RESUMO
BACKGROUND: The 'headache attributed to airplane travel', also named 'airplane headache' (AH), is a recently described headache disorder that appears exclusively in relation to airplane flights, in particular during the landing phase. Based on the stereotypical nature of the attacks in all reported cases, we proposed provisional diagnostic criteria for AH in a previously published paper. Up to now 37 cases have been described in the literature. METHODS: After our paper was disseminated via the Internet, we received several email messages from subjects around the world who had experienced such a peculiar headache. Their cooperation, by completing a structured questionnaire and allowing the direct observation of three subjects, enabled us to carry out a study on a total of 75 patients suffering from AH. RESULTS: Our survey confirmed the stereotypical nature of the attacks, in particular with regard to the short duration of the pain (lasting less than 30 minutes in up to 95% of the cases), the clear relationship with the landing phase, the unilateral pain, the male preponderance, and the absence of accompanying signs and/or symptoms. It is conceivable to consider barotrauma as one of the main mechanisms involved in the pathophysiology of AH. The observation that the pain appears inconstantly in the majority of cases, without any evident disorder affecting the paranasal sinuses, could be consistent with a multimodal pathogenesis underlying this condition, possibly resulting in the interaction between anatomic, environmental and temporary concurrent factors. CONCLUSIONS: This is by far the largest AH case series ever reported in the literature. The diagnostic criteria that we previously proposed proved to be valid when applied to a large number of patients suffering from this condition. We support its recognition as a new form of headache, to be included in the forthcoming update of the International Headache Society Classification, within '10. Headache attributed to disorder of homoeostasis'. Its formal validation would favour further studies aimed at improving the understanding of its pathophysiology and implementing preventative measures.
Assuntos
Aeronaves , Cefaleia/diagnóstico , Cefaleia/etiologia , Viagem , Adolescente , Adulto , Criança , Feminino , Cefaleia/terapia , Transtornos da Cefaleia Primários/complicações , Transtornos da Cefaleia Primários/diagnóstico , Transtornos da Cefaleia Primários/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Prevenção Secundária , Adulto JovemRESUMO
We report the case of a patient suffering from migraine with and without aura who had a complete remission of both during warfarin treatment for pulmonary embolism; the attacks reappeared promptly during two treatment withdrawals. We highlight warfarin as prophylactic drug in migraine prophylaxis and discuss about new, safer and more specific anticoagulants that could be used in migraine treatment. Their use could also clarify literature's conflicting data about anticoagulants' efficacy in migraine prophylaxis and clear if their efficacy in migraine treatment could be related aspecifically to anticoagulation's effect or to a particular mechanism in the coagulation cascade.
Assuntos
Anticoagulantes/administração & dosagem , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/tratamento farmacológico , Varfarina/administração & dosagem , Adulto , Feminino , Humanos , Transtornos de Enxaqueca/complicações , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/tratamento farmacológicoRESUMO
Thunderclap headache (TCH) is an excruciating headache characterized by a very sudden onset. Recognition and accurate diagnosis of TCH are important in order to rule out the various, serious underlying brain disorders that, in a high percentage of cases, are the real cause of the headache. Primary TCH, which may recur intermittently and generally has a spontaneous, benign evolution, can thus be diagnosed only when all other potential underlying causes have been excluded through accurate diagnostic work up. In this review, we focus on the management of TCH, paying particular attention to the diagnostic work up and treatment of the condition.
Assuntos
Artérias Cerebrais/fisiopatologia , Transtornos da Cefaleia Primários/diagnóstico , Transtornos da Cefaleia Primários/terapia , Artérias Cerebrais/efeitos dos fármacos , Artérias Cerebrais/inervação , Protocolos Clínicos/normas , Diagnóstico Diferencial , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico , Vasoespasmo Intracraniano/complicações , Vasoespasmo Intracraniano/diagnósticoAssuntos
Transtornos de Enxaqueca/etiologia , Doenças do Nervo Troclear/complicações , Adulto , Aminas/uso terapêutico , Analgésicos/uso terapêutico , Ácidos Cicloexanocarboxílicos/uso terapêutico , Gabapentina , Humanos , Masculino , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/fisiopatologia , Doenças do Nervo Troclear/tratamento farmacológico , Doenças do Nervo Troclear/fisiopatologia , Ácido gama-Aminobutírico/uso terapêuticoAssuntos
Glaucoma de Ângulo Fechado/diagnóstico , Transtornos de Enxaqueca/classificação , Transtornos de Enxaqueca/diagnóstico , Diagnóstico Diferencial , Feminino , Glaucoma de Ângulo Fechado/fisiopatologia , Humanos , Pessoa de Meia-Idade , Transtornos de Enxaqueca/fisiopatologia , Retina/patologiaAssuntos
Transtornos da Cefaleia/classificação , Transtornos da Cefaleia/fisiopatologia , Idoso , Analgésicos não Narcóticos/uso terapêutico , Cafeína/uso terapêutico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Di-Hidroergotamina/uso terapêutico , Feminino , Transtornos da Cefaleia/tratamento farmacológico , Humanos , Lítio/uso terapêutico , Masculino , Transtornos do Sono-Vigília/etiologiaAssuntos
Cefaleia Histamínica/complicações , Transtornos de Enxaqueca/complicações , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Cefaleia Histamínica/tratamento farmacológico , Cefaleia Histamínica/fisiopatologia , Lateralidade Funcional , Humanos , Indometacina/uso terapêutico , Masculino , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/fisiopatologia , Agonistas do Receptor de Serotonina/uso terapêutico , Sumatriptana/uso terapêutico , Vasodilatadores/uso terapêutico , Verapamil/uso terapêuticoRESUMO
The authors reviewed the computed tomographic (CT) scans of 129 patients with subarachnoid hemorrhage (SAH). The close correlation is stressed between the severity of the symptoms onset and the amount of blood demonstrated on CT scans. The importance is confirmed of CT in the prognostic evaluation of SAH. As a matter of fact, CT findings define the location and the amount of blood: these factors are closely related to the occurrence of vasospasms -i.e., the primary cause of death and poor outcome. CT also shows the possible complications (hematoma, hydrocephalus, mass effect) that, when present, have a negative impact on prognosis, independent of the neurologic condition. Finally, the authors point out how a reliable prognosis of SAH is based upon combined clinical evaluation and CT study.