Stabbing Headache Research Articles

Advancements in pediatric headache.

To provide an update on advancements in pediatric headache. The symptomatology associated with primary headache disorders has been compared with ICHD-3 criteria. Primary stabbing headache pain lasts longer than 3 seconds in over half of patients. Persistent posttraumatic headache or new daily persistent headache have significant overlap in pain character and nonpain-related symptoms with migraine. In a large cohort with continuous headache at first follow-up, 47% reported resolution of their continuous headache and 19.4% had a 50% or greater reduction in frequency with improvements in fluid intake, sleep, not skipping meals, and exercise. There was no correlation with improved lifestyle habits and clinical outcomes despite the overall improvement. Studies noted significant improvement in headache scores with onabotulinum toxin A and incobotulinum toxin A injections with limited side effects. Intranasal sumatriptan without concurrent intravenous therapies found a clinically meaningful decrease in pain score prior to discharge with shorter lengths of stay and lower emergency department costs compared with the those who received intravenous therapies. Newer studies have suggested changes to symptomatology and duration of pediatric headache syndromes. Onabotulinum toxin A and incobotulinum toxin A injections, and emergency department intranasal sumatriptan are well tolerated therapies in pediatric headache.

Advances in Primary Stabbing Headache: Diagnostic Criteria, Epidemiological Insights, and Tailored Treatment Approaches

Advances in Primary Stabbing Headache: Diagnostic Criteria, Epidemiological Insights, and Tailored Treatment Approaches

Severe Hyperkalemia Caused by Short-term Indomethacin Therapy in a Patient with Primary Stabbing Headache

Severe Hyperkalemia Caused by Short-term Indomethacin Therapy in a Patient with Primary Stabbing Headache

Primary Stabbing Headache in Children and Adolescents.

Primary Stabbing Headache (PSH) is characterized by brief, focal, and paroxysmal pain ("stab"), occurring sporadically or in clusters. Data on pediatric cases are poor. We performed a comprehensive literature review by searching PubMed, Cochrane, and Embase in order to collect pediatric case reports and case series of PSH. A total of 12 out of 162 articles assessed for eligibility were finally included. The prevalence of PSH and probable PSH varies from 2.5 to 10% among children with primary headaches and it is higher among children aged less than 6 years old. The mean age of onset is between 7 and 11 years of age. Attack duration greatly varies, ranging from a few seconds to several minutes. The intensity of pain is usually from moderate to severe. Associated symptoms are infrequent but may be observed (mainly photophobia, vertigo, nausea, and vomiting). Neuroradiological findings are usually unremarkable; EEG may show sporadic epileptiform abnormalities (up to 30% of cases). Preventive therapy is anecdotal, including treatment with indomethacin, trazodone, valproate, and amitriptyline. PSH is a common but still underdiagnosed entity among children with primary headaches; further and larger cohort studies are needed to better assess, in particular, prognosis and response to therapy.

Childhood primary stabbing headache: A double center study.

Primary stabbing headache (PSH) is an idiopathic headache disorder characterized by head pain occurring as a transient and localized single stab or a series of stabs. The present study aimed to examine the characteristics of childhood PSH and whether they fit the International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria. We also investigated the association with migraine and episodic syndromes. In this retrospective study, we included 60 patients seen at two headache clinics (Rome and Bari) between 2016 and 2022. A headache-focused history was obtained. All patients had normal neurological examination. PSH was defined according to ICHD-3 criteria. Twenty-three patients were male (38%) and median (range) age at disease onset was 8 (3-17) years. Stabs recurred with irregular frequency and their duration varied from a few seconds up to 30 minutes. Stabs were located in different head regions. Twenty-five patients (42%) underwent neuroimaging exams. Five children reported a limitation of daily activities and none had a chronic pattern. Forty-seven patients (78%) reported a family history of primary headache, especially migraine, and forty-three had episodic syndromes (i.e. infantile colic, benign paroxysmal vertigo, motion sickness, recurrent abdominal pain, cyclic vomiting). Twenty patients had an associated primary headache: 16 suffered from migraine and four suffered from tension type-headache. According to ICHD-3 criteria, thirty-one patients had a diagnosis of probable PSH as a result of a duration of stabs longer than a few seconds (>3 seconds). Features of childhood PSH can vary widely. As seen in previous studies, several patients reported a stab duration longer than a few seconds and this might suggest that current ICHD-3 criteria may need adjustments to be suitable for children. High frequency of associated migraine and episodic syndromes could suggest a common pathophysiological mechanism between PSH and migraine. We can hypothesize that PSH and migraine attacks may be part of a spectrum of the same disease, although further evidence is needed. Larger studies with long-term follow-up are needed to improve understanding of this condition.

Conventional and unconventional treatments for migraine

Migraine is one of the leading causes of disability in humans. It causes significant deterioration in patients' lives and prevents daily functioning. Its main symptoms include photophobia, an enormous stabbing headache, nausea and vomiting. In addition, it can be accompanied by tinnitus, visual disturbances or dizziness. Before diagnosing migraine, serious intracranial pathology or other neurological conditions should be ruled out. Treatment of acute migraine is difficult due to significant rates of nonresponse to medications and the difficulty in predicting individual response to a particular agent or dose. A new class of drugs, calcitonin gene-related peptide (CGRP) antagonists, has been approved for the prevention of migraine in adults. In contrast, effective first-line therapies for mild to moderate migraine are over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) and combination analgesics containing paracetamol, aspirin and caffeine.

Idiopathic Non-Dental Facial Pain Syndromes in Italian Children: A Clinical Case Series.

The orofacial pain syndromes (OFPs) are a heterogeneous group of syndromes characterized by painful attacks involving the orofacial structures. They may be summarily subdivided into two great categories: (1) orofacial pain mainly attributed to dental disorders such as dentoalveolar and myofascial orofacial pain or temporomandibular joint (TM) pain; (2) orofacial pain mainly attributed to non-dental pain as neuralgias, facial localization of primary headaches or idiopathic orofacial pain. The second group is uncommon, often described by single case reports, can often show overlapping symptoms with the first group, and represents a clinical challenge, carrying the risk of undervaluation and possibly invasive odontoiatric treatment. We aimed to describe a clinical pediatric series of non-dental orofacial pain and better to underline some topographic and clinical features associated with them. We retrospectively collected the data of children admitted to our headache centers (Bari, Palermo, Torino) from 2017 to 2021. Our inclusion criterion was the presence of non-dental orofacial pain following the topographic criteria of 3° International Classification of Headache Disorders (ICHD-3), and exclusion criteria included the pain syndromes attributed to the dental disorders and pain syndromes due to the secondary etiologies Results. Our sample comprised 43 subjects (23/20 M/F, in the range of ages 5-17). We classified them int: 23 primary headaches involving the facial territory during attacks, 2 facial trigeminal autonomic cephalalgias, 1 facial primary stabbing headache, 1 facial linear headache, 6 trochlear migraines, 1 orbital migraine 3 red ear syndrome and 6 atypical facial pain. All patients described debilitating pain for intensity (moderate/severe), 31 children had episodic attacks, and 12 had continuous pain. Almost all received drugs for acute treatment (less than 50% were satisfied), and some received non-pharmacological treatment associated with drug therapy Conclusion. Although rare OFP can occur in pediatric age, it can be debilitating if unrecognized and untreated, affecting the psychophysical well-being of young patients. We highlight the specific characteristics of the disorder for a more correct and earlier identification during the diagnostic process, already difficult in pediatric age, and to define the approach and possible treatment to prevent negative outcomes in adulthood.

Epicranial headache part 1: Primary stabbing headache

Primary stabbing headache is a common but under-recognized primary headache disorder. The objectives of this review were to provide practical information for better understanding and identification of the disease, suggest an algorithm for differential diagnosis, and provide an insight into the pathophysiology of primary stabbing headache hypothesized from its clinical course. This narrative review of primary stabbing headache is based on a literature search and the authors' clinical reasoning. The phenotype of each stab is typically abrupt, ultrashort-lasting (<3 s), focal or multifocal, paroxysms of pain occurring sporadically or in clusters. The diagnosis of primary stabbing headache is clinical; fixed or migrating stabs without background pain or sensory abnormalities and the absence of features suggestive of other disorders (e.g., cranial autonomic symptoms or signs) can aid in the diagnosis of primary stabbing headache. The clinical patterns include monophasic, intermittent, and chronic primary stabbing headache, of which the first two are considered typical. The pathophysiology of primary stabbing headache has not yet been elucidated. In this review, we postulated the mechanism of stabbing headache, based on the pain phenotype and clinical course, and provide a clinical algorithm for the differential diagnosis of primary stabbing headache. Knowledge about the typical manifestations and clinical patterns of primary stabbing headache will aid in the proper diagnosis and differential diagnosis. Treatment should be tailored by considering the clinical patterns. Further research is needed to elucidate the pathophysiological mechanisms and optimal treatment of primary stabbing headache.

Case report: Primary stabbing headache treated with melatonin in Saethre-Chotzen syndrome

Background: Primary stabbing headache (PSH) is a rare primary headache presenting with short, stabbing pain sensations of unknown etiology. Owed to the rare prevalence of the disease, only limited data exists on possible treatment options. The most cumulative expertise exists for indomethacin as a potential treatment in PSH. However, known side effects and long-term tolerability issues have urged the FDA to restrict the use of indomethacin as long-term medication. In about 35% of the cases indomethacin does not provide sufficient relieve, demanding for efficacious and well tolerable alternatives. Case: Herewith we report a case of a young female adult presenting with PSH treated with melatonin resulting in an outstanding and long-lasting response. The patient has a rare underlying genetic disorder leading to facial dysmorphia, which according to the scarce literature, is not associated with PSH so far, but requires extensive exclusion of secondary causes of headaches. Conclusion: Given the exceptional tolerability of melatonin with low concern even on a long-term use, we discuss an indomethacin trial in PSH might be a diagnostic approach rather than a therapeutic one in the future.

Menstrually-related stabbing headache in a patient without migraine: case report

Introduction Stabbing headache is considered a primary headache and is a prevalent entity in the general population. Objective To present an unusual case of stabbing headache associated with menstruation. Method Data collected through complete anamnesis. Case report The authors report a case of a woman suffering from a stabbing headache which features that has not been previously described – a menstrual pattern in the presentation of stabbing headache attacks. Conclusions We conclude that this menstrual pattern of stabbing headache attacks is unusual in patients with primary stabbing headache and that it does not fulfil diagnostic criteria for migraine or tension-type headache.

The Prevalence and Clinical Characteristics of Primary Stabbing Headache.

Objective: This study aimed to determine the prevalence and characteristics of primary stabbing headache in children and adolescents that presented because of headache. Materials and Methods: The medical files of 772 children and adolescents who presented with headache to the Pediatric Neurology Outpatient Clinic at Başkent University between 2012 and 2020 were retrospectively reviewed. In total, 77 patients (9.97%) with primary stabbing headache and those thought to have primary stabbing headache were included in the study. Patient data, including demographic features, headache characteristics, family history of primary headache, electroencephalographic (EEG) findings, and cranial magnetic resonane imaging (MRI) findings, were noted. Results: Age at presentation was <6 years in 16.9% of the patients and onset time of headache was below 3 months in 55.8%. Daily headache attacks occurred in 46.8% of the patients. Headache localization was frontal in 54.5% of patients and bilateral in 68.8%, whereas the quality of headache was undefined in 40.3%. Headache attack duration was seconds long in 37.7% of the patients, attacks occurred at any time of the day in 83.1%, and 80.5% did not have accompanying symptoms. In all, 54.5% of the patients had a negative family history of primary headache. In 95.8% of the patients, EEG findings were normal and cranial MRI findings were normal in 100% of the patients. Conclusion: The prevalence of primary stabbing headache is not rare in children and adolescents. Clinician awareness of the diagnosis and underlying causes of primary stabbing headache should be increased.

Clinical pattern and response to treatment of primary stabbing headache: Retrospective case series study from a Portuguese tertiary hospital.

This retrospective case series study aimed to investigate the demographic and clinical patterns of primary stabbing headache (PSH). In addition, we tried to identify subgroups of treatment responses in a neurology outpatient consultation at a Portuguese tertiary hospital. Clinical records were retrospectively reviewed and patients meeting the International Classification of Headache Disorders, 3rd edition, criteria for PSH were identified from January 2014 to December 2020. We collected data regarding demographic characteristics, clinical features of the headache, primary headache comorbidities, and information about treatment-related do PSH. Of 1857 patients, 32 (1.7%; mean [SD] age of onset 56[3.5]years) had the final diagnosis of PSH. Regarding headache characteristics, 20 patients (62.5%) reported episodes of stabbing in fixed locations and 12 (37.5%) in multiple areas; the duration of each attack was between ≤5 s (seven [21.9%]), 5-60 s (20 [62.5%]), and ≥60 s (five [15.6%]). In all, 18 patients (56.3%) had an episodic course (vs. six of 32 [18.8%] an acute course and eight of 32 [25%] a chronic course). In all, 17 patients started medical treatment (53.1%), with total or partial improvement in 10 (58.8%) of them. It was found that patients with pain in fixed locations had a better response to treatment when compared to patients with multiple locations, in a statistically significant way (eight of 11 vs. two of six, p= 0.023). In our sample, the mean age of onset of PSH was >50 years and there was a wide range of PSH duration. The duration of each attack (>5s), the pain in fixed locations, non-daily episodes of the pain in each attack, and the intermittent course of headache were the most prevalent clinical features. Finally, patients with stabbing in localized areas had a better response to treatment.

Partial Transvenous Coil Embolization with Significant Clinical Improvement in Patient with Indirect Carotid Cavernous Fistula

Highlight: CCF is a rare vascular malformation with challenging management. Partial transvenous embolization is quite effective as an alternative therapy for indirect CCF type D. ABSTRACT Introduction: An indirect carotid-cavernous fistula (CCF) is an abnormal connection between the internal or external carotid artery and the cavernous sinus. The optic, trochlear, abducens, and trigeminal nerves are located in the cavernous sinus. Head Computed Tomography (CT) scan, Magnetic Resonance Imaging (MRI), and Cerebral Angiography are some imaging modalities used to establish and diagnose carotid-cavernous fistula. Endovascular intervention can be performed with trans-arterial or trans-venous access. In some cases, complete embolization by endovascular treatment is not possible because of difficult angioarchitecture. Case: A 61-year-old female reported having pain in her left eye (numerical rating scale was 6). The left eye was bulging, reddish, ptosis, and unable to move. The patient felt double vision when opening both eyes, complained of intermittent stabbing headaches on the left side, and heard a bruit from the left side of the head. The cerebral angiography showed bilateral indirect CCF Barrow type D. The procedure involved partial transvenous embolization with coiling. The angiographic evaluation showed partial occlusion, and residual flow from the fistula was still visible on angiography. There was a significant clinical improvement several days after the procedure and a five-month follow-up. Conclusion: This case report showed that partial targeted transvenous embolization is quite effective in indirect CCF when complete embolization is impossible.

Indomethacin has no effect on trigeminally provoked parasympathetic output.

BackgroundUnlike other non-steroidal anti-inflammatory drugs, indomethacin has been shown to be highly effective in two forms of trigeminal autonomic cephalalgias, hemicrania continua and paroxysmal hemicrania and in some forms of idiopathic stabbing headaches. This specificity is unique in the headache field. Previous findings suggest the involvement of the trigeminal autonomic reflex to play an important role in the pathophysiology of these diseases.Methods22 healthy participants were enrolled in a double-blind, three-day within-subject design. The participants received indomethacin, ibuprofen or placebo in a randomized order. After an incubation period of 65 min the baseline lacrimation and the lacrimation during intranasal stimulation evoked by kinetic oscillation stimulation were assessed using Schirmer II lacrimation tests. The lacrimation difference in mm was calculated and compared in a repeated measures ANOVA.ResultsNo significant differences were found between the three conditions.ConclusionIn our study, neither indomethacin nor ibuprofen had an inhibitory effect on the trigeminal autonomic reflex. We suggest that blocking this reflex may not be the treatment mechanism of indomethacin.

Secondary stabbing headache associated with intracranial tumors, aneurysms, and arteriovenous malformation: An alarming warning sign.

Stabbing headache (SH) is considered as a pure primary headache, but according to a few clinical observations it could also be secondary. Over the past decades, we have been observing the complaint of SH in patients with intracranial vascular and neoplastic lesions. To describe a series of patients with intracranial lesions who experienced SH. This is a cross-sectional, retrospective study of 34patients with intracranial lesions associated with SH, admitted at Hospital das Clínicas, Federal University of Pernambuco, Brazil. In this series of 34 patients [29 women, 44±12years (mean±SD)] with secondary SH, the causes were intracranial neoplasms (n=31), cerebral aneurysms (n=2), or arteriovenous malformation (n=1). Pituitary tumor (n=18), meningioma (n=6), and vestibular schwannomas (n=4) were the most prevalent types of intracranial neoplasms. All these lesions had intimate contact with the dura mater, including an oligodendroglioma, the only intra-axial tumor in the series. A characteristic in the secondary SH is the crescendo pattern (12/34, 35%), progressing from infrequent attacks to recurrent crises occurring several times a day. The SH lasted from 5days to 60months (15±18months, mean±SD) until the correct diagnosis [16/34 (47%) of the patients ≤6months]. The SH was triggered by the movement of the head (5/34, 15%) or Valsalva maneuver (1/34). After surgery, suppression of the SH was observed. In a few of the patients to whom dexamethasone was prescribed, the SH subsided within a few days. This study was able to identify clinical red flags associated with intracranial lesions and secondary SH, for example, recent onset of SH, exclusively unilateral (ipsilateral) at the same location, crescendo pattern, triggered by head movements, or Valsalva maneuver.

Atypical Presentation of Primary Stabbing Headache in a Patient With Type 3 Gaucher Disease

Atypical Presentation of Primary Stabbing Headache in a Patient With Type 3 Gaucher Disease

Primary stabbing headache: the need for a definition for children and adolescents.

This commentary is on the original article by Ahmed et al. on pages 69‐74 of this issue.

Primary stabbing headache in children and adolescents.

To examine the characteristics of primary stabbing headache (PSH) in typically developing children and adolescents. In this prospective non-interventional hospital-based study, we examined 42 eligible individuals (24 females, 18 males; 26 white; mean age 12y 1mo, range 6y-16y 1mo) with spontaneous transient stabs. A headache focused history and/or a headache diary was obtained from each patient. All patients had normal neurological examination. Diagnosis of primary headache was based on the International Classification of Headache Disorders, Third Edition (ICHD-3) beta version. Duration of stabs ranged from a few seconds to up to 10minutes. Stabs were located in a variety of sites on the cranium but mostly in the extra-trigeminal regions (n=28). Intensity of stabs varied from moderate (n=4) to severe (n=38). The frequency of the stabs ranged from daily to monthly. There were up to 50 stabs per headache attack. Stabs among our patients occurred independently from those caused by other primary headache types. Accompanying symptoms during stabs were reported by eight patients. Family history of primary headaches was identified (n=17). Familial transmission of PSH was recognized among two patients. All patients had normal brain magnetic resonance imaging. The presentation and nature of PSH in children and adolescents varies widely. PSH in children may be a different entity to that in adults, and there is a need for further research to support changes in the ICHD-3 criteria for PSH in children and adolescents. Presentation of childhood primary stabbing headache (PSH) varies widely. Duration of PSH could last from a few seconds up to 10minutes.

Primary Stabbing Headache.

To provide a comprehensive and updated review of the literature on primary stabbing headache. Changes to the ICHD-3 criteria have resulted in increased sensitivity to capture primary stabbing headache (PSH). According to the ICHD-3, the sharp stabbing pain is no longer restricted to the first division of the trigeminal nerve. Age, gender, and co-morbidities such as migraine seem to influence the prevalence of PSH. Subclassification into monophasic, intermittent, and chronic forms have been proposed in a recent prospective study and may be helpful from a prognostication perspective; however, further studies are required. Secondary etiologies for stabbing headaches are part of the differential diagnosis of primary stabbing headache; therefore, it is reasonable to perform neuroimaging. For severe frequent attacks, indomethacin continues to be considered first line. Other treatment options include COX2 inhibitors and melatonin.

Development and Validation of the Cluster Headache Screening Questionnaire.

Background and PurposeCluster headache (CH) is frequently either not diagnosed or the diagnosis is delayed. We addressed this issue by developing the self-administered Cluster Headache Screening Questionnaire (CHSQ).MethodsExperts selected items from the diagnostic criteria of CH and the characteristics of migraine. The questionnaire was administered to first-visit headache patients at nine headache clinics. The finally developed CHSQ included items based on the differences in responses between CH and non-CH patients, and the accuracy and reliability of the scoring model were assessed.ResultsForty-two patients with CH, 207 migraineurs, 73 with tension-type headache, and 18 with primary stabbing headache were enrolled. The CHSQ item were scored as follows: 3 points for ipsilateral eye symptoms, agitation, and duration; 2 points for clustering patterns; and 1 point for the male sex, unilateral pain, disability, ipsilateral nasal symptoms, and frequency. The total score of the CHSQ ranged from 0 to 16. The mean score was higher in patients with CH than in non-CH patients (12.9 vs. 3.4, p<0.001). At a cutoff score of >8 points, the CHSQ had a sensitivity, specificity, positive predictive value, and negative predictive value of 95.2%, 96%, 76.9%, and 99.3%, respectively.ConclusionsThe CHSQ is a reliable screening tool for the rapid identification of CH.