Unusual Headache Research Articles

Spontaneous Intraventricular Tension Pneumocephalus

Here, we report a very rare case of spontaneous intraventricular tension pneumocephalus. This case concerns a 40-year-old patient with medical history of a tumor of the pineal region and a secondary hydrocephalus treated by multiple ventriculoperitoneal shunts. He presented in the emergency room because of unusual headaches, nausea, and visual loss. In addition, he reported slight rhinorrhea in the past few weeks. The initial brain computed tomography scan revealed a spontaneous intraventricular tension pneumocephalus. There was no history of recent head trauma and no sign of disconnection of the shunt system. A complementary radiologic assessment including a thin-slice bone computed tomography scan and a radioisotope cisternography revealed an osseous defect and an isotope leakage at the junction between the tegmen tympani and the squamous part of the left temporal bone. A middle cranial fossa surgery was performed to repair the osteo-meningeal breach.

Computational Insights on Migraine and Anxiety in Association with BDNF

Background:: Migraine is an unusual piercing headache on one side of the head. It is due to the dysregulation of epigenetic factors associated with the brain. Migraine affects about one percent of the general population. Despite the recent implementation of worldwide diagnostic criteria for migraine, this disorder remains relatively unknown and is frequently underdiagnosed. Migrainous conditions are also associated with anxiety and stress. This pathologic condition affects the daily life and productivity of the patients. Objective:: Hence, there is a need to develop proper treatment and management strategies to cope with migraine and associated anxiety. Through in silico approaches, this work elucidates to identify the effective lead compounds for migraine and anxiety. Methods:: Brain-derived neurotrophic factor (BDNF) was identified as a possible target for treating migraine and anxiety using computational analysis. Virtual screening and molecular dynamics simulation were used to find potential agonists with high affinities for BDNF. Results:: Based on the results of computational analysis (glide XP score, number of interactions, glide energy, and pharmacokinetic factors), four top hit molecules (Asinex_35922, Enamine_44630, Maybridge_1999, and SMMDB_17457) were identified and taken for further analysis. The hydrogen bond interactions between the agonists and the BDNF protein were verified by dynamics analysis Conclusion:: Computational studies support that BDNF agonist molecules could be effective regulating molecules for migraine and anxiety. For further evidence of the effectiveness of lead compounds in treating migraine and related anxiety, more experimental studies are necessary.

Caractéristiques et profils évolutifs des patients avec un diagnostic récent d’artérite à cellules géantes, étude NEWTON

IntroductionThe management of giant cell arteritis (GCA) has evolved with the arrival of tocilizumab (TCZ) and the use of PET/CT. Our objective is to describe the characteristics and followup of patients with recent diagnosis of GCA in current care. Patients and methodsThe NEWTON cohort is a monocentric retrospective cohort based on data collected from 60 GCA patients diagnosed between 2017 and 2022 according to the ACR/EULAR 2022 criteria. ResultsThe median age at diagnosis was 73 [68.75; 81] years old. At diagnosis, the main manifestations were unusual temporal headaches in 48 (80 %) and an inflammatory syndrome in 50 (83 %) patients. Temporal artery biopsy confirmed the diagnosis in 49/58 (84 %) patients. Doppler of the temporal arteries found a halo in 12/23 (52 %) patients. The PET/CT found hypermetabolism in 19/43 (44 %) patients. Prednisone was stopped in 17.5 [12.75; 24.25] months. During follow-up, 22 (37 %) patients received TCZ. At least one complication of corticosteroid therapy was observed in 22 (37 %) patients. After a median follow-up of 24 [12; 42] months, 25 (42 %) patients relapsed. At the end of the follow-up, 29 (48.3 %) patients were weaned from corticosteroid therapy and 15 (25 %) were on TCZ. ConclusionDespite the increasing use of TCZ in the therapeutic arsenal and of the PET/CT in the imaging tools of GCA patients, relapses and complications of corticosteroid therapy remain frequent, observed in more than a third of patients.

Meningo encephalitis with Epstein-Barr virus in an immunocompetent adult patient: case report

Epstein-Barr virus is a rare ethology of the neurological infections, expressed as encephalitis, aseptic meningitis, Guillain-Barre syndrome or acute demyelinating encephalomyelitis. Most common cases were reported in children, while this infection is rarely described in immunocompetent adults. We present the case of an elderly immunocompetent patient with hypertension and hypothyroidism under treatment who has presented to the emergency department for unusual headache, confusion, sudden loss of consciousness with retrograde amnesia, suddenly onset for 2 hours associated with febrile respiratory symptoms. Traumatic neurological events, cerebral ischemia or metabolic encephalopathies were ruled out, while examination of the cerebrospinal fluid was positive for Epstein-Barr virus. The course of the meningoencephalitis was favorable, although an episode of diarrhea with Clostridioides difficile with binary positive toxin A+B was notified. The primary infection or the reactivation of a previous infection, is a questionable mechanism of meningoencephalitis with Epstein Barr Virus in an old immunocompetent patient. According to the reported studies, the antiviral treatment with Acyclovir is controversial. The long-term prognosis of acute meningoencephalitis with Epstein-Barr virus is unpredictable and involves careful neurological and onco-hematological monitoring.

Headache characteristics to screen for cervicocerebral artery dissection in patients with acute onset unusual headache.

The aim of this preplanned primary analysis was to investigate the clinical manifestations of headache to screen for CAD patients with acute onset headache only. Spontaneous cervicocerebral artery dissection (CAD) with acute onset headache is not rare in clinical practice; however, it is underdiagnosed. On the other hand, subsequent infarction or subarachnoid hemorrhage mainly occurs within 1 week of headache onset. Between April 2017 and January 2022, we conducted a single-center, cross-sectional retrospective study on 197 consecutive referred patients from neurosurgical outpatient clinics with acute onset unusual headache (stronger or longer headache than usual). All patients underwent magnetic resonance imaging to screen for secondary headache and were diagnosed based on the diagnostic protocol. We examined patient background data and the following headache characteristics: distribution, condition at the onset of headache, accompanying vomiting or nausea, worsening headache, and analgesic effects against headache. These factors were analyzed to identify independent diagnostic predictors of CAD. In this study, the rate of missing data was 41% for improvement of headache by analgesia and multiple imputation by chained equations was performed. A total of 93 patients (46 men and 47 women; mean age: 48 years, range: 25-73 years) were diagnosed with CAD. Univariate logistic regression analysis showed CAD was associated with current smoking, systolic blood pressure >140 mmHg, unilateral headache, worsening headache, and no headache improvement by analgesia. Unilateral, worsening headache and no headache improvement by analgesia remained independent diagnostic predictors in multivariable logistic regression after multiple imputation. No headache improvement by analgesia had the highest sensitivity (86%), while worsening headache had the highest specificity (84%). CAD needs to be considered in patients with unilateral, worsening headache and no headache improvement by analgesia.

Pathophysiological crosstalk between migraine aura and epilepsy: Effect of lomerizine hydrochloride

AbstractA 29‐year‐old woman previously diagnosed with both migraine with aura and epilepsy visited our hospital complaining of unusual headaches. The prodromal symptoms changed from typical scintillating scotoma to short‐lasting moving lights against deja‐vu scenery. Then, loss of consciousness and urinary incontinence after headaches, and even generalized convulsion began to occur. Lomerizine hydrochloride decreased her headache attacks, urinary incontinence, loss of consciousness, and seizure. We considered her headache changed from migraine with typical aura to post‐ictal headache. Lomerizine hydrochloride may have alleviated epilepsy in addition to migraine.

A cross-sectional study of knowledge of, attitude towards COVID-19 and prevalence of COVID-19 symptoms among undergraduate students of Niger Delta University, Bayelsa State, Nigeria

This study aimed to assess the levels of Knowledge, Attitude and Prevalence of COVID-19 symptoms among students of Niger Delta University in Bayelsa State of Nigeria. It was a descriptive cross-sectional study. Data was collected using convenience sampling among 350 participants drawn from the faculties of Pharmacy [75], Nursing [80], Management science [150] and Arts [45]. Data was collected with well-structure questionnaires that addressed the objectives of the study. All analyses were performed using SPSS version 23. Participation in this survey was anonymous, consensual and voluntary with informed consent given by all prospective respondents. Most respondents were within the age 18-25 years (63%); more males (55%); of the IJAW ethnic group (55%). All respondents had heard of Covid-19; 99% opined that Covid 19 is more prevalent in old individual; only 9% agreed that Covid-19 has a viral origin. Respondents identified the following as symptoms of Covid 19: Fever (100%), Cough (85%). Sore-throat (67%), Headache (43%). All respondents agreed that Covid-19 can be transmitted through touching the face, eyes, mouth; through contact with infected surfaces and through contact with individuals suspected to be infected. The majority of the respondents (85%) had a positive attitude towards Covid-19; all respondents opined that early detection of Covid-19 can improve treatment and outcome; that Covid-19 can be avoided by proper precautions (95%); if there is an available vaccine for the disease, it should be used (91%) and that health education can help prevent Covid-19 (71%). During the Peak, all respondents reportedly experienced unusual intense fatigue, muscle pain or stiffness; other experienced symptoms included shortness of breath (85%), loss of taste (84%), a runny nose or nasal congestion of unknown cause (77%), sudden loss of smell (77%), Diarrhea (77%), unusual headache (70%), sore throat (69%), fever (60%), flu-like chills (57%) and cough (41%) Overall, participants demonstrated a good knowledge of Covid-19 and most of the participants exhibited good attitudes towards Covid-19. The study was able to highlight gaps in specific aspects of knowledge and attitude of the students towards Covid-19 that should be focused on in future awareness and educational campaigns.

Case report: cerebral sinus vein thrombosis in two patients with AstraZeneca SARS-CoV-2 vaccination

SARS-CoV-2 infection is associated with an increased rate of thromboembolic events and mortality. Different vaccines are globally used to limit the pandemic. In this report, we present the case of two young female patients with newly diagnosed cerebral sinus vein thrombosis occurring after injection of the vector-based ChAdOx1 vaccine. Both patients presented with unusual headache only. The two of them used an estrogen-containing contraception, had had a history of deep venous thrombosis, and both had MTHFR mutations. Both patients developed SARS-CoV-2 specific humoral and cellular immunity including both CD4 and CD8 T cells. This rare, but serious complication needs to be considered after vaccination of young females, even if there is no evidence of heparin-induced thrombocytopenia.

Unusual Fever, Headache, and Abdominal Pain in a Healthy Woman

Question: A healthy, 42-year-old woman was admitted with a 3-day history of fever and headache 5 days after the first vaccination with ChAdOx1 nCoV-19 (AstraZeneca). She had not received hormone replacement therapy or oral contraceptives previously. The polymerase chain reaction test for sever acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was negative. The results of urinalysis and pregnancy test were negative. Brain contrast-enhanced magnetic resonance venography confirmed cerebral sinus–venous thrombosis.

Cerebral Venous Thrombosis Presenting As Subarachnoid Hemorrhage: Clinical Case

Subarachnoid hemorrhage is typically due to an aneurysmal rupture. Cerebral venous thrombosis is a rare cause, especially if the clinical presentation is atypical. We report a patient with unusual acute headaches, with an entirely normal physical examination. His cerebral MRI, and cerebral venous angio-MRI documented a cerebral venous thrombosis associated with subarachnoid hemorrhage. The outcome was favorable with anticoagulant treatment.

Headache Related to PPE Use during the COVID-19 Pandemic.

Purpose of ReviewPersonal protection equipment (PPE)–associated headache is an unusual secondary headache disorder that predominantly occurs in healthcare workers as a consequence of the donning of protective respirators, face masks and/or eyewear. The appreciation of this entity is important given the significant ramifications upon the occupational health of healthcare workers and could additionally have an impact on persons living with pre-existing headache disorder(s).Recent FindingsThere has been a renewed interest and recognition of PPE-associated headaches amongst healthcare professionals, largely brought about by the ongoing COVID-19 pandemic which has besieged healthcare systems worldwide. De novo PPE-associated headaches may present with migrainous or tension-type features and can be viewed as a subtype of external compression headache. The prognosis of the disorder is generally favourable, given that most headaches are short-lived without long-term sequalae. Several aetiologies have been postulated to account for the development of these headaches. Notably, these headaches can affect the occupational health and work performance of healthcare workers.SummaryIn this review, we discuss the epidemiology, clinical characteristics, probable etiopathogenesis, management and prognosis of PPE-associated headaches in the context of the COVID-19 pandemic. Future directions for research and PPE development are proposed.

Actualités dans le syndrome de Susac

Susac syndrome is a rare disease affecting mainly young women, characterized by a microangiopathy limited to the cerebral, retinal, and cochlear vessels. Although the pathophysiology of Susac syndrome is not yet fully elucidated, recent advances favour a primitive vasculitis affecting the cerebral, retinal and cochlear small vessels. Susac syndrome must be recognized in the presence of the pathognomonic clinical triad associating: 1/subacute encephalopathy with unusual headache and pseudopsychiatric features associated with diffuse white matter, grey matter nuclei and specifically corpus callosum lesions on brain MRI; 2/eye involvement that may be pauci-symptomatic, with occlusions of the branches of the central artery of the retina at fundoscopy and arterial wall hyperfluorescence on fluorescein angiography; and 3/cochleo-vestibular damage with hearing loss predominating at low frequencies on the audiogram. Relapses are frequent during an active period lasting approximately 2 years. Eventually, the disease resolves but isolated retinal arterial wall hyperfluorescence without new occlusions may recur, which should not lead to treatment intensification. First-line treatment consists of a combination of anti-aggregants and high dose corticosteroids. In refractory patients or in case of relapse, immunomodulatory molecules such as intravenous immunoglobulins or immunosuppressive drugs such as mycophenolate mofetil, cyclophosphamide or rituximab should be started. Unfortunately, sequelae-mostly hearing loss- remain frequent in these young patients.

Matchmaking and the Future of Hypertension Management.

Matchmaking and the Future of Hypertension Management.

An unusual postural headache: a case report

BackgroundThis paper presents a case of an evolving unusual thunderclap headache that presented to a chiropractor.Case presentationThe intense “migraine-like” headache was aggravated by standing up and relieved substantially when lying down. This low pressure, orthostatic headache was diagnosed as a spontaneous intracranial hypotension (SIH) secondary to a spontaneous tear of the dura. It was referred to the local hospital for management with autogolous blood injection to form an epidural blood patch of the defect. It resolved substantially within 3 days.ConclusionsThe significance of key features in the history and examination and how if not recognised and subsequently treated with manual therapy, the dural tear could be attributed to the treatment of the chiropractor, a treatment that would typically involve cervical manipulation. Discussion is provided of the implications of a missed diagnosis and possible subsequent chiropractic management with the evolving SIH being attributed to the chiropractic intervention rather than its true “spontaneous” nature.

Apoplexie hypophysaire après pontage aorto-coronarien : à propos d'une observation et revue de la littérature

IntroductionPituitary apoplexy is a >rare entity that presents with a sudden onset of headache associated with visual and endocrinological disturbances due to pituitary hemorrhage or infarction. It usually occurs in patients with an unknown pituitary adenoma. Cardiac surgery, and especially coronary artery bypass grafting, can be a precipitating factor in these patients. Case reportWe report an 82-year-old male patient who presented with sudden headache and delirium, a right sixth cranial nerve palsy, a right temporal hemianopsia, and a severe loss of left eye visual acuity in the immediate post-operative course of a coronary artery bypass surgery. Pituitary apoplexy was demonstrated on both MRI and CT-scan. Trans-sphenoidal surgical decompression was performed 13 days after coronary artery bypass grafting, with immediate beneficial effect on the delirium and a partial recovery of visual disturbances. ConclusionPituitary apoplexy is a rare and life-threatening complication that may occur after cardiac surgery (coronary artery bypass, cardiac valve surgery), often precipitated by the use of cardiopulmonary bypass. It can occur after other surgical procedures (orthopedic, digestive, thoracic). The diagnosis must be considered during the early postoperative period in the presence of unusual and severe headache associated with visual disturbances.

Çocukluk Çağı ve Ergenlik Döneminin Nadir Primer Baş Ağrıları: Hekimler için pratik ipuçları

Childhood and adolescent headaches somehow looks like adulthood headaches but not known as its. In this paper eight rare known primary headache disorders of children and adolescents have been given with practical clues for physicians. All of the cases have been selected from the archives of Mersin University School of Medicine Childhood and Adolescent Headache Outpatient Department database and discussed with literature. This paper mainly based on increasing physician avareness about unusual primary headache disorders of children and adolescents.

Knowledge about Obstetric Warning Signs during Pregnancy among Mothers Attending the Primary Health Care Centers in Hilla City

Pregnancy is the most attractive stage in a woman’s life. Signs of risk of pregnancy include bleeding, fluid leakage from the vagina, unusual abdominal pain, cramping, pelvic pressure, headaches or blurred vision, marked swelling in the hands and face, burning urination, foul odors, chills or fever, reduced fetal movements and others with all those the mother need to knowledgeable. A descriptive (cross-sectional) design study was conducted in Al.Hilla city from the period1st September/2018-13thJuly/2019, to assess the knowledge toward the obstetric warning signs during pregnancy and to find out the relationship between the knowledge of the study sample and their demographic characteristics with obstetrical history). The sample of the study was non- probability (convenient sample)consist of(250)pregnant women. Data was collected through the use of interview technique, each participant needs(25-30)minutes to complete the form. The questionnaire was validated through a committee of(19)experts. A pilot study was conducted to determine the reliability of the instrument. The data were analyzed using statistical and descriptive data analysis methods carried out by(SPSSversion20). The results of the present study shows that the overall knowledge assessment of the pregnant women were good responses regarding warning signs during pregnancy.

Implementation of a Computerized Decision Support System for Computed Tomography Scan Requests for Nontraumatic Headache in the Emergency Department.

Nontraumatic headache is a frequent complaint in the emergency department (ED). Cranial computed tomography (CT) is a widely available test for the diagnostic work-up, despite the risk of exposure to ionizing radiation. We sought to develop and evaluate a cranial CT request computerized decision support system (CDSS) for adults with their first presentation of unusual severe nontraumatic headache in the ED. Electronic database searches identified clinical decision and prediction rules and studies delineating risk factors in nontraumatic headache. A long list of risk factors extracted from these articles was reduced by a 30-member multidisciplinary expert panel (radiologists, emergency physicians, methodologists), using a 90% agreement threshold. This shortlist was used to develop the algorithm for the cranial CT request CDSS, which was implemented in March 2016. Impact evaluation compared CT scan frequency and diagnostic yield of pathologic findings before (March-August 2015) and after (March-August 2016) implementation. From the 10 selected studies, 10 risk factors were shortlisted to activate a request for cranial CT. Before implementation, 377 cranial CTs were ordered (15.3% of 2469 CT scans) compared with 244 after (9.5% of 2561 CT scans; pre-post difference 5.74%; 95% confidence interval [CI] 3.92-7.56%; p<0.001), corresponding to a 37.6% relative reduction in the test ordering rate (95% CI 25.7-49.5%; p<0.001). Despite the reduction in cranial CT scans, we did not observe an increase in pathological findings after introducing the decision support system (70 cases before [18.5%] vs. 35 cases after [14.3%]; pre-post difference -4.0% [95% CI -10.0 to 1.6%]; p=0.170). In nontraumatic headache amongadults seen in the ED, CDSS decreased the cranial CT request rate but the diagnostic yield did not improve.

Cold Stimulus Headache

To provide an updated review on cold stimulus headache. Age, type of stimulus, comorbidities, and study design but not necessarily gender appear to influence the reported prevalence of cold stimulus headache (CSH). Different cold stimuli appear to provoke different types of CSH. Ice water appears to provoke more frequent and higher pain intensity with a shorter latency compared to CSH provoked by ice cubes. Cold stimulus headache is very common unusual headache with limited literature. The severity, frequency, and latency appear to be influenced by the speed and size of the exposed area.

Provision of Gefitinib as Targeted Therapy in Lung Adenocarcinoma with EGFR Mutation and Brain Metastatic

Adenocarcinoma is a malignant epithelial tumor with glandular differentiation or mucin production. Adenocarcinoma covers 30% of lung cancers in Europe and America. This report described a case of an unusual chronic headache since 3 years ago without any complementing symptom except for nausea. The primary tumor was detected with Thorax CT scan and confirmed by histopathology examination. Patient treated with gefitinib (1 x 250 mg) and showed a satisfying result. Gefitinib, as first-line therapy for patients with epidermal growth factor receptor ( EGFR) mutation, was effective and well-tolerated in this patient.