Are repetitive pericranial nerve blocks effective in the management of chronic paroxysmal hemicrania?: A case report.

INTRODUCTION: Paroxysmal hemicrania (PH) is a chronic headache disorder characterized by unilateral pain attacks accompanied by cranial autonomic symptoms and responds to indomethacin completely. There are few alternative treatment options for the patients who cannot tolerate indomethacin. Studies exploring the effects of repetitive peripheral cranial nerve blocks in the management of chronic PH are limited. PATIENT CONCERNS AND DIAGNOSIS: A 34-year-old woman with a 4-year history of PH was evaluated. Her pain was prevented by indomethacin without side effects; however, she wanted to try to conceive. INTERVENTIONS: Repetitive pericranial nerve blocks, great occipital nerve, infraorbital nerve, supraorbital nerve, and sphenopalatine ganglion block, using local anesthetics and steroids were performed once a week for a 6 weeks period. OUTCOMES: A follow-up of 3 months showed that there was no pain relief following the injections and patient was needed to be maintained on indomethacin. CONCLUSION: Although pericranial nerve blocks have been tried in chronic PH cases with positive influences, this case indicated that repetitive nerve blocks were not always a successful therapy option.

Hemicrania Continua-Like Headache Related to Transdermal Nitroglycerine Therapy.

Several cases of symptomatic hemicrania continua (HC) have been reported. A 66-year-old man, suffering from migraine without aura, presented with a four month history of a new headache fulfilling the ICHD 3beta clinical criteria for HC. HC onset was strictly related to the use of transdermal nitroglycerine patch (TNP). In agreement with the cardiologist, TNP was discontinued and the headache promptly disappeared; symptoms reappeared within 6-12 hours after nitroglycerine reintroduction. After permanent discontinuation of TNP, headache disappeared at one year follow-up. To the best of our knowledge, this is the first report of the occurrence of an HC-like headache related to TNP.

Side-locked headaches: an algorithm-based approach.

The differential diagnosis of strictly unilateral hemicranial pain includes a large number of primary and secondary headaches and cranial neuropathies. It may arise from both intracranial and extracranial structures such as cranium, neck, vessels, eyes, ears, nose, sinuses, teeth, mouth, and the other facial or cervical structure. Available data suggest that about two-third patients with side-locked headache visiting neurology or headache clinics have primary headaches. Other one-third will have either secondary headaches or neuralgias. Many of these hemicranial pain syndromes have overlapping presentations. Primary headache disorders may spread to involve the face and / or neck. Even various intracranial and extracranial pathologies may have similar overlapping presentations. Patients may present to a variety of clinicians, including headache experts, dentists, otolaryngologists, ophthalmologist, psychiatrists, and physiotherapists. Unfortunately, there is not uniform approach for such patients and diagnostic ambiguity is frequently encountered in clinical practice.Herein, we review the differential diagnoses of side-locked headaches and provide an algorithm based approach for patients presenting with side-locked headaches. Side-locked headache is itself a red flag. So, the first priority should be to rule out secondary headaches. A comprehensive history and thorough examinations will help one to formulate an algorithm to rule out or confirm secondary side-locked headaches. The diagnoses of most secondary side-locked headaches are largely investigations dependent. Therefore, each suspected secondary headache should be subjected for appropriate investigations or referral. The diagnostic approach of primary side-locked headache starts once one rule out all the possible secondary headaches. We have discussed an algorithmic approach for both secondary and primary side-locked headaches.

[Trigeminal autonomic cephalgias].

Review of literature on the trigeminal autonomic cephalgias are presented. Trigeminal autonomic cephalgias are primary headaches with phenotype consisting of trigeminal pain with autonomic sign including lacrimation, rhinorrhea and miosis. Discussed are issues of classification, pathogenesis, clinical picture, diagnosis, differential diagnosis and treatment of this headache. Special attention is paid to cluster headache, paroxysmal hemicrania, SUNCT syndrome, hemicrania continua.

Concomitant occurrence of different trigeminal autonomic cephalalgias: a case series and review of the literature.

INTRODUCTION: The trigeminal autonomic cephalalgias (TACs) subsume four primary headache disorders. Hemicrania continua is increasingly regarded as an additional TAC. In rare cases patients may present with two different TACs or a TAC and hemicrania continua. CASES: We report four patients with two different TACs or one TAC and hemicrania continua. Two patients presented with cluster headache and paroxysmal hemicrania, one patient with cluster headache and hemicrania continua, and one patient suffered from cluster headache and SUNCT. DISCUSSION: While the International Classification of Headache Disorders (ICHD-II) proposes specific diagnostic criteria, the variability of clinical presentation may make clear diagnosis difficult. All patients fulfilled the ICHD-II criteria. The manifestation of two different TACs or hemicrania continua in one patient is uncommon but possible and should be taken into account especially when chronic headache patients present with changing headache symptoms.

Cefalea y sueño / No disponible

Introducción: la relación entre cefalea y sueño es conocida desde hace muchos años. El sueño y la cefalea tienen una fuerte interacción bidireccional, y comparten elementos anatómicos y fisiológicos. La intención de la presente revisión es presentar los distintos tipos de cefaleas relacionadas con el sueño y su aproximación fisiopatológica. Desarrollo: exponemos los distintos tipos de cefaleas relacionadas con el sueño, es decir aquellas que ocurren durante la noche o en las primeras horas de la mañana, la migraña, la cefalea en racimo, la hemicránea crónica paroxística y la cefalea hípnica. También, desarrollamos el síndrome de la cabeza que explota o síndrome del estallido cefálico, puesto que en la práctica clínica debe ser valorado en el diagnóstico diferencial de las cefaleas relacionadas con el sueño. Conclusión: se necesita una mayor investigación en el tema para establecer conclusiones, esclarecer los mecanismos fisiopatológicos entre cefalea y sueño, así como entender cómo los cambios en la biología del sueño provocan dolor de cabeza y por qué los distintos tipos de cefaleas afectan a la biología del sueño (AU)

Introduction: the link between cephalalgia and sleep has been known for many years. Sleep and cephalalgia have a strong bidirectional interaction and share anatomical and physiological aspects. The intention of this paper is to present the different types of cephalalgias related with sleep and their physiopathological closeness. Discussion: different types of cephalalgia related with sleep will be exposed. That is, cephalalgia that occurs at night time or first time in the morning: migraine, cluster headache, chronic hemicrania continua and hypnic headaches. We also review the exploding head syndrome since it should be assessed in differential diagnosis when looking at sleep-related cephalalgias. Conclusions: further research is needed on this subject in order to establish conclusions, to clarify physiopathological mechanisms between cephalalgia and sleep and to understand how changes in sleep biology cause headaches and why different types of cephalalgias affect sleep biology (AU)

Hemicrania continua in a patient with concomitant dental disease.

BACKGROUND: There are nonodontogenic headache disorders that mimic dental pain. One such headache disorder is hemicrania continua (HC). HC is a primary headache syndrome characterized by a continuous, unilateral headache that is completely responsive to indomethacin. Patients may have signs and symptoms that the dentist should differentiate from odontogenic pain and temporomandibular disorders. These symptoms can make the diagnostic process a challenge for dentists if patients' pain has multiple causes. Dentists, thus, must have thorough knowledge of odontogenic and nonodontogenic causes of pain so they can make accurate diagnoses and prepare treatment plans. CASE DESCRIPTION: The authors describe the case of a 41-year-old woman with a six-year history of continuous headaches and a one-year history of temporomandibular dysfunction and odontogenic pain. She sought treatment from a number of dentists and received a diagnosis of right-side facial pain and headache on the basis of the results of clinical and radiologic examinations, which was followed by dental treatment. She did not experience any pain relief. Additional results of our examination led to a diagnosis of HC. CLINICAL IMPLICATIONS: Dentists must consider headache disorders in patients who have continuous headaches after undergoing dental treatment for odontogenic pain.

A case of strictly unilateral migraine without aura transformed in an episodic hemicrania continua.

According to the diagnostic criteria of International Headache Society classification, hemicrania continua is a strictly unilateral continuous headache of moderate intensity with painful exacerbations associated with ipsilateral autonomic signs without pain-free periods. We report a case of a 42-year-old woman suffered of a remitting form of hemicrania continua evolved from a strictly unilateral migraine without aura.

Paroxysmal hemicrania with visual aura in a 17-year-old boy.

We report the case of a 17-year-old boy presenting with a history of recurrent episodes of isolated visual aura later followed infrequently by indomethacin-responsive headache attacks resembling paroxysmal hemicrania.

Coexistence of cluster headache and paroxysmal hemicrania: does it exist? A case report and literature review.

The coexistence of different types of trigeminal autonomic cephalalgias is a rare phenomenon. The two different types of headache may occur either at two different periods or simultaneously at the same time. We report a 22-year-old male who had cluster headache (CH) and chronic paroxysmal hemicrania (CPH) since the onset of symptoms. Both types of headache responded to indomethacin. Review of the literature suggests that simultaneous occurrence of CH and CPH in a patient may be both over and under reported.

Coexistence of TACS and trigeminal neuralgia: pathophysiological conjectures.

BACKGROUND: Trigeminal autonomic cephalgias (TACs) and trigeminal neuralgia are short-lasting unilateral primary headaches whose study is providing insights into craniofacial pain mechanisms. We report on 2 patients in whom trigeminal neuralgia coexists with the TACs paroxysmal hemicrania and SUNCT. CONCLUSION: Coexistence of trigeminal neuralgia with various TAC forms suggests a pathophysiological relationship between these short-lasting unilateral headaches.

Side-shifting hemicrania continua with aura (migraine with aura with autonomic symptoms responsive to indomethacin?).

Atypical features of hemicrania continua (HC), including both visual aura and side shifting, have been reported previously. However, auras and variable unilaterality have never been reported together in HC. We report two patients with side-shifting HC with aura. These patients' symptoms are unilateral headaches, visual aura, autonomic features, throbbing pain, nausea and photo/phonophobia. One could speculate that the unilaterality and/or the autonomic symptom modules are indomethacin responsive. The patients can also be classified as chronic migraine with aura, with autonomic symptoms, responsive to indomethacin. Neither migraine subtype nor side-shifting HC with aura is included in the current International Headache Society (IHS) classification, so these patients are not classifiable. Side-shifting HC with aura implies the need to revisit the traditional IHS categorization of headaches into unique diagnostic groups. The modular headache theory may be a tool for the understanding of these rare and complex cases.

Chronic paroxysmal hemicrania presenting as recurrent orbital inflammation.

Patients with chronic headache associated with ocular symptoms regularly seek ophthalmologists' opinions. We report an unusual case of chronic paroxysmal hemicrania (CPH), a rare but well-described variant of cluster headache in a female presenting to an eye department with recurrent episodes of severe unilateral periorbital swelling with a chronic history of headaches. Clinical features, review of literature, and therapeutic response to indomethacin helped to establish the diagnosis as CPH. This is the first report of severe orbital inflammation with CPH to our knowledge.