Cluster headache variant. Spectrum of a new headache syndrome.

The syndrome of cluster headache variant is characterized by the occurrence of three combined symptoms: atypical cluster headaches, multiple jabs, and background vascular headaches. Atypical cluster headaches are localized headaches that occur several times daily, usually without any headache-free periods. They differ from the typical chronic cluster headache in their location, duration, frequent shifting, and frequency. Multiple jabs are short-lasting, sharp pains of variable severity and location. Background vascular headache is a chronic, continuous often unilateral headache of variable severity that throbs at rest or begins to throb during exertion. We have studied 54 patients between the ages of 14 and 78 years (average age, 40.5 years). Forty-five (83%) patients responded to indomethacin. Complete control was achieved in 50% of the patients. The nine patients who did not respond to indomethacin were depressed. These nine patients responded well to tricyclic antidepressants.

[Spontaneous carotid cavernous fistula in a case of hereditary hemorrhagic telangiectasia (Osler-Rendu) (author's transl)]. / Spontane Carotis-cavernosus-Fistel bei Morbus Osler-Rendu (Teleangiektasia hereditaria)

A 37-year-old woman suffered from headaches, right facial pain, double vision and occasional tinnitus. On examination there was only a slightly dilated right pupil, weakened corneal reflex and capillary bleeding from telangiectasia of both hands. Similar bleedings occured in her mother (mouth and hands) and son (nose). The arteriography of the right carotid artery showed a cavernous sinus fistula with a small shunt. Steady compression of the carotid artery by hand caused a marked improvement in the subjective symptomatology.

Does anisocoria by clonidine reflect a central sympathetic dysfunction in cluster headache?

Local pharmacological manipulations of both pupils in persons with cluster headache (CH) have shown a reduced pain-side sympathetic activity. It is difficult to determine if this sympathetic defect is localized in the nuclei of the CNS and/or in peripheral neurons that innervate the pupil. This study demonstrates that in a CH group 2% tyramine (an intraneuronal norepinephrine releaser) instillation into both eyes induces an asymmetric and bilateral mydriasis with the onset of anisocoria characterized by a pupillary diameter being less on the pain-side eye. In addition, intravenous administration of 0.10 mg clonidine, an inhibitor of central sympathetic activity, causes a bilateral miotic response, which is more marked on the pain-side eye. In a healthy control group, clonidine induces a symmetric and bilateral miosis but less intense than that observed in both eyes of CH sufferers. In CH patients, pretreatment with clonidine augments the degree of anisocoria induced by tyramine instillation, increasing the mydriatic response only in the pain-free-side pupil. The hypothesis of a permanent sympathetic defect of the pain-side pupil expressing itself as a reduced sympathetic tone of CNS nuclei and peripheral neurons that innervate the pupil is proposed.

Neuro-ophthalmic complications of migraine and cluster headaches.

The neuro-ophthalmic complications of migraine and migraine treatment, the various modes of presentation of these complications, possible mechanisms, and therapy are discussed.

Focal vascular headaches with focal arterial disease. An ultrasonographic analysis.

The relationship between migraine and premature stroke and heart disease has been firmly established in the literature. The probable mechanism relates to release of vasoactive agents locally that produce intimal changes and if chronic may lead to permanent changes to the artery. We have attempted to identify individuals at risk for premature stroke utilizing the highly accurate B-mode real time carotid ultrasonogram. Sixteen patients demonstrated varying degrees of focal dilatation or plaque disease and 44% had abnormal Doppler flow studies. Since many of these patients were asymptomatic during the examination it is suggested that vascular changes may be more persistent than were previously suspected. These plaques, in the setting of increased platelet aggregability may be responsible for the augmented risk of stroke. Precise identification of these individuals can be easily accomplished with B-mode real time scanning (High resolution), and will allow for safe followup if specific dietary or drug interventions are contemplated.

Orofacial pain with vascular-type features.

OBJECTIVE: To examine whether a classifiable primary vascular-type craniofacial pain subgroup exists that predominantly affects intraoral structures. STUDY DESIGN: Fifty-five patients were chosen prospectively according to the following inclusion criteria; periodic craniofacial pain that was unilateral, pulsatile, severe, and that may wake the patient from sleep. Accompanying phenomena could include local autonomic and/or systemic signs. Twenty-six cases could be further classified into one of the categories of vascular craniofacial pain. The remaining 29, all with predominantly intraoral pain, were not readily classifiable. RESULTS: Of the 29 patients 70% were women, with an average onset-age of 42.6 years. All reported severe, episodic pain that was usually unilateral and lasted minutes to hours. In all, 55% of patients had autonomic or systemic signs, 48% had pulsatile pain, and 35.4% of patients were awakened by the pain. CONCLUSION: Although clinical similarities were observed within these patients, further studies are needed to confirm vascular orofacial pain as a clear diagnostic category.

Headaches in the athlete.

Headache is one of the most common entities to affect mankind. In addition to headaches seen in the general population, there are numerous types of headaches that are related to physical activity and sports. This article discusses the mechanism, presentation, evaluation, treatment, and prevention of the most common causes of headache in the athlete.

Cluster headache with trigeminal neuralgia. An uncommon association that may be more than coincidental.

Cluster headache and trigeminal neuralgia (tic douloureux) share a common pattern of exacerbation and remission of pain that is described in similar terms by patients. Although the treatment of these conditions is markedly different, the results of adequate prophylaxis can be extremely impressive in both. The physician who treats headache patients should be aware of the common characteristics of each condition and of the possibility of their concomitant occurrence.

Chronic facial pain.

The diagnosis of the cause of facial pain can be made clinically in the great majority of cases, if the physician is aware of the gamut of manifestations of the various disorders which may produce the symptom. Therapeutic tests are sometimes helpful in diagnosis, but extensive ancillary investigation often is unnecessary. The management of facial pain is one area of medicine in which the knowledgeable clinician can more than hold his own with the contemporary proliferation of specialized investigational tools.

["Cluster-tic syndrome" with a report of our case]. / Zespól "cluster-tic" z opisem wlasnego przypadku.

The author describes a case with elements of trigeminal neuralgia coexistent with Horton's headaches, with predominance of the latter ones. For this syndrome the author proposes the name "cluster-tic". In the pathogenesis of headache attacks of Horton's type and neuralgia of the V nerve the mediation of neurotransmitters and the nosological position of the described syndrome are discussed.

[Modified acupuncture in the treatment of pain]. / Igloterapia w zwalczaniu bólu.

The authors report the results of treatment with a modification of acupuncture associated with chemical stimulation in 144 patients with painful radicular syndromes and headaches. In 57 cases sciatic pains were present, in 21 cases shoulder pains, in 20 migraine and in 46 vasomotor headaches. Permanent disappearance of pain, that is disappearance of pain during the procedure and lack of recurrence within several successive days, was obtained in about 40% of cases of radicular syndromes and in 62% of cases of headaches, early disappearance of pain for 3 to 48 hours after the procedure was obtained in 14% of radicular syndromes and nearly 26% headaches, while improvement, that is reduction of pain intensity, was achieved in 29.5% of radicular pains and 3% of headaches, while in 15.3% of cases of radicular syndromes and 9% of cases of headaches no improvement was observed. Both vasomotor headaches and neuralgias belong to the group of nervous system diseases in which pain is the basic and sole symptom, while treatment includes its removal. In these cases acupuncture is a valuable analgesic method. The presently reported results agree with those in the literature on the use of classical acupuncture and its modifications. It is worth stressing that insertion of needles into the traditional points used in classical acupuncture is without any greater importance was shown by the presently reported experiences (various points were used in the same case) as well as by the reports of other authors. The modification of acupuncture with addition of chemical stimulation has been tried by the authors for 4 years. A weak stimulus resulting from insertion of the needle and irritation of the nerve endings with concentrated sodium chloride acts similarly as mechanical or electrical irritation. The method is simple and completely safe.

Aura with non-migraine headache.

The typical aura associated with migraine is characterized by visual or sensory and speech symptoms, with a mix of positive and negative features and complete reversibility within 1 hour. However, auras are not an exclusive migraine-dependent phenomenon. There have been descriptions of aura occurring in association with cluster headache, hemicrania continua, and even with chronic paroxysmal hemicrania. In addition, the occurrence of aura without headache or followed by a headache resembling the criteria of tension-type headache is encountered in clinical practice. This paper reviews the literature about auras in non-migraine headaches and the features involving this uncommon presentation. The possibility of a specific genetic origin for the auras, not related to the primary headache type, also is raised.