Secondary Causes Of Headache Research Articles

Cranial osteomyelitis associated with SAPHO syndrome: An underdiagnosed cause of chronic headache

AbstractA 50‐year‐old woman having palmoplantar pustulosis was admitted with a headache accompanied by occipital bulge. She had a history of cryptogenic cervical spondylitis which had not completely remitted despite treatment with nonsteroidal anti‐inflammatory drugs. Head magnetic resonance imaging revealed enhanced swelling in the soft tissues of the right occipital region corresponding to the bulging locus. Bone scintigraphy demonstrated increased uptake in the parieto‐occipital bone, cervical spine, and sternoclavicular joints. Considering the negative results of the culture tests, she was diagnosed with aseptic cranial osteomyelitis induced by synovitis‐acne‐pustulosis‐hyperostosis‐osteitis (SAPHO) syndrome; cervical osteitis might induce her unidentified spondylitis. This syndrome is unrecognized as a cause of secondary headache. Based on our review of previous reports and the current case, we suggest that a painful bulge, which is demonstrated as an enhanced swelling in the cephalic soft tissue, may be a diagnostic cue for SAPHO syndrome.

Current Understanding of the Pathophysiology and Approach to Tension-Type Headache

Description of headache dates back thousands of years, and to date, tension-type headache (TTH) remains the most common form of headache. We will review the history and current understanding of the pathophysiology of TTH and discuss the recommended clinical evaluation and management for this syndrome. Despite being the most prevalent headache disorder, TTH pathophysiology remains poorly understood. Patients with TTH tend to have muscles that are harder, more tender to palpation, and may have more frequent trigger points of tenderness than patients without headache. However, cause and effect of these muscular findings are unclear. Studies support both peripheral and central mechanisms contributing to the pain of TTH. Diagnosis is based on clinical presentation, while the focus of evaluation is to rule out possible secondary causes of headache. Treatment options have remained similar over the course of the past decade, with some additional studies supportive of both pharmacological and non-pharmacological options. An approach to TTH has been outlined including historical context, evolution over time, and the best evidence regarding our current understanding of the complex pathophysiology and treatment of this disease.

Headache in hypertension patients in young rural population of Punjab

Objectives; To find the association of essential hypertension and headache in rural young population of PUNJAB, so as to treat the cases at the earliest stage . Material and Methods: The study is conducted in medical department of Pak Red Crescent Medical college Dina Nath in the period from October 2020 to June 2021 . fifty four patients including thirty three males and twenty one females with essential hypertension in age group of 18-35 were selected after scrutinizing clinically and on investigations. The patients were then differentiated as those suffering from generalized headaches without any secondary cause of headache were included Results: Total nineteen patients including seven males out of thirty three males and twelve out of twenty one females in the hypertension patients were having headache. So positivity in males was twenty one percent and in females was fifty seven percent , however in total 19/54 I e 35% were found having headache. Conclusions: All the patients with hypertension should be further evaluated for headache and it is not necessary that some secondary cause of hypertension is necessary for headache but there are many other other pathophysiological links which are still to be evaluated. Keywords: headache, hypertension.migraine, antihypertensive

Clinical presentation and assessment of older patients presenting with headache to emergency departments: A multicentre observational study.

To describe the characteristics, assessment and management of older emergency department (ED) patients with non-traumatic headache. Planned sub-study of a prospective, multicentre, international, observational study, which included adult patients presenting to ED with non-traumatic headache. Patients aged ≥75years were compared to those aged <75years. Outcomes of interest were epidemiology, investigations, serious headache diagnosis and outcome. A total of 298 patients (7%) in the parent study were aged ≥75years. Older patients were less likely to report severe headache pain or subjective fever (both P<0.001). On examination, older patients were more likely to be confused, have lower Glasgow Coma Scores and to have new neurological deficits (all P<0.001). Serious secondary headache disorder (composite of headache due to subarachnoid haemorrhage (SAH), intracranial haemorrhage, meningitis, encephalitis, cerebral abscess, neoplasm, hydrocephalus, vascular dissection, stroke, hypertensive crisis, temporal arteritis, idiopathic intracranial hypertension or ventriculoperitoneal shunt complications) was diagnosed in 18% of older patients compared to 6% of younger patients (P<0.001). Computed tomography brain imaging was performed in 66% of patients ≥75years compared to 35% of younger patients (P<0.001). Older patients were less likely to be discharged (43% vs 63%, P<0.001). Older patients with headache had different clinical features to the younger cohort and were more likely to have a serious secondary cause of headache than younger adults. There should be a low threshold for investigation in older patients attending ED with non-traumatic headache.

Pediatric Headaches: One year of Observation from A Tertiary Center

Objective: This study aims to investigate the demographic, clinical features of children and adolescents with headaches which is one of the most common reason for referral to pediatric neurology clinics in addition to elucidating the frequency of primary and secondary headaches as well as their management. Material and Methods: We retrospectively reviewed the medical reports of children and adolescents who were referred to Ankara City Hospital, Department of Pediatric Neurology between December 2019 and December 2020. Results: During the study period, 236 (86.8%) children, and adolescents were diagnosed with primary headaches and 36 (13.2%) were diagnosed with secondary headaches. Tension headaches were the most frequent (71.2%) type of primary headaches while headache or facial pain attributed to disorders of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cervical structure were the most frequent (38.8%) type of secondary headaches. All patients with secondary headaches had at least one red flag while 23 (63.8%) patients had 2 or more red flags. Magnetic resonance imaging was diagnostic in 58.3% of the patients while EEG was diagnostic in 6% of the patients. Conclusion: Pediatric patients presenting with headaches should be carefully examined to diagnose and treat the causes of secondary headaches which can be life-threatening and require urgent treatment. On the other hand, accurate diagnosis is very important in primary headaches which constitute more than 80% of all headaches and have detrimental effects on life quality as a result of refraining from daily activities.

Approach to Pediatric Intractable Migraine.

Intractable migraine in children and adolescents is a significant cause of disability and decreased quality of life (QoL) in this population. Challenges include lack of unifying definition for intractable migraine, and limited data on best-practice management in this age group, with most current treatment pathways extrapolated from adult studies or expert consensus. A comprehensive approach in the evaluation and management of intractable migraine in this age group encompasses excluding secondary causes of headache; making an accurate diagnosis; identifying and appropriately managing modifiable risk factors; and initiating appropriate pharmacologic therapy to reduce disability, improve health-related quality of life, reduce risk of progression, and develop adaptive pain coping strategies. Several strategies for management of pediatric intractable migraine including use of acute medications, bridge therapy in outpatient setting, emerging therapies for preventive therapy, and a stepwise combination therapy for management of pediatric intractable migraine in emergency and inpatient setting are presented based on available clinical data, safety/tolerability, availability, cost-effectiveness, and expert consensus. This descriptive review of the available literature focuses on approach to therapy for acute intractable migraine in a pediatric population including outpatient, emergency department (ED), and inpatient management.

Hypnic headache: a rare type of primary headache disorder

ObjectiveHypnic Headache are is a very rare primary headaches that affect the elderly, with an average age of 60 years. Research in the areas of neurophysiology and treatment options for Hypnic Headache are necessary in order to better understand, and improve outcomes for this rare headache disorder.Case reportMr. X is a 70-year-old patient, has been presenting with the complaints of headache during sleep at night for the last 1 year. The Headache started after 3 to 4 hours after falling asleep. Due to headache, he wakes up from sleep around 03:00 to 04:00 am almost every night and his headache persist for 30 to 40 minutes. After waking up from sleep he keeps himself busy with religious activity and the headache gradually resolves. He then goes back to bed again.Mr. X also informed that, the headache is dull in nature and located in left temporo occipital region. It is not associated with photophobia, phonophobia, nausea, vomiting, tearing or discomfort in the leg. He gives no history of early morning headache or day time headache, sleep disorder, snoring or sleep apnea. He has no past history of trauma to the head, fainting attack, unconsciousness, weakness or paralysis of limbs, seizures or non-epileptic seizures. He is an non-smoker, non-alcoholic, non-hypertensive &amp; non-diabetic person.On general examination, his heart rate is 70 beats/min, blood pressure 138/68 mm of Hg. There are no anemia, jaundice or oedema present in him. His both lung fields are clear. On neurological examinations there are nothing abnormality detected. His Serological investigations, CBC (Complete Blood Count) FBS (Fasting Blood Glucose), lipid profile are within normal limit. CT scan of the brain is normal. There are no cerebral atrophy or volume loss compatible with age.Mr. X was treated by several general practitioners with paracetamol, diclofenac sodium, mefenamic acid, tramadol hydrochloride. He used these drugs either singly or in combinations. But with this treatment there were no significant improvement occurs. Mr. X is scared and depressed for his sleep time headache.DiscussionHypnic headache is a very rare headache disorder. It occurs in age groups over 60 years. It is occur at night during in sleep and waking the patient up, hence the name of it “alarm clock headache”. It is commonly unilateral and lasts for 15 minutes to 4 hours. Hypnic headache commonly dull or throbbing in character and does not make the patient restless, unlike in Cluster Headache. After waking up from sleep, most patients engage in some activity. Hypnic headache is not associated with rhinorrhea, tearing and ptosis. Diagnosis is mainly clinical. Secondary causes headache must be excluded. International Classification of Headache Disorders 3rd Edition (ICHD-3)-beta provides diagnostic criteria for hypnic headache. Pathophysiology of hypnic headache is not clearly identified. Usual treatment options of Hypnic headache includes bed time coffee, lithium carbonate, indomethacin. Our patient fulfil all the criteria of Hypnic headache and he fells improvement with Indomethacin 50 mg in devided doses.ConclusionHypnic Headache is a very rare type of primary headache. It should be diagnosed only after other secondary causes of headache have been excluded. Caffeine, lithium carbonate, flunarizine, indomethacin, used to treat the patient of Hypnic Headache. Lack of study and awareness about these disorders can lead to delays in diagnosis and treatment. Clinical trials are needed to find out proper treatment, but it will be difficult to perform because of the rareness of this disorder.

Diagnosing Secondary and Primary Headache Disorders.

This article provides a systematic diagnostic approach to the patient with headache. The vast majority of patients presenting with headache in clinical practice have a primary headache disorder. The most common primary headache disorder in clinical practice is overwhelmingly migraine. Unfortunately, a substantial proportion of patients with migraine do not receive an accurate diagnosis. In addition, the clinical features of migraine overlap with secondary causes of headache, making a careful history and deliberative evaluation for warning symptoms or signs of a secondary headache disorder of paramount importance. The approach to the patient with headache requires knowledge of the diagnostic criteria for primary headache disorders, recognition of the importance of a systematic evaluation for red flags associated with secondary headache disorders, and awareness of the pearls and pitfalls encountered in the diagnostic evaluation of a patient with headache.

When doom is vincible but imperceptible

An eighty-year-old gentleman without any comorbidity or significant medical illness had presented with headache of recent onset. A detail clinical evaluation and imaging (MRI of brain) ruled out secondary cause of headache. A month later, he presented to emergency with altered sensorium and quadriparesis. Repeat brain imaging revealed bilateral subdural hemorrhage requiring emergent surgery. He was back to normalcy within few days postoperatively. A confession was obtained about his daily habit of induced vomiting after drinking large amount of water (kunjala kriya). The repeated habit of induced vomiting might have been responsible for the slowly evolving subdural hemorrhage. Interestingly, though he had significant clinical symptoms at the initial presentation, he had normal initial MRI of brain (the more sensitive imaging modality). Our case highlights the interesting neurophysiology of subdural hemorrhage and the importance of close monitoring of elderly patients of recent onset headache.

RCVS: An Unusual But Treatable Cause Of Headache

Introduction: Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by severe headaches, with or without other acute neurological symptoms, and diffuse segmental constriction of cerebral arteries that resolves spontaneously within 3 months. The mean age of onset is 42 years, and it affects more women than men. RCVS is possibly caused by a transient dysregulation of cerebral vascular tone, leading to multi-focal arterial constriction and dilation. Approximately 60% of the cases are secondary to a known likely cause. Case Report: We report the case of 20 year old female with severe headache, due to vasospasm of vessels with intraparenchymal haemorrhage and spasm that relieved spontaneously in 7 weeks documented with repeat MRI. Conclusion: RCVS is a secondary cause of headache. Patients who have thunderclap headache with normal brain CT and cerebrospinal fluid without xanthochromia should be investigated for reversible cerebral vasoconstriction syndrome.

Breaking the cycle of medication overuse headache.

Care of this disorder can be complex-from ruling out another secondary cause of headache to supervising detox from abortives, providing preventives, and educating often-fearful patients.

Clinical Characteristics and Management of Headache: A Real-Life Prospective, Observational Study From a Tertiary Care Center in Eastern India

Objective: To describe clinical profile and management pattern of headache in patients presenting to a tertiary care center. Methods: In this observational study, demographics, radiological investigations, triggers, and treatment pattern in patients aged ≥ 14 years presenting with headache were recorded. Disability and severity of headache were assessed with Migraine Disability Assessment (MIDAS) score, Visual Analogue Scale (VAS), and Headache Impact Test (HIT-6) in case of migraineurs and VAS and HIT-6 for all other headache disorders. Patients were evaluated at baseline and after three and six months post-treatment.Results: Out of 400 patients (60.25% females and 39.75% males), 277 (69.25%) had primary headache among whom 119 (42.96%) had migraine without aura. Stress, menstruation, fasting, and inadequate sleep were common triggers for migraine. Nausea, vomiting, photo-phonophobia and neck pain were the most common accompanying symptoms in patients with headache. Out of 106 (38.3%) patients with tension-type headache, 68.9% were episodic. In the migraine subset, 81% presented with moderate to severe disability at baseline, which changed to minimal to mild disability at three and six months post-treatment (p < 0.001). For abortive treatment, 130 (79.7%) patients were prescribed naproxen, domperidone, and sumatriptan. In 69 (42.3%) patients, valproic acid/divalproex was used for prophylaxis. Most common causes of secondary headaches (30.75%) were intracranial bleeds and cerebral venous sinus thrombosis. Most common abnormalities on computerized tomography were intracerebral hemorrhage, subarachnoid hemorrhage, sinusitis, and space-occupying lesions (SOLs).Conclusion: In our study, migraine was the most common etiology of headache. Headache was more common in females than males, and primary headache was more common than secondary headache. Sodium valproate was the commonly used prophylaxis in migraine.

Secondary Headache: Current Update

The purpose of this paper is to review some of the causes of secondary headache particularly focusing on the subcategories of secondary headache in the International Classification of Headache Disorders, 3rd edition, the clinical features of these headaches, and their associated features and management. Headache attributed to trauma or injury to the head and/or neck, headache attributed to cranial or cervical vascular disorder, headache attributed to non-vascular intracranial disorder, headache attributed to a substance or its withdrawal, headache attributed to infection, headache attributed to disorder of homeostasis, and headache or facial pain attributed to disorder of the cranium, neck, eye, ears, nose, sinuses, teeth, mouth, or other facial or cervical structure are discussed in this paper. Headache is a common symptom of multiple medical conditions. Although a minority of headache patients have a secondary basis for their headaches, it is important to identify clinical features of secondary headache disorders including both the headache and non-headache features of the condition, diagnose the secondary etiology correctly, and treat them appropriately.

Presence of red flags in patients with cerebral venous sinus thrombosis admitted to the emergency department because of headache: A STROBE compliant cohort-study.

Cerebral venous sinus thrombosis (CVST) is a cause of secondary headache with substantial morbimortality. Headache dominates the clinical presentation, but no typical phenotype has been described. We aim to evaluate the presence of red flags in headache in patients with confirmed CVST at the moment of emergency department (ED) presentation.Retrospective STROBE compliant cohort study including patients with confirmed CVST that consulted because of headache at the ED. We analyzed presence and type of red flags at the moment of consult. We evaluated whether CVST was suspected at the moment of imaging request and analyzed delay in the diagnosis.Nineteen patients fulfilled inclusion and exclusion criteria. Mean age was 48.5 years, 47.4% were female. All the studied patients exhibited at least 1 red flag, being abnormal neurological examination the most frequent (79%), followed by the presence of other neurological symptoms (68%), alarm data related with headache phenotype (63%), or risk factors concerning prior medical history (47%). Temporal pattern of the headache was acute in 42.1%, thunderclap in 31.6%, and subacute in 26.3%. In none patient CVST was the specific suspicion when imaging was requested. Median time since headache onset and ED presentation was 84 hours, being different in patients with associated symptoms (48 hours) when compared with isolated headache patients (168 hours). Time since ED presentation and the diagnosis also differed between the 2 groups, being more prolonged in patients with an isolated headache at presentation.Headache attributed with CVST did not exhibit any distinctive phenotype, but all the patients presented some red flag, being abnormal neurological examination the most frequent.

Headache in Behçet’s Disease

Our objective is to describe the various neurologic manifestations of Behcet's syndrome with special attention to headache syndromes. Most recent studies have focused on data collection to better characterize the relatively rare disorder of neuro-Behcets (NBD). In patients with Behcet's disease (BD) who are experiencing headache, most are primary headache disorders, specifically tension type or migraines. Worsening headache can, however, be a sign of increased Behcets disease activity. Behcet's disease is a chronic, systemic, inflammatory disorder of unknown etiology. The prevalence of BD is most notable in countries along the ancient Silk Road, particularly the Middle East. BD occasionally has neurologic manifestations, further categorized into parenchymal and non-parenchymal syndromes. Headache is the most frequently reported neurological symptom of BD. Primary headaches are the most common headache type among patients with BD with comorbid headache disorders with debate regarding whether migraine or tension-type headache is most prevalent. Of the secondary causes of headache in BD, cerebral venous thrombosis is the most common.

Suspected Status Migrainosus During Flu Season

Objective: The following case report is presented to highlight the importance of maintaining a high index of suspicion for secondary causes of headache, especially during influenza season. Case Report: A 61-year-old woman with a history of infrequent episodic migraine without aura presented to our multidisciplinary pain management center during the flu season with a 1-month history of persistent and continuous headache, suspicious for status migrainosus. Imaging of the brain was obtained to rule out secondary causes of headache and was notable for findings consistent with acute rhinosinusitis. Conclusion: We discuss a case of headache secondary to acute rhinosinusitis during the flu season presenting as suspected status migrainosus. Herein, we discuss the differential diagnosis of secondary headache of 1-month duration and present the treatment options for headache secondary to acute rhinosinusitis.

Functional Neuroimaging Biomarkers in Migraine: Diagnostic, Prognostic and Therapeutic Implications.

In current migraine clinical practice, conventional neuroimaging examinations are often sought to exclude possible causes of secondary headaches or migraineassociated disorders. Contrariwise, although advanced Magnetic Resonance Imaging (MRI) has improved tremendously our understanding of human brain processes in migraine patients, to the state of the art they have not superseded the conventional neuroimaging techniques in the migraine clinical setting. A comprehensive review was conducted of PubMed citations by entering the keyword "marker" and/or "biomarker" combined with "migraine" and/or "headache". Other keywords included "imaging" or "neuroimaging", "structural" or "functional". The only restriction was English-language publication. The abstracts of all articles meeting these criteria were reviewed, and the full text was retrieved and examined for relevant references. Several authors tried to identify imaging biomarkers able to identify different migraine phenotypes or, even better, to follow-up the same migraine patients during the course of the disease, to predict the evolution into more severe phenotypes and, finally, the response to specific treatment. The identification of diagnostic, prognostic and therapeutic advanced neuroimaging biomarkers in the migraine clinical setting, in order to approach to patients in a more and more rational and "tailored" way, is extremely intriguing and futuristic. Unfortunately, reliable and robust neuroimaging biomarkers are still lacking for migraine, probably due to both not completely understood pathogenesis and clinical and neuroimaging heterogeneity. Although further longitudinal advanced neuroimaging studies, aimed to identify effective neuroimaging biomarkers, are needed, this review aims to collect the main and most recent works on this topic.

Headache and Methemoglobinemia

This basic review is intended to summarize the current knowledge of methemoglobinemia as an important cause of secondary headache with the hope of generating a growing interest in studying this phenomenon. We describe the pathological underpinnings of headaches generated by hypoxia. Possible mechanisms include cerebral vasodilation-associated stretching of the vessel nociceptors, sensitization of perivascular nociceptors mediated by nitric oxide, cerebral calcitonin gene-related peptide, activation of the cyclic adenosine monophosphate pathway, cortical spreading depression, disruption of the blood-brain barrier, and neurogenic inflammation. We review the clinical features, pathophysiology, and management of methemoglobinemia. We conducted a literature review of reports of symptomatic methemoglobinemia with headache. In addition, we describe a case report of a patient who presented with an acute onset of severe holocranial headache associated with rapidly progressive perioral paresthesia, cyanosis in lips and hands, nausea, and mild dyspnea on exertion. These features can be misinterpreted as an acute attack of migraine with pain-related hyperventilation syndrome and anxiety leading to clinically detrimental delay in the management of the progressive hypoxia. Her symptoms resolved following treatment with methylene blue. The complex relationship of migraine and hypoxia-related headaches is also reviewed. We propose that methemoglobinemia-associated headaches are possibly generated by stretching of the nociceptor nerve endings during cerebral vasodilation and hypoxia-mediated oxidative stress. The case highlights the need to broaden the formulated differential diagnosis of an acute onset severe holocranial headache and pay careful attention to other signs and symptoms that may provide hints on potential mechanism(s) for secondary headaches. We provide justification for the need to incorporate "Headache attributed to Methemoglobinemia" as a subtype under the section "Headache attributed to hypoxia and/or hypercapnia" of the International Classification of Headache Disorders to support clinical decision making.

Reflection of the burden of headache and facial pain on the community and underlying pathologies: A prospective study from benghazi libya

Background Headache is the most common cause of neurological referral. An International Classification for headache produced by the International Headache Society (IHS) is regularly updated. Objectives The aims of the study were to define prospectively the clinical and economic burden of the different types of headache and cranio-cervical pains in 202 patients referred to Benghazi neurological clinics. Methods 202 adult Libyan patients with headache referred to the neurology clinics and emergency rooms of Benghazi Teaching Hospitals, Libya, (80males and 122 females) were studied prospectively both clinically and using a questionnaire. Results Stress was a prominent trigger for headache in 91.6%, the most common comorbidity was arterial hypertension in 27.7%. The most common single primary headache was migraine in 47%,followed by tension headache in 20.8%, both types occurred in 6.4% patients, and the most common single causes of secondary headaches were sinusitis 9.4% and cervicogenic headache 8.9%, analgesia excess headache occurred in 27.7%. Genetic phenotypes were found in 11.9% patients and epilepsy in 16.3%. Most of the patients were highly educated 62.6% but, only 42.6% had an economical status consistent with a professional of their educational level. The patients who were aware that headache prophylaxis is possible were 31.7% and 62.3%were imaged. Further analysis of the headache types, trigger and relieving factors and management was performed in this study. Conclusion Educating students, medical and paramedical staff into the various aspects of the pathophysiology and management of headaches and facial pains can have huge economical and health-related beneficial impact.

VANISHING HEADACHE IN A YOUNG FEMALE: AN INTERESTING CASE REPORT

Headache is one of the most common neurological symptom occurring worldwide. Here, we present a unique case of secondary headache in a young female which got reversed with appropriate treatment. A young female who presented with a severe subacute unilateral left-sided intractable headache with papilledema and obstructive hydrocephalus was found to have 4th ventricular neurocysticercosis causing obstruction of the foramen of Magendi and Luschka, relieved on timely surgical excision and with medical management. This case is reported to highlight the rare causes of secondary headache and various presentations of neurocysticercosis, in endemic areas like India as it causes neurological morbidity which can be alleviated on appropriate treatment, thereby preventing economic hardship and improving the quality of life.