Intractable SUNCT Cured After Resection of a Pituitary Microadenoma

Background:SUNCT is a rare primary headache disorder that is associated with activation of the posterior hypothalamus and often poorly responsive to medication. Recently, a relationship between between pituitary microadenoma and SUNCT has been suggested, and reports of both amelioration and exacerbation by dopamine-agonists have been published. These findings suggest a functional role for the hypothalamic-pituitary axis in SUNCT.Methods:We report the long-term 4 year follow-up of a 35 year-old patient with a 14-year history of medically and surgically intractable SUNCT who experienced immediate and complete resolution of symptoms after resection of a 6 mm pituitary microadenoma.Results:This patient was first seen at the age of 28 years with a 10-year history of attacks of right retro-orbital pain satisfying the IHS criteria for SUNCT. Many medical and surgical treatments were attempted without success. An MRI demonstrated a 6 mm microadenoma without compression of surrounding structures. A trial of bromocriptine caused marked exacerbation of his pain. The patient underwent a trans-sphenoidal resection of the pituitary lesion. SUNCT attacks worsened for the first 24h post-operatively, then disappeared. He has been completely headache-free, without medication, for the past 43 months with the last follow-up being January 2006.Conclusion:This case emphasizes the relationship between pituitary microadenomas and SUNCT, supports the role of the hypothalamic-pituitary axis in the genesis of SUNCT, and illustrates the importance of careful imaging of the pituitary region in patients with SUNCT.

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Case series of sixteen patients with nummular headache

Cephalalgia ◽

10.1177/0333102410368445 ◽

2010 ◽

Vol 30 (12) ◽

pp. 1527-1530 ◽

Cited By ~ 20

Author(s):

Justin Moon ◽

Kamran Ahmed ◽

Ivan Garza

Keyword(s):

Medication Overuse ◽

Age Of Onset ◽

Medication Overuse Headache ◽

Case Series ◽

Primary Headache ◽

Headache Disorder ◽

Therapeutic Interventions ◽

Nummular Headache ◽

Primary Headache Disorder ◽

History Of

Introduction: Nummular headache is a rare primary headache disorder described by a focal circumscribed area of pain (2–6 cm in diameter). Literature on this disorder is sparse. Patients and methods: Here, we describe a case series of 16 patients (6 men, 10 women) seen at the Mayo Clinic. Results: Mean age of onset was 50 years (range, 19–79 years) and mean duration of headache was 7.9 years (range, 0.33–40 years). Location of headache varied and was found to be an average of 3.9 cm in diameter (range, 2–10 cm). Headache was episodic (<15 days/month) in four patients and chronic (>15 days/month) in 12 patients. Attention was paid to therapeutic interventions. Resolution was seen in 38% of patients. Migraine was present in the history of 56% of patients and medication overuse headache was found in 25%. Conclusions: Our series results support previous findings. In our population, no specific therapy was identified to be effective in more than one patient.

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Characteristics of Migraine in an Out-Patient Population Over 60 Years of Age

Cephalalgia ◽

10.1046/j.1468-2982.2003.00616.x ◽

2003 ◽

Vol 23 (10) ◽

pp. 953-960 ◽

Cited By ~ 13

Author(s):

G Mazzotta ◽

V Gallai ◽

A Alberti ◽

AMR Billeci ◽

F Coppola ◽

...

Keyword(s):

Beta Blockers ◽

Primary Headache ◽

Headache Disorder ◽

Moderate Intensity ◽

Primary Headache Disorder ◽

Headache Centre ◽

Prophylactic Drugs ◽

Ihs Criteria ◽

Accompanying Symptoms ◽

The University

One hundred and sixty-three consecutive patients (129 females and 34 males) over 60 years of age attending the Headache Centre of the University of Perugia in the period January 2000-December 2001 were included in the study. One hundred and fifty-two (93.3%) were affected by a primary headache disorder. According to the 1988 IHS Criteria, their prevailing attacks could be diagnosed as migraine without aura (MwoA) in 57.2% of cases ( n = 87) and as migraine with aura (MwA) in 11.8% of cases ( n = 18). Attacks both in MwoA and MwA were unilateral and of severe-to-moderate intensity in 45% and 50% of cases. Head pain was referred as pulsating by 56% and 38.9% of MwoA patients MwA patients, respectively. Aggravation with routine daily activities was present in 72.4% and 61.1% in MwoA and MwA patient groups. The most frequent accompanying symptoms were photophobia and phonophobia. Headache attacks were of shorter duration in MwA patients, but in 3.4% of MwoA patients attacks lasted between 2 and 4 h. Of patients affected by MwA, 55% referred, together with the typical attacks, symptoms of aura not followed by headache. A worsening of headache in the last 5 years was reported by 67.8% and 44.4% of MwoA and MwA patients, respectively. Of the patients with MwoA, 86.2% ( n = 75), and 83.3% ( n = 15) of those with MwA used symptomatic drugs for their attacks. In the majority of cases they took more than one analgesic or non steroidal anti-inflammatory drug. A total of 51.7% of patients with MwoA and 55.5% of patients with MwA were under prophylactic treatment. Preventive drugs included antidepressants, beta-blockers, calcium channel antagonists and antiepileptic drugs. The choice of symptomatic or prophylactic drugs was made, in the majority of cases, on the basis of concomitant diseases.

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CACNA1A Gene Polymorphisms in Cluster Headache

Cephalalgia ◽

10.1046/j.1468-2982.2001.00281.x ◽

2001 ◽

Vol 21 (10) ◽

pp. 953-958 ◽

Cited By ~ 30

Author(s):

C Sjöstrand ◽

V Giedratis ◽

K Ekbom ◽

E Waldenlind ◽

J Hillert

Keyword(s):

Cluster Headache ◽

Primary Headache ◽

Headache Disorder ◽

Familial Hemiplegic Migraine ◽

Hemiplegic Migraine ◽

Promising Candidate ◽

Primary Headache Disorder ◽

Increased Risk ◽

Ihs Criteria ◽

Cacna1a Gene

Cluster headache (CH) is a primary headache disorder where the aetiological and pathophysiological mechanisms still are largely unknown. An increased risk of CH in first- and second-degree relatives suggests the importance of genetic factors. Mutations of the P/Q type calcium channel alpha 1 subunit (CACNA1A) gene on chromosome 19p13 have been shown to cause several neurological disorders with a wide clinical spectrum, mainly episodic diseases. Missence mutations of the gene cause familial hemiplegic migraine (FHM) and it is also likely to be involved in the more common forms of migraine. The CACNA1A gene is thus a promising candidate gene for CH. In this study we performed an association analysis of an intragenic polymorphic (CA)n-repeat with marker D19S1150 and a (CAG)n-repeat in the 3′UTR region, in 75 patients with CH according to IHS criteria and 108 matched controls. Genotypes and allele frequencies were similarly distributed in patients and controls. Linkage disequilibrium between the two markers was similar in patients and controls. We conclude that an importance of the CACNA1A gene in sporadic CH is unlikely.

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Headache associated with head trauma

Oxford Textbook of Headache Syndromes ◽

10.1093/med/9780198724322.003.0035 ◽

2020 ◽

pp. 314-321

Author(s):

Sylvia Lucas

Keyword(s):

Primary Headache ◽

Headache Disorder ◽

Standard Of Care ◽

Temporal Association ◽

Prior History ◽

Secondary Headache ◽

Primary Headache Disorder ◽

Global Health Issue ◽

History Of ◽

Probable Migraine

Traumatic brain injury (TBI) is an extremely important, common global health issue with approximately 2.5 million TBIs occurring yearly in the civilian population alone. The symptom manifestations of TBI are called ‘concussion’ symptoms and headache is the most common. Post-traumatic headache (PTH) is a secondary headache occurring in temporal association with the TBI and thought to be caused by the injury. Many studies have found PTH to be frequent and persistent, with a higher prevalence of PTH after mild than moderate to severe TBI. In both severity injuries, the most frequent phenotype of PTH is migraine or probable migraine. PTH risk factor after injury is a prior history of primary headache disorder. The relationship between TBI and PTH is unknown and currently the subject of intense research. As yet, treatment of PTH is empiric with standard of care to ‘phenotype’ the headache according to primary headache clinical characteristics and use the type as a guideline for management.

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Safety of select headache medications in patients with cerebral and spinal cavernous malformations

Cephalalgia Reports ◽

10.1177/25158163211062254 ◽

2021 ◽

Vol 4 ◽

pp. 251581632110622

Author(s):

Kelly D Flemming ◽

Chia-Chun Chiang ◽

Robert D Brown ◽

Giuseppe Lanzino

Keyword(s):

Primary Headache ◽

Headache Disorder ◽

Surgical Excision ◽

Bleeding Risk ◽

Cavernous Malformations ◽

Primary Headache Disorder ◽

Complete Surgical Excision ◽

Number Of Patients ◽

Increased Risk

Background: Patients with cerebral or spinal cavernous malformations (CM) and a primary headache disorder are often limited in medication options due to concern for bleeding risk. Methods: From a prospective cohort of CM patients (2015–2020), demographics, mode of clinical presentation, and radiographic data were collected. Follow up of patients was performed with electronic medical record review, in person visits and/or written surveys. Select medication use was ascertained from the time of the CM diagnosis to a censor date of first prospective symptomatic hemorrhage, complete surgical excision of sporadic form CM, or death. The influence of non-aspirin NSAID (NA-NSAID), triptan, or OnabotulinumtoxinA on prospective hemorrhage risk was assessed. Results: As of August 20, 2020, 329 patients with spinal or cerebral CM (58% female; 20.1% familial; 42.2% initial presentation due to hemorrhage; 27.4% brainstem) were included. During a follow-up of 1799.9 patient years, 92 prospective hemorrhages occurred. Use of NA-NSAIDs, triptans, and OnabotulinumtoxinA after the diagnosis of CM was unassociated with an increased risk of prospective hemorrhage. Conclusions: Use of triptans and NA-NSAIDs, does not precipitate CM hemorrhage. Similarly, we did not find that OnabotulinumtoxinA precipitated CM hemorrhage in a limited number of patients at doses <200 units per session.

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Medication Overuse Headache: Clinical Features Predicting Treatment Outcome at 1-Year Follow-Up

Cephalalgia ◽

10.1111/j.1468-2982.2007.01432.x ◽

2007 ◽

Vol 27 (11) ◽

pp. 1219-1225 ◽

Cited By ~ 57

Author(s):

J Zidverc-Trajkovic ◽

T Pekmezovic ◽

Z Jovanovic ◽

A Pavlovic ◽

M Mijajlovic ◽

...

Keyword(s):

Chronic Headache ◽

Medication Overuse ◽

Medication Overuse Headache ◽

Age At Onset ◽

Primary Headache ◽

Headache Disorder ◽

Primary Headache Disorder ◽

A Prospective Study ◽

Predicting Treatment Outcome

We present a prospective study of 240 patients with medication overuse headache (MOH) treated with drug withdrawal and prophylactic medications. At 1-year follow-up, 137 (57.1%) patients were without chronic headache and without medication overuse, eight (3.3%) patients did not improve after withdrawal and 95 (39.6%) relapsed developing recurrent overuse. Age at time of MOH diagnosis, regular use of benzodiazepines, frequency and Migraine Disability Assessment (MIDAS) score of chronic headache, age at onset of primary headache, frequency and MIDAS score of primary headache, ergotamine compound overuse and daily drug intake were significantly different between successfully and unsuccessfully treated patients. Multivariate analysis determined the frequency of primary headache disorder, ergotamine overuse and disability of chronic headache estimated by MIDAS as independent predictors of treatment efficacy at 1-year follow-up.

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Effectiveness of paranasal air suction on acute migraine using portable air sucker – a randomized, double blind study

BMC Neurology ◽

10.1186/s12883-021-02203-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

S. M. R. Bandara ◽

S. Samita ◽

A. M. Kiridana ◽

H. M. M. T. B. Herath

Keyword(s):

Clinical Trial ◽

Side Effects ◽

Sri Lanka ◽

Primary Headache ◽

Headache Disorder ◽

Low Pressure ◽

Outcome Variable ◽

Double Blind ◽

Primary Headache Disorder ◽

Before And After

Abstract Background Migraine is a primary headache disorder and is the most common disabling primary headache disorder that occurs in children and adolescents. A recent study showed that paranasal air suction can provide relief to migraine headache. However, in order to get the maximum benefit out of it, an easy to use effective air sucker should be available. Aiming to fulfil the above requirement, a randomized, double blind control clinical trial was conducted to investigate the efficacy of a recently developed low–pressure portable air sucker. Methods Eighty-six Sri Lankan school children of age 16–19 years with migraine were enrolled for the study. They were randomly allocated into two groups, and one group was subjected to six intermittent ten-second paranasal air suctions using the portable air sucker for 120 s. The other group was subjected to placebo air suction (no paranasal air suction). The effect of suction using portable air sucker was the primary objective but side of headache, type of headache, and gender were also studied as source variables. The primary response studied was severity of headache. In addition, left and right supraorbital tenderness, photophobia, phonophobia, numbness over the face and scalp, nausea and generalized tiredness/weakness of the body were studied. The measurements on all those variables were made before and after suction, and the statistical analysis was performed based on before and after differences. As a follow–up, patients were monitored for 24-h period. Results There was a significant reduction in the severity of headache pain (OR = 25.98, P < 0.0001), which was the primary outcome variable, and other migraine symptoms studied, tenderness (left) (OR = 289.69, P < 0.0001), tenderness (right) (OR > 267.17, P < 0.0001), photophobia (OR = 2115.6, P < 0.0001), phonophobia (OR > 12.62, P < 0.0001) nausea (OR > 515.59, P < 0.0001) and weakness (OR = 549.06, P < 0.0001) except for numbness (OR = 0.747, P = 0.67) in the treatment group compared to the control group 2 min after the suction. These symptoms did not recur within 24-h period and there were no significant side effects recorded during the 24-h observation period. Conclusion This pilot study showed that low–pressure portable air sucker is effective in paranasal air suction, and suction for 120 s using the sucker can provide an immediate relief which can last for more than 24-h period without any side effects. Trail registration Clinical Trial Government Identification Number – 1548/2016. Ethical Clearance Granted Institute – Medical Research Institute, Colombo, Sri Lanka (No 38/2016). Sri Lanka Clinical Trial Registration No: SLCTR/2017/018. Date of registration = 29/ 06/2017. Approval Granting Organization to use the device in the clinical trial– National Medicines Regulatory Authority Sri Lanka (16 Jan 2018), The device won award at Geneva international inventers exhibition in 2016 and President award in 2018 in Sri Lanka. It is a patented device in Sri Lanka and patent number was SLKP/1/18295. All methods were carried out in accordance with CONSORT 2010 guidelines.

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Diagnosis and management of migraine in ten steps

Nature Reviews Neurology ◽

10.1038/s41582-021-00509-5 ◽

2021 ◽

Author(s):

Anna K. Eigenbrodt ◽

Håkan Ashina ◽

Sabrina Khan ◽

Hans-Christoph Diener ◽

Dimos D. Mitsikostas ◽

...

Keyword(s):

Clinical Decision Making ◽

Consensus Statement ◽

Preventive Treatment ◽

Primary Headache ◽

Headache Disorder ◽

Clinical Decision ◽

Diagnosis And Management ◽

Primary Headache Disorder ◽

Management Of Complications ◽

European Headache Federation

AbstractMigraine is a disabling primary headache disorder that directly affects more than one billion people worldwide. Despite its widespread prevalence, migraine remains under-diagnosed and under-treated. To support clinical decision-making, we convened a European panel of experts to develop a ten-step approach to the diagnosis and management of migraine. Each step was established by expert consensus and supported by a review of current literature, and the Consensus Statement is endorsed by the European Headache Federation and the European Academy of Neurology. In this Consensus Statement, we introduce typical clinical features, diagnostic criteria and differential diagnoses of migraine. We then emphasize the value of patient centricity and patient education to ensure treatment adherence and satisfaction with care provision. Further, we outline best practices for acute and preventive treatment of migraine in various patient populations, including adults, children and adolescents, pregnant and breastfeeding women, and older people. In addition, we provide recommendations for evaluating treatment response and managing treatment failure. Lastly, we discuss the management of complications and comorbidities as well as the importance of planning long-term follow-up.

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Topiramate Versus Propranolol in the Prophylaxis of Migraine in Bangladeshi Population

Chattagram Maa-O-Shishu Hospital Medical College Journal ◽

10.3329/cmoshmcj.v18i2.47764 ◽

2020 ◽

Vol 18 (2) ◽

pp. 12-17

Author(s):

Muhammad Tayeb ◽

Md Hasanuzzaman ◽

Abul Mansur Md Rezaul Karim ◽

Mohammad Sanaullah ◽

Md Ashraful Islam

Keyword(s):

Migraine Attack ◽

Divided Dose ◽

Low Dose ◽

Primary Headache ◽

Headache Disorder ◽

Treatment Groups ◽

Primary Headache Disorder ◽

Significant Difference ◽

The Mean ◽

Bangladeshi Population

Background : Migraine is primary headache disorder characterized by recurring attacks of pain and associated symptoms. The management modality is still unsatisfactory due to poor understanding of its cause and pathogenesis. To assess the efficacy and safety of low dose Topiramate vs Propranolol in migraine prophylaxis. Materials and methods : A randomized clinical trial including 130 patients with frequent migraine headache >5 attacks per month was performed in the out patients Department of Medicine and Neurology, CMCH for a period of 12 weeks. The patients were randomly divided into two treatment groups – treated by Topiramate 50mg/day and Propranolol 80mg/day respectively. Topiramate started with 25mg/day for 7 days then increased up to 50mg/day in two divided dose. Propranolol started with 40mg/day for 7 days then increased up to 80mg/day in two divided dose. The patients were assessed at 0, 8 and 12 weeks of the study. Results: The Topiramate group showed a reduction in the mean (±SD) of frequency of migraine attack from 6.95(±2.88) to 1.75(±1.08) episode per month, headache days per month from 7.62(±4.14) to 1.83(±1.10), intensity of headache per attack from 8.98(±1.05) to 6.10(±2.50) based on VAS scale, duration of headache per episode from 11.56(±9.16) to 5.40(±2.97) per hour and MIDAS score from 16.19(±3.91) to 8.14(±3.93). In patient treated with Propranolol, the mean (±SD) of monthly frequency of migraine attack declined from 7.09(±2.87) to 1.92(±0.98) episode per month, headache days per month from 8.17(±4.52) to 1.86(±o.83), intensity of headache per attack from 8.47(±1.10) to 6.03(±2.05) based on VAS scale, duration of headache per episode from 11.16(±8.08) to 5.97(±3.45), MIDAS score from 15.48(±3.55) to7.77(±3.49). Pre- and post-treatment values were significantly different for individual groups but no significant difference observed between groups. Conclusion: This study demonstrated that both low dose Topiramate and propranolol could significantly reduce migraine frequency, intensity and duration. Chatt Maa Shi Hosp Med Coll J; Vol.18 (2); July 2019; Page 12-17

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Hypnic headache: a rare type of primary headache disorder

BJPsych Open ◽

10.1192/bjo.2021.349 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S120-S120

Author(s):

Muhammad Sayed Inam ◽

Saifun Nahar ◽

Mohammad Zubayer Miah

Keyword(s):

Treatment Options ◽

Primary Headache ◽

Headache Disorder ◽

Lithium Carbonate ◽

Hypnic Headache ◽

Rare Type ◽

Falling Asleep ◽

History Of ◽

Waking Up ◽

Secondary Causes

ObjectiveHypnic Headache are is a very rare primary headaches that affect the elderly, with an average age of 60 years. Research in the areas of neurophysiology and treatment options for Hypnic Headache are necessary in order to better understand, and improve outcomes for this rare headache disorder.Case reportMr. X is a 70-year-old patient, has been presenting with the complaints of headache during sleep at night for the last 1 year. The Headache started after 3 to 4 hours after falling asleep. Due to headache, he wakes up from sleep around 03:00 to 04:00 am almost every night and his headache persist for 30 to 40 minutes. After waking up from sleep he keeps himself busy with religious activity and the headache gradually resolves. He then goes back to bed again.Mr. X also informed that, the headache is dull in nature and located in left temporo occipital region. It is not associated with photophobia, phonophobia, nausea, vomiting, tearing or discomfort in the leg. He gives no history of early morning headache or day time headache, sleep disorder, snoring or sleep apnea. He has no past history of trauma to the head, fainting attack, unconsciousness, weakness or paralysis of limbs, seizures or non-epileptic seizures. He is an non-smoker, non-alcoholic, non-hypertensive & non-diabetic person.On general examination, his heart rate is 70 beats/min, blood pressure 138/68 mm of Hg. There are no anemia, jaundice or oedema present in him. His both lung fields are clear. On neurological examinations there are nothing abnormality detected. His Serological investigations, CBC (Complete Blood Count) FBS (Fasting Blood Glucose), lipid profile are within normal limit. CT scan of the brain is normal. There are no cerebral atrophy or volume loss compatible with age.Mr. X was treated by several general practitioners with paracetamol, diclofenac sodium, mefenamic acid, tramadol hydrochloride. He used these drugs either singly or in combinations. But with this treatment there were no significant improvement occurs. Mr. X is scared and depressed for his sleep time headache.DiscussionHypnic headache is a very rare headache disorder. It occurs in age groups over 60 years. It is occur at night during in sleep and waking the patient up, hence the name of it “alarm clock headache”. It is commonly unilateral and lasts for 15 minutes to 4 hours. Hypnic headache commonly dull or throbbing in character and does not make the patient restless, unlike in Cluster Headache. After waking up from sleep, most patients engage in some activity. Hypnic headache is not associated with rhinorrhea, tearing and ptosis. Diagnosis is mainly clinical. Secondary causes headache must be excluded. International Classification of Headache Disorders 3rd Edition (ICHD-3)-beta provides diagnostic criteria for hypnic headache. Pathophysiology of hypnic headache is not clearly identified. Usual treatment options of Hypnic headache includes bed time coffee, lithium carbonate, indomethacin. Our patient fulfil all the criteria of Hypnic headache and he fells improvement with Indomethacin 50 mg in devided doses.ConclusionHypnic Headache is a very rare type of primary headache. It should be diagnosed only after other secondary causes of headache have been excluded. Caffeine, lithium carbonate, flunarizine, indomethacin, used to treat the patient of Hypnic Headache. Lack of study and awareness about these disorders can lead to delays in diagnosis and treatment. Clinical trials are needed to find out proper treatment, but it will be difficult to perform because of the rareness of this disorder.

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