Chronic migraine and medication overuse headache

2020 ◽  
pp. 275-283
Author(s):  
David W. Dodick ◽  
Stephen D. Silberstein
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Chronic Migraine ◽  
Cerebral Aneurysm ◽  
Medication Overuse Headache ◽  
Abrupt Onset ◽  
Severe Headache ◽  
Thunderclap Headache ◽  
Work Up ◽  
Neurologically Intact ◽  
Secondary Causes

Thunderclap headache refers to the abrupt onset of a severe headache. Characteristics of the pain are not strictly defined, but intensity is considered to peak in seconds to a minute. This chapter focuses on the work-up of alert neurologically intact patients presenting with an acute and severe headache, not related to trauma. Work-up to detect or exclude a subarachnoid haemorrhage is described first, followed by an overview of investigations to detect a cerebral aneurysm. Thereafter, other secondary causes of thunderclap headache and their suitable analysis will be discussed, followed by a brief overview of primary thunderclap headaches.

Thunderclap headache

2020 ◽  
pp. 307-313
Author(s):  
Hille Koppen ◽  
Agnes van Sonderen ◽  
Sebastiaan F.T.M. de Bruijn
Keyword(s):  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Sudden Onset ◽  
Severe Headache ◽  
Thunderclap Headache ◽  
Cerebral Vasoconstriction ◽  
Initial Work ◽  
Life Threatening ◽  
Work Up ◽  
Neurologically Intact

Severe headache of sudden onset is relatively common, especially in emergency departments, and has an extensive differential. Neurovascular disorders often present with thunderclap headache. Although the initial work-up is focused to exclude subarachnoid haemorrhage, several other serious life-threatening disorders must be considered, such as cerebral venous sinus thrombosis and stroke. Furthermore, other causes like reversible cerebral vasoconstriction syndrome are recognized more and more. In this chapter the work-up of alert, neurologically intact patients presenting with an acute and severe headache, not related to trauma, will be described.

Secondary Headache Disorders

2021 ◽  
pp. 892-900
Author(s):  
Amaal J. Starling ◽  
David W. Dodick
Keyword(s):  
Primary Headache ◽  
Abrupt Onset ◽  
Severe Headache ◽  
Maximum Intensity ◽  
Thunderclap Headache ◽  
Secondary Headache ◽  
Headache Disorders ◽  
Primary Headache Disorders ◽  
Neurologic Emergency ◽  
Secondary Causes

In the evaluation of a patient with headache, the first task is to differentiate between a secondary headache and a primary headache. This step is essential because secondary causes of headache may require vastly different evaluation and treatment than primary headache disorders. Thunderclap headache (TCH) is an acute, severe headache with an abrupt onset, reaching maximum intensity in less than 1 minute. TCH is a neurologic emergency and should immediately prompt an urgent evaluation for a secondary headache.

scholarly journals Modulation of intrinsic resting-state fMRI networks in women with chronic migraine

Neurology ◽  
2017 ◽  
Vol 89 (2) ◽  
pp. 163-169 ◽  
Author(s):  
X. Michelle Androulakis ◽  
Kaitlin Krebs ◽  
B. Lee Peterlin ◽  
Tianming Zhang ◽  
Nasim Maleki ◽  
...  
Keyword(s):  
Functional Connectivity ◽  
Chronic Migraine ◽  
Resting State ◽  
Medication Overuse Headache ◽  
Brain Networks ◽  
Resting State Fmri ◽  
Severe Headache ◽  
Resting State Functional Connectivity ◽  
Cutaneous Allodynia ◽  
Resting State Connectivity

Objective:To evaluate the intrinsic resting functional connectivity of the default mode network (DMN), salience network (SN), and central executive network (CEN) network in women with chronic migraine (CM), and whether clinical features are associated with such abnormalities.Methods:We analyzed resting-state connectivity in 29 women with CM as compared to age- and sex-matched controls. Relationships between clinical characteristics and changes in targeted networks connectivity were evaluated using a multivariate linear regression model.Results:All 3 major intrinsic brain networks were less coherent in CM (DMN: p = 0.030, SN: p = 0.007, CEN: p = 0.002) as compared to controls. When stratified based on medication overuse headache (MOH) status, CM without MOH (DMN: p = 0.029, SN: p = 0.023, CEN: p = 0.003) and CM with MOH (DMN: p = 0.016, SN: p = 0.016, CEN: p = 0.015) were also less coherent as compared to controls. There was no difference in CM with MOH as compared to CM without MOH (DMN: p = 0.382, SN: p = 0.408, CEN: p = 0.419). The frequency of moderate and severe headache days was associated with decreased connectivity in SN (p = 0.003) and CEN (p = 0.015), while cutaneous allodynia was associated with increased connectivity in SN (p = 0.011).Conclusions:Our results demonstrated decreased overall resting-state functional connectivity of the 3 major intrinsic brain networks in women with CM, and these patterns were associated with frequency of moderate to severe headache and cutaneous allodynia.

Bath-Related Headache

Cephalalgia ◽  
2005 ◽  
Vol 25 (3) ◽  
pp. 191-198 ◽  
Author(s):  
W Mak ◽  
KL Tsang ◽  
TH Tsoi ◽  
KM Au Yeung ◽  
KH Chan ◽  
...  
Keyword(s):  
Hong Kong ◽  
Acute Treatment ◽  
Primary Headache ◽  
Severe Headache ◽  
Thunderclap Headache ◽  
Headache Syndrome ◽  
Cerebral Vasoconstriction ◽  
Duration Of Illness ◽  
Specific Trigger ◽  
Secondary Causes

Bath-related headache (BRH) is a rare primary headache syndrome. We present our experience over seven years and review all reported cases of BRH. Thirteen patients, including six from our group, are described. BRH occurred exclusively in middle-aged or elderly Oriental women (mean age 51 years, range 32-67. Hong Kong 6 cases, Taiwan 4 cases, Japan 3 cases). The typical presentation was a uniphasic cluster of severe headache recurrently triggered by bathing or other activities involving contact with water. Each attack lasted 30 min to 30 h. Onset was hyperacute, consistent with that of thunderclap headache. Reversible multisegmental cerebral vasoconstriction was found in two patients. No underlying secondary causes were identified. Response to acute treatment was generally unsatisfactory, but headache could be prevented by avoiding the specific trigger(s). BRH runs a self-limiting course; all patients remitted within three months after onset. Nimodipine may shorten the duration of illness.

scholarly journals Differences in Frontal Lobe Dysfunction in Patients with Episodic and Chronic Migraine

2021 ◽  
Vol 10 (13) ◽  
pp. 2779
Author(s):  
Sang-Hwa Lee ◽  
Yeonkyeong Lee ◽  
Minji Song ◽  
Jae Jun Lee ◽  
Jong-Hee Sohn
Keyword(s):  
Chronic Migraine ◽  
Frontal Lobe ◽  
Iowa Gambling Task ◽  
Medication Overuse Headache ◽  
Wisconsin Card Sorting Test ◽  
Episodic Migraine ◽  
Frontal Lobe Dysfunction ◽  
Card Sorting ◽  
Cross Sectional ◽  
Frontal Lobe Function

Neuroimaging and neuropsychological investigations have indicated that migraineurs exhibit frontal lobe-related cognitive impairment. We investigated whether orbitofrontal and dorsolateral functioning differed between individuals with episodic migraine (EM) and chronic migraine (CM), focusing on orbitofrontal dysfunction because it is implicated in migraine chronification and medication overuse headache (MOH) in migraineurs. This cross-sectional study recruited women with CM with/without MOH (CM + MOH, CM − MOH), EM, and control participants who were matched in terms of age and education. We conducted neuropsychological assessments of frontal lobe function via the Trail Making Test (TMT) A and B, the Wisconsin Card Sorting Test (WCST), and the Iowa Gambling Task (IGT). We enrolled 36 CM (19 CM + MOH, 17 CM–MOH), 30 EM, and 30 control participants. The CM patients performed significantly (p < 0.01) worse on the TMT A and B than the EM patients and the control participants. The WCST also revealed significant differences, with poorer performance in the CM patients versus the EM patients and the control participants. However, the net scores on the IGT did not significantly differ among the three groups. Our findings suggest that the CM patients exhibited frontal lobe dysfunction, and, particularly, dorsolateral dysfunction. However, we found no differences in frontal lobe function according to the presence or absence of MOH.

Management of subarachnoid haemorrhage

2019 ◽  
pp. 575-590
Author(s):  
Michael Lawton ◽  
Brian P. Walcott ◽  
Roberto Rodriguez
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Cerebral Aneurysm ◽  
Cerebral Perfusion ◽  
Surgical Care ◽  
Rapid Diagnosis ◽  
Skill Level ◽  
Treatment Modalities ◽  
Clinical Scenario ◽  
Acute Period ◽  
Risks And Benefits

Subarachnoid haemorrhage resulting from a ruptured cerebral aneurysm requires advanced medical and surgical care to maximize patient outcomes. In the acute period, care is focused on rapid diagnosis and repairing the aneurysm with either clipping or coiling to prevent further haemorrhage. In the days to weeks that follow, the focus shifts to optimizing cerebral perfusion in order to prevent delayed ischaemia. Patients are best served by a multimodality team that can weigh the risks and benefits of treatment based on aneurysm characteristics, clinical scenario, best available evidence, and provider skill level. While controversy exists over various treatment modalities and management protocols, widespread advances in surgical and endovascular techniques and vasospasm care continue to decrease morbidity and mortality associated with this challenging disease.

Novel Endovascular Neck Reconstruction and Coiling Technique for the Treatment of a Large Wide-Necked Basilar Apex Aneurysm Through a Radial Artery Approach: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (4) ◽  
pp. E157-E157
Author(s):  
Thomas J Sorenson ◽  
Giuseppe Lanzino ◽  
Leonardo Rangel Castilla
Keyword(s):  
Radial Artery ◽  
Hip Replacement ◽  
Aneurysm Neck ◽  
Neck Reconstruction ◽  
Guide Catheter ◽  
History Of ◽  
Computed Tomography Angiogram ◽  
Artery Disease ◽  
Work Up ◽  
Neurologically Intact

Abstract Herein, we demonstrate a case of a large, wide-necked, basilar apex aneurysm (BAA) that was treated with neck reconstruction-assisted coil embolization using the PulseRider device (PulsarVascular, Los Gatos, California), a novel neck-reconstruction device. A 68-yr-old man was found to have large BAA during work-up for sinusitis. Computed tomography angiogram revealed an 11 × 10-mm BAA. Patient has history of coronary artery disease, atrial fibrillation (currently taking Warfarin), recent left hip replacement and right femoral bypass. Treatment of the aneurysm was advised due to its location and size. Microsurgical clip reconstruction was high risk for general anesthesia due to his medical comorbidities and anticoagulation. Wide-necked bifurcation aneurysms are challenging to treat with traditional balloon- or stent-assisted techniques. To mitigate these challenges, novel neck-reconstruction devices have been developed. The Pulsar is one of these neck-reconstruction devices that removes the need to selectively catheterize branch arteries; it is available in a “Y” and “T” configuration. Under conscious sedation and through a radial artery approach, the patient underwent endovascular reconstruction of BAA with Pulsar device and coils. A 6-Fr guide catheter, a 0.021" microcatheter for the Pulsar device and a 0.017" microcatheter for coil delivering were used. A 3 × 8.6 mm Pulsar device was selected based on aneurysm neck and basilar artery measurements. Complete embolization (Raymond-Roy 1 obliteration) of the aneurysm was successfully achieved with no complications. The patient remained neurologically intact and was discharged on postoperative day 1.  Parts of this video were published in Intracranial Aneurysms (1st Edition), Ringer (Ed), online companion to chapter 33B, Copyright Elsevier (2018).

Vessel-wall MRI in thunderclap headache: A useful tool to answer the riddle?

2020 ◽  
pp. 159101992097949
Author(s):  
Arianna Rustici ◽  
Elena Merli ◽  
Sabina Cevoli ◽  
Marco Di Donato ◽  
Giulia Pierangeli ◽  
...  
Keyword(s):  
Vessel Wall ◽  
Incidental Finding ◽  
Abrupt Onset ◽  
Thunderclap Headache ◽  
Endovascular Coiling ◽  
Headache Attack ◽  
History Of ◽  
Mri Sequences ◽  
The Stability

Background Finding an intracranial aneurysm (IA) during a thunderclap headache (TCH) attack, represents a problem because it is necessary to distinguish whether the aneurysm is responsible for the headache as a warning leak or as an incidental finding. High-Resolution Vessel-Wall (HRVW) MRI sequences have been proposed to assess the stability of the wall, as it permits to detect the presence of aneurysmal wall enhancement (AWE). In fact, AWE has been confirmed due to inflammation, recognizable preceding rupture. Case 1: A 37-year-old woman with a migraine more intense than her usual. A CTA revealed a 10 mm AComA aneurysm without subarachnoid hemorrhage (SAH) and HRVW-MRI excluded AWE. The patient’s headache improved, and therefore, the aneurysm was considered an incidental finding, and the headache diagnosed as TCH attack. Subsequently, the aneurysm was surgically clipped, and typical migraine relapsed was reported at follow-up (FU). Case 2: A 67-year-old woman with no history of headaches underwent CTA for an abrupt onset of headache. A 7 mm right carotid-ophthalmic aneurysm with no sign of SAH was discovered. HRVW-MRI demonstrated AWE and thus, a TCH attack for a warning leak of an unstable wall was suspected. Endovascular coiling was immediately performed and at FU any further headache attack was reported. Conclusions HRVW-MRI is useful in case of finding aneurysm as the cause of headaches, particularly the TCH attack. In fact, HRVW-MRI could assess the stability of the aneurysms wall, allowing different patient management and eventually the aneurysmal treatment.

Sign in / Sign up

Export Citation Format

Share Document