- Posttraumatic Headache: Basic Mechanisms and Therapeutic Targets. [Review]
- HHeadache 2018 May 14
- Frequent or continuous headache, often refractory to medical therapy, is a common occurrence after head trauma. In addition to being the most common acute symptom after traumatic brain injury (TBI), ...
Frequent or continuous headache, often refractory to medical therapy, is a common occurrence after head trauma. In addition to being the most common acute symptom after traumatic brain injury (TBI), headache is also one of the most persistent and disabling symptoms. Different studies indicate that 18-58% of those suffering a TBI will have significant headache at 1 year following the trauma. In addition to being disabling on its own, posttraumatic headache (PTH) is a predictor of overall outcome after concussion. Despite its remarkable prevalence and associated social and economic costs, many fundamental and important questions about PTH remain unanswered. The purpose of this review is to identify key questions regarding the clinical characteristics of posttraumatic headache, its basic mechanisms, and its optimal management. We discuss phenotypic features of PTH, pathophysiological mechanisms of TBI including potential overlaps with those of migraine and other primary headache disorders, and potential novel targets for treatment. We suggest different strategies to finding answers to the questions regarding PTH in order to advance the understanding of the disorder and develop more effective therapies.
- Polypharmacy Among Headache Patients: A Cross-Sectional Study. [Journal Article]
- CDCNS Drugs 2018 May 11
- CONCLUSIONS: Patients with primary headaches, mainly young adults, are exposed to high polypharmacy, comparable to that of the elderly. Because increased numbers of drugs increase the risk of adverse reactions, the many medications concomitantly taken by primary headache sufferers should be frequently reviewed.
- Relationship between Cough-Associated Changes in CSF Flow and Disease Severity in Chiari I Malformation: An Exploratory Study Using Real-Time MRI. [Journal Article]
- AAAJNR Am J Neuroradiol 2018 May 10
- CONCLUSIONS: Our exploratory study suggests that assessment of CSF flow response to a coughing challenge has the potential to become a valuable objective noninvasive test for clinical assessment of disease severity in patients with Chiari I malformation.
- Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents - assessment of adverse events in non-randomised studies. [Review]
- CDCochrane Database Syst Rev 2018 May 09; 5:CD012069
- CONCLUSIONS: Our findings suggest that methylphenidate may be associated with a number of serious adverse events as well as a large number of non-serious adverse events in children and adolescents, which often lead to withdrawal of methylphenidate. Our certainty in the evidence is very low, and accordingly, it is not possible to accurately estimate the actual risk of adverse events. It might be higher than reported here.Given the possible association between methylphenidate and the adverse events identified, it may be important to identify people who are most susceptible to adverse events. To do this we must undertake large-scale, high-quality RCTs, along with studies aimed at identifying responders and non-responders.
- Spontaneous Resolution of Chiari 1-Associated Syringomyelia: A Report of Two Cases. [Journal Article]
- PNPediatr Neurosurg 2018 May 07; :1-5
- CONCLUSIONS: Some children with Chiari I and syringomyelia may show spontaneous resolution of symptoms and syringomyelia. Large registry studies will be needed to determine how likely it is that Chiari-associated syringes will resolve, and whether there are particular anatomic or neurologic differences between those who require surgery and those who don't.
- Hemicrania Continua. [Review]
- AIAnn Indian Acad Neurol 2018; 21(Suppl 1):S23-S30
- Hemicrania continua (HC) is an indomethacin responsive primary chronic headache disorder which is currently classified as a subtype of trigeminal autonomic cephalalgias (TACs). It is not very uncommo...
Hemicrania continua (HC) is an indomethacin responsive primary chronic headache disorder which is currently classified as a subtype of trigeminal autonomic cephalalgias (TACs). It is not very uncommon. There are >1000 cases of HC in the literature, and it constitutes 1.7% of total headache in the clinic settings. Misdiagnosis for HC is very common at all clinical settings. A diagnosis of HC is missed even by neurologists and headache specialists. It is characterized by a continuous strictly unilateral headache with superimposed exacerbations. Just like other TACs, exacerbations are associated with cranial autonomic symptoms and restlessness. A large number of patients may have migrainous features (nausea, vomiting, photophobia, and phonophobia) during exacerbations phase. The "key" feature of HC is persistent featureless background headaches. However, patients and physicians may focus only on the exacerbation part. As durations, frequency and associated symptoms of exacerbations are highly variables; it may mimic a large number of primary and secondary headache disorders. Migraine and cluster headache are two most common misdiagnosed conditions. Another specific feature of HC is remarkable repose to indomethacin. A "complete" response to indomethacin is as "sine qua non" for HC. However, a few other medications may also be effective in a subset of HC patients. Various surgical procedures have been tried with mixed results in patients who were intolerant to indomethacin or other drugs.
- Quest for haller cells: A digital orthopantomography study. [Journal Article]
- IJIndian J Dent Res 2018 Mar-Apr; 29(2):181-185
- CONCLUSIONS: This study has attempted to explore the characteristics of Haller's cells on panoramic radiographs. A description of Haller's cells on these radiographs may prove vital in enumerating the differential diagnosis for patients afflicted with intractable orofacial pain and reduce the risk of untoward intraoperative complications during endonasal procedures.
- Hemicrania continua: Case series presenting in an orofacial pain clinic. [Journal Article]
- CCephalalgia 2018 Jan 01; :333102418764895
- Aim of investigation Hemicrania continua (HC) is an uncommon primary headache and little is known of the characteristics of such patients managed in an orofacial pain setting. This study provides cli...
Aim of investigation Hemicrania continua (HC) is an uncommon primary headache and little is known of the characteristics of such patients managed in an orofacial pain setting. This study provides clinical features of HC, its association with other disorders, and treatment outcomes of patients managed in the TMD and Orofacial Pain Clinic at the University of Minnesota. Methods A retrospective review of patient records was undertaken. Inclusion criteria were a diagnosis of HC and confirmation at follow-up. Results Six of the 1617 new patients seen between 2015 and 2017 met the selection criteria. Four patients presented with "facial pain", one with "toothache" and one with "jaw pain". All were female with mean age 55 ± 10.5 years (range = 41-69). Headache characteristics included unilateral (R:L = 1:1) pain of moderate intensity with severe exacerbations in the distribution of V1 (1/6), V1 + V2 (3/6) and V1 + V2 + V3 (2/6). Lacrimation and photophobia were the most common associated symptoms. Patient presentations were complicated by multiple medical and comorbid diagnoses. All were diagnosed with temporomandibular disorder (TMD). Indomethacin alone was sufficient for adequate headache control in 2/6 patients with several add-on medications providing sustained pain relief. Conclusions Comorbid pain conditions can be expected in patients with HC presenting to orofacial pain clinics. Symptom presentation varies, and multimodal treatment approach is necessary for success.
- [Migrainous cephaleas revealing stroke due to carotid dissection]. [Case Reports]
- PAPan Afr Med J 2017; 28:165
- Dissections of cervicocephalic arteries are the main cause of stroke among the young adults. We report the case of a hypertensive and migrainous patient aged 59-years presenting with migrainous cepha...
Dissections of cervicocephalic arteries are the main cause of stroke among the young adults. We report the case of a hypertensive and migrainous patient aged 59-years presenting with migrainous cephalea with flashes of light in his left eye and paroxysmal regressive paresthesia of the right hemicorpus. Clinical examination showed apraxia of speech associated with phonemic paraphasia. MRI of cerebral vascular territories with diffusion weighted imaging showed perivascular hyper-intense signal of the left internal carotid artery (intra-petrous portion) and T2 hyposignal suggesting hematoma in the wall with arterial occlusion at this level. MRI with diffusion and flair weighted imaging showed several ponctiform hyperintense signals at the level of the left anterior cerebral arterial territory and junctional hyperintense signals between the anterior cerebral artery and the middle cerebral artery without microbleeds at the level of the parenchyma, suggesting embolic stroke due to carotid dissection. The patient underwent curative Vitamin K antagonist anticoagulation treatment (target INR range of 2 to 3) after heparinotherapy with language therapy. At the three-month follow-up, angio MRI of the supra aortic trunk showed left intrapetrous internal carotid revascularization. Imaging plays an important role in the diagnostic confirmation of the dissections of cervicocephalic arteries and of possible stroke as well as in the immediate management and follow-up of patients.
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- Factors Associated With Medication-Overuse Headache in Patients Seeking Treatment for Primary Headache. [Journal Article]
- HHeadache 2018 Mar 09
- CONCLUSIONS: Items that assess headache-related disability, use of combination medications, and fear of pain help identify patients who are currently overusing acute headache medications and may serve as indicators of treatment progress. Future studies should apply similar analytic approaches longitudinally to identify headache sufferers at risk for medication-overuse headache prior to headache progression.