[Role of arterial hypertension in comorbidity of chronic headaches]. / El papel de la hipertensión arterial en la comorbilidad de las cefaleas crónicas.

INTRODUCTION: The literature concerning the association between headache and arterial hypertension is very scarce, mostly prior to the actual IHS classification and based on very diverse methods, being therefore difficult to interpret. OBJECTIVES: To analyse the association between arterial hypertension and two types of chronic headache and to determine, if and how arterial hypertension may affect the outcome of prophylactic therapy for chronic headaches. PATIENTS AND METHODS: Sixty four files of our headache outpatient clinic, chosen randomly among patients suffering from migraine or tensional type headache (TTH), were analysed retrospectively. Patients were considered hypertensive, if blood pressure was higher than normal several times without an acute crisis present. Resistance to treatment was defined as lack of benefit concerning number and/or intensity of crisis. RESULTS: Age varied between 18 and 80 years, the mean age being 42,9 (SD 13,86) years. Eighty six percent were females. Twenty nine patients suffered from TTH and 35 from migraine. Prevalence of hypertension was 35,9% among all patients, 28,5% among migraine patients, 44,8% among patients with TTH. The prevalence of resistance to treatment was 39,8%, 34,3% and 41,3%, respectively. Of the patients resistant to treatment 60% were hypertensive and 62,5% of the hypertensive patients showed resistance to therapy. CONCLUSIONS: Arterial hypertension was more prevalent in the study sample than would be expected in an equivalent sample of the general population. Hypertension was significantly more prevalent among patients resistant to therapy, as was resistance to treatment among hypertensive patients. We therefore conclude that there is a relevant comorbidity between chronic headache and hypertension and that arterial hypertension complicates the control of chronic headaches.

[Headaches, otalgia and peripheral facial palsy as a form of presentation of neurosyphilis]. / Cefaleas, otalgias, hipoacusia y parálisis facial periférica como forma de presentación de la neurosífilis.

INTRODUCTION: Decrease in incidence of neurosyphilis over the last few decades implies that clinicians consider less frequently this diagnosis. On the other hand, some reports suggest an increase in atypical forms of this disease that represent an additional reason for missing this diagnosis. CLINICAL CASE: We report on a 16 year-old immunocompetent black female from Guinea-Bissau presented with headaches, ear pain, hearing loss and peripheral facial paralysis. A cranial CT scan showed a hypodense area in the left cortico-subcortical zone and a contrast enhancement on the left pontocerebellar angle and internal auditory meatus. On the third day of admission a diagnosis of meningitis was made, with high titles of VDRL and TPHA in CSF and serum, leading to a diagnosis of neurosyphilis. The epidemiological aspects of this case suggest either a late congenital syphilis or an infection as a result of a blood transfusion administered seven years earlier in Guinea-Bissau. CONCLUSION: This rare form of presentation of neurosyphilis emphasizes the importance of considering systematically this diagnosis, even in the context of atypical presentations.