Description of series of 10 patients with hypnic headache: Discussion of the diagnostic criteria.

INTRODUCTION: Hypnic headache is a rare primary headache. The diagnostic criteria of the International Headache Classification (IHS) for this condition are discussed, as they have been modified in the new edition of the 2013. PATIENTS AND METHODS: The clinical characteristics, and fulfilment of the criteria of the IHS classification in a series of 10patients diagnosed in our Headaches Clinic, are analyzed. RESULTS: The mean age of onset of symptoms was 52.1years (SD: 13.4; range: 28-69). The pain was reported as oppressive in 60% of the patients, and as sharp in 30%. The headache was described as holocranial in 60% and hemicranial in 40%. They occurred exclusively during night-time sleep in 80% of the patients. The mean duration of headache was 136.5minutes (range: 10-480). The mean number of days per month was 16.4 (range: 3-30), and 50% had less than 15 headache days per month. No patient had autonomic manifestations, 70% had phonophobia, 50% had photophobia, and 50% had both. All of them (100%) had a VAS score equal to or higher than 8. CONCLUSIONS: The criteria for hypnic headache of the new classification are best suited to the characteristics of these patients. Our results show the major changes in the criteria: pain is not always dull, headache frequency may be less than 15days a month, and it can occur in people under age 50. There may be phonophobia or photophobia only, or both. Although it does not form part of the diagnostic criteria, the pain intensity in our series was higher than described.

Headache in the elderly: characteristics in a series of 262 patients.

INTRODUCTION: Although headache prevalence decreases in patients older than 65, headaches are a common complaint and their different clinical and therapeutic features must be understood. This article analyses the clinical characteristics of elderly patients treated in an outpatient headache unit. METHODS: We collected demographic and clinical data from patients treated in a tertiary hospital headache unit between January 2008 and May 2013. Headaches were codified according to the International Classification of Headache Disorders, 2nd edition (ICHD-2). RESULTS: Of a total of 1868 patients treated, 262 patients (14%, 189 women and 73 men) were older than 65 years. Ninety-nine (68 women, 31 men, 5.3% of the total) were over 75. Headaches began after the age of 65 in only 136 patients (51.9%). The 362 headaches were codified as follows: 23.8% as Group 1 (Migraine) and 28.7% as Group 2 (Tension-type headache). We diagnosed 58 (16%) secondary headaches; 26 (7.2%) were classified as Group 13 (Cranial neuralgias) and 23 (6.4%) in Group 14 (Other headaches). Symptomatic medication overuse was detected in 38 patients (14.5%). We also identified headaches considered typical in the elderly, including chronic migraine (41 cases), hypnic headache (6), occipital neuralgia (4), SUNCT (2), cervicogenic headache (1), primary cough headache (1), and giant cell arteritis (2). CONCLUSIONS: Elderly patients were frequently treated in our outpatient headache unit. Tension-type headache was the most common diagnosis in this population. Geriatric headache syndromes such as hypnic headache or occipital neuralgia were also represented in our series.

Otras cefaleas primarias / Other primary headaches

El capítulo de otras cefaleas primarias, abarca un grupo de cefaleas descritas como desórdenes clínicos heterogéneos. Aunque estas entidades no son frecuentemente encontradas en el escenario clínico es relevante conocer los aspectos epidemiológicos, fisiopatológicos, clínicos y de tratamiento concernientes. Una de las características de mayor relevancia en este grupo está dado por el pobre entendimiento de los mecanismos fisiopatológicos y por las recomendaciones terapéuticas basadas en reportes anecdóticos por lo tanto la Asociación internacional de dolor de cabeza estimula la investigación de estas entidades en pro de adquirir un mayor grado de comprensión de este tipo de cefaleas. Presentamos una revisión de los principales artículos relacionados con hemicrania continua, cefalea hípnica, cefalea primaria por tos, cefalea primaria relacionada con actividad sexual, cefalea primaria por ejercicio, cefalea primaria tipo punzada, cefalea primaria tipo trueno y nueva cefalea diaria persistente.

This chapter, other primary headaches, encompasses a group of headaches that are described as heterogeneous clinical disorders. Although these entities are not frequently seen in the setting of general consultation, it is relevant to know the most important aspects related to epidemiology, clinical manifestations, pathogenesis and treatment. One of the most relevant features of this group is that pathogenesis and suggested treatments are based in hypothetical descriptions and anecdotal reports therefore the International headache association aims to stimulate further investigations of these entities in order to get broader comprehension of this group. We review recent important papers pertaining to hemicrania continua, hypnic headache, primary cough headache, primary headache related to sexual activity, primary exertional headache, primary stabbing headache, primary thunderclap headache and new daily persistent headache.