Roller pressure algometry as a new tool for assessing dynamic pressure sensitivity in migraine.

Objectives To explore the validity of the roller pressure algometer as a new tool for evaluating dynamic pressure sensitivity by assessing its association with pain features and widespread pressure pain sensitivity in migraine women, and also to determine whether dynamic pressure algometry differentiates between episodic and chronic migraine. Methods One hundred and twenty women with migraine (42% chronic, 58% episodic) participated. Dynamic pressure sensitivity was assessed with a set of roller pressure algometers (Aalborg University, Denmark®) consisting of 11 rollers with fixed pressure levels from 500 to 5300 g. Each roller was moved at a speed of 0.5 cm/sec over a 60 mm horizontal line covering the temporalis muscle. The dynamic pain threshold (the pressure level of the first painful roller) and pain elicited during the pain threshold (roller evoked pain) were determined. Static pressure pain thresholds were assessed over the temporalis muscle, C5/C6 joint, second metacarpal, and tibialis anterior. Results Side-to-side consistency between dynamic pain threshold (rs = 0.769, p < 0.001) and roller evoked pain (rs = 0.597; p < 0.001) were found. Women with chronic migraine exhibited bilateral lower dynamic pain thresholds ( p < 0.01), but similar widespread pressure pain thresholds (all, p > 0.284) than those with episodic migraine. Dynamic pain threshold was moderately positively associated with widespread pressure pain thresholds (0.358 > rs > 0.700, all p < 0.001). This association was slightly stronger in chronic migraine. Pain during dynamic pain threshold was negatively associated with widespread pressure pain thresholds (-0.336 < rs < -0.235, all p < 0.01). Conclusions Roller pressure algometry was valid for assessing dynamic pressure sensitivity in migraine in the trigeminal area and is consistent with widespread static pressure pain sensitivity. Roller, but not static, pressure algometry differentiated between episodic and chronic migraine. Assessing static and dynamic deep somatic tissue sensitivity may provide new opportunities for evaluating treatment outcomes.

Características clínicas de la migraña vestibular: consideraciones en una serie de 41 pacientes / Clinical characteristics of vestibular migraine: considerations in a series of 41 patients

Introducción. Tras años de debates sobre su enfoque desde las cefaleas y su denominación, la migraña vestibular ha sido recientemente incluida en el apéndice de investigación de la III edición de la Clasificación Internacional de Cefaleas. Objetivo. Analizar las características de una serie de pacientes con migraña vestibular en los que el motivo de consulta fue la cefalea. Pacientes y métodos. Pacientes atendidos en una unidad de cefaleas entre enero de 2014 y diciembre de 2015. Se consideran las variables demográficas y características tanto de la migraña como de los síntomas vestibulares, y se excluyen los casos con otras patologías otorrinolaringológicas. Resultados. Se incluyen 41 pacientes (11 varones, 30 mujeres) con una edad media de 31,8 ± 13,3 años en el momento de la inclusión. Dieciséis pacientes (39%) reunían criterios de migraña crónica y dos (4,9%) presentaban auras visuales. Los síntomas vestibulares fueron considerados graves en ocho casos (19,5%) y ocurrían en un 74,6% de los episodios de migraña. El vértigo se describía como interno en 18 casos (43,9%), externo en 22 (53,7%) y mixto en uno (2,4%). El síntoma más frecuente fue el vértigo posicional (n = 25; 61%), seguido del inducido por movimientos cefálicos (n = 18; 43,9%) y el espontáneo (n = 15; 36,6%). Como síntomas acompañantes se observaron acúfenos (n = 12; 29,3%) y plétora aural (n = 8; 19,5%). Conclusión. La identificación de síntomas compatibles con una migraña vestibular no es excepcional en los pacientes que acuden a una unidad de cefaleas; se trata de pacientes en los que el vértigo no suele interferir en sus actividades habituales (AU)

Introduction. After years of debate about its being approached from headaches and its denomination, vestibular migraine has recently been included in the research appendix of the 3rd edition of the International Headache Classification. Aim. To analyse the characteristics of a series of patients with vestibular migraine who visited because of headaches. Patients and methods. Our sample consisted of patients who were attended in a headache unit between January 2014 and December 2015. The demographic variables and the characteristics of both migraine and vestibular symptoms were considered, and cases with other otorhinolaryngological conditions were excluded. Results. The sample was finally made up of 41 patients (11 males, 30 females) with a mean age of 31.8 ± 13.3 years at the time they were included in the study. Sixteen patients (39%) met criteria for chronic migraine and two (4.9%) presented visual auras. The vestibular symptoms were considered severe in eight cases (19.5%) and occurred in 74.6% of the migraine attacks. Vertigo was described as internal in 18 cases (43.9%), external in 22 (53.7%) and mixed in one case (2.4%). The most frequent symptom was positional vertigo (n = 25; 61%), followed by that induced by head movements (n = 18; 43.9%) and spontaneous (n = 15; 36.6%). Accompanying symptoms included tinnitus (n = 12; 29.3%) and a feeling of fullness in the ear (n = 8; 19.5%). Conclusion. It is not uncommon to identify symptoms consistent with vestibular migraine in patients who visit a headache unit; they are patients whose day-to-day activities are not usually affected by their vertigo (AU)

Differences in Topographical Pressure Pain Sensitivity Maps of the Scalp Between Patients With Migraine and Healthy Controls.

OBJECTIVE: To investigate differences in topographical pressure pain sensitivity maps of the scalp between patients with migraine and healthy controls considering the chronicity (episodic/chronic) and side (strictly unilateral/bilateral) of the symptoms. BACKGROUND: It seems that the trigeminal area is sensitized in migraine. No study has investigated topographical pressure sensitivity maps of the scalp in patients with migraine. METHODS: Pressure pain thresholds (PPTs) were assessed from 21 points distributed over the scalp in 86 patients with episodic migraine, 76 with chronic migraine, and 42 healthy age and matched healthy controls in a blinded design. Topographical pressure pain sensitivity maps based on interpolation of the PPTs were constructed. Clinical features of migraine, anxiety, and depression (Hospital Anxiety and Depression Scale, HADS) were collected. RESULTS: The multivariate ANCOVA revealed significant differences in PPT between points (F = 55.674; P < .001) and groups (F = 5.316; P = .006), but not sides (F = 0.880; P = .417). No significant effect of gender (F = 0.897; P = .656), depression (F = 1.109; P = .220), or anxiety (F = 0.981; F = 0.569) was found. Post hoc comparisons revealed: (1) lower PPTs in both migraine groups than in healthy controls in all points (P < .001); (2) no significant differences between chronic or episodic migraine (P > .335) except for Fp1 (P = .045) and Fp2 (P = .017) points where subjects with chronic migraine had lower PPTs than those with episodic migraine; (3) no differences between bilateral/unilateral migraine (P > .417). An anterior to posterior gradient was found, with the lowest PPTs located in frontal regions and the highest PPTs in occipital areas (all groups, P < .001). CONCLUSIONS: We found that patients with migraine exhibited generalized pressure pain hypersensitivity in the head as compared to healthy controls and that hypersensitivity was similar between episodic/chronic and unilateral/bilateral migraine. Topographical pressure pain sensitivity maps revealed an anterior to posterior gradient of pressure pain sensitivity in both migraine and control groups.

Women with Chronic and Episodic Migraine Exhibit Similar Widespread Pressure Pain Sensitivity.

OBJECTIVE: To investigate widespread pressure hyperalgesia in the trigemino-cervical and extra-trigeminal (distant pain-free) regions in women with episodic and chronic migraine. METHODS: Fifty-one women with episodic migraine, 52 women with chronic migraine, and 52 healthy women without headache history were recruited. Pressure pain thresholds (PPT) were bilaterally assessed over the trigeminal area (i.e., temporalis muscle), cervical area (i.e., C5/C6 zygapophyseal joint), and two extra-trigeminal areas (i.e., second metacarpal, tibialis anterior muscle) in a blinded design. Clinical features of migraine and anxiety/depression (Hospital Anxiety and Depression Scale, HADS) were also assessed. RESULTS: The multivariate analysis of covariance (ANCOVA) revealed that PPTs were significantly decreased bilaterally over trigeminal and extra-trigeminal points in migraine patients compared to healthy women (all sites, P < 0.001). No differences between episodic and chronic migraine were observed (all, P > 0.919). The presence of neck pain (all, P > 0.282), anxiety (P > 0.425) or depression (all, P > 0.316) did not influence the results. The intensity of migraine pain was negatively associated with widespread pressure pain sensitivity: The greater the intensity of migraine attacks, the lower the widespread PPT levels, i.e., the greater the widespread sensitization. CONCLUSIONS: This study found similar widespread pressure hypersensitivity in women with episodic or chronic migraine suggesting that central manifestations are involved both in episodic and chronic migraine.

Pressure pain sensitivity map of multifocal nummular headache: a case report.

BACKGROUND: Nummular headache (NH) is most commonly a localized unifocal headache; however, some patients infrequently exhibit multifocal symptomatic painful head areas retaining all features of NH. We present the pressure pain sensitivity map of an adolescent with multifocal NH. CASE PRESENTATION: We describe a case of a 14 year-old-girl with a 3-year history of continuous pain in four rounded areas, all of them with the same size and shape. Pressure pain thresholds (PPT) were assessed on 21 points over the scalp and over the symptomatic areas. A pressure pain sensitivity map of the head was constructed. The neurological exam was unremarkable, with neither sensory symptoms nor trophic changes within the painful areas. As previously shown, symptomatic points exhibited lower PPTs compared to the surrounding areas. The map reflected 4 restricted areas of mechanical hyperalgesia confined just to the painful areas. Treatment with gabapentin achieved complete remission. CONCLUSION: This is the first pain sensitivity map of a patient with multifocal NH. Our results support peripheral mechanisms are maintained in multifocal NH.

Atypical nummular headache or circumscribed migraine: the utility of pressure algometry.

A peripheral mechanism has been proposed for nummular headache; however, there have been descriptions of atypical features resembling migraine. The authors describe a case in which algometry assessment facilitated the discrimination between atypical nummular headache and circumscribed migraine. A 21-year-old woman presented with a history of focal episodic pain in a circumscribed area on the left frontal region. The algometry study showed a unilateral and diffuse decrease of the pain pressure thresholds with frontal predominance, as has been proposed for migraine patients. This result led the authors to introduce a more specific preventive therapy with topiramate, with significant relief. In conclusion, cartographic investigation of pressure pain sensitivity is a simple tool that can help to differentiate between nummular headache and migraine. Further confirmatory investigations are needed.

From wakefulness to sleep: migraine and hypnic headache association in a series of 23 patients.

OBJECTIVES/BACKGROUND: We analyzed characteristics of hypnic headache (HH), migraine and the relationship between both headaches in 23 patients. HH is an uncommon primary headache characterized by exclusively sleep-related attacks. Concurrence of other headaches, mainly migraine, has been reported, but relationship between both syndromes has rarely been considered. METHODS: We prospectively collected data in a headache outpatient office from January 2008 to September 2013. Demographic data and migraine and hypnic headache mean features were assessed. RESULTS: Twenty-three out of 2500 (0.92%) were diagnosed with HH or probable HH, and 16 of them (69.5%) had a history of migraine. Mean age at onset of HH and migraine was 56.2 ± 9.3 and 24.6 ± 12.2 years, respectively. In 12 cases, migraine attacks disappeared at 56.7 ± 9.8 years old. Regarding the relationship between both syndromes, in 10 patients, migraine disappeared and HH began immediately after. In 1 case there was a pain-free period, and in 5 an overlap between both headaches was registered. CONCLUSION: A history of migraine is common in HH patients in our series. Most frequent transition pattern was an immediate change between both syndromes. Hypnic headache and migraine might share a common pathophysiological predisposition.

[Encephalitis due to the Epstein-Barr virus: a description of a clinical case and review of the literature]. / Encefalitis por el virus de Epstein-Barr: descripción de un caso clínico y revisión de la bibliografía.

INTRODUCTION. Infection by the Epstein-Barr virus (EBV) -either as a primary infection, a reactivation or an active chronic infection- can give rise to several clinical forms of involvement of the central nervous system. We report a case of encephalitis due to EBV produced by viral reactivation in an immunocompetent patient which initially mimicked, from the clinical and electroencephalographic point of view, encephalitis due to type 1 herpes simplex virus (HSV-1). CASE REPORT. A 51-year-old male who had reported the presence of dorsal herpes zoster some days earlier. The patient visited the emergency department after suffering a holocranial oppressive headache and febricula for seven days; 24 hours before admission to hospital, he was suffering from drowsiness and language disorder. The neurological examination revealed stiffness in the back of the neck and dysphasia. An analysis of the cerebrospinal fluid revealed pleocytosis (422 cells/mm(3)) with 98% of mononuclear cells and normal protein and glucose concentration levels in cerebrospinal fluid. Magnetic resonance imaging of the brain and electroencephalogram readings were normal with periodic lateralised epileptiform discharges in the left temporal region. Intravenous acyclovir treatment was initiated, but renal failure meant it had to be changed to oral valaciclovir with clinical resolution and improvement of the liquoral parameters. Polymerase chain reaction in the cerebrospinal fluid was positive for EBV and negative for the other neurotropic viruses. In blood, the serology test for EBV with IgG was positive, while IgM and heterophile antibody tests were negative. CONCLUSIONS. EBV infection can give rise to acute disseminated encephalomyelitis or affect several locations in the central nervous system, especially the cerebellum. Clinical pictures mimicking HSV-1 are less frequent. When encephalitis is related to viral reactivation, precipitating factors can be detected, as in our case.

TITLE: Encefalitis por el virus de Epstein-Barr: descripcion de un caso clinico y revision de la bibliografia.Introduccion. La infeccion por el virus de Epstein-Barr (VEB) puede dar lugar ­tanto como primoinfeccion, reactivacion o infeccion cronica activa­ a varias formas clinicas de afectacion del sistema nervioso central. Presentamos un caso de encefalitis por VEB producido por reactivacion virica en un paciente inmunocompetente, que inicialmente simulaba, desde el punto de vista clinico y electroencefalografico, una encefalitis por virus herpes simple tipo 1 (VHS-1). Caso clinico. Varon de 51 años con antecedente de herpes zoster dorsal en los dias previos. Acudio a urgencias por un cuadro de siete dias de duracion de cefalea opresiva holocraneal y febricula; 24 horas antes de su ingreso, padecia somnolencia y alteracion del lenguaje. En la exploracion neurologica presentaba rigidez nucal y disfasia. En el liquido cefalorraquideo se evidencio pleocitosis (422 celulas/mm3) con un 98% de mononucleares, y proteinorraquia y glucorraquia normales. Resonancia magnetica cerebral normal y electroencefalograma con descargas epileptiformes lateralizadas periodicas en la region temporal izquierda. Se trato con aciclovir intravenoso; una insuficiencia renal motivo su cambio a valaciclovir oral con resolucion clinica y mejoria de los parametros licuorales. La reaccion en cadena de la polimerasa en el liquido cefalorraquideo fue positiva para VEB y negativa para el resto de virus neurotropos. En sangre, la serologia para VEB con IgG resulto positiva, y negativa con IgM y anticuerpos heterofilos. Conclusiones. La infeccion por VEB puede dar lugar a una encefalitis aguda diseminada o afectar a varias localizaciones del sistema nervioso central, principalmente el cerebelo. Menos frecuentes son los cuadros imitadores de VHS-1. Cuando la encefalitis se relaciona con reactivacion viral pueden detectarse, como en nuestro caso, factores precipitantes.

Encefalitis por el virus de Epstein-Barr: descripción de un caso clínico y revisión de la bibliografía / Encephalitis due to the Epstein-Barr virus: a description of a clinical case and review of the literature

Introducción. La infección por el virus de Epstein-Barr (VEB) puede dar lugar –tanto como primoinfección, reactivación o infección crónica activa– a varias formas clínicas de afectación del sistema nervioso central. Presentamos un caso de encefalitis por VEB producido por reactivación vírica en un paciente inmunocompetente, que inicialmente simulaba, desde el punto de vista clínico y electroencefalográfico, una encefalitis por virus herpes simple tipo 1 (VHS-1). Caso clínico. Varón de 51 años con antecedente de herpes zóster dorsal en los días previos. Acudió a urgencias por un cuadro de siete días de duración de cefalea opresiva holocraneal y febrícula; 24 horas antes de su ingreso, padecía somnolencia y alteración del lenguaje. En la exploración neurológica presentaba rigidez nucal y disfasia. En el líquido cefalorraquídeo se evidenció pleocitosis (422 células/mm3) con un 98% de mononucleares, y proteinorraquia y glucorraquia normales. Resonancia magnética cerebral normal y electroencefalograma con descargas epileptiformes lateralizadas periódicas en la región temporal izquierda. Se trató con aciclovir intravenoso; una insuficiencia renal motivó su cambio a valaciclovir oral con resolución clínica y mejoría de los parámetros licuorales. La reacción en cadena de la polimerasa en el líquido cefalorraquídeo fue positiva para VEB y negativa para el resto de virus neurotropos. En sangre, la serología para VEB con IgG resultó positiva, y negativa con IgM y anticuerpos heterófilos. Conclusiones. La infección por VEB puede dar lugar a una encefalitis aguda diseminada o afectar a varias localizaciones del sistema nervioso central, principalmente el cerebelo. Menos frecuentes son los cuadros imitadores de VHS-1. Cuando la encefalitis se relaciona con reactivación viral pueden detectarse, como en nuestro caso, factores precipitantes (AU)

Introduction. Infection by the Epstein-Barr virus (EBV) –either as a primary infection, a reactivation or an active chronic infection– can give rise to several clinical forms of involvement of the central nervous system. We report a case of encephalitis due to EBV produced by viral reactivation in an immunocompetent patient which initially mimicked, from the clinical and electroencephalographic point of view, encephalitis due to type 1 herpes simplex virus (HSV-1). Case report. A 51-year-old male who had reported the presence of dorsal herpes zoster some days earlier. The patient visited the emergency department after suffering a holocranial oppressive headache and febricula for seven days; 24 hours before admission to hospital, he was suffering from drowsiness and language disorder. The neurological examination revealed stiffness in the back of the neck and dysphasia. An analysis of the cerebrospinal fluid revealed pleocytosis (422 cells/mm3) with 98% of mononuclear cells and normal protein and glucose concentration levels in cerebrospinal fluid. Magnetic resonance imaging of the brain and electroencephalogram readings were normal with periodic lateralised epileptiform discharges in the left temporal region. Intravenous acyclovir treatment was initiated, but renal failure meant it had to be changed to oral valaciclovir with clinical resolution and improvement of the liquoral parameters. Polymerase chain reaction in the cerebrospinal fluid was positive for EBV and negative for the other neurotropic viruses. In blood, the serology test for EBV with IgG was positive, while IgM and heterophile antibody tests were negative. Conclusions. EBV infection can give rise to acute disseminated encephalomyelitis or affect several locations in the central nervous system, especially the cerebellum. Clinical pictures mimicking HSV-1 are less frequent. When encephalitis is related to viral reactivation, precipitating factors can be detected, as in our case (AU)

[Occipital neuralgia: clinical and therapeutic characteristics of a series of 14 patients]. / Neuralgia occipital: características clinicas y terapéuticas de una serie de 14 pacientes.

INTRODUCTION. Occipital neuralgia is a pain in the distribution of the occipital nerves, accompanied by hypersensitivity to touch in the corresponding territory. AIMS. We present the occipital neuralgia series from the specialised headache unit at a tertiary hospital and analyse its clinical characteristics and its response to therapy. PATIENTS AND METHODS. Variables were collected from the cases of occipital neuralgia diagnosed in the above-mentioned headache unit between January 2008 and April 2013. RESULTS. A series of 14 patients (10 females, 4 males) with occipital neuralgia was obtained out of a total of 2338 (0.59%). Age at onset of the clinical signs and symptoms: 53.4 ± 20.3 years (range: 17-81 years) and time elapsed to diagnosis was 35.5 ± 58.8 months (range: 1-230 months). An intracranial or cervical pathology was ruled out by suitable means in each case. Baseline pain of a generally oppressive nature and an intensity of 5.3 ± 1.3 (4-8) on the verbal analogue scale was observed in 13 of them (92.8%). Eleven (78.5%) presented exacerbations, generally stabbing pains, a variable frequency (4.6 ± 7 a day) and an intensity of 7.8 ± 1.7 (range: 4-10) on the verbal analogue scale. Anaesthetic blockade was not performed in four of them (two due to a remitting pattern and two following the patient's wishes); in the others, blockade was carried out and was completely effective for between two and seven months. Four cases had previously received preventive treatment (amitriptyline in three and gabapentin in one), with no response. CONCLUSIONS. In this series from a specialised headache unit, occipital neuralgia is an infrequent condition that mainly affects patients over 50 years of age. Given its poor response to preventive treatment, the full prolonged response to anaesthetic blockades must be taken into account.

TITLE: Neuralgia occipital: caracteristicas clinicas y terapeuticas de una serie de 14 pacientes.Introduccion. La neuralgia occipital es un dolor en la distribucion de los nervios occipitales, acompañado de hipersensibilidad al tacto en el territorio correspondiente. Objetivos. Presentamos la serie de neuralgia occipital de la consulta monografica de cefaleas de un hospital terciario y analizamos sus caracteristicas clinicas y su respuesta terapeutica. Pacientes y metodos. Se recogen variables de los casos de neuralgia occipital diagnosticados en dicha consulta entre enero de 2008 y abril de 2013. Resultados. Serie de 14 pacientes (10 mujeres, 4 varones) con neuralgia occipital sobre un total de 2.338 (0,59%). Edad al inicio del cuadro: 53,4 ± 20,3 años (rango: 17-81 años), y tiempo hasta el diagnostico de 35,5 ± 58,8 meses (rango: 1-230 meses). Se descarto apropiadamente en cada caso patologia intracraneal o cervical. En 13 de ellos (92,8%) se observo dolor basal de caracter generalmente opresivo e intensidad 5,3 ± 1,3 (4-8) en la escala analogica verbal. Once (78,5%) presentaban exacerbaciones, generalmente de caracter punzante, frecuencia variable (4,6 ± 7 al dia) e intensidad 7,8 ± 1,7 (rango: 4-10) en la escala analogica verbal. En cuatro no se llevo a cabo bloqueo anestesico (dos por patron remitente y dos por deseo del paciente); en los restantes, se realizo bloqueo con eficacia completa de duracion entre dos y siete meses. Cuatro casos habian recibido anteriormente tratamiento preventivo (amitriptilina en tres y gabapentina en uno), sin respuesta. Conclusiones. En esta serie de una consulta monografica de cefaleas, la neuralgia occipital es una entidad infrecuente y que afecta principalmente a pacientes mayores de 50 años. Ha de tenerse en cuenta, dada su respuesta escasa a preventivos, y completa y prolongada a bloqueos anestesicos.

Antibacterial activity and tensile strength of provisional cements modified with fluoridecontaining varnish.

OBJECTIVE: To test three noneugenol provisional cements (TempBond NE, RelyX Temp NE, and Freegenol) for their antibacterial properties and to test the hypothesis that addition of fluoride varnish confers antibacterial properties on these provisional cements without compromising their tensile strength. METHOD AND MATERIALS: A total of 576 cylindrical samples were prepared (96 of each of six types) from three noneugenol provisional cements, both unmodified and modified by the addition of 5% w/w Duraphat fluoride varnish. The samples were aged in saline that was replaced twice a week for up to 90 days. Twenty-four samples of each type were removed from the saline at 1, 7, 30, or 90 days and assessed for antibacterial properties against Streptococcus mutans by using an agar diffusion test (n = 12) and tensile strength by using a diametral tensile strength test (n = 12). Data were subjected to one- and three-way ANOVA, the Tukey honestly significant difference test, and t test at a significance level of .002 (P < .002). RESULTS: TempBond NE had no antibacterial activity in its unmodified form but showed antibacterial activity when modified by the addition of 5% w/w fluoride varnish. Freegenol had the highest antibacterial activity in its unmodified form, which was not altered by the addition of the varnish. RelyX Temp NE had mild antibacterial activity that was slightly enhanced by adding the varnish. Adding the varnish reduced the tensile strength of TempBond NE and Freegenol, but did not affect the tensile strength of RelyX Temp NE. CONCLUSION: Antibacterial activity was observed for the unmodified form of Freegenol and TempBond NE after the addition of the fluoride varnish. The addition of the fluoride varnish reduced the tensile strength of both TempBond NE and Freegenol.

[Primary stabbing headache: clinical characteristics and response to treatment in a series of 67 patients]. / Cefalea primaria punzante: caracteristicas clínicas y respuesta al tratamiento en una serie de 67 pacientes.

INTRODUCTION: Primary stabbing headache (PSH) is defined by the presence of short stabbing pains in the first branch of the trigeminal nerve. According to population-based studies, it is very prevalent, but most cases present stabbing pains with low frequencies and intensities that do not lead the patient to seek medical attention. AIMS: We report on 67 cases of PSH attended in the headache service of a tertiary hospital. In the study, the demographic and clinical characteristics are studied, treatment response is reviewed and the features of PSH are compared in terms of whether it was the only headache or was accompanied by others. PATIENTS AND METHODS: The study involved 67 patients (51 females and 16 males) diagnosed with PSH between January 2008 and January 2012, of a total number of 1668 (4%) patients attended in the above-mentioned service. RESULTS: Age at onset: 34.5 ± 16.7 years. Forty-nine cases (73.1%) were associated to another headache, above all migraine. Stabbing pains were often bilateral; 38 (56.7%) patients suffered more than one a day and 11 (16.4%) had more than 10 per day. They lasted less than five seconds in 48 patients (71.6%) and more than 10 seconds in 11 of them (16.4%), with an intensity of 6.8 ± 1.5. The age of onset of PSH was higher if it was the only type of headache than if it was accompanied by others. Twenty-six (38.8%) patients required preventive treatment for the associated headache and 16 (23.8%) took indomethacin, with a similar response in the two groups (73 versus 75%). CONCLUSIONS; PSH is not infrequent in headache clinics, but its phenotype differs from that reported in population-based studies. The characteristics of PSH vary depending on whether it is the only headache or is associated with others. Preventive treatment is often required and patients respond well to it.

Cefalea primaria punzante: características clínicas y respuesta al tratamiento en una serie de 67 pacientes / Primary stabbing headache: clinical characteristics and response to treatment in a series of 67 patients

Introducción. La cefalea primaria punzante (CPP) se define por la presencia de punzadas breves localizadas en la primera rama del nervio trigémino. Según estudios de base poblacional, es muy prevalente, pero la mayoría de casos presenta punzadas de baja frecuencia e intensidad que no requieren consulta médica. Objetivos. Presentar 67 casos de CPP de la consulta de cefaleas de un hospital terciario, analizar las características demográficasy clínicas, revisar la respuesta al tratamiento y comparar las características de la CPP según sea cefalea única o se acompañe de otras. Pacientes y métodos. Muestra de 67 pacientes (51 mujeres y 16 varones) diagnosticados de CPP entre enero de 2008 y enero de 2012, de un total de 1.668 (4%) atendidos en dicha consulta. Resultados. Edad al inicio: 34,5 ± 16,7 años. Cuarenta y nueve casos (73,1%) asociaban otra cefalea, sobre todo migraña. Las punzadas eran frecuentemente bilaterales; 38 pacientes (56,7%) sufrían más de una al día y 11 (16,4%) más de 10 al día. Su duración era menor de cinco segundos en 48 (71,6%) pacientes y mayor de 10 segundos en 11 (16,4%), con una intensidad de 6,8 ± 1,5. La edad de inicio de la CPP era mayor si era cefalea única que si acompañaba a otras. Veintiséis (38,8%) pacientes requirieron un preventivo para la cefalea asociada y 16 (23,8%) indometacina con respuesta similar en los dos grupos (73 frente a 75%). Conclusiones. La CPP no es infrecuente en una consulta de cefaleas, pero su fenotipo difiere del descrito en estudios de base poblacional. Las características de la CPP son diferentes en función de si es cefalea única o asocia otras. Se requiere tratamiento preventivo con frecuencia y la respuesta es buena (AU)

Introduction. Primary stabbing headache (PSH) is defined by the presence of short stabbing pains in the first branch of the trigeminal nerve. According to population-based studies, it is very prevalent, but most cases present stabbing pains with low frequencies and intensities that do not lead the patient to seek medical attention. Aims. We report on 67 cases of PSH attended in the headache service of a tertiary hospital. In the study, the demographic and clinical characteristics are studied, treatment response is reviewed and the features of PSH are compared in terms of whether it was the only headache or was accompanied by others. Patients and methods. The study involved 67 patients (51 females and 16 males) diagnosed with PSH between January 2008 and January 2012, of a total number of 1668 (4%) patients attended in the above-mentioned service. Results. Age at onset: 34.5 ± 16.7 years. Forty-nine cases (73.1%) were associated to another headache, above all migraine. Stabbing pains were often bilateral; 38 (56.7%) patients suffered more than one a day and 11 (16.4%) had more than 10 per day. They lasted less than five seconds in 48 patients (71.6%) and more than 10 seconds in 11 of them (16.4%), with an intensity of 6.8 ± 1.5. The age of onset of PSH was higher if it was the only type of headache than if it was accompanied by others. Twenty-six (38.8%) patients required preventive treatment for the associated headache and 16 (23.8%) took indomethacin, with a similar response in the two groups (73 versus 75%). Conclusions. PSH is not infrequent in headache clinics, but its phenotype differs from that reported in population-based studies. The characteristics of PSH vary depending on whether it is the only headache or is associated with others. Preventive treatment is often required and patients respond well to it (AU)

Non-traumatic supraorbital neuralgia: a clinical study of 13 cases.

INTRODUCTION: Supraorbital neuralgia (SON) is an uncommon disorder characterized by pain in the area supplied by the supraorbital nerve, which covers the medial aspect of the forehead, together with tenderness over the supraorbital notch or along the course of the nerve. Few hospital-based series of non-trauma SON have been published. METHODS AND RESULTS: We prospectively analyzed 13 patients (11 females, two males) diagnosed with SON in a headache outpatient clinic over a four-year period. Background pain was mostly dull and of moderate intensity. In addition, nine patients reported sharp, burning or stabbing exacerbations of severe intensity. Eight cases were treated with an anesthetic blockade and achieved complete relief lasting from two to six months. Three patients also received gabapentin, with no or only slight improvement. CONCLUSION: Non-traumatic SON is an uncommon disorder in our headache clinic. Female preponderance and clinical features are comparable to the data collected in previous studies. A spontaneously remitting pattern is not uncommon, and anesthetic blockades are not always required.

Hemicránea continua: características y experiencia terapéutica en una serie de 36 pacientes / Hemicrania continua: characteristics and therapeutic experience in a series of 36 patients

Introducción. La hemicránea continua se caracteriza por un dolor unilateral, continuo, con exacerbaciones frecuentementeasociadas a síntomas autonómicos. Es probablemente poco conocida e infradiagnosticada. Su diagnóstico requiere respuesta a la indometacina, no siempre bien tolerada. Objetivo. Se presenta una serie de 36 casos de hemicránea continua atendidos en la consulta de cefaleas de un hospitalterciario. Analizamos sus características demográficas y clínicas y las alternativas terapéuticas a la indometacina.Pacientes y métodos. Entre enero de 2008 y abril de 2012, 36 pacientes (28 mujeres, ocho varones) fueron diagnosticadosde hemicránea continua entre 1.800 (2%) atendidos en dicha consulta.Resultados. La edad al inicio fue de 46,3 ± 18,4 años. En cuatro pacientes (11,1%) existían remisiones del dolor superioresa tres meses. El dolor basal era principalmente opresivo o quemante, y su intensidad era de 5,2 ± 1,4 en la escala analógicaverbal. Las exacerbaciones tenían una duración de 32,3 ± 26,1 minutos, carácter predominantemente punzante,intensidad de 8,3 ± 1,4, y en el 69,4% de casos se acompañaban de síntomas autonómicos. El 16,7% de los pacientes no toleró la indometacina más allá de un indotest, y un 50% lo hizo con efectos adversos. En 13 casos se llevó a cabo al menos un bloqueo anestésico en el nervio supraorbitario o el occipital mayor, o una inyección de corticoides en la tróclea con respuesta completa en el 53,8% y parcial en el 38,5%.Conclusiones. La hemicránea continua no es un diagnóstico infrecuente en una consulta de cefaleas, y es necesario aumentarsu conocimiento al tratarse de una entidad tratable. Los bloqueos anestésicos del nervio supraorbotario o del occipital mayor o la inyección de corticoides en la tróclea son una opción terapéutica que se debe considerar cuando la indometacina no se tolera bien (AU)

Introduction. Hemicrania continua is characterised by a continuous unilateral pain, which frequently gets worse in association with autonomic symptoms. It is probably little known and underdiagnosed. Its diagnosis requires a responseto indomethacin, which is not always well tolerated. Aims. We report a series of 36 cases of hemicrania continua that were treated in the headache service of a tertiary hospital. We analyse their demographic and clinical features and the therapeutic alternatives to indomethacin. Patients and methods. Between January 2008 and April 2012, 36 patients (28 females, eight males) were diagnosed with hemicrania continua from among 1800 (2%) who were treated in that service Results. The age of onset was 46.3 ± 18.4 years. In four patients (11.1%) there were pain remissions that lasted overthree months. The baseline pain was chiefly oppressive or burning with an intensity of 5.2 ± 1.4 on the verbal analogue scale. Exacerbations lasted 32.3 ± 26.1 minutes, were of a predominantly stabbing nature with an intensity of 8.3 ± 1.4, and in 69.4% of cases were accompanied by autonomic symptoms. Altogether 16.7% of the patients did not tolerate indomethacin beyond an indotest and 50% did so with side effects. In 13 cases at least one anaesthetic blockade was performed in the supraorbital or the greater occipital nerve or a trochlear injection of corticoids was carried out with a fullresponse in 53.8% and a partial response in 38.5%. Conclusions. Hemicrania continua is not an infrequent diagnosis in a headache clinic and, because it is a treatablecondition, further knowledge on the subject is needed. Anaesthetic blockades of the supraorbital or greater occipital nerves or a trochlear injection of corticoids are the therapeutic options that must be taken into consideration whenindomethacin is not well tolerated (AU)

[Hemicrania continua: characteristics and therapeutic experience in a series of 36 patients]. / Hemicránea continua: características y experiencia terapéutica en una serie de 36 pacientes.

INTRODUCTION: Hemicrania continua is characterised by a continuous unilateral pain, which frequently gets worse in association with autonomic symptoms. It is probably little known and underdiagnosed. Its diagnosis requires a response to indomethacin, which is not always well tolerated. AIMS: We report a series of 36 cases of hemicrania continua that were treated in the headache service of a tertiary hospital. We analyse their demographic and clinical features and the therapeutic alternatives to indomethacin. PATIENTS AND METHODS: Between January 2008 and April 2012, 36 patients (28 females, eight males) were diagnosed with hemicrania continua from among 1800 (2%) who were treated in that service. RESULTS: The age of onset was 46.3 ± 18.4 years. In four patients (11.1%) there were pain remissions that lasted over three months. The baseline pain was chiefly oppressive or burning with an intensity of 5.2 ± 1.4 on the verbal analogue scale. Exacerbations lasted 32.3 ± 26.1 minutes, were of a predominantly stabbing nature with an intensity of 8.3 ± 1.4, and in 69.4% of cases were accompanied by autonomic symptoms. Altogether 16.7% of the patients did not tolerate indomethacin beyond an indotest and 50% did so with side effects. In 13 cases at least one anaesthetic blockade was performed in the supraorbital or the greater occipital nerve or a trochlear injection of corticoids was carried out with a full response in 53.8% and a partial response in 38.5%. CONCLUSIONS: Hemicrania continua is not an infrequent diagnosis in a headache clinic and, because it is a treatable condition, further knowledge on the subject is needed. Anaesthetic blockades of the supraorbital or greater occipital nerves or a trochlear injection of corticoids are the therapeutic options that must be taken into consideration when indomethacin is not well tolerated.