Headache
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Short-lasting, unilateral, neuralgiform headache attacks with conjunctival injection, tearing, rhinorrhea (SUNCT syndrome) is a headache form generally refractory to drug therapy. Occasional patients with SUNCT have been reported with a successful response to lamotrigine. ⋯ If the positive effect of lamotrigine in patients with SUNCT is confirmed in other cases, lamotrigine could become the first specific treatment for SUNCT syndrome.
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The psychosocial impact of headache combined with other pains has previously been insufficiently investigated. ⋯ It is recommended that adolescents suffering from recurrent headaches routinely should be asked about the presence of other pains, anxiety and depressive symptoms, medication usage, in addition to psychosocial consequences in their everyday life activities. Longitudinal research is also needed to delineate causal relationships between psychosocial factors and recurrent pains, in particular regarding possible sex differences.
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Comparative Study
Chronic daily headache: identification of factors associated with induction and transformation.
Chronic daily headache (CDH) is one of the more frequently encountered headache syndromes at major tertiary care centers. The analysis of factors related to the transformation from episodic to chronic migraine (CM) and to the de novo development of new daily persistent headache (NDPH) remain poorly understood. ⋯ Several strong correlations were obtained between patients with specific types of CDH and certain somatic conditions or behaviors; some have not been previously described. Transformation of previously episodic headache or development of a NDPH thus may be related to certain medical conditions and behaviors beyond the frequently incriminated precipitant analgesic overuse. As similar results were obtained when CPTH was used as a control, the correlation is more complex than simple comorbidity.
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To investigate the incidence and characteristics of seizure-associated headaches and the modalities of treatment. ⋯ Headaches associated with partial and generalized seizures are frequent and undertreated. Treatment should consider both the headache syndrome and the general guidelines for treating primary headaches. The pathophysiology of seizure-associated headaches cannot be explained by the epileptic syndrome.
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We analyzed the results of treating patients who had chronic daily headaches that were refractory to standard medications with repetitive low-dose boluses of intravenous propofol (2,6-diisopropylphenol). Patients were treated over a 1-year period at Thomas Jefferson University Hospital. A total of 18 patients were treated a total of 21 times. ⋯ The headache cycle was broken in eight patients. There were no complications. Intravenous propofol is safe and effective when used under monitored conditions and should be considered for patients who have refractory chronic daily headache and have failed other interventions.