Cefalea: embarazo y lactancia. Recomendaciones del Grupo de Estudio de Cefaleas de la Sociedad Española de Neurología (GECSEN) / Headache: pregnancy and breastfeeding Recommendations of the Spanish Society of Neurology's Headache Study Group

Introducción: La cefalea es uno de los motivos de consulta más comunes en neurología, siendo más frecuente durante la edad reproductiva. Por ello, es habitual encontrar en nuestras consultas pacientes embarazadas o en periodo de lactancia con dicha queja. Es importante conocer las opciones farmacológicas más seguras, cuáles no se deben emplear, así como cuándo sospechar cefaleas secundarias. Por este motivo, el Grupo de Estudio de Cefaleas de la Sociedad Española de Neurología ha elaborado una guía con las recomendaciones consensuadas acerca de los algoritmos diagnósticos y terapéuticos que se deben emplear durante el embarazo y la lactancia. Desarrollo: Esta guía ha sido redactada por un grupo de jóvenes neurólogos con especial interés y experiencia en cefaleas en colaboración con la Junta Directiva del Grupo de Estudio de Cefaleas de la Sociedad Española de Neurología. Las recomendaciones se centran en los fármacos aconsejados en las cefaleas primarias más frecuentes, tanto en su fase aguda como preventiva. En una segunda parte se aborda cuándo sospechar y qué pruebas realizar ante una posible cefalea secundaria durante el embarazo y la lactancia. Conclusiones: Esperamos que esta guía resulte de utilidad y permita su aplicación práctica en la consulta diaria. Asimismo, que sirva para actualizar y mejorar el conocimiento del manejo de las cefaleas durante estas etapas, para actuar con mayor confianza ante estas pacientes. (AU)

Introduction: Headache is one of the most common neurological complaints, and is most frequent during reproductive age. As a result, we are routinely faced with pregnant or breastfeeding women with this symptom in clinical practice. It is important to know which pharmacological choices are the safest, which should not be used, and when we should suspect secondary headache. To this end, the Spanish Society of Neurology's Headache Study Grouphas prepared a series of consensus recommendations on the diagnostic and therapeutic algorithms that should be followed during pregnancy and breastfeeding. Development: This guide was prepared by a group of young neurologists with special interest and experience in headache, in collaboration with the Group's Executive Committee. Recommendations focus on which drugs should be used for the most frequent primary headaches, both during the acute phase and for prevention. The second part addresses when secondary headache should be suspected and which diagnostic tests should be performed in the event of possible secondary headache during pregnancy and breastfeeding. Conclusions: We hope this guide will be practical and useful in daily clinical practice and that it will help update and improve understanding of headache management during pregnancy and breastfeeding, enabling physicians to more confidently treat these patients. (AU)

Headache: pregnancy and breastfeeding. Recommendations of the Spanish Society of Neurology's Headache Study Group.

INTRODUCTION: Headache is one of the most common neurological complaints, and is most frequent during reproductive age. As a result, we are routinely faced with pregnant or breastfeeding women with this symptom in clinical practice. It is important to know which pharmacological choices are the safest, which should not be used, and when we should suspect secondary headache. To this end, the Spanish Society of Neurology's Headache Study Group has prepared a series of consensus recommendations on the diagnostic and therapeutic algorithms that should be followed during pregnancy and breastfeeding. DEVELOPMENT: This guide was prepared by a group of young neurologists with special interest and experience in headache, in collaboration with the Group's Executive Committee. Recommendations focus on which drugs should be used for the most frequent primary headaches, both during the acute phase and for prevention. The second part addresses when secondary headache should be suspected and which diagnostic tests should be performed in the event of possible secondary headache during pregnancy and breastfeeding. CONCLUSIONS: We hope this guide will be practical and useful in daily clinical practice and that it will help update and improve understanding of headache management during pregnancy and breastfeeding, enabling physicians to more confidently treat these patients.

Cómo y cuándo derivar un paciente con cefalea primaria y neuralgia craneofacial desde Urgencias y Atención Primaria: recomendaciones del Grupo de Estudio de Cefalea de la Sociedad Española de Neurología / How and when to refer patients diagnosed with primary headache and craniofacial neuralgia in the Emergency department or Primary Care: Recommendations of the Spanish Society of Neurology's Headache Study Group

INTRODUCCIÓN: Cuando tras una correcta anamnesis y exploración neurológica se diagnostica a un paciente con una cefalea primaria o una neuralgia craneofacial en urgencias o atención primaria y se decide derivar a neurología por complejidad es útil conocer si además se deberían solicitar exploraciones complementarias y la preferencia (urgente, preferente o normal) con la que se debería derivar para que el paciente llegue a la consulta del neurólogo sin demoras innecesarias en pacientes con dolores incapacitantes o con sospecha de organicidad. Por este motivo, el Grupo de Estudio de Cefalea de la Sociedad Española de Neurología, ha decidido crear unas recomendaciones consensuadas que establezcan un protocolo de derivación de pacientes con cefalea y/o neuralgias craneofaciales. DESARROLLO: Se ha contactado con neurólogos jóvenes con interés y experiencia en cefalea y con la Junta Directiva del Grupo de Estudio de Cefalea de la Sociedad Española de Neurología que han desarrollado este documento que, por razones prácticas, se ha dividido en 2 artículos. Esta primera centrada en las cefaleas o neuralgias craneofaciales primarias y una segunda que se focaliza en las cefaleas secundarias. El enfoque es práctico con tablas que resumen los criterios de derivación con exploraciones complementarias y otros especialistas a los que derivar, para que sea útil y facilite su uso en nuestra práctica asistencial diaria. CONCLUSIONES: Esperamos ofrecer una guía y herramientas para mejorar la toma de decisiones ante un paciente con cefalea, valorando exploraciones a priorizar y qué circuitos seguir para así evitar la duplicación de consultas y retrasos en el diagnóstico y en el tratamiento

INTRODUCTION: When a patient is diagnosed with primary headache or craniofacial neuralgia in the emergency department or in primary care, and is referred to a neurologist due to the complexity of the case, it is useful to know whether additional examination should be sought and the priority (urgent, preferential or normal) with which the patient should be seen. This will avoid unnecessary delays in patients with disabling headache and where organic causes are suspected. In order to issue recommendations on this matter, the Spanish Society of Neurology's Headache Study Group has decided to create a series of agreed recommendations constituting a referral protocol for patients with headache and/or craniofacial neuralgia. DEVELOPMENT: Young neurologists with an interest and experience in headache were invited to draft a series of practical guidelines in collaboration with Spanish Society of Neurology's Headache Study Group Executive Committee. For practical reasons, the document was divided into 2 articles: this first article focuses on primary headaches and craniofacial neuralgias and the second on secondary headaches. In order for the recommendations to be helpful for daily practice they follow a practical approach, with tables summarising referral criteria, examinations to be performed, and referral to other specialists. CONCLUSIONS: We hope to offer a guide and tools to improve decision-making regarding patients with headache, identifying complementary tests to prioritise and referral pathways to be followed, in order to avoid duplicated consultations and delayed diagnosis and treatment

How and when to refer patients diagnosed with primary headache and craniofacial neuralgia in the Emergency department or Primary Care: Recommendations of the Spanish Society of Neurology's Headache Study Group. / Cómo y cuándo derivar un paciente con cefalea primaria y neuralgia craneofacial desde Urgencias y Atención Primaria: recomendaciones del Grupo de Estudio de Cefalea de la Sociedad Española de Neurología.

INTRODUCTION: When a patient is diagnosed with primary headache or craniofacial neuralgia in the emergency department or in primary care, and is referred to a neurologist due to the complexity of the case, it is useful to know whether additional examination should be sought and the priority (urgent, preferential or normal) with which the patient should be seen. This will avoid unnecessary delays in patients with disabling headache and where organic causes are suspected. In order to issue recommendations on this matter, the Spanish Society of Neurology's Headache Study Group has decided to create a series of agreed recommendations constituting a referral protocol for patients with headache and/or craniofacial neuralgia. DEVELOPMENT: Young neurologists with an interest and experience in headache were invited to draft a series of practical guidelines in collaboration with Spanish Society of Neurology's Headache Study Group Executive Committee. For practical reasons, the document was divided into 2 articles: this first article focuses on primary headaches and craniofacial neuralgias and the second on secondary headaches. In order for the recommendations to be helpful for daily practice they follow a practical approach, with tables summarising referral criteria, examinations to be performed, and referral to other specialists. CONCLUSIONS: We hope to offer a guide and tools to improve decision-making regarding patients with headache, identifying complementary tests to prioritise and referral pathways to be followed, in order to avoid duplicated consultations and delayed diagnosis and treatment.

Headache: pregnancy and breastfeeding Recommendations of the Spanish Society of Neurology's Headache Study Group. / Cefalea: embarazo y lactancia. Recomendaciones del Grupo de Estudio de Cefaleas de la Sociedad Española de Neurología (GECSEN).

INTRODUCTION: Headache is one of the most common neurological complaints, and is most frequent during reproductive age. As a result, we are routinely faced with pregnant or breastfeeding women with this symptom in clinical practice. It is important to know which pharmacological choices are the safest, which should not be used, and when we should suspect secondary headache. To this end, the Spanish Society of Neurology's Headache Study Grouphas prepared a series of consensus recommendations on the diagnostic and therapeutic algorithms that should be followed during pregnancy and breastfeeding. DEVELOPMENT: This guide was prepared by a group of young neurologists with special interest and experience in headache, in collaboration with the Group's Executive Committee. Recommendations focus on which drugs should be used for the most frequent primary headaches, both during the acute phase and for prevention. The second part addresses when secondary headache should be suspected and which diagnostic tests should be performed in the event of possible secondary headache during pregnancy and breastfeeding. CONCLUSIONS: We hope this guide will be practical and useful in daily clinical practice and that it will help update and improve understanding of headache management during pregnancy and breastfeeding, enabling physicians to more confidently treat these patients.

Cefalea en jóvenes: características clínicas en una serie de 651 casos / Headache in young patients: Clinical characteristics of a series of 651 cases

Introducción: La cefalea produce un impacto negativo sobre la calidad de vida de los jóvenes. Nuestro objetivo es analizar las características de esta población en una consulta monográfica de cefaleas (CMC) y evaluar la carga de las diferentes cefaleas codificadas según la Clasificación Internacional de Cefaleas (CIC). Métodos: Durante un período de 6 años y medio, se han registrado los pacientes de edades entre los 14 y los 25 años atendidos en la CMC recogiendo de cada uno de ellos el sexo, pruebas complementarias y tratamiento utilizado previamente. Se llevó a cabo la comparación de las características de esta población con la de mayores de 25 años. Resultados: Seiscientos cincuenta y un pacientes de entre 14 y 25 años fueron atendidos durante el período de inclusión; el 95,6% había recibido tratamiento sintomático y el 30,1% tratamiento preventivo. Setecientas cincuenta y cinco cefaleas fueron registradas, 80 fueron cefaleas secundarias, la mayoría codificadas en el grupo 8. El 77,2% de ellas fueron incluidas en el grupo 1, el 3,1% en el grupo 2, el 1,2% en el grupo 3 y el 5% en el grupo 4. El 0,6% de ellas fueron clasificadas en el grupo 13 y el 0,9% en el grupo 14. En 449 pacientes la puntuación del Headache Impact Test (HIT-6) mostró al menos un impacto moderado sobre la calidad de vida. Conclusión: La mayoría de las cefaleas en jóvenes podrían ser codificadas de acuerdo con los criterios de la CIC. La migraña fue el diagnóstico más frecuente. Aunque la cefalea fue comúnmente asociada con impacto negativo en la calidad de vida, los tratamientos preventivos no fueron utilizados extensamente antes de ser derivados a la CMC

Introduction: Headache has a negative impact on health-related quality of life in young patients. We aim to analyse the characteristics of a series of young patients visiting a headache clinic and estimate the burden of different types of headaches listed by the International Classification of Headache Disorders (ICHD). Methods: We prospectively recruited patients aged 14 to 25 years who were treated at our clinic during a period of 6.5 years. We recorded each patient's sex, complementary test results, and previous treatment. We subsequently compared the characteristics of our sample to those of patients older than 25. Results: During the study period, we treated 651 patients aged 14 to 25 years; 95.6% had received symptomatic treatment, and 30.1% had received preventive treatment. A total of 755 headaches were recorded. Only 80 were secondary headaches, most of which were included in Group 8; 77.2% were included in Group 1, 3.1% in Group 2, 1.2% in Group 3, 5% in Group 4, 0.6% in Group 13, and 0.9% in Group 14. According to Headache Impact Test (HIT-6) scores, headache had at least a moderate impact on the quality of life of 449 patients. Conclusion: Most headaches in young patients can be classified according to ICHD criteria. Migraine was the most frequent diagnosis in our sample. Although headache was commonly associated with a negative impact on quality of life, most patients had received little preventive treatment before being referred to our clinic

Headache in young patients: Clinical characteristics of a series of 651 cases. / Cefalea en jóvenes: características clínicas en una serie de 651 casos.

INTRODUCTION: Headache has a negative impact on health-related quality of life in young patients. We aim to analyse the characteristics of a series of young patients visiting a headache clinic and estimate the burden of different types of headaches listed by the International Classification of Headache Disorders (ICHD). METHODS: We prospectively recruited patients aged 14 to 25 years who were treated at our clinic during a period of 6.5 years. We recorded each patient's sex, complementary test results, and previous treatment. We subsequently compared the characteristics of our sample to those of patients older than 25. RESULTS: During the study period, we treated 651 patients aged 14 to 25 years; 95.6% had received symptomatic treatment, and 30.1% had received preventive treatment. A total of 755 headaches were recorded. Only 80 were secondary headaches, most of which were included in Group 8; 77.2% were included in Group 1, 3.1% in Group 2, 1.2% in Group 3, 5% in Group 4, 0.6% in Group 13, and 0.9% in Group 14. According to Headache Impact Test (HIT-6) scores, headache had at least a moderate impact on the quality of life of 449 patients. CONCLUSION: Most headaches in young patients can be classified according to ICHD criteria. Migraine was the most frequent diagnosis in our sample. Although headache was commonly associated with a negative impact on quality of life, most patients had received little preventive treatment before being referred to our clinic.

[Nasal congestion as an autonomic symptom accompanying migraine attacks]. / Congestion nasal como sintoma autonomico acompañante de crisis migranosas.

TITLE: Congestion nasal como sintoma autonomico acompañante de crisis migranosas.

[Clinical characteristics of vestibular migraine: considerations in a series of 41 patients]. / Caracteristicas clinicas de la migraña vestibular: consideraciones en una serie de 41 pacientes.

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.

TITLE: Caracteristicas clinicas de la migraña vestibular: consideraciones en una serie de 41 pacientes.Introduccion. Tras años de debates sobre su enfoque desde las cefaleas y su denominacion, la migraña vestibular ha sido recientemente incluida en el apendice de investigacion de la III edicion de la Clasificacion Internacional de Cefaleas. Objetivo. Analizar las caracteristicas de una serie de pacientes con migraña vestibular en los que el motivo de consulta fue la cefalea. Pacientes y metodos. Pacientes atendidos en una unidad de cefaleas entre enero de 2014 y diciembre de 2015. Se consideran las variables demograficas y caracteristicas tanto de la migraña como de los sintomas vestibulares, y se excluyen los casos con otras patologias otorrinolaringologicas. Resultados. Se incluyen 41 pacientes (11 varones, 30 mujeres) con una edad media de 31,8 ± 13,3 años en el momento de la inclusion. Dieciseis pacientes (39%) reunian criterios de migraña cronica y dos (4,9%) presentaban auras visuales. Los sintomas vestibulares fueron considerados graves en ocho casos (19,5%) y ocurrian en un 74,6% de los episodios de migraña. El vertigo se describia como interno en 18 casos (43,9%), externo en 22 (53,7%) y mixto en uno (2,4%). El sintoma mas frecuente fue el vertigo posicional (n = 25; 61%), seguido del inducido por movimientos cefalicos (n = 18; 43,9%) y el espontaneo (n = 15; 36,6%). Como sintomas acompañantes se observaron acufenos (n = 12; 29,3%) y pletora aural (n = 8; 19,5%). Conclusion. La identificacion de sintomas 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 vertigo no suele interferir en sus actividades habituales.

Aneurisma intracraneal distal con presentación atípica, localización y evolución en una mujer joven / Atypical presentation of a distal cerebral aneurysm: location and outcome in a young woman

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Bloqueo anestésico de nervios pericraneales como tratamiento preventivo de migraña: experiencia en una serie de 60 pacientes / Pericranial nerve blockade as a preventive treatment for migraine: Experience in 60 patients

Introducción: El bloqueo anestésico de nervios pericraneales es utilizado con frecuencia en el tratamiento de diferentes cefaleas. No hay evidencia acerca de su indicación en pacientes migrañosos. Pretendemos evaluar su eficacia como tratamiento preventivo de migraña con criterios determinados. Métodos: Entre enero del 2009 y mayo del 2013 se ofreció este tratamiento a migrañosos con fracaso o intolerancia de fármacos preventivos. Seleccionamos a aquellos con sensibilidad a la palpación en al menos un nervio supraorbitario u occipital mayor. A los 3 meses, consideramos la respuesta completa (sin dolor), parcial (reducción al menos de un 50% en severidad y/o frecuencia de episodios) o ausente. Resultados: Se practicó un bloqueo anestésico en 60 pacientes (52 mujeres, 8 varones, edad media ± desviación estándar: 40,6 ± 12,4 años, rango 19-76). El procedimiento más habitual fue el bloqueo de ambos nervios occipitales y supraorbitarios. Hubo respuesta completa de al menos 2 semanas en 23 (38,3%), parcial en 24 (40%) y ausente en 13 (21,7%). En el grupo con respuesta completa, la edad y el tiempo de evolución de la migraña eran significativamente inferiores. Sin efectos adversos significativos. Tiempo de respuesta entre 2 semanas y 3 meses. Conclusiones: El bloqueo anestésico de nervios pericraneales utilizando la sensibilidad a la palpación como criterio de selección es un procedimiento seguro y potencialmente eficaz como tratamiento preventivo de migraña. Las mayores respuestas en nuestra serie se observan en pacientes jóvenes con menos tiempo de evolución de la migraña

Introduction: Anaesthetic blockade of pericranial nerves is frequently used to treat headache disorders. There is no evidence on indication of this treatment for migraine. We aim to evaluate its effectiveness as a preventive treatment for migraine using specific indication criteria. Methods: Between January 2009 and May 2013 we offered pericranial nerve blockade to migraine patients with a history of preventive drug intolerance or failure. We selected patients with tenderness to palpation of at least one greater occipital nerve (GON) or supraorbital nerve (SON). Responses at 3 months were categorised as complete response (no pain), partial response (reduction of at least 50% in severity or frequency of headache episodes), or no response. Results: Anaesthetic blockade was performed in 60 patients (52 females, 8 males; mean age 40.6 ± 12.4 years, range 19-76). The most common procedure was blockade of GON and SON on both sides. Complete response lasting at least 2 weeks was recorded in 23 patients (38.3%), with partial response in 24 patients (40%), and no response in 13 (21.7%). In the group presenting complete response, age and length of history of migraine were significantly lower. No severe side effects were detected. Response time ranged from 2 weeks to 3 months. Conclusions: Pericranial nerves blockade using tenderness to palpation as an inclusion criterion is safe and potentially effective as prophylactic treatment for migraine. The best responses in our series were observed in younger patients with shorter histories of migraine

Neuralgia del nervio laríngeo superior: a propósito de un caso de difícil control / Refractory neuralgia of the superior laryngeal nerve: A case study

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Pericranial nerve blockade as a preventive treatment for migraine: Experience in 60 patients. / Bloqueo anestésico de nervios pericraneales como tratamiento preventivo de migraña: experiencia en una serie de 60 pacientes.

INTRODUCTION: Anaesthetic blockade of pericranial nerves is frequently used to treat headache disorders. There is no evidence on indication of this treatment for migraine. We aim to evaluate its effectiveness as a preventive treatment for migraine using specific indication criteria. METHODS: Between January 2009 and May 2013 we offered pericranial nerve blockade to migraine patients with a history of preventive drug intolerance or failure. We selected patients with tenderness to palpation of at least one greater occipital nerve (GON) or supraorbital nerve (SON). Responses at 3 months were categorised as complete response (no pain), partial response (reduction of at least 50% in severity or frequency of headache episodes), or no response. RESULTS: Anaesthetic blockade was performed in 60 patients (52 females, 8 males; mean age 40.6 ± 12.4 years, range 19-76). The most common procedure was blockade of GON and SON on both sides. Complete response lasting at least 2 weeks was recorded in 23 patients (38.3%), with partial response in 24 patients (40%), and no response in 13 (21.7%). In the group presenting complete response, age and length of history of migraine were significantly lower. No severe side effects were detected. Response time ranged from 2 weeks to 3 months. CONCLUSIONS: Pericranial nerves blockade using tenderness to palpation as an inclusion criterion is safe and potentially effective as prophylactic treatment for migraine. The best responses in our series were observed in younger patients with shorter histories of migraine.