Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
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Primary stabbing headache (PSH) is a primary syndrome of unknown aetiology, characterised by brief, jabbing stabs predominantly felt in the orbital, temporal and parietal areas, whose frequency may vary from one to many per day, usually responding to indomethacin. PSH frequency in the general population is not well defined, but recent evidence suggests it could be more frequent than previously thought. In clinical series, PSH incidence was 33/100,000 per year, while in a population study 35.2 % prevalence was found. ⋯ Seven out of eight patients responded to indomethacin 75 mg/die, and one to topiramate 100 mg/die. Interestingly, both drugs share with acetazolamide a CSF pressure lowering effect. Our findings indicate that PSH is associated with central sinus stenosis and suggest that an undiagnosed ss-IHWOP might be involved in PSH pathogenesis.
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Migraine with aura (MWA) is a common headache, characterized by short-lasting neurological signs preceding an headache attack with migraine characteristics. We have recently performed several investigations about time-delay for migraine without aura diagnosis (MWoA). Aim of this study was to compare the time necessary to obtain a correct diagnosis in MWA and MWoA patients. ⋯ In fact, subjects affected by MWA had a mean diagnostic delay of 6.70 years (SE ± 1.5), while patients affected by MWoA had a mean interval of 10.7 years (SE ± 1.20). Patients affected by MWA present a significant lower delay for the formulation of a correct diagnosis with respect to subjects with MWoA. This could be probably due to the fact that MWA patients develop major alarm reactions related to visual symptoms and look for an earlier appointment with a specialist medical center.
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Headache may occur in neurosarcoidosis and diagnostic criteria are given in the International Classification of Headache Disorders (ICHD-II). We present a case series of patients suffering from neurosarcoidosis in whom headache was the presenting symptom. The aim of the present study was to analyze the possible clinical presentations and the corresponding cerebral lesions in a retrospective chart review of patients suffering from neurosarcoidosis in whom headache was the presenting symptom. ⋯ In the remaining three cases headache was the only neurological symptom found in association with systemic features of sarcoidosis, and had the clinical features of tension-type headache. Our findings confirm that the clinical features of headache in patients with this disorder may have different presentations, which depend on neuropathologic involvement. Thus, a detailed neuroimaging study and CSF evaluation are needed to confirm diagnosis, particularly in patients with no sign of systemic sarcoidosis or in those in whom head pain may mimic a primary headache syndrome.
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Patients with chronic migraine (CM) headaches present some of the most difficult treatment challenges for headache practitioners. Attention to psychological and behavioral issues become significant treatment considerations as the frequency of a patient's headaches increases, there is increased disability secondary to headaches, and/or there is inadequate response to usually effective treatment. Recent research has identified a variety of risk factors (including medication overuse) that appear to be associated with the escalation of the frequency and severity of migraine headache and are amenable to behavioral (non-pharmacological) treatment. The present article will highlight therapies that may be effective in the treatment of patients with CM headache.
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The aim of the present study was to investigate the possible relationships between the presence of headache-related photophobia and migraine-associated allodynia--a hallmark of central sensitization--among patients with different migraine types. A sample of 456 migraineurs was studied. ⋯ Overall, these findings suggest that light stimulation may contribute to central sensitization of pain pathways in migraineurs, possibly contributing to progression into chronic forms. The possible connections underlying this type of sensitization is offered by the recently published data on a non-image-forming visual retino-thalamo-cortical pathway which may allow photic signals to converge on a thalamic region which is selectively activated during migraine headache.