Cause Of Headache Research Articles

Assessing the Diagnostic Value of Brain White Matter Hyperintensities and Clinical Symptoms in Predicting the Detection of CSF Venous Fistula in Patients with Suspected Spontaneous Intracranial Hypotension.

Spontaneous intracranial hypotension (SIH) due to CSF venous fistula (CVF) is increasingly recognized as a secondary cause of headaches, with symptoms often overlapping with primary headache syndromes such as migraine. While brain MRI studies have focused on features indicative of SIH, findings that support an alternate headache etiology, such as the bifrontal white matter hyperintensities (WMH) often seen in migraines, have not been explored in this context. This study assesses 1) the quantity and distribution of WMH and 2) the presenting clinical features in patients with and without CVF found on dynamic decubitus CT myelography (dCTM). 72 consecutive patients underwent clinical workup for SIH due to suspected CVF, including pre-procedural brain and spine MRI followed by dCTM. Brain imaging features were analyzed, including Bern score, quantitative WMH burden, and WMH distribution. Demographics and clinical symptoms present at the time of presentation were recorded. Imaging features were compared between groups with and without CVF using parametric or nonparametric comparisons according to variable normality. Multivariate logistic regression explored the relationships between imaging features, clinical symptoms, and the presence of CVF. The cohort included 40 patients with (CVF+) and 32 patients without (CVF-), with no significant age or sex differences. CVF+ patients had significantly higher Bern scores and significantly fewer WMH. There were significant differences in the frequencies of WMH patterns between groups, with a migrainous pattern observed most frequently in CVF-patients. Logistic regression combining Bern score, WMH burden, and WMH pattern demonstrated a better fit for predicting CVF than using Bern score or WMH features alone. Fourteen clinical symptoms showed the greatest differences between CVF+ and CVF-groups. Logistic regression demonstrated a positive association between CVF detection and a pressure/throbbing headache quality, and negative associations for neck pain, facial pain, phonophobia, and anhedonia/depression. These findings suggest a negative association between CVF detection, increased burden of WMH, and a migrainous WMH pattern. Symptom analysis describes distinct clinical phenotypes, challenging orthostatic headache as a defining characteristic. These results support a comprehensive assessment of imaging and clinical presentations in the workup of suspected SIH. SIH = spontaneous intracranial hypotension; CVF = CSF venous fistula; WMH = white matter hyperintensities; dCTM = dynamic CT myelography; dDSM = dynamic digital subtraction myelography; PPV = positive predictive value; NPV = negative predictive value Received month day, year; accepted after revision month day, year.

Primary headaches in children

Headaches in children are common, and can have a significant impact on children’s school attendance and quality of life. Although most causes of headaches in children are benign, concern from clinicians and patient caregivers about missing a serious underlying cause can result in a high referral rate to secondary care. This article provides a succinct and practical approach to the assessment and management of a child presenting to general practice with a headache. This will include consideration of possible underlying pathology, diagnosis and management of primary headaches, with emphasis on managing lifestyle and psychosocial factors that negatively impact on headaches.

7405 A Case of Pituitary Apoplexy in Pregnancy

Abstract Disclosure: Y. Esaki: None. G.E. Vates: None. I. Shafiq: None. Pituitary apoplexy is a rare cause of headache during pregnancy. The prevalence of pituitary apoplexy during gestation and the peripartum period is estimated to be 1 in 10,000 term pregnancies. Approximately 42-47% of these patients were known to have a pituitary lesion especially history of prolactinoma. Here we report a pregnant female developing pituitary apoplexy after discontinuation of dopamine agonist. A 27-year-old female was initially diagnosed with prolactinoma with elevated prolactin of 158.1 ng/ml (3.0-300 ng/ml). MRI revealed a 1.3 cm x 1.5 cm x 1.4 cm pituitary mass with solid and cystic components. Treatment with cabergoline 0.25 mg twice weekly was started. After 2 years of treatment, prolactin was 74.2 ng/ml and the size of the adenoma decreased to 1.0 cm x 1.2 cm x 1.3 cm. One year later, she became pregnant at age 30 and discontinued cabergoline after 7 weeks of gestation. At 12 weeks of gestation, she presented to the Emergency Department for 3 days of severe headaches associated with emesis. The ED work up includes prolactin > 2,000 ng/ml. MRI head without contrast demonstrated an interval increase in size to 1.5 cm x 1.7 cm with hemorrhagic component. Urgent evaluation by a Neuro-ophthalmologist revealed no clinical evidence of optic neuropathy. Blood work showed AM cortisol 2.3 mcg/dl (4.0-22.0 mcg/dl), TSH 0.5 mIU/L (0.4-0.5 mIU/L), FT4 0.6 ng/dl (0.8-1.8 ng/dl). Cabergoline 0.25 mg twice weekly was restarted to control the size of the tumor as well as hydrocortisone and levothyroxine for central adrenal insufficiency and hypothyroidism respectively. Four weeks later, she was 17 weeks pregnant. MRI showed a further increase in the size of the adenoma, now measuring 1.8 cm x 2.0 cm x 1.3 cm. The lesion now extended into the suprasellar cistern, affecting the optic chiasm. She underwent the transsphenoidal resection of the pituitary adenoma at 18 weeks of gestation due to the increase in size of the tumor. The final pathology was consistent with pituitary adenoma, lactotroph cell type, WHO grade 1. MRI obtained 3 months post-operation showed no residual T1 hyperintense tumor signal. There was a cyst-like expansion of the sella turcica with a decreased mass effect on the optic chiasm. She delivered her healthy baby at 40 weeks and 5 days via vaginal delivery. She received stress dose steroid during labor, then was discharged home with hydrocortisone 10 mg twice daily. She is doing well following the delivery and breastfeeding the baby. This case illustrates a rare case of pituitary apoplexy during pregnancy in a patient with prolactinoma. Pituitary apoplexy should be considered as a differential diagnosis when pregnant patients develop an acute, severe headache, especially those with an underlying pituitary adenoma. It is critical to assess and treat the hormonal deficiencies. For prolactinoma, pharmacological therapy can be initiated. Surgery is considered if the medical therapy fails. Presentation: 6/3/2024

Review of Ocular and Non-Ocular causes of Headache in Adult and Pediatric Patients; A multicenter study

Purpose: To determine ocular and non-ocular causes of headache in adult and pediatric patients in three tertiary care hospital of Multan, Pakistan Study Design: Cross-sectional study. Place and Duration of Study: This multi-centre study was conducted in Combined Military Hospital, Multan, Pakistan and The Children’s Hospital and The Institute of Child Health, Multan, Pakistan from February 2023 to September 2023. Methods: The non-probability convenience sampling technique was used. The data collection and diagnosis were done by a consultant ophthalmologist. The statistical analysis of this study was conducted using SPSS version 23. Results: The study comprised of a total of 600 patients. The mean age of the adult patients was 27.16±14.39 years ranging between 16to 80 years and the mean age of pediatric patients was 10.1±2.40 years. The patients were divided into four groups based on the etiology of headache that were ocular, non-ocular, combined ocular causes and ocular and non-ocular causes combined. The most common ocular cause was myopia in 43(14.3%) adults and 47 (15.8%) pediatric patients. However, the most common non-ocular cause was migraine in 72(24.0%) adult patients and frontal sinusitis in 43 (14.3%) pediatric patients. Conclusion: Refractive errors were the most common ocular etiology of headache in ophthalmology patients predominately myopia in the adult and pediatric population. Migraine was the most common non-ocular etiology in adult population whereas frontal sinusitis was most common in the pediatric age group.

Headache in diabetes.

Diabetes can present with multiple manifestations and subjective symptoms. One of these is headache. Headache can be a clinical presentation of diabetes per se, its complications or its comorbidities. It can also point towards certain causes of secondary diabetes, as well as iatrogenic issues. This communication lists the various causes of headache in diabetes, so as to help the clinician keep a high index of vigilance.

Idiopathic intracranial hypertension following childbirth: a case report and management strategies

Introduction: A postpartum headache, also known as pseudotumor cerebri, is defined as a headache and shoulder or neck pain that occur in the first six weeks following childbirth. Common causes of headaches during puerperium include pre-eclampsia, subarachnoid hemorrhage, cerebral venous thrombosis, meningitis, brain tumors, cerebrovascular diseases, and posterior reversible encephalopathy syndrome. Pseudotumor cerebri is an extremely rare cause of postpartum severe headache with visual disturbance with or without papilledema. Case Presentation: Here we present a 32-year-old postpartum female patient who presented with a severe headache and visual disturbance for 10 days. Neurological examination did not show any focal or lateralizing deficit. However, a fundus examination showed severe bilateral papilledema. A contrast-enhanced brain MRI did not reveal a space-occupying mass lesion. MRV excluded venous occlusion. A lumbar puncture demonstrated high opening pressure of 75 cmH2O with a normal cell count and protein and glucose levels. The patient was diagnosed with idiopathic intracranial hypertension. After 8 weeks of treatment with diazomid and topiramate, the patient improved clinically and her papilledema regressed. Clinical Discussion: The occurrence of IIH is very rare among postpartum females. To our knowledge, very few cases of postpartum IIH have been reported in the medical literature. Although rare, patients with postpartum headache with visual disturbances should have a fundoscopic examination. The patient was diagnosed and managed in time, which led to significant clinical improvement and salvage of her vision. Conclusion: As described in this case, idiopathic intracranial hypertension can cause severe headaches with and without visual disturbance during the postpartum period (despite being rare in this period), it should be considered in the differential diagnosis.

Study of prevalence of non-strabismic binocular vision anomalies in a tertiary centre: An important but often forgotten cause of ophthalmic headache

To study the presence of non strabismic binocular vision anomalies in young patients presenting with headache. A prospective, non-interventional study of 110 patients was conducted for a period of one year in our tertiary eye care institute after obtaining informed consent and taking into consideration the inclusion and exclusion criteria. Patients presenting with asthenopic symptoms were subjected to thorough ophthalmic examination. After excluding refractive errors, patients were further subjected to detailed orthoptic evaluation (including accommodation and convergence assessment). Other non-ocular causes of headache were ruled out by appropriate referrals. Out of 110 patients, 33% were found to have accommodative insufficiency, 14% were having convergence insufficiency and 4% showed both accommodative and convergence insufficiency. 49% patients showed no extraocular muscle imbalance and were referred to relevant specialities for further evaluation. It is important to perform a thorough evaluation of patients presenting with headache for the presence of non strabismic binocular vision anomalies after ruling out other ophthalmic causes.

An uncommon cause of headache

An uncommon cause of headache

The Effects of Combination Herbal Medicine Tablet on Migraine Headache: A Randomized, Double-blind, Placebo, Controlled Study

Background: Migraine is the second most common cause of headache, various methods have been mentioned for the treatment of migraine, including herbal medicine. Iaraj Fiqra is a combination of Aloe, saffron, cinnamon, mustalci, balsam incense and asaroon and claim to be effective in migraine. The present study aims to compare the effect of Iaraj Fiqra and placebo tablets on migraine headache. Methods: In this randomized, controlled trial, patients with migraine (based on the International Headache Society definition) received Iaraj Fiqra (500mg/daily) or placebo tablets for two months. Headache characteristics were measured using the Migraine Disability Assessment (MIDAS) and Headache Impact Test-6 (HIT-6). Results: Iaraj Fiqra reduced significantly the frequency (P=0.007), the severity (P=0.000) and the duration (P=0.000) of attacks compared to placebo. MIDAS and HIT-6 scores were significantly reduced in the drug group other than the placebo group (P=0.014 and P=0.000 respectively). Analgesic use also reduced. No significant difference was observed between the two groups in term of side effects (P=0.23). Conclusion: This study showed that Iaraj Fiqra had significant effects on reducing headache characteristics and analgesic use and given its limited side effects, it is recommended for the treatment of migraine.

Upper cervical spine syndrome: A new perspective

Headaches are widespread in Western Society; they affect approximately 50% of the adult population in the United States. Headaches can present with a variety of clinical and regional symptoms. Although a headache disorder classification system exists, clinical experience has identified various overlapping causes for headaches. It remains clinically challenging to identify the exact etiology causing headaches. For example, the underlying mechanism of cervicogenic headaches remains elusive, but the upper cervical spine plays a key role. Abnormal upper cervical movement patterns, in combination with muscular dysfunctions, are a possible contributing factor to headaches. The upper vertebral spinal nerves C0-C3 have been correlated with cervicogenic headaches. It has been established that biomechanical dysfunction of the upper cervical spine can contribute to neck pain. The atlas plays a key role in the biomechanical dysfunction in the upper cervical spine. Previously, it has been identified that the relative position of the atlas to the axis correlates with headaches. Additionally, it has been demonstrated that an extended contraction of the homolateral obliquus capitis inferior muscles can result in positional default rotation of the atlas. As managing headaches remains multimodal and challenging, there is enough evidence to support the inclusion of the upper cervical spine to normalize joint position, joint mobility, muscle tonicity, and upright positioning. When recognizing the “upper cervical syndrome” and addressing the functioning of the atlas, clinical outcomes will improve for those treating patients with headaches.

Spontaneous Intracranial Hypotension Associated with Marfan Syndrome: A Case Report.

Spontaneous intracranial hypotension (SIH) is an uncommon and frequently misdiagnosed condition characterized by a lower-than-normal volume of cerebrospinal fluid (CSF) caused by leakage of CSF through the dural membrane. The primary manifestation of SIH is an orthostatic headache, which is frequently accompanied by nausea and vomiting. Patients with connective tissue disorders are at increased risk for spontaneous CSF leaks due to the structural weakness of their dural membranes. An 18-year-old woman with no reported past medical history presented to the emergency department with 10 days of a bifrontal headache that was orthostatic in nature with associated nausea and vomiting. She was noted to have several marfanoid features on physical examination. Spontaneous intracranial hypotension was ultimately diagnosed and treated successfully with an epidural blood patch. Subsequent genetic testing revealed a diagnosis of Marfan syndrome. Spontaneous intracranial hypotension is an uncommon cause of headache. Individuals with connective tissue disorders such as Marfan syndrome are at increased risk for SIH. Knowledge of the relationship between these two conditions allows for a more rapid diagnosis of SIH.

Prospective analysis of optic nerve diameter and NSE values in patients with refractory headaches

Purpose: This study aims to investigate the usability of ultrasonographic optic nerve diameter measurement and plasma neuron-specific enolase (NSE) levels in detecting secondary causes of headaches in patients with refractory headaches in emergency department.
 Materials and Methods: The study was conducted in a university-based adult emergency department over 3 years. Sixty-six consecutive patients presenting to the emergency department with refractory headaches and 50 healthy volunteers for the control group were included. Information recorded included the duration of complaints, type and location of headache, symptoms, co-morbidities, results of imaging studies, optic nerve diameters, results of lactate, arterial blood gas and NSE levels.
 Results: A total of 66 patients were included, comprising 33 females. The mean age was 43.05 ± 17.06 years. Secondary causes of headache were identified in 45 patients (68.2%). Evaluation of ultrasonographic optic nerve diameter revealed that 17 (25.8%) right and 21 (31.8%) left optic nerve diameters were ≥5 mm. Optic nerve diameter values were significantly higher in patients diagnosed with secondary headache compared to those with primary headache, with no statistically significant difference observed in NSE values. Lactate levels in patients with secondary headaches were significantly higher than those in patients with primary headaches.
 Conclusion: In patients admitted to the emergency department with refractory headaches and normal imaging, ultrasonographic optic nerve diameter measurement may be preferred as an easily accessible method to guide the detection of secondary causes. NSE was not an effective in the early selection of patients with secondary headaches.

Clinical Characteristics and Appropriateness of Investigations in Children With Headaches at the Emergency Department

BackgroundIdentifying the cause of headaches in pediatric emergency departments (PEDs) can be challenging due to the lack of comprehensive research. This study aims to identify the frequency, characteristics, and unnecessary diagnostic procedures of patients with headaches in the PED setting. MethodsA six-month cross-sectional study was conducted at the PED of Alexandria University Children's Hospital, including all children with headaches. Children were classified as having primary headache (PH), secondary benign headache (SBH), and secondary serious headache (SSH) according to predetermined criteria. Logistic regression was employed to analyze the risk factors associated with SSH. ResultsA total of 164 visits to the PED were recorded, out of a total of 22,662 visits, accounting for approximately 0.72% of all visits and 1.17% of the total number of children admitted. PH was the most common cause, accounting for 61.0% of cases, followed by SSH with 24.4%, whereas SBH was the least common with 13.4%. Abnormal neurological examination (odds ratio, 53.752 [1.628 to 1774.442], P = 0.026∗) was found to have a strong and statistically significant association with SSH in the multivariate analysis. Regarding the appropriateness of the investigations conducted, it was found that over half (66.5%) of the cases had unnecessary neuroimaging, with 52% of these cases being children with PH. ConclusionsHeadaches in children are commonly reported during visits to the PED. PH was the most prevalent, followed by SSH, whereas SBH was the least common. Many of the children received inaccurate first diagnoses and performed unnecessary laboratory tests, neuroimaging, and other tests, mostly electroencephalography.

Effectiveness of Homoeopathic Treatment in the Management of Headache- A Retrospective Observational Study

Headache is one of the most common complaint that most people experience in their lives. It is a pain or discomfort in head. Headache is mainly categorized into two types: primary and secondary headache. The cause of headache is mostly stress, anxiety, depression, injury or trauma, infections, climate changes etc. It creates a burden on people’s quality of life and more suffering due to regular use of pain-killers. As an alternative mode of treatment, Homoeopathy is the safest way to relieve headaches without any side-effects. The aim of the study was to know the effectiveness of homoeopathic treatment in management of headache.

Migraine and pregnancy : Gender-specific aspects and current knowledge

Migraine, afrequent and debilitating neurological disease, shows gender-specific differences in prevalence and severity. Pregnancy is associated with numerous unique features in terms of migraine course, treatment options and differential diagnoses. How does pregnancy influence the course of migraine? What are the possible treatment options during pregnancy? Which differential diagnoses should be considered? Narrative review with summary and discussion of relevant studies and guidelines on migraine in pregnancy. During pregnancy up to three quarters of women experience improvement of their migraine; however, there may be arenewed increase in frequency after childbirth. Choosing an appropriate treatment during pregnancy requires acareful risk-benefit assessment. It is important to consider secondary causes of headache as these can occur more frequently during pregnancy and some can be life-threatening. Consideration of specific aspects of migraine in pregnancy is crucial to be able to develop the best possible treatment strategies for affected patients.

Extracting brain behavior change in patients with migraine by quantitative analysis of electroencephalogram signal of patients compared to healthy people

Background. Migraine disease is the second most common cause of headaches. Despite the high prevalence, the exact etiology of migraine is yet unknown. In this study, to evaluate the behavior change of electroencephalography (EEG) signals in migraine patients, various features of the EEG signals of migraine patients and healthy controls (HCs) were extracted and compared. Methods. This cross-sectional analytical study was conducted on 21 HCs and 18 migraine patients. Various features, such as fractal dimension (FD), approximate entropy (ApEn), and largest Lyapunov exponent (LLE), were calculated from the EEG signals of migraine patients and HCs. Then different frequency sub-bands of delta, theta, alpha, beta, and gamma were extracted using the wavelet transform, and the energy of these sub-bands was computed. By calculating the mean and variance of the features and applying statistical tests, the feature changes were compared between two groups, and channels with significant differences were identified. Results. The mean of ApEn, FD and energy of all frequency sub-bands in most of the analyzed channels was higher in migraine patients than in HCs. The mean LLE was mostly lower in migraine patients than in healthy controls. According to the statistical tests, the energy of theta and delta frequency sub-bands with 36 and 35 channels was the feature with the highest number of channels, with a significant difference. In this study, P values less than 0.05 were considered statistically significant. Conclusion. Migraine patients may have a less sophisticated brain dynamic system due to an increase in irregularity and randomness, as indicated by an increase in ApEn and a decrease in FD in their EEG signals compared to HCs. Anxiety, tension, and other intense sentiments and emotions, as well as the creation of new neural circuits in the brain, can all contribute to an overall increase in energy across all frequency sub-bands in migraine patients. Practical Implications. Considering the EEG signal behavior as the response of a dynamic system, we can say that the brain function of migraine patients, even in the inter-ictal phase, leaves the definite chaotic state, which is a healthy brain behavior, and enters the random state.

Migraines in childhood as a cause of headache in adulthood – how to prevent it? A literature review

Migraines in childhood as a cause of headache in adulthood – how to prevent it? A literature review

Morning headache caused by obstructive sleep apnea misdiagnosed as temporomandibular disorders-related headache: A case report.

A 67-year-old woman presented to our clinic with chief complaints of headache and mandibular heaviness. Physical examination revealed bilateral tenderness in the temporalis and masseter muscles, corresponding to the patient's chief complaint. Thus, a diagnosis of temporomandibular disorders (TMDs)-related headache was made. However, sleep disorders were identified after further consultation. Hence, sleep apnea-related headache was suspected due to a snoring habit with a Mallampati classification of Class IV. Out-of-center sleep testing (OCST) revealed a respiratory event index (REI) of 10.1/h and a low peripheral oxygen saturation (SpO2) of 76%. Consequently, a diagnosis of obstructive sleep apnea (OSA) was made, and treatment using the mandibular advancement device (MAD) was recommended. Following MAD treatment, the patient's sleep quality improved, and morning headaches ceased. Subsequent OCST performed while wearing the MAD showed a significant reduction in the REI to 1.6/h and an increase in the SpO2 to 86%, indicating the therapeutic efficacy of the MAD in treating OSA. MAD treatment effectively alleviated the patient's morning headaches, suggesting that sleep bruxism should not be considered the only cause of headaches. OSA should also be considered and addressed when investigating the potential causes of morning headaches in patients. In patients experiencing TMDs symptoms and morning headaches, TMDs should not be presumed as the sole cause. Dentists should discuss the likelihood of sleep disorders during consultations. If sleep disorders are suspected, the possibility of OSA should be considered, and sleep tests should be conducted when necessary.

Retrospective Evaluation of Patients Admitted to the Pediatric Neurology Outpatient Clinic with Headache: Experience of a Tertiary Hospital.

It was aimed to determine the etiological and clinical features of pediatric patients with headache complaints. The files of patients who were admitted to the pediatric neurology outpatient clinic with headache were reviewed retrospectively. Patients' age, gender, features of headache, symptoms accompanying headache, available blood tests, brain magnetic resonance (MR) and electroencephalography (EEG) results were recorded. Of the total 470 patients, aged between 3 and 17 years, 291 (61.9%) were female and 179 (39.1%) were male. The mean age of the patients was 12.38±3.45 years. According to age groups, there were 16 (3.4%) patients under the age of 5, 159 (33.8%) between the ages of 6-11, and 295 (62.8%) patients aged 12-17 years. While 289 (61.5%) patients were diagnosed with primary headache, 122 (26.0%) patients were diagnosed with secondary headache, and headaches of 59 (12.5%) patients could not be classified. The most common primary headaches were tension-type headache (TTN) (n=177, 37.7%) and migraine (n=111, 23.6%). The 86 (70.5%) of the patients with secondary headache were diagnosed with sinusitis. Abnormal neurological examination finding was determined in 8 (1.7%) patients. Brain MR was performed in 439 (93.4%) of all patients and abnormal brain MR findings were detected in 52 (11.8%) patients. EEG was performed in 205 (43.6%) of all patients and abnormal EEG findings were detected in 24 (11.7%) patients. According to age groups, headache was most common in the 12-17 age group. The most common causes of headache were TTN and migraine, respectively. The most common secondary headache cause was sinusitis. We think that physical and neurological examination still maintains its priority in determining the causes of headache.

Unexpected cause of headache in a patient with Noonan syndrome: aseptic meningitis

Unexpected cause of headache in a patient with Noonan syndrome: aseptic meningitis