Precisión de la prueba diagnóstica de acentuación de la cefalea mediante sacudidas cefálicas para el diagnóstico de meningitis aguda en urgencias / Diagnostic test accuracy of jolt accentuation for headache in acute meningitis in the emergency setting

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

Introducción: La cefalea produce un impacto negativo sobre la calidad de vida de los jóvenes. Nuestro objetivo es analizar las características de esta población en una consulta monográfica de cefaleas (CMC) y evaluar la carga de las diferentes cefaleas codificadas según la Clasificación Internacional de Cefaleas (CIC). Métodos: Durante un período de 6 años y medio, se han registrado los pacientes de edades entre los 14 y los 25 años atendidos en la CMC recogiendo de cada uno de ellos el sexo, pruebas complementarias y tratamiento utilizado previamente. Se llevó a cabo la comparación de las características de esta población con la de mayores de 25 años. Resultados: Seiscientos cincuenta y un pacientes de entre 14 y 25 años fueron atendidos durante el período de inclusión; el 95,6% había recibido tratamiento sintomático y el 30,1% tratamiento preventivo. Setecientas cincuenta y cinco cefaleas fueron registradas, 80 fueron cefaleas secundarias, la mayoría codificadas en el grupo 8. El 77,2% de ellas fueron incluidas en el grupo 1, el 3,1% en el grupo 2, el 1,2% en el grupo 3 y el 5% en el grupo 4. El 0,6% de ellas fueron clasificadas en el grupo 13 y el 0,9% en el grupo 14. En 449 pacientes la puntuación del Headache Impact Test (HIT-6) mostró al menos un impacto moderado sobre la calidad de vida. Conclusión: La mayoría de las cefaleas en jóvenes podrían ser codificadas de acuerdo con los criterios de la CIC. La migraña fue el diagnóstico más frecuente. Aunque la cefalea fue comúnmente asociada con impacto negativo en la calidad de vida, los tratamientos preventivos no fueron utilizados extensamente antes de ser derivados a la CMC

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

Angina de Prinzmetal en el aura de la migraña que se resuelve con la cefalea / Prinzmetal angina in the migraine's aura resolving with headache

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Thunderclap headache with orgasm: a case of basilar artery dissection associated with sexual intercourse.

BACKGROUND: Headaches associated with sexual intercourse (coital cephalgia) have many different causes and are often divided in the literature into pre-orgasmic and orgasmic headaches. OBJECTIVE: To present a case of orgasmic headache caused by a basilar artery dissection and to present a literature-based guide to the diagnosis and management of patients presenting with headaches related to sexual activity. CASE REPORT: We report the case of a 34-year-old man without significant past medical history who presented to the Emergency Department with two episodes of orgasmic headache caused by basilar artery dissection. CONCLUSIONS: The cause of headaches related to sexual activity range from the benign to the life-threatening. Due to the dynamics of cerebral blood flow during sexual intercourse, basilar artery dissections and aneurysms should be considered in patients with sudden-onset headaches during orgasm. Appropriate brain imaging and, possibly, lumbar puncture may assist in identifying potentially life-threatening causes of coital headaches.

[Relationship between lupus headache and headache due to internal injury in traditional Chinese medicine].

In 1999, the nomenclature and case definitions for neuropsychiatric lupus syndromes were published by American College of Rheumatology (ACR), and the cognition of neuropsychiatric damage of systemic lupus erythematosus (SLE) was gradually unified and standardized. Lupus headache is an intractable problem in SLE, especially in SLE patients complicated with multiple organ injury. In general, vascular headache is common in most SLE patients, and a small number of SLE patients complicated with nervous headache are found in clinic. Moreover, its pathophysiological mechanism is far from being understood. Although early diagnosis is essential for good outcomes, the diagnosis method is rather confused in the world. There still exist some limitations in the proposal of clinical classification of headache from ACR and International Headache Society (IHS), and the proposal does not mention the classification of headache related to psychiatric damage. Current therapeutic regimens are almost exclusively based on empirical evidence. Treatment approaches include symptomatic treatment, immunosuppressive, anticoagulant and anti-aggregant therapies. It provides enormous and hopeful space in research of combined therapy strategy, especially in the field of traditional Chinese medicine. The authors discussed the relationship between lupus headache and headache due to internal injury in the view of integrated traditional Chinese and Western medicine, and suggested that the treatment strategy for lupus headache should be made in argument with the headache due to internal injury. Syndrome differentiation treatment according to deficiency in the root and excess in the branch and the therapy for activating blood to dredge collaterals maybe have great advantages in treatment of the headache in SLE.

Duloxetina en el tratamiento de los síntomas somáticos dolorosos asociados a la depresión / Duloxetine in the treatment of somatic pain symptoms associated with depression

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Central nervous system vasculitis.

PURPOSE OF REVIEW: In the past decade, primary and secondary central nervous system (CNS) vasculitides have been more commonly diagnosed and recognized than previously. With the increasing awareness of these disorders, it is crucial for the treating physician to differentiate between causes of CNS vasculitis and to recognize their marked clinical and pathophysiological heterogeneity. This review focuses on the major forms of primary CNS vasculitis, as well as secondary CNS vasculitis with emphasis on their clinical findings, diagnoses, and treatment. RECENT FINDINGS: The proposal of reversible cerebral vasoconstriction syndromes (RCVS) as a unifying concept for a group of disorders which are characterized by acute-onset severe recurrent headaches, with or without additional neurologic signs and symptoms, and prolonged but reversible vasoconstriction of the cerebral arteries, has been a major breakthrough in this field over the past decade. Recognition of this common mimic (i.e. RCVS) has allowed optimal management of a sizable group of patients previously confused with pathologically documented CNS vasculitis. SUMMARY: Sound treatment decisions are based on accurate diagnosis. It is essential for the clinicians involved in the evaluation of patients with CNS vasculitis to be aware of its mimics especially RCVS. This article provides a comprehensive review of CNS vasculitis and its differential diagnosis. Furthermore, it touches upon workup and treatment of CNS vasculitis.

[Trigeminal autonomic headache, hemicrania continua and hypnic headache. A review of rare primary headache forms]. / Trigeminoautonome Kopfschmerzen, Hemicrania continua und Hypnic Headache. Ein Uberblick über die seltenen primären Kopfschmerzformen.

Tension-type headache and migraine are the most common types of primary headaches. Apart from these well known diseases, the group of primary headaches includes other relatively rare headache disorders. Some of these seldom syndromes have been described for the first time within the last twenty years and have been newly included in the revised IHS classification from 2004. Their typical symptomatic is less known, but offers an excellent opportunity to diagnose these syndromes. The importance of recognising these disorders is underlined by the fact, that rare primary headaches response often complete and rapid to a specific treatment. This review summarizes the current knowledge on the clinical presentation and treatment of cluster headache, paroxysmal hemicrania, SUNCT syndrome, hemicrania continua and hypnic headache.

Trombose venosa cerebral extensa - relato de caso / Extensive cerebral venous thrombosis - case report

A trombose venosa cerebral é uma doença vascular pouco freqüente, com múltiplas manifestações clínicas e distintas etiologias. Tem sido diagnosticada mais freqüentemente nas últimas décadas devido à melhora na qualidade dos exames de neuroimagem. O diagnóstico precoce é crucial e deve ser sempre considerado por clínicos e neurologistas. Relatamos o caso de uma jovem de 23 anos com quadro de cefaléia frontal, pulsátil, intensa, com irradiação holocraniana, associada à vômitos e sonolência, que teve seu diagnóstico firmado por investigação neurorradiológica. O presente relato discute aspectos relevantes da apresentação clínica, diagnóstico, tratamento, manejo clínico e prognóstico desta condição

A dental perspective on headache.

Patients complaining of pain in tooth bearing regions of the oral cavity may be suffering from a disorder unrelated to pulpal pathology. Unnecessary dental procedures may complicate the diagnosis and aggravate the underlying disorder. Referral of pain to the oral cavity and teeth may easily be explained by the extensive neurological connections of the trigeminal brain stem complex with other cranial nerves and input from the upper segment of the cervical spine. Accurate diagnosis of painful disorders can be a complex and time consuming process. The primary responsibility of the dentist in this scenario is to rule out the possibility of odontogenic pain.

[Headache in the elderly]. / Alter Patient mit neu aufgetretenem Kopfschmerz. Stellen Sie keine Diagnose ohne Labor und CT!

Although the elderly generally suffer less often from headache, symptomatic headache and concomitant diseases are more frequent. For the diagnostic work-up of newly occurring headaches in old age, imaging examinations of the head (CT or MRI), together with laboratory investigations are necessary. The treatment of symptomatic headache is oriented to the underlying disease, and should be applied promptly, with the aim of preventing serious complications. When considering the management strategy, account must be taken of possible changes in pharmacokinetics, pharmacodynamics and the therapeutic response in the elderly. Numerous medications often cause headache or other side effects in patients of advanced age. Most antiheadache drugs have not been adequately been investigated in the group of over 65-year-olds. This means that drug treatment for headache is often applied in accordance with the principle: start low, go slow.