arteriovenous fistula is a rare cerebrovascular malformation carrying a poor prognosis with an anatomic cure of only 9%. Endovascular embolization is mainly selected to treat this entity, aiming to obtain normal development of the patients. We present a case of a 20-month-old girl with epilepsy. Digital subtraction angiography revealed a dural arteriovenous fistula involving the right transverse sinus. The arteriovenous fistula was fed by multiple dural branches from the middle meningeal, occipital, meningohypophyseal, and anteroinferior cerebellar arteries. The right transverse sinus was transvenously embolized with platinum coils. Although the shunt flow remained, the patient was liberated from epilepsy. Nine months later, the patient suffered from a recurrence of epilepsy. Digital subtraction angiography demonstrated some increase in shunt flow. Right middle meningeal, occipital, posterior deep temporal, and tentorial arteries were transarterially embolized using N-butyl cyanoacrylate, followed by complete surgical resection of the right transverse sinus. The shunt flow disappeared after surgery, and her epilepsy improved significantly. Our experience suggests that the combination of endovascular and surgical treatment is effective for recurrent infantile dural arteriovenous fistula.

  16. 5-HT7 receptors are involved in neurogenic dural vasodilatation in an experimental model of migraine.

    PubMed

    Wang, Xiaojuan; Fang, Yannan; Liang, Jianbo; Yan, Miansheng; Hu, Rong; Pan, Xiaoping

    2014-01-01

    Neurogenic dural vasodilation has been demonstrated to play an important role in migraine. 5-HT(7) receptors have been found on trigeminal nerve endings and middle meningeal arteries and demonstrated involved in the dilatation of meningeal arteries. The aim of the present study was to demonstrate whether 5-HT(7) receptors are involved in neurogenic dural vasodilation in migraine. The neurogenic dural vasodilation model of migraine was used in this study. Unilateral electrical stimulation of dura mater was performed in anesthetized male Sprague-Dawley rats. Animals were pretreated with selective 5-HT(7) receptor agonist AS19, 5-HT(7) receptor antagonist SB269970, 5-HT1B/1D receptor agonist sumatriptan, or vehicles. Blood flow of the middle meningeal artery (MMA) was measured by a laser Doppler flowmetry. AS19 significantly increased the basal and stimulated blood flows of the middle meningeal artery following electrical stimulation of dura mater, and its effect was dose dependent at the early stage. SB269970 and sumatriptan significantly reduced the basal and stimulated blood flows of middle meningeal artery. The present study demonstrates for the first time that 5-HT(7) receptors are involved in neurogenic dural vasodilation evoked by electrical stimulation of dura mater and maybe of relevance in the pathophysiology and treatment of migraine.

  17. Variations in magnetic resonance venographic anatomy of the dorsal dural venous sinus system in 51 dogs.

    PubMed

    Fenn, Joe; Lam, Richard; Kenny, Patrick J

    2013-01-01

    Variations in intracranial dural venous sinus anatomy have been widely reported in humans, but there have been no studies reporting this in dogs. The purpose of this retrospective study was to describe variations in magnetic resonance (MR) venographic anatomy of the dorsal dural venous sinus system in a sample population of dogs with structurally normal brains. Medical records were searched for dogs with complete phase contrast, intracranial MR venograms and a diagnosis of idiopathic epilepsy. Magnetic resonance venograms were retrieved for each dog and characteristics of the dorsal dural sinuses, symmetry of the transverse sinuses and other anatomic variations were recorded. A total of 51 dogs were included. Transverse sinus asymmetry was present in 58.8% of the dogs, with transverse sinus hypoplasia seen in 39.2%, and aplasia in 23.5% of dogs. For 70.6% of dogs, at least one anatomic variation in the dorsal sagittal sinus was observed, including deviation from the midline (33.3%) and collateral branches from either the dorsal sagittal sinus or dorsal cerebral veins (54.9%). In 5 dogs (9.8%) a vessel was also identified running from the proximal transverse sinus to the distal sigmoid sinus, in a similar location to the occipital sinus previously reported in children. Findings from this study indicated that, as in humans, anatomic variations are common in the intracranial dural venous sinus system of dogs. These anatomic variations should be taken into consideration for surgical planning or diagnosis of cerebrovascular disease.

  18. N-Butyl 2-Cyanoacrylate Embolization of Spinal Dural Arteriovenous Fistula

    PubMed Central

    Kwon, B.J.; Kim, T.-K.; Seo, S.I.; Kyung, J.B.; Seol, H.Y.; Han, M.H.

    2005-01-01

    Summary We report an unusual case of spinal dural arteriovenous fistula (SDAVF) presenting with subarachnoid haemorrhage (SAH). Cure was achieved with endovascular treatment with n-butyl 2-cyanoacrylate (NBCA). A review of the literature revealed five cases of cervical SDAVF that presented with SAH. None of these cases were treated with NBCA. PMID:20584439

  19. A dural lymphatic vascular system that drains brain interstitial fluid and macromolecules.

    PubMed

    Aspelund, Aleksanteri; Antila, Salli; Proulx, Steven T; Karlsen, Tine Veronica; Karaman, Sinem; Detmar, Michael; Wiig, Helge; Alitalo, Kari

    2015-06-29

    The central nervous system (CNS) is considered an organ devoid of lymphatic vasculature. Yet, part of the cerebrospinal fluid (CSF) drains into the cervical lymph nodes (LNs). The mechanism of CSF entry into the LNs has been unclear. Here we report the surprising finding of a lymphatic vessel network in the dura mater of the mouse brain. We show that dural lymphatic vessels absorb CSF from the adjacent subarachnoid space and brain interstitial fluid (ISF) via the glymphatic system. Dural lymphatic vessels transport fluid into deep cervical LNs (dcLNs) via foramina at the base of the skull. In a transgenic mouse model expressing a VEGF-C/D trap and displaying complete aplasia of the dural lymphatic vessels, macromolecule clearance from the brain was attenuated and transport from the subarachnoid space into dcLNs was abrogated. Surprisingly, brain ISF pressure and water content were unaffected. Overall, these findings indicate that the mechanism of CSF flow into the dcLNs is directly via an adjacent dural lymphatic network, which may be important for the clearance of macromolecules from the brain. Importantly, these results call for a reexamination of the role of the lymphatic system in CNS physiology and disease.

  20. A dural lymphatic vascular system that drains brain interstitial fluid and macromolecules

    PubMed Central

    Aspelund, Aleksanteri; Antila, Salli; Proulx, Steven T.; Karlsen, Tine Veronica; Karaman, Sinem; Detmar, Michael; Wiig, Helge

    2015-01-01

    The central nervous system (CNS) is considered an organ devoid of lymphatic vasculature. Yet, part of the cerebrospinal fluid (CSF) drains into the cervical lymph nodes (LNs). The mechanism of CSF entry into the LNs has been unclear. Here we report the surprising finding of a lymphatic vessel network in the dura mater of the mouse brain. We show that dural lymphatic vessels absorb CSF from the adjacent subarachnoid space and brain interstitial fluid (ISF) via the glymphatic system. Dural lymphatic vessels transport fluid into deep cervical LNs (dcLNs) via foramina at the base of the skull. In a transgenic mouse model expressing a VEGF-C/D trap and displaying complete aplasia of the dural lymphatic vessels, macromolecule clearance from the brain was attenuated and transport from the subarachnoid space into dcLNs was abrogated. Surprisingly, brain ISF pressure and water content were unaffected. Overall, these findings indicate that the mechanism of CSF flow into the dcLNs is directly via an adjacent dural lymphatic network, which may be important for the clearance of macromolecules from the brain. Importantly, these results call for a reexamination of the role of the lymphatic system in CNS physiology and disease. PMID:26077718

  1. Dural tear and myelomalacia caused by an airgun pellet in a cat

    PubMed Central

    de la Fuente, Cristian; Ródenas, Sergio; Pumarola, Martí; Añor, Sònia

    2013-01-01

    An 8-year-old cat was presented with severe neurological deficits secondary to a traumatic cervical spinal cord injury caused by an airgun pellet. This report describes, for the first time, the myelographic findings of a dural rupture in a cat and also describes a bilateral Horner’s syndrome in a cat. PMID:24155462

  2. Blood mixtures: impact of puncture site on blood parameters.

    PubMed

    Bonnet, X; El Hassani, M S; Lecq, S; Michel, C L; El Mouden, E H; Michaud, B; Slimani, T

    2016-08-01

    Various puncture routes, veins, arteries, heart, are used to take blood in animals. For anatomical reasons, differences in blood composition are expected among puncture sites. However, this issue has been rarely assessed and contrasted results have been reported: strong effects of puncture site versus a lack of effect. We captured free-ranging freshwater turtles from different locations to compare the mean concentrations of 12 blood parameters (metabolites, hormone, ions, and enzyme) among three puncture sites: (1) a lateral branch of the jugular vein, (2) a dorsal subcarapacial cervical plexus (sometimes incorrectly referred as the 'cervical sinus' in the literature), and (3) a caudal plexus site (sometimes incorrectly referred as the 'caudal sinus'). Because we used very small syringes (27-30G), we were able to separate lymph, blood, or blood-lymph mixtures. Our results show very strong effects of puncture site and of mixture level (mean maximal difference between sites was 250 %). We also found strong sex and geographical effects. Typically, there were differences in concentrations of blood solutes sampled from the lateral jugular vein and subcarapacial plexus, mainly due to sampling a mixture of blood and lymph from the 'blood' at the subcarapacial site and pure blood from the lateral jugular site, and likewise, samples from the caudal site were highly variable due to often sampling a mixture of blood and lymph. These results have technical and fundamental implications, especially when performing comparative analyses. Further, by selecting precise puncture sites, physiological differences between lymph and blood compartments could be investigated. PMID:27146147

  3. Evolving a puncture black hole with fixed mesh refinement

    SciTech Connect

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

    2004-12-15

    We present an algorithm for treating mesh refinement interfaces in numerical relativity. We discuss the behavior of the solution near such interfaces located in the strong-field regions of dynamical black hole spacetimes, with particular attention to the convergence properties of the simulations. In our applications of this technique to the evolution of puncture initial data with vanishing shift, we demonstrate that it is possible to simultaneously 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 and wave extraction is meaningful.

  4. BIOFEEDBACK TRAINING AND TENSION-TYPE HEADACHE.

    PubMed

    Šecić, Ana; Cvjeticanin, Timon; Kes, Vanja Bašić

    2016-03-01

    Biofeedback is a training method, which connects physiological and psychological processes in a person for the purposes of improving his/her physical, emotional, mental and spiritual health. In biofeedback treatment, an active role of the patient is stressed for him/her to be able to actively control the physiological and emotional processes. The aim of biofeedback is to improve the conscious control of the individual's involuntary physiological activity. Research has shown that biofeedback, either applied alone or in combination with other behavioral therapies (techniques), is an effective treatment for various medical and psychological disorders, from headache and hypertension to temporomandibular and attention deficit disorders. More than 90% of adults experience headache once a year, which makes headache one of the most common symptoms and diagnoses in medicine. Tension-type headaches occur in at least 40% of the population and their impact on the health insurance costs and diminished productivity is significant. Studies have shown that clinical biofeedback training is effective in treating headaches. Moreover, the authors stress the need for additional research and further development of methodology for this kind of research. PMID:27333731

  5. Impairment in episodic and chronic cluster headache.

    PubMed

    Jürgens, Tim P; Gaul, Charly; Lindwurm, Andrea; Dresler, Thomas; Paelecke-Habermann, Yvonne; Schmidt-Wilcke, Tobias; Lürding, Ralf; Henkel, Karsten; Leinisch, Elke

    2011-04-01

    Despite being an excruciating headache, little is known about the burden of cluster headache (CH) regarding its various subtypes. In a multicentre, prospective study, patients with chronic CH (n = 27), with episodic CH in the active (n = 26) and outside the active period (n = 22), migraine patients (n = 24) and healthy controls (n = 31) were included. Epidemiological data, the German version of the Headache Disability Inventory (HDI) and a screening for psychiatric complaints were applied. About 25% of chronic CH patients in our study received invalidity allowance due to CH. HDI scores (total and subscales emotion and function) indicated a severe headache-specific disability (one-way ANOVA: P < 0.01). Patients with chronic and active episodic CH were significantly more affected than patients with inactive CH and migraine. Healthy volunteers were significantly less affected than all headache patients. Symptoms suggestive of psychiatric co-morbidity were found predominantly in chronic CH: depressive symptoms (56%), signs of agoraphobia (33%) and suicidal tendencies (25%) were frequently reported. Patients with chronic and active episodic CH were severely impaired in non-economic and economic domains such as disability, working life and psychiatric complaints. Remarkably, psychiatric co-morbidity was highest in chronic CH. Thus, especially chronic CH warrants special medical and further supportive care. PMID:21123629

  6. BIOFEEDBACK TRAINING AND TENSION-TYPE HEADACHE.

    PubMed

    Šecić, Ana; Cvjeticanin, Timon; Kes, Vanja Bašić

    2016-03-01

    Biofeedback is a training method, which connects physiological and psychological processes in a person for the purposes of improving his/her physical, emotional, mental and spiritual health. In biofeedback treatment, an active role of the patient is stressed for him/her to be able to actively control the physiological and emotional processes. The aim of biofeedback is to improve the conscious control of the individual's involuntary physiological activity. Research has shown that biofeedback, either applied alone or in combination with other behavioral therapies (techniques), is an effective treatment for various medical and psychological disorders, from headache and hypertension to temporomandibular and attention deficit disorders. More than 90% of adults experience headache once a year, which makes headache one of the most common symptoms and diagnoses in medicine. Tension-type headaches occur in at least 40% of the population and their impact on the health insurance costs and diminished productivity is significant. Studies have shown that clinical biofeedback training is effective in treating headaches. Moreover, the authors stress the need for additional research and further development of methodology for this kind of research.

  7. Post-Traumatic Headache Therapy in the Athlete.

    PubMed

    Seifert, Tad

    2016-06-01

    Post-traumatic headache can occur after any traumatic brain injury, regardless of severity. Headache is consistently the most common symptom following concussion and occurs in over 90% of athletes with sports-related concussion. Despite this prevalence, the complaint of headache after a possible concussive injury is often dismissed. Even when sports-related concussion is accurately diagnosed, many athletes fall victim to mismanagement of this associated symptom by clinicians who are not well-versed in headache treatment. Furthermore, benign headaches may also occur incidentally in the context of head trauma. This complex, and often non-specific, nature of headaches provides a significant challenge in return to play decision-making. Post-traumatic headaches are generally categorized according to primary headache disorders in an attempt to guide treatment; however, there is minimal medical literature on headache management in the concussed athlete. There is clearly a continued need for prospective studies of existing treatments and new approaches. PMID:27184059

  8. Headache in primary care: how important is diagnosis to management?

    PubMed Central

    O'Flynn, Norma; Ridsdale, Leone

    2002-01-01

    Headache is a common presentation in primary care. The classification of headache was overhauled by the International Headache Society (IHS) in 1988, and the past decade has seen rapid growth in the understanding of headache disorders. The IHS places particular importance on precise headache diagnosis. This paper discusses the relevance of such an approach to primary care. A review of the literature revealed a dearth of evidence regarding headache management in primary care settings. The evidence from other settings is considered and gaps in the literature highlighted. PMID:12120731

  9. The "other" primary headaches in children and adolescents.

    PubMed

    Lewis, Donald W; Gozzo, Yeisid F; Avner, Marc T

    2005-11-01

    Headache represents one of the most common reasons why children and adolescents are referred to pediatric neurology practices where the most common headache syndromes diagnosed are migraine and its variants, and chronic daily headache. The bulk of recent literature regarding headache in children has focused on these two clinical entities even though large epidemiologic studies have demonstrated that tension-type headache may be two to three times more common in children. Why has so little attention been given to these other disorders? The purpose of this review is to examine the "other" primary headache disorders in children and adolescents.

  10. Cough headache and thoracic inlet valvular competence in uremia.

    PubMed

    Chuang, Yu-Ming; Hu, Han-Haw

    2005-01-01

    Cough headache is a transient headache upon coughing, bending, stooping, or lifting in the absence of intracranial lesions. Reports show that incompetent jugular venous valve and cerebrospinal fluid hypervolemia are contributing factors. Headache is a common complaint of uremia patients. We conducted a clinical-radiological correlation study on 15 uremia patients with headache and central venous thrombosis. Thirteen patients were diagnosed to have benign cough headache (BCH); the others were diagnosed with chronic tension type headache. Venogram disclosed either internal jugular or vertebral venous regurgitation in the BCH group. Acquired thoracic inlet valvular incompetence might contribute to BCH. PMID:15785073

  11. Habituation and sensitization in primary headaches.

    PubMed

    Coppola, Gianluca; Di Lorenzo, Cherubino; Schoenen, Jean; Pierelli, Francesco

    2013-07-30

    The phenomena of habituation and sensitization are considered most useful for studying the neuronal substrates of information processing in the CNS. Both were studied in primary headaches, that are functional disorders of the brain characterized by an abnormal responsivity to any kind of incoming innocuous or painful stimuli and it's cycling pattern over time (interictal, pre-ictal, ictal). The present review summarizes available data on stimulus responsivity in primary headaches obtained with clinical neurophysiology. In migraine, the majority of electrophysiological studies between attacks have shown that, for a number of different sensory modalities, the brain is characterised by a lack of habituation of evoked responses to repeated stimuli. This abnormal processing of the incoming information reaches its maximum a few days before the beginning of an attack, and normalizes during the attack, at a time when sensitization may also manifest itself. An abnormal rhythmic activity between thalamus and cortex, namely thalamocortical dysrhythmia, may be the pathophysiological mechanism subtending abnormal information processing in migraine. In tension-type headache (TTH), only few signs of deficient habituation were observed only in subgroups of patients. By contrast, using grand-average responses indirect evidence for sensitization has been found in chronic TTH with increased nociceptive specific reflexes and evoked potentials. Generalized increased sensitivity to pain (lower thresholds and increased pain rating) and a dysfunction in supraspinal descending pain control systems may contribute to the development and/or maintenance of central sensitization in chronic TTH. Cluster headache patients are characterized during the bout and on the headache side by a pronounced lack of habituation of the brainstem blink reflex and a general sensitization of pain processing. A better insight into the nature of these ictal/interictal electrophysiological dysfunctions in primary

  12. Nasal decongestant and chronic headache: a case of naphazoline overuse headache?

    PubMed Central

    Di Lorenzo, Cherubino; Coppola, Gianluca; La Salvia, Valeria; Pierelli, Francesco

    2013-01-01

    Background: Chronic headache is an incapacitating condition afflicting patients at least for 15 days per month. In the most cases it is developed as a consequence of an excessive use of symptomatic drugs. Case: Here we report the case of a 34 year-old man suffering from chronic headache possibly related to the overuse of naphazoline nitrate nasal decongestant, used to treat a supposed chronic sinusitis. However, the patient did not suffer from sinusitis, but from a medication overuse headache (ICHD-II 8.3; ICD-10 44.41) that appeared to be due to excessive use of naphazoline. Conclusion: The use of naphazoline nitrate may result in an analgesic effect upon first use, through activation of adrenergic and opioidergic systems, followed by a pro-migraine effect via a late induction of an inflammatory cascade, modulated by nitric oxide and arachidonic acid. The observation that naphazoline detoxification relieved the patient’s headache, indicates that prolonged use of naphazoline may cause chronic headaches. Therefore, physicians should ask for details on the use of nasal decongestants in patients complaining of chronic headache, as they could potentially be suffering from a medication-overuse headache. PMID:25110575

  13. Oral habits in common between tension headache and non-headache populations.

    PubMed

    Moss, R A; Lombardo, T W; Hodgson, J M; O'Carroll, K

    1989-01-01

    Previous research has suggested a relationship between migraine pain and oral habits. The present study was designed as a replication of a prior study that found self-reported higher frequencies of certain oral habits in migraine as opposed to tension headache and non-headache groups. Three groups of subjects (common migraine, tension headache and non-headache) were given a single questionnaire in which five oral habits (i.e. teeth clenching, jaw jutting, cupping the chin in the hand, and resting the right and left side of the face on the hand) were rated on a 0 (not at all) to 10 (almost always) scale. Significant main effects were obtained for groups and oral habits in a 3 (groups) X5 (oral habits) ANOVA. Post hoc Tukey tests revealed the common migraine group reported significantly more frequent oral habits than did the tension headache group. The non-headache control group did not differ significantly from either headache group. Discussion focuses on the need for continued research in this area.

  14. [Imaging in the evaluation of headaches].

    PubMed

    Chacowry Pala, K; Platon, A; Delémont, C

    2013-09-25

    Headache is a common complaint in primary care medicine. Most of the time, they are primary and benign headaches, with no need for further investigations; nevertheless, in the presence of red flags, a brain imaging is warranted. The diagnostic approach depends upon the most likely suspected cause and the degree of emergency. In those situations, a head CT scan without and with contrast is the exam of choice in most patients, because it is helpful for identifying intracranial lesions or bleeding. The MRI, more sensible, is preferred in the ambulatory setting for investigation and follow-up of intracranial tumoral or infectious diseases.

  15. [Imaging in the evaluation of headaches].

    PubMed

    Chacowry Pala, K; Platon, A; Delémont, C

    2013-09-25

    Headache is a common complaint in primary care medicine. Most of the time, they are primary and benign headaches, with no need for further investigations; nevertheless, in the presence of red flags, a brain imaging is warranted. The diagnostic approach depends upon the most likely suspected cause and the degree of emergency. In those situations, a head CT scan without and with contrast is the exam of choice in most patients, because it is helpful for identifying intracranial lesions or bleeding. The MRI, more sensible, is preferred in the ambulatory setting for investigation and follow-up of intracranial tumoral or infectious diseases. PMID:24163879

  16. Recent Advances in Thermoplastic Puncture-Healing Polymers

    NASA Technical Reports Server (NTRS)

    Bogert, Philip B.; Working, Dennis C.; Wise, Kristopher E.; Smith, Janice Y.; Topping, Crystal C.; Britton, Sean M.; Bagby, Paul R.; Siochi, Emilie J.

    2010-01-01

    The motivation for this work is to develop self-healing polymeric materials to enable damage tolerant systems, and to tailor puncture healing for use temperatures and applications. This will be a benefit in environments and conditions where access for manual repair is limited or impossible, or where damage may not be detected.

  17. Complications in Percutaneous Vertebroplasty Associated with Puncture or Cement Leakage

    SciTech Connect

    Baumann, Clemens Fuchs, Heiko; Kiwit, Juergen; Westphalen, Kerstin; Hierholzer, Johannes

    2007-04-15

    Due to the minimally invasive character and excellent clinical outcome of percutaneous vertebroplasty (PVP), the procedure is being performed in greatly increasing numbers. While PVP has a low complication rate in general, severe complications can occur. We focus on the imaging appearance of complications of PVP associated with puncture or cement leakage-from harmless to life-threatening.

  18. Puncture mechanics of cnidarian cnidocysts: a natural actuator

    PubMed Central

    Oppegard, Shawn C; Anderson, Peter A; Eddington, David T

    2009-01-01

    Background Cnidocysts isolated from cnidarian organisms are attractive as a drug-delivery platform due to their fast, efficient delivery of toxins. The cnidocyst could be utilized as the means to deliver therapeutics in a wearable drug-delivery patch. Cnidocysts have been previously shown to discharge upon stimulation via electrical, mechanical, and chemical pathways. Cnidocysts isolated from the Portuguese Man O' War jellyfish (Physalia physalis) are attractive for this purpose because they possess relatively long threads, are capable of puncturing through hard fish scales, and are stable for years. Results As a first step in using cnidocysts as a functional component of a drug delivery system, the puncture mechanics of the thread were characterized. Tentacle-contained cnidocysts were used as a best-case scenario due to physical immobilization of the cnidocysts within the tentacle. Ex vivo tentacle-contained cnidocysts from Physalia possessed an elastic modulus puncture threshold of approximately 1-2 MPa, based on puncture tests of materials with a gamut of hardness. Also, a method for inducing discharge of isolated cnidocysts was found, utilizing water as the stimulant. Preliminary lectin-binding experiments were performed using fluorophore-conjugated lectins as a possible means to immobilize the isolated cnidocyst capsule, and prevent reorientation upon triggering. Lectins bound homogeneously to the surface of the capsule, suggesting the lectins could be used for cnidocyst immobilization but not orientation. Conclusion Cnidocysts were found to puncture materials up to 1 MPa in hardness, can be discharged in a dry state using water as a stimulant, and bind homogeneously to lectins, a potential means of immobilization. The information gained from this preliminary work will aid in determining the materials and design of the patch that could be used for drug delivery. PMID:19785761

  19. Medication-Overuse Headache: Differences between Daily and Near-Daily Headache Patients

    PubMed Central

    Krymchantowski, Abouch V.; Tepper, Stewart J.; Jevoux, Carla; Valença, Marcelo M.

    2016-01-01

    Medication-overuse headache (MOH) is a challenging neurological disease, which brings frustration for sufferers and treating physicians. The patient’s lack of adherence and limited treatment evidence are frequent. The aim of this study was to compare the outcome and treatment strategies between consecutive MOH patients with daily and near-daily headache from a tertiary center. Methods: Every consecutive patient seen between January and December 2014 with the diagnosis of MOH was included. Psychiatric comorbidities, inability to inform baseline headache frequency, current or previous two-month use of preventive medications, and refusal to sign informed consent were exclusion criteria. The patients were evaluated in thorough initial consultations and divided in two groups based on their baseline headache frequency. The diagnosis and treatment strategies were clearly explained. The filling out of a detailed headache diary was requested from all patients. Endpoints compared headache frequency and adherence after two, four, and eight months between the two study groups. Results: One-hundred sixty-eight patients (31 male, 137 female) met the inclusion criteria. Nineteen patients (11.3%) were excluded. All patients had migraine or chronic migraine as primary headaches. Eighty had daily (DH), and 69 near-daily headache (NDH), at baseline consultation. Mean baseline frequency was 24.8 headache days/month (18.9 days/month for the near-daily group), average headache history was 20.6 years and mean time with >15 headache days/month was 4.8 years. Outpatient withdrawal, starting prevention, and enforcing the correct use of rescue therapy was carried out with all patients. After two months, 88% of the DH and 71% of the NDH groups adhered to treatment (p = 0.0002). The HF decreased to 12 and 9 headache days/month, respectively in DH and NDH groups (p > 0.05, non-significant) (Intention-to-treat (ITT) 14 DH; 12 NDH; p > 0.05). After four and eight months, 86.3% and 83.7% of the

  20. Transvenous Coil Embolization for Dural Arteriovenous Fistulas of the Ophthalmic Sheath: Report of Two Cases and Review of the Literature

    PubMed Central

    Hwang, Juyoung; Jo, Kyung-Il; Yeon, Je Young; Hong, Seung-Chyul

    2016-01-01

    We present two patients with a dural arteriovenous fistula (dAVF) of the ophthalmic sheath who developed progressive exophthalmos, conjunctival chemosis, and visual loss. These symptoms mimic those of cavernous sinus dAVFs. Dural AVFs of the ophthalmic sheath are extremely rare and their clinical management is controversial. We successfully treated these two patients by transvenous coil embolization. Transvenous embolization appears to be a safe and effective method to treat dAVFs of the ophthalmic sheath.

  1. Neural Plasticity in Common Forms of Chronic Headaches

    PubMed Central

    Lai, Tzu-Hsien; Protsenko, Ekaterina; Cheng, Yu-Chen; Loggia, Marco L.; Coppola, Gianluca; Chen, Wei-Ta

    2015-01-01

    Headaches are universal experiences and among the most common disorders. While headache may be physiological in the acute setting, it can become a pathological and persistent condition. The mechanisms underlying the transition from episodic to chronic pain have been the subject of intense study. Using physiological and imaging methods, researchers have identified a number of different forms of neural plasticity associated with migraine and other headaches, including peripheral and central sensitization, and alterations in the endogenous mechanisms of pain modulation. While these changes have been proposed to contribute to headache and pain chronification, some findings are likely the results of repetitive noxious stimulation, such as atrophy of brain areas involved in pain perception and modulation. In this review, we provide a narrative overview of recent advances on the neuroimaging, electrophysiological and genetic aspects of neural plasticity associated with the most common forms of chronic headaches, including migraine, cluster headache, tension-type headache, and medication overuse headache. PMID:26366304

  2. Headache and Tremor: Co-occurrences and Possible Associations

    PubMed Central

    Kuiper, Mathys; Hendrikx, Suzan; Koehler, Peter J.

    2015-01-01

    Background Tremor and headache are two of the most prevalent neurological conditions. This review addresses possible associations between various types of tremor and headache, and provides a differential diagnosis for patients presenting with both tremor and headache. Methods Data were identified by searching MEDLINE in February 2015, with the terms “tremor” and terms representing the primary headache syndromes. Results Evidence for an association between migraine and essential tremor is conflicting. Other primary headaches are not associated with tremor. Conditions that may present with both tremor and headache include cervical dystonia, infectious diseases, hydrocephalus, spontaneous cerebrospinal fluid leaks, space-occupying lesions, and metabolic disease. Furthermore, both can be seen as a side effect of medication and in the use of recreational drugs. Discussion No clear association between primary headaches and tremor has been found. Many conditions may feature both headache and tremor, but rarely as core clinical symptoms at presentation. PMID:26175954

  3. Acupuncture laser in treating headache pain

    NASA Astrophysics Data System (ADS)

    Smesny, Dunja B.

    1990-09-01

    Cervicoocipital headache observed in 112 patient were treated, half of them with acupuncture, and other 50% with He-e laser (con tinuous emission- lo mW, 633nm: IEC). With this treatment was also combined an exercise program ne cesary for the mobilisation of functionaly blocked vertebral segment.

  4. Behavioral Assessment and Treatment of Pediatric Headache

    ERIC Educational Resources Information Center

    Andrasik, Frank; Schwartz, Mark S.

    2006-01-01

    Headaches are quite common in children and adolescents, and they appear to persist into adulthood in a sizable number of individuals. Assessment approaches (interview, pain diaries, and general and specific questionnaires) and behavioral treatment interventions (contingency management, relaxation, biofeedback, and cognitive behavior therapy) are…

  5. Migraine headache. Working for the best outcome.

    PubMed

    Diamond, S; Freitag, F G; Solomon, G D; Millstein, E

    1987-06-01

    Migraine is a common hereditary disorder manifested by episodic headache, irritability, and gastrointestinal upset. The condition may be triggered by dietary, environmental, psychological, or pharmacologic factors. With proper diagnosis and judicious use of abortive and prophylactic therapy, patients often obtain excellent results. PMID:3588460

  6. Psychosocial Precursors and Correlates of Migraine Headache.

    ERIC Educational Resources Information Center

    Levor, Robert M.; And Others

    1986-01-01

    Tested the interactions of migraine headache cycles and sufferers' daily experiences of stressful events, emotional arousal, and physical activity. Results support a model of migraine characterized by parallel physiological and psychosocial instability during a 4-day cycle and by an interaction of personality and behavioral (self-reported stress)…

  7. Recurrent Pediatric Headaches: Behavioral Concepts and Interventions

    ERIC Educational Resources Information Center

    Allen, Keith D.

    2006-01-01

    Recurrent pediatric headaches are increasingly understood to be a function of both respondent and operant processes. In particular, the environment is thought to elicit internal autonomic instability and to evoke external maladaptive pain behavior. While medical interventions often provide an appropriate first line treatment, behavioral…

  8. Headache after substance abuse: a diagnostic dilemma.

    PubMed

    Kamat, A S; Aliashkevich, A F; Denton, J R; Fitzjohn, T P

    2012-03-01

    An 18-year-old man inhaled a substance containing synthetic cannabinoids and 1 hour later developed a severe global headache. Imaging revealed a perimesencephalic subarachnoid haemorrhage. An angiogram suggested that a small superior cerebellar artery aneurysm was the culprit. This report discusses the, as yet undefined, relationship between "herbal highs" and intracranial haemorrhage.

  9. 49 CFR 179.16 - Tank-head puncture-resistance systems.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 3 2014-10-01 2014-10-01 false Tank-head puncture-resistance systems. 179.16... CARS General Design Requirements § 179.16 Tank-head puncture-resistance systems. (a) Performance standard. When the regulations in this subchapter require a tank-head puncture-resistance system,...

  10. 49 CFR 179.16 - Tank-head puncture-resistance systems.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 3 2012-10-01 2012-10-01 false Tank-head puncture-resistance systems. 179.16... CARS General Design Requirements § 179.16 Tank-head puncture-resistance systems. (a) Performance standard. When the regulations in this subchapter require a tank-head puncture-resistance system,...

  11. 49 CFR 179.16 - Tank-head puncture-resistance systems.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 3 2011-10-01 2011-10-01 false Tank-head puncture-resistance systems. 179.16... CARS General Design Requirements § 179.16 Tank-head puncture-resistance systems. (a) Performance standard. When the regulations in this subchapter require a tank-head puncture-resistance system,...

  12. Unilateral headache with features of hemicrania continua and cervicogenic headache--a case report.

    PubMed

    Rothbart, P

    1992-10-01

    A case is presented which has features of Cervicogenic Headache and of Hemicrania Continua. A sudden maneuver of the neck and later a greater occipital nerve block, both resulted in relief of the pain. A cervical cause is suggested.

  13. Headaches in Multiple Sclerosis Patients Might Imply an Inflammatorial Process

    PubMed Central

    Zettl, Uwe K.

    2013-01-01

    Recent studies on Multiple Sclerosis (MS) pathology mention the involvement of “tertiary B cell follicles” in MS pathogenesis. This inflammatory process, which occurs with interindividually great variance, might be a link between MS pathology and headaches. The aim of this study was to detect the prevalence of headaches and of subtypes of headaches (migraine, cluster, tension-type headache [TTH]) in an unselected MS collective and to compile possibly influencing factors. Unselected MS patients (n = 180) with and without headache were examined by a semi-structured interview using a questionnaire about headache, depression and the health status. Additionally clinical MS data (expanded disability state score [EDSS], MS course, medication, disease duration) were gathered. N = 98 MS patients (55.4%) reported headaches in the previous 4 weeks. We subsequently grouped headache patients according to the IHS criteria and detected 16 (16.3%) MS patients suffering from migraine (migraine with aura: 2 [2%]; migraine without aura: 14 [14.3%]), 23 (23.5%) suffering from TTH and none with a cluster headache. Thus, headaches of 59 (60.2%) MS patients remained unclassified. When comparing MS patients with and without headaches significant differences in age, gender, MS course, physical functioning, pain and social functioning occurred. MS patients with headaches were significantly younger of age (p = 0.001), female (p = 0.001) and reported more often of a clinically isolated syndrome (CIS) and relapsing/remitting MS (RRMS) instead of secondary chronic progressive MS (SCP). EDSS was significantly lower in MS patients suffering from headaches compared to the MS patients without headaches (p = 0.001). In conclusion headache in MS patients is a relevant symptom, especially in early stages of the MS disease. Especially unclassified headache seems to represent an important symptom in MS course and requires increased attention. PMID:23940524

  14. Annual scientific meeting--American Headache Society Washington 2011--highlights.

    PubMed

    Purdy, R Allan

    2012-05-01

    The 53rd Annual Scientific Meeting of the American Headache Society was held in Washington from June 2 to 5, 2011. Important clinical and basic science information was presented at this meeting. This is a review of the highlights of that meeting dealing in many areas of headache medicine. Once again, this meeting, which is the premier scientific meeting of the American Headache Society, provided lots of new and exciting information about multiple facets of migraine headache and other disorders.

  15. Recent Advances in Thermoplastic Puncture-Healing Polymers

    NASA Technical Reports Server (NTRS)

    Gordon, K. L.; Working, D. C.; Wise, K. E.; Bogert, P. B.; Britton, S. M.; Topping, C.C.; Smith, J. Y.; Siochi, E. J.

    2009-01-01

    Self-healing materials provide a route for enhanced damage tolerance in materials for aerospace applications. In particular, puncture-healing upon impact has the potential to mitigate significant damage caused by high velocity micrometeoroid impacts. This type of material also has the potential to improve damage tolerance in load bearing structures to enhance vehicle health and aircraft durability. The materials being studied are those capable of instantaneous puncture healing, providing a mechanism for mechanical property retention in lightweight structures. These systems have demonstrated healing capability following penetration of fast moving projectiles -- velocities that range from 9 mm bullets shot from a gun (approx.330 m/sec) to close to micrometeoroid debris velocities of 4800 m/sec. In this presentation, we report on a suite of polymeric materials possessing this characteristic. Figure 1 illustrates the puncture healing concept. Puncture healing in these materials is dependent upon how the combination of a polymer's viscoelastic properties responds to the energy input resulting from the puncture event. Projectile penetration increases the temperature in the vicinity of the impact. Self-healing behavior occurs following puncture, whereby energy must be transferred to the material during impact both elastically and inelastically, thus establishing two requirements for puncture healing to occur: a.) The need for the puncture event to produce a local melt state in the polymer material and b.) The molten material has to have sufficient melt elasticity to snap back and close the hole. 1,2 Previous ballistic testing studies revealed that Surlyn materials warmed up to a temperature approx.98 C during projectile puncture (3 C higher than it s melting temperature). 1,2 The temperature increase produces a localized flow state and the melt elasticity to snap back thus sealing the hole. Table 1 lists the commercially polymers studied here, together with their physical

  16. Chronic Daily Headache and Medication Overuse Headache in First-Visit Headache Patients in Korea: A Multicenter Clinic-Based Study

    PubMed Central

    Cha, Myoung-Jin; Moon, Heui-Soo; Sohn, Jong-Hee; Kim, Byung-Su; Song, Tae-Jin; Kim, Jae-Moon; Park, Jeong Wook; Park, Kwang-Yeol; Kim, Soo-Kyoung; Kim, Byung-Kun

    2016-01-01

    Background and Purpose Chronic daily headache (CDH) is defined as a headache disorder in which headaches occur on a daily or near-daily basis (at least 15 days/month) for more than 3 months. Chronic migraine (CM) and medication overuse headache (MOH) are very disabling headaches that remain underdiagnosed. The aim of this study was to establish the frequency of CDH and its various subtypes, and examine the associations with MOH among first-visit headache patients presenting at neurology outpatient clinics in Korea. Methods Eleven neurologists enrolled first-visit patients with complaints of headaches into outpatient clinics for further assessment. Headache disorders were classified according to the International Classification of Headache Disorder (third edition beta version) by each investigator. Results Primary CDH was present in 248 (15.2%) of the 1,627 included patients, comprising CM (143, 8.8%), chronic tension-type headache (CTTH) (98, 6%), and definite new daily persistent headache (NDPH) (7, 0.4%). MOH was associated with headache in 81 patients (5%). The association with MOH was stronger among CM patients (34.5%) than patients with CTTH (13.3%) or NDPH (14.3%) (p=0.001). The frequency of CDH did not differ between secondary and tertiary referral hospitals. Conclusions The frequencies of CDH and MOH diagnoses were 15.2% and 5%, respectively in first-visit headache patients presented at secondary or tertiary referral hospitals in Korea. CM was the most common subtype of CDH and was most frequently associated with MOH. PMID:27449912

  17. Needle puncture in rabbit functional spinal units alters rotational biomechanics

    PubMed Central

    Hartman, Robert A.; Bell, Kevin M.; Quan, Bichun; Nuzhao, Yao; Sowa, Gwendolyn A.; Kang, James D.

    2014-01-01

    Study Design An in vitro biomechanical study for rabbit lumbar functional spinal units (FSUs) using a robot-based spine testing system. Objective To elucidate the effect of annular puncture with a 16G needle on mechanical properties in flexion/extension, axial rotation, and lateral bending. Summary of Background Data Needle puncture of the intervertebral disc has been shown to alter mechanical properties of the disc in compression, torsion, and bending. The effect of needle puncture in FSUs, where intact spinal ligaments and facet joints may mitigate or amplify these changes in the disc, on spinal motion segment stability subject to physiological rotations remains unknown. Methods Rabbit FSUs were tested using a robot testing system whose force/moment and position precision were assessed to demonstrate system capability. Flexibility testing methods were developed by load-to-failure testing in flexion/extension, axial rotation, and lateral bending. Subsequent testing methods were used to examine a 16G needle disc puncture and No. 11 blade disc stab (positive control for mechanical disruption). Flexibility testing was used to assess segmental range-of-motion (°), neutral zone stiffness (Nm/°) and width (° and Nm), and elastic zone stiffness before and after annular injury. Results The robot-based system was capable of performing flexibility testing on FSUs—mean precision of force/moment measurements and robot system movements were less than 3% and 1%, respectively, of moment-rotation target values. Flexibility moment targets were 0.3 Nm for flexion and axial rotation and 0.15 Nm for extension and lateral bending. Needle puncture caused significant (p<0.05) changes only in flexion/extension range-of-motion and neutral zone stiffness and width (Nm) compared to pre-intervention. No.11 blade-stab significantly increased range-of-motion in all motions, decreased neutral zone stiffness and width (Nm) in flexion/extension, and increased elastic zone stiffness in

  18. Acute subarachnoid hemorrhage in posterior condylar canal dural arteriovenous fistula: imaging features with endovascular management

    PubMed Central

    Mondel, Prabath Kumar; Saraf, Rashmi; Limaye, Uday S

    2014-01-01

    A 43-year-old man presented with acute subarachnoid hemorrhage. He was investigated and found to have a rare posterior condylar canal dural arteriovenous fistula (DAVF). DAVFs of the posterior condylar canal are rare. Venous drainage of the DAVF was through a long, tortuous, and aneurysmal bridging vein. We describe the clinical presentation, cross sectional imaging, angiographic features, and endovascular management of this patient. The patient was treated by transarterial embolization of the fistula through the ascending pharyngeal artery. This is the first report of an acutely bled posterior condylar canal DAVF treated by transarterial Onyx embolization with balloon protection in the vertebral artery. The patient recovered without any neurological deficit and had an excellent outcome. On 6 month follow-up angiogram, there was stable occlusion of the dural fistula. PMID:24990846

  19. Experimental evaluation of the net "Dallop" covered with collagen as the dural substitute.

    PubMed

    Harat, M; Radek, A; Koktysz, R; Kulig, A

    1989-01-01

    Evaluation of the usefulness of the net "Dallop" produced by Tricomed Lódź covered with collagen to the dural defects reparation was analysed. This new original product of Lódź Technical University was compared with widely used in neurosurgery "Zenoderm" produced by Ethicon and "Duratexol" produced by Czechoslovakia. The trial was conducted on 38 rabbits: 4 as a control group (just an original dura sutured after incision with Mersilk Ethicon sutures), 19 with implanted the net "Dallop" covered with collagen, 11 with the "Zenoderm" and 4 with the "Duratexol". Animals were sacrificed after 3, 14, 30 or 90 days after surgery. There were no significant differences between all analysed groups in clinical, macroscopical and morphological investigations. No negative local reactions in histopathological evaluation of the net "Dallop" covered with collagen were observed. The results of our investigations show that the net "Dallop" covered with collagen seems to be the "Zenoderm" and the "Duratexol" dural substitute.

  20. Trigeminal Cardiac Reflex Caused by Onyx Embolization of Intracranial Dural Arteriovenous Fistula.

    PubMed

    Wang, Jian; Wu, Huan-Cheng; Wang, Wei-Wei; Zhao, Hong-Sen; Dao, Ri-Na; Liu, Wei-Min; Zhou, Dong-Zhe; Wang, Hui-Yu; DU, Chao

    2016-01-01

    Trigeminocardiac reflex (TCR) is a reflexive response of bradycardia, hypotension and gastric hypermotility which is observed upon mechanical stimulation in the distribution of the trigeminal nerve. Previous articles have described TCR during intracranial operations, ophthalmic surgery, microcompression of the trigeminal ganglion and radiofrequency lesioning of the trigeminal ganglion. TCR may occur during transarterial embolization of dural arteriovenous fistula (DAVF) with Onyx, leading to a significant decrease in heart rate under a standard anesthetic protocol. TCR may also occur due to chemical stimulus of dimethyl sulfoxide (DMSO) in transvenous Onyx embolization of dural cavernous sinus fistula. Slow rate of injection may give DMSO enough time to dissipate in the blood stream which is important for the prevention of toxicity. This report confirms that the reflex was blunted by the anticholinergic effects of atropine and there was no harm to patients if stopped immediately.

  1. Nanofibrous Synthetic Dural Patch for Skull Base Defects: Preliminary Experience for Reconstruction after Extended Endonasal Approaches.

    PubMed

    Zenga, Francesco; Tardivo, Valentina; Pacca, Paolo; Garzaro, Massimiliano; Garbossa, Diego; Ducati, Alessandro

    2016-03-01

    Setting One of the consequences of the widespread use of endoscopic endonasal approaches (EEA) to skull base pathologies is the management of complex skull base defects. Nowadays, the gold standard is a multilayer closure that reproduces the physiological tissue barriers. Several techniques have been described in the literature; however, skull base reconstruction after EEA still represents a matter of debate, especially after extended EEA. A watertight closure is paramount to prevent cerebrospinal fluid leak and meningitis. Design Regarding this issue, we present our experience with a new synthetic dural patch, ReDura (Medprin Biotech, La Mirada, California, United States), as a subdural inlay in three patients who underwent endoscopic endonasal removal of sellar and suprasellar lesions. Conclusions ReDura patch showed the same versatility of autologous iliotibial tract. A dural patch that easily adapts to all defects, revealed to be a useful tool for performing watertight closure, possibly in a short operative time, after endoscopic approaches. PMID:26937335

  2. Dural-based infantile hemangioma of the posterior fossa: Case report

    PubMed Central

    Shakir, Hakeem J.; McBride, Paul; Reynolds, Renée M.

    2016-01-01

    Background: The authors present the unique case of a dural-based, infantile hemangioma located in the posterior fossa of a 15-day-old infant. Case Description: The patient presented with hydrocephalus. The lesion was identified by magnetic resonance imaging and was subsequently resected. Diagnosis of the lesion was confirmed with immunohistochemistry staining. The patient's hospital course was complicated by transverse sinus thrombosis and a cerebrospinal fluid leak that were treated with anticoagulation therapy and ventriculoperitoneal shunt placement, respectively. Conclusion: Although hemangiomas are benign entities, our patient's lesion was in the posterior fossa causing compression and hydrocephalus that necessitated resection. We encourage others to consider the possibility of hemangioma in the differential diagnosis of dural-based posterior fossa lesions in infants. PMID:27213106

  3. Trigeminal Cardiac Reflex Caused by Onyx Embolization of Intracranial Dural Arteriovenous Fistula.

    PubMed

    Wang, Jian; Wu, Huan-Cheng; Wang, Wei-Wei; Zhao, Hong-Sen; Dao, Ri-Na; Liu, Wei-Min; Zhou, Dong-Zhe; Wang, Hui-Yu; DU, Chao

    2016-01-01

    Trigeminocardiac reflex (TCR) is a reflexive response of bradycardia, hypotension and gastric hypermotility which is observed upon mechanical stimulation in the distribution of the trigeminal nerve. Previous articles have described TCR during intracranial operations, ophthalmic surgery, microcompression of the trigeminal ganglion and radiofrequency lesioning of the trigeminal ganglion. TCR may occur during transarterial embolization of dural arteriovenous fistula (DAVF) with Onyx, leading to a significant decrease in heart rate under a standard anesthetic protocol. TCR may also occur due to chemical stimulus of dimethyl sulfoxide (DMSO) in transvenous Onyx embolization of dural cavernous sinus fistula. Slow rate of injection may give DMSO enough time to dissipate in the blood stream which is important for the prevention of toxicity. This report confirms that the reflex was blunted by the anticholinergic effects of atropine and there was no harm to patients if stopped immediately. PMID:27161455

  4. Nanofibrous Synthetic Dural Patch for Skull Base Defects: Preliminary Experience for Reconstruction after Extended Endonasal Approaches

    PubMed Central

    Zenga, Francesco; Tardivo, Valentina; Pacca, Paolo; Garzaro, Massimiliano; Garbossa, Diego; Ducati, Alessandro

    2016-01-01

    Setting One of the consequences of the widespread use of endoscopic endonasal approaches (EEA) to skull base pathologies is the management of complex skull base defects. Nowadays, the gold standard is a multilayer closure that reproduces the physiological tissue barriers. Several techniques have been described in the literature; however, skull base reconstruction after EEA still represents a matter of debate, especially after extended EEA. A watertight closure is paramount to prevent cerebrospinal fluid leak and meningitis. Design Regarding this issue, we present our experience with a new synthetic dural patch, ReDura (Medprin Biotech, La Mirada, California, United States), as a subdural inlay in three patients who underwent endoscopic endonasal removal of sellar and suprasellar lesions. Conclusions ReDura patch showed the same versatility of autologous iliotibial tract. A dural patch that easily adapts to all defects, revealed to be a useful tool for performing watertight closure, possibly in a short operative time, after endoscopic approaches. PMID:26937335

  5. Nanofibrous Synthetic Dural Patch for Skull Base Defects: Preliminary Experience for Reconstruction after Extended Endonasal Approaches.

    PubMed

    Zenga, Francesco; Tardivo, Valentina; Pacca, Paolo; Garzaro, Massimiliano; Garbossa, Diego; Ducati, Alessandro

    2016-03-01

    Setting One of the consequences of the widespread use of endoscopic endonasal approaches (EEA) to skull base pathologies is the management of complex skull base defects. Nowadays, the gold standard is a multilayer closure that reproduces the physiological tissue barriers. Several techniques have been described in the literature; however, skull base reconstruction after EEA still represents a matter of debate, especially after extended EEA. A watertight closure is paramount to prevent cerebrospinal fluid leak and meningitis. Design Regarding this issue, we present our experience with a new synthetic dural patch, ReDura (Medprin Biotech, La Mirada, California, United States), as a subdural inlay in three patients who underwent endoscopic endonasal removal of sellar and suprasellar lesions. Conclusions ReDura patch showed the same versatility of autologous iliotibial tract. A dural patch that easily adapts to all defects, revealed to be a useful tool for performing watertight closure, possibly in a short operative time, after endoscopic approaches.

  6. Dural Metastases in Advanced Prostate Cancer: A Case Report and Review of the Literature

    PubMed Central

    Weiner, A.B.; Cortes-Mateus, S.; De Luis, E.; Durán, I.

    2014-01-01

    Dural metastases from advanced prostate cancer are considered an uncommon diagnosis. However, autopsy studies show a high association between advanced prostate cancer and metastases to the meninges. Because the overall survival of advanced prostate cancer patients is expected to improve with the advent of new therapies, the incidence of clinically relevant dural metastases from prostate cancer will likely increase. We present a case of a heavily pre-treated castration-resistant prostate cancer patient who developed metastases to the duramater. This entity should be considered in the differential diagnosis of any patient with advanced castration-resistant prostate cancer and neurological symptoms. Clinicians should also be aware of the poor prognosis and survival rates associated with the condition. PMID:24917781

  7. A novel equine-derived pericardium membrane for dural repair: A preliminary, short-term investigation

    PubMed Central

    Centonze, Roberto; Agostini, Emiliano; Massaccesi, Samantha; Toninelli, Stefano; Morabito, Letterio

    2016-01-01

    Background: A large variety of biological and artificial materials are employed in dural repair, each of them with major limitations. Autologous grafts have limited availability and require an additional incision and surgical time. Cadaveric preparations and heterologous materials entail the risk of iatrogenic transmission of prions, whereas synthetic substitutes have been reported to cause inflammatory reactions and graft rejection. An equine-derived pericardium membrane has been developed (Heart®, Bioteck, Vicenza, Italy) with mechanical and safety-related features that could make it suitable for neurosurgical application. Aims: This preliminary study aimed to evaluate the short-term safety and efficacy of the Heart® membrane in dural repair procedures following meningioma surgeries. Subjects and Methods: Medical records of patients who were surgically treated for an intracranial meningioma and underwent duraplasty with the Heart® membrane were reviewed retrospectively. The occurrence of any graft-related complications such as cerebrospinal fluid (CSF) leakage, postoperative hematoma, wound infection, meningitis, and neurological symptoms was analyzed. Results: Eight patients were identified as meeting the inclusion criteria. A watertight closure was achieved in all of them. Postoperatively, no patients exhibited CSF leak, cerebral contusion, hemorrhage, or wound infection. The 1-month radiological follow-up revealed no evidence of pseudomeningocele, wound breakdown, or meningitis. Neurologic complications were observed in three patients but not directly imputable to the dural substitute or its application. Conclusions: In all the patients, the pericardium membrane enabled achievement of a watertight dural closure without graft-related adverse events. Further investigations should be performed to assess medium- and long-term clinical outcomes in a larger set of patients. PMID:27366245

  8. Ferumoxytol-enhanced MRI differentiation of meningioma from dural metastases: a pilot study with immunohistochemical observations.

    PubMed

    Hamilton, Bronwyn E; Woltjer, Randall L; Prola-Netto, Joao; Nesbit, Gary M; Gahramanov, Seymur; Pham, Thao; Wagner, Jaime; Neuwelt, Edward A

    2016-09-01

    Malignant dural neoplasms are not reliably distinguished from benign dural neoplasms with contrast-enhanced magnetic resonance imaging (MRI). MRI enhancement in central nervous system (CNS) diseases imaged with ferumoxytol has been attributed to intracellular uptake in macrophages rather than vascular leakage. We compared imaging to histopathology and immunohistochemistry in meningiomas and dural metastases having ferumoxytol-enhanced MRI (FeMRI) and gadolinium-enhanced MRI (GdMRI) in order to correlate enhancement patterns to macrophage presence and vascular state. All patients having extraaxial CNS tumors were retrospectively selected from one of two ongoing FeMRI studies. Enhancement was compared between GdMRI and FeMRI. Diagnoses were confirmed histologically and/or by characteristic imaging. Tumor and vascular histology was reviewed. Immunohistochemical staining for CD68 (a macrophage marker), Connexin-43 (Cx43) (a marker of normal gap junctions), and smooth muscle actin (SMA) as a marker of vascularity, was performed in seven study cases with available tissue. Immunohistochemistry was performed on archival material from 33 subjects outside of the current study as controls: 20 WHO grade I cases of meningioma and 13 metastatic tumors. Metastases displayed marked delayed enhancement on FeMRI, similar to GdMRI. Four patients with dural metastases and one patient with meningioma showed similar enhancement on FeMRI and GdMRI. Five meningiomas with typical enhancement on GdMRI lacked enhancement on FeMRI. Enhancement on FeMRI was better associated with decreased Cx43 expression than intralesional macrophages. These pilot data suggest that FeMRI may better differentiate metastatic disease from meningiomas than GdMRI, and that differences in tumor vasculature rather than macrophage presence could underlie differences in contrast enhancement. PMID:27393348

  9. Aspartame ingestion and headaches: a randomized crossover trial.

    PubMed

    Van den Eeden, S K; Koepsell, T D; Longstreth, W T; van Belle, G; Daling, J R; McKnight, B

    1994-10-01

    To examine whether ingestion of aspartame is associated with headaches, we conducted a double-blind crossover study using volunteers with self-identified headaches after using aspartame. Of the 32 subjects randomized to receive aspartame (approximately 30 mg/kg/d) and placebo in a two-treatment, four-period crossover design, 18 completed the full protocol, seven completed part of the protocol before withdrawing due to adverse effects, three withdrew for other reasons, two were lost to follow-up, one was withdrawn due to noncompliance, and one withdrew and gave no reason. Each experimental period was 7 days long. Subjects reported headaches on 33% of the days during aspartame treatment, compared with 24% on placebo treatment (p = 0.04). Subjects who were "very sure" prior to the study that aspartame triggered some of their headaches reported larger treatment differences (aspartame = 0.37 headache-days, placebo = 0.18 headache-days; p < 0.001) than subjects who were "somewhat sure" (aspartame = 0.29 headache-days, placebo = 0.22 headache-days; p = 0.51) or "not sure" (aspartame = 0.33 headache-days, placebo = 0.39 headache-days; p = 0.51). There was no significant treatment difference in the length or intensity of headaches or in the occurrence of side effects associated with the headaches. This experiment provides evidence that, among individuals with self-reported headaches after ingestion of aspartame, a subset of this group report more headaches when tested under controlled conditions. It appears that some people are particularly susceptible to headaches caused by aspartame and may want to limit their consumption.

  10. Repair of Inaccessible Ventral Dural Defect in Thoracic Spine: Double Layered Duraplasty

    PubMed Central

    Lee, Dong-Hyun; Park, Jeong-Ill; Park, Ki-Su; Cho, Dae-Chul; Sung, Joo-Kyung

    2016-01-01

    We propose a double layered (intradural and epidural patch) duraplasty that utilizes Lyoplant and Duraseal. We examined a 47-year-old woman after decompression for thoracic ossification of posterior longitudinal ligament was performed in another hospital. On postoperative day 7, she complained of weakness in both legs. Postoperative magnetic resonance imaging (MRI) showed cerebrospinal fluid (CSF) collection with cord compression. In the operative field, we found 2 large dural defects on the ventral dura mater. We performed a conventional fat graft with fibrin glue. However, the patient exhibited neurologic deterioration, and a postoperative MRI again showed CSF collection. We performed dorsal midline durotomy and inserted a intradural and epidural Lyoplant patch. She immediately experienced diminishing back pain postoperatively. Her visual analog scale and motor power improved markedly. Postoperative MRIs performed at 2 and 16 months showed no spinal cord compression or CSF leakage to the epidural space. We describe a new technique for double layered duraplasty. Although we do not recommend this technique for all dural repairs, double-layered duraplasty may be useful for repairing large inaccessible dural tears in cases of persistent CSF leakage refractory to conventional management. PMID:27437022

  11. Hypoxia facilitates neurogenic dural plasma protein extravasation in mice: a novel animal model for migraine pathophysiology

    PubMed Central

    Hunfeld, Anika; Segelcke, Daniel; Bäcker, Ingo; Mecheri, Badreddine; Hemmer, Kathrin; Dlugosch, Elisabeth; Andriske, Michael; Paris, Frank; Zhu, Xinran; Lübbert, Hermann

    2015-01-01

    Migraine animal models generally mimic the onset of attacks and acute treatment processes. A guinea pig model used the application of meta-chlorophenylpiperazine (mCPP) to trigger immediate dural plasma protein extravasation (PPE) mediated by 5-HT2B receptors. This model has predictive value for antimigraine drugs but cannot explain the delayed onset of efficacy of 5-HT2B receptor antagonists when clinically used for migraine prophylaxis. We found that mCPP failed to induce dural PPE in mice. Considering the role 5-HT2B receptors play in hypoxia-induced pulmonary vessel muscularization, we were encouraged to keep mice under hypoxic conditions and tested whether this treatment will render them susceptible to mCPP-induced dural PPE. Following four-week of hypoxia, PPE, associated with increased transendothelial transport, was induced by mCPP. The effect was blocked by sumatriptan. Chronic application of 5-HT2B receptor or nitric oxide synthase blockers during hypoxia prevented the development of susceptibility. Here we present a migraine model that distinguishes between a migraine-like state (hypoxic mice) and normal, normoxic mice and mimics processes that are related to chronic activation of 5-HT2B receptors under hypoxia. It seems striking, that chronic endogenous activation of 5-HT2B receptors is crucial for the sensitization since 5-HT2B receptor antagonists have strong, albeit delayed migraine prophylactic efficacy. PMID:26644235

  12. Dural repair using autologous fat: Our experience and review of the literature

    PubMed Central

    Di Vitantonio, Hambra; De Paulis, Danilo; Del Maestro, Mattia; Ricci, Alessandro; Dechordi, Soheila Raysi; Marzi, Sara; Millimaggi, Daniele F.; Galzio, Renato J.

    2016-01-01

    Background: Various materials have been proposed to obliterate dead spaces and to reconstruct dural defects during a neurosurgical approach. This study describes our technique of using the abdominal autologous fat graft and evaluates the complications and characteristics related to the use of this tissue during cranial procedures. Methods: Autologous fat grafts were used in 296 patients with basicranial and convexity extraaxial tumors from April 2005 to January 2015. The adipose tissue was removed from the paraumbilical abdominal region and was transformed into a thin foil. When possible, a watertight suture was made between the dural or bone edge with a fat graft. We always used fibrin glue to reinforce the dural closure. Results: Complications occurred between 2 days and 1 year following procedure. Cerebrospinal fluid leaks were found in 11 cases. No case of mortality, pseudomeningoceles, fistula, infections, bacterial meningitides, or lipoid meningitides was reported. No patient required removal of the graft. No adhesion was observed between the brain and the autologous fat. Other fat-related complications observed were 2 cases of fat necrosis in the abdomen and 2 cases of abdominal hemorrhage. Conclusion: The technique of harvesting and applying fat grafts is fairly simple, although it must be performed meticulously to be effective. Our experience has led us to believe that the use of fat grafts presents low morbidity and mortality. However, a neurosurgeon should never forget the possible late or early complications related to the use of fat grafts. PMID:27500007

  13. Watertight dural closure constructed with DuraSeal TM for bypass surgery.

    PubMed

    Nishimura, Kengo; Kimura, Toshikazu; Morita, Akio

    2012-01-01

    Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis is a common procedure for the treatment of cerebral ischemia and is useful for cerebral aneurysms and tumors. The STA has to pass through the dura and the dura cannot be sutured tightly around the STA to prevent vessel narrowing, so subcutaneous cerebrospinal fluid (CSF) collection is common. This study analyzed the feasibility of using a synthetic dural sealant in the STA-MCA anastomosis to establish watertight closure. Twenty-four patients underwent STA-MCA anastomosis for cerebral ischemia or cerebral aneurysm. After creation of a standard STA-MCA anastomosis, the dura was reapproximated closely, leaving a small defect around the STA. Then, DuraSeal(TM) was sprayed over the dural defect, and a negative-pressure drain was positioned before closing the skin. Only two patients developed subcutaneous CSF collection, which was managed conservatively. The patency of the anastomosis was proven by magnetic resonance angiography in all cases, and no ischemic complication suggesting chemical spasm of the STA due to the sealant occurred. With DuraSeal(TM), watertight dural closure can be obtained easily and safely in bypass surgery. PMID:22850505

  14. Repair of Inaccessible Ventral Dural Defect in Thoracic Spine: Double Layered Duraplasty.

    PubMed

    Lee, Dong-Hyun; Kim, Kyoung-Tae; Park, Jeong-Ill; Park, Ki-Su; Cho, Dae-Chul; Sung, Joo-Kyung

    2016-06-01

    We propose a double layered (intradural and epidural patch) duraplasty that utilizes Lyoplant and Duraseal. We examined a 47-year-old woman after decompression for thoracic ossification of posterior longitudinal ligament was performed in another hospital. On postoperative day 7, she complained of weakness in both legs. Postoperative magnetic resonance imaging (MRI) showed cerebrospinal fluid (CSF) collection with cord compression. In the operative field, we found 2 large dural defects on the ventral dura mater. We performed a conventional fat graft with fibrin glue. However, the patient exhibited neurologic deterioration, and a postoperative MRI again showed CSF collection. We performed dorsal midline durotomy and inserted a intradural and epidural Lyoplant patch. She immediately experienced diminishing back pain postoperatively. Her visual analog scale and motor power improved markedly. Postoperative MRIs performed at 2 and 16 months showed no spinal cord compression or CSF leakage to the epidural space. We describe a new technique for double layered duraplasty. Although we do not recommend this technique for all dural repairs, double-layered duraplasty may be useful for repairing large inaccessible dural tears in cases of persistent CSF leakage refractory to conventional management. PMID:27437022

  15. Similarity relation upon the puncture of a thin sheet

    NASA Astrophysics Data System (ADS)

    Yakovlev, N. O.; Chernatkin, S. E.; Kuz'ko, E. I.; Shtremel', M. A.

    2009-08-01

    Puncture is a break in a membrane (clamped on a distant peripheral outline) caused by pressing an indenter whose diameter is much less than the diameter of the membrane. Based on the measurements of the force P required for puncturing an aluminum foil over a wide range of relationships between its thickness h and the indenter radius R (for h/R = 0.12-7.00, i.e., from a blunt-indenter-thin-foil to a sharp-indenter-thick-foil case), we found a common nonlinear dependence of the dimensionless force P/ EhR ˜ ( h/2 R) n on the deformation of plastic bend in the contact h/2 R.

  16. Puncture Initial Data for Highly Spinning Black-Hole Binaries

    NASA Astrophysics Data System (ADS)

    Ruchlin, Ian; Healy, James; Lousto, Carlos; Zlochower, Yosef

    2015-04-01

    Accretion arguments suggest that some astrophysical black-holes will possess nearly extremal spins. It is expected that gravitational wave signals from orbiting and merging black-hole binaries will be detected by Advanced LIGO in the next few years. Accurate waveform models are needed to interpret detector data. We solve the Hamiltonian and momentum constraints of General Relativity representing two black-holes with nearly extremal spins and ultra-relativistic boosts in the puncture formalism using spectral methods in the Cactus/Einstein Toolkit framework. We use a non-conformally-flat ansatz with an attenuated superposition of two conformally rescaled Lorentz-boosted-Kerr 3-metrics and their corresponding conformal extrinsic curvatures. The initial data are evolved in time using moving punctures in the BSSN and Z4 formalisms. We compare with the standard Bowen-York conformally-flat ansatz, finding an order of magnitude smaller burst of spurious radiation.

  17. Migraine headache confounding the diagnosis of acute mountain sickness.

    PubMed

    Karle, Francis J; Auerbach, Paul S

    2014-03-01

    A 36-year-old man with a history of migraine headache attempted to hike from Lukla, Nepal, to Mount Everest Base Camp. On the sixth day of hiking, he had a migraine headache. After achieving resolution with typical therapies and rest, he ascended higher. Another headache developed that was interpreted to be a migraine. The headache was treated, and he ascended higher, after which severe symptoms of acute mountain sickness developed, necessitating his evacuation by helicopter. Persons with headaches in daily life may present challenges to diagnosis when traveling to high altitude. Careful evaluation and decision making are needed to achieve proper diagnosis and treatment of acute mountain sickness. PMID:24462763

  18. Resolution of New Daily Persistent Headache After Osteopathic Manipulative Treatment.

    PubMed

    Alexander, Joshua

    2016-03-01

    New daily persistent headache is a refractory headache with an elusive cause and treatment. Limited available data suggest that abnormalities in the musculoskeletal system may increase vulnerability to this type of headache. Osteopathic manipulative treatment has been used successfully to manage primary headache disorders. In this case report, a patient with new daily persistent headache and severe somatic dysfunction had resolution of her pain after osteopathic manipulative treatment. This case suggests that osteopathic manipulative treatment may be useful in patients with this typically treatment-resistant disorder.

  19. Puncture Self-Healing Polymers for Aerospace Applications

    NASA Technical Reports Server (NTRS)

    Gordon, Keith L.; Penner, Ronald K.; Bogert, Phil B.; Yost, W. T.; Siochi, Emilie J.

    2011-01-01

    Space exploration launch costs on the order of $10K per pound provide ample incentive to seek innovative, cost-effective ways to reduce structural mass without sacrificing safety and reliability. Damage-tolerant structural systems can provide a route to avoiding weight penalty while enhancing vehicle safety and reliability. Self-healing polymers capable of spontaneous puncture repair show great promise to mitigate potentially catastrophic damage from events such as micrometeoroid penetration. Effective self-repair requires these materials to heal instantaneously following projectile penetration while retaining structural integrity. Poly(ethylene-co-methacrylic acid) (EMMA), also known as Surlyn is an ionomer-based copolymer that undergoes puncture reversal (self-healing) following high impact puncture at high velocities. However EMMA is not a structural engineering polymer, and will not meet the demands of aerospace applications requiring self-healing engineering materials. Current efforts to identify candidate self-healing polymer materials for structural engineering systems are reported. Rheology, high speed thermography, and high speed video for self-healing semi-crystalline and amorphous polymers will be reported.

  20. A new multiple noncontinuous puncture (pointage) technique for corneal tattooing

    PubMed Central

    Park, Jin Hyoung; Um, Taewoong; Kim, Myoung Joon; Tchah, Hungwon; Kim, Jae Yong

    2015-01-01

    AIM To assess the safety and cosmetic efficacy of a new multiple noncontinuous transepithelial puncture technique for tattooing a decompensated cornea. METHODS It was a non-comparative clinical case series study. The study examines 33 eyes in 33 patients with total corneal opacity due to corneal decompensation, which developed following intraocular surgery. Corneal tattooing was performed using the multiple noncontinuous transepithelial puncture technique (i.e. pointage). The safety of this new surgical strategy was assessed by occurrence of adverse events for the follow-up period. The cosmetic efficacy was determined by the patient's cosmetic satisfaction and independent observer's opinion about patient appearance. RESULTS Seven women and 26 men were included in the study. The mean age was 46.4±17.5y (range: 7-67). In total, 30 of 33 patients (91%) reported cosmetic satisfaction within the follow-up period. Only 3 patients (9%) required additional tattooing due to cosmetic unsatisfaction. Cosmetic outcomes were analyzed and classified as excellent or good in 13 (39%) and 17 (52%) patients, respectively. No serious adverse events developed, except delayed epithelial healing in 3 cases. CONCLUSION The cosmetic outcomes of the multiple noncontinuous transepithelial puncture technique for corneal tattooing were good. The safety of this method is higher than conventional procedures. This new procedure also provides improved cost-effectiveness and safety over current corneal tattooing techniques. PMID:26558203

  1. Alcohol-induced headaches: Evidence for a central mechanism?

    PubMed Central

    Panconesi, Alessandro

    2016-01-01

    Alcoholic drinks (ADs) have been reported as a migraine trigger in about one-third of the migraine patients in retrospective studies. Some studies found that ADs trigger also other primary headaches. The studies concerning the role of ADs in triggering various types of primary headaches published after the International Headache Society classification criteria of 1988 were reviewed, and the pathophysiological mechanisms were discussed. Many studies show that ADs are a trigger of migraine without aura (MO), migraine with aura (MA), cluster headache (CH), and tension-type headache (TH). While data on MO and CH are well delineated, those in MA and TH are discordant. There are sparse reports that ADs are also triggers of less frequent types of primary headache such as familial hemiplegic migraine, hemicrania continua, and paroxysmal hemicrania. However, in some countries, the occurrence of alcohol as headache trigger is negligible, perhaps determined by alcohol habits. The frequency estimates vary widely based on the study approach and population. In fact, prospective studies report a limited importance of ADs as migraine trigger. If ADs are capable of triggering practically all primary headaches, they should act at a common pathogenetic level. The mechanisms of alcohol-provoking headache were discussed in relationship to the principal pathogenetic theories of primary headaches. The conclusion was that vasodilatation is hardly compatible with ADs trigger activity of all primary headaches and a common pathogenetic mechanism at cortical, or more likely at subcortical/brainstem, level is more plausible. PMID:27114660

  2. Alcohol-induced headaches: Evidence for a central mechanism?

    PubMed

    Panconesi, Alessandro

    2016-01-01

    Alcoholic drinks (ADs) have been reported as a migraine trigger in about one-third of the migraine patients in retrospective studies. Some studies found that ADs trigger also other primary headaches. The studies concerning the role of ADs in triggering various types of primary headaches published after the International Headache Society classification criteria of 1988 were reviewed, and the pathophysiological mechanisms were discussed. Many studies show that ADs are a trigger of migraine without aura (MO), migraine with aura (MA), cluster headache (CH), and tension-type headache (TH). While data on MO and CH are well delineated, those in MA and TH are discordant. There are sparse reports that ADs are also triggers of less frequent types of primary headache such as familial hemiplegic migraine, hemicrania continua, and paroxysmal hemicrania. However, in some countries, the occurrence of alcohol as headache trigger is negligible, perhaps determined by alcohol habits. The frequency estimates vary widely based on the study approach and population. In fact, prospective studies report a limited importance of ADs as migraine trigger. If ADs are capable of triggering practically all primary headaches, they should act at a common pathogenetic level. The mechanisms of alcohol-provoking headache were discussed in relationship to the principal pathogenetic theories of primary headaches. The conclusion was that vasodilatation is hardly compatible with ADs trigger activity of all primary headaches and a common pathogenetic mechanism at cortical, or more likely at subcortical/brainstem, level is more plausible.

  3. American academic headache specialists in neurology: practice characteristics and culture.

    PubMed

    Finkel, A G

    2004-07-01

    Headache diagnosis and treatment is the most important focus or concentration area for practising neurologists in America. The American Headache Society, formerly the American Association for the Study of Headache, is made up predominantly of neurologists. Recognition of the importance of the teaching and practice of headache medicine, especially migraine, is still incomplete at many academic teaching institutions. Suggestions that this results from inadequate academic hierarchies and education at graduate and post-graduate levels have been made. We therefore undertook a survey of academic practitioners of headache medicine in departments of neurology with membership of the American Headache Society. Subjects and addresses were identified using the 1999-2000 membership directory of the American Headache Society. Practice characteristics and time distribution were assessed. Teaching in undergraduate and resident programmes was also assessed. Fifty-five surveys from 46 institutions in 25 states were judged as adequate for this report. Academic neurologists with interest in headache medicine spent most of their time in clinic, with less than 25% spent doing either research or teaching. Medical schools had an average of 1 h of preclinical and 2 h of clinical teaching in headache. Neurology residents received an average of 3 h of didactic instruction in headache. This report is the first of its kind to review the practice characteristics and culture of headache medicine in the setting of academic departments of neurology. It describes a clinical practice similar to those of other non-academic American neurologists.

  4. The role of neuroimaging in the diagnosis of headache disorders

    PubMed Central

    Obermann, Mark

    2013-01-01

    Headache is a common clinical feature in patients in the emergency room and in general neurology clinics. For physicians not experienced in headache disorders it might be difficult sometimes to decide in which patients neuroimaging is necessary to diagnose an underlying brain pathology and in which patients cerebral imaging is unnecessary. Most patients presenting to the primary-care physician with a nonacute headache and no further neurological signs or symptoms will not be suffering from an underlying serious condition. This review focuses on the main primary headache diseases, including migraine, tension-type headache and cluster headache, as well as frequent secondary headache entities with common clinical presentation and appropriate diagnostic and therapeutic algorithms to help guide the decision on the utilization of neuroimaging in the diagnostic workup. PMID:24228072

  5. Sildenafil can induce the onset of a cluster headache bout.

    PubMed

    Lin, Guan-Yu; Lee, Jiunn-Tay; Peng, Giia-Sheun; Yang, Fu-Chi

    2014-05-01

    About 25% of patients who are prescribed sildenafil, the phosphodiesterase type 5 (PDE-5) inhibitor, for erectile dysfunction (ED) experience headaches. These migraine effects are well-described, including cluster headaches. We report the case of a man who experienced a cluster headache attack following each of 2 sildenafil doses. His symptoms were resolved by adding naproxen to his treatment regimen and changing his ED treatment from 50 mg of sildenafil to 5 mg of vardenafil. To our knowledge, no study has reported cluster headaches triggered by the less commonly used PDE-5 inhibitors, namely vardenafil and tadalafil. Urologists should be cautious in prescribing sildenafil to patients with ED and with a history of cluster headaches. In these patients, they should consider prescribing low-dose vardenafil or tadalafil instead. Failure to recognize sildenafil risks could result in unnecessary headache bouts in patients with a history of cluster headaches. PMID:24940471

  6. Epidemiology of headache in the Republic of San Marino.

    PubMed Central

    D'Alessandro, R; Benassi, G; Lenzi, P L; Gamberini, G; Sacquegna, T; De Carolis, P; Lugaresi, E

    1988-01-01

    An epidemiological survey on headache was performed in the Republic of San Marino, which is the smallest independent State in the world, located near the Adriatic Coast, within Italy. Among a random sample of 1500 inhabitants over 7 years of age the frequency of headache, severe headache and migraine in the previous year was 35.3%, 12.2%, 9.3% respectively for men, and 46.2%, 20.6%, 18% for women. The most common factors reported to provoke headache were emotional stress, physical strain, lack of sleep, particular foods or drinks and for women menstruation. Migraine patients differed from people without headache in that they had a higher consumption of coffee, more frequently reported bad sleep, allergic disease and previous appendectomy. Furthermore, migraine patients and severe headache sufferers had a higher diastolic blood pressure than non headache subjects. PMID:3258357

  7. [Individual medical relevance of headaches. Comorbidities and quality of life].

    PubMed

    Haag, G

    2014-08-01

    In a multitude of cases, very frequent primary headaches lead to a clear deterioration in quality of life. Particularly in patients with chronic migraine, chronic tension headache, and cluster headache, quality of life is limited. This contradicts the preconception still encountered today that headaches are not a serious illness. Comorbidities with somatic and above all mental disorders are also very frequently observed in headache patients. In the foreground are the cardiovascular diseases of arterial hypertension, stroke, and coronary heart disease, as well as the mental disorders of depression, anxiety disorders, posttraumatic stress disorders, and sleep disorders. When such comorbidities are present, the quality of life of the sufferers is significantly reduced. Therefore, headache disorders should be taken seriously and sufferers should be provided with a consistent therapy. In cases of severe types of headache and in the presence of comorbidities, it is imperative that therapy is also prophylactic and multimodal in nature.

  8. Headache and comorbidity in children and adolescents

    PubMed Central

    2013-01-01

    Headache is one of the most common neurological symptom reported in childhood and adolescence, leading to high levels of school absences and being associated with several comorbid conditions, particularly in neurological, psychiatric and cardiovascular systems. Neurological and psychiatric disorders, that are associated with migraine, are mainly depression, anxiety disorders, epilepsy and sleep disorders, ADHD and Tourette syndrome. It also has been shown an association with atopic disease and cardiovascular disease, especially ischemic stroke and patent foramen ovale (PFO). PMID:24063537

  9. Payroll: A Headache You Can Cure!

    PubMed

    Miller, Rita J; Mattern, Jay

    2015-01-01

    Payroll is not only an expense for your practice; it can be a headache for you or your practice manager. Payroll is also a major scope of audit procedures. Don't rely on the word of anyone else that your taxes were processed and remitted. Demand to see proof. By outsourcing your human resources and payroll functions to one company, you can free up valuable time to concentrate on your area of expertise, leaving the administrative hassles to the staffing firm.

  10. Managing Migraine Headaches in Children and Adolescents.

    PubMed

    Green, Antoinette; Kabbouche, Marielle; Kacperski, Joanne; Hershey, Andrew; O'Brien, Hope

    2016-01-01

    The diagnosis and management of migraine headaches can be challenging in children and adolescents. The description of migraine in this population may include symptoms that are not typically described in adults. Treatment options for pediatric migraine is increasing, however remain limited. This article will go through the key components to diagnosing migraine in pediatric patients as well as give options for short and long-term management.

  11. A Kinect™ camera based navigation system for percutaneous abdominal puncture

    NASA Astrophysics Data System (ADS)

    Xiao, Deqiang; Luo, Huoling; Jia, Fucang; Zhang, Yanfang; Li, Yong; Guo, Xuejun; Cai, Wei; Fang, Chihua; Fan, Yingfang; Zheng, Huimin; Hu, Qingmao

    2016-08-01

    Percutaneous abdominal puncture is a popular interventional method for the management of abdominal tumors. Image-guided puncture can help interventional radiologists improve targeting accuracy. The second generation of Kinect™ was released recently, we developed an optical navigation system to investigate its feasibility for guiding percutaneous abdominal puncture, and compare its performance on needle insertion guidance with that of the first-generation Kinect™. For physical-to-image registration in this system, two surfaces extracted from preoperative CT and intraoperative Kinect™ depth images were matched using an iterative closest point (ICP) algorithm. A 2D shape image-based correspondence searching algorithm was proposed for generating a close initial position before ICP matching. Evaluation experiments were conducted on an abdominal phantom and six beagles in vivo. For phantom study, a two-factor experiment was designed to evaluate the effect of the operator’s skill and trajectory on target positioning error (TPE). A total of 36 needle punctures were tested on a Kinect™ for Windows version 2 (Kinect™ V2). The target registration error (TRE), user error, and TPE are 4.26  ±  1.94 mm, 2.92  ±  1.67 mm, and 5.23  ±  2.29 mm, respectively. No statistically significant differences in TPE regarding operator’s skill and trajectory are observed. Additionally, a Kinect™ for Windows version 1 (Kinect™ V1) was tested with 12 insertions, and the TRE evaluated with the Kinect™ V1 is statistically significantly larger than that with the Kinect™ V2. For the animal experiment, fifteen artificial liver tumors were inserted guided by the navigation system. The TPE was evaluated as 6.40  ±  2.72 mm, and its lateral and longitudinal component were 4.30  ±  2.51 mm and 3.80  ±  3.11 mm, respectively. This study demonstrates that the navigation accuracy of the proposed system is acceptable

  12. [Iatrogenic spinal epidermoid tumors. A late complication of spinal puncture].

    PubMed

    Reina, M A; López-García, A; Dittmann, M; de Andrés, J A; Blázquez, M G

    1996-04-01

    INTRODUCTION. Epidermoid tumors in the spinal canal are rare. Whether congenitally or iatrogenically caused, they form as the result of epidermal cells implanted within the spinal channel. Such implantation can occur during a variety of procedures and events such as bullet wounds, surgery, myelography or punctures for diagnosis, anesthesia or treatment. Although this complication is not discussed in books or journals on anesthesiology, we have found it mentioned in over 100 published cases reporting iatrogenically caused spinal epidermoid tumors. ETIOPATHOGENESIS. Iatrogenic epidermoid tumors of the spine derive from the implantation of epidermal tissue transported inside the spinal canal during lumbar punctures without guidance or with inadequate guidance. There is ample evidence that such tumors are iatrogenic. All cases occur in patients with a history of lumbar puncture. They are rarely associated with congenital anomalies. They are extramedullary. They tend to develop near sites of earlier lumbar puncture, usually near the conus medullaris and the cauda equina. Iatrogenic epidermoid tumors of the spine have been reproduced experimentally in two studies in which autologous skin fragments were implanted in the spinal canal. CLINICAL SIGNS. These tumors are well tolerated by patients for extended periods of time, ranging from 2 to 10 years. At the cauda equinus, tumors can grow slowly for long periods without signs of nerve compression. Symptoms are directly related to tumor size and site. All patients with tumors at the cauda equinus report severe pain radiating toward the roots of compressed nerves. Nuclear magnetic resonance makes it possible to detect the tumor without administration of intrathecal contrast. At present gadolinium-DTPA improves the image so that these tumors can be distinguished from other types. The prognosis for epidermoid tumors of the spine is good, as they are histologically benign. Treatment is always surgical. CONCLUSION. Although the

  13. Clinical aspects of medication overuse headaches.

    PubMed

    Da Silva, Arnaldo Neves; Lake, Alvin E

    2014-01-01

    Medication overuse headache (MOH) is a subset of chronic daily headache, occurring from overuse of 1 or more classes of migraine abortive medication. Acetaminophen, combination analgesics (caffeine combinations), opioids, barbiturates (butalbital), non-steroidal anti-inflammatory drugs, and triptans are the main classes of drugs implicated in the genesis of MOH. Migraine seems to be the most common diagnosis leading to MOH. The development of MOH is associated with both frequency of use of medication and behavioral predispositions. MOH is not a unitary concept. The distinction between simple (type 1) vs complex (type 2) forms is based on both the class of overused medication and behavioral factors, including psychopathology and psychological drug dependence. MOH is a challenging disorder causing decline in the quality of life and causing physical symptoms, such as daily and incapacitating headaches, insomnia, and non-restorative sleep, as well as psychological distress and reduced functioning. MOH is associated with biochemical, structural, and functional brain changes. Relapse after detoxification is a challenge, but can be addressed if the patient is followed over a prolonged period of time with a combination of prophylactic pharmacotherapy, use of abortive medication with minimal risk of MOH, withholding previously overused medication, and providing psychological (cognitive-behavioral) therapy. PMID:24116964

  14. New daily persistent headache with a thunderclap headache onset and complete response to Nimodipine (A new distinct subtype of NDPH)

    PubMed Central

    2013-01-01

    At present new daily persistent headache is just a group of conditions that are connected based on the temporal profile of their mode of onset. If new daily persistent headache is a true distinct syndrome like migraine then we need to start to define subtypes that have specific effective treatments such has been noted for migraine sub-forms. We present what we believe is the first recognized subtype of new daily persistent headache that which starts with a thunderclap headache onset. A patient presented with a 13 month history of a daily headache from onset which initiated as a thunderclap headache along with persistent acalculia. All neuroimaging studies for secondary causes were negative. Nimodipine rapidly and completely alleviated her headache and associated neurologic symptoms. We propose that this subtype of new daily persistent headache is caused by a very rapid increase in CSF tumor necrosis factor alpha levels leading to cerebral artery vasospasm with a subsequent thunderclap headache, then continuous or near continuous cerebral artery vasospasm leading to a persistent daily headache. Nimodipine which not only inhibits cerebral artery vasospasm but also tumor necrosis factor alpha production appears to be a specific treatment for this distinct subtype of new daily persistent headache. PMID:24364890

  15. New daily persistent headache with a thunderclap headache onset and complete response to nimodipine (a new distinct subtype of NDPH).

    PubMed

    Rozen, Todd D; Beams, Jennifer L

    2013-12-23

    At present new daily persistent headache is just a group of conditions that are connected based on the temporal profile of their mode of onset. If new daily persistent headache is a true distinct syndrome like migraine then we need to start to define subtypes that have specific effective treatments such has been noted for migraine sub-forms. We present what we believe is the first recognized subtype of new daily persistent headache that which starts with a thunderclap headache onset. A patient presented with a 13 month history of a daily headache from onset which initiated as a thunderclap headache along with persistent acalculia. All neuroimaging studies for secondary causes were negative. Nimodipine rapidly and completely alleviated her headache and associated neurologic symptoms. We propose that this subtype of new daily persistent headache is caused by a very rapid increase in CSF tumor necrosis factor alpha levels leading to cerebral artery vasospasm with a subsequent thunderclap headache, then continuous or near continuous cerebral artery vasospasm leading to a persistent daily headache. Nimodipine which not only inhibits cerebral artery vasospasm but also tumor necrosis factor alpha production appears to be a specific treatment for this distinct subtype of new daily persistent headache.

  16. A chronopharmacological preventive treatment for sleep-related migraine headaches and chronic morning headaches: Nitric oxide supersensitivity can cause sleep-related headaches in a subset of patients.

    PubMed

    Eli, Robert; Fasciano, James A

    2006-01-01

    Frequent and recurrent migraine headaches can, over time, pose the additional risks of stroke, brain damage, heart failure and attention deficit. This is why prevention should always be a part of the treatment. Nitric oxide supersensitivity is the hypothesis upon which this model is based. Its role in causing migraine headaches and chronic morning headaches can be triggered by both normal and abnormal characteristics of the sleep cycle and more specifically by the release of nitric oxide that occurs towards the end of the sleep cycle. Stress and the age-related loss of sleep continuity, together with the corresponding increase in cortisol levels, potentiate delta rebound. Delta rebound results in deeper sleep intensity. It is associated with increased nitric oxide production. Increased delta rebound then causes an increase in the amount and duration of nitric oxide release at night. Migraineurs are susceptible to migraine headaches because they are supersensitive to nitric oxide. The diurnal pattern of the incidence of sleep-related headaches in a subset of the general population is caused by the effect of nitric oxide supersensitivity during the sleep cycle. The proposed treatment is for both sleep-related migraine headaches and chronic morning headaches. It consists of melatonin and moclobemide taken during the night, close the end of the sleep cycle so as to achieve the maximum concentrations. Both melatonin and moclobemide affect three important aspects of sleep-related headaches: nitric oxide supersensitivity, stress system dysfunction and sleep pathology. Both melatonin and moclobemide have demonstrated effectiveness in preventing migraine headaches. Additionally, both melatonin and moclobemide are compatible with most of the other therapeutic agents used to prevent migraine headaches and with at least 1 therapeutic agent that is used to treat migraine headaches.

  17. Sleep features and central sensitization symptoms in primary headache patients

    PubMed Central

    2014-01-01

    Background Association between sleep disorders and headache is largely known. The aim of the present study was to evaluate sleep quality and quantity in a large cohort of primary headache patients, in order to correlate these scores with symptoms of central sensitization as allodynia, pericranial tenderness and comorbidity with diffuse muscle-skeletal pain. Methods One thousand six hundreds and seventy primary headache out patients were submitted to the Medical Outcomes Study (MOS) within a clinical assessment, consisting of evaluation of frequency of headache, pericranial tenderness, allodynia and coexistence of fibromyalgia syndrome (FM). Results Ten groups of primary headache patients were individuated, including patients with episodic and chronic migraine and tension type headache, mixed forms, cluster headache and other trigeminal autonomic cephalalgias. Duration but not sleep disturbances score was correlated with symptoms of central sensitization as allodynia and pericranial tenderness in primary headache patients. The association among allodynia, pericranial tenderness and short sleep characterized chronic migraine more than any other primary headache form. Patients presenting with FM comorbidity suffered from sleep disturbances in addition to reduction of sleep duration. Conclusion Self reported duration of sleep seems a useful index to be correlated with allodynia, pericranial tenderness and chronic headache as a therapeutic target to be assessed in forthcoming studies aiming to prevent central sensitization symptoms development. PMID:25260261

  18. Types of headache and those remedies in traditional persian medicine

    PubMed Central

    Zarshenas, Mohammad M.; Petramfar, Peyman; Firoozabadi, Ali; Moein, Mahmood Reza; Mohagheghzadeh, Abdolali

    2013-01-01

    The history of headache, as a common neurological complication, goes back to almost 9000 years ago. Many ancient civilizations present references to headaches and the coherent treatment strategies. Accordingly, several documents comprising headache complications embodying precise medical information stem from Traditional Persian Medicine (TPM) that can provide useful opportunities for more comprehensive treatment. We conducted a survey on headache through original important pharmacopeias and other important medical manuscripts of TPM which were written during 9th to 19th centuries and have derived all headache categories and herbal remedies. An extensive search of scientific data banks, such as Medline and Scopus, has also been exercised to find results relating to the anti-inflammatory, anti-nociceptive, and analgesic effects of denoted medicinal herbs. The concept of headache and treatments in TPM covers over 20 various types of headache and more than 160 different medicinal plants administered for oral, topical, and nasal application according to 1000 years of the subject documents. Nearly, 60% of remarked medicinal herbs have related anti-inflammatory or analgesic effects and some current headache types have similarities and conformities to those of traditional types. Beside historical approaches, there are many possible and available strategies that can lead to development of new and effective headache treatment from medicinal plants so that this study can provide beneficial information on clinical remedies based on centuries of experience in the field of headache which can stand as a new candidate for further investigations. PMID:23922452

  19. Headache induced by the use of combined oral contraceptives.

    PubMed

    Allais, Gianni; Gabellari, Ilaria Castagnoli; Airola, Gisella; Borgogno, Paola; Schiapparelli, Paola; Benedetto, Chiara

    2009-05-01

    Although combined oral contraceptives (COCs) are a safe and highly effective method of birth control, they may also give rise to problems of clinical tolerability in migraine patients. Indeed, headache is among the most common side effects reported with the use of COCs, frequently leading to their being discontinued. The latest International Classification of Headache Disorders identified at least two entities evidently related to the use of COCs, i.e., exogenous hormone-induced headache and estrogen-withdrawal headache. As to the former, the newest formulations of COCs are generally well tolerated by migraine without aura patients, but can worsen headache in migraine with aura patients. Headache associated with COCs, generally, tends to improve as their use continues. However, although it is not yet clear if there is an association between headache and the composition of COCs (both in the type and amount of hormones), it has been observed that the incidence of headache during COC use seems greater if migraine is associated with menstrual trigger. The estrogen-withdrawal headache is a headache that generally appears within the first 5 days after cessation of estrogen use and resolves within 3 days, even if in some cases it may appear on the sixth or seventh day after pill suspension and lasts more than 3 days.

  20. Biologically inert synthetic dural substitutes. Appraisal of a medical-grade aliphatic polyurethane and a polysiloxane-carbonate block copolymer.

    PubMed

    Sakas, D E; Charnvises, K; Borges, L F; Zervas, N T

    1990-12-01

    Two types of artificial membranes, a medical-grade aliphatic polyurethane and a polysiloxane-carbonate block copolymer, were tested as substitutes for dura in 24 and 12 rabbits, respectively. The films were placed either epidurally, subdurally, or as dural grafts in equal subgroups of animals. The postoperative course was uneventful with no manifestations of convulsive disorder or cerebrospinal fluid leak. The animals were sacrificed 3, 6, or 9 months after implantation of the artificial membranes. Both types of artificial membranes were easily removed from the underlying nervous and the other surrounding tissues. The histological examination failed to reveal adhesions, neomembrane formations, or any type of foreign body reactions to the polyurethane film. The implantation of the polysiloxane-carbonate film caused no reaction when it was applied epidurally. As a dural graft, the polysiloxane-carbonate copolymer induced the formation of a thin neomembrane of one to two layers of fibroblasts which formed a watertight seal of the dural defect. A similar thin neomembrane was found to encase this artificial membrane in the group of animals in which it was implanted subdurally. There was no foreign body reaction to the polysiloxane-carbonate film. The authors conclude that these materials hold promise as dural substitutes or in the prevention of spinal dural scarring, and should be evaluated clinically.

  1. Weather and headache onset: a large-scale study of headache medicine purchases

    NASA Astrophysics Data System (ADS)

    Ozeki, Kayoko; Noda, Tatsuya; Nakamura, Mieko; Ojima, Toshiyuki

    2015-04-01

    It is widely recognized that weather changes can trigger headache onset. Most people who develop headaches choose to self-medicate rather than visit a hospital or clinic. We investigated the association between weather and headache onset using large-sample sales of the headache medicine, loxoprofen. We collected daily sales figures of loxoprofen and over-the-counter drugs over a 1-year period from a drugstore chain in western Shizuoka prefecture, Japan. To adjust for changes in daily sales of loxoprofen due to social environmental factors, we calculated a proportion of loxoprofen daily sales to over-the-counter drug daily sales. At the same time, we obtained weather data for the study region from the website of the Japan Meteorological Agency. We performed linear regression analysis to ascertain the association between weather conditions and the loxoprofen daily sales proportion. We also conducted a separate questionnaire survey at the same drugstores to determine the reason why people purchased loxoprofen. Over the study period, we surveyed the sale of hundreds of thousands of loxoprofen tablets. Most people purchased loxoprofen because they had a headache. We found that the sales proportion of loxoprofen increased when average barometric pressure decreased, and that precipitation, average humidity, and minimum humidity increased on loxoprofen purchase days compared to the previous day of purchases. This study, performed using a large dataset that was easy-to-collect and representative of the general population, revealed that sales of loxoprofen, which can represent the onset and aggravation of headache, significantly increased with worsening weather conditions.

  2. Weather and headache onset: a large-scale study of headache medicine purchases.

    PubMed

    Ozeki, Kayoko; Noda, Tatsuya; Nakamura, Mieko; Ojima, Toshiyuki

    2015-04-01

    It is widely recognized that weather changes can trigger headache onset. Most people who develop headaches choose to self-medicate rather than visit a hospital or clinic. We investigated the association between weather and headache onset using large-sample sales of the headache medicine, loxoprofen. We collected daily sales figures of loxoprofen and over-the-counter drugs over a 1-year period from a drugstore chain in western Shizuoka prefecture, Japan. To adjust for changes in daily sales of loxoprofen due to social environmental factors, we calculated a proportion of loxoprofen daily sales to over-the-counter drug daily sales. At the same time, we obtained weather data for the study region from the website of the Japan Meteorological Agency. We performed linear regression analysis to ascertain the association between weather conditions and the loxoprofen daily sales proportion. We also conducted a separate questionnaire survey at the same drugstores to determine the reason why people purchased loxoprofen. Over the study period, we surveyed the sale of hundreds of thousands of loxoprofen tablets. Most people purchased loxoprofen because they had a headache. We found that the sales proportion of loxoprofen increased when average barometric pressure decreased, and that precipitation, average humidity, and minimum humidity increased on loxoprofen purchase days compared to the previous day of purchases. This study, performed using a large dataset that was easy-to-collect and representative of the general population, revealed that sales of loxoprofen, which can represent the onset and aggravation of headache, significantly increased with worsening weather conditions.

  3. Influence of headache frequency on clinical signs and symptoms of TMD in subjects with temple headache and TMD pain

    PubMed Central

    Anderson, Gary C.; John, Mike T.; Ohrbach, Richard; Nixdorf, Donald R.; Schiffman, Eric L.; Truelove, Edmond S.; List, Thomas

    2011-01-01

    The relationship of the frequency of temple headache to signs and symptoms of temporomandibular disorders (TMD) was investigated in a subset of a larger convenience sample of community TMD cases. The study sample included: 86 painful TMD, non-headache subjects; 309 painful TMD subjects with varied frequency of temple headaches; and 149 subjects without painful TMD or headache for descriptive comparison. Painful TMD included Research Diagnostic Criteria (RDC) diagnoses of myofascial pain, TMJ arthralgia and TMJ osteoarthritis. Mild to moderate intensity temple headaches were classified by frequency using criteria based on the ICHD-II classification of TTH. Outcomes included TMD signs and symptoms (pain duration, pain intensity, number of painful masticatory sites on palpation, mandibular range of motion), PPTs and temple headache resulting from masticatory provocation tests. Trend analyses across the painful TMD groups showed a substantial trend for aggravation of all of the TMD signs and symptoms associated with increased frequency of the temple headaches. In addition, increased headache frequency showed significant trends associated with reduced PPTs and reported temple headache with masticatory provocation tests. In conclusion, these findings suggest that these headaches may be TMD-related, as well as a possible role for peripheral and central sensitization in TMD patients. PMID:21196079

  4. Reinvestigation of moving punctured black holes with a new code

    SciTech Connect

    Cao Zhoujian; Yo Hweijang; Yu Juiping

    2008-12-15

    We report on our code, in which the moving puncture method is applied and an adaptive/fixed mesh refinement is implemented, and on its preliminary performance on black hole simulations. Based on the Baumgarte-Sharpiro-Shibata-Nakamura (BSSN) formulation, up-to-date gauge conditions and the modifications of the formulation are also implemented and tested. In this work, we present our primary results about the simulation of a single static black hole, of a moving single black hole, and of the head-on collision of a binary black hole system. For the static punctured black hole simulations, different modifications of the BSSN formulation are applied. It is demonstrated that both the currently used sets of modifications lead to a stable evolution. For cases of a moving punctured black hole with or without spin, we search for viable gauge conditions and study the effect of spin on the black hole evolution. Our results confirm previous results obtained by other research groups. In addition, we find a new gauge condition, which has not yet been adopted by any other researchers, which can also give stable and accurate black hole evolution calculations. We examine the performance of the code for the head-on collision of a binary black hole system, and the agreement of the gravitational waveform it produces with that obtained in other works. In order to understand qualitatively the influence of matter on the binary black hole collisions, we also investigate the same head-on collision scenarios but perturbed by a scalar field. The numerical simulations performed with this code not only give stable and accurate results that are consistent with the works by other numerical relativity groups, but also lead to the discovery of a new viable gauge condition, as well as clarify some ambiguities in the modification of the BSSN formulation. These results demonstrate that this code is reliable and ready to be used in the study of more realistic astrophysical scenarios and of numerical

  5. Chronic Daily Headache: Mechanisms and Principles of Management.

    PubMed

    Voigt, Amy W; Gould, Harry J

    2016-02-01

    Primary headache is a common malady that is often under-recognized and frequently inadequately managed in spite of the fact that it affects up to 95 % of the population in a lifetime. Many forms of headache, including episodic tension and migraine headaches, if properly diagnosed, are reasonably amenable to treatment, but a smaller, though not insignificant, percent of the population suffer daily from a chronic, intractable form of headache that destroys one's productivity and quality of life. These patients are frequently seen in neurological practices at a point when treatment options are limited and largely ineffective. In the following review, we will discuss mechanisms drawn from recent studies that address the transition from acute to chronic pain that may apply to the transformation from episodic to chronic daily headaches which may offer opportunities for preempting headache transformation.

  6. Access to care - an unmet need in headache management?

    PubMed Central

    2014-01-01

    Access to care for headache sufferers is not always simple. A survey conducted in a large number of members of lay associations point to the existence of multiple barriers to care for headache in several European countries. Patients usually discover the existence of specialized structures with a delay of several years after the onset of their headache. Furthermore, a relevant portion of them are not satisfied with the management of their disease, partly because of the poor efficacy of treatments and partly because of the difficulty to get in touch with the specialist. Headache disorders, and primary headaches in particular, represent an important issue in public health, because they are common, disabling and treatable. A joint effort is required from the relevant stakeholders (scientists, lay organizations, decision-makers, healthcare policymakers, and others) to improve the access to care for headache sufferers. PMID:24742114

  7. Cisternal Puncture Complications—Treatment of Coccidioidal Meningitis with Amphotericin B

    PubMed Central

    Keane, James R.

    1973-01-01

    Of two patients who had acute neurologic damage from cisternal punctures, one died 17 hours following a tap which produced major subarachnoid hemorrhage, the other patient recovered from probable brain stem infarction associated with cisterna magna amphotericin injection. Subarachnoid hemorrhage is the commonest major complication of cisternal puncture, with at least 30 reported fatalities. Other serious complications result from direct puncture of brain substance. Cisternal puncture is not an appropriate alternative to a difficult lumbar puncture, and indications for its use are limited. The occasional required cisternal tap should be performed only by persons carefully trained in the technique, preferably utilizing fluoroscopic guidance, and only where neurosurgical assistance is readily available. Post-puncture subarachnoid hemorrhage accompanied by progressive obtundation requires emergency evaluation and consideration of posterior fossa decompression. ImagesFigure 1.Figure 2.Figure 3. PMID:4741057

  8. Trumpet solution from spherical gravitational collapse with puncture gauges

    SciTech Connect

    Thierfelder, Marcus; Bernuzzi, Sebastiano; Hilditch, David; Bruegmann, Bernd; Rezzolla, Luciano

    2011-03-15

    We investigate the stationary end state obtained by evolving a collapsing spherical star with the gauges routinely adopted to study puncture black holes. We compare the end state of the collapse with the trumpet solution found in the evolution of a single wormhole slice and show that the two solutions closely agree. We demonstrate that the agreement is caused by the use of the Gamma-driver shift condition, which allows the matter to fall inwards into a region of spacetime that is not resolved by the numerical grid, and which simultaneously finds the stationary coordinates of the trumpet outside the matter.

  9. A unique type of dural arteriovenous fistula at confluence of sinuses treated with endovascular embolization: a case report.

    PubMed

    Gupta, Rahul; Miyachi, Shigeru; Matsubara, Noriaki; Izumi, Takashi; Naito, Takehiro; Haraguchi, Kenichi; Wakabayashi, Toshihiko

    2013-02-01

    Dural arteriovenous fistula (DAVF) is classically defined as abnormal arteriovenous connections located within the dural leaflets. Though the exact etiology is still not clear, they are generally accepted as acquired lesions. However, some DAVFs formed as the congenital disorders are called dural arteriovenous malformations and these lesions with a marked cortical venous reflux are considered to be aggressive and warrant an early intervention. The authors describe a case of 35-year-old man presented with unique type of DAVF. The fistula was located adjacent to the confluence of venous sinuses with multiple feeders. The feeders drained into a large venous pouch just anterior to the confluence which had a bilateral venous drainage. This was associated with multiple cerebellar venous ectasia along the draining cortical vein. It was managed by staged endovascular procedures and complete cure could be achieved. The pathogenesis and technique of embolization of this complex fistula/malformation are also discussed.

  10. In situ precise electrospinning of medical glue fibers as nonsuture dural repair with high sealing capability and flexibility

    PubMed Central

    Lv, Fu-Yan; Dong, Rui-Hua; Li, Zhao-Jian; Qin, Chong-Chong; Yan, Xu; He, Xiao-Xiao; Zhou, Yu; Yan, Shi-Ying; Long, Yun-Ze

    2016-01-01

    Purpose In this work, we propose an in situ precise electrospinning of medical glue fibers onto dural wound for improving sealing capability, avoiding tissue adhesion, and saving time in dural repair. Methods N-octyl-2-cyanoacrylate, a commercial tissue adhesive (medical glue), can be electrospun into ultrathin fibrous film with precise and homogeneous deposition by a gas-assisted electrospinning device. Results The self-assembled N-octyl-2-cyanoacrylate film shows high compactness and flexibility owing to its fibrous structure. Simulation experiments on egg membranes and goat meninges demonstrated that this technology can repair small membrane defects quickly and efficiently. Conclusion This method may have potential application in dural repair, for example, working as an effective supplementary technique for conventional dura suture.

  11. In situ precise electrospinning of medical glue fibers as nonsuture dural repair with high sealing capability and flexibility

    PubMed Central

    Lv, Fu-Yan; Dong, Rui-Hua; Li, Zhao-Jian; Qin, Chong-Chong; Yan, Xu; He, Xiao-Xiao; Zhou, Yu; Yan, Shi-Ying; Long, Yun-Ze

    2016-01-01

    Purpose In this work, we propose an in situ precise electrospinning of medical glue fibers onto dural wound for improving sealing capability, avoiding tissue adhesion, and saving time in dural repair. Methods N-octyl-2-cyanoacrylate, a commercial tissue adhesive (medical glue), can be electrospun into ultrathin fibrous film with precise and homogeneous deposition by a gas-assisted electrospinning device. Results The self-assembled N-octyl-2-cyanoacrylate film shows high compactness and flexibility owing to its fibrous structure. Simulation experiments on egg membranes and goat meninges demonstrated that this technology can repair small membrane defects quickly and efficiently. Conclusion This method may have potential application in dural repair, for example, working as an effective supplementary technique for conventional dura suture. PMID:27621616

  12. Pediatric febrile seizures and childhood headaches in primary care.

    PubMed

    Reinhold, J; Bentti, A L

    2000-03-01

    Febrile seizures and migraine headaches in children are two of the most common neurological diagnoses seen by primary care practitioners. It is essential that a knowledge base be developed to better care for this population. This article reviews pediatric febrile seizures, including management and treatment recommendations and childhood headaches, with an emphasis on migraine headaches. Diagnosis, management, and referral criteria are also reviewed. PMID:10673570

  13. CERVICOGENIC HEADACHES: AN EVIDENCE-LED APPROACH TO CLINICAL MANAGEMENT

    PubMed Central

    2011-01-01

    Cervicogenic headache (CGH), as the diagnosis suggests, refers to a headache of cervical origin. Historically, these types of headaches were difficult to diagnose and treat because their etiology and pathophysiology was not well-understood. Even today, management of a CGH remains challenging for sports rehabilitation specialists. The purpose of this clinical suggestion is to review the literature on CGH and develop an evidence-led approach to assessment and clinical management of CGH. PMID:22034615

  14. Headache features in patients with dengue virus infection.

    PubMed

    Domingues, R B; Kuster, G W; Onuki de Castro, F L; Souza, V A; Levi, J E; Pannuti, C S

    2006-07-01

    The aim of this study was to describe the frequency and features of headache among patients with confirmed dengue virus infection and to compare the headache features in patients with dengue fever and dengue haemorrhagic fever, primary and secondary dengue infection, and patients with and without neurological involvement. Patients with classic dengue fever had a more intense headache than those with the more severe form of the disease, dengue haemorrhagic fever.

  15. Payroll: A Headache You Can Cure!

    PubMed

    Miller, Rita J; Mattern, Jay

    2015-01-01

    Payroll is not only an expense for your practice; it can be a headache for you or your practice manager. Payroll is also a major scope of audit procedures. Don't rely on the word of anyone else that your taxes were processed and remitted. Demand to see proof. By outsourcing your human resources and payroll functions to one company, you can free up valuable time to concentrate on your area of expertise, leaving the administrative hassles to the staffing firm. PMID:26856025

  16. Transsphenoidal cyst cisternostomy with a keyhole dural opening for sellar arachnoid cysts: technical note.

    PubMed

    Oyama, Kenichi; Fukuhara, Noriaki; Taguchi, Manabu; Takeshita, Akira; Takeuchi, Yasuhiro; Yamada, Shozo

    2014-04-01

    A less invasive transsphenoidal approach with a keyhole dural opening for intrasellar arachnoid cysts is described. This approach was used to address seven sellar cystic lesions with suprasellar extension; they were six intrasellar arachnoid cysts (IACs) and one Rathke's cleft cyst (RCC). In all cases, preoperative MRI revealed cerebrospinal fluid (CSF) intensity on both T1- and T2-weighted images. On preoperative contrast-enhanced MRI, five of the six IACs manifested posterior displacement of the flattened pituitary gland toward the dorsum sellae; one of the six IACs and the RCC exhibited a flattened pituitary gland on the anterior surface of the cyst. Wide cyst cisternostomy through a keyhole dural opening was carried out safely using a microscope with the support of a thin angled endoscope (30° and/or 70°, diameter 2.7 mm). As we aimed to avoid iatrogenic injury of the pituitary function, we found it difficult to obtain a sufficiently wide and precise opening of the cyst wall when the pituitary gland was located on the anterior surface of the cyst wall. Our approach facilitates safe cyst cisternostomy as wide as that obtainable by transcranial manipulation. In addition, CSF leakage is prevented by dural plasty using the fascia lata and stitching with 6-0 monofilament sutures. This technique can be adapted to address various sellar cystic lesions. However, as the posterior or anterior displacement of the normal pituitary gland in the presence of IACs or RCCs, respectively, affects the width of the cyst opening, our technique is more suitable for IACs than RCCs.

  17. Dural neurogenic inflammation induced by neuropathic pain is specific to cranial region.

    PubMed

    Filipović, B; Matak, I; Lacković, Z

    2014-05-01

    Up to now, dural neurogenic inflammation (DNI) has been studied primarily as a part of migraine pain pathophysiology. A recent study from our laboratory demonstrated the occurrence of DNI in response to peripheral trigeminal nerve injury. In this report, we characterize the occurrence of DNI after different peripheral nerve injuries in and outside of the trigeminal region. We have used the infraorbital nerve constriction injury model (IoNC) as a model of trigeminal neuropathic pain. Greater occipital nerve constriction injury (GoNC), partial transection of the sciatic nerve (ScNT) and sciatic nerve constriction injury (SCI) were employed to characterize the occurrence of DNI in response to nerve injury outside of the trigeminal region. DNI was measured as colorimetric absorbance of Evans blue plasma protein complexes. In addition, cellular inflammatory response in dural tissue was histologically examined in IoNC and SCI models. In comparison to the strong DNI evoked by IoNC, a smaller but significant DNI has been observed following the GoNC. However, DNI has not been observed either in cranial or in lumbar dura following ScNT and SCI. Histological evidence has demonstrated a dural proinflammatory cell infiltration in the IoNC model, which is in contrast to the SCI model. Inflammatory cell types (lymphocytes, plasma cells, and monocytes) have indicated the presence of sterile cellular inflammatory response in the IoNC model. To our knowledge, this is the first observation that the DNI evoked by peripheral neuropathic pain is specific to the trigeminal area and the adjacent occipital area. DNI after peripheral nerve injury consists of both plasma protein extravasation and proinflammatory cell infiltration.

  18. Endovascular Treatment of Transverse-Sigmoid Sinus Dural Arteriovenous Malformations Presenting as Pulsatile Tinnitus

    PubMed Central

    Shownkeen, Harish; Yoo, Kevin; Leonetti, John; Origitano, T.C.

    2001-01-01

    Transverse-sigmoid sinus dural arteriovenous malformations (DAVM) are uncommon vascular lesions for which complete cure may be difficult to obtain. A wide variety of treatments for these lesions include observation, arterial compression, surgical resection, and endovascular embolization. We propose that transverse-sigmoid sinus DAVM can be completely cured by occluding the ipsilateral dural sinus with detachable balloon and Guglielmi detachable coils (GDC) coils before arterial feeder embolization with histoacryl. Three patients who presented with pulsatile tinnitus and normal magnetic resonance imaging (MRI) studies underwent angiography, which demonstrated transverse-sigmoid sinus DAVM. All three patients wer treated with retrograde transvenous sinus embolization with complete occlusion of the transverse-sigmoid sinus with detachable balloons and GDC coils with preservation of the vein of Labbé. Subsequently, the various feeders from the external carotid artery were embolized. The tentorial arteries arising from the ipsilateral internal carotid arteries were not embolized in any of the cases, which were still contributing to the DAVM. Complete cure with thrombosis of the tentorial branch of the internal carotid artery (ICA) was seen on follow-up angiogram 1 day after embolization in one patient and on 4-week and 6-week follow-up angiograms in the other two patients. Complete occlusion of the transverse sinus proximal to the vein of Labbé, in spite of incomplete arterial feeder embolization, can result in complete cure of the transversesinus dural AVF if adequate time is given for the remaining feeders to occlude, once the fistula is obliterated. ImagesFigure 1Figure 1p18-aFigure 2Figure 3 PMID:17167600

  19. The relationship of headache occurrence to barometric pressure

    NASA Astrophysics Data System (ADS)

    Schulman, Jane; Leviton, A.; Slack, W.; Porter, D.; Graham, J. R.

    1980-09-01

    A total of 75 people residing in the metropolitan Boston area who had frequently recurring headaches kept a headache diary for one month beginning March 1975. Data were also collected about barometric pressure during this time. We found that the probability of headache severity on any day was independent of the effects of time. An inference of this, supported by other findings in this study, is that headache occurrence is minimally affected by time-related phenomena such as barometric pressure readings or changes..

  20. Chiropractic management of a patient with persistent headache

    PubMed Central

    West, Jason; Phillips, Reed B.

    2013-01-01

    Objective The purpose of this case report is to describe chiropractic care of a patient with persistent headache treated using chiropractic manipulative therapy and adjunct treatments. Clinical features A 54-year-old multiparous woman had chronic debilitating headaches for 11 months. Previous care from a variety of specialties had brought no appreciable relief. Intervention and outcome The patient was managed with chiropractic manipulative therapy, injections, and electromagnetic therapy. Five treatments over 6 weeks brought resolution of the headaches. Conclusion This patient with persistent headache responded favorably to a course of chiropractic and adjunctive care. PMID:24396331

  1. Reversible Cerebral Vasoconstriction Syndrome Without Typical Thunderclap Headache.

    PubMed

    Wolff, Valérie; Ducros, Anne

    2016-04-01

    Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by severe headache and diffuse segmental intracranial arterial constriction that resolve within three months. Stroke, which is the major complication of RCVS, can result in persistent neurological disability, and rarely causes death. Diagnosis of RCVS early in the clinical course might improve outcomes. Although recurrent thunderclap headache is the clinical hallmark of RCVS, the absence of such a pattern should not lead to discard the diagnosis. Our literature review shows that RCVS can also manifest as an unspecific headache, such as a single severe headache episode, a mild or a progressive headache. Moreover, a subset of patients with severe RCVS presents without any headache, but frequently with seizures, focal neurological deficits, confusion or coma, in the setting of stroke or posterior reversible encephalopathy syndrome. These patients may be aphasic or in comatose state, explaining their inability to give their own medical history. They may have forgotten the headache they had a few days before more dramatic symptoms, or may have a variant of the classical RCVS. By consequence, an RCVS should be suspected in patients with any unusual headache, whether thunderclap or not, and in patients with cryptogenic stroke or convexity subarachnoid hemorrhage, whether the patient also has headache or not. Diagnosis in such cases relies on the demonstration of reversible multifocal intracranial arterial stenosis and the exclusion of other causes. PMID:27016378

  2. Diagnosis and clinical features of trigemino-autonomic headaches.

    PubMed

    May, Arne

    2013-10-01

    Although severe short-lasting headaches are rare, they can be considered disabling conditions with a major impact on the quality of life of patients. These headaches can divided broadly in to those associated with autonomic symptoms, so called trigeminal autonomic cephalgias (TACs), and those with few or no autonomic symptoms. The TACs include cluster headache, paroxysmal hemicranias, hemicrania continua, and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms as well as short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing syndrome. In all of these syndromes, half-sided head pain and ipsilateral cranial autonomic symptoms such as lacrimation or rhinorrhea are prominent. The paroxysmal hemicranias have, unlike cluster headaches, a very robust response to indomethacin, leading to a notion of indomethacin-sensitive headaches. The diagnosis of TACs is exclusively a clinical task. Because of the fact that cluster headache is strictly half-sided, typically involves the region around the eye and temple and often starts in the upper jaw, most patients first consult a dentist or ophthalmologist. No single instrumental examination has yet been able to define, or ensure, the correct diagnosis, or differentiate idiopathic headache syndromes. It is crucial that a trained neurologist sees these patients early so that management can be optimized and unnecessary procedures can be avoided. Although TACS are, in comparison to migraine, quite rare, they are nevertheless clinically very important for the neurologist to consider as they are easy to diagnose and the treatment is very effective in most patients.

  3. Update of Inpatient Treatment for Refractory Chronic Daily Headache.

    PubMed

    Lai, Tzu-Hsien; Wang, Shuu-Jiun

    2016-01-01

    Chronic daily headache (CDH) is a group of headache disorders, in which headaches occur daily or near-daily (>15 days per month) and last for more than 3 months. Important CDH subtypes include chronic migraine, chronic tension-type headache, hemicrania continua, and new daily persistent headache. Other headaches with shorter durations (<4 h/day) are usually not included in CDH. Common comorbidities of CDH are medication overuse headache and various psychiatric disorders, such as depression and anxiety. Indications of inpatient treatment for CDH patients include poor responses to outpatient management, need for detoxification for overuse of specific medications (particularly opioids and barbiturates), and severe psychiatric comorbidities. Inpatient treatment usually involves stopping acute pain, preventing future attacks, and detoxifying medication overuse if present. Multidisciplinary integrated care that includes medical staff from different disciplines (e.g., psychiatry, clinical psychology, and physical therapy) has been recommended. The outcomes of inpatient treatment are satisfactory in terms of decreasing headache intensity or frequency, withdrawal from medication overuse, reducing disability, and improving life quality, although long-term relapse is not uncommon. In conclusion, inpatient treatment may be useful for select patients with refractory CDH and should be incorporated in a holistic headache care program.

  4. Combat-related headache and traumatic brain injury.

    PubMed

    Waung, Maggie W; Abrams, Gary M

    2012-12-01

    Post-traumatic headache is a commonly described complication of traumatic brain injury. Recent studies highlight differences between headache features of combat veterans who suffered traumatic brain injury compared to civilians. Not surprisingly, there is a higher rate of associated PTSD and sleep disturbances among veterans. Factors of lower socioeconomic status, rank, and multiple head injuries appear to have a similar effect on post-traumatic headache in combat-related traumatic brain injury. Areas of discordance in the literature include the effect of prolonged loss of consciousness and the prevalence of specific headache phenotypes following head trauma. To date, there have been no randomized trials of treatment for post-traumatic headache. This may be related to the variability of headache features and uncertainty of pathophysiologic mechanisms. Given this lack of data, many practitioners follow treatment guidelines for primary headaches. Additionally, because of mounting data linking PTSD to post-traumatic headache in combat veterans, it may be crucial to choose multimodal agents and take a multidisciplinary approach to combat-related headache.

  5. Reversible Cerebral Vasoconstriction Syndrome Without Typical Thunderclap Headache.

    PubMed

    Wolff, Valérie; Ducros, Anne

    2016-04-01

    Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by severe headache and diffuse segmental intracranial arterial constriction that resolve within three months. Stroke, which is the major complication of RCVS, can result in persistent neurological disability, and rarely causes death. Diagnosis of RCVS early in the clinical course might improve outcomes. Although recurrent thunderclap headache is the clinical hallmark of RCVS, the absence of such a pattern should not lead to discard the diagnosis. Our literature review shows that RCVS can also manifest as an unspecific headache, such as a single severe headache episode, a mild or a progressive headache. Moreover, a subset of patients with severe RCVS presents without any headache, but frequently with seizures, focal neurological deficits, confusion or coma, in the setting of stroke or posterior reversible encephalopathy syndrome. These patients may be aphasic or in comatose state, explaining their inability to give their own medical history. They may have forgotten the headache they had a few days before more dramatic symptoms, or may have a variant of the classical RCVS. By consequence, an RCVS should be suspected in patients with any unusual headache, whether thunderclap or not, and in patients with cryptogenic stroke or convexity subarachnoid hemorrhage, whether the patient also has headache or not. Diagnosis in such cases relies on the demonstration of reversible multifocal intracranial arterial stenosis and the exclusion of other causes.

  6. Economic recession and headache-related hospital admissions.

    PubMed

    Chinta, Ravi; Rao, M B; Narendran, Vivek; Malla, Ganesh; Joshi, Hem

    2013-01-01

    Incidence of headaches across different regions and its relationship to unemployment rates in the United States before and during an economic recession was evaluated. Years 2008 and 2009 were determined as recessionary period. Headache-related admissions, particularly the uncomplicated headaches, increased significantly during recession. Proportion of women with headaches has increased and the age group of 25-54 years was the most affected during the recession. The hospital charges have increased even though the average length and charge of stay decreased. These findings are consistent with our understanding of effects of stress and unemployment on psychological and physical health.

  7. Headaches and myofascial temporomandibular disorders: overlapping entities, separate managements?

    PubMed

    Conti, P C R; Costa, Y M; Gonçalves, D A; Svensson, P

    2016-09-01

    There are relevant clinical overlaps between some of the painful temporomandibular disorders (TMD) and headache conditions that may hamper the diagnostic process and treatment. A non-systematic search for studies on the relationship between TMD and headaches was carried out in the following databases: PubMed, Cochrane Library and Embase. Important pain mechanisms contributing to the close association and complex relationship between TMD and headache disorders are as follows: processes of peripheral and central sensitisation which take place in similar anatomical areas, the possible impairment of the descending modulatory pain pathways and the processes of referred pain. In addition, the clinical examination does not always provide distinguishing information to differentiate between headaches and TMD. So, considering the pathophysiology and the clinical presentation of some types of headache and myofascial TMD, such overlap can be considered not only a matter of comorbid relationship, but rather a question of disorders where the distinction lines are sometimes hard to identify. These concerns are certainly reflected in the current classification systems of both TMD and headache where the clinical consequences of diagnosis such as headache attributed to or associated with TMD are uncertain. There are several similarities in terms of therapeutic strategies used to manage myofascial TMD and headaches. Considering all these possible levels of interaction, we reinforce the recommendation for multidisciplinary approaches, by a team of oro-facial pain specialists and a neurologist (headache specialist), to attain the most precise differential diagnosis and initiate the best and most efficient treatment. PMID:27191928

  8. Headaches and myofascial temporomandibular disorders: overlapping entities, separate managements?

    PubMed

    Conti, P C R; Costa, Y M; Gonçalves, D A; Svensson, P

    2016-09-01

    There are relevant clinical overlaps between some of the painful temporomandibular disorders (TMD) and headache conditions that may hamper the diagnostic process and treatment. A non-systematic search for studies on the relationship between TMD and headaches was carried out in the following databases: PubMed, Cochrane Library and Embase. Important pain mechanisms contributing to the close association and complex relationship between TMD and headache disorders are as follows: processes of peripheral and central sensitisation which take place in similar anatomical areas, the possible impairment of the descending modulatory pain pathways and the processes of referred pain. In addition, the clinical examination does not always provide distinguishing information to differentiate between headaches and TMD. So, considering the pathophysiology and the clinical presentation of some types of headache and myofascial TMD, such overlap can be considered not only a matter of comorbid relationship, but rather a question of disorders where the distinction lines are sometimes hard to identify. These concerns are certainly reflected in the current classification systems of both TMD and headache where the clinical consequences of diagnosis such as headache attributed to or associated with TMD are uncertain. There are several similarities in terms of therapeutic strategies used to manage myofascial TMD and headaches. Considering all these possible levels of interaction, we reinforce the recommendation for multidisciplinary approaches, by a team of oro-facial pain specialists and a neurologist (headache specialist), to attain the most precise differential diagnosis and initiate the best and most efficient treatment.

  9. Dural venous sinuses distortion and compression with supratentorial mass lesions: a mechanism for refractory intracranial hypertension?

    PubMed Central

    Qureshi, Adnan I.; Qureshi, Mushtaq H.; Majidi, Shahram; Gilani, Waqas I.; Siddiq, Farhan

    2014-01-01

    Objective To determine the effect of supratentorial intraparenchymal mass lesions of various volumes on dural venous sinuses structure and transluminal pressures. Methods Three set of preparations were made using adult isolated head derived from fresh human cadaver. A supratentorial intraparenchymal balloon was introduced and inflated at various volumes and effect on dural venous sinuses was assessed by serial intravascular ultrasound, computed tomographic (CT), and magnetic resonance (MR) venograms. Contrast was injected through a catheter placed in sigmoid sinus for both CT and MR venograms. Serial trasluminal pressures were measured from middle part of superior sagittal sinus in another set of experiments. Results At intraparenchymal balloon inflation of 90 cm3, there was attenuation of contrast enhancement of superior sagittal sinus with compression visualized in posterior part of the sinus without any evidence of compression in the remaining sinus. At intraparenchymal balloon inflation of 180 and 210 cm3, there was compression and obliteration of superior sagittal sinus throughout the length of the sinus. In the coronal sections, at intraparenchymal balloon inflations of 90 and 120 cm3, compression and obliteration of the posterior part of superior sagittal sinus were visualized. In the axial images, basal veins were not visualized with intraparenchymal balloon inflation of 90 cm3 or greater although straight sinus was visualized at all levels of inflation. Trasluminal pressure in the middle part of superior sagittal sinus demonstrated a mild increase from 0 cm H2O to 0.4 cm H2O and 0.5 cm H2O with inflation of balloon to volume of 150 and 180 cm3, respectively. There was a rapid increase in transluminal pressure from 6.8 cm H2O to 25.6 cm H2O as the supratentorial mass lesion increased from 180 to 200 cm3. Conclusions Our experiments identified distortion and segmental and global obliteration of dural venous sinuses secondary to supratentorial mass lesion and

  10. Papilloedema in Behçet's disease: value of MRI in diagnosis of dural sinus thrombosis.

    PubMed Central

    el-Ramahi, K M; al-Kawi, M Z

    1991-01-01

    Behçet's disease is a multisystem disease characterised by the clinical triad of oral ulcers, genital ulcers and uveitis. Nervous system involvement is frequent and occasionally precedes other manifestations. Behcet's disease is not frequently considered in the differential diagnosis of papilloedema. We report four cases of Behcet's disease in which papilloedema occurred with or without dural sinus thrombosis. MRI is of great value in the investigation of such patients as it can demonstrate venous sinus thrombosis non-invasively or suggest the diagnosis by showing the associated parenchymal lesions secondary to small vessel pathology. Images PMID:1955903

  11. Percutaneous puncture of renal calyxes guided by a novel device coupled with ultrasound

    PubMed Central

    Chan, Chen Jen; Srougi, Victor; Tanno, Fabio Yoshiaki; Jordão, Ricardo Duarte; Srougi, Miguel

    2015-01-01

    ABSTRACT Purpose: To evaluate the efficiency of a novel device coupled with ultrassound for renal percutaneous puncture. Materials and Methods: After establishing hydronephrosis, ten pigs had three calyxes of each kidney punctured by the same urology resident, with and without the new device (“Punctiometer”). Time for procedure completion, number of attempts to reach the calyx, puncture precision and puncture complications were recorded in both groups and compared. Results: Puncture success on the first attempt was achieved in 25 punctures (83%) with the Punctiometer and in 13 punctures (43%) without the Punctiometer (p=0.011). The mean time required to perform three punctures in each kidney was 14.5 minutes with the Punctiometer and 22.4 minutes without the Punctiometer (p=0.025). The only complications noted were renal hematomas. In the Punctiometer group, all kidneys had small hematomas. In the no Punctiometer group 80% had small hematomas, 10% had a medium hematoma and 10% had a big hematoma. There was no difference in complications between both groups. Conclusions: The Punctiometer is an effective device to increase the likelihood of an accurate renal calyx puncture during PCNL, with a shorter time required to perform the procedure. PMID:26689521

  12. CASPER, a Computer ASsisted PERicardial puncture system: first clinical results.

    PubMed

    Marmignon, Christophe; Chavanon, Olivier; Troccaz, Jocelyne

    2005-01-01

    Pericardial puncture is the percutaneous insertion of a needle into the pericardial space to drain a pathological pericardial effusion. The challenge for the operating surgeon is to reach percutaneously a target zone in the vicinity of the mobile heart, in a soft-tissue environment. The surgeon's ability to accomplish this depends on his own mental picture of the effusion. CASPER is a navigation software using an optical localizer which assists the surgeon by enhancing the representation of the effusion and guiding the needle's progress. Using a localized and calibrated echographic probe, the surgeon acquires a set of images in the region of interest. This zone is then manually segmented on each image, a common zone is computed, and the surgeon defines a trajectory for the needle. During the puncture procedure, the surgeon follows the position of the localized needle on a computer monitor. After initial validation on an experimental phantom, a feasibility study was performed using canine and porcine models. The optical localization device was changed from an Optotrak to a Polaris device for easier use in the clinical setting. Prior to clinical application, various tests were performed concerning the mobility of the thoracic cage, the reproducibility of the thoracic position over several apneas, and the stability of anatomic structures relative to the thoracic cage. Finally, a first clinical application was successfully performed using this system. The present paper reports on these last two stages. PMID:16199378

  13. Puncture evaluation of radiological gloves to assess use performance

    SciTech Connect

    Steckle, W. P. , Jr.; Mittelstet, R. P.; Castro, J. M.; Smith, M. E.

    2002-01-01

    Tensile testing of gloves is an accepted method for the qualification of a new glove material or the qualification of a production run. Most often these tests are performed in accordance to ASTM standards, i.e. - D412-98a Standard Test Methods (STM) for Vulcanized Rubber and Thermoplastic Rubbers and Thermoplastic Elastomers-Tension, Unfortunately for elastomers such protocols do not exist for puncture testing. There are however several test methods for the puncture resistance of Protective Clothing [F1342-91(1996)e2], Barrier FiIms and Laminates[F1306-90(1998)], and Coated Fabrics [D751-001]. Each of these standards uses different probe geometries and testing rates. Initial testing of the gloves has been performed using the standard one inch ball burst fixture as supplied by Instron. Samples tested using this fixture usually did not burst within the travel of the test fixture, except for lead lined hypalon. Three fixtures were fabricated in accordance to the aforementioned ASTM standards. Results for these fixtures for several materials will be reported along with the observed rate dependence.

  14. Binary black hole evolutions of approximate puncture initial data

    SciTech Connect

    Bode, Tanja; Laguna, Pablo; Shoemaker, Deirdre M.; Hinder, Ian; Herrmann, Frank; Vaishnav, Birjoo

    2009-07-15

    Approximate solutions to the Einstein field equations are valuable tools to investigate gravitational phenomena. An important aspect of any approximation is to investigate and quantify its regime of validity. We present a study that evaluates the effects that approximate puncture initial data, based on skeleton solutions to the Einstein constraints as proposed by [G. Faye, P. Jaranowski, and G. Schaefer, Phys. Rev. D 69, 124029 (2004).], have on numerical evolutions. Using data analysis tools, we assess the effectiveness of these constraint-violating initial data for both initial and advanced LIGO and show that the matches of waveforms from skeleton data with the corresponding waveforms from constraint-satisfying initial data are > or approx. 0.97 when the total mass of the binary is > or approx. 40M{sub {center_dot}}. In addition, we demonstrate that the differences between the skeleton and the constraint-satisfying initial data evolutions, and thus waveforms, are due to negative Hamiltonian constraint violations present in the skeleton initial data located in the vicinity of the punctures. During the evolution, the skeleton data develops both Hamiltonian and momentum constraint violations that decay with time, with the binary system relaxing to a constraint-satisfying solution with black holes of smaller mass and thus different dynamics.

  15. Medication-overuse headache: a perspective review

    PubMed Central

    Westergaard, Maria Lurenda; Munksgaard, Signe Bruun; Bendtsen, Lars; Jensen, Rigmor Højland

    2016-01-01

    Medication-overuse headache (MOH) is a debilitating condition in which frequent and prolonged use of medication for the acute treatment of pain results in the worsening of the headache. The purpose of this paper is to review the most recent literature on MOH and discuss future avenues for research. MOH accounts for a substantial share of the global burden of disease. Prevalence is often reported as 1–2% but can be as high as 7% overall, with higher proportions among women and in those with a low socioeconomic position. Management consists of withdrawing pain medication, focusing on prophylactic and nonmedical treatments, and limiting acute symptomatic medication. Stress reduction and lifestyle interventions may support the change towards rational pain medication use. Support, follow up, and education are needed to help patients through the detoxification period. There is fertile ground for research in MOH epidemiology, pathophysiology, and neuroimaging. Randomized and long-term follow-up studies on MOH treatment protocols are needed. Further focused research could be of major importance for global health. PMID:27493718

  16. [Application of phototherapy in children with headache].

    PubMed

    2000-01-01

    The paper presents an analysis of the influence of 10 sessions of phototherapy (exposure to bright white light, 3300 lux) in 9 children with episodic headache of tension (EHAT), in 21 children with chronic headache of tension (CHAT) and in 10 children with migraine. Clinical complaints, mood, autonomic status, blood levels of thyroid hormones, hydrocortisone, prolactin, excretion of catecholamines with daily urine were analysed. A course of phototherapy resulted in improvement of the mood, a decrease in the number of the complaints, a tendency to normalization of autonomic homeostasis, an increase in the levels of hydrocortisone and prolactin, a decrease of the high initial level of urine adrenaline and noradrenaline as well as elevation of initially low one in 92.5% of children from all the groups. The most pronounced positive effect was observed after phototherapy in children with CHAT, weaker effect was found in children with migraine. The conclusion is made about optimizing and modulating influence of phototherapy on the levels of stress-realizing hormones and autonomic homeostasis, that improves adaptation of a child's organism.

  17. Headache in children: young age at onset does not imply a harmful etiology or predict a harsh headache disability.

    PubMed

    Ravid, Sarit; Gordon, Shirie; Schiff, Aharon; Shahar, Eli

    2013-07-01

    The purpose of this retrospective study was to compare headache etiology, type, and burden and the learning and behavioral profile in children with early-onset (under 6 years) and late-onset (8-12 years) headaches. The study included 133 patients, 35 in the early-onset group and 98 in the late-onset group. Headache diagnosis was based on International Classification of Headache Disorders -II (ICHD-II) criteria. Learning profile and behavioral problems were assessed by parental reports. Tension headache was the most common diagnosis in the early-onset headache group (51.4%). No significant differences were found between the age groups with regard to headache etiology, disability, abnormal neuroimaging results, school performance, or attention problems. Nevertheless, the early-onset group patients had a significantly higher prevalence of behavioral problems: 25.7% versus 11.2% (P < .02). The authors suggest that early age of headache onset does not imply a harmful etiology or a relentless headache disability or burden. PMID:22914375

  18. Headache, anxiety and depressive disorders: the HADAS study.

    PubMed

    Beghi, Ettore; Bussone, Gennaro; D'Amico, Domenico; Cortelli, Pietro; Cevoli, Sabina; Manzoni, Gian Camillo; Torelli, Paola; Tonini, Maria Clara; Allais, Giovanni; De Simone, Roberto; D'Onofrio, Florindo; Genco, Sergio; Moschiano, Franca; Beghi, Massimiliano; Salvi, Sara

    2010-04-01

    The objective of this paper was to assess prevalence and characteristics of anxiety and depression in migraine without aura and tension-type headache, either isolated or in combination. Although the association between headache and psychiatric disorders is undisputed, patients with migraine and/or tension-type headache have been frequently investigated in different settings and using different tests, which prevents meaningful comparisons. Psychiatric comorbidity was tested through structured interview and the MINI inventory in 158 adults with migraine without aura and in 216 persons with tension-type headache or migraine plus tension-type headache. 49 patients reported psychiatric disorders: migraine 10.9%, tension-type headache 12.8%, and migraine plus tension-type headache 21.4%. The MINI detected a depressive episode in 59.9, 67.0, and 69.6% of cases. Values were 18.4, 19.3, and 18.4% for anxiety, 12.7, 5.5, and 14.2%, for panic disorder and 2.3, 1.1 and 9.4% (p = 0.009) for obsessive-compulsive disorder. Multivariate analysis showed panic disorder prevailing in migraine compared with the other groups (OR 2.9; 95% CI 1.2-7.0). The association was higher (OR 6.3; 95% CI 1.4-28.5) when migraine (with or without tension-type headache) was compared to pure tension-type headache. This also applied to obsessive-compulsive disorder (OR 4.8; 95% CI 1.1-20.9) in migraine plus tension-type headache. Psychopathology of primary headache can reflect shared risk factors, pathophysiologic mechanisms, and disease burden.

  19. Psychological predictors of headache remission in children and adolescents

    PubMed Central

    Carasco, Marcel; Kröner-Herwig, Birgit

    2016-01-01

    Objective Longitudinal studies on headaches often focus on the identification of risk factors for headache occurrence or “chronification”. This study in particular examines psychological variables as potential predictors of headache remission in children and adolescents. Methods Data on biological, social, and psychological variables were gathered by questionnaire as part of a large population-based study (N=5,474). Children aged 9 to 15 years who suffered from weekly headaches were selected for this study sample, N=509. A logistic regression analysis was conducted with remission as the dependent variable. In the first step sex, age, headache type, and parental headache history were entered as the control variables as some data already existed showing their predictive power. Psychological factors (dysfunctional coping strategies, internalizing symptoms, externalizing symptoms, anxiety sensitivity, somatosensory amplification) were entered in the second step to evaluate their additional predictive value. Results Highly dysfunctional coping strategies reduced the relative probability of headache remission. All other selected psychological variables reached no significance, ie, did not contribute additionally to the explanation of variance of the basic model containing sex and headache type. Surprisingly, parental headache and age were not predictive. The model explained only a small proportion of the variance regarding headache remission (R2=0.09 [Nagelkerke]). Conclusion Successful coping with stress in general contributed to remission of pediatric headache after 2 years in children aged between 9 and 15 years. Psychological characteristics in general had only small predictive value. The issue of remission definitely needs more scientific attention in empirical studies. PMID:27186149

  20. Prospective Study of Elective Bilateral Versus Unilateral Femoral Arterial Puncture for Uterine Artery Embolization

    SciTech Connect

    Bratby, M. J.; Ramachandran, N.; Sheppard, N.; Kyriou, J.; Munneke, G. M.; Belli, A.-M.

    2007-11-15

    The purpose of this study was to assess the effect of elective bilateral femoral arterial punctures for uterine artery embolization (UAE) of symptomatic fibroids on fluoroscopy and procedural time, patient dose, and ease of procedure. We conducted a prospective study of UAE with either the intention to catheterize both uterine arteries using a single femoral puncture (n = 12) or elective bilateral arterial punctures from the outset (n = 12). The same two operators undertook each case. Main outcome measures were total procedure time, fluoroscopy time, dose-area product (DAP), and total skin dose. A simulation was then performed on an anthropomorphic phantom using the mean in vivo fluoroscopy parameters to estimate the ovarian dose. Bilateral UAE was achieved in all patients. None of the patients with initial unilateral arterial puncture required further contralateral arterial puncture. The mean fluoroscopy time in the group with elective bilateral punctures was 12.8 min, compared with a mean of 16.6 min in patients with unilateral puncture (p = 0.046). There was no significant difference in overall procedure time (p = 0.68). No puncture-site complications were found. Additional catheters were required only following unilateral puncture. The simulated dose was 25% higher with unilateral puncture. Although there was no significant difference in measured in vivo patient dose between the two groups (DAP, p = 0.32), this is likely to reflect the wide variation in other patient characteristics. Allowing for the small study size, our results show that the use of elective bilateral arterial punctures reduces fluoroscopy time, requires less catheter manipulation, and, according to the simulation model, has the potential to reduce patient dose. The overall procedure time, however, is not significantly reduced.

  1. Toxicity Associated With Bowel or Bladder Puncture During Gynecologic Interstitial Brachytherapy

    SciTech Connect

    Shah, Anand P.; Strauss, Jonathan B.; Gielda, Benjamin T.; Zusag, Thomas W.

    2010-05-01

    Purpose: Interstitial brachytherapy for gynecologic malignancies is associated with significant toxicity. Some reports have correlated this toxicity with needle puncture of the visceral organs. This study examined our experience with interstitial brachytherapy and investigated the relationship between the visceral puncture and toxicity. Methods and Materials: The outcomes of 36 patients treated with interstitial brachytherapy for gynecologic malignancies at a single institution between 2002 and 2007 were reviewed. Computed tomography was used to guide needle placement based solely on tumor coverage. No attempts were made to avoid visceral puncture; however, the source dwell times were minimized in these areas. Results: At a median follow-up of 21 months, the crude locoregional control rate was 78%. Bowel puncture was noted in 26 patients and bladder puncture in 19. The mean operating time was 50 min, and 86% of patients were discharged in <=3 days. The incidence of acute and late toxicity was similar between patients with and without visceral puncture according to the log-rank analysis of Kaplan-Meier curves. No patients with bowel puncture experienced Grade 2 or greater acute gastrointestinal toxicity and only 1 had Grade 3 or greater late gastrointestinal toxicity. No patients with bladder puncture experienced greater than Grade 2 acute genitourinary toxicity and only 2 had late Grade 3 or greater genitourinary toxicity. Conclusion: The operating time, length of hospital stay, and treatment-induced morbidity in this cohort compared favorably to series using techniques to avoid visceral puncture. Additionally, visceral puncture did not correlate with the occurrence of acute or late toxicity. These data suggest that visceral puncture in the absence of source loading carries a low risk of morbidity.

  2. Double-lumen arterial balloon catheter technique for Onyx embolization of dural arteriovenous fistulas: initial experience

    PubMed Central

    Chiu, Albert Ho Yuen; Aw, Grace; Wenderoth, Jason David

    2014-01-01

    Background Dural arteriovenous fistulas are vascular malformations with variable clinical symptoms that range in severity from completely asymptomatic to seizures, dementia, loss of vision and intracranial hemorrhage. Historically, surgical obliteration was the treatment of choice but, more recently, endovascular embolization has become the first-line treatment. The liquid embolic agent Onyx (ethyl vinyl copolymer) has become the agent of choice, but problems with reflux around the delivery microcatheter and inadvertent venous penetration have arisen. Methods and results We present six cases in which the double-lumen balloon microcatheter was used to transarterially embolize dural arteriovenous fistulas via injection of Onyx through the wire lumen. Depending on the individual pathology a venous balloon was also used in some cases. The advantages and disadvantages of the use of these devices are discussed. Conclusions We consider that the use of the double-lumen balloon technique for fistula embolization has the potential for reducing overall procedural times, procedural failures and catheter retention in certain situations. In such cases we would advocate this as a first-line technique. When lower profile, more navigable balloon catheters become available, this may become the standard of care. PMID:23749795

  3. The art of history-taking in a headache patient

    PubMed Central

    Ravishankar, K.

    2012-01-01

    Headache is a common complaint that makes up for approximately 25% of any neurologists outpatient practice. Yet, it is often underdiagnosed and undertreated. Ninety percent of headaches seen in practice are due to a primary headache disorder where there are no confirmatory tests, and neuroimaging studies, if done, are normal. In this situation, a good headache history allows the physician to recognize a pattern that in turn leads to the correct diagnosis. A comprehensive history needs time, interest, focus and establishment of rapport with the patient. When to ask what question to elicit which information, is an art that is acquired by practice and improves with experience. This review discusses the art of history-taking in headache patients across different settings. The nuances of headache history-taking are discussed in detail, particularly the questions related to the time, severity, location and frequency of the headache syndrome in general and the episode in particular. An emphasis is made on the recognition of red flags that help in the identification of secondary headaches. PMID:23024567

  4. Headache attributed to unruptured saccular aneurysm, mimicking hemicrania continua.

    PubMed

    Vikelis, Michail; Xifaras, Michail; Magoufis, Georgios; Gekas, Georgios; Mitsikostas, Dimos Dimitrios

    2005-06-01

    Unruptured cerebral arterial aneurysms most often remain asymptomatic, but they may cause headache or other symptoms or signs. We describe herewith a case of headache attributed to an unruptured internal carotid artery aneurysm, clearly mimicking the phenotype of hemicrania continua. Potential pathophysiological explanations and recommendations for recognition of similar cases are discussed.

  5. The Effect of Migraine Headache on Educational Attainment

    ERIC Educational Resources Information Center

    Rees, Daniel I.; Sabia, Joseph J.

    2011-01-01

    Despite the fact that migraine headaches are common and debilitating, little is known about their effect on educational attainment. Using data drawn from the National Longitudinal Study of Adolescent Health, we estimate the relationship between migraine headache and three outcomes: high school grade point average, the probability of graduating…

  6. The methodology of population surveys of headache prevalence, burden and cost: Principles and recommendations from the Global Campaign against Headache

    PubMed Central

    2014-01-01

    The global burden of headache is very large, but knowledge of it is far from complete and needs still to be gathered. Published population-based studies have used variable methodology, which has influenced findings and made comparisons difficult. Among the initiatives of the Global Campaign against Headache to improve and standardize methods in use for cross-sectional studies, the most important is the production of consensus-based methodological guidelines. This report describes the development of detailed principles and recommendations. For this purpose we brought together an expert consensus group to include experience and competence in headache epidemiology and/or epidemiology in general and drawn from all six WHO world regions. The recommendations presented are for anyone, of whatever background, with interests in designing, performing, understanding or assessing studies that measure or describe the burden of headache in populations. While aimed principally at researchers whose main interests are in the field of headache, they should also be useful, at least in parts, to those who are expert in public health or epidemiology and wish to extend their interest into the field of headache disorders. Most of all, these recommendations seek to encourage collaborations between specialists in headache disorders and epidemiologists. The focus is on migraine, tension-type headache and medication-overuse headache, but they are not intended to be exclusive to these. The burdens arising from secondary headaches are, in the majority of cases, more correctly attributed to the underlying disorders. Nevertheless, the principles outlined here are relevant for epidemiological studies on secondary headaches, provided that adequate definitions can be not only given but also applied in questionnaires or other survey instruments. PMID:24467862

  7. Puncture-Healing Properties of Carbon Nanotube-Filled Ionomers

    NASA Technical Reports Server (NTRS)

    Ward, Thomas C.

    2003-01-01

    Ionomers are polymers that contain ionic groups in relatively low concentrations along the polymer backbone. These ionic groups, in the presence of oppositely charged ions, form aggregates that lead to novel physical properties of the polymer. React-A-Seal(trademark) and Surlyn(trademark) are poly(ethylene-co-methacrylic acid) (EMAA) ionomer-based materials and Nucrel(trademark) is the EMAA acid copolymer neutralized to produce Surlyn(trademark). React-A-Seal(trademark), Surlyn(trademark), and Nucrel(trademark) recover into their original shapes following a high impact puncture at velocities ranging from 300 to 1200 ft/s ('self-healing'). This self-healing process may be of great benefit in space applications where structures are exposed to matter impacts. A thermal IR camera indicated a temperature increase to 98 C for Nucrel(trademark) 925, Surlyn(trademark) 8940, React-A-Seal(trademark), and Surlyn(trademark) 8920 after initial penetration. To understand and generalize the observed phenomena, questions concerning the mechanism of the puncture resealing must be answered. One suggestion is that the elastic character of the melt created by the puncture drives the self-healing. This inference is based on the observed temperature rise of approx. 3 C above the melting temperature of the samples (approx. 95 C) during the impact. With the expectation of gaining additional insight into the self-healing phenomenon, a thermodynamic and viscoelastic investigation was conducted using primarily DSC and DMA. Surlyn(trademark) and React-A-Seal(trademark) showed the characteristic order-disorder transition at approx. 52 C that has been reported in literature. Master curves were constructed from the creep isotherms for the four EMAA samples. An aging study was performed to investigate the irreproducibility and "tailing effect" observed in the creep data. The aging study indicated that, with increased aging time and temperature, changes in the polyethylene matrix lead to

  8. The effect of intrathecal iohexol on visual evoked response latency: a comparison including incidence of headache with iopamidol and metrizamide in myeloradiculography.

    PubMed

    Broadbridge, A T; Bayliss, S G; Brayshaw, C I

    1987-01-01

    Fifty consecutive unselected patients referred for myeloradiculography and examined by the same radiologist, when facilities for measuring the visual evoked response were available, are considered. The effect on the visual evoked response of the examination and the incidence of headache following the use of iohexol as the contrast medium are compared with those after the use of iopamidol and metrizamide reported in a previous study. A total of 400 cases examined with iopamidol and 200 cases examined with iohexol are reviewed with regard to the incidence of headache. Whereas iopamidol and, to a greater extent metrizamide, were found to cause significant lengthening of the visual evoked response latency 20 hours after the radiological examination, iohexol did not. Furthermore there was no significant difference in the 20 hour reading following the use of iohexol compared with the original control group of patients who underwent lumbar puncture alone. There was a lower incidence and severity of headache following the use of iohexol than with iopamidol and a markedly reduced incidence compared with metrizamide. Iohexol is considered less neurotoxic than iopamidol which had previously superceded metrizamide as the contrast medium used for myeloradiculography in the Royal Surrey County Hospital. Volumes of up to 14 ml of iohexol 300 mg I/ml have been used for lumbar radiculography and for total myelography and up to 10 ml for direct lateral cervical puncture. In 350 cases examined to date with iohexol the only serious sequel was a case of chemical meningitis following the lumbar injection of 10 ml of the 300 mg I/ml solution for a cervical examination. The patient made an uneventful recovery.

  9. New clinical decision rule to exclude subarachnoid haemorrhage for acute headache: a prospective multicentre observational study

    PubMed Central

    Kimura, Akio; Kobayashi, Kentaro; Yamaguchi, Hitoshi; Takahashi, Takeshi; Harada, Masahiro; Honda, Hideki; Mori, Yoshio; Hirose, Keika; Tanaka, Noriko

    2016-01-01

    Objective To ensure good outcomes in the management of subarachnoid haemorrhage (SAH), accurate prediction is crucial for initial assessment of patients presenting with acute headache. We conducted this study to develop a new clinical decision rule using only objectively measurable predictors to exclude SAH, offering higher specificity than the previous Ottawa SAH Rule while maintaining comparable sensitivity. Design Multicentre prospective cohort study. Setting Tertiary-care emergency departments of five general hospitals in Japan from April 2011 to March 2014. Participants Eligible patients comprised 1781 patients aged >15 years with acute headache, excluding trauma or toxic causes and patients who presented in an unconscious state. Main outcome measures Definitive diagnosis of SAH was based on confirmation of SAH on head CT or lumbar puncture findings of non-traumatic red blood cells or xanthochromia. Results A total of 1561 patients were enrolled in this study, of whom 277 showed SAH. Using these enrolled patients, we reached a rule with mainly categorical predictors used in previous reports, called the ‘Ottawa-like rule’, offering 100% sensitivity when using any of age ≥40 years, neck pain or stiffness, altered level of consciousness or onset during exertion. Using the 1317 patients from whom blood samples were obtained, a new rule using any of systolic blood pressure >150 mm Hg, diastolic blood pressure >90 mm Hg, blood sugar >115 mg/dL or serum potassium <3.9 mEq/L offered 100% sensitivity (95% CI 98.6% to 100%) and 14.5% specificity (12.5% to 16.9%), while the Ottawa-like rule showed the same sensitivity with a lower specificity of 8.8% (7.2% to 10.7%). Conclusions While maintaining equal sensitivity, our new rule seemed to offer higher specificity than the previous rules proposed by the Ottawa group. Despite the need for blood sampling, this method can reduce unnecessary head CT in patients with acute headache. Trial registration

  10. A guide to children with acute and chronic headaches.

    PubMed

    Rosenblum, R K; Fisher, P G

    2001-01-01

    Children with acute and chronic headaches are often seen by primary care providers. A complete, elaborate history, obtained from both the parents and child, is key in diagnosing and managing the child who presents with a headache. A thorough social and educational history may reveal significant school or family stresses. Historic features of concern must be explored immediately. A thorough physical examination with a focused neurologic examination must be done Focal neurologic findings may indicate serious organic problems. A comprehensive approach to the management of headaches in children consisting of reassurance, education, pharmacologic interventions, and nonpharmacologic interventions is presented. A two-tiered management plan is used in conjunction with medications. The aim of this article is to provide the novice or experienced practitioner with a comprehensive review of acute and chronic headache pathogenesis, assessment, and management. This review includes migraines and other nonmigraine types of headaches. PMID:11562640

  11. Combat exposure and migraine headache: evidence from exogenous deployment assignment.

    PubMed

    Cesur, Resul; Sabia, Joseph J; Tekin, Erdal

    2015-01-01

    Migraine headache is a growing problem for U.S. servicemembers deployed to Iraq and Afghanistan and has been linked to substantial negative socioeconomic consequences. However, there has been no comprehensive examination of the relationship between combat exposure and migraine headache or its stress-related triggers. Analyzing data drawn from the National Longitudinal Study of Adolescent Health, we use exogenous variation in deployment assignment to estimate the effect of combat exposure on migraine headache. We find that those deployed to a combat zone with enemy firefight are at substantially increased risk for migraine headache relative to those deployed to non-combat zones outside the United States or to combat zones without enemy firefight. We find that combat-induced sleep disorders, stress-related psychological problems, and physical injuries in combat explain approximately 40-45 percent of the relationship between combat exposure and migraine headache.

  12. Chronic unremitting headache associated with Lyme disease-like illness.

    PubMed

    Kowacs, Pedro André; Martins, Rodrigo Tomazini; Piovesan, Elcio Juliato; Pinto, Maria Cristina Araujo; Yoshinari, Natalino Hagime

    2013-07-01

    The Brazilian Lyme-disease-like illness (BLDLI) or Baggio-Yoshinari syndrome is a unique zoonosis found in Brazil. It reproduces all the clinical symptoms of Lyme disease except for the high frequencies of relapse and the presence of autoimmune manifestations. Two cases of borreliosis manifesting with unremitting headache, which is a symptom associated with late-stage BLDLI, were presented. Clinical, therapeutic, and prognostic aspects of the BLDLI and its associated headaches were showed and discussed in this article. BLDLI diagnosis requires additional attention by physicians, since the disease has a tendency to progress to the late, recurrent stage or the chronic form, and the associated headache can be confused with chronic primary headache or with analgesic-overuse one. Special attention should be paid to patients with headaches who have traveled to endemic areas. PMID:23857618

  13. Combat exposure and migraine headache: evidence from exogenous deployment assignment.

    PubMed

    Cesur, Resul; Sabia, Joseph J; Tekin, Erdal

    2015-01-01

    Migraine headache is a growing problem for U.S. servicemembers deployed to Iraq and Afghanistan and has been linked to substantial negative socioeconomic consequences. However, there has been no comprehensive examination of the relationship between combat exposure and migraine headache or its stress-related triggers. Analyzing data drawn from the National Longitudinal Study of Adolescent Health, we use exogenous variation in deployment assignment to estimate the effect of combat exposure on migraine headache. We find that those deployed to a combat zone with enemy firefight are at substantially increased risk for migraine headache relative to those deployed to non-combat zones outside the United States or to combat zones without enemy firefight. We find that combat-induced sleep disorders, stress-related psychological problems, and physical injuries in combat explain approximately 40-45 percent of the relationship between combat exposure and migraine headache. PMID:24560382

  14. 49 CFR Appendix A to Part 179 - Procedures for Tank-Head Puncture-Resistance Test

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... A Appendix A to Part 179 Transportation Other Regulations Relating to Transportation (Continued...) SPECIFICATIONS FOR TANK CARS Pt. 179, App. A Appendix A to Part 179—Procedures for Tank-Head Puncture-Resistance... of 29 km/hour (18 mph). Tank-head puncture-resistance is a function of one or more of the...

  15. Different transseptal puncture for different procedures: Optimization of left atrial catheterization guided by transesophageal echocardiography

    PubMed Central

    Radinovic, Andrea; Mazzone, Patrizio; Landoni, Giovanni; Agricola, Eustachio; Regazzoli, Damiano; Bella, Paolo Della

    2016-01-01

    Background: Left atrial catheterization through transseptal puncture is frequently performed in cardiac catheterization procedures. Appropriate transseptal puncture is critical to achieve procedural success. Aims: The aim of the study is to evaluate the feasibility of selective transseptal punctures, using a modified radiofrequency (RF) transseptal needle and transesophageal echocardiography (TEE), in different types of procedures that require specific sites of left atrial catheterization. Setting and Design: This was an observational trial in a cardiac catheterization laboratory of a teaching hospital. Materials and Methods: Patients undergoing different percutaneous procedures requiring atrial transseptal puncture such as atrial fibrillation (AF) ablation, left atrial appendage (LAA) occlusion, and mitral valve repair were included in the study. All procedures were guided by TEE and an RF transseptal needle targeting a specific region of the septum to perform the puncture. Statistical Analysis: The statistical analysis was descriptive only. Results: RF-assisted transseptal punctures were performed in six consecutive patients who underwent AF ablation (two patients), LAA closure (two patients), and mitral valve repair (two patients). In all patients, transseptal punctures were performed successfully at the desired site. No adverse events or complications were observed. Conclusions: Selective transseptal puncture, using TEE and an RF needle, is a feasible technique that can be used in multiple approaches requiring a precise site of access for left atrial catheterization. PMID:27716687

  16. 49 CFR Appendix A to Part 179 - Procedures for Tank-Head Puncture-Resistance Test

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 3 2011-10-01 2011-10-01 false Procedures for Tank-Head Puncture-Resistance Test... Test 1. This test procedure is designed to verify the integrity of new or untried tank-head puncture-resistance systems and to test for system survivability after coupler-to-tank-head impacts at relative...

  17. A method for the determination of syringe needle punctures in rubber stoppers using stereoscopic light microscopy.

    PubMed

    Platek, S Frank; Keisler, Mark A; Ranieri, Nicola; Reynolds, Todd W; Crowe, John B

    2002-09-01

    The ability to accurately determine the number of syringe needle penetration holes through the rubber stoppers in pharmaceutical vials and rubber septa in intravenous (i.v.) line and bag ports has been a critical factor in a number of forensic cases involving the thefts of controlled substances or suspected homicide by lethal injection. In the early 1990s, the microscopy and microanalysis group of the U.S. Food and Drug Administration's Forensic Chemistry Center (FCC) developed and implemented a method (unpublished) to locate needle punctures in rubber pharmaceutical vial stoppers. In 1996, as part of a multiple homicide investigation, the Indiana State Police Laboratory (ISPL) contacted the FCC for information on a method to identify and count syringe needle punctures through rubber stoppers in pharmaceutical vials. In a joint project and investigation using the FCC's needle hole location method and applying a method of puncture site mapping developed by the ISPL, a systematic method was developed to locate, identify, count, and map syringe punctures in rubber bottle stoppers or i.v. bag ports using microscopic analysis. The method requires documentation of punctures on both sides of the rubber stoppers and microscopic analysis of each suspect puncture site. The final result of an analysis using the method is a detailed diagram of puncture holes on both sides of a questioned stopper and a record of the minimum number of puncture holes through a stopper.

  18. 49 CFR Appendix A to Part 179 - Procedures for Tank-Head Puncture-Resistance Test

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 3 2014-10-01 2014-10-01 false Procedures for Tank-Head Puncture-Resistance Test...) SPECIFICATIONS FOR TANK CARS Pt. 179, App. A Appendix A to Part 179—Procedures for Tank-Head Puncture-Resistance Test 1. This test procedure is designed to verify the integrity of new or untried tank-head...

  19. 49 CFR Appendix A to Part 179 - Procedures for Tank-Head Puncture-Resistance Test

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 3 2012-10-01 2012-10-01 false Procedures for Tank-Head Puncture-Resistance Test...) SPECIFICATIONS FOR TANK CARS Pt. 179, App. A Appendix A to Part 179—Procedures for Tank-Head Puncture-Resistance Test 1. This test procedure is designed to verify the integrity of new or untried tank-head...

  20. Comparative study of thyroid puncture biopsy guided by contrast-enhanced ultrasonography and conventional ultrasound

    PubMed Central

    LI, FENGSHENG; LUO, HUITING

    2013-01-01

    The aim of this study was to investigate the application value of thyroid puncture biopsy guided by contrast-enhanced ultrasound (CEUS). A total of 48 patients with 51 solid thyroid nodules (suspected papillary thyroid carcinoma, PTC) were enrolled in the study. Following detection by conventional ultrasonography and CEUS, puncture biopsy of the suspicious lesions guided by conventional ultrasonography and CEUS was conducted, respectively. Then, pathological diagnosis was performed. The number of PTC positive nodules and puncture points detected by the two methods were compared. In 51 nodules with 310 punctures, 44 nodules (86.3%, 44/51) and 240 punctures (77.4%, 240/310) were pathologically diagnosed as PTC. In the 44 nodules diagnosed as PTC, 43 and 34 nodules were detected by CEUS and conventional ultrasound, respectively, with a significant difference between the two methods (P=0.022). Eleven (25%) nodules were independently detected by CEUS. The sensitivity and accuracy of puncture point detection by CEUS (82.9 and 82.6%, respectively) were significantly higher compared with those of conventional ultra-sound (48.3 and 56.5%, respectively; P<0.001). The specificity of puncture points detected by CEUS (81.4%) was significantly lower compared with that by conventional ultrasound (84.3%; P=0.009). Compared with conventional ultrasound, a greater number of PTC-positive nodules were detected by CEUS, with increased sensitivity and accuracy of the puncture points. PMID:23737884

  1. Evidence-based treatments for cluster headache

    PubMed Central

    Gooriah, Rubesh; Buture, Alina; Ahmed, Fayyaz

    2015-01-01

    Cluster headache (CH), one of the most painful syndromes known to man, is managed with acute and preventive medications. The brief duration and severity of the attacks command the use of rapid-acting pain relievers. Inhalation of oxygen and subcutaneous sumatriptan are the two most effective acute therapeutic options for sufferers of CH. Several preventive medications are available, the most effective of which is verapamil. However, most of these agents are not backed by strong clinical evidence. In some patients, these options can be ineffective, especially in those who develop chronic CH. Surgical procedures for the chronic refractory form of the disorder should then be contemplated, the most promising of which is hypothalamic deep brain stimulation. We hereby review the pathogenesis of CH and the evidence behind the treatment options for this debilitating condition. PMID:26635477

  2. MTBE: The headache of cleaner air

    SciTech Connect

    Kneiss, J.

    1995-07-01

    Gasoline with methyl tertiary butyl ether (MTBE) has been sold in the United States since 1979, when it was added to fuels as an octane enhancer after lead was phased out of motor fuels. Recently it has been introduced as a means of reducing carbon monoxide emissions during the winter months in targeted US cities. However, there is concern over health complaints including headaches, dizziness and nausea from residents of some areas. These reports have launched an era of assidious research by scientists and public health officials across the country to learn more about MTBE`s short-term and long-term, and possibly carcinogenic, health effects. New research should help weigh the risk of MTBE as a possible carcinogen and the effectiveness of MTBE-blended fuels in reducing carbon monoxide levels. The question is whether, in minimizing one risk, is another risk - however small - being introduced?

  3. Direct Puncture and Sclerotherapy with Sotradecol®

    PubMed Central

    Svendsen, P.A.; Wikholm, G.; Rodriguez, M.; Enoksson, P.; Frisén, L.; Strömland, K.; Seregard, S.

    2001-01-01

    Summary We evaluated sclerotherapy in the treatment of orbital lymphatic malformations. Six consecutive patients with unilateral orbital cystic masses and recurrent episodes of orbital swelling were included in this retrospective study. All have been treated with percutaneous puncture and injection of Sotradecol (sodium tetredecyl sulphate) under radiographic guidance, on one or more occasions. Reduction of orbital mass volume was documented clinically and radiologically within a few weeks in all cases. There was total regression of proptosis in three instances. There were no immediate complications. One subject suffered a presumably coincidental orbital hemorrhage two weeks after treatment. Follow-up times ranged between six months and four years. Sotradecol sclerotherapy appears to be a useful adjunct to the therapeutic arsenal for orbital lymphatic malformations. PMID:20663348

  4. On the monodromy problem for the four-punctured sphere

    NASA Astrophysics Data System (ADS)

    Menotti, Pietro

    2014-10-01

    We consider the monodromy problem for the four-punctured sphere in which the character of one composite monodromy is fixed, by looking at the expansion of the accessory parameter in the modulus x directly, without taking the limit of the quantum conformal blocks for an infinite central charge. The integrals that appear in the expansion of the Volterra equation involve products of two hypergeometric functions to first order and up to four hypergeometric functions to second order. It is shown that all such integrals can be computed analytically. We give the complete analytical evaluation of the accessory parameter to first and second order in the modulus. The results agree with the evaluation obtained by assuming the exponentiation hypothesis of the quantum conformal blocks in the limit of infinite central charge. Extension to higher orders is discussed.

  5. Laparotomized Direct Puncture for Embolization of a Retroperitoneal Arteriovenous Fistula

    SciTech Connect

    Inagawa, Shoichi; Unno, Naoki; Yamashita, Shuhei; Tanaka, Hiroki; Sakahara, Harumi

    2010-02-15

    A 28-year-old woman was referred to our institution with hope for another child after having an abortion several months previously to avoid a potential risk of catastrophic hemorrhage from a retroperitoneal arteriovenous fistula (AVF) with enlarged and twisted draining veins in the pelvis. Multiple branches coming from the right lumbar arteries and the right iliac arteries fed fistulae converging on an enlarged venous pouch anterior to the psoas major muscle in the right retroperitoneal space. It seemed impossible to achieve complete occlusion of the lesion in a single session by either transarterial or transvenous approach. A laparotomy and direct puncture of the enlarged draining vein immediately downstream of the venous pouch was performed and embolization was done with n-butyl cyanoacrylate and the aid of coils. Complete occlusion of the retroperitoneal AVF was achieved and confirmed in control angiography 5 months later.

  6. Evaluation of headache relief with cosmetic onabotulinumtoxinA injections.

    PubMed

    Goldman, Neal D; Dorton, Leighanne H; Marcum, Kristin K; Gilbert, Ryan M; Sandoval, Laura F

    2014-09-01

    Chronic headaches are common and can have a significant effect on quality of life. Approved treatment options are vast and include the use botulinum toxin injections. The objective of this study is to evaluate the effects of purely cosmetic onabotulinumtoxinA (BOTOX) injections on the frequency and severity of chronic headaches. Patients seeking treatment of hyperfunctional facial lines were enrolled to complete pre- and posttreatment questionnaires assessing headache symptoms. Quantitative data was compared using paired two-tailed student t-tests between groups of patients who received onabotulinumtoxinA injections, both onabotulinumtoxinA and hyaluronic acid (Restylane) injections, and hyaluronic acid injections. One hundred and ten patients were enrolled; 73 completed the study. Of the 45 patients with pretreatment headaches, 76% (22/29) that received cosmetic onabotulinumtoxinA injections alone and 69% (27/39) that received onabotulinumtoxinA with or without hyaluronic acid injections reported overall improvement in headaches. Patients who received only onabotulinumtoxinA reported a significant decrease in the frequency (P = 0.0016) and severity (P = 0.0002) of headaches, and the number of days over-the-counter medications were taken (P = 0.0238). It took an average 9.5 days for headache improvement vs. 4.4 days for an appearance change. In patients who received only hyaluronic acid injections (n = 6), no significant improvement in headaches was reported. Overall satisfaction was high and unaffected by whether patients experienced headache relief. The majority of patients (93%) reported that they would "definitely" or "likely" receive onabotulinumtoxinA injections again in the future. Purely cosmetic onabotulinumtoxinA injections of doses between 15-50 units can significantly decrease the severity and frequency of headaches.

  7. Prevalence of medication overuse headache in an interdisciplinary pain clinic

    PubMed Central

    2013-01-01

    Background Medication overuse headache (MOH) has been recognized as an important problem in headache patients although the pathophysiological mechanisms remain unclear. The diagnosis of MOH is based on clinical characteristics defined by the International Headache Society. The aim was the evaluation of the diagnostic criteria of MOH in a mixed population of chronic pain patients to gain information about the prevalence and possible associations with MOH. Methods Data of all patients referred to the interdisciplinary pain clinic at the University Hospital of Zurich between September 2005 and December 2007 were retrospectively analyzed. Demographic data (age, sex, history of migration), as well as data about duration of pain disease, category of pain disease (neurological, psychiatric, rheumatologic, other), use of medication, history of trauma, and comorbidity of depression and anxiety have been collected. Results Totally 178 of 187 consecutive chronic pain patients were included in the study. A total of 138 patients (78%) used analgesics on 15 or more days per month. Chronic headache was more prevalent among patients with analgesic overuse (39.8%) than without analgesic overuse (18%). The prevalence of MOH was 29%. The odds ratio (OR) for a patient with medication overuse to have chronic headache was 13.1 if he had a history of primary headache, compared to a patient without a primary headache syndrome. Furthermore, history of headache (OR 2.5, CI [1.13;5.44]), history of migration (OR 2.9, CI [1.31;6.32]) and comorbid depression (OR 3.5, CI [1.46;8.52]) were associated with overuse of acute medication, in general. Conclusions Primary headaches have a high risk for chronification in patients overusing analgesics for other pain disorders. Whereas history of headache, history of migration and comorbidity of depression are independentely associated with analgesic overuse in this group of patients. PMID:23565761

  8. Modified Valsalva test differentiates primary from secondary cough headache

    PubMed Central

    2013-01-01

    Background The current definition of cough headache includes provocation of the symptom by Valsalva manoeuvre, and it is generally believed that all cough headache results from a sudden increase in intracranial pressure. We sought to question that presumption and to determine whether the Valsalva test might distinguish primary from secondary cough headache. Methods We examined 16 consecutive cough headache patients using a modified Valsalva test (exhalation into the connecting tube of a standard anaeroid sphygmomanometer to 60 mm Hg for 10 seconds). A positive response was recorded if the manoeuvre provoked headache. All patients subsequently underwent brain MRI. Results None of the patients had neurological signs. Eleven had positive modified Valsalva tests. Ten were found subsequently to have posterior fossa pathologies (secondary cough headache: 8 Chiari Type 1 malformations, 2 posterior fossa meningiomas). The cough headache was relieved following surgery in all cases. One patient with a positive Valsalva test had an apparently normal brain MRI but measurements of hindbrain and posterior fossa dimensions were consistent with ‘posterior fossa crowdedness’. The remaining 5 patients had negative (4 patients) or equivocal (1 patient) Valsalva tests and normal MRI scans (primary cough headache). Conclusions These findings suggest that secondary cough headache results from a transient increase in intracranial CSF pressure during exertion in the presence of obstruction to normal cerebrospinal fluid dynamics. The modified Valsalva test can also determine whether tonsillar herniation found on brain MRI is symptomatic. Primary cough headache appears to be caused by a different mechanism, possibly through congestion of the orbital venous plexus in the presence of jugular venous incompetence and a reduced threshold for trigeminal sensory activation. PMID:23565708

  9. Headache and anxiety-depressive disorder comorbidity: the HADAS study.

    PubMed

    Beghi, E; Allais, G; Cortelli, P; D'Amico, D; De Simone, R; d'Onofrio, F; Genco, S; Manzoni, G C; Moschiano, F; Tonini, M C; Torelli, P; Quartaroli, M; Roncolato, M; Salvi, S; Bussone, G

    2007-05-01

    Psychiatric comorbidity (prevalence and types) was tested in a naturalistic sample of adult patients with pure migraine without aura, and in two control groups of patients, one experiencing pure tension-type headache and the other combined migraine and tension-type headaches. The study population included 374 patients (158, 110 and 106) from nine Italian secondary and tertiary centres. Psychiatric comorbidity was recorded through structured interview and also screened with the Mini International Neuropsychiatry Interview (MINI). Only anxiety and depression were investigated. Psychiatric disorders were reported by 49 patients (14.6%; 10.9% of patients with migraine, 12.8% of those with tension-type headache and 21.4% of those with combined migraine and tension-type headaches). The MINI interview detected a depressive episode in 59.9% of patients with migraine, 68.3% of patients with tension-type headache and 69.6% of patients with combined migraine and tension-type headaches. Depression subtypes were significantly different across groups (p=0.03). Anxiety (mostly generalised) was reported by 18.4% of patients with migraine, 19.3% of patients with tension-type headache, and 18.4% of patients with combined migraine and tension-type headaches. The values for panic disturbance were 12.7, 5.5 and 14.2, and those for obsessive-compulsive disorders were 2.3, 1.1 and 9.4% (p=0.009). Based on these results, psychopathology of primary headache can be a reflection of the burden of the disease rather than a hallmark of a specific headache category.

  10. Evaluation and Complications of Direct Graft Puncture in Thrombolysis and Other Interventional Techniques

    SciTech Connect

    Cowling, Mark G.; Belli, Anna-Maria; Buckenham, Timothy M.

    1996-03-15

    Purpose: To evaluate the value and complications of direct graft puncture in conducting interventional procedures in synthetic vascular bypass grafts. Methods: We retrospectively reviewed 65 direct graft punctures in 50 patients undergoing a variety of interventional vascular procedures. In two patients the grafts were found to be infected and the procedures abandoned. Results: Complications encountered included hematomas that did not require treatment in three patients, and four hematomas requiring surgical drainage. One graft became infected (despite prophylactic cefuroxime), after three consecutive punctures over a 10-day period for a variety of interventions. All the patients who developed hematomas had undergone pharmacological thrombolysis. Conclusion: Direct graft puncture is a relatively safe technique, with a minimal risk of infection and hemostatic complications attributable to thrombolysis. In 31 of the 41 patients undergoing successful thrombolysis, additional percutaneous procedures were undertaken, and these were facilitated by the direct graft puncture route.

  11. Lumbar Puncture in HIV-Infected Patients with Syphilis and No Neurologic Symptoms

    PubMed Central

    Ghanem, Khalil G.; Moore, Richard D.; Rompalo, Anne M.; Erbelding, Emily J.; Zenilman, Jonathan M.; Gebo, Kelly A.

    2009-01-01

    Background The decision to perform lumbar puncture in patients with asymptomatic human immunodeficiency virus (HIV) infection and syphilis is controversial. The Centers for Disease Control and Prevention recommend certain criteria that warrant lumbar puncture. Here, we assess the performance of these criteria for detecting asymptomatic neurosyphilis (ANS). Methods Eligible subjects consisted of all patients with concurrent HIV infection and syphilis in a prospective clinical cohort who had no neurologic symptoms at the time of lumbar puncture. We retrospectively applied different stratification criteria to calculate the performance of lumbar puncture in detecting ANS: (1) lumbar puncture in patients with late latent syphilis or syphilis of an unknown duration, regardless of the CD4 cell count or rapid plasma reagin titer; (2) lumbar puncture if the CD4 cell count was ≤350 cells/mL and/or the rapid plasma reagin titer was ≥1:32, regardless of the syphilis stage; and (3) lumbar puncture in the context of serologic nonresponse to syphilis therapy. Results Two hundred two of 231 patients with syphilis did not have neurologic symptoms. Immediate lumbar puncture was performed for 46 patients, and 10 cases (22%) of ANS were detected. With use of the first criterion, 2 (14%) of 10 cases of ANS in patients with early-stage syphilis would have been missed (sensitivity, 80% [95% confidence interval {CI}, 44%–97%]; specificity, 76% [95% CI, 60%–89%]). Criterion 2 would not have missed any cases of ANS (sensitivity, 100% [95% CI, 70%–100%]; specificity, 87% [95% CI, 72%–96%]) but would have required that a lumbar puncture be performed for 88% of patients. Performance of lumbar puncture performed in 13 cases based on serologic nonresponse to syphilis therapy yielded 4 cases (31%) of ANS. Conclusions In patients with concurrent HIV infection and syphilis, the use of criteria based on rapid plasma reagin titer and CD4 cell count, instead of stage-based criteria

  12. Dural metastases from disseminated prostate cancer clinically mimicking a benign reactive condition of the dura: case report and review of the literature.

    PubMed

    Gunia, S; Ecke, T; Wohlfarth, B; Koch, S; Erbersdobler, A

    2011-01-01

    Dural spread from prostate cancer (PC) is exceedingly uncommon. We report on a 62-year-old man suffering from disseminated PC with osseous metastases who presented with a parietal skull metastasis along with a circumscribed nodular thickening of the adjacent dura. Magnetic resonance imaging findings suggested a benign reactive condition of the dura which, however, histologically turned out to be a dural metastasis. Therefore, the present case report stresses the notion that very rarely, disseminated PC might present with clinically unsuspected dural metastases radiologically mimicking a benign condition.

  13. A systematic review of causes of sudden and severe headache (Thunderclap Headache): should lists be evidence based?

    PubMed Central

    2014-01-01

    Background There are many potential causes of sudden and severe headache (thunderclap headache), the most important of which is aneurysmal subarachnoid haemorrhage. Published academic reviews report a wide range of causes. We sought to create a definitive list of causes, other than aneurysmal subarachnoid haemorrhage, using a systematic review. Methods Systematic Review of EMBASE and MEDLINE databases using pre-defined search criteria up to September 2009. We extracted data from any original research paper or case report describing a case of someone presenting with a sudden and severe headache, and summarized the published causes. Results Our search identified over 21,000 titles, of which 1224 articles were scrutinized in full. 213 articles described 2345 people with sudden and severe headache, and we identified 6 English language academic review articles. A total of 119 causes were identified, of which 46 (38%) were not mentioned in published academic review articles. Using capture-recapture analysis, we estimate that our search was 98% complete. There is only one population-based estimate of the incidence of sudden and severe headache at 43 cases per 100,000. In cohort studies, the most common causes identified were primary headaches or headaches of uncertain cause. Vasoconstriction syndromes are commonly mentioned in case reports or case series. The most common cause not mentioned in academic reviews was pneumocephalus. 70 non-English language articles were identified but these did not contain additional causes. Conclusions There are over 100 different published causes of sudden and severe headache, other than aneurysmal subarachnoid haemorrhage. We have now made a definitive list of causes for future reference which we intend to maintain. There is a need for an up to date population based description of cause of sudden and severe headache as the modern epidemiology of thunderclap headache may require updating in the light of research on cerebral

  14. Characteristics of Elderly-Onset (≥65 years) Headache Diagnosed Using the International Classification of Headache Disorders, Third Edition Beta Version

    PubMed Central

    Song, Tae-Jin; Kim, Yong-Jae; Kim, Byung-Kun; Kim, Byung-Su; Kim, Jae-Moon; Kim, Soo-Kyoung; Moon, Heui-Soo; Cha, Myoung-Jin; Park, Kwang-Yeol; Sohn, Jong-Hee; Chu, Min Kyung

    2016-01-01

    Background and Purpose New-onset headache in elderly patients is generally suggestive of a high probability of secondary headache, and the subtypes of primary headache diagnoses are still unclear in the elderly. This study investigated the characteristics of headache with an older age at onset (≥65 years) and compared the characteristics between younger and older age groups. Methods We prospectively collected demographic and clinical data of 1,627 patients who first visited 11 tertiary hospitals in Korea due to headache between August 2014 and February 2015. Headache subtype was categorized according to the International Classification of Headache Disorders, Third Edition Beta Version. Results In total, 152 patients (9.3%, 106 women and 46 men) experienced headache that began from 65 years of age [elderly-onset group (EOG)], while the remaining 1,475 patients who first experienced headache before the age of 65 years were classified as the younger-age-at-onset group (YOG). Among the primary headache types, tension-type headache (55.6% vs. 28.8%) and other primary headache disorders (OPH, 31.0% vs. 17.3%) were more common in the EOG than in the YOG, while migraine was less frequent (13.5% vs. 52.2%) (p=0.001) in the EOG. Among OPH, primary stabbing headache (87.2%) was more frequent in the EOG than in the YOG (p=0.032). The pain was significantly less severe (p=0.026) and the frequency of medication overuse headache was higher in EOG than in YOG (23.5% vs. 7.6%, p=0.040). Conclusions Tension-type headache and OPH headaches, primarily stabbing headache, were more common in EOG patients than in YOG patients. The pain intensity, distribution of headache diagnoses, and frequency of medication overuse differed according to the age at headache onset.

  15. Relationships between food, wine, and beer-precipitated migrainous headaches.

    PubMed

    Peatfield, R C

    1995-06-01

    Five hundred seventy-seven consecutive patients attending the Princess Margaret Migraine Clinic from 1989 to 1991 have been questioned about dietary precipitants of their headaches. Four hundred twenty-nine patients had migraine, of which 16.5% reported that headaches could be precipitated by cheese or chocolate, and nearly always both. Of the migraine patients, 18.4% reported sensitivity to all alcoholic drinks, while another 11.8% were sensitive to red wine but not to white wine; 28% of the migrainous patients reported that beer would precipitate headaches. There was a definite statistical association between sensitivity to cheese/chocolate and to red wine (P < 0.001) and also to beer (P < 0.001), but none between diet sensitivity and sensitivity to alcoholic drinks in general. None of 40 patients with tension headache (diagnosed by International Headache Society criteria) reported sensitivity to foods, and only one was sensitive to alcoholic drinks. The prevalence of sensitivity among 46 patients with some migrainous features was intermediate between the migraine and tension headache categories. It is concluded that cheese/chocolate and red wine sensitivity, in particular, have closely related mechanisms, in some way related more to migraine than to more chronic tension-type headache, while quite separate mechanisms play a major role in sensitivity to alcoholic drinks in general.

  16. Headache attributed to temporomandibular disorders and masticatory myofascial pain.

    PubMed

    Hara, Kazuhiko; Shinozaki, Takahiro; Okada-Ogawa, Akiko; Matsukawa, Yumiko; Dezawa, Ko; Nakaya, Yuka; Chen, Jui-Yen; Noma, Noboru; Oka, Shunichi; Iwata, Koichi; Imamura, Yoshiki

    2016-01-01

    We investigated the temporal association between temporomandibular disorders (TMD)-related symptoms and headache during TMD treatment for patients who fulfilled the diagnostic criteria for headache attributed to TMD (HATMD) specified in the Diagnostic criteria for TMD (DC/TMD) and International classification of headache disorders (ICHD)-3 beta. The study enrolled 34 patients with HATMD induced by masticatory myofascial pain but not by temporomandibular arthralgia. Facial pain intensity, the pressure pain threshold of pericranial muscles, and maximum unassisted opening of the jaw were assessed at an initial examination and before and after physical therapy. The intensity and frequency of headache episodes and tooth contact ratio were also recorded before and after the intervention. Headache intensity and frequency significantly decreased, and these reductions were temporally related to improvements in facial pain intensity, maximum unassisted opening, and pressure pain threshold during TMD treatment. Linear regression analysis showed significant correlations between facial pain intensity and headache intensity and between tooth contact ratio and pressure pain threshold. Among patients who fulfilled the DC/TMD and ICHD-3 beta diagnostic criteria for HATMD, headache improved during TMD treatment, and the improvement was temporally related to amelioration of TMD symptoms. These findings suggest that sensitization in the central and peripheral nervous systems is responsible for HATMD. (J Oral Sci 58, 195-204, 2016). PMID:27349540

  17. Current Understanding on Pain Mechanism in Migraine and Cluster Headache

    PubMed Central

    Buture, Alina; Gooriah, Rubesh; Nimeri, Randa; Ahmed, Fayyaz

    2016-01-01

    Context Migraine and cluster headache are undoubtedly painful conditions. The respective pathogenesis of these two conditions is incompletely understood. In both cases, the treatments used have largely been empirical and have relied to a much lesser extent on our understanding of the mechanisms causing pain. We hereby review the pain mechanisms in migraine and cluster headache, two of the commonest primary headache disorders. Evidence Acquisition A review of the English literature was conducted by searching PubMed for studies on pain mechanism in migraine and cluster headache. We entered [migraine] and [pain mechanism] in Pubmed and 488 articles were obtained. Articles were then included according to their relevance to the topic. Similarly, [cluster headache] and [pain mechanism] revealed 79 search results. Results There is evidence that the trigeminovascular system and neurogenic inflammation play important roles, together with certain areas of the brain, leading to these conditions being termed ‘neurovascular headaches’. Functional imaging findings suggest a possible role of the dorsolateral pons in generating migraine attacks while the role of the hypothalamus in cluster headache is more firmly established. Conclusions Migraine and cluster headache have complex pathophysiologies. The exact mechanism causing pain in both conditions is incompletely understood and more research needs to be undertaken in this area. PMID:27642579

  18. Headache attributed to temporomandibular disorders and masticatory myofascial pain.

    PubMed

    Hara, Kazuhiko; Shinozaki, Takahiro; Okada-Ogawa, Akiko; Matsukawa, Yumiko; Dezawa, Ko; Nakaya, Yuka; Chen, Jui-Yen; Noma, Noboru; Oka, Shunichi; Iwata, Koichi; Imamura, Yoshiki

    2016-01-01

    We investigated the temporal association between temporomandibular disorders (TMD)-related symptoms and headache during TMD treatment for patients who fulfilled the diagnostic criteria for headache attributed to TMD (HATMD) specified in the Diagnostic criteria for TMD (DC/TMD) and International classification of headache disorders (ICHD)-3 beta. The study enrolled 34 patients with HATMD induced by masticatory myofascial pain but not by temporomandibular arthralgia. Facial pain intensity, the pressure pain threshold of pericranial muscles, and maximum unassisted opening of the jaw were assessed at an initial examination and before and after physical therapy. The intensity and frequency of headache episodes and tooth contact ratio were also recorded before and after the intervention. Headache intensity and frequency significantly decreased, and these reductions were temporally related to improvements in facial pain intensity, maximum unassisted opening, and pressure pain threshold during TMD treatment. Linear regression analysis showed significant correlations between facial pain intensity and headache intensity and between tooth contact ratio and pressure pain threshold. Among patients who fulfilled the DC/TMD and ICHD-3 beta diagnostic criteria for HATMD, headache improved during TMD treatment, and the improvement was temporally related to amelioration of TMD symptoms. These findings suggest that sensitization in the central and peripheral nervous systems is responsible for HATMD. (J Oral Sci 58, 195-204, 2016).

  19. Sphenopalatine ganglion stimulation for the treatment of cluster headache

    PubMed Central

    Puche, Miguel; Garcia, Ana; Gascón, Francisco

    2014-01-01

    Cluster headache is a severe, debilitating disorder with pain that ranks among the most severe known to humans. Patients with cluster headaches have few therapeutic options and further, 10–20% develop drug-resistant attacks. The often brief duration of cluster attacks makes abortive therapy a challenge, and preventive medications are almost always provided to patients, but the side effects of these preventive medications can be significant. The sphenopalatine ganglion (SPG) is believed to play a role in headache pain and cranial autonomic symptoms associated with cluster headache, which is a result of activation of the trigeminal-autonomic reflex. For over 100 years, the SPG has been a clinical target to treat primary headache disorders using pharmacologic and nonpharmacologic methods. Radiofrequency lesioning and nerve-resection therapies, while initially beneficial, are irreversible procedures, and the use of neurostimulation provides one method of interfacing with the neural pathways without causing permanent damage to neural tissue. SPG neurostimulation is both reversible and adjustable, and has recently been tested in both proof-of-concept work and in a randomized, sham-controlled trial for the treatment of cluster headache. A randomized, sham-controlled study of 32 patients was performed to evaluate further the use of SPG stimulation for the acute treatment of chronic cluster headache. Of the 32 patients, 28 completed the randomized experimental period. Overall, 68% of patients experienced an acute response, a frequency response, or both. In this study the majority of adverse events were related to the implantation procedure, which typically resolved or remained mild in nature at 3 months following the implant procedure. This and other studies highlight the promise of using SPG stimulation to treat the pain-associated cluster headache. SPG stimulation could be a safe and effective option for chronic cluster headache. PMID:24790646

  20. Migraine and tension-type headache triggers in a Greek population.

    PubMed

    Constantinides, Vasilios; Anagnostou, Evangelos; Bougea, Anastasia; Paraskevas, George; Kapaki, Elisavet; Evdokimidis, Ioannis; Kararizou, Evangelia

    2015-08-01

    Migraine and tension type headache are the two most common primary headaches. The purpose of this study was to detect differences in clinical characteristics and headache triggers and in a Greek cohort of 51 migraineurs and 12 patients with tension-type headache. (TTH) Migraine patients had a significantly lower age at headache onset and frequency, higher mean visual analogue scale (VAS) and greater maximum duration of headache episodes compared to TTH patients. They did not differ from (TTH) patients in quality of headache, laterality of pain, way of headache installation and progression and temporal pattern of headaches. Nausea, vomiting and phonophobia were more frequent in migraine. Triggering of headaches by dietary factors was associated with migraine, whereas there was no difference between the two groups in any of the other headache triggers. Stress, both physical and psychological, were particularly common in both patient groups.

  1. Headache in the writings of Elizabeth Gaskell (1810-1865).

    PubMed

    Larner, A J

    2015-11-01

    Mrs Elizabeth Gaskell was a celebrated author of the Victorian era, a friend of both Charles Dickens and Charlotte Brontë and the latter's first biographer. References to headache in Mrs Gaskell's six major novels, published between 1848 and 1866 as well as some of her shorter fiction, have been collated. These multiple references suggest that Elizabeth Gaskell used headache as a narrative device, possibly based on her own experience of headache and that of female acquaintances, most notably Charlotte Brontë. PMID:24585607

  2. Posttraumatic headache with ptosis, miosis and chronic forehead hyperhidrosis.

    PubMed

    Khurana, R K

    1990-01-01

    Injury to the right lateral forehead was followed by headaches, and chronic ipsilateral ptosis, miosis, and forehead hyperhidrosis. Episodes of headache were accompanied by an increase in ptosis, miosis and forehead hyperhidrosis. The headaches abated within 6 weeks but the ptosis and miosis, due to postganglionic sympathetic insufficiency, were persistent. Spontaneous forehead hyperhidrosis, was also persistent at the time of last follow-up, 15 months later. Autonomic assessment of the oculocephalic sympathetic dysfunction, localization of the lesion and possible explanation of the autonomic findings are discussed. PMID:2406222

  3. Three cases of dural arteriovenous fistula of the anterior condylar vein within the hypoglossal canal.

    PubMed

    Ernst, R; Bulas, R; Tomsick, T; van Loveren, H; Aziz, K A

    1999-01-01

    Dural arteriovenous fistulas (DAVFs) of the anterior condylar vein are an uncommon but important subset of fistulas occurring at the skull base that can be confused with DAVFs of the marginal sinus on angiography. MR angiography source images can document the intraosseous extent and the relationship to the hypoglossal canal of this type of fistula, which can have significant clinical implications. We present the imaging features of angiography, CT, and MR angiography of three cases of DAVFs localized to the anterior condylar vein and within the hypoglossal canal, which were confirmed by source images from MR angiography. Transvenous coil embolization was curative in two of three cases and would seem to be the treatment of choice when venous access is available. PMID:10588137

  4. Neonatal dural arteriovenous fistula at the confluence presenting with paralysis of the orbicularis oris muscle.

    PubMed

    Iizuka, Y; Koda, E; Tsutsumi, Y; Konishi, Y; Ashida, H; Nakanishi, T; Funabiki, M

    2013-02-01

    A male neonate presented a dural arteriovenous fistula (DAVF) at the confluence with paralysis of the orbicularis oris muscle. The interesting features in our case were the clinical symptoms (orbicularis oris muscle paralysis at birth), angioarchitecture (high-flow arteriovenous shunts at the confluence) and the size and hemodynamic flow (mid-sized venous pouch) of the fistula. Additionally, the embolization technique (i.e., occipital artery approach, closing shunts with pure glue) automatically resulted in the immediate and complete closure of accessory feeders without any additional treatment, and the midterm clinical outcome was good. We succeeded improving the symptoms of a neonate with a congenital high-flow DAVF by closing a fistula using a small amount of glue.

  5. Onyx extrusion through the scalp after embolization of dural arteriovenous fistula.

    PubMed

    Singla, Amit; Fargen, Kyle Michael; Hoh, Brian

    2016-09-01

    A man in his sixties referred with symptoms of episodic left lip numbness and left arm weakness was diagnosed with a Borden type 3 dural arteriovenous fistula (DAVF) on DSA. Successful Onyx embolization of the DAVF was performed via the distal left occipital artery using an ev3 Apollo detachable tip microcatheter. He underwent surgical obliteration for the residual DAVF 3 days later. Three months later during a routine postoperative clinic visit, the patient produced a plastic bag containing multiple small pieces of Onyx cast and the detached tip of the Apollo microcatheter that had extruded out from his scalp through small spontaneous holes about 5 weeks after the embolization procedure. This spontaneous extrusion of Onyx can be alarming to the patient not expecting it; however, prior knowledge and discussion can lessen the anxiety of both the treating physician and the patient dealing with such a situation.

  6. Onyx extrusion through the scalp after embolization of dural arteriovenous fistula.

    PubMed

    Singla, Amit; Fargen, Kyle Michael; Hoh, Brian

    2015-01-01

    A man in his sixties referred with symptoms of episodic left lip numbness and left arm weakness was diagnosed with a Borden type 3 dural arteriovenous fistula (DAVF) on DSA. Successful Onyx embolization of the DAVF was performed via the distal left occipital artery using an ev3 Apollo detachable tip microcatheter. He underwent surgical obliteration for the residual DAVF 3 days later. Three months later during a routine postoperative clinic visit, the patient produced a plastic bag containing multiple small pieces of Onyx cast and the detached tip of the Apollo microcatheter that had extruded out from his scalp through small spontaneous holes about 5 weeks after the embolization procedure. This spontaneous extrusion of Onyx can be alarming to the patient not expecting it; however, prior knowledge and discussion can lessen the anxiety of both the treating physician and the patient dealing with such a situation.

  7. Single-session, transarterial complete embolization of Galenic dural AV fistula.

    PubMed

    Laviv, Yosef; Kasper, Ekkehard; Perlow, Eliyahu

    2016-02-01

    Galenic dural arteriovenous fistula (DAVF) represents a unique, hard to treat subgroup of tentorial DAVFs. We present an unusual case of hemorrhagic Galenic DAVF in a 54-year-old woman. The fistula drained directly to the vein of Galen through multiple feeders. Complete occlusion of the fistula was achieved through transarterial embolization. Deep venous drainage remained intact and the patient recovered well. To our knowledge, this is the first report on complete closure of hemorrhagic Galenic DAVF using transarterial embolization with complete obliteration of vein of Galen. The presence of nonfunctioning straight sinus may have contributed to the success of treatment and it may be considered as a predictive marker for endovascular embolization.

  8. A dural arteriovenous fistula in cavernous sinus developed from viral meningitis.

    PubMed

    Hai, Jian; Zhang, Lin; Wan, Jue-Feng; Su, Shao-Hua; Wang, Fei; Zhang, Gui-Yun

    2011-06-01

    Although hormonal influences, inflammation, trauma, sinus thrombosis, venous hypertension, and congenital origin have been proposed as sources of dural arteriovenous fistulas (DAVFs) in cavernous and sigmoid sinuses, the etiology of these lesions remains controversial. We present a case with a cavernous sinus DAVF developed from viral meningitis which has not been previously described. A 24-year-old male was admitted to our institute because of periorbital pain, decreased vision, pulsatile tinnitus, chemosis, and exophthalmos on the right side after he had suffered viral meningitis four months before. Cerebral angiography demonstrated a cavernous sinus DAVF, which was successfully obliterated with several platinum coils using a transvenous approach. The viral meningitis most likely caused the inflammation, that may be responsible for the occurrence of the cavernous sinus DAVF. Prompt treatment for inflammation may help to prevent the development of DAVFs.

  9. Pulsatile Tinnitus with a Dural Arterio-Venous Fistula Diagnosed by Computed Tomography-Angiography

    PubMed Central

    Kim, Sujin; Byun, Jaeyong; Park, Moonsuh

    2013-01-01

    A 43 year-old female patient suffered the sudden onset of pulsatile tinnitus in the left ear 2 months ago. The tinnitus did not subside spontaneously and remained unchanged. The patient had no history of head trauma or surgery of the head and neck. The character of the tinnitus was pulsatile, and it was synchronous with the heart beat. Audiologic examinations were performed and all of the results were normal. Computed tomography with angiography was performed and evidence of an arterio-venous fistula (AVF) was found. 4-vessel angiography was performed to confirm the dural AVF between the external carotid artery and sigmoid sinus. Embolization of the feeder-vessels was done under a fluoroscope and 70% of the fistula flow was controlled after embolization and the tinnitus totally subsided during the embolization. PMID:24653921

  10. Endovascular treatment resolves non-hemorrhagic brainstem dysfunction due to tentorial dural AV fistula.

    PubMed

    Panagiotopoulos, V; Kastrup, O; Wanke, I

    2009-02-01

    Tentorial dural arteriovenous fistulas (tDAVF) clinically present usually with subarachnoid and/or intraparenchymal hemorrhage. Reported rates range from 58% to 92% and neurological deficits occur in 79% to 92% of patients. This is due to venous congestion resulting from retrograde leptomeningeal venous drainage, which rarely, can be clinically silent. A 69-year-old woman presented with vertigo, double vision and gait instability. Cerebral digital subtraction angiography revealed a tDAVF with retrograde cerebellar venous drainage directed through the vein of Galen into the straight sinus. MRI showed extensive cerebellar edema due to venous congestion. Clinical manifestations of cerebellar and brainstem dysfunction resolved completely after transarterial embolization with N-butylcyanoacrylate.

  11. Endovascular management of six simultaneous intracranial dural arteriovenous fistulas in a single patient

    PubMed Central

    Gist, Taylor L; Rangel-Castilla, Leonardo; Krishna, Chandan; Roman, Gustavo C; Cech, David A; Diaz, Orlando

    2013-01-01

    A 64-year-old man with a history of traumatic brain injury 4 years previously presented with progressive cognitive decline and gait abnormality. MRI revealed diffusion restriction in the bilateral centrum semiovale and multiple serpiginous flow voids. Cerebral angiogram revealed a total of six intracranial dural arteriovenous fistulas with separate fistulas of the right and left sphenoid bones, left clival plexus, right transverse sinus, right sigmoid sinus, and superior sagittal sinus. A diffuse pseudophlebitic pattern of venous drainage indicating severe venous hypertension was also observed. The patient underwent a series of endovascular treatments over the next 10 months to achieve resolution of all arteriovenous shunting. Repeat MRI showed resolution of the diffusion restriction and marked reduction in T2 vascular flow voids. The patient's clinical status improved significantly over the course of treatment, paralleling the improvement in venous hypertension. PMID:23475992

  12. Quasi-static puncture resistance behaviors of high-strength polyester fabric for soft body armor

    NASA Astrophysics Data System (ADS)

    Wang, Qiu-Shi; Sun, Run-Jun; Tian, Xiao; Yao, Mu; Feng, Yan

    A series of economical and flexible fabrics were prepared using high-strength polyester yarns with different fabric structures, weft density and number of layers. The effect of these factors on quasi-static puncture resistance was comparatively studied. The failure mode of the fabrics was analyzed with SEM photographs. Findings indicate that the structure and the weft density affected the quasi-static puncture resistance property of the fabrics, the plain fabrics had better puncture resistance property than twill and satin fabrics. The max puncture force and puncture energy of the plain fabrics with 160 yarn/10 cm reached the max values which were 107.43 N and 0.44 J, respectively. The number of layers had a linear relationship to quasi-static puncture resistance. The contact pressure and friction of the probe against the fibers were the main hindrance during the quasi-static puncture process and the breakage of the fibers during the penetration was caused by the bend and tensile deformation.

  13. Sumatriptan inhibition of N-type calcium channel mediated signaling in dural CGRP terminal fibres

    PubMed Central

    Baillie, Landon D.; Ahn, Andrew H.; Mulligan, Sean J.

    2012-01-01

    The selective 5-HT1 receptor agonist sumatriptan is an effective therapeutic for migraine pain yet the antimigraine mechanisms of action remain controversial. Pain-responsive fibres containing calcitonin gene-related peptide (CGRP) densely innervating the cranial dura mater are widely believed to be an essential anatomical substrate for the development of migraine pain. 5HT1 receptors in the dura colocalize with CGRP fibres in high density and thus provide a possible peripheral site of action for sumatriptan. In the present study, we used high-resolution optical imaging selectively within individual mouse dural CGRP nociceptive fibre terminations and found that application of sumatriptan caused a rapid, reversible dose-dependent inhibition in the amplitude of single action potential evoked Ca2+ transients. Pre-application of the 5-HT1 antagonist GR127935 or the selective 5-HT1D antagonist BRL 15572 prevented inhibition while the selective 5-HT1B antagonist SB 224289 did not, suggesting this effect was mediated selectively through the 5-HT1D receptor subtype. Sumatriptan inhibition of the action potential evoked Ca2+ signaling was mediated selectively through N-type Ca2+ channels. Although the T-type Ca2+ channel accounted for a greater proportion of the Ca2+ signal it did not mediate any of the sumatriptan inhibition. Our findings support a peripheral site of action for sumatriptan in inhibiting the activity of dural pain fibres selectively through a single Ca2+ channel subtype. This finding adds to our understanding of the mechanisms that underlie the clinical effectiveness of 5HT1 receptor agonists such as sumatriptan and may provide insight for the development of novel peripherally targeted therapeutics for mitigating the pain of migraine. PMID:22691374

  14. Percutaneous Direct Puncture Embolization with N-butyl-cyanoacrylate for High-flow Priapism.

    PubMed

    Tokue, Hiroyuki; Shibuya, Kei; Ueno, Hiroyuki; Tokue, Azusa; Tsushima, Yoshito

    2016-09-01

    There are many treatment options in high-flow priapism. Those mentioned most often are watchful waiting, Doppler-guided compression, endovascular highly selective embolization, and surgery. We present a case of high-flow priapism in a 57-year-old man treated by percutaneous direct puncture embolization of a post-traumatic left cavernosal arteriovenous fistula using N-butyl-cyanoacrylate. Erectile function was preserved during a 12-month follow-up. No patients with percutaneous direct puncture embolization for high-flow priapism have been reported previously. Percutaneous direct puncture embolization is a potentially useful and safe method for management of high-flow priapism.

  15. Granulomatous hypophysitis: a case of severe headache.

    PubMed

    Wan Muhamad Hatta, Sharifah Faradila; Hamdan, M Farhan; Md Ali, Siti Aishah; Abdul Ghani, Rohana

    2016-01-01

    Idiopathic granulomatous hypophysitis (GH) is an uncommon inflammatory disease of the pituitary with impairment of pituitary gland function due to infiltration by lymphocytes, plasma cells and macrophages. We report the case of a 39-year-old woman who presented with worsening of headaches for 1 month and blurring of vision over 5 days. An MRI revealed a homogeneous supra-sellar mass evoking a pituitary tumour with bulky pituitary stalk extending into the left and right cavernous sinuses. Hormonal investigations showed anterior pituitary hormone deficiencies; meanwhile histopathological examination revealed an aspect of hypophysitis. Clinical and radiological remission occurred immediately postglucocorticoid therapy with the addition of a steroid-sparing agent later in view of recurrence of symptoms on glucocorticoid dose reduction. GH has important diagnostic and therapeutic implications, as clinical and radiological features ameliorate via medical treatment. With further understanding and recognition of the disease, we hope to highlight a case of GH, in which signs and symptoms improved after initiation of corticosteroids. PMID:27613264

  16. [Vasculitis as a reason of chronic headache].

    PubMed

    Ataia, I; Casaulta, C; von Vigier, R O; Pfammatter, J P; Brekenfeld, C; Sauvain, M J; Steinlin, M

    2008-03-19

    A 13-year-old girl presented to our emergency with a one week history of fever and skin rash and new onset of chorea for the last three days. There was a long standing history of right predominant headache; followed by personality change, fatigue, arthralgia and weight loss over the last few months. Previous investigations by head CT and ophthalmological examination did not explain the symptoms. Further investigations revealed peri- and pancarditis with aortic insufficiency, a renal involvement with elevated creatinin, protein- and hematuria and a hemolytic anemia. Diagnosis of lupus eythematodes was confirmed by high ANA, anti-dsDNS and Anticardiolipin antibodies. Within the first 48 hours after admission there was significant deterioration with reduced vigilance and dysarthria. MRI of the brain and dopplersonography of cerebral vessels showed a complete thrombosis of the right medial cerebral artery with a small net of collaterals, irregularities of the left cerebral artery due to vasculitis and several subacute leftsided ischemias. Immunosuppressive therapy with high-dose corticosteroids and cyclophosphamid together with antithrombotic therapy induced an improvement of neurologic, renal and cardiac function. PMID:18548940

  17. Can You Blame Your Headaches on Your Thyroid?

    MedlinePlus

    ... greater risk of a thyroid disease known as hypothyroidism, a new study suggests. Hypothyroidism occurs when the body doesn't produce sufficient ... headaches -- had a 21 percent higher risk of hypothyroidism, the investigators found. And people with a possible ...

  18. Frontal headache induced by osteoma of frontal recess.

    PubMed

    Kim, Kyung Soo

    2013-01-01

    We reported a case of osteoma involving the frontal recess, which presented as frontal headache and reviewed literatures. Also, this case highlights that sinunasal osteomas can cause pain by local mass effects, referred pain, or prostaglandin E2-mediated mechanisms.

  19. Migraine Headache Treatment & Research | NIH MedlinePlus the Magazine

    MedlinePlus

    ... The molecular basis for migraine headaches and the aura associated with certain migraines is uncertain. One multi-faceted research study is examining how migraine with aura may affect metabolism and neurophysiological function. Investigators are ...

  20. Enucleation and development of cluster headache: a retrospective study

    PubMed Central

    Sörös, Peter; Vo, Oanh; Gerding, Heinrich; Husstedt, Ingo W; Evers, Stefan

    2005-01-01

    Background Cluster headache (CH) is a neurovascular, primary headache disorder. There are, however, several case reports about patients whose CH started shortly after a structural brain disease or trauma. Motivated by a patient who developed CH 3 weeks after the removal of an eye and by similar case reports, we tested the hypothesis that the removal of an eye is a risk factor for CH. Methods A detailed headache questionnaire was filled out by 112 patients on average 8 years after enucleation or evisceration of an eye. Results While 21 % of these patients experienced previously unknown headaches after the removal of an eye, no patient fulfilled the diagnostic criteria for CH. Conclusion Our data does not suggest that the removal of an eye is a major risk factor for the development of CH. PMID:15784136

  1. Headaches in antiquity and during the early scientific era.

    PubMed

    Magiorkinis, Emmanouil; Diamantis, Aristidis; Mitsikostas, Dimos-Dimitrios; Androutsos, George

    2009-08-01

    This paper presents the evolution of ideas on headache symptoms from antiquity through the 19th century. A thorough study of texts, medical books and reports along with a review of the available literature in PubMed was undertaken: observations on headaches date back nearly 4,000 years to the ritual texts of Mesopotamia. Nicolaes Tulp, Thomas Willis and Gerhard van Swieten also made important contributions on various forms of headaches in the 17th and 18th centuries. Edward Liveing and William Gowers made the major contributions to the field in the late 19th century. Overall, observations on headaches span a timeline of nearly 9,000 years. The work of the physicians during the 18th and 19th century, however, set the basis for scientific research. PMID:19288044

  2. The Prevalence of Headache Among Athletic University Students

    PubMed Central

    Jahani, Pegah; Salesi, Mohsen; Marzban, Maral; Abdollahifard, Gholamreza

    2016-01-01

    Background: Headache is certainly one of the most common medical complaints of general population and one of the important causes of consumption of drugs. Despite its high overall prevalence, the epidemiology of exertional headache is not clear enough. Objectives: To determine the prevalence of headache in athletic and non-athletic university students and also estimating its variation between different sports fields including concussion prone sports. Materials and Methods: This cross-sectional study comprised 739 subjects (367 athletes and 372 non-athletes). The present study was carried out on athletic and non-athletic university students aging between 18 to 28 years. An athlete was defined as a person who had at least one year of experience in sports including football, volleyball, basketball, wrestling, boxing, martial arts, track and field, chess, handball and swimming for three sessions a week each lasting at least 2 hours. The random selection of these participants was done by an independent statistical consultant. A questionnaire was used for data collection which was then analyzed by statistical methods. Results: Our study comprised 739 subjects (367 athletes and 372 non-athletes). Among athletic university students, 152 (41.2%) participants complained of headache. Such a complaint was present in 217 (58.3%) non-athletic university students. This lower prevalence of headache in athletes was statistically significant (P value < 0.001). Among ten different sports fields, the prevalence of headache among wrestlers was significantly higher than others (P value < 0.001). Conclusions: The prevalence of headache is seemingly lower in athletic university students than non-athletic ones. In addition, among athletes, those who are participating in concussion prone sports especially wrestling experience headache more than athletes of other fields. PMID:27231525

  3. A Fuzzy Method for Medical Diagnosis of Headache

    NASA Astrophysics Data System (ADS)

    Ahn, Jeong-Yong; Mun, Kill-Sung; Kim, Young-Hyun; Oh, Sun-Young; Han, Beom-Soo

    In this note we propose a fuzzy diagnosis of headache. The method is based on the relations between symptoms and diseases. For this purpose, we suggest a new diagnosis measure using the occurrence information of patient's symptoms and develop an improved interview chart with fuzzy degrees assigned according to the relation among symptoms and three labels of headache. The proposed method is illustrated by two examples.

  4. Cluster headache-like pain in multiple sclerosis.

    PubMed

    Leandri, M; Cruccu, G; Gottlieb, A

    1999-10-01

    We describe a case with simultaneous occurrence of cluster headache-like pain and multiple sclerosis. Both neuroimaging and neurophysiology (trigeminal evoked potentials) revealed a demyelination plaque in the pons, at the trigeminal root entry zone, on the side of pain. Although that type of lesion is usually associated with trigeminal neuralgia pain, we hypothesize that in this case it may be linked with the concomitant cluster headache, possibly by activation of trigemino-vascular mechanisms.

  5. Hemicrania continua evolving from cluster headache responsive to valproic acid.

    PubMed

    Lambru, Giorgio; Castellini, Paola; Bini, Annamaria; Evangelista, Andrea; Manzoni, Gian Camillo; Torelli, Paola

    2008-10-01

    Hemicrania continua (HC) is a rare type of primary headache characterized by a prompt and enduring response to indomethacin. We describe a patient who suffered from cluster headache evolving into ipsilateral HC, who does not tolerate a long-term indomethacin therapy. The case was complex in terms of diagnosis, associated comorbidity, and choice of treatment; after several trials with different therapeutic regimens, we started the patient on a therapy with valproic acid and obtained an improvement of her HC.

  6. Intracranial saccular aneurysm in a child with only persistent headache.

    PubMed

    Güngör, Olcay; Özkaya, Ahmet Kağan; Dilber, Cengiz; Çinar, Celal

    2015-06-01

    Headache is one of the common symptoms of intracranial aneursym. A 5-year-old child lately presented to our pediatric emergency department with persistent headache. Brain magnetic resonance imaging revealed a 7×8 mm rounded lesion with slowly heterogeneous low signal in T2 sequence consistent with a partial occluded aneurysm, in the right medial frontal lobe that close to anterior cerebral artery. Intracranial aneurysms are rare in children and they are noncommon without complications as our case.

  7. Response of cluster headache to psilocybin and LSD.

    PubMed

    Sewell, R Andrew; Halpern, John H; Pope, Harrison G

    2006-06-27

    The authors interviewed 53 cluster headache patients who had used psilocybin or lysergic acid diethylamide (LSD) to treat their condition. Twenty-two of 26 psilocybin users reported that psilocybin aborted attacks; 25 of 48 psilocybin users and 7 of 8 LSD users reported cluster period termination; 18 of 19 psilocybin users and 4 of 5 LSD users reported remission period extension. Research on the effects of psilocybin and LSD on cluster headache may be warranted.

  8. Neural-Dural Transition at the Thoracic and Lumbar Spinal Nerve Roots: A Histological Study of Human Late-Stage Fetuses

    PubMed Central

    Cho, Kwang Ho; Jin, Zhe Wu; Abe, Hiroshi; Shibata, Shunichi; Murakami, Gen; Rodríguez-Vázquez, Jose Francisco

    2016-01-01

    Epidural blocks have been used extensively in infants. However, little histological information is available on the immature neural-dural transition. The neural-dural transition was histologically investigated in 12 late-stage (28–30 weeks) fetuses. The dural sheath of the spinal cord was observed to always continue along the nerve roots with varying thicknesses between specimens and segments, while the dorsal root ganglion sheath was usually very thin or unclear. Immature neural-dural transitions were associated with effective anesthesia. The posterior radicular artery was near the dorsal root ganglion and/or embedded in the nerve root, whereas the anterior radicular artery was separated from the nearest nerve root. The anterior radicular artery was not associated with the dural sheath but with thin mesenchymal tissue. The numbers of radicular arteries tended to become smaller in larger specimens. Likewise, larger specimens of the upper thoracic and lower lumbar segments did not show the artery. Therefore, elimination of the radicular arteries to form a single artery of Adamkiewicz was occurring in late-stage fetuses. The epidural space was filled with veins, and the loose tissue space extended ventrolaterally to the subpleural tissue between the ribs. Consequently, epidural blocks in infants require special attention although immature neural-dural transitions seemed to increase the effect. PMID:27069926

  9. Headaches as Somatoform Disorders in Children and Adolescents

    PubMed Central

    Emich-Widera, Ewa; Szwed-Białożyt, Barbara; Kopyta, Ilona; Kostorz, Anna

    2012-01-01

    Somatoform disorders are often the main cause for seeking professional advice and performing a number of specialist checks. The aim of the study was to determine the frequency of somatoform disorders in the form of headaches in children and adolescents neurologically diagnosed and the risk factors thereof. Analysis of the biological and situational risk factors were established. Somatoform disorders were diagnosed in 27 out of 276 children with headaches. We concluded that in the differential diagnosis of headaches, somatoform headaches should not be omitted as every 10th patient in the developmental age diagnosed on the neurological ward because of headache shows signs of somatoform headaches. In diagnostically difficult cases it is recommended that analysis of biological and situational risk factors be performed with special attention paid to chronic disease of the patient and/or in his immediate family, the patient’s psychological disorders and dysfunctional or low social status families. The creation of separate criteria for somatoform disorders of the developmental age should be considered. PMID:25478111

  10. Behavioral management of headache in children and adolescents.

    PubMed

    Faedda, Noemi; Cerutti, Rita; Verdecchia, Paola; Migliorini, Daniele; Arruda, Marco; Guidetti, Vincenzo

    2016-12-01

    Headache is the most frequent neurological symptom and the most prevalent pain in children and adolescents, and constitutes a serious health problem that may lead to impairment in several areas. Psychosocial factors, social environment, life events, school and family stressors are all closely related to headaches. A multidisciplinary strategy is fundamental in addressing headache in children and adolescents. Applying such a strategy can lead to reductions in frequency and severity of the pain, improving significantly the quality of life of these children.It has been demonstrated that behavioral intervention is highly effective, especially in the treatment of paediatric headache, and can enhance or replace pharmacotherapy, with the advantage of eliminating dangerous side effects and or reducing costs. Behavioral interventions appear to maximize long-term therapeutic benefits and improve compliance with pharmacological treatment, which has proven a significant problem with child and adolescent with headache.The goal of this review is to examine the existing literature on behavioral therapies used to treat headache in children and adolescents, and so provide an up-to-date picture of what behavioral therapy is and what its effectiveness is. PMID:27596923

  11. Focus on therapy: hemicrania continua and new daily persistent headache.

    PubMed

    Rossi, Paolo; Tassorelli, Cristina; Allena, Marta; Ferrante, Enrico; Lisotto, Carlo; Nappi, Giuseppe

    2010-06-01

    Hemicrania continua (HC) and new daily-persistent headache (NDPH) represent the only two forms of chronic daily headache in Chap. IV "Other Primary Headaches" of the second edition of the International Classification of Headache Disorders. HC and NDPH are rare and poorly defined from a pathophysiological point of view; as a consequence, their management is largely empirical. Indeed, there is a lack of prospective, controlled trials in this field, and treatment effectiveness is basically inferred from the results of sparse open-label trials, retrospective case series, clinical experience and expert opinions. In this narrative review we have summarised the information collected from an extensive analysis of the literature on the treatment of HC and NDPH in order to provide the best available and up-to-date evidence for the management of these two rare forms of primary headache. Indomethacin is the mainstay of HC management. The reported effective dose of indomethacin ranges from 50 to 300 mg/day. Gabapentin 600-3,600 mg tid, topiramate 100 mg bid, and celecoxib 200-400 mg represent the most interesting alternative choices in the patients who do not tolerate indomethacin or who have contraindications to its use. NDPH is very difficult to treat and it responds poorly only to first-line options used for migraine or tension-type headache.

  12. Closure Using a Surgical Closure Device of Inadvertent Subclavian Artery Punctures During Central Venous Catheter Placement

    SciTech Connect

    Berlet, Matthew H.; Steffen, Diana; Shaughness, George; Hanner, James

    2001-03-15

    Severe complications can and do occur when central venous catheters are inadvertently placed into subclavian arteries. Two cases are discussed that describe how these inadvertent arterial punctures can be closed using the Perclose device (Abbott Laboratories, Redwood City, CA, USA)

  13. Numerical method for computing Maass cusp forms on triply punctured two-sphere

    SciTech Connect

    Chan, K. T.; Kamari, H. M.; Zainuddin, H.

    2014-03-05

    A quantum mechanical system on a punctured surface modeled on hyperbolic space has always been an important subject of research in mathematics and physics. This corresponding quantum system is governed by the Schrödinger equation whose solutions are the Maass waveforms. Spectral studies on these Maass waveforms are known to contain both continuous and discrete eigenvalues. The discrete eigenfunctions are usually called the Maass Cusp Forms (MCF) where their discrete eigenvalues are not known analytically. We introduce a numerical method based on Hejhal and Then algorithm using GridMathematica for computing MCF on a punctured surface with three cusps namely the triply punctured two-sphere. We also report on a pullback algorithm for the punctured surface and a point locater algorithm to facilitate the complete pullback which are essential parts of the main algorithm.

  14. Evolution of near-extremal-spin black holes using the moving puncture technique

    SciTech Connect

    Liu, Y.T.; Etienne, Zachariah B.; Shapiro, Stuart L.

    2009-12-15

    We propose a new radial coordinate to write the Kerr metric in puncture form. Unlike the quasiradial coordinate introduced previously, the horizon radius remains finite in our radial coordinate in the extreme Kerr limit a/M{yields}1. This significantly improves the accuracy of the evolution of black holes with spins close to the extreme Kerr limit. We are able to evolve accurately both stationary and boosted black holes with spins as high as a/M=0.99 using initial data constructed in these new puncture coordinates. Initial data of compact binaries with rapidly spinning black holes can be constructed using our proposed new puncture metric for the background conformal metric. Our simulations for single black holes suggest that such initial data can be evolved successfully by the moving puncture technique.

  15. "BABY, BABY I'VE GOT HEADACHE".

    PubMed

    Kaiksow, F A; Bhatnagar, D

    2015-01-01

    A 26-year-old woman with no prior medical history presented post-partum with altered mental status. She had no complications during pregnancy and had a spontaneous vaginal delivery at term one week prior. On post-partum day five, she began complaining of headaches, initially responsive to ibuprofen but eventually worsened with no relief. On the evening of admission, her boyfriend noted strange behavior and movements consistent with a tonic-clonic seizure. On the way to the hospital, she had two more similar seizures witnessed by emergency medical serevices (EMS). EMS reported her blood pressures in route to be 200/100s. She was given 5 mg of magnesium by EMS due to concern for postpartum eclampsia. Upon arrival at the emergency room, she was somnolent but arousable although unable to answer any questions. She was mildly tachycardic at 106 beats per minute and had a temperature of 38.2°C. Her blood pressure was elevated at 165/95 mm Hg. On exam, dried blood was noted on her lips and her tongue was swollen. On auscultation, she was tachycardic with clear lung sounds. Her abdomen was soft and non-tender and there was no vaginal bleeding or other discharge. Laboratory values revealed a sodium of 142, potassium of 3.3, chloride of 110, bicarbonate of 16, creatinine of 1.1, magnesium of 3.9, and white blood cell count of 12.3 x103/mm3 with 88% neutrophils and no bands. A toxicology panel was negative for opiates, benzodiazepines, or other illicit drugs. Urine was remarkable for large blood, 448 red blood cells, protein, moderate leukocyte esterase, and 73 white blood cells. Chest x-ray and CT scan of the head were both normal. She was admitted to the medical intensive care unit for close monitoring, neurological checks, and continued magnesium administration. By hospital day two, her mental status had improved significantly. PMID:27159471

  16. The Headache of Carbon Dioxide Exposures

    NASA Technical Reports Server (NTRS)

    James, John T.

    2007-01-01

    Carbon dioxide (CO2), a natural product of human metabolism, accumulates quickly in sealed environments when humans are present, and can induce headaches, among other symptoms. Major resources are expended to control CO2 levels to concentrations that are tolerable to the crews of spacecraft and submersible craft. It is not practical to control CO2 levels to those found in the ambient environment on earth. As NASA looks ahead to long-duration missions conducted far from earth, difficult issues arise related to the management and effects of human exposure to CO2. One is the problem of pockets of CO2 in the habitat caused by excess generation of the gas in one location without a mechanism to purge the area with fresh air. This results in the crew rebreathing CO2 from their exhaled breath, exposing them to a much higher concentration of CO2 than whole-module measurements would suggest. Another issue is the potential increased sensitivity to CO2 in microgravity. For example, based on anecdotal information, it appears that space crews may be more susceptible than submarine crews to some of the subtle, yet adverse effects of CO2 exposure. Another issue, not unique to spaceflight, is the possibility of inter-individual differences in the susceptibility of crewmembers to CO2 exposure. Again, anecdotal reports from the International Space Station (ISS) crews suggest that certain individuals may experience a greater susceptibility. The implications associated with these issues are extremely important as NASA sets CO2 exposure limits that protect the crew from this compound s subtle adverse effects, without causing an unwarranted expenditure of resources to scrub CO2 from the habitat atmosphere.

  17. A single burr hole approach for direct transverse sinus cannulation for the treatment of a dural arteriovenous fistula

    PubMed Central

    Caplan, Justin M; Kaminsky, Ian; Gailloud, Philippe; Huang, Judy

    2014-01-01

    A 55-year-old woman with a symptomatic Borden II/Cognard IIa+b transverse sinus dural arteriovenous fistula underwent an attempted percutaneous transvenous embolization which was ultimately not possible given the fistula anatomy. She then underwent a partial percutaneous transarterial embolization but the fistula recurred. Given the failed percutaneous interventions, the patient underwent a combined open surgical/transvenous embolization using neuronavigation and a single burr hole craniectomy. She has remained symptom free for 3 months. This case report illustrates the feasibility of combining minimally invasive open surgical access to allow for direct venous cannulation for endovascular embolization of a dural arteriovenous fistula when traditional percutaneous methods are not an option. PMID:24398868

  18. Use of a vegetable model as a training tool for PCNL puncture

    PubMed Central

    Sinha, Maneesh; Krishnamoorthy, Venkatesh

    2015-01-01

    Introduction: Training residents to perform a PCNL puncture is hampered by the non-availability of a good inanimate model that can be used for demonstration and practice. The ethics of surgical training during actual surgeries is being questioned and the role of simulation is increasingly important. Virtual reality trainers, however, are prohibitively expensive and the use of animal models is fraught with regulatory and ethical concerns. We have devised a model that can be used to teach the concept of depth perception during a PCNL puncture. Methods: A bottle gourd was used to mimic the posterior abdominal wall. Cotton pledgets dipped in intravenous contrast were fitted into 4 mm holes made at staggered levels in the bottle gourd which was strapped onto the operating table with the cotton pledgets facing away from the surgeon. Surgeons with varying degrees of experience made fluoroscopy-guided punctures onto the cotton pledgets. We recorded the time taken for puncture in seconds and the distance of the needle exit site from the center of the cotton ball. Speed was measured by recording the fluoroscopy time in seconds on the C-arm. Accuracy was documented by using a Vernier caliper to measure the distance from the edge of the target to the actual puncture. One second of fluoroscopy time and 0.1 mm distance were each given one point. The total points accumulated over a set of 10 punctures was added to give a total score. Longer fluoroscopy times and inaccurate punctures resulted in higher scores. Results: A surgeon with more than 1000 PCNLs to his credit had a score of 99. The average score of five residents was 555. Conclusion: The bottle gourd model provides an ethically acceptable, inexpensive, easy to replicate model that can be used to train residents in the PCNL puncture. PMID:25878423

  19. Suitability of Exoseal Vascular Closure Device for Antegrade Femoral Artery Puncture Site Closure

    SciTech Connect

    Schmelter, Christopher Liebl, Andrea; Poullos, Nektarios; Ruppert, Volker; Vorwerk, Dierk

    2013-06-15

    Purpose. To assess the efficacy and safety of the Exoseal vascular closure device for antegrade puncture of the femoral artery. Methods. In a prospective study from February 2011 to January 2012, a total of 93 consecutive patients received a total of 100 interventional procedures via an antegrade puncture of the femoral artery. An Exoseal vascular closure device (6F) was used for closure in all cases. Puncture technique, duration of manual compression, and use of compression bandages were documented. All patients were monitored by vascular ultrasound and color-coded duplex sonography of their respective femoral artery puncture site within 12 to 36 h after angiography to check for vascular complications. Results. In 100 antegrade interventional procedures, the Exoseal vascular closure device was applied successfully for closure of the femoral artery puncture site in 96 cases (96 of 100, 96.0 %). The vascular closure device could not be deployed in one case as a result of kinking of the vascular sheath introducer and in three cases because the bioabsorbable plug was not properly delivered to the extravascular space adjacent to the arterial puncture site, but instead fully removed with the delivery system (4.0 %). Twelve to 36 h after the procedure, vascular ultrasound revealed no complications at the femoral artery puncture site in 93 cases (93.0 %). Minor vascular complications were found in seven cases (7.0 %), with four cases (4.0 %) of pseudoaneurysm and three cases (3.0 %) of significant late bleeding, none of which required surgery. Conclusion. The Exoseal vascular closure device was safely used for antegrade puncture of the femoral artery, with a high rate of procedural success (96.0 %), a low rate of minor vascular complications (7.0 %), and no major adverse events.

  20. The Dural AV-Fistula (DAVF), the Most Frequent Acquired Vascular Malformation of the Central Nervous System (CNS).

    PubMed

    Wanke, I; Rüfenacht, D A

    2015-10-01

    Acquired arteriovenous malformations, such as is the case with dural arteriovenous fistulae (DAVF), are the consequence of a pathological new arterial ingrowth into venous spaces that reaches directly the venous lumen, without interposition of a capillary network, thereby creating an AV-shunt.The following concise text will provide elements in regards to diagnosis, indication for treatment discussion and choice of endovascular treatment (EVT) method. PMID:26308245

  1. Efficacy of Percutaneous Epidural Neuroplasty Does Not Correlate with Dural Sac Cross-Sectional Area in Single Level Disc Disease

    PubMed Central

    Ji, Gyu Yeul; Oh, Chang Hyun; Moon, Bongju; Choi, Seung Hyun; Yoon, Young Sul; Kim, Keung Nyun

    2015-01-01

    Purpose Percutaneous epidural neuroplasty (PEN) is a minimally invasive treatment. The efficacy of PEN has been relatively well investigated; however, the relationship between the clinical effectiveness of PEN and the severity of spinal canal stenosis by disc material has not yet been established. The purpose of this study was to compare clinical outcomes of PEN according to the dural sac cross-sectional area in single level disc disease. Materials and Methods This study included 363 patients with back pain from single level disc disease with and without radiculopathy. Patients were categorized into groups according to spinal canal compromise by disc material: Category 1, less or more than 50%; and Category 2, three subgroups with lesser than a third, between a third and two thirds, and more than two thirds. Clinical outcomes were assessed according to the Visual Analog Scale (VAS) score for back pain and leg pain and Odom's criteria at 1, 3, 6, 12, and 24 months after treatment. Results The demographic data showed no difference between groups according to spinal canal compromise by disc material except age (older age correlated with more spinal canal compromise). The dural sac cross-sectional area did not correlate with the VAS scores for back and leg pain after PEN in single level disc disease in Groups 1 and 2. Odom's criteria after PEN were also not different according to dural sac cross-sectional area by disc material. Conclusion PEN is an effective procedure in treating single level lumbar disc herniation without affecting dural sac cross-sectional area. PMID:25837174

  2. Point of impact: the effect of size and speed on puncture mechanics.

    PubMed

    Anderson, P S L; LaCosse, J; Pankow, M

    2016-06-01

    The use of high-speed puncture mechanics for prey capture has been documented across a wide range of organisms, including vertebrates, arthropods, molluscs and cnidarians. These examples span four phyla and seven orders of magnitude difference in size. The commonality of these puncture systems offers an opportunity to explore how organisms at different scales and with different materials, morphologies and kinematics perform the same basic function. However, there is currently no framework for combining kinematic performance with cutting mechanics in biological puncture systems. Our aim here is to establish this framework by examining the effects of size and velocity in a series of controlled ballistic puncture experiments. Arrows of identical shape but varying in mass and speed were shot into cubes of ballistic gelatine. Results from high-speed videography show that projectile velocity can alter how the target gel responds to cutting. Mixed models comparing kinematic variables and puncture patterns indicate that the kinetic energy of a projectile is a better predictor of penetration than either momentum or velocity. These results form a foundation for studying the effects of impact on biological puncture, opening the door for future work to explore the influence of morphology and material organization on high-speed cutting dynamics. PMID:27274801

  3. Histological analysis of the repair of dural lesions with silicone mesh in rats subjected to experimental lesions

    PubMed Central

    da Rosa, Fernando William Figueiredo; Pohl, Pedro Henrique Isoldi; Mader, Ana Maria Amaral Antônio; de Paiva, Carla Peluso; dos Santos, Aline Amaro; Bianco, Bianca; Rodrigues, Luciano Miller Reis

    2015-01-01

    ABSTRACT Objective To evaluate inflammatory reaction, fibrosis and neovascularization in dural repairs in Wistar rats using four techniques: simple suture, bovine collagen membrane, silicon mesh and silicon mesh with suture. Methods Thirty Wistar rats were randomized in five groups: the first was the control group, submitted to dural tear only. The others underwent durotomy and simple suture, bovine collagen membrane, silicon mesh and silicon mesh with suture. Animals were euthanized and the spine was submitted to histological evaluation with a score system (ranging from zero to 3) for inflammation, neovascularization and fibrosis. Results Fibrosis was significantly different between simple suture and silicon mesh (p=0.005) and between simple suture and mesh with suture (p=0.015), showing that fibrosis is more intense when a foreign body is used in the repair. Bovine membrane was significantly different from mesh plus suture (p=0.011) regarding vascularization. Inflammation was significantly different between simple suture and bovine collagen membrane. Conclusion Silicon mesh, compared to other commercial products available, is a possible alternative for dural repair. More studies are necessary to confirm these findings. PMID:26761555

  4. Improving the safety and efficiency of outpatient lumbar puncture service.

    PubMed

    Sweeney, Mark; Al-Diwani, Adam; Hadden, Robert

    2016-01-01

    Lumbar puncture (LP) is a commonly performed procedure in diagnosis and management of neurological conditions. LP is generally safe, however there are a number of potentially serious complications, including epidural haematoma and cerebral herniation. The risks of these should be considered and minimised prior to undertaking LP. Our regional neuroscience centre provides an outpatient LP service for patients throughout southeast England. Referrals from distant hospitals meant there was frequently no access to important clinical information, including indication for LP, past medical history, or medication history until the day of the procedure, and no access to results of investigations such as coagulation profile, platelet count, or intracranial imaging. Furthermore, there was limited capacity or time available in the day ward to perform these tests prior to LP. As a result, patients were either having LPs cancelled on the day of the procedure, were delayed by several hours on the day of the procedure for investigations, or were subject to the risk of having the LP performed without the knowledge of these key safety indicators. To address this issue we implemented an LP safety checklist to be completed by referring neurologists, providing details of the patient's medical history and results of investigations performed locally. In doing this, we increased the proportion of patients with an available platelet count prior to LP from 25% to 89%, and available coagulation profile from 18% to 82%. In addition, we saw a qualitative increase in the confidence of junior doctors in the safety of the LP clinic, as measured by a survey taken before and after the implementation of this system. This simple intervention made a rapid and remarkable difference to the safety and efficiency of this outpatient LP clinic. We would encourage other units to adopt this approach to address similar problems in a variety of outpatient settings. PMID:27493745

  5. Modelling headache and migraine and its pharmacological manipulation

    PubMed Central

    Erdener, S E; Dalkara, T

    2014-01-01

    Similarities between laboratory animals and humans in anatomy and physiology of the cephalic nociceptive pathways have allowed scientists to create successful models that have significantly contributed to our understanding of headache. They have also been instrumental in the development of novel anti-migraine drugs different from classical pain killers. Nevertheless, modelling the mechanisms underlying primary headache disorders like migraine has been challenging due to limitations in testing the postulated hypotheses in humans. Recent developments in imaging techniques have begun to fill this translational gap. The unambiguous demonstration of cortical spreading depolarization (CSD) during migraine aura in patients has reawakened interest in studying CSD in animals as a noxious brain event that can activate the trigeminovascular system. CSD-based models, including transgenics and optogenetics, may more realistically simulate pain generation in migraine, which is thought to originate within the brain. The realization that behavioural correlates of headache and migrainous symptoms like photophobia can be assessed quantitatively in laboratory animals, has created an opportunity to directly study the headache in intact animals without the confounding effects of anaesthetics. Headache and migraine-like episodes induced by administration of glyceryltrinitrate and CGRP to humans and parallel behavioural and biological changes observed in rodents create interesting possibilities for translational research. Not unexpectedly, species differences and model-specific observations have also led to controversies as well as disappointments in clinical trials, which, in return, has helped us improve the models and advance our understanding of headache. Here, we review commonly used headache and migraine models with an emphasis on recent developments. Linked Articles This article is part of a themed section on Animal Models in Psychiatry Research. To view the other articles in this

  6. Dural sinus obstruction following head injury: a diagnostic and clinical study.

    PubMed

    Benifla, Mony; Yoel, Uri; Melamed, Israel; Merkin, Vladimir; Cohen, Avi; Shelef, Ilan

    2016-09-01

    OBJECTIVE The aim of this study is to describe the clinical characteristics of patients with skull fracture adjacent to a dural venous sinus (DVS) and evaluate the role of CT venography (CTV) in the diagnosis of the effect of this fracture on the involved DVS. METHODS The study comprised patients with vault or skull base fracture adjacent to a DVS who were admitted to 1 medical center during a 2-year period. The medical records were reviewed for the clinical and radiographic characteristics. All patients had undergone CTV to evaluate potential DVS pathology. The clinical and radiological findings of the patients with DVS pathology were compared with those of the patients with normal DVS. The groups were compared using the chi-square and t-tests for categorical and continuous data, respectively. The potential risk for poor outcome among the patients with DVS pathology was also investigated. RESULTS Of 434 patients with skull fractures, 41 (9.4%) had fractures adjacent to a DVS. DVS pathology was detected in 51% of patients (21 of 41 patients). For 9 (43%) patients, obstruction was extraluminal without thrombosis, and 12 (57%) patients had dural sinus thrombosis (DST). In patients with a positive-CTV scan, the severity of injury according to the Glasgow Coma Scale score at presentation was correlated with the presence of DST (p = 0.007). The sensitivity of noncontrast CT (NCCT) for DVS involvement was 38% among the patients with positive-CTV scans. For patients with DVS pathology, poor outcome was correlated with DST (intraluminal), rather than extraluminal obstruction without thrombosis (p = 0.02), and superior sagittal sinus (SSS) involvement (p = 0.05). CONCLUSIONS NCCT is not sensitive enough to detect DVS obstruction in patients with skull fracture adjacent to a DVS, and CTV should be performed in order to rule it out. A correlation was found between the severity of injury and the presence of DST, rather than extraluminal obstruction. The authors' findings

  7. Postoperative headache after the lateral suboccipital approach: craniotomy versus craniectomy.

    PubMed

    Koperer, H; Deinsberger, W; Jödicke, A; Böker, D K

    1999-12-01

    The lateral suboccipital approach to the cerebellopontine angle is typically performed as a small craniectomy. Incisional pain and headache following cerebellopontine angle surgery have been reported. Adherence of the cervical muscles to the dura, which is richly innervated, with consequent traction has been suggested to be responsible for postoperative headache. Therefore, postoperative headache probably could be reduced by replacing the bone flap between the muscles and the dura. In a prospective non-randomized study this hypothesis was tested by comparing craniectomy and craniotomy. 40 patients underwent removal of an acoustic neuroma via the retrosigmoid approach. Patients with a history of migraine, with additional intracerebral tumors or recurrencies as well as patients who developed a CSF fistula postoperatively were excluded. 29 patients were eligible for further evaluation. 13 patients underwent a craniotomy, 16 patients a craniectomy. All patients were subject to a standardized telephone interview three months and one year after surgery. Comparing the craniotomy group to the craniectomy group no difference was observed regarding age, sex, tumor size and duration of operation. 3 months as well as 12 months postoperatively headache was significantly (p < 0.05) less frequent in the craniotomy group as compared to the craniectomy group. In conclusion, an osteoplastic craniotomy significantly reduces postoperative headache and is therefore highly recommended. PMID:10667820

  8. High-altitude cerebral edema with absence of headache.

    PubMed

    Thomassen, Oyvind; Skaiaa, Sven Chr

    2007-01-01

    Headache is the cardinal symptom of acute mountain sickness (AMS). The headache normally worsens, with increased cerebral affection and the development of high-altitude cerebral edema (HACE). A Norwegian expedition aimed to climb Baruntse (7129 m) in Nepal in 2003. At 5400 m a 35-year-old man felt exhausted. The next day he aborted his attempt at further climbing as a result of extreme fatigue. Over the next 24 hours he developed cough, dyspnea, and severe hypoxia before progressing to ataxia and blurred vision. At no point did he experience headache or nausea. The patient was evacuated by helicopter. He improved immediately after descent and recovered completely within a week. The speed of progression from AMS to HACE varies. Abrupt onset of HACE is occasionally reported. High-altitude pulmonary edema (HAPE) may induce severe hypoxia that can lead to rapid development of HACE. High-altitude cerebral edema in the setting of HAPE was the most likely diagnosis despite the unusual lack of headache. Rapid onset of HAPE with subsequent severe desaturation should raise awareness of the development of HACE, even in the absence of headache. PMID:17447714

  9. Galeata: chronic migraine independently considered in a medieval headache classification

    PubMed Central

    2014-01-01

    Background Chronic migraine is a quite recent concept. However, there are descriptions suggestive of episodic migraine since the beginning of scientific medicine. We aim to review main headache classifications during Classical antiquity and compared them with that proposed in the 11th century by Constantine the African in his Liber Pantegni, one of the most influential texts in medieval medicine. Method We have carried out a descriptive review of Henricum Petrum's Latin edition, year 1539. Results Headache classifications proposed by Aretaeus of Cappadocia, Galen of Pergamun and Alexander of Tralles, all of them classifying headaches into three main types, considered an entity (called Heterocrania or Hemicrania), comparable to contemporary episodic migraine. In ninth book of Liber Pantegni, headaches were also classified into three types and one of them, Galeata, consisted on a chronic pain of mild intensity with occasional superimposed exacerbations. Conclusion In Liber Pantegni we have firstly identified, as a separate entity, a headache comparable to that we currently define as chronic migraine: Galeata. PMID:24655582

  10. Patients with tension-type headaches feel stigmatized.

    PubMed

    Prakash, Sanjay

    2016-01-01

    The author, a sufferer of tension-type headache (TTH), believes that the word "tension" in "tension-type headache" carries a social stigma and that patients do not accept a diagnosis of TTH readily. TTH is the most common primary headache disorder. The disability of TTH as a burden of society is greater than that of migraine. Absenteeism because of TTH is higher than that due to migraine. However, patients with TTH do not go for consultation. Even the prevalence of new daily persistent headache (NDPH) is 12 times higher at the headache clinic than that of chronic TTH (CTTH). These points hint that TTH patients probably do not want to visit the clinic. The author believes that it could be because of the stigma attached to "tension." Herein, the author has noted the first responses given by 50 consecutive patients with TTH when they were told that they had been suffering from TTH. The first answer of 64% of patients with TTH was "I do not have any tension/stress." This denial is similar to the denial declared by patients with depression. Depression and tension are similar in the sense that both are considered as a signs of personal weakness. Such a preconception in the society creates a stigma, and patients deny the diagnosis, conceal symptoms, and become reluctant to seek help and treatment.

  11. QEEG-guided neurofeedback for recurrent migraine headaches.

    PubMed

    Walker, Jonathan E

    2011-01-01

    Seventy-one patients with recurrent migraine headaches, aged 17-62, from one neurological practice, completed a quantitative electroencephalogram (QEEG) procedure. All QEEG results indicated an excess of high-frequency beta activity (21-30 Hz) in 1-4 cortical areas. Forty-six of the 71 patients selected neurofeedback training while the remaining 25 chose to continue on drug therapy. Neurofeedback protocols consisted of reducing 21-30 Hz activity and increasing 10 Hz activity (5 sessions for each affected site). All the patients were classified as migraine without aura. For the neurofeedback group the majority (54%) experienced complete cessation of their migraines, and many others (39%) experienced a reduction in migraine frequency of greater than 50%. Four percent experienced a decrease in headache frequency of < 50%. Only one patient did not experience a reduction in headache frequency. The control group of subjects who chose to continue drug therapy as opposed to neurofeedback experienced no change in headache frequency (68%), a reduction of less than 50% (20%), or a reduction greater than 50% (8%). QEEG-guided neurofeedback appears to be dramatically effective in abolishing or significantly reducing headache frequency in patients with recurrent migraine.

  12. Childhood Adversities and Adult Headache in Poland and Germany

    PubMed Central

    Reuchlein, Bettina; Henn, Lea; Brian, Tamara; Schier, Katarzyna; Hardt, Jochen

    2016-01-01

    Objective Various childhood adversities have been found to be associated with chronic pain in adulthood. However, associations were moderate in most studies, i.e. odds ratios (OR) were between one and two. Method An internet survey was performed in 508 Polish and 500 German subjects. A total of 19 childhood adversities were selected and their associations with headaches explored. Age, gender and country were included as potential confounders, as well as their two-way interaction with the risk factors. Results Two strong risk factors were identified. (1) A combined score for physical and emotional neglect showed an odds ratio (OR) of 2.78 (p < .002) to the frequency of headache in adulthood as a main effect. (2) Father having had chronic pain showed an OR of 4.36 (p < .001) with headache in adulthood for women, but not for men (OR = 0.86, p < .556). The majority of the examined childhood adversities were not associated with adult headache, neither when tested individually nor as a sum score. Conclusion This study confirms results from previous ones that childhood adversities may play a role in the development of adult headache, but it is a rather minor one. Contrary to other studies, neglect turned out to be one of the strongest predictors. PMID:26859500

  13. Anterior stromal puncture for treatment of contact lens-intolerant keratoconus patients

    PubMed Central

    Kang, Su Yeon; Park, Young Kee; Song, Jong-Suk

    2010-01-01

    Purpose To report the results and effectiveness of anterior stromal puncture for contact lens-intolerant keratoconus patients with subepithelial fibrotic nodules. Methods Nine eyes of nine keratoconus patients who were rigid gas-permeable contact lenses (RGP)-intolerant due to subepithelial nodular scars were included in this study. The nine patients were enrolled in the study between March 2008 and December 2008. After confirming nodular elevation from slit-lamp biomicroscopy, the area where the epithelium of nodular scars had sloughed was punctured by anterior stromal puncture using a 26-gauge needle attached to a 1-ml syringe under slit-lamp biomicroscopy. The RGPs of all patients were refitted around 4 weeks after the puncture. Results Five of the nine patients were male, and the average patient age was 29.6 years (SD ± 5.22 years). Mean follow-up time was 13.7 months (SD ± 4.8 months), and the epithelial defect healed in 1.4 days on average. After the puncture, four of nine patients presented with a recurrent erosion of the nodule during follow-up and needed a second puncture. All the patients showed good contact lens tolerance and satisfactory contact lens fit. No complications such as corneal perforation or keratitis developed. Conclusions Anterior stromal puncture using a 26-gauge needle can be a successful and effective method to induce corneal epithelium and Bowman’s layer reattachment. It can be used as an outpatient procedure to improve RGP tolerance in patients with keratoconus with elevated subepithelial nodules. PMID:20625761

  14. Iatrogenic Creutzfeldt-Jakob disease subsequent to dural graft: persisting risk after 1987.

    PubMed

    Boutoleau, C; Guillon, B; Martinez, F; Vercelletto, M; Faure, A; Fève, J R

    2003-09-01

    The first case of Creutzfeldt-Jakob disease (CJD) related to the use of a dura mater graft of cadaveric origin was identified in 1987 and this procedure is now considered as one of the main causes of iatrogenic CJD. Although the decontamination procedure for the preparation of graft material was modified, the product was withdrawn from the market in many countries a few years later and replaced by synthetic material. In this context, two patients treated in our institution developed CJD following a cadaveric dural graft performed after cerebral and lumbar trauma. Their clinical presentation, showing predominant cerebellar symptoms, late deterioration and myoclonic jerks, and a rapid disease course until death, was similar to that of previously reported cases involving the iatrogenic form. As the graft for one of the patients was performed in 1991 (several years after modification of the decontamination procedure), this fourth reported case suggests that the risk of iatrogenic CJD may have persisted in some patients treated after 1987, when grafts of cadaveric origin were totally abandoned.

  15. Transarterial Onyx Embolization for Patients with Cavernous Sinus Dural Arteriovenous Fistulas Who Have Failed Transvenous Embolization.

    PubMed

    Wen, Jun; Duan, Chuan-Zhi; Huang, Li-Jing; Zhang, Xin; He, Xu-Ying; Li, Xi-Feng

    2015-09-01

    Transvenous embolization is the treatment of choice for cavernous sinus dural arteriovenous fistulas (csDAVFs) despite occasional difficulty in transvenous catheterization. We reported our experience in the treatment of csDAVFs by transarterial Onyx embolization in patients who had failed transvenous catheterization. We reviewed the clinical and radiographic records of csDAVFs patients receiving transarterial Onyx embolization after failed transvenous Onyx embolization at our institution over a period of 31 months. Success was defined as complete or near complete occlusion upon angiographic examination. In seven cases, the microcatheter failed to reach the cavernous sinus; in the remaining case, the internal jugular vein was occlusive. Eight sessions of the embolization and catheterization procedures via the arterial routes were conducted. Among them, five cases via the middle meningeal artery and the other three via the accessory meningeal artery. Angiography, immediately after embolization, revealed complete occlusion in seven cases (87.5 %) and partial occlusion in the remaining case. Angiographic follow-up (range, 6-10 months) showed that all patients achieved complete embolization. In cases where transvenous embolization of the cavernous sinus is difficult, transarterial embolization of the fistulas offers a safe and effective alternative.

  16. [A case of solitary fibrous tumor in the cerebral convexity indicating its non-dural origin].

    PubMed

    Sano, Masakazu; Saito, Akihiko; Nishihira, Yasushi; Oishi, Makoto; Kakita, Akiyoshi; Takahashi, Hitoshi; Fujii, Yukihiko

    2007-07-01

    We report a case of solitary fibrous tumor (SFT) in the cerebral convexity, and present characteristic radiological and surgical findings to determine its origin. The patient was a 59-year-old man with mental dullness and mild gait disturbance. CT scan and MR images showed a highly enhanced large mass lesion mimicking a meningioma in the left parietal convexity. However, neither dural enhancement nor tail sign indicative of meningioma was observed. Angiography showed prominent feedings from branches of the internal carotid and basilar arteries rather than the external carotid artery. For this reason, presurgically, we suggested hemangiopericytoma or other specific meningiomas as a differential diagnoses. Surgery confirmed that the tumor had no attachment to the dura mater and was covered by the arachnoid membrane. The bottom of the tumor adhered tightly to brain tissue. The origin was considered to be the brain surface, pia mater or a part of the arachnoid membrane. Histopathologically, the tumor was diagnosed as a SFT with findings of "attemless pattern" and diffuse CD34 staining. The radiological and surgical findings of the present case indicated in the cerebral convexity as a unique site of origin of SFT.

  17. The Incidence of Trigeminocardiac Reflex in Endovascular Treatment of Dural Arteriovenous Fistula with Onyx

    PubMed Central

    Lv, X.; Li, Y.; Jiang, C.; Wu, Z.

    2010-01-01

    Summary This paper reports the incidence of trigeminocardiac reflex (TCR) in endovascular treatment of dural arteriovenous fistulas (DAVFs) with Onyx. The consecutive case histories of 45 patients with DAVFs, treated with Onyx transarterially and transvenously, from February 2005 to February 2008 at Beijing Tiantan Hospital, China, were retrospectively reviewed. The time period was limited as the anesthetic and intravascular procedure was performed under the same standardized anesthetic protocol and by the same team. The TCR rate was subsequently calculated. Of the 45 patients, five showed evidence of TCR during transarterial Onyx injection and transvenous DMSO injection. Their HR fell 50% during intravascular procedures compared with levels immediately before the stimulus. However, blood pressure values were stable in all cases. The TCR rate for all patients was 11.1% (95% CI, 4 to 24%), 7.7% (95% CI, 2 to 21%) in patients treated intraarterially and 33.3% (4 to 78%) in patients treated intravenously. Once HR has fallen, intravenous atropine is indicated to block the depressor response and prevention further TCR episodes. TCR may occur due to chemical stimulus of DMSO and Onyx cast formation under a standardized anesthetic protocol and should be blunted by atropine. PMID:20377980

  18. Dural reconstruction by fascia using a temperature-controlled CO2 laser soldering system

    NASA Astrophysics Data System (ADS)

    Forer, Boaz; Vasilyev, Tamar; Brosh, Tamar; Kariv, Naam; Gil, Ziv; Fliss, Dan M.; Katzir, Abraham

    2005-04-01

    Conventional methods for dura repair are normally based on sutures or stitches. These methods have several disadvantages: (1) The dura is often brittle, and the standard procedures are difficult and time consuming. (2) The seal is leaky. (3) The introduction of a foreign body (e.g. sutures) may cause an inflammatory response. In order to overcome these difficulties we used a temperature controlled fiber optic based CO2 laser soldering system. In a set of in vitro experiments we generated a hole of diameter 10 mm in the dura of a pig corpse, covered the hole with a segment of fascia, and soldered the fascia to the edges of the hole, using 47% bovine albumin as a solder. The soldering was carried out spot by spot, and each spot was heated to 65° C for 3-6 seconds. The soldered dura was removed and the burst pressure of the soldered patch was measured. The average value for microscopic muscular side soldering was 194 mm Hg. This is much higher than the maximal physiological pressure of the CSF fluid in the brain, which is 15 mm Hg. In a set of in vivo experiments, fascia patches were soldered on holes in five farm pigs. The long term results of these experiments were very promising. In conclusion, we have developed an advanced technique for dural reconstruction, which will find important clinical applications.

  19. Onyx removal after embolization of a superior sagittal sinus dural arteriovenous fistula involving scalp artery

    PubMed Central

    Watanabe, Jun; Maruya, Jun; Nishimaki, Keiichi; Ito, Yasushi

    2016-01-01

    Background: Most dural arteriovenous fistula (DAVF) in superior sagittal sinus (SSS) requires multimodal treatment. Onyx embolization is useful for DAVF; however, scalp artery embolization has cast extrusion risk. Case Description: A 59-year-old male presented with involuntary movements of both legs and progressive dementia. Cerebral angiography demonstrated the DAVF in the SSS fed by bilateral superficial temporal, occipital, and middle meningeal arteries. The posterior SSS was thrombosed, and the main drainers were cortical veins. Combined treatment with transarterial embolization using Onyx and transvenous embolization using coils was performed. Although symptoms were improved, a small DAVF remained. Two months later, Onyx cast extrusion through the scalp was observed, requiring removal and debridement because of infection at the extrusion sites. Surgery for the residual DAVF would be difficult because of scalp condition; therefore, an additional endovascular treatment was conducted, completely occluding DAVF. Conclusion: Onyx embolization is useful for DAVF; however, scalp artery embolization has cast extrusion risk. Therefore, scalp infection should be considered because it may preclude additional surgical procedures. PMID:27313969

  20. Radiographic imaging of the distal dural ring for determining the intradural or extradural location of aneurysms.

    PubMed

    Beretta, Federica; Sepahi, Ali Nader; Zuccarello, Mario; Tomsick, Thomas A; Keller, Jeffrey T

    2005-11-01

    The effectiveness of several anatomical and radiological landmarks proposed to determine whether an aneurysm is located intradurally or extradurally is still debated. In anatomical and radiological studies, we examined the relationships of the distal dural ring (DDR) to the internal carotid artery (ICA) and surrounding bony structures to aid in the localization of aneurysms near the DDR. Anatomical relationships were examined by performing dissections on 10 specimens (5 formalin-fixed cadaveric heads). After the position of the DDR, optic nerve, and tuberculum sellae were marked with surgical steel wire, radiographs were taken in multiple projections. The only bony landmark consistently visible on radiographs was the planum sphenoidale. The superior border of the DDR is located at or below the level of the tuberculum sellae, which laterally becomes the superomedial aspect of the optic strut; thus, the optic strut marks the dorsal limit of the DDR. On 50 dry skulls, we measured the vertical distance between the planum sphenoidale and medial aspect of the optic strut (5.0 +/- 0.4 mm), the interoptic strut distance (14.4 +/- 1.4 mm), and the linear distance between the most posterior aspect of the planum sphenoidale (limbus sphenoidale) and the tuberculum sellae (6.0 +/- 0.5 mm). Using these measurements and the planum sphenoidale, tuberculum sellae, and optic strut as reference landmarks, we determined the location of the aneurysm relative to the DDR on angiographic images. In this way, we were able to identify whether lesions were intra- or extradural. PMID:16648887

  1. Modulation of nociceptive dural input to the trigeminocervical complex through GluK1 kainate receptors.

    PubMed

    Andreou, Anna P; Holland, Philip R; Lasalandra, Michele P; Goadsby, Peter J

    2015-03-01

    Migraine is a common and disabling neurologic disorder, with important psychiatric comorbidities. Its pathophysiology involves activation of neurons in the trigeminocervical complex (TCC). Kainate receptors carrying the glutamate receptor subunit 5 (GluK1) are present in key brain areas involved in migraine pathophysiology. To study the influence of kainate receptors on trigeminovascular neurotransmission, we determined the presence of GluK1 receptors within the trigeminal ganglion and TCC with immunohistochemistry. We performed in vivo electrophysiologic recordings from TCC neurons and investigated whether local or systemic application of GluK1 receptor antagonists modulated trigeminovascular transmission. Microiontophoretic application of a selective GluK1 receptor antagonist, but not of a nonspecific ionotropic glutamate receptor antagonist, markedly attenuated cell firing in a subpopulation of neurons activated in response to dural stimulation, consistent with selective inhibition of postsynaptic GluK1 receptor-evoked firing seen in all recorded neurons. In contrast, trigeminovascular activation was significantly facilitated in a different neuronal population. The clinically active kainate receptor antagonist LY466195 attenuated trigeminovascular activation in all neurons. In addition, LY466195 demonstrated an N-methyl-d-aspartate receptor-mediated effect. This study demonstrates a differential role of GluK1 receptors in the TCC, antagonism of which can inhibit trigeminovascular activation through postsynaptic mechanisms. Furthermore, the data suggest a novel, possibly presynaptic, modulatory role of trigeminocervical kainate receptors in vivo. Differential activation of kainate receptors suggests unique roles for this receptor in pro- and antinociceptive mechanisms in migraine pathophysiology. PMID:25679470

  2. [Organisation of headache units from a multidisciplinary point of view].

    PubMed

    Sanchez-Del-Rio Gonzalez, M

    2015-01-01

    Headache units have come into being to respond to the need to address the treatment of patients with complex headaches in a multidisciplinary manner. Although headaches are one of the most prevalent medical pathologies, it is surprising how little is being done to foster the development of such units. Within the multidisciplinary organisation, the role of the neurologist with adequate training in this field is essential. He or she is the person responsible for receiving, directing, supervising and coordinating the treatment, together with other medical specialties. The basic core of the team should consist of a psychiatrist, psychologist and physiotherapist. Their joint coordinated action generates an objective improvement in the pain over and beyond that achieved with each isolated treatment.

  3. Mindfulness meditation in the control of severe headache.

    PubMed

    Sun, Tzan-Fu; Kuo, Chung-Chih; Chiu, Nien-Mu

    2002-08-01

    In the West, the use of the methods of alternative medicine, including meditation, has been on the rise. In the US, Kabat-Zinn and associates have pioneered the extensive use of mindfulness meditation (MM) for the treatment of people facing pain and illness. Among the essentials of MM is the observation of bodily sensations, including pain. In Taiwan, despite the deep cultural roots of meditation, its therapeutic use has received little attention from institutionalized medicine. We report on the case of a man who was prone to developing severe headaches due to activities requiring extreme concentration. He learned to control his pain and discomfort through mindfulness meditation, although this practice in fact induced headaches initially. It is suggested that training in MM may be a medically superior and cost-effective alternative to pain medication for the control of headaches with no underlying organic causes in highly motivated patients.

  4. Guideline for primary care management of headache in adults

    PubMed Central

    Becker, Werner J.; Findlay, Ted; Moga, Carmen; Scott, N. Ann; Harstall, Christa; Taenzer, Paul

    2015-01-01

    Abstract Objective To increase the use of evidence-informed approaches to diagnosis, investigation, and treatment of headache for patients in primary care. Quality of evidence A comprehensive search was conducted for relevant guidelines and systematic reviews published between January 2000 and May 2011. The guidelines were critically appraised using the AGREE (Appraisal of Guidelines for Research and Evaluation) tool, and the 6 highest-quality guidelines were used as seed guidelines for the guideline adaptation process. Main message A multidisciplinary guideline development group of primary care providers and other specialists crafted 91 specific recommendations using a consensus process. The recommendations cover diagnosis, investigation, and management of migraine, tension-type, medication-overuse, and cluster headache. Conclusion A clinical practice guideline for the Canadian health care context was created using a guideline adaptation process to assist multidisciplinary primary care practitioners in providing evidence-informed care for patients with headache. PMID:26273080

  5. Neurotoxins: Expanding Uses of Neuromodulators in Medicine--Headache.

    PubMed

    Nahabet, Edward; Janis, Jeffrey E; Guyuron, Bahman

    2015-11-01

    Over the course of the past 17 years, since the initial discovery of the association between botulinum toxin-A (BT-A) and the reduction of headache symptoms, the use of this neurotoxin has greatly evolved. BT-A has emerged as an alternative to prophylactic pharmacological therapies in the prevention of chronic migraine headaches, with an excellent safety profile and proven efficacy, and is Food and Drug Administration-approved for on-label use since October 2010. The mechanism of BT-A involves its effect at the neuromuscular junction, inhibition of neuropeptide and neurotransmitter release in peripheral sensory neurons, and retrograde axonal transport allowing for its direct effect on inhibiting central sensitization. Through its diagnostic and therapeutic utility, BT-A has proven to be an integral part in the treatment of chronic headache disorders.

  6. Cerebral Venous Thrombosis with Migraine-Like Headache and the Trigeminovascular System

    PubMed Central

    Nascimento, Fábio A.; Sória, Marília Grando; Rizelio, Vanessa; Kowacs, Pedro A.

    2016-01-01

    Cerebral venous thrombosis- (CVT-) associated headache is considered a secondary headache, commonly presenting as intracranial hypertension headache in association with seizures and/or neurological signs. However, it can occasionally mimic migraine. We report a patient presenting with a migraine-like, CVT-related headache refractory to several medications but intravenous dihydroergotamine (DHE). The response to DHE, which is considered to be an antimigraine medication, in addition to the neurovascular nature of migraine, points out to a probable similarity between CVT-headache and migraine. Based on experimental studies, we discuss this similarity and hypothesize a trigeminovascular role in the genesis of CVT-associated headache. PMID:26989532

  7. Headache and ADHD in Pediatric Age: Possible Physiopathological Links.

    PubMed

    Paolino, Maria Chiara; Ferretti, Alessandro; Villa, Maria Pia; Parisi, Pasquale

    2015-07-01

    Primary headache and attention-deficit/hyperactivity disorder (ADHD) are common disorders in children and adolescences, frequently associated to severe cognitive, emotional, and behavioral impairments. They both are a disabling condition with consequences on family and child's quality of life. Literature data on their association are contrasting. Dopaminergic system dysfunction, brain iron deficiency, and sleep disturbance should be considered to better understand headache and ADHD overlap. In this review, we analyze the complex association between these two diseases and the potential impact on child neurodevelopment. PMID:26049768

  8. Nummular headache: Clinico-epidemiological features in South Indian population

    PubMed Central

    Rammohan, K.; Mundayadan, Shyma M.; Mathew, Robert

    2016-01-01

    Context: Nummular headache (NH) is a primary disorder characterized by head pain exclusively felt in a small-rounded area typically 2–6 cm in diameter. Aims: The aim of this review is to study the clinical and epidemiological features of NH in a patient population of South India and to compare this with that of described in the international literature. Settings and Design: A prospective, observational study conducted in a tertiary care center. Materials and Methods: Patients attending the medicine and neurology outpatient departments of a tertiary referral hospital in South India diagnosed to have NH as per the International Classification of Headache Disorders 3 beta (2013) criteria were studied over 30 months. All of the patients had a normal neurological examination. Neuroimaging findings were normal, except in one patient. Results: A total of 19 females and 10 males were studied. The mean age of onset was 47.62 years (range 36–60). The duration of headache varied from a minimum of 3 months to a maximum of 5 years, with a mean of 24.17 months. The site of headache was predominantly in the parietal area 15 (51.72%), followed by the occipital area 7 (24.13%). The mean diameter of the affected area was 3.23 cm. The intensity of the headache proved to be mild to moderate with a mean visual analog scale score of 5.03. The quality of pain was mainly felt as burning dysesthesia 12 (41.38%). In the majority of patients, i.e. 21 (72.41%), pain was chronic and continuous. None of the patients had any significant trophic change even though paresthesias, dysesthesias, and allodynia were reported by a significant minority of patients, i.e. 9 (31.03%). Only one (3.45%) patient gave a history of head injury. Ten (34.48%) out of 29 patients had other types of concurrent headaches; the majority of which proved to be migrainous, i.e. 7 (24.14%), 2 patients (6.89%) with tension headache, and 1 patient (3.45%) with trigeminal neuralgia. Conclusion: Our study proves the

  9. The Sphenopalatine Ganglion: Anatomy, Pathophysiology, and Therapeutic Targeting in Headache.

    PubMed

    Robbins, Matthew S; Robertson, Carrie E; Kaplan, Eugene; Ailani, Jessica; Charleston, Larry; Kuruvilla, Deena; Blumenfeld, Andrew; Berliner, Randall; Rosen, Noah L; Duarte, Robert; Vidwan, Jaskiran; Halker, Rashmi B; Gill, Nicole; Ashkenazi, Avi

    2016-02-01

    The sphenopalatine ganglion (SPG) has attracted the interest of practitioners treating head and face pain for over a century because of its anatomical connections and role in the trigemino-autonomic reflex. In this review, we discuss the anatomy of the SPG, as well as what is known about its role in the pathophysiology of headache disorders, including cluster headache and migraine. We then address various therapies that target the SPG, including intranasal medication delivery, new SPG blocking catheter devices, neurostimulation, chemical neurolysis, and ablation procedures.

  10. [Coaxil treatment of primary headaches comorbid with depression].

    PubMed

    Vorob'eva, O V; Shavlovskaia, O A

    2005-01-01

    Twenty patients with headaches and concomitant mild depression (the Beck scale mean score 13,6), aged 20-62 years (mean 40,3), illness duration 0,5-40 years, (mean 17,7), attack frequency 3-30 days, (mean 13,4), have been studied. Coaxil was prescribed in dosage of 12,5 mg daily during 6 weeks. Neurological examination and clinical evaluation using a number of scales, along with patients self-rating, was conducted. Twenty one patients have completed the treatment course. Coaxil therapy resulted in significant decrease of frequency and severity of headache attacks and improvement of the patient's general state.

  11. [Systematization of primary headache: current and future prospects].

    PubMed

    Odinak, M M; Iskra, D A

    2014-02-01

    The article is devoted to the current state of the problem of systematization of primary headaches and main clinical forms. The conceptual evolution of ideas about the classification of certain options of cephalgia and identified major trends for its improvement is given. Verification of types and subtypes of individual cephalgia can present a significant challenge even for experienced neurologists, neurosurgeons, and internists. In this regard in most European countries and the US. have set up specialized centers for the treatment of headaches. Concluded that in the short term in the national health care system, including. Including the Armed Forces, it is advisable to create such centers.

  12. Nummular headache: Clinico-epidemiological features in South Indian population

    PubMed Central

    Rammohan, K.; Mundayadan, Shyma M.; Mathew, Robert

    2016-01-01

    Context: Nummular headache (NH) is a primary disorder characterized by head pain exclusively felt in a small-rounded area typically 2–6 cm in diameter. Aims: The aim of this review is to study the clinical and epidemiological features of NH in a patient population of South India and to compare this with that of described in the international literature. Settings and Design: A prospective, observational study conducted in a tertiary care center. Materials and Methods: Patients attending the medicine and neurology outpatient departments of a tertiary referral hospital in South India diagnosed to have NH as per the International Classification of Headache Disorders 3 beta (2013) criteria were studied over 30 months. All of the patients had a normal neurological examination. Neuroimaging findings were normal, except in one patient. Results: A total of 19 females and 10 males were studied. The mean age of onset was 47.62 years (range 36–60). The duration of headache varied from a minimum of 3 months to a maximum of 5 years, with a mean of 24.17 months. The site of headache was predominantly in the parietal area 15 (51.72%), followed by the occipital area 7 (24.13%). The mean diameter of the affected area was 3.23 cm. The intensity of the headache proved to be mild to moderate with a mean visual analog scale score of 5.03. The quality of pain was mainly felt as burning dysesthesia 12 (41.38%). In the majority of patients, i.e. 21 (72.41%), pain was chronic and continuous. None of the patients had any significant trophic change even though paresthesias, dysesthesias, and allodynia were reported by a significant minority of patients, i.e. 9 (31.03%). Only one (3.45%) patient gave a history of head injury. Ten (34.48%) out of 29 patients had other types of concurrent headaches; the majority of which proved to be migrainous, i.e. 7 (24.14%), 2 patients (6.89%) with tension headache, and 1 patient (3.45%) with trigeminal neuralgia. Conclusion: Our study proves the

  13. Simulation and training of lumbar punctures using haptic volume rendering and a 6DOF haptic device

    NASA Astrophysics Data System (ADS)

    Färber, Matthias; Heller, Julika; Handels, Heinz

    2007-03-01

    The lumbar puncture is performed by inserting a needle into the spinal chord of the patient to inject medicaments or to extract liquor. The training of this procedure is usually done on the patient guided by experienced supervisors. A virtual reality lumbar puncture simulator has been developed in order to minimize the training costs and the patient's risk. We use a haptic device with six degrees of freedom (6DOF) to feedback forces that resist needle insertion and rotation. An improved haptic volume rendering approach is used to calculate the forces. This approach makes use of label data of relevant structures like skin, bone, muscles or fat and original CT data that contributes information about image structures that can not be segmented. A real-time 3D visualization with optional stereo view shows the punctured region. 2D visualizations of orthogonal slices enable a detailed impression of the anatomical context. The input data consisting of CT and label data and surface models of relevant structures is defined in an XML file together with haptic rendering and visualization parameters. In a first evaluation the visible human male data has been used to generate a virtual training body. Several users with different medical experience tested the lumbar puncture trainer. The simulator gives a good haptic and visual impression of the needle insertion and the haptic volume rendering technique enables the feeling of unsegmented structures. Especially, the restriction of transversal needle movement together with rotation constraints enabled by the 6DOF device facilitate a realistic puncture simulation.

  14. Simulated digestion status of intact and exoskeletally-punctured insects and insect larvae: a spectroscopic investigation.

    PubMed

    Prinz, J F; Silwood, C J L; Claxson, A W D; Grootveld, M

    2003-01-01

    In this study, we tested the hypothesis that puncturing the chitin exoskeleton of insect and insect larvae food sources aids the ingress of digestive fluids and increases the rate of digestion and energy uptake in insectivorous mammals. For this purpose 10 crickets (Acheta domesticus) and 10 mealworms (Tenebrio molitor larvae) were divided into two groups of 5; one group was punctured using a small blade to mimic the effect of a single bite, the remainder serving as controls. The insects were then individually immersed in 5 ml of a 1 x 10(-2) mol.dm(-3) solution of hydrochloric acid (pH 2.0) for a period of 2 h in order to mimic digestion in the stomach. The matrix was then centrifuged and the supernatant fluid subjected to spectrophotometric and high-resolution proton (1H) NMR analysis. Electronic absorption spectra of these supernatants revealed that puncturing the exoskeleton of mealworms and crickets gave rise to substantial elevations (up to 14-fold) in the concentrations of UV-absorbing biomolecules (p < 0.025 for both species). The 400-MHz 1H NMR profiles of supernatants derived from mealworm and cricket specimens with punctured exoskeletons contained a wide variety of prominent biomolecule resonances, whereas those from unpunctured (control) insects contained signals of a much lower intensity, ascribable only to selected biomolecules. We conclude that puncturing the cuticle of insects and insect larvae prior to swallowing confers significant nutritional advantages over swallowing prey whole.

  15. [Lumbar puncture training using simulation-based educational strategies: Experience in a clinical pediatric residency].

    PubMed

    Vassallo, Juan C; Gouguenheim, Bárbara; Ghiglione, Analía; Bravo, Nélida; Prudencio, Carla I; Villois, Florencia; Abadie, Yamila; Zubieta, Ana; Golini, Carol; Villar, Victoria; Rodríguez, Susana P

    2015-12-01

    Pediatricians should acquire multiple skills during their professional training, including procedural skills. Skill acquisition requires knowledge on theoretical bases, direct observation and, lastly, supervised repetitive practice. Training using simulators allows to learn procedures in a controlled setting, ensuring patients' safety, integrating this as a learning stage prior to the actual contact with patients. Here we report on the teaching experience of a simulated lumbar puncture procedure. Training was provided to 112 first year pediatric residents who entered Hospital Prof. Dr. Juan P. Garrahan in the 2013-2014 period. Educational contents included communication with parents regarding the procedure, material preparation, compliance with biosafety standards, sepsis and general patient care, puncture and subsequent cerebrospinal fluid collection, and specimen collection. Strategies included, in a sequential order, the introduction of theoretical aspects using the bibliography and audiovisual resources available at the hospital's online campus and subsequent practice of lumbar puncture in a 3-month-old infant phantom on a lateral recumbent position that allowed to make a puncture and collect cerebrospinal fluid. At each training session, the level of confidence was measured before and after the procedure, and a checklist was developed to verify an adequate compliance with each step of the procedure. The simulated lumbar puncture training model has been introduced as an educational strategy of our Pediatric Residency Program. PMID:26593801

  16. Fabrication of Bonding-Type Hollow Microneedle Array by Injection Molding and Evaluation of its Puncture Characteristics

    NASA Astrophysics Data System (ADS)

    Ogai, Noriyuki; Sugimura, Ryo; Tamaru, Takuya; Takiguchi, Yoshihiro

    A microneedle array which consists from small needles compared to a conventional metal injection needle is expected as a low invasive transdermal medical treatment device, and many fabrication approach have been conducted. In this study, we fabricated plastic hollow microneedle array by a fabrication method based on the combination of injection molding, bonding and assembly techniques. To evaluate puncture characteristics of the fabricated needle, we measured a puncture force to silicone rubber by experimental equipment using loadcell and automatic stage. Furthermore, we propose and demonstrate a new method to measure actual punctured depth from punctured trace on the needle surface modified by O2 plasma treatment.

  17. Overlap between Headache, Depression, and Anxiety in General Neurological Clinics: A Cross-sectional Study

    PubMed Central

    Wei, Cui-Bai; Jia, Jian-Ping; Wang, Fen; Zhou, Ai-Hong; Zuo, Xiu-Mei; Chu, Chang-Biao

    2016-01-01

    Background: Many studies have reported that depression and anxiety have bidirectional relationship with headache. However, few researches investigated the roles of depression or anxiety in patients with headache. We surveyed the prevalence of depression and anxiety as a complication or cause of headache among outpatients with a chief complaint of headache at neurology clinics in general hospitals. Additional risk factors for depression and anxiety were also analyzed. Methods: A cross-sectional study was conducted at 11 general neurological clinics. All consecutive patients with a chief complaint of headache were enrolled. Diagnoses of depression and anxiety were made using the Chinese version of the Mini International Neuropsychiatric Interview, and those for headache were made according to the International Classification of Headache Disorders, 2nd Edition. The headache impact test and an 11-point verbal rating scale were applied to assess headache severity and intensity. Logistic regression was used to analyze risk factors of patients with headache for depression or anxiety. Results: A total of 749 outpatients with headache were included. Among them, 148 (19.7%) were diagnosed with depression and 103 (13.7%) with anxiety. Further analysis showed that 114 (15.2%) patients complaining headache due to somatic symptoms of psychiatric disorders and 82 (10.9%) had a depression or anxiety comorbidity with headache. Most patients with depression or anxiety manifested mild to moderate headaches. Poor sleep and severe headache-related disabilities were predictors for either depression or anxiety. Conclusion: Clinicians must identify the etiology of headache and recognize the effects of depression or anxiety on headache to develop specific treatments. PMID:27270532

  18. Headache under simulated microgravity is related to endocrine, fluid distribution, and tight junction changes.

    PubMed

    Feuerecker, Matthias; van Oosterhout, Willebrordus P J; Feuerecker, Benedikt; Matzel, Sandra; Schelling, Gustav; Rehm, Markus; Vein, Alla A; Choukèr, Alexander

    2016-05-01

    Head-down-tilted bed rest (HDTBR) induces headaches similar to headaches during space flights. The objective of this investigation was to study hematological, endocrinological, fluid changes and tight junctions in HDTBR-induced headaches as a proxy for space headache. The randomized crossover HDTBR design by the European Space Agency included 12 healthy, nonheadache male subjects. Before, during, and after confined HDTBR periods, epinephrine (urine), cortisol (saliva), hematological, endothelium markers, and fluid distribution parameters were measured. Headaches were assessed with a validated headache questionnaire. Compared with baseline, HDTBR in all subjects was associated with higher hematocrit, hemoglobin, and epinephrine levels, higher erythrocyte counts, and lower relative plasma volumes (all P < 0.05). In total, 26 headache episodes occurred. In subjects with headaches during HDTBR, epinephrine levels were exaggerated (vs headache-free subjects; HDTBR day 3; 5.1 ± 1.7 vs 3.4 ± 2.4; P = 0.023), cortisol levels were decreased (vs headache-free subjects; HDTBR day 1; 0.37 ± 0.16 vs 0.50 ± 0.20; P < 0.001) and the tight junction marker zonulin was elevated (vs headache-free subjects in HDTBR days 1, 3, 5; P < 0.05). HDTBR induces hemoconcentration and fluid redistribution in all subjects. During headache episodes, endocrinological changes, fluid distribution, and tight junctions were more pronounced, suggesting an additional role in headache pathophysiology. PMID:26761382

  19. The relationship between primary headache and constipation in children and adolescents

    PubMed Central

    Park, Mi-Na; Choi, Min-Gyu

    2015-01-01

    Purpose Many patients presenting with headache also complain of constipation; the relationship between these two symptoms has not been explored in detail. The aim of this study was to investigate the association between primary headache and constipation. Methods This retrospective study included all children who attended the Inje University Sanggye Paik Hospital complaining of headache, and who had been followed up for at least 100 days. Patients were divided into 2 groups: group A, in whom the headache improved after treatment for constipation, and group B, in whom headache was not associated with constipation. Results Of the 96 patients with primary headache, 24 (25.0%) also had constipation (group A). All 24 received treatment for constipation. Follow-up revealed an improvement in both headache and constipation in all patients. Group B contained the remaining 72 children. Comparison of groups A and B indicated a significant difference in sex ratio (P=0.009, chi-square test). Patients with probable tension-type headache were more likely to be in Group A (P=0.006, chi-square test). Conclusion Resolution of constipation improves headache in many patients diagnosed with primary headache, especially those with probable tension-type headache. We suggest that either constipation plays a key role in triggering headache, or that both constipation and headache share a common pathophysiology. PMID:25774197

  20. Nitroglycerin headache and nitroglycerin-induced primary headaches from 1846 and onwards: a historical overview and an update.

    PubMed

    Tfelt-Hansen, Peer C; Tfelt-Hansen, Jacob

    2009-03-01

    Nitroglycerin (NTG) (glyceryl trinitrate) was synthesized by the Italian chemist Ascanio Sobrero in Paris in 1846. A very unstable explosive, Alfred Nobel while working on explosives, combined it with Kiselguhr and patented it as dynamite in 1867. NTG was introduced in 1879 in medicine in the treatment of angina pectoris by the English doctor William Murrell. NTG-induced headache was quickly recognized as an important adverse event both in the industrial use of NTG, where it was used to produce dynamite, as well as in the use of NTG as drug. This review traces the evolution of our understanding of NTG headache.