Headache Attributed to Cranial or Cervical Vascular Disorders

Neurology, 2006

To investigate the clinical pictures of patients with recurrent thunderclap headaches of unknown etiology and to field-test two relevant International Classification of Headache Disorders, 2nd edition (ICHD-II) criteria, i.e., primary thunderclap headache (Code 4.6) and benign (or reversible) angiopathy of the CNS (Code 6.7.3). Methods: We prospectively recruited patients presenting with idiopathic recurrent thunderclap headaches from a hospital-based headache clinic. Detailed histories, neurologic examinations, and MRIs and magnetic resonance angiographies (MRAs) were performed in all patients to exclude secondary causes. Patients with cerebral vasoconstriction received serial MRA follow-up. Results: Fifty-six consecutive patients (51 female/5 male, mean age 49.6 Ϯ 9.8 [range 22 to 76] years) were enrolled. Segmental vasoconstriction (or benign CNS angiopathy) was found in 22 patients (39%). Thunderclap headache recurred in all patients with a median frequency of 0.7 times per day for a median period of 14 days (range 6 to 86 days). The median duration for each single attack was 3 hours. Most patients (84%) reported at least one trigger. Nimodipine effectively aborted further attacks in 83% of the treated patients. Headache attacks subsided within 3 months. Four patients (7%) developed ischemic complications. Patients with and without vasoconstriction based on MRA images were similar regarding demographics and headache profile. Except for the duration criterion, our patients generally mapped well into the proposed ICHD-II criteria. Conclusions: This study suggests that the two diagnostic entities proposed by the ICHD-II may present different spectra of the same disorder. The distinct headache profile may help physicians quickly recognize this disabling headache disorder with risk of stroke and provide timely treatment.

Journal of Medicine, 2009

Neurological Sciences, 2017

The International Classification of Headache Disorders (ICHD-3 beta) includes headache attributed to intracranial endovascular procedures (EVPs). The aim of this review is to describe the clinical and pathophysiological aspects of headache related to vascular lesions and EVPs. Current studies regarding this issue are contradictory, although generally favouring headache improvement after EVPs. Further large studies are needed to adequately assess the effect of EVPs on headache.

2013

Mild (140 to 159/90 to 99 mmHg) or moderate (160 to 179/100 to 109 mmHg) chronic arterial hypertension does not appear to cause headache. Whether moderate hypertension predisposes patients to headache at all remains controversial, but there is little evidence that it does. Ambulatory blood pressure monitoring in patients with mild and moderate hypertension has shown no convincing relationship between blood pressure uctuations over a 24-hour period and presence or absence of headache. However, headaches are associated to various disorders that lead to abrupt, severe, and paroxysmal elevations in blood pressure. In this paper, the secondary headaches attributed to acute crises of hypertension and the criteria for diagnosing each of them have been reviewed. These are headaches attributed to pheochromocytoma, hypertensive crisis without encephalopathy, hypertensive encephalopathy, pre-eclampsia, eclampsia, and acute pressure response to exogenous agents.

The journal of headache and pain, 2006

Headache is one of the most common outpatient pain conditions encountered in both physician offices and emergency departments. Establishment of an accurate diagnosis, accomplished only by a thorough history followed by a physical examination, is critical before treatment can be initiated. Many patients undergo evaluation with computed tomography and more recently magnetic resonance imaging to exclude important abnormalities. It is known that a little percentage of patients showed significant neuroradiologiacal abnormalities and the rate of significant intracranial abnormalities in patients with headache and normal neurological examination exists.

A 39-year-old North African housewife without any previous health problems came to our headache centre with a 4-week history of sudden-onset, bilateral (mainly right side), severe headache. Pain was continuous and fl uctuating in severity, with associated photo-and phonophobia, not worsened by physical activity or exercise and not disabling with partial benefi t from NSAIDs. Primarily, she was referred by her family doctor to the ENT specialist for evaluation. In the absence of clinical abnormalities, a cerumen plug from the left ear (suspecting a sinus headache) was removed without any other indication. A few days later, she also started experiencing fl uctuating then permanent horizontal diplopia, so that she was referred to the local headache centre. At fi rst observation she denied fever, nausea, vomiting and any other sensorimotor symptoms with the exception of diplopia. The general examination (BMI 24.8),

Current Opinion in Neurology, 2018

Purpose of review To review the most relevant developments in the understanding of headache in idiopathic intracranial hypertension (IIH). Recent findings The phenotype of the typical IIH headache is diverging from the historical thinking of a raised intracranial pressure headache, with the majority being classified as having migraine. A larger proportion of those with IIH have a past medical history of migraine, compared with the general population, highlighting the importance of re-examining those who have a change or escalation in their headache. The mechanisms underlying headache in IIH are not understood. Additionally, factors which confer a poor headache prognosis are not established. It is clear, however, that headache has a detrimental effect on all aspects of the patient's quality of life and is currently ranked highly as a research priority by IIH patients to better understand the pathophysiology of headache in IIH and identification of potential headache specific ther...

The Journal of Headache and Pain, 2015

The diagnosis of primary headache disorders is clinical and based on the diagnostic criteria of the International Headache Society (ICHD-3-beta). However several brain conditions may mimic primary headache disorders and laboratory investigation may be needed. This necessity occurs when the treating physician doubts for the primary origin of headache. Features that represent a warning for a possible underlying disorder causing the headache are new onset headache, change in previously stable headache pattern, headache that abruptly reaches the peak level, headache that changes with posture, headache awakening the patient, or precipitated by physical activity or Valsalva manoeuvre, first onset of headache ≥50 years of age, neurological symptoms or signs, trauma, fever, seizures, history of malignancy, history of HIV or active infections, and prior history of stroke or intracranial bleeding. All national headache societies and the European Headache Alliance invited to review and comment the consensus before the final draft. The consensus recommends brain MRI for the case of migraine with aura that persists on one side or in brainstem aura. Persistent aura without infarction and migrainous infarction require brain MRI, MRA and MRV. Brain MRI with detailed study of the pituitary area and cavernous sinus, is recommended for all TACs. For primary cough headache, exercise headache, headache associated with sexual activity, thunderclap headache and hypnic headache apart from brain MRI additional tests may be required. Because there is little and no good evidence the committee constructed a consensus based on the opinion of experts, and should be treated as imperfect.

Neuroimaging Clinics of North America, 2003

Most causes of headache are benign; however, there are a small percentage of headaches that require urgent diagnostic evaluation and treatment . These include subarachnoid hemorrhage (SAH) from ruptured aneurysm, intracranial bleeding from an arteriovenous malformation, neoplastic lesions, encephalitis, meningitis, intracranial venous sinus thrombosis, vasculitis, and metabolic disorders .

Headache: The Journal of Head and Face Pain, 2013

Objective/Background.-Some headache syndromes have few cases reported in the literature. Their clinical characteristics, pathogenesis, and treatment may have not been completely defined. They may not actually be uncommon but rather underrecognized and/or underreported. Methods.-A literature review of unusual headache syndromes, searching PubMed and ISI Web of Knowledge, was performed. After deciding which disorders to study, relevant publications in scientific journals, including original articles, reviews, meeting abstracts, and letters or correspondences to the editors were searched. Findings.-This paper reviewed the clinical characteristics, the pathogenesis, the diagnosis, and the treatment of five interesting and unusual headache syndromes: exploding head syndrome, red ear syndrome, neck-tongue syndrome, nummular headache, and cardiac cephalgia. Conclusions.-Recognizing some unusual headaches, either primary or secondary, may be a challenge for many nonheadache specialist physicians. It is important to study them because the correct diagnosis may result in specific treatments that may improve the quality of life of these patients, and this can even be life saving.

Headache: The Journal of Head and Face Pain, 2021

ObjectiveHeadache is a near‐universal sequela of idiopathic intracranial hypertension (IIH). The aim of this paper is to report current knowledge of headache in IIH and to identify therapeutic options.BackgroundDisability in IIH is predominantly driven by headache; thus, headache management is an urgent and unmet clinical need. At present, there is currently no scientific evidence for the directed use of abortive or preventative headache therapy.MethodsA detailed search of the scientific literature and narrative review was performed.ResultsHeadache in IIH is driven by raised intracranial pressure (ICP) and reduction of ICP has been reported in some studies to reduce headache. Despite resolution of papilledema and normalization of raised ICP, a majority suffer persistent post‐IIH headache. The lack of evidence‐based management approaches leaves many untreated. Where clinicians attempt to manage IIH headache, they use off‐label therapies to target the prevailing headache phenotype. A ...

Seminars in Pediatric Neurology, 1995

When a headache develops in a child or adolescent, both the patient and the parents may fear the presence of a brain tumor. However, most headaches are not a symptom of a serious neurological disease but are related to stress or migraine. In this article, headaches in relationship to neurological disorders are reviewed. The pathophysiology of head pain and Increased Intracranlal pressure are reviewed. Methods used to evaluate patients suspected of harboring an intracranial abnormality include a thorough history, a carefully performed physical examination, and neuroimaging studies. This article reviews cerebrovascular disease, neoplasms, hydrocephalus, and other structural abnormalities that cause headaches.

Case Reports in Neurological Medicine, 2016

Cerebral venous thrombosis- (CVT-) associated headache is considered a secondary headache, commonly presenting as intracranial hypertension headache in association with seizures and/or neurological signs. However, it can occasionally mimic migraine. We report a patient presenting with a migraine-like, CVT-related headache refractory to several medications but intravenous dihydroergotamine (DHE). The response to DHE, which is considered to be an antimigraine medication, in addition to the neurovascular nature of migraine, points out to a probable similarity between CVT-headache and migraine. Based on experimental studies, we discuss this similarity and hypothesize a trigeminovascular role in the genesis of CVT-associated headache.

British journal of pain, 2012

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 disor...

Cephalalgia, 2008