Cephalalgia : an international journal of headache
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The aetiology of primary cough headache (PCH) is obscure. The aim of this study was to investigate the magnetic resonance (MR) morphometric characteristics of the posterior cranial fossa (PCF) in patients with PCH. Eighteen consecutive patients with PCH (14M/4F, mean age 75.1 +/- 6.0 years) and 18 sex- and age-matched control subjects were recruited for study. ⋯ Compared with controls, patients with PCH had a similar size of hindbrain tissue area but a significantly smaller PCF area, resulting in a higher mean hindbrain/PCF ratio (0.78 +/- 0.04 vs. 0.73 +/- 0.06, P = 0.005). In addition, these patients also had a lower position of the cerebellar tonsillar tip, a shorter clivus length and shorter distances from the clivus to the mid-pons and from the basion to the medulla than the control group. Patients with PCH were associated with a more crowded PCF, which might be a contributing factor for the pathogenesis of this headache syndrome.
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Using data from a cross-sectional survey and a prospective record linkage study the aims of this study were to: (i) determine sources of advice and care for headaches in a population survey of adults, and (ii) investigate prospectively the influences of headaches on general practice consultation in a 12-month follow-up of the responders to the population survey. A population based cross-sectional survey was mailed to 4885 adults (aged > or = 18 years) with an adjusted response rate of 56% (n = 2662). The main outcome measures of interest were (i) self-report advice and care-seeking in the survey (ii) consultation with general practitioner for headache and for other conditions in 12-month period subsequent to the survey. ⋯ Only a minority of headache sufferers consult their GP, regardless of severity, with opticians and pharmacists being other important sources of information. Headache appears to have an additional impact upon GP workload through increased rates of consultations for nonheadache conditions amongst headache sufferers. The interesting findings regarding rates of consultation for digestive and circulatory conditions amongst headache sufferers may be linked to the use of headache medication.
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Case Reports
Hypothalamic activation in trigeminal autonomic cephalgia: functional imaging of an atypical case.
We report headache induced BOLD changes in an atypical case of trigeminal autonomic cephalgia (TAC). A 68-year-old patient was imaged using fMRI during three attacks of a periorbital head-pain with a average duration of 3 min. During the attacks, left sided conjunctival injection, rhinorrhea, lacrimation, facial sweating and hypersalivation were apparent. ⋯ The cerebral activation pattern was similar but not identical to those previously observed in cluster headache and SUNCT with a prominent activation in the hypothalamic grey matter. This case study underlines the conceptual value of the term TAC for the group of headaches focusing around the trigeminal-autonomic reflex. Our results emphasize the importance of the hypothalamus as key region in the pathophysiology of this entity.
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Cortical hypersensitivity and absent habituation to different stimuli have been observed in migraine patients. These features might also be transmitted to the cerebral vasoreactivity, but results are conflicting so far. Transcranial Doppler ultrasound (TCD) was used to assess cerebral blood flow velocity (CBFV) changes in the middle (MCA) and posterior cerebral arteries (PCA) in relation to repetitive checkerboard visual stimulation. ⋯ In controls it decreased over the last 5 stimulation cycles compared with the first 5 cycles (P = 0.04). Migraineurs with aura exhibit a larger cerebrovascular response to repetitive visual stimulation compared to headache-free subjects. A reduced adaptation to environmental stimuli in migraine is suggested, since there was no habituation in migraineurs in contrast to healthy controls.
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Letter Case Reports
Subarachnoid haemorrhage headache from a developmental venous anomaly.