Facial presentations of migraine, TACs, and other paroxysmal facial pain syndromes

Neurology ◽  
2019 ◽  
Vol 93 (12) ◽  
pp. e1138-e1147 ◽  
Author(s):  
Christian Ziegeler ◽  
Arne May
Keyword(s):  
Facial Pain ◽  
Care Center ◽  
Tertiary Care ◽  
Primary Headache ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Primary Headaches ◽  
Cranial Autonomic Symptoms ◽  
Pain Syndromes ◽  
The Face

ObjectiveTo assess the prevalence of facial pain (V2 and/or V3) presentations among nearly 3,000 patients with headache treated in a university tertiary care center.MethodsBetween 2010 and 2018, we routinely assessed the prevalence of facial pain presentations of all patients with primary headaches.ResultsOf 2,912 patient datasets, 291 patients reported facial pain either as an independent or as an additional symptom. Among patients with migraine, 2.3% (44 of 1,935) reported a facial involvement, most commonly in V2. Of these, 18 patients (40.9%) experienced the pain predominantly in the face. In patients with cluster headache, 14.8% (42 of 283) reported a facial involvement, of which 31.0% perceived the pain predominantly in the face. A facial involvement was seen in 45.0% of patients with paroxysmal hemicrania (9 of 20), 21.4% of patients with hemicrania continua (9 of 42), and 20.0% of patients with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing/short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (3 of 15). In addition, we present 6 patients who reported a constant side-locked facial pain with superseded well-defined facial pain attacks of 10- to 30-minute duration that appeared several times per day.ConclusionOur data suggest that a facial involvement in primary headaches is infrequent but not uncommon. A sole facial presentation of primary headache symptomatology seems to be exceptionally rare. We describe 3 different types of facial pain involvement and, in this context, distinguish patients with paroxysmal orofacial pain syndromes that have not been previously described. These patients may represent a new entity that could tentatively be called constant unilateral facial pain with added attacks.

Classification, diagnostic criteria, and epidemiology

2020 ◽  
pp. 177-181
Author(s):  
Thijs H. Dirkx ◽  
Peter J. Koehler
Keyword(s):  
Cluster Headache ◽  
Epidemiological Data ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Primary Headaches ◽  
Conjunctival Injection ◽  
Headache Disorders ◽  
Cranial Autonomic Symptoms ◽  
Unilateral Headache

The trigeminal autonomic cephalalgias (TACs), including cluster headache, paroxysmal hemicrania, SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing), SUNA (with cranial autonomic symptoms), and hemicrania continua, belong to the primary headaches. They are characterized by severe unilateral headache attacks in association with ipsilateral cranial autonomic features. Cluster headache is the most frequent of the TACs. The other TACs are rare, but epidemiological data are scarce and variable. The various types of TAC are distinguished not only by differences in attack frequency and duration, but also by differences with respect to treatment response. The typical headache syndromes, fulfilling the International Classification of Headache Disorders-3 criteria, have also been described in association with other disorders and imaging is required to exclude intracranial pathology in all newly diagnosed patients.

INDOMETHACIN TEST USAGE AT UNITED KINGDOM TERTIARY CENTRES OVER 20 YEARS-AN AUDIT

2015 ◽  
Vol 86 (11) ◽  
pp. e4.127-e4
Author(s):  
Pyari Bose ◽  
DG Palethorpe ◽  
J Marin ◽  
A Nesbitt ◽  
J Lowe ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Test Procedure ◽  
Primary Headache ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Serious Adverse Events ◽  
Data Set ◽  
Primary Headache Disorders ◽  
Test Usage

BackgroundIndomethacin-responsive trigeminal autonomic cephalalagias (TACS), paroxysmal hemicrania (PH) and hemicrania continua (HC), are unique, important syndromes to understand.AimEvaluation of the role of the placebo-controlled indomethacin test (P-Indotest) in the diagnosis of primary headache disorders.MethodPatients notes, clinic letters and headache diaries of patients under our care (PJG) over a 20 year period across various UK Neurology tertiary care centres were examined to obtain data against an audit collection tool. A pre-determined set of data were extracted, and the test procedure reviewed for compliance against a standard with minimum data set requirement by an unblinded observer. The original test score was noted, and prospectively re-scored by a blinded observer.ResultsPatients (n=7; 4 female) were aged from 24 to 51 years. The majority (85%) had side locked headache. P-Indotest was positive in 78% of the cases with patients having either HC or PH. Of all patients tested, 42% had unilateral photophobia and phonophobia and all these cases had a positive response. No serious adverse events were noted. Sleepiness was often reported on the active treatment as was transient worsening of headache in unilateral chronic migraine. Further data is being compiled.ConclusionThe P-IndoTest is a reliable and safe test and should in the diagnosis of patients with possible indomethacin sensitive TACs. While far from ideal, a positive indomethacin test does identify a particular biology and should be retained as a diagnostic marker of PH and HC until its basis is understood.

scholarly journals Alcohol-induced headaches: Evidence for a central mechanism?

2016 ◽  
Vol 07 (02) ◽  
pp. 269-275 ◽  
Author(s):  
Alessandro Panconesi
Keyword(s):  
International Headache Society ◽  
Primary Headache ◽  
Familial Hemiplegic Migraine ◽  
Tension Type Headache ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Primary Headaches ◽  
Study Approach ◽  
Type Headache ◽  
International Headache Society Classification

ABSTRACTAlcoholic drinks (ADs) have been reported as a migraine trigger in about one-third of the migraine patients in retrospective studies. Some studies found that ADs trigger also other primary headaches. The studies concerning the role of ADs in triggering various types of primary headaches published after the International Headache Society classification criteria of 1988 were reviewed, and the pathophysiological mechanisms were discussed. Many studies show that ADs are a trigger of migraine without aura (MO), migraine with aura (MA), cluster headache (CH), and tension-type headache (TH). While data on MO and CH are well delineated, those in MA and TH are discordant. There are sparse reports that ADs are also triggers of less frequent types of primary headache such as familial hemiplegic migraine, hemicrania continua, and paroxysmal hemicrania. However, in some countries, the occurrence of alcohol as headache trigger is negligible, perhaps determined by alcohol habits. The frequency estimates vary widely based on the study approach and population. In fact, prospective studies report a limited importance of ADs as migraine trigger. If ADs are capable of triggering practically all primary headaches, they should act at a common pathogenetic level. The mechanisms of alcohol-provoking headache were discussed in relationship to the principal pathogenetic theories of primary headaches. The conclusion was that vasodilatation is hardly compatible with ADs trigger activity of all primary headaches and a common pathogenetic mechanism at cortical, or more likely at subcortical/brainstem, level is more plausible.

Atypical facial pain–application of the IHS criteria in a clinical sample

Cephalalgia ◽  
1993 ◽  
Vol 13 (12_suppl) ◽  
pp. 84-88 ◽  
Author(s):  
Volker Pfaffenrath ◽  
Michael Rath ◽  
Walter Pöllmann ◽  
Wolfgang Keeser
Keyword(s):  
Facial Pain ◽  
Clinical Sample ◽  
International Headache Society ◽  
Pain Syndrome ◽  
Primary Headache ◽  
Atypical Facial Pain ◽  
Facial Region ◽  
Pain Syndromes ◽  
The Face ◽  
Ihs Criteria

Atypical facial pain is a residual category for otherwise unclassifiable pain syndromes in the facial region. In 35 patients (31F, 4M) with a mean age of 53.2 ± 14.9 years and a chronic facial pain syndrome we tested the new diagnostic criteria of the International Headache Society (IHS). There was a marked female preponderance, vague description of symptoms and a long history of incorrect diagnoses. A high number of invasive procedures (3.5 ± 3.0 (1–13)) were performed in this group. In agreement with the IHS criteria, an operaiion or injury to the face was a suspected cause in 43%. In contrast to the IHS criteria, our patient sample had dysaesthesiae (63%), bilateral occurrence (37%), remission periods (57%), pain attacks (23%) and superficial as well as deep pain. The IHS classification is insufficient to separate atypical facial pain from other primary headache and facial pain syndromes. We suggest a modified version of the IHS criteria for atypical facial pain.

scholarly journals Migraine in Nursing Students—A Study from a Tertiary Care Center in South India

2021 ◽  
Vol 12 (01) ◽  
pp. 129-132
Author(s):  
Bindu Menon ◽  
Nikethana Remadevi
Keyword(s):  
Nursing Students ◽  
South India ◽  
Care Center ◽  
Tertiary Care ◽  
Work Productivity ◽  
Primary Headache ◽  
Tertiary Care Center ◽  
Headache Severity ◽  
Accompanying Symptoms

Abstract Objective Nursing profession is subject to occupational stress, which can be a trigger for headaches. Our study aimed to study the prevalence of migraine, its characteristics, triggers, and relieving factors among nursing students in a tertiary care center. Materials and Methods This study was performed in a super-specialty hospital in South India. A structured questionnaire captured data on the occurrence of headache, demographics, aura, triggering factors, relieving factors, and lifestyle habits. Results are presented in numbers and percentage. Results A total of 20% of nursing students in the study had headache of which 85% had migraine. Weekly and daily attacks were reported in 12 and 4% students, respectively. Twenty-two percent had headache severity of more than 5 visual analogue scale. Most common accompanying symptoms were photophobia (80%), phonophobia (70%), nausea (75%), vomiting (71%), neck pain (25%), and vertigo (20%). Thirty-nine percent had auras. Ninety-five percent reported triggers with 70% students having more than one trigger. Sleep was the relieving factor in 69%, head massage in 50%, and relaxing from work in 48%. Conclusion The most common type of primary headache in nurses in our study was migraine. More than three-fourths nurses reported triggers and relieving factors. Addressing these factors could help in managing migraines and help in improving the quality of life and increased work productivity of nurses.

scholarly journals A case of remitting hemicrania continua with seasonal variation and clustering: a diagnostic confusion with cluster headache

2019 ◽  
Vol 12 (5) ◽  
pp. e229650
Author(s):  
Sanjay Prakash ◽  
Kalu Singh Rawat
Keyword(s):  
Discrete Series ◽  
Primary Headache ◽  
Complete Response ◽  
Hemicrania Continua ◽  
Therapeutic Trial ◽  
Cranial Autonomic Symptoms ◽  
Unilateral Headache ◽  
Continuous Background ◽  
Diagnostic Confusion ◽  
History Of

Hemicrania continua (HC) is an indomethacin responsive primary headache that is characterised by a continuous strictly unilateral headache with periodic exacerbations. About 15% may have a remitting subtype of HC. Herein, we are reporting a 36-year-old man who had a 5-year history of episodic right-sided headaches. The headaches used to occur in a discrete series lasting 4–6 weeks, separated by pain-free remissions of 10–11 months. In each relapse, he had continuous background pain with superimposed exacerbations. The superimposed exacerbations were 1–2 attacks per day, lasting for 2–5 hours, and were associated with ipsilateral cranial autonomic symptoms. However, the patient did not respond to usual therapies of custer headache (CH). He had a complete response to indomethacin. We suggest that remitting subtype of HC may mimic CH. A therapeutic trial of indomethacin should be done in all strictly unilateral headaches who are not responding to other drugs.

Unilateral Photophobia or Phonophobia in Migraine Compared With Trigeminal Autonomic Cephalalgias

Cephalalgia ◽  
2008 ◽  
Vol 28 (6) ◽  
pp. 626-630 ◽  
Author(s):  
P Irimia ◽  
E Cittadini ◽  
K Paemeleire ◽  
AS Cohen ◽  
PJ Goadsby
Keyword(s):  
Cluster Headache ◽  
Clinical Symptoms ◽  
Medication Overuse Headache ◽  
Episodic Migraine ◽  
Chronic Cluster Headache ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Primary Headaches ◽  
Trigeminal Autonomic Cephalalgias ◽  
A Prospective Study

Our objective was to compare the presence of self-reported unilateral photophobia or phonophobia, or both, during headache attacks comparing patients with trigeminal autonomic cephalalgias (TACs)—including cluster headache, shortlasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and paroxysmal hemicrania—or hemicrania continua, and other headache types. We conducted a prospective study in patients attending a referral out-patient clinic over 5 months and those admitted for an intramuscular indomethacin test. Two hundred and six patients were included. In episodic migraine patients, two of 54 (4%) reported unilateral photophobia or phonophobia, or both. In chronic migraine patients, six of 48 (13%) complained of unilateral photophobia or phonophobia, or both, whereas none of the 24 patients with medication-overuse headache reported these unilateral symptoms, although these patients all had clinical symptoms suggesting the diagnosis of migraine. Only three of 22 patients (14%) suffering from new daily persistent headache (NDPH) experienced unilateral photophobia or phonophobia. In chronic cluster headache 10 of 21 patients (48%) had unilateral photophobia or phonophobia, or both, and this symptom appeared in four of five patients (80%) with episodic cluster headache. Unilateral photophobia or phonophobia, or both, were reported by six of 11 patients (55%) with hemicrania continua, five of nine (56%) with SUNCT, and four of six (67%) with chronic paroxysmal hemicrania. Unilateral phonophobia or photophobia, or both, are more frequent in TACs and hemicrania continua than in migraine and NDPH. The presence of these unilateral symptoms may be clinically useful in the differential diagnosis of primary headaches.

scholarly journals A potential nitrergic mechanism of action for indomethacin, but not of other COX inhibitors: relevance to indomethacin-sensitive headaches

2010 ◽  
Vol 11 (6) ◽  
pp. 477-483 ◽  
Author(s):  
Oliver Summ ◽  
Anna P. Andreou ◽  
Simon Akerman ◽  
Peter J. Goadsby
Keyword(s):  
Nitric Oxide ◽  
Mechanism Of Action ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Primary Headaches ◽  
Special Effect ◽  
Cox Inhibitors ◽  
Calcitonin Gene ◽  
Inflammatory Drugs

Abstract Non-steroidal anti-inflammatory drugs (NSAIDs) that act as cyclo-oxygenase (COX) inhibitors are commonly used in the treatment of a range of headache disorders, although their mechanism of action is unclear. Indomethacin is of particular interest given its very special effect in some primary headaches. Here the in vivo technique of intravital microscopy in rats has been utilised as a model of trigeminovascular nociception to study the potential mechanism of action of indomethacin. Dural vascular changes were produced using electrical (neurogenic) dural vasodilation (NDV), calcitonin gene-related peptide (CGRP) induced dural vasodilation and nitric oxide (NO) induced dural vasodilation using NO donors. In each of these settings the effect of intravenously administered indomethacin (5 mg kg−1), naproxen (30 mg kg−1) and ibuprofen (30 mg kg−1) was tested. All of the tested drugs significantly inhibited NDV (between 30 and 52%). Whilst none of them was able to inhibit CGRP-induced dural vasodilation, only indomethacin reduced NO induced dural vasodilation (35 ± 7%, 10 min post administration). We conclude NSAIDs inhibit release of CGRP after NDV without an effect on CGRP directly. Further we describe a differentiating effect of indomethacin inhibiting nitric oxide induced dural vasodilation that is potentially relevant to understanding its unique action in disorders such as paroxysmal hemicrania and hemicrania continua.

scholarly journals Emergency obstetric hysterectomy: a two-year observational study at tertiary care center in Berhampur, Odisha, India

2019 ◽  
Vol 8 (12) ◽  
pp. 4695
Author(s):  
Ritanjali Behera ◽  
Bibekananda Rath
Keyword(s):  
Caesarean Section ◽  
Postpartum Hemorrhage ◽  
Care Center ◽  
Tertiary Care ◽  
Medical College ◽  
Balanced Approach ◽  
The Face ◽  
Life Threatening ◽  
Emergency Hysterectomy ◽  
Febrile Morbidity

Background: Emergency obstetric hysterectomy is an unequivocal marker of severe maternal morbidity and, in many respects, the treatment of last resort for rupture uterus, severe postpartum hemorrhage (PPH) and other such life-threatening conditions. In no other gynaecological or obstetrical surgery is the surgeon in as much a dilemma as when deciding to resort to an emergency hysterectomy. On one hand it is the last resort to save a mother’s life, and on the other hand, the mother’s reproductive capability is sacrificed. This study is conducted with an aim to determine the frequency, demographic characteristics, indications, and feto-maternal outcomes associated with emergency obstetric hysterectomy in a tertiary care centre.Methods: We conducted a prospective, observational, and analytical study over a period of two years, from September 2017 till September 2019. A total of 56 cases of emergency obstetric hysterectomy (EOH) were studied in the Department of Obstetrics and Gynecology, MKCG Medical College, Berhampur.Results: The incidence of EOH in our study was 12 following vaginal delivery and 44 following caesarean section. The overall incidence was 56 per 21,128 deliveries. Uterine rupture (37.5%) was the most common indication followed by atonic postpartum hemorrhage (25%) and placenta accrete spectrum (10.7%). The most frequent sequelae were febrile morbidity (25.7%) and disseminated intravascular coagulation (21.4%). Maternal mortality was 17.1% whereas perinatal mortality was 51.7%.Conclusions: A balanced approach to EOH can prove to be lifesaving at times when conservative surgical modalities fail and interventional radiology is not immediately available. Our study highlights the place of extirpative surgery in modern obstetrics in the face of rising rates of caesarean section and multiple pregnancies particularly in urban settings in developing countries.

scholarly journals Is Single-Drug Prophylaxis in Migraine Prevention a Better Option than Combination Therapy? An Observational Study in a Rural Tertiary Care Center in North West India

2019 ◽  
Vol 10 (03) ◽  
pp. 479-482 ◽  
Author(s):  
Monika Angra ◽  
Amit Bhardwaj ◽  
Ashish Sharma ◽  
Girish Kumar ◽  
Mandeep Singh ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Care Center ◽  
Tertiary Care ◽  
Primary Headache ◽  
Headache Disorder ◽  
Preventive Therapy ◽  
Pharmacologic Therapy ◽  
North West ◽  
Single Drug

Abstract Background Migraine is a primary headache disorder that has a great impact on quality of life of patients. Pharmacologic therapy may be given in acute or abortive form and in the form of preventive therapy. In what form is preventive therapy to be given? Whether monotherapy is to be used or combination therapy? In what cases does combination therapy fare better than monotherapy? These queries are still unanswered. Materials and Methods All patients with headache reporting to the outpatient department were screened, and those fulfilling inclusion criteria were included in the study. Those patients who had chronic daily headache (headache for 15 or more days in a month) or who had other comorbidities and those who were taking any other drugs and were pregnant were excluded from the study. Baseline parameters, duration of headache, frequency of attacks, severity, and location of headache, triggers, and aggravating factors were recorded. Then, patients were started on abortive and preventive therapy. The follow-up was done at 3 and 6 months and if required earlier. At each follow-up, data regarding frequency, severity, and adverse effects were recorded and analyzed. Results We studied 105 patients of migraine, out of which 15 (14.3%) were males and 90 (85.7%) were females. Moreover, most (72%) of the patients were of the age group of 30 to 49 years. Only 11 (10.5%) patients required three or more preventive medicines for the control of headache and rest 94 (89.5%) patients were controlled on single (49 patients, i.e., 46.7%) or two 45, that is, 42.9% preventive medicines 49. Conclusion For the newly diagnosed migraine cases, the single-drug preventive therapy is more useful than the combination of drugs.

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