Headache in Pediatric Moyamoya Disease after Revascularization Surgery.

INTRODUCTION: Patients with moyamoya disease (MMD) often have headaches after successful revascularization surgery. We aimed to characterize headache in surgically treated MMD patients and elucidate its clinical meaning and pathophysiology. METHODS: Headache and related symptoms were surveyed using structured questionnaires in pediatric MMD patients with follow-up for 6 months or longer after indirect revascularization surgery. Clinical information including initial presentation, surgical method, and outcome was collected from medical records. Surgical outcomes were assessed clinically and by perfusion imaging. We defined "headache associated with MMD" as the headache accompanied by a transient ischemic attack or provoked by hyperventilation. Other headaches were further classified based on the diagnostic criteria of the International Headache Society-3. We analyzed the characteristics of "headache associated with MMD" and newly developed headache after surgery. RESULTS: Among 90 participants, 65 (72.2%) had headaches within the last year before survey, including 28 (43.1%) with "headaches associated with MMD," 10 (15.3%) with probable migraines, 2 (3.1%) with infrequent episodic tension-type headaches, and 4 (6.2%) with probable tension-type headaches. Headache quality was pulsatile in 27 (41.5%) patients and pressing or tightening in 27 (41.5%) patients. Nausea or vomiting was accompanied in 30 (46.2%) patients. Headache upon awakening was reported in 37 (57.8%) patients. Headache disturbed daily life in 12 (18.5%) patients. Among the 32 (35.6%) patients who suffered headache during both the pre- and postoperative period, the headache quality was similar in 27 (84.4%) patients, and its severity decreased in 24 (75.0%) and did not change in 8 (25.0%) patients. Twelve (13.3%) patients experienced newly developed headaches after surgery. Among them, six (50.0%) were classified as having "headaches associated with MMD." They were predominantly electric shock-like or stabbing in 5 (45.6%) patients and nondisturbing in all patients. All 90 patients achieved improvement of ischemic symptoms after surgery. CONCLUSION: Headaches often persist or newly develop after revascularization surgery in MMD patients. Accompanying nausea or vomiting and occurrence upon awakening are characteristic features. Postoperative headache does not necessarily imply insufficient disease control.

Classification of pediatric headache cases referred to a neurology department.

BACKGROUND: Headaches are very common in children. The patients often have mild symptoms, but on occasion may have severe, secondary headaches. The present study aimed to clarify the details of children with headaches seen at the outpatient clinic of a pediatric neurological department. METHODS: The present, retrospective observational study was conducted at a tertiary pediatric hospital in Japan and enrolled children referred to the neurology department outpatient clinic for headache between April 2018 and March 2021. RESULTS: In total, 113 cases of headache were examined; of these, 99 (87.6%) were primary headaches, one case (0.9%) was a secondary headache, and 13 (11.5%) were unclassified or unspecified. There were 46 cases (40.7%) of tension-type headache (TTH), both confirmed and suspected, 30 cases (26.5%) of migraine, and 23 cases (20.4%) of a combination of the TTH and migraine. One case of secondary headache was attributed to an infection. Arachnoid cysts were found in seven patients (7.8%). Acute drug treatments were administered to 93 patients (82.3%), with acetaminophen being the most common drug, followed by ibuprofen. Prophylactic drug treatments were administered to 39 patients (34.5%), with goreisan (a Chinese herbal medicine containing Alisma orientale, Poria cocos, Polyporus umbellatus, Atractylodes lancea, and Cinnamomum cassia) being the most common (41%). CONCLUSIONS: Few cases of secondary headache and none of emergency headache were diagnosed. The prevalence of arachnoid cysts was higher than in the general pediatric population, suggesting that arachnoid cysts might be associated with headache.

A pilot analysis of headache disorders in breast cancer patients.

INTRODUCTION: The interaction between breast cancer and migraine is complex and not fully elucidated. Large epidemiological studies point towards a beneficial effect of migraines on breast cancer (BC). We aimed to investigate the BC-migraine relationship, with strict data checks and clinical evaluations of both BC and common headache forms. METHODS: Consecutive BC patients were evaluated with the International Classification of Headache Disorders. Clinical data on the BC subtypes and treatments were collected. Parametric and nonparametric statistics were used according to data distributions. RESULTS: Fifty patients were recruited. The mean age was 53.5 ± 12.5 years; 42% were postmenopausal, 52% were premenopausal, and 6% were peri-menopausal. Eleven patients were diagnosed as luminal A, nine as luminal B, 24 as HER2-positive (HER2 +), six as triple-negative BC. Thirty-eight (76%) patients had hormone receptor-positive disease. Ninety-two percent received chemotherapy, 66% received endocrine therapy, and 52% received radiotherapy. Nine out of 50 reported a worsening of headache after systemic treatment. Migraine was diagnosed in 29 patients (18 with menstrual migraine), tension-type headache (TTH) in nine, and no headache in 12. Patients with migraine were younger (48.4 ± 10.7 vs. 60.5 ± 12; p < 0.01). Patients with migraine and TTH had a higher chance of having a HER2 + BC (p < 0.05). Active migraine was associated with a higher expression of estrogen receptors (p = 0.04). CONCLUSIONS: Patients with active migraine had higher estrogen receptor expression, while migraine and TTH patients mainly had HER2 + BC. This association was not known earlier and could be helpful to understand deeper the relationship between BC and headache.

The Effect of Body Awareness Therapy on Pain, Fatigue and Health-related Quality of Life in Female Patients with Tension-type Headaches and Migraine

ABSTRACT Objective: To examine the effect of body awareness therapy on pain, fatigue and quality of life in women with tension-type headaches (TTH) and migraine. Methods: Socio-demographic features of patients who are included in the study were recorded. Visual analogue scale was used for pain and fatigue severity scale was used for fatigue, Nottingham health profile (NHP) was used for life quality related to health. Following the first evaluation, body awareness therapy (BAT) was applied to patients for six weeks per 60 minutes in three sessions. Results: Among patients with TTH, there was statistical difference between visual analogue scale, fatigue severity scale and total NHP score before and after BAT (p < 0.05). Among patients with migraine, there was statistical difference between total NHP score before and after BAT (p < 0.05). Conclusion: Body awareness therapy is an effective method that can be used in order to increase life quality related to health among female patients with TTH and migraine.

Constipation is associated with tension type headache in women / Constipação está associada à cefaleia do tipo tensional em mulheres

ABSTRACT Tension-type headaches (TTH) and irritable bowel syndrome (IBS) are comorbid diseases affecting, especially, women. One of the underlying mechanisms for both is autonomic dysfunction in the brain-gut axis. We aimed to evaluate the factors accompanying TTH and their relation to functional gastrointestinal disorders. Methods: Women diagnosed with TTH were questioned about headache pattern and severity, and accompanying factors, as well as being screened for IBS according to the Rome III criteria. The participants were divided into two groups: constipation-dominant IBS (IBS-C) group and "others", with a total of 115 individuals included in the study. Results: Of the 115 patients; 48 (41.8%) of the women had IBS-C criteria while 67 (58.2%) described mixed-type IBS or diarrhea-dominant IBS. There were no significant differences in terms of mean age (p = 0.290), body mass index (p = 0.212), visual analog scale (p = 0.965), duration of attacks (p = 0.692), and episodic/chronic type (p = 0.553). Osmophobia was seen in 43.5%; phonophobia in 68.7%, and photophobia in 47.0% of the patients, and only osmophobia was significantly associated in women in the IBS-C group (p = 0.001). Conclusion: In female patients with TTH, a higher level of constipation was detected. The relationship of these two diseases suggests that they may share common mechanisms. This is the first study showing the relationship of osmophobia with constipation.

RESUMO As cefaléias do tipo tensional (TTH) e a síndrome do intestino irritável (IBS) são comorbidades que afetam especialmente as mulheres. O mecanismo subjacente para ambas é a disfunção autonômica no eixo cérebro-intestino. Nosso objetivo foi avaliar os fatores que acompanham as TTH e sua relação com distúrbios gastrointestinais funcionais (FGID). Métodos: Mulheres com diagnóstico de TTH foram questionadas quanto ao padrão e gravidade da cefaleia, fatores acompanhantes e triadas para IBS de acordo com os critérios de Roma III e foram divididas em dois grupos: grupo com IBS com predominância de constipação (IBS-C) e as demais. Um total de 115 mulheres foram incluídas no estudo. Resultados: Do total de 115 pacientes; 48 (41,8%) das mulheres tiveram os critérios da IBS-C, enquanto 67 (58,2%) tiveram IBS do tipo misto ou IBS com predominância de diarreia. Não houve diferenças significativas em termos de idade média (p = 0,290), índice de massa corporal (IMC) (p = 0,212), escala visual analógica (VAS) (p = 0,965), duração dos ataques (p = 0,692), e tipo episódico / crônico (p = 0,553). Osmofobia foi observada em 43,5% das pacientes; fonofobia em 68,7% e fotofobia em 47,0%, e apenas osmofobia foi significativamente associada no grupo de mulheres com predominância de constipação (p = 0,001). Conclusão: Em pacientes do sexo feminino com TTH, encontra-se uma maior constipação. A relação dessas duas doenças sugere que elas podem compartilhar mecanismos comuns. Além disso, este é o primeiro estudo mostrando a relação da osmofobia com a constipação.

[Reversible cerebral vasoconstriction syndrome following smoking cessation and treatment with bupropion]. / Sindrome de vasoconstriccion cerebral reversible tras abandono de habito tabaquico y tratamiento con bupropion.

TITLE: Sindrome de vasoconstriccion cerebral reversible tras abandono de habito tabaquico y tratamiento con bupropion.

Fibromyalgia Among Patients With Chronic Migraine and Chronic Tension-Type Headache: A Multicenter Prospective Cross-Sectional Study.

OBJECTIVES: To investigate the frequency and impact of fibromyalgia among patients with chronic migraine (CM) and chronic tension-type headache (CTTH). BACKGROUND: Fibromyalgia (FM) is a common comorbidity in patients with chronic headaches. CM and CTTH are the two common types of chronic headaches. METHODS: We conducted a cross-sectional study in neurology outpatient clinics of four university hospitals and selected first-visit 136 patients with CM and 35 patients with CTTH. FM was assessed based on the 2010 American College of Rheumatology diagnostic criteria. RESULTS: The frequency of FM was significantly higher among patients with CM when compared to those with CTTH (91/136 [66.9%] vs 9/35 [25.7%], P < .001). Logistic regression analyses revealed an increased odds ratio (OR) for FM for patients with CM when compared to those with CTTH after adjustment for age, sex, anxiety, depression, and insomnia (OR = 3.6, 95% confidence interval = 1.1-11.4). Furthermore, CM patients with FM had higher scores in FM Impact Questionnaire compared to CTTH patients with FM (51.5 ± 16.3 vs 43.7 ± 18.7, P = .015). Comorbidity of FM was associated with increased frequency of photophobia, phonophobia, anxiety, depression, and insomnia among patients with CM. Such association was not noted among patients with CTTH. CONCLUSION: FM based on 2010 American College of Rheumatology diagnostic criteria was more prevalent among patients with CM than those with CTTH. Some clinical features and comorbidities of CM varied with the presence of FM.

Vitamin D Deficiency in Patients With Chronic Tension-Type Headache: A Case-Control Study.

OBJECTIVE: To see the interrelation between chronic tension-type headache (CTTH) and serum vitamin D levels. BACKGROUND: Several studies have suggested an association between chronic pain and vitamin D deficiency. Anecdotal evidence suggests that vitamin D deficiency may be associated with tension-type headache and migraine. METHODS: This case-control study was carried out to examine the association between CTTH and serum 25-hydroxy vitamin (25(OH) D) levels. One hundred consecutive adult (>18 years) patients with CTTH and 100 matched healthy controls were enrolled. RESULTS: The serum 25(OH) D levels were significantly lower in CTTH patients than in the controls (14.7 vs 27.4 ng/mL). The prevalence of vitamin D deficiency (serum 25 (OH) D < 20 ng/mL) was greater in patients with CTTH (71% vs 25%). CTTH patients had a significantly high prevalence of musculoskeletal pain (79% vs 57%), muscle weakness (29%vs 10%), muscle tenderness score (7.5 vs 1.9), and bone tenderness score (3.0 vs 0.8) in comparison to controls. CTTH patients with vitamin D deficient group (<20 ng/mL) had a higher prevalence of musculoskeletal pain (58% vs 31%), muscle weakness (38%vs 7%), muscle and bone tenderness score, associated fatigue (44% vs 17%) and more prolonged course (15.5 months vs 11.2 months). A strong positive correlation was noted between serum vitamin D levels and total muscle tenderness score (R2 = 0. 7365) and total bone tenderness score (R2 = 0. 6293). CONCLUSION: Decreased serum 25(OHD) concentration was associated with CTTH. Intervention studies are required to find out if supplementation of vitamin D is effective in patients with CTTH.

[Tension-type headache in ulcerative colitis]. / Tenziós típusú fejfájás és colitis ulcerosa.

BACKGROUND AND PURPOSE: Tension-type headache is a very common disease with a high socio-economic impact as its lifetime prevalence is 30-78% in the general population. The incidence of inflammatory bowel diseases is continuously rising. Limited data are accessible on quality of life in patients with surgically treated ulcerative colitis. The aim of our study is to examine quality of life, concerning headache, among patients who had undergone surgery due to ulcerative colitis. METHODS: Between 1 January 2005 and 1 March 2016, surgery was performed due to ulcerative colitis in 75 patients. During this retrospective analysis the average duration of the follow-up was 46 (1-124) months. The pre-sence of headache was evaluated by the use of Brief Illness Perception and Headache Questionnaires. RESULTS: Among the primary headache disorders (n=27), tension-type headache occurred in 19 (70.4%) cases, and 8 (29.6%) patients had migraine (without aura). Among tension-type headache cases 17 (89.5%) patients experienced episodic form and 2 (10.5%) suffered from chronic form. Patients with headache had obtained a significantly higher score on Brief Illness Perception Questionnaire. CONCLUSION: According to our study tension-type headache is common among patients with ulcerative colitis. This observation raises the question whether stress plays role in the pathogenesis of both diseases, which influences and worsens considerably quality of life. Neurological examination, psychological and psychiatric guidance are worth considering in patients with ulcerative colitis.

Alcohol use problems in migraine and tension-type headache / Consumo problematico de alcool na migranea e cefaleia do tipo tensional

Objective: The aim of this study was to assess alcohol use problems in patients with migraine and tension-type headache. Method: We evaluated 81 patients with migraine and 62 patients with tension-type headache. The identification of alcohol consumption problems was carried out with Alcohol Use Disorders Identification Test (AUDIT). Alcohol use problem was defined as an AUDIT score of 8 or above. The headache impact was calculated with headache impact test (HIT-6). Results: The proportions of alcohol use problem among patients with migraine and tension-type headache were 5.2% and 16.1%, respectively (P=0.044). The headache impact was significantly higher with migraine than with tension-type headache (P<0.0001). There was an inverse correlation between headache impact and AUDIT (P=0.043). Conclusions: Our results suggest that migraine patients are less prone to alcohol use problems than tension-type headache patients. One of the possible reasons is that migraine is associated with greater impact than tension-type headache. .

Objetivo: Este estudo avaliou o consumo problemático de álcool em pacientes com migrânea e em pacientes com cefaleia do tipo tensional. Método: Foram avaliados 81 pacientes com migrânea e 62 pacientes com cefaleia do tipo tensional. A avaliação do consumo de álcool foi realizada com o Teste para Identificação de Problemas Relacionados ao Uso de Álcool (AUDIT), sendo considerado consumo problemático quando o escore do AUDIT foi igual ou maior que 8. O impacto funcional da cefaleia foi avaliado pelo Teste de Impacto da Cefaleia (HIT-6). Resultados: As proporções de desordens relacionadas ao álcool entre pacientes com migrânea e cefaleia do tipo tensional foram 5,2% e 16,1%, respectivamente (P=0,044). O impacto funcional foi significativamente maior na migrânea que na cefaleia do tipo tensional (P<0,0001). Houve significativa correlação entre comprometimento funcional da cefaleia e os escores do AUDIT (P=0,043). Conclusões: Nossos resultados sugerem que pacientes com migrânea têm menor probabilidade de apresentar consumo problemático do álcool que pacientes com cefaleia do tipo tensional. Uma das possíveis explicações é que o impacto funcional da cefaleia é maior na migrânea que na cefaleia do tipo tensional. .

No todo es diversión: papiledema y montana rusa / Not everything is fun: papilledema and roller coaster

Presentamos el caso de una paciente de 30 años de edad previamente saludable, quien desarrolló luego de numerosos viajes en una montaña rusa un hematoma subdural espontáneo y un higroma contralateral. La estroma velocidad y despliegue de fuerza G, la sucesión de momentos de aceleración y desaceleración, los bruscos movimientos cefálicos con tironeo lateral del cerebro y el número de veces que permitió el viaje, constituyeron un riesgo significativo de ruptura de venas puente, siendo posible que las reiteradas caídas de una boya remolcada hayan constituido el último trauma y desencadenamiento final

We present the case of a 30-year-old previously healthy patient, who developed ofter numerous trips on a roller coaster a spontaneous hematoma subdural and a contralateral hygroma. Extreme speed and G-force deployment, the succession of moments of acceleration and deceleration, sudden cephalic movements with snarling side of the brain and the number of times that he repeated the trip, they constituted a significant risk of rupture of veins bridge, being possible that repeated falls from a towed buoy have produced the latest trauma and final trigger

Cerebral MRI and EEG studies in the initial management of pediatric headaches.

BACKGROUND AND STUDY PURPOSE: High resolution imaging modalities and electroencephalographic studies (EEG) are used in the assessment of children with headaches. We evaluated the role of cerebral MRI (cMRI) and EEG in the initial assessment of children with headache as the chief complaint of initial presentation. METHODS: A retrospective chart analysis was performed at a tertiary University Hospital. RESULTS: 209 patients were included in this study [mean age 11.3 years; male 91 (43.5%); female 118 (56.5%)]. The following types of headaches were seen: Unclassified headache: 23.4%; probable migraine 17.2%, migraine without aura 13.4%, complicated migraine 12.4%, migraine with aura 1.0%; tension-type 15.3%, and cluster headaches 0.5%, and secondary headaches 16.7%. In 93 children (44.5%) abnormal physical/neurological findings were noted (multiple entries possible). On cMRI studies the following findings were seen: Infection of sinuses (7.2%), pineal cysts (2.4%), arachnoidial cyst and Chiari malformation (1.9%), unspecified signal enhancement (1.0%), and pituitary enlargement, inflammatory lesion, angioma, cerebral ischaemia, and intra-cerebral cyst (each 0.5%). Electroencephalographic findings included both focal and generalised abnormal slowing (5.3%) and Spike-wave complexes (3.3%). CONCLUSIONS: Despite abnormal findings on neurological/physical examination in a substantial number of children with headaches, the yield of pathological cMRIs was low. The use of EEG recordings was not contributory to the diagnostic and therapeutic approach. More research is needed to better define those patients who are likely to have an intracranial pathology.

Causes of headache in patients with a primary diagnosis of sinus headache.

Headache is a common occurrence among the general population. Although the pain could be a symptom of acute sinusitis, chronic sinusitis is not considered as a usual cause of headache. In addition, autonomic-related symptoms in the sinonasal region may be associated with vascular pain. Confusion regarding these symptoms could lead to an incorrect diagnosis of sinusitis. A prospective cross-sectional study was conducted at two tertiary referral centers with residency programs in otorhinolaryngology, head and neck surgery and neurology. The study included 58 patients with a diagnosis of "sinus headache" made by a primary care physician. Exclusion criteria were as follows: previous diagnosis of migraine or tension-type headache; evidence of sinus infection during the past 6 months; and the presence of mucopurulent secretions. After comprehensive otorhinolaryngologic and neurologic evaluation, appropriate treatment was started according to the final diagnosis and the patient was assessed monthly for 6 months. The final diagnoses were migraine, tension-type headache and chronic sinusitis with recurrent acute episodes in 68, 27 and 5% of the patients, respectively. Recurrent antibiotic therapy was received by 73% of patients with tension-type headache and 66% with migraine. Sinus endoscopy was performed in 26% of the patients. Therapeutic nasal septoplasty was performed in 16% of the patients with a final diagnosis of migraine, and 13% with tension-type headache. Many patients with self-described or primary care physician labeled "sinus headache" have no sinonasal abnormalities. Instead, most of them meet the IHS criteria for migraine or tension-type headache.

Medication overuse as a cause of chronic headache in shunted hydrocephalus patients.

PURPOSE: To highlight the group of hydrocephalus patients known to have a long history of shunt revisions and refractory chronic headache. When a shunt in perfect working order has no effect on headache, other causes of headache should be investigated. In this paper, patients with medication overuse headache are identified and the positive effect of medication withdrawal are described. MATERIALS AND METHOD: Patients with hydrocephalus and shunt referred from the neurosurgical department to the Danish Headache Centre were identified. In all cases, over- and underdrainage was ruled out prior to referral. Six patients with medication overuse headache were documented and their charts were reviewed retrospectively with specific attention to: shunt revisions, inpatient and outpatient contacts, headache data and medication use before and after withdrawal of analgesic medication overuse. RESULTS: A marked reduction in shunt revisions and inpatient contacts in five out of six patients was found and a reduction in outpatient contacts in four out of six patients. Furthermore, an improvement in headache intensity was found in three out of six patients and a reduction in duration was found in two out of six patients. CONCLUSION: This study indicates that it is important to identify shunt patients with persistent chronic headache from causes other than shunt malfunction. By reducing their analgesic intake, it is possible to reduce headaches, the number of surgical interventions and hospital contacts. Hopefully this will raise awareness and lead to further research on the subject.

The relationship between idiopathic intracranial hypertension and obesity.

OBJECTIVE: Idiopathic intracranial hypertension (IIH) is usually considered to result from deficient intracranial absorption of cerebrospinal fluid, but has also been suggested to be caused by decreased cranial venous flow because of increased intrathoracic pressure resulting from intra-abdominal obesity. To test this hypothesis, cerebrospinal fluid pressure (Pcsf), extracranial venous pressure (Pvf), intracranial venous pressure, and body mass index (BMI) were studied in patients with IIH with papilledema compared with patients with chronic tension-type headache (CTTH). DESIGN AND SUBJECTS: The Pcsf and the pressures in frontal veins without (Pvf) and with bilateral compression of the supraorbital branch of the frontal veins and the superficial facial veins (Pvfc), the latter considered to be about equal to Pvfc, were studied in 10 consecutive patients with IIH with papilledema. Ten consecutive CTTH patients were used for controls. Orbital phlebography was performed to confirm that the compression of facial veins other than the frontal veins resulted in adequate communication between the frontal vein used for the studies and the cavernous sinus. RESULTS: Cerebrospinal fluid pressure was between 200 and 250 mm water in 5 of the CTTH patients and above 350 mm water in all IIH patients. Body mass index was >25 in all CTTH patients and similar in the 2 groups. Cerebrospinal fluid pressure was similar to Pvfc in all 10 CTTH patients but significantly greater in 6 of the 10 IIH patients. Pvf was similar in the 2 groups and related to BMI. CONCLUSIONS: Chronic tension-type headache patients may be prone to have Pcsf > 200 mm water and BMI > 25. Papilledema because of intracranial hypertension occurred in the present study at Pcsf > 350 mm water. The findings of Pvfc and Pcsf being similar in all CTTH patients support the suggestion that the techniques used for measuring intracranial venous pressure are adequate. The findings of similar BMI in the CTTH and the IIH patients who differed significantly as to Pcsf refute the hypothesis that obesity precedes, and is the cause of, intracranial hypertension in IIH. The difference between Pcsf and Pvfc in 6 of the IIH patients also does not support such a hypothesis but may indicate that IIH is due to deficient intracranial cerebrospinal fluid absorption. Since a relationship between intracranial hypertension and obesity is established and obesity is not found to cause intracranial hypertension in IIH, intracranial hypertension may be suggested to be the primary cause of weight increase in IIH. Obesity, however, may secondarily increase the preexistent IIH.

Prevalence of migraine, tension-type headache and trigeminal neuralgia in multiple sclerosis.

BACKGROUND: Prevalence rates of headache in multiple sclerosis (MS) patients varied widely in recent studies. This study aimed to investigate the 1 year prevalence of headache in MS compared with the general population. METHODS: Population-based case-control study in Germany. RESULTS: We included 491 patients with definite MS (68% female, mean age 45.3 years, 63.7% relapsing remitting MS, mean Expanded Disability Status Scale (EDSS) 3.2, 106 treated with interferon-beta, 53 with glatiramer acetate, 271 untreated) and 447 age and gender matched controls. Headache was diagnosed with a validated questionnaire according to the International Headache Society Criteria. Headache prevalence was 56.2% (tension type headache 37.2%, migraine 24.6%). Headache prevalence rates did not differ from controls. Headache was not associated with disability or treatment. Trigeminal neuralgia was found in 6.3% of MS cases. CONCLUSION: Results suggest that headache in MS patients reflects comorbidity in most conditions.

Review of pediatric migraine headaches refractory to medical management.

OBJECTIVE: The surgical treatment of migraine headache is a recent innovation that has broadened the potential patient population who may benefit from craniofacial surgical techniques to millions of affected adults. However, the population at risk in the pediatric age group has not been clearly established. The present retrospective review was performed to provide demographic information of the adolescent migraine in a major children's hospital. This information is essential before considering surgical treatment of migraine in this age group. METHODS: Five hundred eighty-eight charts of patients aged 12 to 18 years who presented to the pediatric neurology clinic with headache in 2006 were retrospectively reviewed to evaluate for the diagnosis of migraine. Data collected included headache location, frequency, duration, intensity, associated migraine symptoms, and headache precipitants, as well as the response to medical treatment. RESULTS: Two hundred ten (36%) of 588 patients had the diagnosis of migraine headache, and 51 patients (24%) were considered refractory to the medical treatment offered. In 101 of the 210 migraine patients, anatomic location of the headaches could be identified. Thirty-nine children (19%) with refractory migraines (mean age, 14.7 years [SD, 0.3 years]) reported definitive migraine triggers. CONCLUSIONS: A significant percentage of pediatric patients with migraine headache remain refractory to medical treatment. At present, there is no good treatment regimen for migraine headaches in the pediatric population. We believe that surgical treatment of migraine headaches may be a realistic option for these patients.

Cefaléia do tipo tensional episódica: avaliação clínica de 50 pacientes / Episodic tension-type headache: clinical evaluation of 50 patients

Com o objetivo de estudar os aspectos clínicos, a história familiar e o impacto da dor nas atividades laborativas, foi conduzido estudo de série de casos de 50 pacientes portadores de cefaléia do tipo tensional episódica (CTTE). Foram avaliados 40 mulheres e 10 homens, com idade média de 30 (±12) anos. Dor constrictiva esteve presente em 40 pacientes (80 por cento). O enjôo foi o principal fenômeno acompanhante (20 por cento). A dor bilateral predominou; entretanto, a localização unilateral também esteve presente (10 por cento). Embora classicamente descrita como uma dor leve, observou-se que a CTTE pode se manifestar como crises de forte intensidade (16 por cento). A história familiar foi positiva em 12 pacientes (24 por cento). O impacto nas atividades laborativas foi detectado em 14 por cento da amostra. Os achados a respeito das características da dor estão de acordo com a literatura. O impacto representado pela CTTE a nível individual e na sociedade deve, entretanto, ser reconsiderado.

Tension-type headache and fibromyalgia: what's common, what's different?

Chronic tension-type headache and fibromyalgia have striking clinical and pathophysiologic similarities. They can be associated in patients. In both conditions there is evidence of altered processing of peripheral nociceptive information. Peripheral sensitisation of musculotendinous nociceptors may play a role and, at least in chronic tension-type headache, there are indications of central sensitisation. As for the clinical presentation, there also pathophysiological differences between the two disorders. A better understanding of both these differences and similarities may hopefully help in the future management of patients.