scholarly journals 063 Headache with periorbital ecchymosis; a rare clinical entity

2019 ◽  
Vol 90 (e7) ◽  
pp. A20.3-A21
Author(s):  
Srimathy Vijayan ◽  
Carolyn Orr ◽  
Catherine Franconi
Keyword(s):  
Case Reports ◽  
Tension Headache ◽  
Primary Headache ◽  
Young Female ◽  
Clinical Entity ◽  
List Type ◽  
Treatment Regimens ◽  
Primary Headache Disorders ◽  
Headache Pain ◽  
Trigeminal Autonomic Cephalgia

ObjectivesPrimary headache disorders are common with migraine and tension headache accounting for the vast majority of cases. A smaller proportion suffer from trigeminal autonomic cephalgia (TAC). We present a 23-year-old Caucasian female who described characteristic, episodic headaches starting with a dull retro-orbital/bi-frontal pressure evolving, over the course of 1 minute, to experience florid periorbital ecchymosis. While this phenomenon has been described in the literature, the characteristics of our case are unique and noteworthy of reporting.MethodsWe reviewed the literature surrounding this rare entity by using PubMed/OVID databases and the search terms ‘Headache AND ecchymosis’.ResultsCase reports exist in older patients1–3, where the headache is side locked and associated with other autonomic characteristics such as periorbital oedema, conjunctival injection and tearing. Our case is a young female with only ecchymosis in a unilateral and/or bilateral manner and no other autonomic or indeed migraine features. The patient underwent vascular/cranial imaging and blood tests to exclude haematological, autoimmune, vasculitic causes for this presentation which were unrewarding.ConclusionVariations on this clinical entity are described;1–4 we hope this report may bring attention to this fascinating phenomenon. The pathophysiological process is likely to be similar to those implicated in TACs, namely activation of the trigemino-neurovascular system and facial autonomic pathways. The release of neuromediators such as CGRP, VIP and Substance P cause blood vessel fragility resulting in diapedesis. Optimal treatment regimens are unknown but various agents have been trialled. Our patient declined treatment and continues to be followed.ReferencesDeBroff B, et al. Migraine Associated with Periorbital Ecchymosis. Headache 1990;30:260–263.Dafer R, et al. Atypical Chronic Headache and Recurrent Facial Ecchymosis: A Case Report. Neuro-Ophthalmology 2011;35:76–77.Nozzolillo D, et al. Migraine associated with facial ecchymoses ipsilateral to the symptomatic side. J Headache Pain ( 2004) 5:256–259.Sethi PK, et al. Teaching neuroimages: Red forehead dot syndrome and migraine revisited. Neurology 2015;85;e28.

Posttraumatic Headache

2018 ◽  
Vol 38 (06) ◽  
pp. 619-626 ◽  
Author(s):  
Brigid Dwyer
Keyword(s):  
Tension Headache ◽  
Primary Headache ◽  
Secondary Headache ◽  
Postconcussion Syndrome ◽  
Posttraumatic Headache ◽  
Posttraumatic Epilepsy ◽  
Primary Headache Disorders ◽  
History Of ◽  
Military Populations ◽  
Patients Experience

AbstractPosttraumatic headaches are among the most challenging complaints after mild traumatic brain injury (mTBI). They are a debilitating problem experienced by patients after TBI of all severities. Up to 90% of mild TBI patients experience headache, particularly if female and with a premorbid history of primary headache. Tension headache has classically been the most common subtype, but in military populations migraine has dominated. Posttraumatic headache encompasses a spectrum of headache types that overlap heavily with common primary headache disorders, but also autonomic cephalgias as well as several secondary headache conditions. It is important to understand the evolution of postconcussion syndrome as a concept, and the challenges associated with diagnosing and treating multidomain drivers effectively. The first-line treatments for posttraumatic headache are typically the same as those used in nontraumatic headache, with additional considerations for cognitive side effects, posttraumatic epilepsy, and coexisting injuries resulting in neuropathic pain or medication overuse.

Hypnic headache

Cephalalgia ◽  
2013 ◽  
Vol 33 (16) ◽  
pp. 1349-1357 ◽  
Author(s):  
Dagny Holle ◽  
Steffen Naegel ◽  
Mark Obermann
Keyword(s):  
Current Knowledge ◽  
Blood Pressure Monitoring ◽  
Case Reports ◽  
Case Series ◽  
Primary Headache ◽  
Headache Disorder ◽  
Hypnic Headache ◽  
Primary Headache Disorder ◽  
Primary Headache Disorders ◽  
Cerebral Mri

Background Hypnic headache (HH) is a rare primary headache disorder that is characterised by strictly sleep-related headache attacks. Purpose Because of the low prevalence of this headache disorder, disease information is mainly based on case reports and small case series. This review summarises current knowledge on HH in regard to clinical presentation, pathophysiology, symptomatic causes and therapeutic options. Method We review all reported HH cases since its first description in 1988 by Raskin. Broadened diagnostic criteria were applied for patient selection that slightly deviate from the current ICHD-II criteria. Patients were allowed to describe the headache character to be other than dull. Additionally, accompanying mild trigemino-autonomic symptoms were permitted. Conclusions Mainly elderly patients are affected, but younger patients and even children might also suffer from HH. Headache attacks usually last between 15 and 180 minutes, but some patients report headache attacks up to 10 hours. Almost all patients report motor activity during headache attacks. Cerebral MRI and 24-hour blood pressure monitoring should be performed in the diagnostic work-up of HH. Other primary headache disorders such as migraine and cluster headache may also present with sleep-related headache attacks and should be considered first. Caffeine taken as a cup of strong coffee seems to be the best acute and prophylactic treatment option.

scholarly journals An unusual phenotype of MEN1 syndrome with a SI-NEN associated with a deletion of the MEN1 gene

2016 ◽  
Vol 2016 ◽  
Author(s):  
Jerena Manoharan ◽  
Caroline L Lopez ◽  
Karl Hackmann ◽  
Max B Albers ◽  
Anika Pehl ◽  
...  
Keyword(s):  
Germline Mutation ◽  
Sanger Sequencing ◽  
Case Reports ◽  
Adrenal Adenoma ◽  
Young Female ◽  
List Type ◽  
Gene Deletions ◽  
Aggressive Phenotype ◽  
Men1 Syndrome ◽  
Large Deletions

Summary We report about a young female who developed an unusual and an aggressive phenotype of the MEN1 syndrome characterized by the development of a pHPT, malignant non-functioning pancreatic and duodenal neuroendocrine neoplasias, a pituitary adenoma, a non-functioning adrenal adenoma and also a malignant jejunal NET at the age of 37 years. Initial Sanger sequencing could not detect a germline mutation of the MEN1 gene, but next generation sequencing and MPLA revealed a deletion of the MEN1 gene ranging between 7.6 and 25.9 kb. Small intestine neuroendocrine neoplasias (SI-NENs) are currently not considered to be a part of the phenotype of the MEN1-syndrome. In our patient the SI-NENs were detected during follow-up imaging on Ga68-Dotatoc PET/CT and could be completely resected. Although SI-NENs are extremely rare, these tumors should also be considered in MEN1 patients. Whether an aggressive phenotype or the occurrence of SI-NENs in MEN1 are more likely associated with large deletions of the gene warrants further investigation. Learning points Our patient presents an extraordinary course of disease. Although SI-NENs are extremely rare, these tumors should also be considered in MEN1 patients, besides the typical MEN1 associated tumors. This case reports indicate that in some cases conventional mutation analysis of MEN1 patients should be supplemented by the search for larger gene deletions with modern techniques, if no germline mutation could be identified by Sanger sequencing.

Legal Update: Using the Guides for Permanent Partial Disability Determinations

1997 ◽  
Vol 2 (2) ◽  
pp. 6-6
Author(s):  
Christopher R. Brigham
Keyword(s):  
Daily Living ◽  
Primary Headache ◽  
Headache Disorder ◽  
Careful Evaluation ◽  
Primary Headache Disorder ◽  
Primary Headache Disorders ◽  
The Central Nervous System ◽  
Headache Pain ◽  
Tension Type Headaches ◽  
Cluster Headaches

Abstract Rating the impairment related to various chronic painful conditions, including headaches, is challenging and is addressed in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) in a section of the chapter on pain. Primary headache disorders include migraines, tension-type headaches, and cluster headaches caused by disturbances in the central nervous system. Headaches occur with varying intensities and frequencies but follow three broad patterns: 1) minimal, slight, moderate, and marked headache; 2) cycles or episodes that may last from moments to years; and 3) consistent and persistent pain that may last years, decades, or a lifetime. Physicians should estimate impairment related to headache pain according to the procedures discussed in section 15.8, including a multidimensional assessment of an individual's capabilities, including biological, psychological, and social aspects and excluding the existence of a separate comorbid pathologic process. The AMA Guides does not provide specific numeric values for impairment of headache or for pain itself. For patients who have a primary headache disorder, the physician should clearly understand the frequency and severity of the condition, the approach to treatment, and the effects of headaches on activities of daily living. The discussion of headaches in the AMA Guides emphasizes the importance of careful evaluation over merely assigning a numeric value to an impairment.

Headache and Chiari malformation

2020 ◽  
pp. 442-446
Author(s):  
Dagny Holle ◽  
Julio Pascual
Keyword(s):  
Chiari Malformation ◽  
Medical Condition ◽  
Case Reports ◽  
Case Series ◽  
Physical Exertion ◽  
Primary Headache ◽  
Foramen Magnum ◽  
Tension Type Headache ◽  
Primary Headache Disorders ◽  
Type Headache

Chiari malformation is a rare medical condition that is characterized by downward displacement of the cerebellar tonsils through the foramen magnum. The clinical presentation of Chiari malformation is diverse, but headache is the most often reported symptom. The typical Chiari malformation headache is localized in the occipital part of the head and aggravated by coughing, other Valsalva manoeuvres, or physical exertion. The prevalence of other episodic primary headache disorders such as tension-type headache and migraine is not increased in patients with Chiari malformation. The underlying pathophysiology of headache in Chiari malformation is still enigmatic, but alteration of intrathecal pressure was suggested to be involved. Controlled treatment trials for CM-related headaches are not available and treatment recommendations are mainly based on case reports, small case series and clinical experience. Therefore, no firm recommendation regarding surgical treatment can be made.

About differential diagnosis of cephalalgia (literature review)

10.12737/7239 ◽  
2014 ◽  
Vol 8 (1) ◽  
pp. 0-0
Author(s):  
Сапожников ◽  
Vladimir Sapozhnikov ◽  
Ларикова ◽  
A. Larikova
Keyword(s):  
Differential Diagnosis ◽  
Literature Review ◽  
Tension Headache ◽  
Primary Headache ◽  
Headache Disorders ◽  
Diagnostic Problem ◽  
Trigger Factors ◽  
Primary Headache Disorders ◽  
Adolescent Period

Cephalalgia must be the leading or sometimes the single symptom of 50 different diseases. This paper is devoted to analysis the causes, the clinical features and methods of cephalalgia diagnosis in children, teenagers, as well as the modifiable and trigger factors. There is cephalalgia in 40-60% children and the prevalence of the disease increases with age, especially with the beginning of school, and reaches a peak with adolescent period 75%, this explains the importance of this work. In the last 30 years, scientists have registered the growth of the epidemiology incidence of primary headache disorders, including the chronic form of headaches: tension headache has grown in ten times, migraines – in 5-6 times. Due to the uncertainty of subjective sensations in infancy the revelation of cephalalgia becomes sometimes quite a complicated diagnostic problem. Many researchers mention the difficulty of differentiation of various cephalalgia types in infancy due to insufficient sensibility of diagnostic criteria, which were offered by the International Classification of Headache Disorders 2003. 20-35% of cases cann’t classified. In this article, the importance of headache studying is accentuated, that is necessary for life optimization of children suffering from headaches.

scholarly journals Headache disorders: differentiating and managing the common subtypes

2012 ◽  
Vol 6 (3) ◽  
pp. 124-132 ◽  
Author(s):  
Fayyaz Ahmed
Keyword(s):  
Tension Headache ◽  
Primary Headache ◽  
Care Physician ◽  
Common Symptom ◽  
National Society ◽  
Headache Disorders ◽  
Special Investigation ◽  
Primary Headache Disorders ◽  
The Uk ◽  
Headache Care

Headache is an extremely common symptom and collectively headache disorders are among the most common of the nervous system disorders, with a prevalence of 48.9% in the general population.1 Headache affects people of all ages, races and socioeconomic status and is more common in women. Some headaches are extremely debilitating and have significant impact on an individual’s quality of life, imposing huge costs to healthcare and indirectly to the economy in general. Only a small proportion of headache disorders require specialist input. The vast majority can be effectively treated by a primary care physician or generalist with correct clinical diagnosis that requires no special investigation. Primary headache disorders – migraine, tension headache and cluster headache – constitute nearly 98% of all headaches; however, secondary headaches are important to recognise as they are serious and may be life threatening. This article provides an overview of the most common headache disorders and discusses the red flag symptoms that help identify serious causes that merit urgent specialist referral. The current pathway of headache care in the UK is discussed with a view to proposing a model that might fit well in the financially constrained National Health Service (NHS) and with new NHS reforms. The role of the national society, the British Association for the Study of Headache, and the patient organisations such as Migraine Trust in headache education to the professionals and the general public in shaping headache care in the UK is described. The article concludes by summarising evidence-based management of common headache diagnoses.

Infection with antiretroviral-susceptible HIV in an individual adherent to pre-exposure prophylaxis: strategies for treatment initiation

2021 ◽  
pp. 095646242097112
Author(s):  
Jessica M Hughes ◽  
Darrell HS Tan ◽  
Peter Anderson ◽  
Janani Bodhinayake ◽  
Paul A MacPherson
Keyword(s):  
Viral Load ◽  
Copy Number ◽  
Case Reports ◽  
Pharmacy Records ◽  
Treatment Regimens ◽  
Viral Copy Number ◽  
Low Copy Number ◽  
Viral Copy ◽  
Exposure Prophylaxis ◽  
Tenofovir Diphosphate

HIV pre-exposure prophylaxis (PrEP) is effective at preventing sexual acquisition of HIV, and failures in clinical trials are largely attributable to medication nonadherence. We report here a case of infection with a fully susceptible strain of HIV in an individual adherent to PrEP as demonstrated by pharmacy records and intracellular tenofovir diphosphate levels. At diagnosis, the viral load was 90 copies/mL precluding initial genotype testing due to low copy number. While PrEP failure is rare, this case underscores the importance of regular HIV testing for patient on PrEP and prompts discussion regarding the approach to treatment following failure where an initial genotype is not yet available or not possible due to low viral load. Few other case reports of PrEP failure exist in the literature and approaches to treatment varied widely. We suggest the initial viral copy number may guide next steps and discuss the risks and benefits of stopping PrEP, escalating therapy with integrase inhibitors or boosted protease inhibitors, or switching to non-nucleoside antiretroviral treatment regimens.

Headache

2018 ◽  
Author(s):  
Benjamin W Friedman
Keyword(s):  
Differential Diagnosis ◽  
Clinical Characteristics ◽  
Sinus Thrombosis ◽  
International Headache Society ◽  
Primary Headache ◽  
Primary Headaches ◽  
Key Words Migraine ◽  
Secondary Headaches ◽  
Primary Headache Disorders ◽  
Greater Occipital Nerve

Headaches are one of the most common complaints of patients seen by emergency physicians. They can be classified as primary headaches, which have no identifiable underlying cause, and secondary headaches, which are classified according to their cause. The majority of headaches are benign in origin, and most patients with headache can be treated successfully in the emergency department and discharged home; however, some have potentially life-threatening causes, and consideration of a broad differential diagnosis for all patients is essential. This review covers the primary headache disorders, pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes. The figure shows areas of the brain sensitive to pain. Tables review differential diagnosis of headache, International Headache Society primary headache criteria, clinical characteristics of secondary headaches, high-risk clinical characteristics among patients with a headache peaking in intensity within 1 hour, drugs associated with headache, and parenteral treatment of acute migraine. This review contains 1 figure, 9 tables, and 58 references. Key words: migraine, calcitonin gene related peptide, greater occipital nerve block, venous sinus thrombosis, reversible cerebral vasoconstriction syndrome, Ottawa, subarachnoid, cluster headache, trigeminal autonomic cephalalgias, post-traumatic headache

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