[Primary orthostatic tremor]. / Le tremblement orthostatique primaire.

INTRODUCTION: Tremor is frequent in neurologic practice but primary orthostatic tremor was first described in 1984. Its prevalence accounts for around 4% for tremors explored in neurophysiology; in contrast, essential and parkinsonian tremors represent respectively 28 and 22% of these cases. EXEGESIS: Orthostatic tremor is characterized by its appearance while standing. Walking, sitting, and lying down are unaffected. Clinical examination is normal except for unsteadiness disappearing when walking. Surface electromyography in the standing position is necessary for the diagnosis and shows a regular rapid tremor (frequency around 14 to 18 Hz). Its pathophysiology is unknown. CONCLUSION: Clonazepam is the first-line treatment for orthostatic tremor. In cases of resistance or side effects of this drug orthostatic tremor may be improved by primidone or, as in our case, gabapentin.

[Treatment of cluster headache]. / Le traitement de l'algie vasculaire de la face.

INTRODUCTION: The cluster headache (CH) is one of the most severe types of head pain. It is a typical example of a periodic disease and the International Headache Society classification recognizes two forms of this disease: episodic and chronic CH. Its prevalence is about 0.1 to 0.4% in the general population. PATHOPHYSIOLOGY: A global hypothesis is still lacking to explain the pain, the vasodilation, the autonomic features (ipsilateral lacrimation, conjunctiva injection, rhinorrhea, partial Horner syndrome, etc.) and the periodicity of the CH. Pain and vasodilation seem secondary to an activation of the trigeminal vascular system and the periodicity of the attacks is thought to be due to a dysfunction of hypothalamic biologic clock mechanisms. Treatment of acute CH attacks. The most effective agents are oxygen inhalation and subcutaneous sumatriptan, a 5HT1B and D receptor agonist which has vasoconstrictor and anti-neurogenic inflammation properties by blocking the release from the trigeminal-sensitive fibers of neuropeptides such as CGRP and substance P. With subcutaneous sumatriptan, headache relief is very rapid, within 5 to 10 min. Prophylactic treatment of CH: The number of attacks per day varies from one to three, but some patients can have four to eight per day and acute treatments fail to provide sufficient relief or give rise to side-effects. Several different regimens have been proven effective. FUTURE PROSPECTS AND PROJECTS: Contraindications and side-effects of the drugs limit the choice of the prophylactic treatment: corticosteroids in a tapering course, verapamil and methysergide are the most useful treatments of the episodic form. Lithium carbonate is more effective for the chronic stage of CH, but side-effects are often troublesome. Numerous other medications have been used for prophylaxis: valproate, capsaicin, beta-blockers. Unfortunately, double-blind studies are often lacking and are difficult to realize due to spontaneous variable remission of episodic CH. When adequate trials of drug therapies show a total resistance to the treatments, surgery may be considered. Radiofrequency trigeminal rhizotomy is the treatment of choice with 70% of beneficial effects. Risks and complications have to be discussed in balance with the benefit of the different surgical procedures.

[Systemic urticaria induced by hops]. / Urticaire systémique induite par le houblon.

The authors report a patient who presented 4 times a systemic urticaria with arthralgias and fever treated by corticosteroids with efficacy. Wild hop (Humulus lupulus) was finally proved to be the causal factor. H.L. belongs to the cannabinaceas family. Hop dermatitis in hop workers population is the main widely described clinical manifestation. Rhinitis, conjunctivitis, asthma are rare as soon as contact urticaria. IgE-anti Hop induced allergies are described in the literature. However, in some cases of reactions to hop the mechanisms are uncertain: toxicity--possible role of lupuline--or immunoallergic processus with immunocomplexes (IC) (with increased IC in serum) and systemic urticaria such as in our observation.

[The transformed migraine]. / La migraine transformée.

Patients consulting in headache centers complained very often of chronic daily or near daily headaches unclassifiable with the IHS criteria of the categories migraine, migraine + chronic tension headache or chronic tension headache. Many of these patients report a clear-cut history of distinct attacks of migraine with an aggravation of the headaches over the years. For these patients the term "transformed migraine" was recently proposed. The authors described and discussed the criteria of this concept. Knowledge of transformed migraine seems to be justified because their natural history and their response to treatment which is different from chronic tension-type headache.