Case series of sixteen patients with nummular headache

Cephalalgia ◽  
2010 ◽  
Vol 30 (12) ◽  
pp. 1527-1530 ◽  
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.

scholarly journals Comprehensive approach for the treatment of medication-overuse headache

2021 ◽  
Vol 64 (12) ◽  
pp. 843-851
Author(s):  
Hong-Kyun Park ◽  
Soo-Jin Cho
Keyword(s):  
Medication Overuse ◽  
Medical Condition ◽  
Botulinum Toxin A ◽  
Medication Overuse Headache ◽  
Healthcare Providers ◽  
Primary Headache ◽  
Headache Disorder ◽  
Primary Headache Disorder ◽  
Education Of Patients ◽  
Frequent Use

Background: Medication-overuse headache (MOH) is defined by the International Classification of Headache Disorders as a headache in patients with a pre-existing primary headache disorder that occurs on 15 or more days per month for more than 3 months. It is caused by overuse of medication for acute or symptomatic headache treatment. Regular and frequent use of acute or symptomatic medications can worsen headaches and lead to chronic headache or MOH. MOH is a burdensome medical condition that is difficult to treat, and the frequent recurrence of headaches may result in disability in individuals and impair socioeconomic outcomes.Current Concepts: Awareness of MOH and the education of patients, the general population, and healthcare providers are important for the first step of treatment. Scientific research regarding the treatment of MOH has been published in the past few years.Discussion and Conclusion: Physicians should educate and counsel patients to stop or at least reduce the intake of acute or symptomatic medications that can be discontinued abruptly or tapered slowly. During the period after the discontinuation of the overused medications, some withdrawal symptoms including headache might be manageable with bridging therapy. Evidence-based preventive therapies including anticonvulsants (topiramate and divalproex sodium), botulinum toxin A, and medications acting by antagonism of the calcitonin generelated peptide pathway might be helpful in patients with MOH for both avoiding the overused medication and preventing the relapse of overuse. A comprehensive and multidisciplinary approach may improve the outcomes of patients with MOH.

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

Cephalalgia ◽  
2007 ◽  
Vol 27 (11) ◽  
pp. 1219-1225 ◽  
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.

Secondary headache attributed to exposure to or overuse of a substance

Cephalalgia ◽  
2020 ◽  
pp. 033310242094223
Author(s):  
Kati Toom ◽  
Mark Braschinsky ◽  
Mark Obermann ◽  
Zara Katsarava
Keyword(s):  
Health Care Professionals ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Primary Headache ◽  
Headache Disorder ◽  
Tension Type Headache ◽  
Secondary Headache ◽  
Primary Headache Disorder ◽  
Type Headache ◽  
Acute Headache

Background Secondary headaches attributed to exposure to or the overuse of a substance are classified under chapter eight in the International Classification of Headache Disorders 3rd edition. Three distinct sub-chapters consider: 1. Headache attributed to exposure to a substance, 2. Medication overuse headache, and 3. Headache attributed to substance withdrawal. Headache attributed to exposure to a substance refers to a headache with onset immediately or within hours after the exposure, while medication overuse headache is a headache occurring on 15 or more days per month that has developed as a consequence of regular usage of acute headache medication(s) for more than three consecutive months in a patient with a pre-existing primary headache disorder. The withdrawal of caffeine, oestrogen, and opioids is most often associated with the development of headache. Discussion Despite the current headache classification, there is no certainty of a causal relationship between the use of any substance and the development of headache. Some substances are likely to provoke headache in patients that suffer from a primary headache disorder like migraine, tension-type headache or cluster headache, while others were described to cause headache even in people that generally do not get headaches. Toxic agents, such as carbon monoxide (CO) are difficult to investigate systematically, while other substances such as nitric oxide (NO) were specifically used to induce headache experimentally. If a patient with an underlying primary headache disorder develops a headache, in temporal relation to exposure to a substance, which is significantly worse than the usual headache it is considered secondary. This is even more the case if the headache phenotype is different from the usually experienced headache characteristics. Medication overuse headache is a well-described, distinct disease entity with only marginally understood pathophysiology and associated psychological factors. Managing medication overuse headache patients includes education, detoxification, prophylactic treatments and treating comorbidities, which is reflected in available guidelines. Viewing medication overuse headache as a separate entity helps clinicians and researchers better recognise, treat and study the disorder. Conclusion Identification of substances that may cause or trigger secondary headache is important in order to educate patients and health care professionals about potential effects of these substances and prevent unnecessary suffering, as well as deterioration in quality of life. Treatment in case of medication overuse and other chronic headache should be decisive and effective.

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.

Headache associated with head trauma

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.

Prevalence of Primary Headache Disorders in Kuwait

2017 ◽  
Vol 48 (3-4) ◽  
pp. 138-146 ◽  
Author(s):  
Jasem Yousef Al-Hashel ◽  
Samar Farouk Ahmed ◽  
Raed Alroughani
Keyword(s):  
Medication Overuse Headache ◽  
Primary Headache ◽  
Headache Disorder ◽  
Episodic Migraine ◽  
Tension Type Headache ◽  
Primary Headaches ◽  
Primary Headache Disorder ◽  
Work Related ◽  
Primary Headache Disorders ◽  
Kuwaiti Population

Background: Only an insignificant quantum of data exists on the prevalence of primary headaches among those living in Kuwait. We aimed to determine the prevalence of primary headaches among the Kuwaiti population. Methods: This community-based study included Kuwaiti population aged 18-65 years. Using systematic random sampling, data was collected by the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation questionnaire. Responses to the diagnostic questions were transformed into diagnoses algorithmically to confirm the diagnosis of primary headache. Results: A total of 15,523 patients were identified of whom 9,527 (61%) were diagnosed with primary headache disorder; a female predominance of 62.2% was observed. The mean age was 34.84 ± 10.19. Tension-type headache (TTH) was the most prevalent at 29% followed by episodic migraine (23.11%), chronic migraine (5.4%), and medication overuse headache (2.4%). Primary headache prevalence declined steadily from 71% in those aged 18-30 years to 23% in those over 50 (p < 0. 037). The female:male ratio was 1.7:1. Frequency and severity of primary headache were correlated significantly with lost work days (r = 0.611, p < 0.001 and r = 0.102, p = 0.001, respectively). Conclusions. In Kuwait, primary headache disorder is more frequent in young adults and females. TTH followed by episodic migraine were the more prevalent types of headache. Higher frequency and severe headaches were associated with increasing social and work-related burden.

Nummular headache associated with focal hair heterochromia in a child

Cephalalgia ◽  
2010 ◽  
Vol 30 (11) ◽  
pp. 1403-1405 ◽  
Author(s):  
Gabriel Dabscheck ◽  
Peter Ian Andrews
Keyword(s):  
Primary Headache ◽  
Headache Disorder ◽  
Nummular Headache ◽  
Primary Headache Disorder ◽  
Headache Syndrome

Nummular headache (NH) is a recently described headache syndrome where continuous or intermittent pain is localised to a coin-shaped region of the skull. NH can be a primary headache disorder or secondary to intracranial or extracranial pathology. We report a four-year-old boy who presented with nummular headache co-localised with a patch of discoloured hair and propose a common aetiology.

scholarly journals Medication Overuse Headache: A Trap for the Headache Patients

2013 ◽  
Vol 3 (2) ◽  
pp. 94-98
Author(s):  
A Rahman ◽  
R Habib ◽  
NB Bhowmik ◽  
A Haque
Keyword(s):  
Chronic Daily Headache ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Primary Headache ◽  
Headache Disorder ◽  
Tension Type Headache ◽  
Clinical Impression ◽  
Drug Induced ◽  
Daily Headache ◽  
Drug Induced Headache

Medication Overuse Headache (MOH) was previously termed analgesic rebound headache, drug-induced headache, and medication-misuse headache. It is not a primary headache but frequently coexists with primary chronic daily headache. All acute symptomatic medications used to treat headaches have the potential for causing MOH. Highest with opioids, butalbital-containing combination analgesics, and aspirin/ acetaminophen/caffeine combinations. The development is typically preceded by an episodic headache disorder, usually migraine or tension-type headache, that has been treated with frequent and excessive amounts of acute symptomatic medications. The diagnosis is based upon clinical impression. A history of analgesic use averaging more than two to three days per week in association with chronic daily headache is suggestive. The diagnosis is made when the pattern of frequent headaches fulfills the diagnostic criteria for MOH. The basic steps in the management: Patient education, withdrawal of the offending medication, bridge (transitional) therapy, establishment of a headache treatment regimen covering acute and preventive care, follow up and relapse prevention. Birdem Med J 2013; 3(2): 94-98 DOI: http://dx.doi.org/10.3329/birdem.v3i2.17213

scholarly journals Medication Overuse Headache

Migraine ◽  
2020 ◽  
Author(s):  
Dhruv Bansal ◽  
Pritesh Pranay ◽  
Fayyaz Ahmed
Keyword(s):  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Previous History ◽  
Treatment Strategies ◽  
Primary Headache ◽  
Secondary Headache ◽  
Prophylactic Drugs ◽  
History Of ◽  
Withdrawal Therapy ◽  
The Individual

Medication overuse headache (MOH) is defined in the latest ICHD-3 criteria as a secondary headache caused by worsening of a pre-existing headache (usually a primary headache) owing to overuse of one or more attack-aborting or pain-relieving medications. MOH can be debilitating and results from biochemical and functional brain changes induced by certain medications taken too frequently. Various risk factors some modifiable, other non-modifiable (Multiple Gene Polymorphisms) have been hypothesised in MOH. Psychiatric co-morbidities in MOH are noticeably (anxiety and depression) found to be co morbid disorders by more than chance. This has to be managed effectively along with treatment strategies for MOH for efficacious response to withdrawal treatment. Ample literature and clinical evidence shown in prospective trials, that withdrawal therapy is the best treatment for MOH. The mainstay of MOH treatment is not only to detoxify the patients and to stop the chronic headache but also, most likely, to improve responsiveness to acute or prophylactic drugs. Studies advocating prophylactic treatment with good response to mainly topiramate and OnabotulinumtoxinA do exist, less prominent for prednisolone, however, not recommended for every patient. Management may be complex and must be done via MDT approach with involvement of specialists when needed along with incorporating adequate treatment of acute withdrawal symptoms, educational and behavioural programs to ensure patient understanding of the condition and compliance. There are arguments on either sides of inpatient and outpatient withdrawal for MOH patients dependent heavily on the individual circumstances i.e. patient’s motivation, the duration of the overuse, the type of overused drugs, possible previous history of detoxification failures and co morbidities. Treatment trials are still required to determine for clinicians the best evidence-based approach for helping these patients break their headache cycle.

Hemicrania Continua: Who Responds to Indomethacin?

Cephalalgia ◽  
2009 ◽  
Vol 29 (3) ◽  
pp. 300-307 ◽  
Author(s):  
MJ Marmura ◽  
SD Silberstein ◽  
M Gupta
Keyword(s):  
Medication Overuse ◽  
Primary Headache ◽  
Headache Disorder ◽  
Rapid Onset ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Autonomic Symptoms ◽  
Primary Headache Disorder ◽  
Unilateral Headache ◽  
Headache Onset

Hemicrania continua (HC) is a primary headache disorder characterized by a continuous, moderate to severe, unilateral headache and defined by its absolute responsiveness to indomethacin. However, some patients with the clinical phenotype of HC do not respond to indomethacin. We reviewed the records of 192 patients with the putative diagnosis of HC and divided them into groups based on their headaches' response to indomethacin. They were compared for age, gender, presence or absence of specific autonomic symptoms, medication overuse, rapidity of headache onset, and whether or not the headaches met criteria for migraine when severe. Forty-three patients had an absolute response and 122 patients did not respond to adequate doses of indomethacin. The two groups did not differ significantly in terms of age, sex, presence of rapid-onset headache, or medication overuse. Autonomic symptoms, based on a questionnaire, did not predict response. Eighteen patients could not complete a trial of indomethacin due to adverse events. Nine patients could not be included in the HC group despite improvement with indomethacin: one patient probably had primary cough headache, another paroxysmal hemicrania; three patients improved but it was uncertain if they were absolutely pain free, and four patients dramatically improved but still had a baseline headache. We found no statistically significant differences between patients who did and did not respond to indomethacin. All patients with continuous, unilateral headache should receive an adequate trial of indomethacin. Most patients with unilateral headache suggestive of HC did not respond to indomethacin.

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