Headache
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To assess the utility of neuroimaging in the evaluation of children presenting with two of the most common forms of headache, migraine and chronic daily headache, and to determine the utility and pathological yield of neuroimaging in specific headache syndromes in children whose neurological examinations are normal. ⋯ The yield of neuroimaging in children with uncomplicated migraine and normal neurological examination was 3.7%. The yield in children with chronic daily headache and normal neurological examination was higher at 16.6%. The abnormalities discovered included arachnoid cysts, Chiari I malformations, sinus disease, occult vascular malformations and "dilated Virchow-Robin spaces." While none of the neuroimaging findings were apparent clinically, their discovery did not influence the diagnosis, management, or outcome of the patients. None of the abnormalities necessitated surgical intervention or were associated with the headache presentation. Therefore, neuroimaging is not warranted in children and adolescents with defined clinical headache syndrome diagnoses whose neurological examinations are normal.
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The coexistence of chronic paroxysmal hemicrania and trigeminal neuralgia is called chronic paroxysmal hemicrania-tic syndrome. We describe the case of a man who has suffered both types of pain occurring synchronously but with different localization on the ipsilateral side. ⋯ To the best of our knowledge, this is the third case to be reported, the first in the male sex. We review this new disorder and discuss the pathophysiology.
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Randomized Controlled Trial Clinical Trial
Solubilized ibuprofen: evaluation of onset, relief, and safety of a novel formulation in the treatment of episodic tension-type headache.
To evaluate the relative efficacy of a new solubilized formulation of ibuprofen compared with acetaminophen caplets. ⋯ Although several other studies have demonstrated the overall analgesic superiority of ibuprofen to acetaminophen, this study demonstrated that the liquigel formulation also provides a clinically relevant advantage for time to analgesic effects.
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Clinical Trial
Effectiveness of amitriptyline in the prophylactic management of childhood headaches.
To study the effectiveness of a standardized dose of amitriptyline, 1 mg/kg, for childhood headaches. ⋯ Amitriptyline is an effective prophylactic medication for children with frequent headaches. A standardized dosing regimen results in a significant number of children responding with minimal side effects. The children are able to tolerate this dosing scheme and demonstrate good adherence to a dosing schedule of once a day.