Pericranial nerve blockade as a preventive treatment for migraine: Experience in 60 patients. / Bloqueo anestésico de nervios pericraneales como tratamiento preventivo de migraña: experiencia en una serie de 60 pacientes.

INTRODUCTION: Anaesthetic blockade of pericranial nerves is frequently used to treat headache disorders. There is no evidence on indication of this treatment for migraine. We aim to evaluate its effectiveness as a preventive treatment for migraine using specific indication criteria. METHODS: Between January 2009 and May 2013 we offered pericranial nerve blockade to migraine patients with a history of preventive drug intolerance or failure. We selected patients with tenderness to palpation of at least one greater occipital nerve (GON) or supraorbital nerve (SON). Responses at 3 months were categorised as complete response (no pain), partial response (reduction of at least 50% in severity or frequency of headache episodes), or no response. RESULTS: Anaesthetic blockade was performed in 60 patients (52 females, 8 males; mean age 40.6 ± 12.4 years, range 19-76). The most common procedure was blockade of GON and SON on both sides. Complete response lasting at least 2 weeks was recorded in 23 patients (38.3%), with partial response in 24 patients (40%), and no response in 13 (21.7%). In the group presenting complete response, age and length of history of migraine were significantly lower. No severe side effects were detected. Response time ranged from 2 weeks to 3 months. CONCLUSIONS: Pericranial nerves blockade using tenderness to palpation as an inclusion criterion is safe and potentially effective as prophylactic treatment for migraine. The best responses in our series were observed in younger patients with shorter histories of migraine.

Headache: pregnancy and breastfeeding. Recommendations of the Spanish Society of Neurology's Headache Study Group.

INTRODUCTION: Headache is one of the most common neurological complaints, and is most frequent during reproductive age. As a result, we are routinely faced with pregnant or breastfeeding women with this symptom in clinical practice. It is important to know which pharmacological choices are the safest, which should not be used, and when we should suspect secondary headache. To this end, the Spanish Society of Neurology's Headache Study Group has prepared a series of consensus recommendations on the diagnostic and therapeutic algorithms that should be followed during pregnancy and breastfeeding. DEVELOPMENT: This guide was prepared by a group of young neurologists with special interest and experience in headache, in collaboration with the Group's Executive Committee. Recommendations focus on which drugs should be used for the most frequent primary headaches, both during the acute phase and for prevention. The second part addresses when secondary headache should be suspected and which diagnostic tests should be performed in the event of possible secondary headache during pregnancy and breastfeeding. CONCLUSIONS: We hope this guide will be practical and useful in daily clinical practice and that it will help update and improve understanding of headache management during pregnancy and breastfeeding, enabling physicians to more confidently treat these patients.

How and when to refer patients diagnosed with primary headache and craniofacial neuralgia in the Emergency department or Primary Care: Recommendations of the Spanish Society of Neurology's Headache Study Group. / Cómo y cuándo derivar un paciente con cefalea primaria y neuralgia craneofacial desde Urgencias y Atención Primaria: recomendaciones del Grupo de Estudio de Cefalea de la Sociedad Española de Neurología.

INTRODUCTION: When a patient is diagnosed with primary headache or craniofacial neuralgia in the emergency department or in primary care, and is referred to a neurologist due to the complexity of the case, it is useful to know whether additional examination should be sought and the priority (urgent, preferential or normal) with which the patient should be seen. This will avoid unnecessary delays in patients with disabling headache and where organic causes are suspected. In order to issue recommendations on this matter, the Spanish Society of Neurology's Headache Study Group has decided to create a series of agreed recommendations constituting a referral protocol for patients with headache and/or craniofacial neuralgia. DEVELOPMENT: Young neurologists with an interest and experience in headache were invited to draft a series of practical guidelines in collaboration with Spanish Society of Neurology's Headache Study Group Executive Committee. For practical reasons, the document was divided into 2 articles: this first article focuses on primary headaches and craniofacial neuralgias and the second on secondary headaches. In order for the recommendations to be helpful for daily practice they follow a practical approach, with tables summarising referral criteria, examinations to be performed, and referral to other specialists. CONCLUSIONS: We hope to offer a guide and tools to improve decision-making regarding patients with headache, identifying complementary tests to prioritise and referral pathways to be followed, in order to avoid duplicated consultations and delayed diagnosis and treatment.

Headache: pregnancy and breastfeeding Recommendations of the Spanish Society of Neurology's Headache Study Group. / Cefalea: embarazo y lactancia. Recomendaciones del Grupo de Estudio de Cefaleas de la Sociedad Española de Neurología (GECSEN).

INTRODUCTION: Headache is one of the most common neurological complaints, and is most frequent during reproductive age. As a result, we are routinely faced with pregnant or breastfeeding women with this symptom in clinical practice. It is important to know which pharmacological choices are the safest, which should not be used, and when we should suspect secondary headache. To this end, the Spanish Society of Neurology's Headache Study Grouphas prepared a series of consensus recommendations on the diagnostic and therapeutic algorithms that should be followed during pregnancy and breastfeeding. DEVELOPMENT: This guide was prepared by a group of young neurologists with special interest and experience in headache, in collaboration with the Group's Executive Committee. Recommendations focus on which drugs should be used for the most frequent primary headaches, both during the acute phase and for prevention. The second part addresses when secondary headache should be suspected and which diagnostic tests should be performed in the event of possible secondary headache during pregnancy and breastfeeding. CONCLUSIONS: We hope this guide will be practical and useful in daily clinical practice and that it will help update and improve understanding of headache management during pregnancy and breastfeeding, enabling physicians to more confidently treat these patients.

Headache in young patients: Clinical characteristics of a series of 651 cases. / Cefalea en jóvenes: características clínicas en una serie de 651 casos.

INTRODUCTION: Headache has a negative impact on health-related quality of life in young patients. We aim to analyse the characteristics of a series of young patients visiting a headache clinic and estimate the burden of different types of headaches listed by the International Classification of Headache Disorders (ICHD). METHODS: We prospectively recruited patients aged 14 to 25 years who were treated at our clinic during a period of 6.5 years. We recorded each patient's sex, complementary test results, and previous treatment. We subsequently compared the characteristics of our sample to those of patients older than 25. RESULTS: During the study period, we treated 651 patients aged 14 to 25 years; 95.6% had received symptomatic treatment, and 30.1% had received preventive treatment. A total of 755 headaches were recorded. Only 80 were secondary headaches, most of which were included in Group 8; 77.2% were included in Group 1, 3.1% in Group 2, 1.2% in Group 3, 5% in Group 4, 0.6% in Group 13, and 0.9% in Group 14. According to Headache Impact Test (HIT-6) scores, headache had at least a moderate impact on the quality of life of 449 patients. CONCLUSION: Most headaches in young patients can be classified according to ICHD criteria. Migraine was the most frequent diagnosis in our sample. Although headache was commonly associated with a negative impact on quality of life, most patients had received little preventive treatment before being referred to our clinic.

[Clinical characteristics of vestibular migraine: considerations in a series of 41 patients]. / Caracteristicas clinicas de la migraña vestibular: consideraciones en una serie de 41 pacientes.

INTRODUCTION: After years of debate about its being approached from headaches and its denomination, vestibular migraine has recently been included in the research appendix of the 3rd edition of the International Headache Classification. AIM: To analyse the characteristics of a series of patients with vestibular migraine who visited because of headaches. PATIENTS AND METHODS: Our sample consisted of patients who were attended in a headache unit between January 2014 and December 2015. The demographic variables and the characteristics of both migraine and vestibular symptoms were considered, and cases with other otorhinolaryngological conditions were excluded. RESULTS: The sample was finally made up of 41 patients (11 males, 30 females) with a mean age of 31.8 ± 13.3 years at the time they were included in the study. Sixteen patients (39%) met criteria for chronic migraine and two (4.9%) presented visual auras. The vestibular symptoms were considered severe in eight cases (19.5%) and occurred in 74.6% of the migraine attacks. Vertigo was described as internal in 18 cases (43.9%), external in 22 (53.7%) and mixed in one case (2.4%). The most frequent symptom was positional vertigo (n = 25; 61%), followed by that induced by head movements (n = 18; 43.9%) and spontaneous (n = 15; 36.6%). Accompanying symptoms included tinnitus (n = 12; 29.3%) and a feeling of fullness in the ear (n = 8; 19.5%). CONCLUSION: It is not uncommon to identify symptoms consistent with vestibular migraine in patients who visit a headache unit; they are patients whose day-to-day activities are not usually affected by their vertigo.

TITLE: Caracteristicas clinicas de la migraña vestibular: consideraciones en una serie de 41 pacientes.Introduccion. Tras años de debates sobre su enfoque desde las cefaleas y su denominacion, la migraña vestibular ha sido recientemente incluida en el apendice de investigacion de la III edicion de la Clasificacion Internacional de Cefaleas. Objetivo. Analizar las caracteristicas de una serie de pacientes con migraña vestibular en los que el motivo de consulta fue la cefalea. Pacientes y metodos. Pacientes atendidos en una unidad de cefaleas entre enero de 2014 y diciembre de 2015. Se consideran las variables demograficas y caracteristicas tanto de la migraña como de los sintomas vestibulares, y se excluyen los casos con otras patologias otorrinolaringologicas. Resultados. Se incluyen 41 pacientes (11 varones, 30 mujeres) con una edad media de 31,8 ± 13,3 años en el momento de la inclusion. Dieciseis pacientes (39%) reunian criterios de migraña cronica y dos (4,9%) presentaban auras visuales. Los sintomas vestibulares fueron considerados graves en ocho casos (19,5%) y ocurrian en un 74,6% de los episodios de migraña. El vertigo se describia como interno en 18 casos (43,9%), externo en 22 (53,7%) y mixto en uno (2,4%). El sintoma mas frecuente fue el vertigo posicional (n = 25; 61%), seguido del inducido por movimientos cefalicos (n = 18; 43,9%) y el espontaneo (n = 15; 36,6%). Como sintomas acompañantes se observaron acufenos (n = 12; 29,3%) y pletora aural (n = 8; 19,5%). Conclusion. La identificacion de sintomas compatibles con una migraña vestibular no es excepcional en los pacientes que acuden a una unidad de cefaleas; se trata de pacientes en los que el vertigo no suele interferir en sus actividades habituales.

[Nasal congestion as an autonomic symptom accompanying migraine attacks]. / Congestion nasal como sintoma autonomico acompañante de crisis migranosas.

TITLE: Congestion nasal como sintoma autonomico acompañante de crisis migranosas.