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1.
J Stroke Cerebrovasc Dis ; 29(9): 105011, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807426

RESUMO

The current COVID-19 pandemic has recently brought to attention the myriad of neuro- logic sequelae associated with Coronavirus infection including the predilection for stroke, particularly in young patients. Reversible cerebral vasoconstriction syndrome (RCVS) is a well-described clinical syndrome leading to vasoconstriction in the intracra- nial vessels, and has been associated with convexity subarachnoid hemorrhage and oc- casionally cervical artery dissection. It is usually reported in the context of a trigger such as medications, recreational drugs, or the postpartum state; however, it has not been described in COVID-19 infection. We report a case of both cervical vertebral ar- tery dissection as well as convexity subarachnoid hemorrhage due to RCVS, in a pa- tient with COVID-19 infection and no other triggers.


Assuntos
Betacoronavirus/patogenicidade , Artérias Cerebrais/fisiopatologia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Hemorragia Subaracnóidea/complicações , Vasoconstrição , Dissecação da Artéria Vertebral/complicações , Adulto , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/efeitos dos fármacos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Feminino , Transtornos da Cefaleia Primários/etiologia , Transtornos da Cefaleia Primários/fisiopatologia , Interações Hospedeiro-Patógeno , Humanos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Fatores de Risco , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/tratamento farmacológico , Hemorragia Subaracnóidea/fisiopatologia , Síndrome , Vasoconstrição/efeitos dos fármacos , Vasodilatação , Dissecação da Artéria Vertebral/diagnóstico por imagem , Dissecação da Artéria Vertebral/tratamento farmacológico , Dissecação da Artéria Vertebral/fisiopatologia
2.
Dev Med Child Neurol ; 62(1): 69-74, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31529464

RESUMO

AIM: To examine the characteristics of primary stabbing headache (PSH) in typically developing children and adolescents. METHOD: In this prospective non-interventional hospital-based study, we examined 42 eligible individuals (24 females, 18 males; 26 white; mean age 12y 1mo, range 6y-16y 1mo) with spontaneous transient stabs. A headache focused history and/or a headache diary was obtained from each patient. All patients had normal neurological examination. Diagnosis of primary headache was based on the International Classification of Headache Disorders, Third Edition (ICHD-3) beta version. RESULTS: Duration of stabs ranged from a few seconds to up to 10 minutes. Stabs were located in a variety of sites on the cranium but mostly in the extra-trigeminal regions (n=28). Intensity of stabs varied from moderate (n=4) to severe (n=38). The frequency of the stabs ranged from daily to monthly. There were up to 50 stabs per headache attack. Stabs among our patients occurred independently from those caused by other primary headache types. Accompanying symptoms during stabs were reported by eight patients. Family history of primary headaches was identified (n=17). Familial transmission of PSH was recognized among two patients. All patients had normal brain magnetic resonance imaging. INTERPRETATION: The presentation and nature of PSH in children and adolescents varies widely. PSH in children may be a different entity to that in adults, and there is a need for further research to support changes in the ICHD-3 criteria for PSH in children and adolescents. WHAT THIS PAPER ADDS: Presentation of childhood primary stabbing headache (PSH) varies widely. Duration of PSH could last from a few seconds up to 10 minutes.


Assuntos
Transtornos da Cefaleia Primários/fisiopatologia , Adolescente , Criança , Feminino , Transtornos da Cefaleia Primários/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Estudos Prospectivos
3.
Neurol Clin ; 37(4): 707-725, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31563228

RESUMO

Most primary headaches can be diagnosed using the history and examination. Judicious use of neuroimaging and other testing, however, is indicated to distinguish primary headaches from the many secondary causes that may share similar features. This article evaluates the reasons for diagnostic testing and the use of neuroimaging, electroencephalography, lumbar puncture, and blood testing. The use of diagnostic testing in adults and children who have headaches and a normal neurologic examination, migraine, trigeminal autonomic cephalalgias, hemicrania continua, and new daily persistent headache are reviewed.


Assuntos
Eletroencefalografia/métodos , Transtornos da Cefaleia Primários/diagnóstico , Transtornos da Cefaleia Primários/fisiopatologia , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/fisiopatologia , Neuroimagem/métodos , Humanos , Exame Neurológico/métodos , Cefalalgias Autonômicas do Trigêmeo/diagnóstico , Cefalalgias Autonômicas do Trigêmeo/fisiopatologia
4.
Neurol Clin ; 37(4): 871-891, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31563237

RESUMO

"Other Primary Headaches" in the ICHD-3 encompasses activity-related headaches, headaches due to direct physical stimuli, epicranial headaches and a miscellanea, including hypnic headache and new daily-persistent headache. They can be primary or secondary and their etiologies differ depending on headache type. For instance, activity-related headaches can be induced by Valsalva maneuvers ("cough headache") or prolonged exercise ("exercise and sexual headaches"). Almost half of cough headaches are secondary to posterior fossa abnormality, whereas only 20% of exertional/sexual headaches are secondary, with subarachnoid hemorrhage the most frequent etiology. This article reviews the clinical diagnosis and management of these heterogeneous headaches.


Assuntos
Exercício Físico/fisiologia , Transtornos da Cefaleia Primários/diagnóstico por imagem , Transtornos da Cefaleia Primários/fisiopatologia , Comportamento Sexual/fisiologia , Transtornos da Cefaleia Primários/etiologia , Humanos , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/fisiopatologia
5.
Biomed Res Int ; 2019: 4630490, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31119170

RESUMO

Objective: Primary headache and obesity are highly prevalent disorders in the general population. Although many studies have reported an association between the two, there is still no overall comprehension about this relationship. To gain a more accurate understanding in this regard, we analyzed data from a 2011 cross-sectional study in Chongqing, China. Methods: Patients with a chief complaint of headache were administered a headache questionnaire and diagnosed by neurology doctors in accordance with the International Classification of Headache Disorders 2nd Edition (ICHD-II) criteria. Patients aged < 18 years or diagnosed with secondary headache were excluded. Results: Of 1327 patients who cited headache as the chief complaint, 16 were excluded for missing data, while 396 were diagnosed with chronic headache (177 chronic migraine [CM], 186 chronic tension-type headache [CTTH], and 33 other chronic headache) and 915 with episodic headache (369 episodic migraine [EM], 319 episodic tension-type headache [ETTH], and 227 other episodic headache). Chronic headache patients had a higher number of headache days per month, longer duration of headache history, and greater tendency to overuse analgesics than episodic headache patients. The CM and ETTH patients were more apt to be overweight and had a significantly greater body mass index (BMI; p < 0.05) than the EM and CTTH patients. Overweight (odds ratio [OR] = 3.64; 95% confidence interval (CI), 1.19-8.81) and obesity (OR = 28.63; 95% CI, 2.96-276.6) were independently associated with CM but not with other headaches, and this association was not influenced by other factors such as medication overuse. Conclusions: The relationship between headache and overweight/obesity varies depending on the type of primary headache. CM patients are more likely to have a higher body mass index than EM patients, while ETTH patients are more likely to be overweight/obese than CTTH patients.


Assuntos
Índice de Massa Corporal , Transtornos da Cefaleia Primários/epidemiologia , Transtornos da Cefaleia/epidemiologia , Obesidade/epidemiologia , Adulto , China/epidemiologia , Cefaleia Histamínica/complicações , Cefaleia Histamínica/epidemiologia , Cefaleia Histamínica/fisiopatologia , Estudos Transversais , Feminino , Transtornos da Cefaleia/complicações , Transtornos da Cefaleia/fisiopatologia , Transtornos da Cefaleia Primários/complicações , Transtornos da Cefaleia Primários/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/epidemiologia , Transtornos de Enxaqueca/fisiopatologia , Obesidade/complicações , Obesidade/fisiopatologia , Inquéritos e Questionários , Cefaleia do Tipo Tensional/complicações , Cefaleia do Tipo Tensional/epidemiologia , Cefaleia do Tipo Tensional/fisiopatologia
6.
J Headache Pain ; 20(1): 35, 2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30961531

RESUMO

Primary headaches are one of the most prevalent neurological disorders and can occur during a wide range of lifespan. Primary headaches, especially migraine, are cyclic disorders with a complex sequence of symptoms within every headache attack. There is no systematic review of whether these symptoms changes during lifespan. Indeed, the clinical presentation of migraine shows an age-dependent change with a significantly shorter duration of the attacks and occurrence of different paroxysmal symptoms, such as vomiting, abdominal pain or vertigo, in childhood and, in contrast, largely an absence of autonomic signs and a more often bilateral headache in the elderly. The age-dependent differences in the clinical presentation are less distinct in cluster headache and, especially, in tension-type headache. The differences in the clinical presentation are in agreement with the idea that the connectivity of hypothalamic areas with different brainstem areas, especially the central parasympathetic areas, is important for the clinical manifestation of migraine, as well as, the change during lifespan.


Assuntos
Transtornos da Cefaleia Primários/diagnóstico , Transtornos da Cefaleia Primários/epidemiologia , Longevidade , Fatores Etários , Idoso , Criança , Cefaleia Histamínica/diagnóstico , Cefaleia Histamínica/epidemiologia , Cefaleia Histamínica/fisiopatologia , Feminino , Transtornos da Cefaleia Primários/fisiopatologia , Humanos , Longevidade/fisiologia , Masculino , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/epidemiologia , Transtornos de Enxaqueca/fisiopatologia , Prevalência , Cefaleia do Tipo Tensional/diagnóstico , Cefaleia do Tipo Tensional/epidemiologia , Cefaleia do Tipo Tensional/fisiopatologia
8.
J Am Geriatr Soc ; 66(12): 2408-2416, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30251385

RESUMO

OBJECTIVES: To provide a unique perspective on geriatric headache and a number of novel treatment options that are not well known outside of the headache literature. DESIGN: Review of the most current and relevant headache literature for practitioners specializing in geriatric care. RESULTS: Evaluation and management of headache disorders in older adults requires an understanding of the underlying pathophysiology and how it relates to age-related physiological changes. To treat headache disorders in general, the appropriate diagnosis must first be established, and treatment of headaches in elderly adults poses unique challenges, including potential polypharmacy, medical comorbidities, and physiological changes associated with aging. CONCLUSION: The purpose of this review is to provide a guide to and perspective on the challenges inherent in treating headaches in older adults. J Am Geriatr Soc 66:2408-2416, 2018.


Assuntos
Avaliação Geriátrica , Transtornos da Cefaleia Primários/diagnóstico por imagem , Transtornos da Cefaleia Primários/terapia , Idoso , Comorbidade , Transtornos da Cefaleia Primários/fisiopatologia , Humanos
9.
Curr Pain Headache Rep ; 22(10): 68, 2018 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-30073574

RESUMO

PURPOSE OF REVIEW: The purpose of this review is to summarize the most up-to-date literature on bath-related headache, a rare disorder. RECENT FINDINGS: Initially described in middle-aged Asian women, it is now reported in a wider demographic. More information is available about the pathophysiology of bath-related headache, including its classification as a subtype of reversible cerebral vasoconstriction syndrome (RCVS). Nimodipine can be effective in patients both with and without vasospasm. Bath-related headache is a rare form of thunderclap headache. Although its mechanism is still unclear, it is associated with vasospasm and RCVS. Controlled trials investigating the use of nimodipine and other agents may be useful in furthering our understanding of and treatment of this phenomenon.


Assuntos
Anti-Hipertensivos/uso terapêutico , Transtornos da Cefaleia Primários/tratamento farmacológico , Nimodipina/uso terapêutico , Vasoespasmo Intracraniano/tratamento farmacológico , Animais , Cefaleia/complicações , Cefaleia/tratamento farmacológico , Transtornos da Cefaleia Primários/fisiopatologia , Humanos , Vasoconstrição/efeitos dos fármacos , Vasoespasmo Intracraniano/fisiopatologia
10.
Trials ; 19(1): 426, 2018 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-30086776

RESUMO

BACKGROUND: The stellate ganglion block (SGB) can lead to vasodilation of the head and neck. However, controversy remains concerning the changes in extracerebral blood flow. The objective of this study is to assess the effects of SGB on the blood flow to the neck. METHODS: A randomized controlled crossover trial with 38 participants will be conducted. Participants who have primary headaches will be assigned to either group A or B. Patients in group A will receive SGB with 6 ml 1% lidocaine, and after a one-week washout period, they will undergo the second SGB with 6 ml normal saline. In contrast, patients in group B will receive the opposite protocol. Data will be collected at baseline (T0) and at 15 min after the first intervention (T1), 15 min before the second intervention (T2), 15 min after the second intervention (T3) and at a 3-week follow up (T4). T1 is the primary time point for the primary outcome analysis. The primary outcomes include the peak systolic velocity (PSV), the end diastolic velocity (EDV), resistance index (RI) and vessel diameter of the common carotid artery (CCA) and vertebral artery (VA). The secondary outcomes include the rate of ptosis, the rate of conjunctival flushing, and the numerical rating scale (NRS) pain score. Additionally, adverse events (AEs) or serious adverse events (SAEs) will be collected at each assessment point. DISCUSSION: This study will comprehensively investigate the efficacy of SGB in extracerebral blood flow. Our research may also suggest that SGB will be effective in reducing pain in patients with primary headaches. TRIAL REGISTRATION: Chinese Clinical Trial Registry, identifier ChiCTR-IOR-17011536 . Registered on 1 June 2017.


Assuntos
Anestésicos Locais/administração & dosagem , Artéria Carótida Primitiva/fisiopatologia , Transtornos da Cefaleia Primários/terapia , Lidocaína/administração & dosagem , Pescoço/irrigação sanguínea , Bloqueio Nervoso/métodos , Gânglio Estrelado/efeitos dos fármacos , Ultrassonografia de Intervenção , Artéria Vertebral/fisiopatologia , Adolescente , Adulto , Idoso , Anestésicos Locais/efeitos adversos , Velocidade do Fluxo Sanguíneo , Artéria Carótida Primitiva/diagnóstico por imagem , Circulação Cerebrovascular , China , Estudos Cross-Over , Feminino , Transtornos da Cefaleia Primários/diagnóstico , Transtornos da Cefaleia Primários/fisiopatologia , Humanos , Lidocaína/efeitos adversos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/efeitos adversos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fluxo Sanguíneo Regional , Gânglio Estrelado/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento , Vasodilatação , Artéria Vertebral/diagnóstico por imagem , Adulto Jovem
11.
J Stroke Cerebrovasc Dis ; 27(11): 3043-3045, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30087075

RESUMO

Reversible cerebral vasoconstriction syndrome is characterized by thunderclap headache and multifocal cerebral vasoconstriction. Cerebral vasoconstriction is reversible, and most cases have good prognosis. However, clinical outcome is possibly severe when it is complicated by stroke, yet detailed reports on such a case are few. We experienced a case of severe reversible cerebral vasoconstriction syndrome in a 32-year-old woman with medical history of preeclampsia 3years prior. She presented with sudden sharp headache followed by altered mental status and vasoconstriction of the bilateral posterior cerebral arteries. She was treated with intravenous and oral calcium channel blockers, edaravone, and glycerol. However, the cerebral infarction in the posterior circulation subsequently remained, and her impaired consciousness did not recover. Furthermore, although imaging findings of vasoconstriction showed improvement a day after the occurrence of symptom, the same vessels showed poor visualization 7 weeks later, which indicated the recurrence of vasoconstriction, without additional symptom due to the fixed infarction. Although most cases of reversible cerebral vasoconstriction syndrome show good prognosis, neurologists must monitor the possibility of worse clinical course and permanent neurological deficit when associated with stroke, such as cerebral infarction. Strict management and treatment are needed in these cases.


Assuntos
Infarto da Artéria Cerebral Posterior/etiologia , Artéria Cerebral Posterior/fisiopatologia , Vasoconstrição , Vasoespasmo Intracraniano/complicações , Adulto , Angiografia Cerebral/métodos , Imagem de Difusão por Ressonância Magnética , Feminino , Transtornos da Cefaleia Primários/etiologia , Transtornos da Cefaleia Primários/fisiopatologia , Humanos , Infarto da Artéria Cerebral Posterior/diagnóstico por imagem , Infarto da Artéria Cerebral Posterior/fisiopatologia , Infarto da Artéria Cerebral Posterior/terapia , Angiografia por Ressonância Magnética , Artéria Cerebral Posterior/diagnóstico por imagem , Síndrome , Tomografia Computadorizada por Raios X , Vasoespasmo Intracraniano/diagnóstico por imagem , Vasoespasmo Intracraniano/fisiopatologia , Vasoespasmo Intracraniano/terapia
12.
Curr Neurol Neurosci Rep ; 18(9): 61, 2018 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-30058035

RESUMO

INTRODUCTION: Headaches are a common occurrence in childhood and adolescence. Most children presenting with a chief complaint of headache have a self-limited infectious disorder or primary headache syndrome that should not require extensive workup. PURPOSE OF REVIEW: Differentiating these conditions from other more serious causes of headache in children can sometimes be difficult. This article aims to provide information regarding "red flags" that should indicate a need for concern for disorders that require more urgent evaluation. RECENT FINDINGS: Long-held beliefs about specific "red flags" that have been analyzed in recent years as to their validity and new criteria for the diagnosis of idiopathic intracranial hypertension have been elaborated based on study. These publications are reviewed in this article. Knowledge of past and current literature on secondary headache in children, combined with thorough history taking and examination, should help determine when there is concern for a serious secondary cause for headache in children and adolescents and direct workup.


Assuntos
Transtornos da Cefaleia Secundários/diagnóstico por imagem , Transtornos da Cefaleia Secundários/fisiopatologia , Pseudotumor Cerebral/diagnóstico por imagem , Pseudotumor Cerebral/fisiopatologia , Adolescente , Criança , Diagnóstico Diferencial , Transtornos da Cefaleia Primários/diagnóstico por imagem , Transtornos da Cefaleia Primários/epidemiologia , Transtornos da Cefaleia Primários/fisiopatologia , Transtornos da Cefaleia Secundários/epidemiologia , Humanos , Pseudotumor Cerebral/epidemiologia
13.
Headache ; 58(5): 648-660, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29520765

RESUMO

BACKGROUND: Although risk factors for medication-overuse headache have been identified within the general population, most studies have neglected clinical samples. The present study examined the relative and combined associations of these factors with medication-overuse headache in a sample of US adults seeking treatment for primary headache disorders. METHODS: Treatment-seeking headache patients provided data on demographics, headache variables, psychiatric variables, use of headache medications, and use of other prescription medications and substances. A classification tree selection strategy was utilized within this cross-sectional study to differentiate between those with and without medication-overuse headache, and a final multivariable model assessed their combined utility. RESULTS: Forty-three of 164 participants (26.2%) met diagnostic criteria for medication-overuse headache. Relative to non-medication-overuse headache participants, participants with medication-overuse headache reported greater headache-related disability (odds ratio = 1.09, 95% confidence interval = 1.01-1.18), escape and avoidance responses indicative of fear of pain (odds ratio = 1.07, 95% confidence interval = 1.00-1.15), and use of combination medications for headache (odds ratio = 3.10, 95% confidence interval = 1.51-6.36). The final multivariable model differentiated well between the 2 groups (area under the receiver operating characteristic curve = .78; 95% confidence interval = .71-.86). CONCLUSIONS: Items that assess headache-related disability, use of combination medications, and fear of pain help identify patients who are currently overusing acute headache medications and may serve as indicators of treatment progress. Future studies should apply similar analytic approaches longitudinally to identify headache sufferers at risk for medication-overuse headache prior to headache progression.


Assuntos
Ansiedade/fisiopatologia , Transtornos da Cefaleia Primários/fisiopatologia , Transtornos da Cefaleia Secundários/fisiopatologia , Dor/fisiopatologia , Adulto , Ansiedade/epidemiologia , Comorbidade , Estudos Transversais , Progressão da Doença , Feminino , Transtornos da Cefaleia Primários/tratamento farmacológico , Transtornos da Cefaleia Primários/epidemiologia , Transtornos da Cefaleia Secundários/tratamento farmacológico , Transtornos da Cefaleia Secundários/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Dor/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde
14.
Scott Med J ; 63(1): 22-24, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28480791

RESUMO

We describe a 39-year-old man who developed thunderclap headaches during a hospital admission for accidental superficial burns. His magnetic resonance brain imaging was normal expect for diffuse segmental vasoconstriction. Prior to admission, he was consuming excessive amounts of caffeine which was restarted and slowly tapered and stopped over weeks. Repeat magnetic resonance angiogram showed resolution of segmental vasoconstriction. The implications of prescribed and non-prescribed drugs on cerebral vasculature have been discussed.


Assuntos
Encéfalo/irrigação sanguínea , Cafeína/efeitos adversos , Artérias Cerebrais/fisiopatologia , Transtornos da Cefaleia Primários/induzido quimicamente , Síndrome de Abstinência a Substâncias/fisiopatologia , Vasoconstrição/efeitos dos fármacos , Vasoespasmo Intracraniano/induzido quimicamente , Adulto , Café/efeitos adversos , Bebidas Energéticas/efeitos adversos , Transtornos da Cefaleia Primários/sangue , Transtornos da Cefaleia Primários/fisiopatologia , Humanos , Masculino , Resultado do Tratamento , Vasoespasmo Intracraniano/sangue , Vasoespasmo Intracraniano/fisiopatologia
15.
Clin Radiol ; 73(5): 417-427, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29274685

RESUMO

Reversible cerebral vasoconstriction syndrome is an intracranial vascular manifestation of a wide variety of diseases. It is the second most common cause of thunderclap headache, the most common cause of recurrent severe secondary headaches, and, in patients <60 years of age, has been reported as the commonest cause of isolated convexity subarachnoid haemorrhage. Radiologically, its key feature is vasoconstriction of the intracranial vessels, a dynamic process that is typically maximal at 2 weeks, varies in its distribution over the course of the disease, and typically resolves after 3 months. It can have haemorrhagic and ischaemic complications and sometimes occurs in concert with posterior reversible encephalopathy syndrome. It also has important associations with dissection and migraine. Rarer atypical cases can present with mild headache, no headache at all, or even a comatose state. This paper provides a detailed review of this syndrome, its pathophysiology, differential diagnosis, imaging findings, and work-up. It also describes the role that high-resolution magnetic resonance imaging (MRI) techniques can have in diagnosing the disease and emphasises the central role that all radiologists have in detecting this important and underdiagnosed condition.


Assuntos
Transtornos da Cefaleia/diagnóstico por imagem , Transtornos da Cefaleia/etiologia , Imagem por Ressonância Magnética/métodos , Neuroimagem/métodos , Vasoespasmo Intracraniano/complicações , Vasoespasmo Intracraniano/diagnóstico por imagem , Diagnóstico Diferencial , Transtornos da Cefaleia/fisiopatologia , Transtornos da Cefaleia Primários/diagnóstico por imagem , Transtornos da Cefaleia Primários/etiologia , Transtornos da Cefaleia Primários/fisiopatologia , Humanos , Síndrome da Leucoencefalopatia Posterior/complicações , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/fisiopatologia , Recidiva , Síndrome , Vasoconstrição , Vasoespasmo Intracraniano/fisiopatologia
17.
Curr Pain Headache Rep ; 21(7): 31, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28551735

RESUMO

PURPOSE OF REVIEW: Headache is a common complaint among children and adolescents. School functioning is one of the most important life domains impacted by chronic pain in children. This review discusses the epidemiological and pathophysiological connections between headaches and school functioning including a suggested clinical approach. RECENT FINDINGS: The connection between recurrent and chronic headache and learning disabilities might be psychosocial (fear of failure) or anatomical (malfunctioning of the frontal and prefrontal areas). Only few population-based and clinical studies were done and good studies are still needed in order to understand the complex relationship better. However, relating to our patients' learning and school performance, history is crucial when a child with primary headaches is evaluated. Learning disabilities seem to have a high prevalence among children with primary headache syndromes especially migraine. The connection between the two is complex and might be either part of a common brain pathophysiology and/or a consequence of poor quality of life.


Assuntos
Escolaridade , Transtornos da Cefaleia Primários/fisiopatologia , Adolescente , Criança , Lobo Frontal/fisiopatologia , Transtornos da Cefaleia Primários/epidemiologia , Transtornos da Cefaleia Primários/psicologia , Humanos , Aprendizagem , Deficiências da Aprendizagem/etiologia , Transtornos de Enxaqueca/fisiopatologia , Córtex Pré-Frontal/fisiopatologia , Prevalência , Qualidade de Vida
18.
Headache ; 57 Suppl 2: 76-88, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28485849

RESUMO

Migraine is a very common, severe disabling condition that can last for days and strike multiple times per month. Attacks, often characterized by severe unilateral throbbing pain that is exacerbated by activity, are commonly preceded by several diverse symptoms including fatigue, irritability, and yawning. This premonitory (prodromal) phase represents the earliest identifiable feature of an attack that is a reliable predictor of ensuing headache. The diversity of these symptoms underlines the complex nature of migraine and focuses considerable attention on the hypothalamus due to its prominent role in homeostatic regulation allowing state dependent behavioral modifications. While multiple neurotransmitter and neuropeptide systems have been proposed to play a role in migraine, the current review will focus on the emerging role of the hypothalamic orexinergic system in primary headache disorders. Specifically the potential role of altered orexinergic signalling in premonitory symptomatology and the future potential of targeted orexinergic therapies that could with other approaches act during the premonitory phase to prevent the occurrence of the headache or reduce an individual's susceptibility to attacks by altering the brain's response to external and internal triggers.


Assuntos
Transtornos da Cefaleia Primários/fisiopatologia , Orexinas/metabolismo , Transtornos da Cefaleia Primários/metabolismo , Humanos
19.
J Headache Pain ; 18(1): 44, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28401499

RESUMO

BACKGROUND: The clinical features and disease courses of primary stabbing headache (PSH) are diverse. We aimed to identify distinct clinical patterns of PSH. METHODS: We prospectively screened consecutive first-visit patients who presented with stabbing headache at the Samsung Medical Centre Headache Clinic from June 2015 to March 2016. Demographics, headache characteristics, and disease courses were prospectively evaluated. After discerning factors related to the chronicity at the time of presentation, clinical patterns were identified based on the frequency (daily vs. intermittent), clinical course (remitted or not), and total disease duration (<3 or >3 months). RESULTS: In the 65 patients with PSH included in this study, monophasic (n = 31), intermittent (n = 17), and chronic daily (n = 12) patterns were identified. The median disease durations were 9 days for monophasic PSH, 9 months for chronic daily PSH, and 2 years for intermittent PSH. The features of monophasic PSH were greater severity, single and side-locked locations, more attacks per day, daily occurrence, and good treatment response. Chronic daily PSH was associated with female predominance, longer-lasting stabs, and multiple or migrating locations on bilateral or alternating sides. The characteristics of intermittent PSH included female predominance and sporadic stabs with less intensity. CONCLUSIONS: Our study demonstrated distinct clinical patterns of PSH. In addition to help early recognition of disease, our findings suggest different pathophysiologic mechanisms. Future prospective studies are required to reveal the etiologies of these different PSH patterns and their optimal treatment strategies.


Assuntos
Progressão da Doença , Transtornos da Cefaleia Primários/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
20.
Headache ; 57(5): 796-800, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28411371

RESUMO

OBJECTIVE: To describe two patients with recurring unilateral brief headaches that fulfilled criteria for both primary cough headache (CH) and chronic paroxysmal hemicrania (CPH). BACKGROUND: CH is typically a bilateral headache, specifically triggered by cough, straining, or other Valsalva maneuvers. The report of cases sharing features with other primary headache disorders, such as CPH, suggest common pathogenic mechanisms. METHODS: Case reports. RESULTS: Two patients (one man), aged 55 and 64, had a two-year history of daily, unilateral, side-locked headache attacks, lasting about 15 minutes, and associated with ipsilateral tearing. Headaches were triggered by cough, sneezing, laughing, or bending forward. Both patients experienced a marked and sustained improvement with indomethacin, and both relapsed when it was interrupted. CONCLUSIONS: These cases suggest the existence of transitional phenotypes, or shared pathogenic mechanisms, between CH and CPH, two indomethacin-responsive headaches. A more comprehensive analysis of different CH subtypes is necessary to understand their relation with other primary headaches.


Assuntos
Tosse/complicações , Inibidores de Ciclo-Oxigenase/farmacologia , Transtornos da Cefaleia Primários , Indometacina/farmacologia , Feminino , Transtornos da Cefaleia Primários/tratamento farmacológico , Transtornos da Cefaleia Primários/etiologia , Transtornos da Cefaleia Primários/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Hemicrania Paroxística/tratamento farmacológico , Hemicrania Paroxística/etiologia , Hemicrania Paroxística/fisiopatologia
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