Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
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Hypnic headache (HH) is a rare sleep-associated primary headache disorder, usually affecting aged people, first described by Raskin in 1988. The headache attacks, single or multiple in one night, occur exclusively during sleep and tend to present at a consistent time each night, sometimes during a dream. Compared to the original description, newly reported cases have expanded the clinical spectrum of the disorder to include unilateral forms (about 40%, half of which are side-locked), forms with a longer duration (up to 3 h) and cases with onset in juvenile/adult age. ⋯ The pathophysiology of HH is still unclear. Available data allow speculation that, in predisposed subjects, an age-related impairment of suprachiasmatic nucleus could cyclically activate a disnociceptive mechanism leading to both a sudden awakening and headache. The mechanism may be precipitated by neurophysiologic events such as the strong reduction of firing occurring in the dorsal raphe nucleus during a REM sleep phase.
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General population studies suggest a non-casual association (comorbidity) between migraine, major depression and anxiety disorders (panic attack disorder, obsessive-compulsive disorder, generalised anxiety disorder). The risk of developing affective and anxiety disorders is not increased uniformly in the different migraine subtypes, but it is more elevated in migraine with aura patients. The relationship between migraine and depression is "bi-directional" (i. e., migraineurs have a more than three-fold risk of developing depression compared with non-migraine patients, while depression patients that have never suffered from migraine before have a more than three-fold risk of developing migraine compared with nondepressed patients) and specific (i. e., the presence of migraine or severe non-migraine headache increases a patient's risk of developing depression or panic attack disorder, whereas the presence of depression or panic attack disorder is associated with a greater risk of developing migraine, but not severe non-migraine headache). Comorbidity with psychiatric disorders has also been described for chronic tension-type headache and for chronic daily headache, although these findings are based only on clinical population data.
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Neuropathic pain is by definition a chronic pain condition that occurs and persists in a heterogeneous group of aetiologically different diseases characterised by a primary lesion or dysfunction of the peripheral or central nervous system. Neuropathic pain has an important prevalence in the general population, and a severe impact on quality of life and mood of affected patients. ⋯ Opioids and analgesics are a second-line choice. Topical medications could be useful in several pain situations.
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Painful ophthalmoplegia (PO) is an important presenting problem to ophthalmologists and neurologists. The etiological differential diagnosis is extensive, including different syndromes and causes (vascular, neoplastic, infectivous, inflammatory). ⋯ Some rare causes of PO, such as Tolosa Hunt syndrome with negative neuroimaging findings or ophthalmoplegic migraine remain till now of uncertain classification. Correct approach to the patient requires correlation to clinical data and careful monitoring, to avoid diagnostic mistakes, as the "history" of Tolosa-Hunt syndrome has underlined.
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Orofacial pain syndromes have traditionally been divided into two groups: the typical neuralgias and atypical facial pain. While typical neuralgias are well characterised, the term atypical facial pain (now persistent idiopathic facial pain) covers a variety of poorly defined head and face pains whose aetiological mechanisms are poorly understood. This paper examines the characteristics and nosography of these conditions, and suggests they should not be considered as neuralgias (section 13 of the 2004 IHS classification) but as other primary headaches (section 4).