Prior History Of Headache Research Articles

Predictors of Headache Before, During, and After Pregnancy: A Cohort Study

The present study endeavored to identify predictors of headache during pregnancy, shortly after delivery, and at 8-week follow-up. Many women suffer from headaches during pregnancy and the post-partum period. However, little is known about factors that predict headache surrounding childbirth. Secondary analysis of longitudinal cohort study of 2434 parturients hospitalized for cesarean or vaginal delivery in 4 university hospitals in the United States and Europe. Data were gathered from interviews and review of medical records shortly after delivery; 972 of the women were contacted 8 weeks later to assess persistent headache. The primary outcome measures were experiencing headache during pregnancy, headache within 72 hours after delivery, and headache at 8 weeks after delivery. Of the parturients, 10% experienced headache during pregnancy, 3.7% within 72 hours after delivery, and 3.6% at 8 weeks postdelivery. Compared to those without a history of headache, a history of headache prior to pregnancy was the strongest predictor of headache during pregnancy (9.8% vs 23.5%; risk ratio 2.4; 95% confidence interval [CI]: 1.4 to 4.0). Experiencing headache during pregnancy (adjusted hazard ratio HR 3.8; 95% CI: 2.4 to 6.2) and receiving needle-based regional anesthesia for pain treatment (adjusted hazard ratio 2.2; 95% CI: 1.1 to 4.5) were independently associated with headache within 72 hours after delivery with event rates of 11.1% and 10.5%, respectively. Compared to those without such a history, headache before pregnancy was significantly associated with experiencing headache 8 weeks after delivery (4.0% vs 23.8%; risk ratio = 6.0; 95% CI: 2.0 to 8.0), but headache during pregnancy or shortly after delivery was not. Several other psychosocial predictors (eg, somatization, smoking before pregnancy) were statistically associated with at least 1 headache outcome. A history of headache prior to pregnancy is a strong predictor of headache during and after pregnancy, the latter independent of but compounded by spinal injection. Physicians should attend to prior headache history when making decisions about pain management during and after childbirth. As the lack of formal International Classification of Headache Disorders, 2nd Edition (ICHD-II), headache diagnoses is a limitation of this study, future longitudinal studies should replicate the present design while including headache subtyping consistent with ICHD-II nosology.

Natural History of Headache after Traumatic Brain Injury

Headache is one of the most common persisting symptoms after traumatic brain injury (TBI). Yet there is a paucity of prospective longitudinal studies of the incidence and prevalence of headache in a sample with a range of injury severity. We sought to describe the natural history of headache in the first year after TBI, and to determine the roles of prior history of headache, sex, and severity of TBI as risk factors for post-traumatic headache. A cohort of 452 acute, consecutive patients admitted to inpatient rehabilitation services with TBI were enrolled during their inpatient rehabilitation from February 2008 to June 2009. Subjects were enrolled across 7 acute rehabilitation centers designated as TBI Model Systems centers. They were prospectively assessed by structured interviews prior to inpatient rehabilitation discharge, and at 3, 6, and 12 months after injury. Results of this natural history study suggest that 71% of participants reported headache during the first year after injury. The prevalence of headache remained high over the first year, with more than 41% of participants reporting headache at 3, 6, and 12 months post-injury. Persons with a pre-injury history of headache (p<0.001) and females (p<0.01) were significantly more likely to report headache. The incidence of headache had no relation to TBI severity (p=0.67). Overall, headache is common in the first year after TBI, independent of the severity of injury range examined in this study. Use of the International Classification of Headache Disorders criteria requiring onset of headache within 1 week of injury underestimates rates of post-traumatic headache. Better understanding of the natural history of headache including timing, type, and risk factors should aid in the design of treatment studies to prevent or reduce the chronicity of headache and its disruptive effects on quality of life.

Juvenile myoclonic epilepsy presenting as a new daily persistent-like headache

New daily persistent headache (NDPH) is a recognized subtype of chronic daily headache with a unique presentation of a daily headache from onset typically in individuals with minimal or no prior headache history. Various secondary mimics of NDPH have now been documented but at present there has been no association made between primary epilepsy syndromes and new daily persistent-like headaches. A case patient is presented who developed a daily continuous headache from onset who 3 months after headache initiation had her first generalized tonic-clonic seizure. Further investigation into her history and her specific EEG pattern suggested a diagnosis of juvenile myoclonic epilepsy (JME). Her NDPH and seizures ceased with epilepsy treatment. Clinically relevant was that the headache was the primary persistent clinical symptom of her JME before the onset of generalized tonic-clonic seizures. The current case report adds another possible secondary cause of new daily persistent-like headaches to the medical literature and suggests another association between primary epilepsy syndromes and distinct headache syndromes.

Acute Hydrocephalus Secondary to Neurocysticercosis

A 43-year-old man was brought to the Emergency Department (ED) by his family for worsening headache and confusion. His only medical problems were hypertension and diabetes; he had no prior history of headaches. Due to the abrupt onset of symptoms over the previous 2 h, an emergent computed tomography (CT) non-contrast head scan was ordered and revealed a dense lesion at the cerebral aqueduct with resulting hydrocephalus (Figure 1). Shortly after the CT scan, he developed emesis and mental status deterioration (Glasgow Coma Scale score went from 14 to 7), necessitating intubation.

Headache at Onset of Acute Cerebral Ischemia

CASE Ten days previously, this 76-year-old woman suddenly developed a shadow over the left field of vision of both eyes associated with a right temporal pressure headache with an intensity of 9/10. The headache resolved in 3 days. There were no other associated neurological symptoms. When seen in consultation, the right temporal headache had recurred the evening before for about 20 minutes with an intensity of 8/10 without associated symptoms. There was no prior history of headaches. There was a history of hypertension, type II diabetes, coronary artery disease post aortocoronary bypass, and cardiac arrhythmias requiring implantation of a permanent defibrillator-pacemaker. She was taking insulin, metoprolol, clonidine, and lasix. On examination, the blood pressure in the left arm while sitting was 210/110. Neurological examination was normal except for a left homonymous hemianopsia. A computerized tomography (CT) scan of the brain was consistent with a subacute infarction of the medial right occipital lobe. A carotid ultrasound study was normal.

What incites new daily persistent headache in children?

This study asked what incites the development of a new daily persistent headache in children. A total of 175 children with chronic daily headache were prospectively identified and observed by the author. Of these patients, 40 (23%) with a new daily persistent headache were identified. These patients had no significant prior headache history. Seventeen patients (43%) had the onset of their symptoms during an infection. Of these patients, over half had positive Epstein-Barr virus serology at the onset of symptoms. Nine patients (23%) manifested minor head injuries at the onset of their symptoms, yet had a normal examination and neuroimaging. Symptom onset was also associated with surgery (four patients) and high-altitude camping (one patient). In five patients, no specific etiologic factor could be identified. Four patients were initially identified as having idiopathic intracranial hypertension, yet their chronic headache persisted despite the normalization of their intracranial pressure. Similar findings were observed in episodic migraine patients who abruptly developed the onset of chronic migraine. In conclusion, the onset of new daily persistent headache in childhood is typically associated with a physiologic stress such as an infection, head trauma, or post-surgery.

Headache and visual change

Dr. Azita. G. Hamedani: Today’s case is that of a 67-year-old man who was transferred to our facility from an outside hospital for further evaluation of headache and visual change. The patient had no prior headache history and had been in his usual state of good health until 2 weeks prior to presentation when he developed sudden onset of a sharp, right-sided headache. He initially rated the headache as an 8 out of 10, and stated it was his “worst headache.” The headache subsequently lessened in intensity without any specific intervention. Dr. Eric S. Nadel: At this point, what diagnoses are most concerning? Dr. Hamedani: Sudden onset of “worst headache” is very concerning for a subarachnoid hemorrhage. More than 10% of neurologically intact patients with the “worst headache” are subsequently found to have subarachnoid hemorrhages (1). Furthermore, at least 20% of patients with subarachnoid hemorrhages have an unusually severe “sentinel headache” in the days to weeks prior to their index hemorrhage (2). Also concerning is the diagnosis of temporal arteritis, as patients classically develop headaches and associated visual changes. Partial or complete permanent unilateral visual loss occurs in 20% of patients, and often is an early manifestation of the disease. Left untreated, the contralateral eye is often involved within the subsequent 2 weeks (3). Dr. David F. M. Brown: As you mentioned, the headache started 2 weeks ago. Did the patient seek any interim medical care? Dr. Hamedani: Several days after the onset of his headache, the patient saw his primary care physician (PCP). An outpatient computed tomography (CT) scan of the head was completed, and read as negative for intracranial pathology. After several more days, the patient noted his right-sided headache now to be associated with right eye aching. He denied any visual changes at this point. Because of his continued headache, the patient revisited his PCP. This time an outpatient magnetic resonance imaging (MRI) of the head was ordered. Soon after the completion of this study, the patient developed diplopia. His wife, a nurse, also noted new right-sided ptosis. The PCP was re-contacted, and the patient was advised to go to the nearest available Emergency Department (ED). As the Emergency Physicians learned, the preliminary read on the patients’ head MRI from earlier that day was negative for any intracranial pathology. Results of laboratory work done at the outside ED, including an erythrocyte sedimentation rate (ESR), were normal. At this point, the patient was transferred to our hospital for further evaluation of his new-onset ptosis and diplopia. Dr. Michelle Finkel: What further information do we have about this patient’s diplopia? Were there any other cranial nerve deficits? Dr. Hamedani: Upon arrival at our ED, the patient no

The clinical characteristics of new daily persistent headache.

New daily persistent headache (NDPH) is a subtype of chronic daily headache. The literature on NDPH is scant and its true aetiology is unknown. A retrospective chart review was carried out from a computerized database at the Jefferson Headache Centre from August 1997 to May 2000 to identify patients with NDPH using the Silberstein et al. criteria. Forty women and 16 men were identified. Age of onset ranged from 12 to 78 years. The peak age of onset was the second and third decade in women and the fifth decade in men. Eighty-two per cent of patients were able to pinpoint the exact day their headache started. Onset occurred in relation to an infection or flu-like illness in 30%. A prior headache history was found in 38% of patients. A family history of headache was documented in 29%. The duration of daily headache ranged from 1.5 h to 24 h; 79% were continuous. Nausea occurred in 68% of patients, photophobia in 66%, phonophobia in 61%, and lightheadedness in 55%. Laboratory testing and neuroimaging in all patients was normal except for Epstein-Barr virus antibody titres, which were positive in 71% of seven patients tested, representing past infection. NDPH appears to be a female-predominant disorder, marked by a continuous daily headache with associated migrainous symptoms. Over 80% of patients could state the exact date their headache began. One-third of patients developed NDPH with a flu-like illness.

Headache in Cerebral Venous Thrombosis

P37 Objectives: Although headache is the most frequent and often the earliest symptom of cerebral venous thrombosis (CVT), few studies have attempted to define its clinical features. Our aim is to describe the main characteristics of headache in CVT patients. Methods: From March 1996 to June 2000 we prospectively evaluated 39 patients. After clinical examination, diagnostic confirmation was obtained by magnetic resonance imaging and/or angiography. Information about headache was recorded on a standardized form, including location, severity, duration, quality, worsening and associated features. Results: The group included 69% females (mean age 35 years; range 8–81). Headache occurred in 35 patients (89.7%), and was the initial symptom in 84.6%. In 28.6% an isolated intracranial hypertension syndrome occurred. Among 66 % with severe headaches, 70% had multiple sinus thrombosis and 43.4% had intraparenchymal lesions. Four patients (11.4%) had a thunderclap-like headache. Headache onset was acute (&lt; 48 hours) in 9 patients (26%), subacute (48 hours to 30 days) in 7 (20%) and chronic (&gt; 30 days) in the remaining 54%. Headache was mostly focal (63%) and pulsatile in 48.6% patients. Pain worsened with head movements in 31.4% of patients, physical activity in 23% and coughing or sneezing in 20%. The most striking feature was the presence of focal signs (aphasia, motor and sensory deficits and visual field defects) in 74% of patients. In 11 of the 23 patients with severe headache, mean initial CSF pressure was 37.6 cmH2O and in those with thunderclap headache it was 51.7 cmH2O. Prior history of headache was present in 17 of CVT patients (48.6%). Conclusions: Headache was a frequent symptom, usually severe and focal at onset in our CVT patients. The severity of headache seems to be associated with initial CSF pressures, however, a clear relationship with intraparenchymal lesions was not observed. A striking feature was the association of headache and other neurological abnormalities. Thunderclap headache is seldom considered in patients with CVT. Prior headache was frequent and may contribute to diagnostic delays. The recognition of headache characteristics may help earlier identification of CVT patients in the emergency room.

Headache in Cerebral Venous Thrombosis

P37 Objectives: Although headache is the most frequent and often the earliest symptom of cerebral venous thrombosis (CVT), few studies have attempted to define its clinical features. Our aim is to describe the main characteristics of headache in CVT patients. Methods: From March 1996 to June 2000 we prospectively evaluated 39 patients. After clinical examination, diagnostic confirmation was obtained by magnetic resonance imaging and/or angiography. Information about headache was recorded on a standardized form, including location, severity, duration, quality, worsening and associated features. Results: The group included 69% females (mean age 35 years; range 8–81). Headache occurred in 35 patients (89.7%), and was the initial symptom in 84.6%. In 28.6% an isolated intracranial hypertension syndrome occurred. Among 66 % with severe headaches, 70% had multiple sinus thrombosis and 43.4% had intraparenchymal lesions. Four patients (11.4%) had a thunderclap-like headache. Headache onset was acute ( 30 days) in the remaining 54%. Headache was mostly focal (63%) and pulsatile in 48.6% patients. Pain worsened with head movements in 31.4% of patients, physical activity in 23% and coughing or sneezing in 20%. The most striking feature was the presence of focal signs (aphasia, motor and sensory deficits and visual field defects) in 74% of patients. In 11 of the 23 patients with severe headache, mean initial CSF pressure was 37.6 cmH2O and in those with thunderclap headache it was 51.7 cmH2O. Prior history of headache was present in 17 of CVT patients (48.6%). Conclusions: Headache was a frequent symptom, usually severe and focal at onset in our CVT patients. The severity of headache seems to be associated with initial CSF pressures, however, a clear relationship with intraparenchymal lesions was not observed. A striking feature was the association of headache and other neurological abnormalities. Thunderclap headache is seldom considered in patients with CVT. Prior headache was frequent and may contribute to diagnostic delays. The recognition of headache characteristics may help earlier identification of CVT patients in the emergency room.

Postdural Puncture Headache in Pediatric Oncology Patients

This prospective cohort study determined the incidence and risk factors for development of postdural puncture headache (PDPH) in children after lumbar puncture (LP). Eighty-six children were enrolled. LPs were performed with use of 22-gauge spinal needles with the bevel oriented parallel to the long axis of the spine. Follow-up telephone interviews and patients' diary of symptoms were collected. Headache brought on by sitting up and relieved by lying down was defined as PDPH. Of the 80 who completed the study, six (8%) developed PDPH. Two (3%) were less than 6 years old and four (5%) were 6 to 12 years of age. Children with a history of headache following a previous LP were nine times as likely to experience PDPH. PDPH occurs not infrequently in children. A prior history of headache is a predisposing factor.

Motor vehicle accidents, headaches and post-traumatic stress disorder: assessment findings in a consecutive series.

Results of 20 consecutive cases referred for post-traumatic headache (PT-HA) to a psychological practice were assessed for both psychiatric and neurological diagnoses. Nineteen of the 20 cases (95%) had a diagnosable psychiatric disorder, with 15 presenting with a post-traumatic stress disorder. Prior headache history was reported for only 25% of the referred patients, while a prior psychiatric disorder was found for 7 (35%) of the cases. Findings suggest that consideration of a psychiatric disorder should be made for PT-HA patients.

Post‐Traumatic Migraine: Chronic Migraine Precipitated by Minor Head or Neck Trauma

Minor trauma to the head or neck is occasionally followed by severe chronic headaches. We have evaluated 35 adults (27 women, 8 men) with no prior history of headaches, who developed recurrent episodic attacks typical of common or classic migraine following minor head or neck injuries ("post-traumatic migraine"-PTM). The median age of these patients was 38 years (range 17 to 63 years), which is older than the usual age at onset of idiopathic migraine. The trauma was relatively minor: 14 patients experienced head trauma with brief loss of consciousness, 14 patients sustained head trauma without loss of consciousness, and 7 patients had a "whiplash" neck injury with no documented head trauma. Headaches began immediately or within the first few days after the injury. PTM typically recurred several times per week and was often incapacitating. The patients had been unsuccessfully treated by other physicians, and there was a median delay of 4 months (range 1 to 30 months) before the diagnosis of PTM was suspected. The response to prophylactic anti-migraine medication (propranolol or amitriptyline used alone or in combination) was gratifying, with 21 of 30 adequately treated patients (70%) reporting dramatic reduction in the frequency and severity of their headaches. Improvement was noted in 18 of the 23 patients (78%) who were still involved in litigation at the time of treatment. The neurologic literature has placed excessive emphasis on compensation neurosis and psychological factors in the etiology of chronic headaches after minor trauma. Physicians must be aware of PTM, as it is both common and treatable.