RESUMO
OBJECTIVE: To describe the clinical features of new daily persistent headache (NDPH) at an outpatient neurology clinic with a subspecialty interest in headache in Houston, Texas. METHODS: A retrospective chart review was performed by a neurologist subspecialty certified in headache medicine of all patients seen from September 1, 2011 through February 28, 2020 (8.5 years) with a provisional diagnosis of NDPH and abstracted charts meeting criteria for primary NDPH. RESULTS: A total of 328 patients met the International Classification of Headache Disorders, 3rd edition criteria including 215 (65.5%) female patients. The mean age of onset was 40.3 years (range 12-87 years) with a mean age at first consultation in the study clinic of 42.6 years (range 12-87 years). The median [25th, 75th] duration of NDPH at initial consultation was 0.7 [0.3, 2.0] years, and at last visit, it was 1.9 [0.7, 4.8] years. The headaches were side-locked unilateral in 28/328 (8.5%). 12/328 cases (3.6%) with a thunderclap onset are reported. There was no obvious seasonal or other cyclical variation. The pain was usually moderate to severe and more often severe for the migraine phenotype (MP; 260/328 [79.3%] of cases) than for the tension-type phenotype (TTP). Precipitating factors were the following: stressful life events, 67/328 (20.4%); upper respiratory infection or flu-like illness, 33/328 (10.1%); and extracranial surgery, 5/328 (1.5%). Exacerbating or aggravating factors similar to migraine triggers were more often reported with the MP than with the TTP in this sample. For the MP, vertigo or dizziness was reported by 19/260 (7.3%) and a visual aura by 21/260 (8.1%) with descriptions provided. The prognostic types were the following for all patients: persisting (refractory), 305/328 (93.0%); relapsing-remitting, 9/328 (2.7%); and remitting (self-limited), 14/328 (4.3%). CONCLUSION: NDPH is typically of moderate to severe intensity often with migraine features without obvious seasonal or other cyclical variation. Most cases are refractory. 3.6% have a thunderclap onset often with a good response to treatment.
Assuntos
Transtornos da Cefaleia/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Tontura , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Recidiva , Estudos Retrospectivos , Texas , Vertigem , Adulto JovemRESUMO
When MRI scans of the brain are obtained for evaluation of primary headaches in children, incidental findings and anatomical variants are commonly present. After a review of the prevalence, 11 types are presented.
Assuntos
Variação Biológica Individual , Encéfalo/diagnóstico por imagem , Transtornos da Cefaleia Primários/diagnóstico por imagem , Achados Incidentais , Adolescente , Encéfalo/patologia , Feminino , Transtornos da Cefaleia Primários/patologia , Humanos , Imageamento por Ressonância MagnéticaRESUMO
When MRI scans of the brain are obtained for evaluation of primary headaches in adults, incidental findings are commonly present. After a review of the prevalence of incidental findings and normal anatomical variants, 21 types are presented.
Assuntos
Encefalopatias/diagnóstico por imagem , Transtornos da Cefaleia Primários/diagnóstico por imagem , Achados Incidentais , Adulto , Humanos , Imageamento por Ressonância Magnética , Transtornos de Enxaqueca/diagnóstico por imagemAssuntos
Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Enxaqueca com Aura/diagnóstico , Enxaqueca sem Aura/diagnóstico , Feminino , Humanos , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/cirurgia , Meningioma/complicações , Meningioma/cirurgia , Pessoa de Meia-Idade , Enxaqueca com Aura/complicações , Enxaqueca com Aura/cirurgia , Enxaqueca sem Aura/complicações , Enxaqueca sem Aura/cirurgiaAssuntos
Anticonvulsivantes/efeitos adversos , Frutose/análogos & derivados , Isoxazóis/efeitos adversos , Cálculos Renais , Adulto , Feminino , Frutose/efeitos adversos , Humanos , Cálculos Renais/induzido quimicamente , Cálculos Renais/diagnóstico , Cálculos Renais/terapia , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/tratamento farmacológico , Pseudotumor Cerebral/complicações , Pseudotumor Cerebral/tratamento farmacológico , Topiramato , ZonisamidaRESUMO
Arachnoid cysts are commonly encountered when neuroimaging is obtained for headaches. Their clinical relevance is not always immediately clear and they may confound medical management.
Assuntos
Cistos Aracnóideos/complicações , Cistos Aracnóideos/patologia , Cefaleia/etiologia , Adulto , Cistos Aracnóideos/cirurgia , Humanos , Imageamento por Ressonância Magnética , MasculinoRESUMO
Primary new daily persistent headache is a rare disorder of children and adults defined by the onset of daily and unremitting headaches within 3 days of onset lasting 4 hours or more daily. There may be a link between a preceding flu-like or upper respiratory infection in about 15%, a stressful life event in 10%, or extracranial surgery in 10%. Migraine symptoms may be present in over 50%. The headache is generalized in most but may be unilateral in 11% and may be localized to any head region. The diagnosis is one of exclusion as many secondary etiologies can cause similar headaches. The pathophysiology of the primary type is unknown. There are no prospective placebo controlled trials of preventive treatment so prevention is empiric using the same medications for the phenotype of chronic migraine or tension-type headache. Most patients have persistent headaches, although about 15% will remit, and 8% will have a relapsing-remitting type.
Assuntos
Transtornos da Cefaleia , Diagnóstico Diferencial , Transtornos da Cefaleia/diagnóstico , Transtornos da Cefaleia/epidemiologia , Transtornos da Cefaleia/terapia , HumanosAssuntos
Cefaleia/etiologia , Cefaleia/fisiopatologia , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/fisiopatologia , Pseudotumor Cerebral/diagnóstico , Pseudotumor Cerebral/fisiopatologia , Adulto , Feminino , Humanos , Obesidade/complicações , Gravidez , Complicações na Gravidez/terapia , Pseudotumor Cerebral/terapia , Baixa Visão/etiologiaAssuntos
Cistos do Sistema Nervoso Central/complicações , Cistos do Sistema Nervoso Central/patologia , Transtornos de Enxaqueca/etiologia , Glândula Pineal/patologia , Adulto , Cistos do Sistema Nervoso Central/fisiopatologia , Doença Crônica , Progressão da Doença , Hormônios Esteroides Gonadais/metabolismo , Humanos , Imageamento por Ressonância Magnética/normas , Masculino , Melatonina/metabolismo , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/fisiopatologia , Glândula Pineal/fisiopatologia , Prognóstico , Distribuição por Sexo , Triptaminas/uso terapêuticoRESUMO
Internists commonly treat migraine, which affects more than 29 million Americans yearly. This article reviews epidemiology, pathophysiology, comorbidity, clinical features, diagnostic testing, acute and preventive treatment, and women's issues. Physicians and migraineurs would like to see more effective and more tolerable medications.
Assuntos
Transtornos de Enxaqueca , Distribuição por Idade , Anticoncepcionais Orais Hormonais/efeitos adversos , Terapia de Reposição de Estrogênios/efeitos adversos , Feminino , Humanos , Masculino , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/fisiopatologia , Agonistas do Receptor de Serotonina/uso terapêutico , Distribuição por SexoAssuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Cefaleia Histamínica/etiologia , Consumo de Bebidas Alcoólicas/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Oxazolidinonas/uso terapêutico , Agonistas do Receptor de Serotonina/uso terapêutico , Fumar , Triazóis/uso terapêutico , Triptaminas/uso terapêuticoAssuntos
Carcinoma/secundário , Queixo/fisiopatologia , Neoplasias Mandibulares/secundário , Nervo Mandibular/fisiopatologia , Neoplasias da Próstata/patologia , Distúrbios Somatossensoriais/etiologia , Doenças do Nervo Trigêmeo/etiologia , Idoso , Carcinoma/complicações , Queixo/inervação , Diagnóstico Diferencial , Humanos , Masculino , Metástase Neoplásica/patologia , Metástase Neoplásica/fisiopatologia , Metástase Neoplásica/radioterapia , Prognóstico , Distúrbios Somatossensoriais/diagnóstico , Distúrbios Somatossensoriais/fisiopatologia , Doenças do Nervo Trigêmeo/diagnóstico , Doenças do Nervo Trigêmeo/fisiopatologiaRESUMO
A 72-year-old man presented with a 7-week history of a new onset constant severe right-sided headache associated with redness and tearing of the right eye, which resolved on indomethacin due to nonmetastatic small cell carcinoma producing a large suprahilar mass. This is the first case report of a hemicrania continua-like headache with autonomic features due to lung cancer. I propose the term "vagal cephalalgia" to include headache and/or facial pain due to nonmetastatic lung cancer and cardiac cephalalgia which result from vagal afferent stimulation.
Assuntos
Carcinoma de Células Pequenas/complicações , Neoplasias Pulmonares/complicações , Transtornos de Enxaqueca/etiologia , Idoso , Sistema Nervoso Autônomo/fisiopatologia , Humanos , Masculino , Transtornos de Enxaqueca/fisiopatologia , Terminologia como AssuntoRESUMO
Primary chronic headaches of long duration include chronic migraine, chronic tension-type headache, new daily persistent headache, and hemicrania continua. This article reviews the utility of neuroimaging and other testing for diagnosis of these headaches. The presentation and diagnosis of the many secondary headaches that can mimic primary headache types are also discussed, including arteriovenous malformations, spontaneous intracranial hypotension, neoplasms, pseudotumor cerebri, cervical artery dissections, cerebral venous thrombosis, Chiari I malformation, and temporal arteritis. Although the yield of diagnostic testing is low, serious pathology as a cause of chronic headaches can be easily overlooked.