New appendix criteria open for a broader concept of chronic migraine.

After the introduction of chronic migraine and medication overuse headache as diagnostic entities in The International Classification of Headache Disorders, Second Edition, ICHD-2, it has been shown that very few patients fit into the diagnostic criteria for chronic migraine (CM). The system of being able to use CM and the medication overuse headache (MOH) diagnosis only after discontinuation of overuse has proven highly unpractical and new data have suggested a much more liberal use of these diagnoses. The International Headache Classification Committee has, therefore, worked out the more inclusive criteria for CM and MOH presented in this paper. These criteria are included in the appendix of ICHD-2 and are meant primarily for further scientific evaluation but may be used already now for inclusion into drug trials, etc. It is now recommended that the MOH diagnosis should no longer request improvement after discontinuation of medication overuse but should be given to patients if they have a primary headache plus ongoing medication overuse. The latter is defined as previously, i.e. 10 days or more of intake of triptans, ergot alkaloids mixed analgesics or opioids and 15 days or more of analgesics/NSAIDs or the combined use of more than one substance. If these new criteria for CM and MOH prove useful in future testing, the plan is to include them in a future revised version of ICHD-2.

The Babinski sign.

Babinski's life and the story of the Babinski sign are summarised. The physiological basis of the sign is discussed.

Global impact of Danish headache research.

Over the past 40 years, Denmark has established a world reputation for the comprehensive nature and excellence of its headache research. Advances have been made in epidemiology, genetics, pathophysiology and treatment across the whole spectrum of headache entities. Moreover, the IHS classification of headache, the guidelines for clinical trials and text books on the basic mechanisms and management of headaches were initiated from Denmark. These achievements are a tribute to all those who have participated and to the continuing leadership of Jes Olesen.

Ophthalmoplegic migraine: a recurrent demyelinating neuropathy?

The demonstration by magnetic resonance imaging (MRI) scanning of thickening and enhancement of the cisternal part of the oculomotor nerve in patients diagnosed as "ophthalmoplegic migraine" prompts reconsideration of this uncommon disorder. The case histories of five patients, three male and two female, varying in age from 6 to 30 years, are presented here. Recurrent painful ophthalmoplegia started in infancy in two cases, childhood in two instances and adult life in one. One child had his first attacks at 3, 5 and 12 months of age, on each occasion 10 days after an injection of triple vaccine. The possibility of this condition being a recurrent demyelinating neuropathy is considered and its possible relationship to migraine explored.

Headache and face pain.

A systematic case history is the primary diagnostic tool for headache problems. An acute ("thunderclap") headache or progressive subacute headache may have sinister implications and warrants urgent investigation. Common recurrent headaches (tension-type, migraine and cluster headaches) are not life-threatening but can destroy the enjoyment of life. Specific medications are available for acute treatment and prophylaxis for most types of recurrent headache. General practitioners should be well informed about management, as they are the most appropriate people to deal with most headache patients.

An akinetic-rigid syndrome, depression, and stereotypies in a young man.

A young man is presented who developed an akinetic-rigid syndrome shortly after a minor illness. Rituals and stereoptypies were prominent. At its most severe he was unable to feed himself. There was no response to L-dopa/cardopa treatment. A course of ECT was followed by a marked improvement in his condition. Attempts to stop ECT for more than a week have led to recurrence of his bradykinesia.

Unilateral exertional headache as a symptom of cardiac ischemia.

A 62-year-old man developed right frontal headache after mild exercise, relieved promptly by rest. Treadmill exercise (stress testing) demonstrated ST depression on the electrocardiogram as the headache appeared. The exertional headaches were cured by coronary bypass surgery. Possible mechanisms for this unusual pain referral pattern are discussed.

The red ear syndrome.

The complaint of a painful, burning, red ear may be associated with irritation of the third cervical root, temporomandibular joint dysfunction, or thalamic syndrome. It may also occur without obvious structural cause in response to touch or heat. The condition may be an example of the ABC (Angry Back-firing C-nociceptor) syndrome with the increase in ear temperature being caused by the antidromic release of vasodilator peptides.

Transient sensations of impending loss of consciousness: the "blip" syndrome.

Momentary sensations of impending loss of consciousness may occur, particularly when a person is relaxed, without any obvious cardiac, cerebral vascular, or epileptic basis. These episodes may be a quasiepileptic phenomenon such as déjà vu and night starts and seem to have a benign prognosis.