Permanent Headache Research Articles

Intracranial hypotension after trauma.

IntroductionIntracranial hypotension (IH) occurs typically spontaneous and is a potentially life-threatening condition characterized by symptoms varying from postural headache to coma, with classical magnetic resonance imaging (MRI) findings.Case descriptionWe report two cases of clinically relevant trauma-related IH and review of the literature.One patient with a cerebral trauma presented unilateral mydriasis and coma resolved by the Trendelenburg position (-20°) as urgency intervention. In the second patient, IH was caused by a lesion of the brachial plexus after a motor vehicle accident.Discussion and conclusionA history of mild or moderate trauma in association with prolonged postural or permanent headache may indicate IH. Posttraumatic IH is rare, nevertheless life-threatening in case of misdiagnosis. Intracranial hypotension in a trauma context is rarely described and difficult to diagnose. The change from tipical supine 30° to Trendelenburg position (0–20°) can be a life-saving manoeuver in these patients.

No increase in headache after previous intracranial infections: a historical cohort study (The Nord-Trøndelag Health Survey)

Despite the absence of robust scientific evidence, it is today generally accepted that the acute headache typical for intracranial infections can develop into permanent headache complaints.

The Lady in the Carriage: Trauma, Embodiment, and the Drive for Resolution

The Lady in the Carriage: Trauma, Embodiment, and the Drive for Resolution

No increase in headache after previous intracranial infections: a historical cohort study (HUNT)

Despite the absence of robust scientific evidence, it is today generally accepted that the acute headache typical for intracranial infections can develop into permanent headache complaints. This widespread concept was explored in the first, large, longitudinal, population-based study. Data on confirmed exposure to intracranial infections amongst all adult inhabitants in a geographical area during a 20-year period were assembled from hospital records. Surviving individuals were later invited to the third Nord-Trøndelag Health Survey (HUNT 3), where 39,690 (42%) of 94,194 invited inhabitants aged ≥20 years responded to a validated headache questionnaire. Using logistic regression, the 1-year prevalence of headache and its subtypes according to the diagnostic criteria of the International Headache Society was assessed and compared between those with and without previous confirmed intracranial infection. Age and sex were used as covariates. Overall, 43 participants were identified with earlier intracranial infection, whereof three had more than one infection: bacterial meningitis (n=19), lymphocytic meningitis (n=18), encephalitis (n=9), and brain abscess (n=1).The mean interval from infection to participation in HUNT 3 was 11.2 (range 1.5-19.7) years. There was no significant increase in the prevalence of headache (OR 1.10, 95% CI 0.58-2.07), its subtypes (migraine, or tension-type headache), or chronic daily headache (OR 1.85, 95% CI 0.45-7.68) amongst participants with previous intracranial infection compared with the surrounding population. This study challenges the existence of chronic post-bacterial meningitis headache and does not indicate the presence of other long-term headaches induced by intracranial infection.

Obstacles to Claiming Permanence and Injury-Relatedness for “Posttraumatic” Headache

Abstract “Posttraumatic” headaches claims are controversial because they are subjective reports often provided in the complex of litigation, and the underlying pathogenesis is not defined. This article reviews principles and scientific considerations in the AMAGuides to the Evaluation of Permanent Impairment (AMA Guides) that should be noted by evaluators who examine such cases. Some examples in the AMA Guides, Sixth Edition, may seem to imply that mild head trauma can cause permanent impairment due to headache. The author examines scientific findings that present obstacles to claiming that concussion or mild traumatic brain injury is a cause of permanent headache. The World Health Organization, for example, found a favorable prognosis for posttraumatic headache, and complete recovery over a short period of time was the norm. Other studies have highlighted the lack of a dose-response correlation between trauma and prolonged headache complaints, both in terms of the frequency and the severity of trauma. On the one hand, scientific studies have failed to support the hypothesis of a causative relationship between trauma and permanent or prolonged headaches; on the other hand, non–trauma-related factors are strongly associated with complaints of prolonged headache.

Abnorme Verstärkung des Ligamentum nuchae und supraspinale

It is reported about hypertrophy of the nuchae ligament in an 28 year old woman. After operation (extirpation) the mobility of the cervical spinal column was nearly free and the permanent headache of the patient had gone.

Surgical treatment of migraine headaches by corrugator muscle resection.

The authors, a plastic surgeon (Dirnberger) and a neurologist (Becker), conducted this study after reading the article by of Bahman Guyuron et al. in the August 2000 issue of Plastic and Reconstructive Surgery (106: 429, 2000). Sixty patients were operated on between June of 2001 and June of 2002; postoperative follow-up ranged between 6 and 18 months. Patients' charts were reviewed to confirm the diagnosis of migraine headache according to the criteria of the International Headache Society. Sixty patients (13 men and 47 women) from Austria and four neighboring countries took part in the study. The patients were divided into three groups, based on the severity of their migraines: group A comprised patients with up to 4 days of migraine per month; group B included patients with 5 to 14 days of migraine per month; and group C was composed of patients with more than 15 days of headache per month ("permanent headache") or evidence of drug abuse and drug-related headaches. The effectiveness of the operation was evaluated using the following factors: percentage reduction of headache days; percentage reduction of drugs; percentage reduction of side effects, severity of headaches, and response to drugs; and patient grade of personal satisfaction, using a scale from 1 to 5 [1 = excellent (total elimination of migraine headache) to 5 = insufficient or no improvement]. From the entire group of 60 patients, 17 (28.3 percent) reported a total relief from migraine, 24 (40 percent) reported an essential improvement, and 19 (31.7 percent) reported minimal or no change. Patients with a rather mild form of migraine headache had a much better chance (almost 90 percent in group A and 75 percent in group B) to experience an improvement or total elimination of migraine than those patients (n = 27) from group C with severe migraine, "permanent headaches," and drug-induced headaches. Contrary to the reports by Guyuron, 11 patients who had a very favorable response immediately and in the first weeks after the operation experienced a gradual return of their headaches to preoperative intensity after about 4 postoperative weeks. After 3 months, the results in all patients could be declared permanent. All side effects, such as paraesthesia in the frontal region, disappeared in all patients within 3 to 9 months.

Posttraumatic headache.

The authors review posttraumatic headache (PTH). The most common symptom following head injury, PTH is paradoxically most severe after mild head injury. Although most cases resolve within 6 to 12 months, many patients have protracted or even permanent headache. Because PTH generally has no objective findings, it is often controversial whether the symptom is "real," "psychogenic," or "fabricated." Despite persisting beliefs by physicians, attorneys, and insurers that PTH resolves upon legal settlement, recent studies have shown that "permanent" PTH is usually still present several years after a legal settlement. Often PTH affects family life, recreation, and employment. Patients require education and support as well as appropriate evaluation and treatment.

Diagnosis and Treatment of Carotid Body Tumors

Carotid body tumors are rare although they must always remain part of the differential diagnosis of a neck mass. Sonography as the screening method of choice followed by angiography determines the diagnosis. In 11 patients 12 carotid body tumors were extirpated. The reconstruction of the internal carotid artery with an interposition of the greater saphenous vein was necessary in two cases after resection of the tumor. One patient underwent preoperative embolisation because of a huge tumor. Two postoperative radiotherapies were undertaken because of malignancy in one case and a partially extirpated tumor in the other. After a 9 year follow-up period all patients are alive. One patient suffers from a persistent palsy of the hypoglossal nerve and another complains of permanent headache supposedly caused by the reocclusion of the venous interposition of the carotid artery. In conclusion, our data support the diagnostic strategies in patients with suspected carotid body tumors. Regarding the exact therapeutic regimen, we suggest the surgical resection, followed by radiotherapy in cases of confirmed malignancy or partially resectable lesions.

Hemicranial attacks or permanent hemicrania--a sequel of upper cervical root compression.

After many years of unsuccessful conservative treatment 16 patients suffering from hemicrania are relieved of their pain or are improved by operative treatment. Hemicranial attacks or permanent hemicrania is found to be caused by upper cervical nerve root compression. Vascular compression of C2 (n = 9) or scar tissue surrounding C2 (n = 1) or C3 (n = 1) is the pathology identified in cases of cervicogenic headache or "cluster headache-like" headache. Compression attributable to tumor, prolapsed disc, or spondylotic changes is found to be a cause of permanent headache. Only in those patients with permanent headache are radiological or electrophysiological findings helpful for diagnosis. In patients with hemicranial attacks and compression of nerve root C2 (n = 10) or C3 (n = 1), only vasoactive tests (provoking or relieving pain) or local anaesthesia prove to be helpful in diagnosing and localizing the origin of pain. The operation involves freeing the nerve roots from vascular compression. In two patients the C2 ganglion is resected. Thirteen patients subsequently become pain free. In three patients, hemicrania improves. Four of the 16 patients experience a recurrence of pain after the decompressive operation. After additional thermorhizotomy two patients have no further complaints and one patient has improved. One patient can tolerate his pain with occasional analgesics. The problem of referred pain into the fronto-ocular region is discussed.