Headache
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To examine the potential influence of random measurement error on estimated rates of chronification and remission. ⋯ Random variation, without real change, has the potential to influence estimated rates of progression and remission in longitudinal migraine studies. The magnitude of random variation needed to fully reproduce observed rates of progression and remission are implausibly large. Recommendations are offered to improve estimation of rates of progression and remission, reducing the influence of random variation.
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Nausea is a defining feature of episodic migraine. Migraine-associated nausea can cause patients to delay or avoid taking oral medication. In April 2011, a round table of headache specialists and a gastroenterologist was convened to explore unmet needs in the treatment of migraine vis-à-vis gastrointestinal signs and symptoms. This supplement summarizes the proceedings of that roundtable meeting.
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Hemicrania continua (HC) is a well-known primary headache. The present version of the International Classification of Headache Disorders lists HC in the "other primary headaches" group. However, evidence has emerged demonstrating that HC is a phenotype that belongs to the trigeminal autonomic cephalalgias together with cluster headache, paroxysmal hemicrania (PH), and short-lasting, unilateral neuralgiform headache attacks with conjunctival injection and tearing. ⋯ Apart from the remarkable clinical similarities, the absolute and incomparable effect of indomethacin in HC parallels the effect of this drug in PH, suggesting a shared core pathogenesis. Finally, neuroimage findings demonstrate a posterior hypothalamic activation in HC similarly to cluster headache, PH, and short-lasting, unilateral neuralgiform headache attacks with conjunctival injection and tearing. Taken together, data indicate that HC is certainly a type of trigeminal autonomic cephalalgia that should no longer be placed in a group of miscellaneous primary headache disorders.
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Epicrania fugax (EF) is a primary headache of recent description. We aimed to report 19 new cases of EF, and thus contribute to the characterization of this emerging headache. ⋯ EF appears as a distinct headache syndrome and could be eventually included in future editions of the International Classification of Headache Disorders.
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Case Reports
Intracranial hypotension caused by anterior cervical CSF leak alleviated by an epidural blood patch [corrected].
We present a case in which a thoracocervical epidural blood patch was used to treat an anteriorly situated cerebrospinal fluid leak following 2 failed blood patches in the lumbar region. The challenge in identifying the source of the leak, deteriorating health of the patient, and risks from the procedure, contributes to the uniqueness of this case.