Headache
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A 52-year-old black female for 19 years had severe intermittent unilateral headaches that demonstrated the "clustering" phenomenon. She was initially diagnosed as having episodic cluster headache. Response to lithium carbonate, ergotamine and courses of corticosteroids was, however, only partial. ⋯ In this case, the intermittent stage was protracted. This stage may, conceivably, even be a permanent one. To our knowledge, this is the first report of hemicrania continua in a black African.
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We prospectively examined the clinical signs of 54 febrile patients associated with recent-onset headache. They underwent lumbar puncture (LP) on suspicion of meningitis. The relation of each sign to cerebrospinal fluid (CSF) pleocytosis was estimated. ⋯ Among 20 patients without pleocytosis, 12 had no jolt accentuation (specificity: 60%). We found jolt accentuation to be the most sensitive sign of CSF pleocytosis. If jolt accentuation is noted in a febrile patient associated with recent onset headache, the CSF should be examined even in the absence of neck stiffness or Kernig's sign.
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Review Case Reports
MSG and hydrolyzed vegetable protein induced headache: review and case studies.
Monosodium glutamate (MSG), an established headache trigger, has become far more prevalent in canned, packaged and prepared foods over the past decade. The presence of MSG in food may be difficult to detect since the terms "natural flavor," "flavoring," or "hydrolyzed vegetable protein (HVP)," all may appear on food labels to refer to MSG, according to current FDA food labeling codes. ⋯ Information and food lists helpful in identifying dietary MSG and HVP are presented. When patients are put on an MSG-free trial diet, attention needs to be given to identification of the wide variety of foods containing MSG and HVP.
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In a questionnaire survey of inpatient polysubstance abusers it was found that cocaine relieved migraine-type headaches much more often in chronic headache sufferers than in those with only occasional headaches (p less than .05). However, cocaine could also bring on headaches after several hours, both in chronic headache sufferers and in those not subject to headaches. The facts that cocaine may relieve headache immediately, and also may precipitate headaches several hours after use, suggests that the well-known vasoconstrictive actions of cocaine may be responsible. Migraineurs seem more susceptible to some of these effects of cocaine than are people without chronic headaches.
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Criteria for the diagnosis of cervicogenic headache are proposed, which include unilateral head pain, symptoms and signs of neck involvement, non-clustering episodic moderate pain originating in the neck then spreading to the head, and response to root or nerve blockade; plus rarer and non-obligatory features such as autonomic disturbances, dizziness, phonophotophobia, monocular visual blurring, and difficulty swallowing.