Handbook of clinical neurology
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New daily persistent headache (NDPH) is a unique form of chronic daily headache (CDH) which is marked by a daily headache from onset, typically occurring in individuals without a significant prior history of headaches. There are two subforms of NDPH: one which is self-limited and normally goes away without therapy, and a more chronic refractory form which is unresponsive to typical headache treatment strategies. The pathogenesis of NDPH is unknown but recent observations suggest a connection with cervical spine hypermobility and elevation of proinflammatory cytokines in the cerebrospinal fluid (CSF). ⋯ The syndrome appears to affect women in their teens and 20s, while males develop NDPH later in life in their 50s or 60s. There are no recognized treatments for this condition, although treatment options will be discussed. Secondary mimics of NDPH will also be touched upon in this chapter.
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Historical Article
Chapter 48: history of neurology in Australia and New Zealand.
In comparison with most Western countries, neurology as a recognized medical specialty has a relatively brief history in Australia: the national body for neurologists, the Australian (since 2006: and New Zealand) Association of Neurologists, was founded only in 1950. The development of neurology in both countries was heavily influenced by British neurology, and until recently a period in the National Hospital for Neurology and Neurosurgery, Queen Square, London was regarded as essential to specialist training in neurology. ⋯ The first Australian physician to unambiguously commit himself to neurology was Alfred Walter Campbell (1868-1938), a remarkable personality who established an imposing reputation as neurocytologist and neuropathologist. The chapter provides a concise overview of the development of neurology as a clinical and academic specialty in Australia and New Zealand.
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Activity-related headaches can be brought on by Valsalva maneuvers ("cough headache"), prolonged exercise ("exertional headache"), and sexual excitation ("orgasmic headache"). These headaches account for 1-2% of the consultations due to headache in a general neurological department. These entities are a challenging diagnostic problem as they can be primary or secondary and as their etiologies differ depending on the headache type. ⋯ The mean age at onset for primary headaches provoked by physical exercise and sexual activity is similar (40 years); they share clinical characteristics (bilateral, pulsating) and respond to beta-blockers. In conclusion, provoked headaches account for a low proportion of headache consultations. Cough headache is a different condition when compared to headache due to physical exercise and sexual activity, which are clinical variants of the same entity.
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A proportion of chronic headache patients become refractory to medical treatment and severely disabled. In such patients various neurostimulation methods have been proposed, ranging from invasive procedures such as deep-brain stimulation to minimally invasive ones like occipital nerve stimulation. They have been applied in single cases or small series of patients affected with varying headache disorders: cervicogenic headache, hemicrania continua, posttraumatic headache, chronic migraine, and cluster headache. ⋯ At this stage, it should be preferred as first-line invasive therapy for iCCH. Recent case reports mention the efficacy of supraorbital (SNS) and vagal (VNS) nerve stimulation. Whether these neurostimulation methods have a place in the management of iCCH patients remains to be determined.