Cause Of Headache Research Articles

A case of breast implant illness presenting as chronic headaches: A case report

AbstractWe describe a middle‐aged patient with breast implants presenting with chronic headaches. We obtained a detailed clinical history from the patient about the temporal course of her headaches to her breast implant placement. We tried to rule out another potential differential diagnosis. Chronic headaches started 6 months after the patient underwent bilateral breast augmentation with saline breast implants, and they resolved soon after the implant was removed. We were able to rule out other possible causes of headaches clinically. Several well‐powered studies have shown a strong association between breast implant illness and neurological conditions. However, this may be easily overlooked if we do not have a solid clinical suspicion based on history. In an appropriate clinical setting, breast implant illness should be considered in patients presenting with new‐onset persistent headaches.

Personal protective equipment-associated headaches in health care workers during COVID-19: A systematic review and meta-analysis.

IntroductionHealth Care Workers (HCWs) use Personal Protective Equipment (PPE) during the COVID-19 pandemic to protect themselves and prevent the transmission of the disease. The use of PPE, especially respiratory masks, has adverse consequences, including headaches, which have been secondary and unusual. The aim of the present systematic review and meta-analysis study was to investigate the prevalence of PPE-associated headaches in HCWs during COVID-19 pandemic.MethodsThe present review study was performed based on the PRISMA guideline. The protocol of the present study was registered in PROSPERO with the code CRD42022304437. Valid data resources such as Scopus, PubMed, Web of Science, Science Direct, Google Scholar, Embase were used to identify and extract relevant studies. The searches were conducted between the beginning of 2020 and the end of January 2022. A random effects model was used for meta-analysis and I2 index was used to investigate between-study heterogeneity. Data were analyzed using STATA ver. 14.ResultsA total of 539 articles were first identified through initial search and finally 26 final studies were selected to undergo the meta-analysis phase. According to the results of meta-analysis, the prevalence of headache after and before the use of PPE was 48.27% (95% CI: 40.20–56.34, I2 = 99.3%, p = 0 < 001) and 30.47% (95% CI: 20.47–40.47, I2 = 97.3%, p = 0 < 001), respectively.ConclusionThe results of the present study showed that the prevalence of PPE-associated headache in HCWs was relatively high, so, the use of PPE during COVID-19 pandemic can be considered as one of the causes of headache. Therefore, management strategies such as regular screening of HCWs for headaches and regular rest periods without the use of PPE can be effective in reducing the prevalence of headaches.

Patterns of MRI Findings in Patients with Chronic Headache: A Retrospective Study from a Private Diagnostic Center in Addis Ababa, Ethiopia.

Headache is one of the most common complaints that lead the patient to seek medical advice however only a few patients with recurrent headaches have a secondary cause like intracranial mass. The appropriate utilization of neuroimaging is important to rule-out secondary cause of headache in resource-limited regions. The objective of this study is to describe the patterns of MRI findings in the evaluation of patients with chronic headache and to determine the clinical variables helpful in identifying patients with intracranial lesions. This cross sectional study was conducted among 590 selected patients who underwent an MRI scan of the head from September 2016 to January 2018 at Wudassie Diagnostic center in Addis Ababa, Ethiopia. Siemens Magnetom 0.35T MRI was used. Out of 590 patients, 372 (63.1%) were females and 218 (36.9%) were males; 300 (50.8%) patients with the mean age of 38.6 ± 0.5 years and a median of 37 ± 16.7years have normal brain MRI and 290(49.2%) have abnormal brain MRI reports. The abnormal findings further divided into non-significant findings were 166(28%) that did not alter patient management and clinically significant findings were 124 (21%) which included by decreasing order of frequency tumors, infection, hydrocephalus, hemorrhage, and vascular abnormalities. It was 1.3 times higher rate of positive brain MR findings in patients who had headaches plus abnormal neurologic findings as compared to patients without neurologic abnormality (P-value = 0.01). There is a high rate of significant abnormal MRI findings in this study as compared to studies from developed nations.

Ocular Findings in Children with Headache

ABSTRACT Purpose To determine the prevalence of ophthalmological findings suggesting an ocular cause for headache or occult neurological disease, among children with headache. Methods Retrospective cross-sectional study on children with headache at a tertiary outpatient ophthalmology clinic. All children underwent sensorimotor, anterior segment, and dilated fundoscopic examinations, with or without cycloplegic refraction. Prevalence of one or more new findings of ocular or occult neurological cause of headache, including glaucoma, uveitis, optic nerve elevation, or possible asthenopia from strabismus or refractive issues. Headache characteristics and associated symptoms were evaluated as risk factors for ocular findings. Results Among 1,878 children with headache (mean age 10 yrs, range 2–18), 492 (26.1%, 95% CI 24.3–28.2%) children had one or more new ocular findings that could cause headache or indicate intracranial disease: refractive issues (342, 18.2%), strabismus (83, 4.4%), optic nerve elevation (51, 2.7%; 26 with papilledema, 25 with pseudopapilledema), uveitis (6, 0.3%), and glaucoma (2, 0.1%). Shorter headache duration was associated with ocular findings (p = .047), but headache frequency, photophobia, nausea/vomiting, and visual changes were not. In univariable analysis, visual changes (p ≤ .001), nausea/vomiting (p ≤ .002), and morning headache (p = .02) were associated with optic nerve elevation. Conclusion An ophthalmologic examination including cycloplegic refraction is indicated in children with headache, as one-quarter have a treatable ocular condition, which may be related to the headache, or sign of intracranial pathology. While nausea, visual changes, or morning headache should raise concern, coincident visual, ocular, or systemic symptoms are not reliable predictors of discovering ocular pathology in a child with headache.

COINCIDENTAL FINDINGS OF PARA NASAL SINUS PATHOLOGY IN PATIENT REQUESTED BRAIN MAGNETIC RESONANCE IMAGING FOR HEADACHE

Background &#x0D; Headache is a ubiquitous symptom, for which magnetic resonance imaging (MRI) is the primary modality of choice to investigate its underlying causes. Two categories of headache have been well known” primary versus secondary types. Sinus pathology, including sinusitis, is a well-recognized cause of secondary headaches.&#x0D; Objectives &#x0D; A retrospective study was conducted to find the incidence of sinus abnormalities in brain MRI patients presenting with headaches, compare the prevalence of sinus abnormalities versus other structural brain abnormalities at the brain MRI, and categorize the sinus abnormalities into significant and non-significant sinus involvement. In which significant sinus abnormalities might be the cause of headaches.&#x0D; Methods&#x0D; A retrospective study at the Sulaymaniyah teaching hospital selected data from brain MRIs of patients with headaches clinically, which were documented on their request paper. First, a Sum of 402 patients (males 157 and females 245) of age (mean age of 40 years) were included in the study from 2021-2022. Patients were grouped according to their imaging findings and specifically sinus abnormality. All statistical analyses were performed on a personal computer with SPSS for Windows (version 27) software.&#x0D; Results&#x0D; Four hundred and two cases during 12 months were reviewed; two hundred forty-five patients (60.9%) were female, and one hundred fifty-seven patients (39.1%) were male. Their ages varied from 14 years to 86 years. Approximately 50% of all patients are between the ages of 31 and 50. Sinus abnormalities were the most frequent group (40%), including significant sinus abnormalities of (19,9%), followed by normal brain MR findings (27.8%). &#x0D; Conclusion&#x0D; The majority of patients suffering from headaches have sinus abnormalities on the brain MRI, in which near half of these abnormalities were significant findings, and the second most common imaging findings were normal brain imaging, which was more than the significant sinus abnormalities from here it is advisable for a better revision for the indication of brain MRI in headache, and as a consequence multidisciplinary evaluation of patients with headache should be introduced at an early stage. The team should include a headache specialist and a rhinologist to avoid unnecessary investigations. The significant sinus findings contribute to a substantial number of patients suffering from headaches, thus suggesting the inclusion of sinus findings as a regular part of the radiological reporting template.

P01.21.A Testing Semantic Verbal Fluency (SVFT) in patients with headache suspicious of cancer helps predict those with tumour on imaging

Abstract Background Differentiating secondary headache from primary headache on history alone can sometimes be difficult. Headache “plus” other subtle cognitive features improves prediction. Patients and relatives may attribute subtle cognitive or behavioural changes to other causes (e.g. anxiety, low mood). Sematic verbal fluency - “how many animals can you think of in a minute” is commonly impaired on admission in patients with headache harbouring a tumour. We were interested whether SVFT at point of referral for scan would help predict a tumour and requested GPs report the SVFT on electronic referral for direct access scanning in cases with a history of headache suspicious of cancer. The aim of the pilot study was to establish if the SVFT was a “red flag” for secondary causes of headache. We report the results of a 20-month audit of cases. Material and Methods An electronic Protocol Based Referral (PBR) was developed for Headache Suspicious of Cancer to expedite scanning. The PBR sat alongside the routine e-DACI system that had been in use for some years. The GP was asked to complete the SVFT at the time of referral for scanning. Other data were gathered: PMH cancer; other symptoms/signs; co-morbid conditions and medications. Results GPs submitted requests for ePBR scanning in 669 cases over 20 months (62% females; Mean age 53: 60% &amp;lt;60 years). SVFT was completed on the request form in 381 (57%) cases. In these cases median SVFT was 17 animals. 11/381 cases were found to have cancer on scanning (2.9%): 10/188 cases with intracranial tumours had a SVFT &amp;lt;17 (5.32%) compared with one with a SVFT &amp;gt;=17. The median SVFT in cases with cancer was 10 animals. Other possible causes of SVFT &amp;lt;17 were - 53 psychiatric or chronic pain conditions on multiple drugs;12 were not native English speakers; 19 had co-existing dementia; 5 had small vessel disease; 4 cysts; 4 Giant Cell Arteritis ; 2 Chiari 1 malformation; PMH - encephalitis (1). Conclusion A SVFT result &amp;lt;17, at the point of referral for brain imaging, in patients with headache suspicious of cancer was associated with intracranial cancer in more than 1:20 cases, whereas a SVFT of &amp;gt;=17 was associated with cancer in 1:200 cases. SVFT may be an additional useful “red flag”. The most appropriate SVFT cut-off requires more research in a larger study. Low SVFT in headache patients may inform Cancer Referral Guidelines, improve the identification of secondary headache and help expedite cases.

Pegfilgrastim-induced vasculitis of the subclavian and basilar artery complicated by subarachnoid hemorrhage in a breast cancer patient: a case report and review of the literature

BackgroundPegfilgrastim (PEG) is a sustained-duration pegylated form of filgrastim, a granulocyte-colony stimulating factor agent that is widely used as prophylaxis against febrile neutropenia during chemotherapy. We report the case of a breast cancer patient who developed PEG-induced vasculitis complicated by subarachnoid hemorrhage (SAH) and review the relevant literature.Case presentationA 48-year-old woman had undergone surgery for breast cancer and was receiving docetaxel and cyclophosphamide as adjuvant chemotherapy (docetaxel 75 mg/m2, cyclophosphamide 600 mg/m2); on day 4 of treatment, PEG had been administered. On day 14, she was admitted to hospital with fever, general malaise, and neck pain, and her C-reactive protein level was found to be high (12.65 mg/dL). Although infection was initially suspected, antimicrobial treatment was ineffective and other laboratory test results were negative for this. Contrast-enhanced computed tomography on day 22 showed thickened vessel walls in the left subclavian artery, the origin of the common carotid artery, and the thoracoabdominal aorta. On day 26, magnetic resonance imaging of the head to investigate possible causes of headache showed signs consistent with SAH, and magnetic resonance angiography images showed irregularity in the basilar artery wall; the findings of both studies were considered to be due to PEG-induced vasculitis. Once treatment with prednisolone 40 mg/day had started, the wall thickening and irregularity improved.ConclusionAlthough an uncommon adverse effect, vasculitis affecting vessels of various sizes may be caused by PEG. To the best of our knowledge, this report is the first to describe a case of G-CSF-induced vasculitis complicated by SAH. In cases of persistent high fever and elevated inflammatory response after PEG administration and in the absence of infection, clinicians should consider the possibility of drug-induced vasculitis.

EP-283 A rare cause of headache – cerebral sinus venous thrombosis after COVID-19 vaccination

IntroductionCerebral sinus venous thrombosis (CSVT) is a rare complication of COVID-19 vaccination. There is an incidence of 0.55 per 100,000 person-months. We describe a case of CSVT post COVID-19 vaccine.Case descriptionA 58-year-old male presented to a district general hospital after being involved in an RTC with a 3 month history of left sided headache which had followed his first COVID-19 vaccine (AstraZeneca). No focal neurological deficits were elicited. Blood results were unremarkable. Radiological workup suggested left transverse and sigmoid sinus thrombosis with no other intracranial complications. The patient was admitted and managed with low molecular weight heparin with an uneventful recovery.DiscussionCSVT is a rare and sometimes fatal disease. An increased risk of CSVT after COVID-19 vaccination has been suggested. An underlying immunological mechanism is suspected with the involvement of platelet factor-4 (PF4) antibody. Headache is the most common presenting symptom with onset within one week of vaccination. Positive D-dimer, PF4 IgG assay and thrombocytopenia may also support the diagnosis. CSVT may progress to major complications including intracranial haemorrhage and even death. Prompt diagnosis and appropriate treatment prevents neurosurgical intervention such as decompressive craniotomy and may improve neurological outcome.ConclusionThis case describes an important and rare finding of complications following COVID-19 vaccine. Consideration should be made in management for patients with a recent history of COVID 19 vaccination presenting with features of headache. A high level of clinical suspicion is needed to investigate and manage these patients appropriately with potential CSVT.

The effect of tension variability for sleep quality in headache patients: A Holter monitoring study.

Background:Hypertension is one of the common causes of headaches. Disruption in the circadian rhythm of blood pressure (BP) also leads to some chronic diseases. Sleep disturbances have a relationship with neurologic and cardiac diseases. Our aim was to compare the sleep quality of patients with headaches showing dipper and nondipper BP patterns.Methods:This retrospective study included 57 patients who applied to a neurology clinic due to headaches and were referred to the cardiology department for Holter monitoring. Chronic diseases, drugs used, smoking and exercise habits, and physical examination findings were recorded. The 24-hour Holter monitoring results were classified as dipper and nondipper. The Pittsburgh Sleep Quality Index scores were determined for each patient. The Pittsburgh Sleep Quality Index scores of patients with dipper and nondipper patterns were compared.Results:The sleep quality of patients with dipper Holter patterns was better than that of patients with nondipper patterns (P < .001), and patients without chronic diseases had significantly better sleep quality compared with those with chronic diseases (P = .029). In the presence of chronic disease, the number of patients with a nondipper Holter pattern was higher (P = .024). There were no significant differences in Holter results or sleep quality between smokers and nonsmokers (P > .05).Conclusion:Diagnoses of sleep disorders and BP abnormalities in the outpatient clinic are valuable in increasing the quality of life of patients and in preventing chronic diseases, especially cardiac diseases that may develop in the future.

T2-Sampling Perfection With Application-Optimized Contrasts by Using Flip Angle Evolution (SPACE) Protocol MRI: A Safe, Minimally Invasive Screening Tool for Spinal CSF Leak Causing Spontaneous Intracranial Hypotension

Spontaneous intracranial hypotension (SIH) due to a spinal cerebrospinal fluid (CSF) leak is secondary cause of headache with potentially devastating consequences. Its diagnosis is complicated owing to the lack of a reasonable, minimally invasive screening test. This results in many patients remaining undiagnosed for years after the headache onset. Current testing approaches are either overly invasive, namely the CSF infusion protocol or both invasive and insensitive viz. lumbar puncture (LP) with an opening pressure (OP) or computed tomography myelogram (CTM). These diagnostic methods are frequently employed in a clinical setting since they require access to the thecal space; they unfortunately have a dearth of sensitivity. CTM will not document a leak if it is intermittent or very slow and in the setting of a spinal CSF leak, the OP on LP may be high, low, or normal. A potential remedy for this state is the T2-sampling perfection with application-optimized contrasts by using flip angle evolution (SPACE) protocol spinal magnetic resonance imaging (MRI). We present two cases that demonstrate its potential value as a screening tool. It is well known for its high sensitivity for identifying spinal pathology and is minimally invasive, making it a good choice for a screening modality when diagnosing possible SIH cases.

Rhinogenic Contact Point Headache – a Review

Headache is a universal symptom in the course of everyone's life. There are myriads of causes for headache ranging from simple migraine, tension headache, refractory errors in the eye, temporomandibular joint arthralgia, and myofascial spasm to severe form of headache by brain tumors. The anatomical variations in the nasal cavity result in mucosal contact between the opposing surface and cause rhinogenic contact point headache (RCPH). RCPH is a new type of headache in medical literature. The pathogenesis of the RCPH is still the subject of controversy. Nose has diverse anatomical variations. Deviated nasal septum or spur, middle turbinate concha bullosa, and enlarged bulla ethmoidalis are the common anatomical variation in the nasal cavity which can cause RCPH. Diagnostic nasal endoscopy and computed tomography scan are helpful to confirm the mucosal contact points inside the nasal cavity. The precise excision of the contact points with the help of endoscopic approach in patients of RCPH is very effective. Clinicians should not ignore the anatomical variation of the nasal cavity during management of the headache. There is not much literature for RCPH indicating that this clinical entity is neglected. This review article presents an overview of the current aspect of RCPH.

MONKEYPOX AND HEADACHE: LITTLE MENTIONED CLINICAL PRESENTATION OF THE CURRENT INFECTIOUS DISEASE PROBLEM

Monkeypox and headache: little mentioned clinical presentation of the current infectious disease problem Dear Editor, the most well-known human pox infections are pox, smallpox, and chickenpox. In addition to the well-known pox infections, zoonotic pox infections have emerged as an interesting, current issue in infectious medicine (1). Monkeypox has spread over Europe, posing a serious public health threat (2). Monkeypox is an uncommon pox infection that has resurfaced, and the cause is considered to be zoonosis (1). Monkeypox has spread throughout Europe, creating a significant public health risk (2). A monkeypox is a rare form of atypical pox that has returned, probably as a result of zoonosis. Human-to-human transmission is thought to be possible. The medical community has been alerted by an increasing number of reported cases in several countries. Headaches can manifest in a variety of ways. In clinical practice, it is necessary to look for dangerous or secondary causes of headaches. Headache is a rarely discussed clinical condition, yet it could be present in any new infectious disease problem. The number of new cases in the current major clusters in Europe and America rapidly increases in 2022, raising fears of a widespread outbreak. Monkeypox is a febrile sickness that causes a rash on the skin. The diagnosis is usually made by looking at the patient’s skin rash. To the best of our knowledge, no previous research has been done on monkeypox patients’ headache symptoms. According to a study of cases during an outbreak in the US in 2003, the headache was among the presenting symptoms in 9 of 34 patients. Still, these patients weren’t coming in with just isolated headaches (3). They had “rash, fever, adenopathy, chills and headache” (3). Hence, many symptoms and signs would alert a clinician that the headache in these cases is most likely secondary in etiology. A febrile, cutaneous lesion, and other clinical symptoms might occur more often than reported. One of the first clinical symptoms that appear could be a headache. As a result, it is critical in modern clinical practice to be prepared for suspected monkeypox because a large-scale outbreak is possible.

Review on primary headache among college students

Introduction: The most common sort of headache problem on the planet is primary headache disorders yet underappreciated, misunderstood, and inadequately treated, and they seem to be the third leading cause of disability in the world, because of the unpredictability of headache attacks and the existence of associated symptoms including dizziness, vomiting, nausea, and visual and/or hearing problems, persistent primary headaches can even have a massive effect on peoples’ health. Migraine, the most common cause of headache in the world, is characterized by headache bouts that last anywhere from 4 to 72 hours if left untreated. Students are more likely to experience exhaustion, stress, and worry, being the most prevalent triggers of TTH as well as migraine. Cluster Headache is amongst the most debilitating headache conditions, with a significant level of severity. CH has a lesser incidence than migraines. It hits about one out of every thousand people. Methodology: Database searches including PubMed Central, Google Scholar and Cochrane library were performed. Studies that investigated Impact of primary headache, prevalence of primary headache among students, health related quality of life in students with primary headache disorders were included and reviewed. Articles that evaluate any form of secondary headache were excluded.

Ocular pathology in patients referred to ophthalmology outpatient clinic at tertiary care hospital with headache

Introduction: Headache has multi-factorial causes; many primary or secondary headache disorders have ocular manifestations and benefit from the systematic ocular examination. Physicians at the point of the first contact should therefore be familiar with common ocular pathologies associated with a headache for appropriate referral.&#x0D; Method: This hospital-based descriptive cross-sectional study was conducted in the Ophthalmology Department of Patan Hospital. All patients with headache as primary symptom and were referred to an ophthalmology clinic for ocular evaluation by other departments were included. The study was done for 15 mo and 354 patients were evaluated for the cause of headache. Findings and diagnoses of consenting participants were recorded and analyzed.&#x0D; Result: All enrolled patients completed all the study procedures and were analyzed. The majority 61% were in 14-40 years. Homemaker was commonly affected 30.2% followed by students 25.4%. Any form of ocular pathology was detected in 76 % of patients. The majority of patients had no refractive errors (67.8%). Although any form of refractive error was more common in the presbyopia age group there was no statistically significant difference between different age groups. Most patients were orthophoric and only 11% of patients had vergence insufficiency. Among the ocular pathology dry eye, glaucoma suspects were more common.&#x0D; Conclusion: This study supports the ocular morbidities and headache symptoms are linked very frequently. Good ocular history is needed for appropriate patient referral to a specialist. Correction of a minor degree of refractive error and lubricating eye drop may relieve worrisome headaches for many patients.

ROLE OF NASAL ENDOSCOPY IN PAEDIATRIC HEADACHE AND CHRONIC ADENOIDITIS AS A DIFFERENTIAL DIAGNOSIS

Headache is one of the most common somatic symptom in children and adolescents. Even though most of these cases are attributed to primary headaches there might be a large proportion of rhinological causes for headache which might be overlooked. This study attempts to diagnose the rhinological causes which were missed during routine examination by paediatricians. Also chronic adenoiditis even though a common condition in children, adenoiditis as a cause for headache is not commonly described. These pitfalls can be easily corrected by a routine nasal endoscopy as part of evaluation of chronic headaches in children and instituting the appropriate clinical management.

Differentiation of Chiari malformation type 1 and spontaneous intracranial hypotension using objective measurements of midbrain sagging.

Chiari malformation type 1 (CM-1) and spontaneous intracranial hypotension (SIH) are causes of headache in which cerebellar tonsillar ectopia (TE) may be present. An accurate method for differentiating these conditions on imaging is needed to avoid diagnostic confusion. Here, the authors sought to determine whether objective measurements of midbrain morphology could distinguish CM-1 from SIH on brain MRI. This is a retrospective case-control series comparing neuroimaging in consecutive adult subjects with CM-1 and SIH. Measurements obtained from brain MRI included previously reported measures of brain sagging: TE, slope of the third ventricular floor (3VF), pontomesencephalic angle (PMA), mamillopontine distance, lateral ventricular angle, internal cerebral vein-vein of Galen angle, and displacement of iter (DOI). Clivus length (CL), an indicator of posterior fossa size, was also measured. Measurements for the CM-1 group were compared to those for the entire SIH population (SIHall) as well as a subgroup of SIH patients with > 5 mm of TE (SIHTE subgroup). Highly significant differences were observed between SIHall and CM-1 groups in the following measures: TE (mean ± standard deviation, 3.1 ± 5.7 vs 9.3 ± 3.5 mm), 3VF (-16.8° ± 11.2° vs -2.1° ± 4.6°), PMA (44.8° ± 13.1° vs 62.7° ± 9.8°), DOI (0.2 ± 4.1 vs 3.8 ± 1.6 mm), and CL (38.3 ± 4.5 vs 44.0 ± 3.3 mm; all p < 0.0001). Eight (16%) of 50 SIH subjects had TE > 5 mm; in this subgroup (SIHTE), a cutoff value of < -15° for 3VF and < 45° for PMA perfectly discriminated SIH from CM-1 (sensitivity and specificity = 1.0). DOI showed perfect specificity (1.0) in detecting SIH among both groups. No subjects with SIH had isolated TE without other concurrent findings of midbrain sagging. Measures of midbrain sagging, including cutoff values for 3VF and PMA, discriminate CM-1 from SIH and may help to prevent misdiagnosis and unnecessary surgery.

Is increased intracranial pressure a reason for headache in COVID-19 patients? Evaluation with optic nerve sheath diameter

Objective: Headache occurs in 10-15% of COVID-19 patients. The optic nerve sheath diameter (ONSD) is an indirect measurement of the intracranial pressure (ICP). This study aimed to determine whether there was a relationship between ICP and headache in COVID-19 patients by measuring the ONSD. Methods: The study included a total of 91 people: 68 COVID-19 patients and 23 healthy volunteers as a control group. The two groups were first compared in terms of the ONSD using the ultrasonography (US) technique. Second, the severity of headache in the COVID-19 group was numerically evaluated (from 0 to 10) and the group was then divided into low, moderate, and high subgroups according to headache severity. Afterwards, the ONSD measurements of participants in the COVID-19 group were compared in between the subgroups. Results: We found that the COVID-19 patients had higher ONSD levels than healthy controls (4.7±0.7 mm vs. 4.1±0.4 mm, p &lt;0.001). In the COVID-19 patients, there was a significant difference of ONSD levels between the low and moderate as well as the low and high groups. However, no significant difference was observed between the moderate and high groups. There was also a positive correlation between the headache intensity and ONSD diameter level (p=0.01 r=0.39). Conclusion: COVID-19 patients with headache had higher ONSD levels than healthy volunteers, consistent with increased intracranial pressure. The latter may be one of the causes of headache in COVID-19.

Can ‘SOVAC’- a set of brain magnetic resonance imaging findings- detect idiopathic intracranial hypertension?

Objective&#x0D; To determine diagnostic ability of brain magnetic resonance imaging (MRI) in detection of idiopathic intracranial hypertension (IIH).&#x0D; Method&#x0D; This descriptive observational study was conducted in radiology department from Jan. 2018 to Jan. 2021, evaluating MR imaging data of all adult patients (n=107) with clinical presentations of headaches. Patients with space occupying lesions, obstructive hydrocephalus and cerebral venous sinus thrombosis were excluded. Presence of all three brain MRI findings of (i) an empty sella (with or without sellar enlargement), (ii) tortuosity of optic nerves (with or without perioptic CSF prominence) and (iii) non-dilated (or slit-like) ventricles was considered positive for IIH. Imaging was reviewed by two neuroradiologists and consensus reporting was made. Findings of IIH were confirmed by presence of high lumbar opening cerebrospinal fluid (CSF) pressure or symptomatic response towards specific medical treatment. Outcomes of brain MRIs were presented on a 2x2 contingency table.&#x0D; Results&#x0D; Sensitivity, and specificity of routine brain MRI findings in detection of IIH were calculated as 76.4% [95% confidence interval (CI), 64.62-85.91%], and 84.6% (95% CI, 69.47-94.14%) respectively. &#x0D; Conclusion:&#x0D; IIH is a known cause of headache. Detection of all three findings of empty sella, tortuosity of optic nerves and non-dilated ventricles on routine brain MRI can predict IIH with greater sensitivity and specificity.

The role of occipital nerve block with ultrasound guidance in occipital neuralgia cases

Introduction. Occipital neuralgia (ON) is a well-known cause of headache that affecting the posterior head at the occipital nerve(s) distribution. It is a multiple-factor clinical condition resulting from the pathology of the greater, lesser or third occipital nerve. Interventional therapy, such as occipital nerve block (ONB), is one of the various modalities that could be normally considered when the conservative wasn’t satisfying. Besides as effective treatment, ONB also used as an important diagnostic procedure for occipital neuralgia. Content. Currently, there is no a complete consensus among practitioners regarding the optimal therapy for occipital neuralgia although many modalities offered. ONB traditionally performed with blinded approach relying on anatomic landmarks create the higher risks of injection in the occipital artery and/or block failure. Therefore, ONB with ultrasound guidance becomes solution to improve the safety and efficacy of therapy especially in occipital neuralgia cases. Conclusion. Occipital nerve block with ultrasound guidance is recommended as primary interventional therapy for occipital neuralgia cases.

Traumatic rupture of an intracranial dermoid cyst: A case report

Intracranial dermoid cyst is a very rare primary intracranial tumor accounting for &lt;0.5% of intracranial masses. They are usually congenital and benign. Rupture of intracranial dermoid may occur spontaneously or with trivial trauma. Most cases of rupture are spontaneous. There are very few reported cases of traumatic rupture of intracranial dermoid cysts in world medical literature. The presentation can range from headache to signs of meningeal irritation and focal neurological deficit. Computed tomography (CT) and magnetic resonance imaging (MRI) of the brain is of paramount importance for early diagnosis and prompt treatment planning which can reduce both morbidity and mortality. The following case report gives an account of a 49-year-old female who presented with complaints of headache after an episode of fall. She was examined and no neurological deficit was found. Examination of the neurological system was within normal limits. She underwent a CT and MRI of the brain and was subsequently diagnosed as traumatic rupture of dermoid cyst based on the findings. She was treated with high-dose steroids until resolution of her symptoms and then discharged with the advice of regular follow-up. This case report highlights the role of CT and MRI in early diagnosis and treatment planning of patients with ruptured dermoid cysts which leads to a decrease in mortality and morbidity and also the ability of the same to rule out other more sinister causes of headache in patients.