Organic headaches mimicking chronic paroxysmal hemicrania

Trigeminal Autonomic Cephalgias and Variants: Clinical Profile in Indian Patients

The present study summarizes the authors' experience of the clinical profile of short-lasting trigeminal autonomic cephalgias (TAC) in Indian patients. Over a period of 17 years a total of 41 cases of episodic cluster headache, seven cases of chronic cluster headache, six cases of variant cluster headache, three cases of paroxysomal hemicrania, and a single case of SUNCT syndrome were encountered. TACs appear to be rare in Indian patients and cluster headache seems to be exclusively a disease of men. The present report is to the best of our knowledge the first of its kind to be reported from India.

Chronic Paroxysmal Hemicrania, Hemicrania Continua and Sunct Syndrome in Association with Other Pathologies: A Review

We present a review of 22 cases of headache mimicking chronic paroxysmal hemicrania (CPH) (17 female and five male; F : M ratio 3.4), nine cases mimicking hemicrania continua (HC) (seven female and two male) and seven cases mimicking SUNCT syndrome (five male and two female) found in association with other pathologies published from 1980 up to the present. All case reports were discussed with respect to diagnostic criteria proposed by International Headache Society (IHS) for CPH, by Goadsby and Lipton for HC and SUNCT, and evaluated to identify a possible causal relationship between the pathology and the onset of headache. The aim of the present review was to evaluate if the presence of associated lesions and their location could help elucidate the pathogenesis of trigeminal autonomic cephalalgias (TACs).

Trigeminal autonomic cephalalgias. Part 2: Paroxysmal hemicrania

Paroxysmal hemicrania (PH) is characterized by severe, strictly unilateral pain attacks lasting 2 to 30 minutes localized to orbital, supraorbital, and temporal areas accompanied by ipsilateral autonomic features. It represents 1 of 3 primary headaches classified as trigeminal autonomic cephalalgias. Although PH is rare, patients may present to dental offices seeking relief for their pain. It is important for oral health care providers to recognize PH and render an accurate diagnosis. This will avoid the pitfall of implementing unnecessary and inappropriate traditional dental treatments in hopes of alleviating this neurovascular pain. This is part 2 of a review on trigeminal autonomic cephalalgias and focuses on PH. Aspects of PH including epidemiology, genetics, pathophysiology, clinical presentation, classification and variants, diagnosis, medical management, and dental considerations are discussed.

[Paroxysmal hemicrania]

Paroxysmal hemicrania (PH) is one of the trigeminal autonomic cephalgias (TACs), a group of primary headache disorders characterized by unilateral trigeminal distribution pain that occurs in association with prominent ipsilateral cranial autonomic features. The TACs are relatively rare, which is likely to be why they are poorly recognized in primary care. TACs will thus be referred to neurologists eventually, offering an excellent opportunity to diagnose and treat these patients. PH responds in a dramatic and absolute fashion to indomethacin. The importance of recognizing these syndromes is underscored by their excellent but highly selective response to treatment. This is the case report of our patient with PH and the review of current knowledge about pathophysiology of TACs, as well as differential diagnosis of other entities from this headache group.

Headaches and brain tumors

A careful history and physical examination remain the most important aspects of headache assessment. enabling the neurologist to decide if any further studies are necessary. Only a minority of patients who have headaches have brain tumors; however, recognition of the headaches characteristically associated with tumors is most important. Some locations are more likely to produce headache (eg, a posterior fossa tumor causes headache more often than a supratentorial tumor). Rapidly growing tumors are more likely to be associated with headache. Uncommon headache presentations can occur with tumors, includin paroxysmal cough, cluster headache, and TACs. The classic brain tumor headache is not as common as a tension-type presentation or migraine. Patients who have prior primary headaches may have more headache symptoms if they have a tumor and of course they still have their primary headache disorder. Mass lesions progress and inevitably develop other symptoms and signs besides headache, and these new symptoms and signs must be sought and found. Metastatic leptomeningeal involvement can present with headache and spinal pain in the neck and back. Imaging of headache patients for tumors, if they have primary headache disorders, such as migraine and typical cluster, generally is not cost effective but is necessary if there are any atypical features. Treatment of headache in patients who have metastatic brain tumors should be aggressive in terms of pain and symptoms control. Treatment of primary CNS tumors is dictated by the kind of neoplasm and site, but control of headache should not be ignored.

Management of trigeminal autonomic cephalgias and hemicrania continua

The trigeminal autonomic cephalgias (TACs) are a group of primary headache disorders characterised by unilateral trigeminal distribution pain that occurs in association with ipsilateral cranial autonomic features. This group of headache disorders includes cluster headache, paroxysmal hemicrania and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT syndrome). Although hemicrania continua has previously been classified amongst the TACs, its nosological status remains unclear. Despite their similarities, these disorders differ in their clinical manifestations and response to therapy, thus underpinning the importance of recognising them. We have outlined the clinical manifestations, differential diagnoses, diagnostic workup and the treatment options for each of these syndromes.

Post-traumatic Headache

Headache is the most common symptom after closed head injury, persisting for more than 2 months in 60% of patients. Rarely does headache occur in isolation. Cervical pain is a frequent accompaniment. Post-traumatic headache is often one of several symptoms of the postconcussive syndrome, and therefore may be accompanied by additional cognitive, behavioral, and somatic problems. Acute post-traumatic headaches may begin at the time of injury and continue for up to 2 months post-injury. Although onset proximate to the time of injury is most common, any new headache type occurring within this period of time is referred to as an acute post-traumatic headache. If such headaches persist beyond the first two months post-injury, they are subsequently referred to as chronic post-traumatic headaches. Over time, post-traumatic headaches may take on a pattern of daily occurrence. If aggressive treatment is initiated early, posttraumatic headache is less likely to become a permanent problem. Once "windup" of post-traumatic headaches occurs, the cycle of ongoing headaches is more difficult to interrupt. The mechanism of post-traumatic headache is poorly understood. Trauma-induced headaches are usually heterogeneous in nature, often including both tension-type pain and intermittent migraine-like attacks. Rebound-headaches may develop from overuse of analgesic medications, and the occurrence of such may complicate significantly the diagnosis of post-traumatic headache. Adequate treatment typically requires both "peripheral" and "central" measures. Understanding the general principles of treatment, especially appropriate use of preventive and abortive medications, will most usefully guide treatment. There is scant literature with which to direct treatment selection for post-traumatic headache. Consequently, treatments for post-traumatic headache are based on those prescribed for phenomenologically similar but etiologically distinct headache disorders. Delayed recovery from post-traumatic headache may be a result of inadequately aggressive or ineffective treatment, overuse of analgesic medications resulting in analgesia rebound phenomena, or comorbid psychiatric disorders (eg, post-traumatic stress disorder, insomnia, substance abuse, depression, or anxiety).

Cluster and related headaches

The disorders described in this article are relatively rare, but probably are more common than previously thought. Because these disorders cause significant pain and disability and treatment response differs from that of migraine, tension-type, and cluster headaches, recognition is essential. Table 1 lists the important clinical features of these syndromes and contrasts them with cluster headache, the disorder for which they are often confused.

Effective management of ice pick pains, SUNCT, and episodic and chronic paroxysmal hemicrania

Idiopathic stabbing headaches, the SUNCT syndrome, and the paroxysmal hemicranias are a group of primary headache disorders that are characterized by brief, short-lived attacks of head pain, which recur multiple times throughout the day. These syndromes are much less prevalent than other types of primary headaches such as migraine and tension-type headaches but are significantly more disabling. Recognition of these uncommon disorders is important because their management differs from standard headache therapies.

Indomethacin-responsive headaches in children and adolescents

Headache is a common symptom in childhood and adolescence. Effective therapy for this symptom is based on the specific headache syndrome. This article presents examples of the four recognized Indomethacin-responsive headache syndromes encountered in pediatrics including exertional headache, cyclic-cluster migraine, chronic paroxysmal hemicrania, and hemicrania continua. Although uncommon conditions, successful treatment depends on recognition of these indomethacin-responsive headache syndromes.

Paroxysmal hemicrania. Case studies and review of the literature

Paroxysmal hemicrania is a vascular-type headache that is characterized by short bouts of severe unilateral pain in the area of the orbit and temple. A chronic and episodic form that has been described is similar to cluster headache and reflects a distinctive temporal pattern. Signs associated with paroxysmal hemicrania include ipsilateral conjunctival injection and tearing with nasal congestion and rhinorrhea. The condition's absolute response to indomethacin pharmacotherapy differentiates paroxysmal hemicrania from cluster headache. Typical symptoms usually make for a relatively straightforward diagnosis of paroxysmal hemicrania, but it may masquerade as pulpitic or temporomandibular-joint-related pain and may even herald systemic disease or malignancy. Paroxysmal hemicrania is a rare syndrome; 111 cases have been reported in the literature thus far. All of these cases have been reported by "headache specialists"; no cases of paroxysmal hemicrania were found in the dental literature. In this review, a relatively large series of seven new cases is reported; all seven were seen in an orofacial pain clinic.

Vascular malformation of the cerebellopontine angle associated with "SUNCT" syndrome

A 70-year-old man complained of two distinct types of unilateral headache during the past fifteen years. When the illness began, the pain was intermittent and short-lasting. In successive years, the crises appeared in clusters and lasted weeks to months. At present, the pain occurs daily, and is located on the right side, from the forehead supraorbitally to the temporal region. Some attacks last 30 sec and are accompanied by tearing, conjunctival injection, rhinorrhea and a subjective need to micturate. Other headaches last 1/2-1 h and are occasionally accompanied by local ipsilateral dysautonomic symptoms. Attacks of pain are provoked by movements of the trunk and neck. A vascular malformation in the right cerebellopontine angle was demonstrated on cranial CT and MRI, and by angiography.