[Health consequences of violence against women by the couple]. / Consecuencias para la salud de la violencia contra la mujer por la pareja.

Intimate partner violence against women (IPV) has devastating effects on the healthcare and well-being of women and their children. Physical, psychological, and social consequences, a worse perception of their own health, and loss of quality of life are well-documented, while aftereffects persist in time even after the end of abuse. Psychological consequences of abuse last longer and are more serious. IPV also affects sons and daughters, disabled people, family, and the attacker himself. Many health problems, both physical and mental, that lead women to go to healthcare services in search of help have an origin in the violence they experience. Treatment of the symptoms without awareness of its relation to such violence favours medicalization, iatrogenesis, and chronification. Psychological violence poses a threat that is invisible, subtle, cumulative, and difficult to detect; it is, however, the most destructive.

[Email in a dedicated headache clinic: experience gained over a five-year period]. / Correo electronico de una consulta monografica de cefaleas: experiencia durante cinco años.

INTRODUCTION: The use of email can facilitate communication between the different levels of an organisation. Our primary care physicians have had an email service in the dedicated headache clinic (DHC) since November 2009, and our aim is therefore to analyse the use of email over that five-year period. PATIENTS AND METHODS: Data concerning the emails sent up until October 2014 were collected prospectively. The questions were classified as need for referral to the DHC (group 1), progress made by the cases seen in the DHC (group 2), training in headaches (group 3) or the treatment of the headaches suffered by primary care physicians themselves as patients (group 4). RESULTS: A total of 274 email messages were analysed. Monthly consultations have increased (from 1.5 per month during the first year to 7.5 per month during the fifth). Findings showed that 10.2% of the email messages came from rural health centres and 89.8% were sent from urban health centres. Replies were sent within 2 ± 2.8 days (range: 0-24 days). Altogether 130 consultations were classified as belonging to group 1 (47.4%), in which referral through the normal channel was recommended in 60 cases (46.2%), via the preferential channel in 47 (36.2%) and non-referral was suggested in 23 cases (17.6%). Group 2 included 125 emails (45.7%) and in 80 cases there was no need to make a new appointment or to bring forward the existing one (64%). Thirteen visits (4.7%) were classified into group 3 and six (2.2%) in group 4. CONCLUSIONS: Our primary care physicians are using the email of the DHC on an increasingly more frequent basis. Its use makes it possible to detect patients whose appointment -whether the first or a follow-up- needs to be brought forward, as well as allowing issues to be solved without the need for referral. It is effective for the treatment of physicians who themselves have headaches and as a tool for continuing education.

TITLE: Correo electronico de una consulta monografica de cefaleas: experiencia durante cinco años.Introduccion. El correo electronico puede facilitar la comunicacion entre niveles. Nuestros medicos de atencion primaria disponen del correo de la consulta monografica de cefaleas (CMC) desde noviembre de 2009, por lo que se pretende analizar la utilizacion del correo electronico durante cinco años. Pacientes y metodos. Recogimos prospectivamente datos de los correos enviados hasta octubre de 2014. Las preguntas se clasificaron en necesidad de derivacion a la CMC (grupo 1), evolucion de casos atendidos en la CMC (grupo 2), formacion en cefaleas (grupo 3) o tratamiento de la cefalea padecida por el propio medico de atencion primaria como paciente (grupo 4). Resultados. Analizamos 274 correos. Las consultas mensuales se han incrementado (de 1,5 al mes durante el primer año a 7,5 al mes durante el quinto). El 10,2% de los correos provenia de centros de salud rurales y el 89,8% de centros de salud urbanos. Se contestaron en 2 ± 2,8 dias (rango: 0-24 dias). En el grupo 1 se encuadraron 130 consultas (47,4%), y en 60 se recomendo (46,2%) la derivacion por via normal, en 47 (36,2%) la preferente y en 23 (17,6%) la no derivacion. En el grupo 2 se incluyeron 125 correos (45,7%), y en 80 no fue necesaria nueva cita o adelanto de la prevista (64%). Trece consultas (4,7%) se clasificaron en el grupo 3 y seis (2,2%) en el grupo 4. Conclusiones. Nuestros medicos de atencion primaria manejan cada vez mas el correo electronico de la CMC. Permite detectar pacientes en los que procede un adelanto de cita, bien primera visita o revision, o resolver cuestiones sin necesidad de derivacion. Es eficaz para la atencion del medico con cefalea y como herramienta de formacion continuada.

Correo electrónico de una consulta monográfica de cefaleas: experiencia durante cinco años / Email in a dedicated headache clinic: experience gained over a five-year period

Introducción. El correo electrónico puede facilitar la comunicación entre niveles. Nuestros médicos de atención primaria disponen del correo de la consulta monográfica de cefaleas (CMC) desde noviembre de 2009, por lo que se pretende analizar la utilización del correo electrónico durante cinco años. Pacientes y métodos. Recogimos prospectivamente datos de los correos enviados hasta octubre de 2014. Las preguntas se clasificaron en necesidad de derivación a la CMC (grupo 1), evolución de casos atendidos en la CMC (grupo 2), formación en cefaleas (grupo 3) o tratamiento de la cefalea padecida por el propio médico de atención primaria como paciente (grupo 4). Resultados. Analizamos 274 correos. Las consultas mensuales se han incrementado (de 1,5 al mes durante el primer año a 7,5 al mes durante el quinto). El 10,2% de los correos provenía de centros de salud rurales y el 89,8% de centros de salud urbanos. Se contestaron en 2 ± 2,8 días (rango: 0-24 días). En el grupo 1 se encuadraron 130 consultas (47,4%), y en 60 se recomendó (46,2%) la derivación por vía normal, en 47 (36,2%) la preferente y en 23 (17,6%) la no derivación. En el grupo 2 se incluyeron 125 correos (45,7%), y en 80 no fue necesaria nueva cita o adelanto de la prevista (64%). Trece consultas (4,7%) se clasificaron en el grupo 3 y seis (2,2%) en el grupo 4. Conclusiones. Nuestros médicos de atención primaria manejan cada vez más el correo electrónico de la CMC. Permite detectar pacientes en los que procede un adelanto de cita, bien primera visita o revisión, o resolver cuestiones sin necesidad de derivación. Es eficaz para la atención del médico con cefalea y como herramienta de formación continuada (AU)

Introduction. The use of email can facilitate communication between the different levels of an organisation. Our primary care physicians have had an email service in the dedicated headache clinic (DHC) since November 2009, and our aim is therefore to analyse the use of email over that five-year period. Patients and methods. Data concerning the emails sent up until October 2014 were collected prospectively. The questions were classified as need for referral to the DHC (group 1), progress made by the cases seen in the DHC (group 2), training in headaches (group 3) or the treatment of the headaches suffered by primary care physicians themselves as patients (group 4). Results. A total of 274 email messages were analysed. Monthly consultations have increased (from 1.5 per month during the first year to 7.5 per month during the fifth). Findings showed that 10.2% of the email messages came from rural health centres and 89.8% were sent from urban health centres. Replies were sent within 2 ± 2.8 days (range: 0-24 days). Altogether 130 consultations were classified as belonging to group 1 (47.4%), in which referral through the normal channel was recommended in 60 cases (46.2%), via the preferential channel in 47 (36.2%) and non-referral was suggested in 23 cases (17.6%). Group 2 included 125 emails (45.7%) and in 80 cases there was no need to make a new appointment or to bring forward the existing one (64%). Thirteen visits (4.7%) were classified into group 3 and six (2.2%) in group 4. Conclusions. Our primary care physicians are using the email of the DHC on an increasingly more frequent basis. Its use makes it possible to detect patients whose appointment –whether the first or a follow-up– needs to be brought forward, as well as allowing issues to be solved without the need for referral. It is effective for the treatment of physicians who themselves have headaches and as a tool for continuing education (AU)

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.

Derivaciones de atención primaria a una consulta monográfica de cefaleas: análisis de los 1.000 primeros pacientes / Referrals from primary care to a dedicated headache clinic: analysis of the first 1, 000 patients

Introducción. Es habitual en las consultas monográficas o unidades de cefaleas que atiendan a pacientes complejos derivados desde consultas generales de neurología. En nuestro centro, parte de la agenda de la consulta monográfica de cefaleas (CMC) se reserva a pacientes remitidos desde atención primaria (AP) con formato de alta resolución. Objetivos. Analizar las características de los pacientes derivados por AP a la CMC y la adecuación a los criterios de derivación consensuados, y compararlos con las primeras visitas por cefalea en una consulta general de neurología. Pacientes y métodos. Muestra de 1.000 pacientes (741 mujeres y 259 varones) en la CMC y 290 (203 mujeres y 87 varones) en la consulta general. Recogemos prospectivamente variables demográficas, uso previo de tratamientos sintomáticos o preventivos, necesidad de exploraciones complementarias y adecuación a los criterios de derivación. Codificamos las cefaleas de acuerdo con la segunda edición de la Clasificación Internacional de Cefaleas (CIC-2). esultados. En el grupo de la CMC se codificaron 1.562 cefaleas, y en la consulta general, 444; su distribución en los grupos de la CIC-2 era similar, y la mayoría se encuadraba en el grupo 1 (migraña). El porcentaje de pacientes que habían recibido tratamiento preventivo era mayor en la CMC. El porcentaje de derivaciones adecuadas fue alto y algo mayor en la consulta general. Conclusiones. Las características de los pacientes derivados desde AP a una CMC en nuestro medio son similares a las previamente descritas. Estos pacientes han recibido tratamiento con más frecuencia que los atendidos en una consulta general de neurología (AU)

Introduction. It is commonplace practice in dedicated clinics or headache units to deal with complex patients referred from general neurology clinics. In our centre, part of the schedule of the dedicated headache clinic (DHC) is reserved for patients referred from primary care (PC) in the form of one-stop clinics. Aims. To analyse both the characteristics of the patients referred by PC to DHC and the suitability of the agreed referral criteria, and to compare them with the first visits due to headache in a general neurology clinic. Patients and methods. The study was conducted on a sample of 1,000 patients (741 females and 259 males) in the DHC and 290 (203 females and 87 males) in the general clinic. Data were collected retrospectively and included demographic variables, previous use of symptomatic or preventive treatments, need for complementary examinations and adjustment to referral criteria. Headaches were coded in accordance with the second edition of the International Headache Classification (IHC-2). Results. A total of 1,562 headaches were coded in the DHC group and 444 in the general clinic group; their distribution over the groups of the IHC-2 was similar, and most of them fell into group 1 (migraine). The percentage of patients who had received preventive treatment was higher in the DHC. The percentage of appropriate referrals was high and a little higher still in the general clinic. Conclusions. The characteristics of the patients referred from PC to a DHC in our milieu were similar to those reported in previous studies. These patients have received treatment more frequently than those who were seen in a general neurology clinic (AU)

Recomendaciones para la prevención de los trastornos de la salud mental en atención primaria / Prevention of mental health disorder

No disponible

[Referrals from primary care to a dedicated headache clinic: analysis of the first 1,000 patients]. / Derivaciones de atencion primaria a una consulta monografica de cefaleas: analisis de los 1.000 primeros pacientes.

INTRODUCTION: It is commonplace practice in dedicated clinics or headache units to deal with complex patients referred from general neurology clinics. In our centre, part of the schedule of the dedicated headache clinic (DHC) is reserved for patients referred from primary care (PC) in the form of one-stop clinics. AIMS: To analyse both the characteristics of the patients referred by PC to DHC and the suitability of the agreed referral criteria, and to compare them with the first visits due to headache in a general neurology clinic. PATIENTS AND METHODS: The study was conducted on a sample of 1,000 patients (741 females and 259 males) in the DHC and 290 (203 females and 87 males) in the general clinic. Data were collected retrospectively and included demographic variables, previous use of symptomatic or preventive treatments, need for complementary examinations and adjustment to referral criteria. Headaches were coded in accordance with the second edition of the International Headache Classification (IHC-2). RESULTS: A total of 1,562 headaches were coded in the DHC group and 444 in the general clinic group; their distribution over the groups of the IHC-2 was similar, and most of them fell into group 1 (migraine). The percentage of patients who had received preventive treatment was higher in the DHC. The percentage of appropriate referrals was high and a little higher still in the general clinic. CONCLUSIONS: The characteristics of the patients referred from PC to a DHC in our milieu were similar to those reported in previous studies. These patients have received treatment more frequently than those who were seen in a general neurology clinic.

TITLE: Derivaciones de atencion primaria a una consulta monografica de cefaleas: analisis de los 1.000 primeros pacientes.Introduccion. Es habitual en las consultas monograficas o unidades de cefaleas que atiendan a pacientes complejos derivados desde consultas generales de neurologia. En nuestro centro, parte de la agenda de la consulta monografica de cefaleas (CMC) se reserva a pacientes remitidos desde atencion primaria (AP) con formato de alta resolucion. Objetivos. Analizar las caracteristicas de los pacientes derivados por AP a la CMC y la adecuacion a los criterios de derivacion consensuados, y compararlos con las primeras visitas por cefalea en una consulta general de neurologia. Pacientes y metodos. Muestra de 1.000 pacientes (741 mujeres y 259 varones) en la CMC y 290 (203 mujeres y 87 varones) en la consulta general. Recogemos prospectivamente variables demograficas, uso previo de tratamientos sintomaticos o preventivos, necesidad de exploraciones complementarias y adecuacion a los criterios de derivacion. Codificamos las cefaleas de acuerdo con la segunda edicion de la Clasificacion Internacional de Cefaleas (CIC-2). Resultados. En el grupo de la CMC se codificaron 1.562 cefaleas, y en la consulta general, 444; su distribucion en los grupos de la CIC-2 era similar, y la mayoria se encuadraba en el grupo 1 (migraña). El porcentaje de pacientes que habian recibido tratamiento preventivo era mayor en la CMC. El porcentaje de derivaciones adecuadas fue alto y algo mayor en la consulta general. Conclusiones. Las caracteristicas de los pacientes derivados desde AP a una CMC en nuestro medio son similares a las previamente descritas. Estos pacientes han recibido tratamiento con mas frecuencia que los atendidos en una consulta general de neurologia.

[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)

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

Introducción. La neuralgia occipital es un dolor en la distribución de los nervios occipitales, acompañado de hipersensibilidad al tacto en el territorio correspondiente. Objetivos. Presentamos la serie de neuralgia occipital de la consulta monográfica de cefaleas de un hospital terciario y analizamos sus características clínicas y su respuesta terapéutica. Pacientes y métodos. 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 diagnóstico de 35,5 ± 58,8 meses (rango: 1-230 meses). Se descartó apropiadamente en cada caso patología intracraneal o cervical. En 13 de ellos (92,8%) se observó dolor basal de carácter generalmente opresivo e intensidad 5,3 ± 1,3 (4-8) en la escala analógica verbal. Once (78,5%) presentaban exacerbaciones, generalmente de carácter punzante, frecuencia variable (4,6 ± 7 al día) e intensidad 7,8 ± 1,7 (rango: 4-10) en la escala analógica verbal. En cuatro no se llevó a cabo bloqueo anestésico (dos por patrón remitente y dos por deseo del paciente); en los restantes, se realizó bloqueo con eficacia completa de duración entre dos y siete meses. Cuatro casos habían recibido anteriormente tratamiento preventivo (amitriptilina en tres y gabapentina en uno), sin respuesta. Conclusiones. En esta serie de una consulta monográfica 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 anestésicos (AU)

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 (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.

Nummular headache and epicrania fugax: possible association of epicranias in eight patients.

OBJECTIVES: Epicrania fugax (EF) is a novel syndrome presenting with brief pain paroxysms that always start in a particular area of the head to spread immediately either forward or backward. Paroxysms stem from a focal area, in which a well-shaped continuous pain reminiscent of the symptomatic area described in nummular headache (NH) can be present. We aimed to analyze the association of these two epicranial headaches in eight patients. METHODS: We prospectively assessed all patients with EF attending an outpatient headache office from March 2008, when EF was first described, to June 2012. Among them, we selected those patients with a well-circumscribed continuous pain at the stemming point fulfilling the research diagnostic criteria for NH of the International Classification of Headache Disorders II Edition (ICHD-II) appendix. We considered the demographic and clinical features of the selected patients. RESULTS: Eight patients (five females, three males) were diagnosed with both EF and NH. Mean age of onset was 44.2 ± 12 (range: 23-60). Regarding NH, the diameter of the painful area was 4.4 ± 1 centimeters (range: 3-6) and pain intensity was 4.2 ± 0.7 (range: 3-5) on a 10-point verbal analogical scale (VAS). As for the EF, the radiating paroxysms always started in the NH painful area and lasted 6.6 ± 4.5 seconds (range: 2-15), with a pain intensity of 7.9 ± 1.6 (range 5-10) on the VAS. Five cases had forward radiation, while three cases had backward EF. Four cases had ipsilateral autonomic accompaniments. Six patients required a preventive, and lamotrigine achieved complete response in three of them. CONCLUSION: Although the etiology of NH and EF remains uncertain, both syndromes seem to share a peripheral source. Their association in a number of patients is probably reflecting a pathophysiological connection. Lamotrigine might be a good therapeutic option for those patients presenting with both disorders.

[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.

Nummular headache with and without exacerbations: comparative characteristics in a series of 72 patients.

OBJECTIVES: Apart from the characteristic chronic head pain in a coin-shaped circumscribed area, superimposed exacerbations have been described from early reports of nummular headache (NH). In a prospective series, we aim to compare the demographic and clinical characteristics between cases of exacerbations (ENH) and non-exacerbations (NENH) in NH. METHODS AND RESULTS: Seventy-two NH patients (44 female, 28 male) attending a headache outpatient office. As eight patients presented with bifocal NH we analysed 80 painful areas; 47 (58.8%) presented in situ exacerbations. Mean intensity of exacerbations was 7.5 ± 1.6 and they lasted 5.7 ± 11.6 minutes. Exacerbation quality was mostly stabbing. We found no differences between ENH and NEHN groups in age at onset, baseline pain intensity, size of painful area, allodynia or other sensory symptoms, or baseline pain quality. There were no differences between populations with respect to relief with symptomatic therapy, requirement of preventative therapy and its response to preventatives. CONCLUSION: In situ exacerbations superimposed on baseline pain are frequent in NH and might be included in diagnostic criteria. No statistically significant differences were found between ENH and NENH cases in demographic and nosological characteristics, or needing or response to therapy, but these sample sizes are small.