Neurologic clinics
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The trigeminal autonomic cephalalgias (TACs) are a group of primary headache syndromes all marked by headache and associated autonomic features. The TACs include cluster headache, paroxysmal hemicrania, hemicrania continua, and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing syndrome. Diagnosis is made after looking at headache frequency, duration, and accompanying symptoms. Each TAC has its own unique treatment modality, which is discussed in depth.
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Vestibular migraine (VM) designates recurrent attacks of vertigo that are caused by migraine. VM presents with attacks of spontaneous or positional vertigo, lasting seconds to days, accompanied by migrainous symptoms. ⋯ In contrast, vestibular testing serves mainly for the exclusion of other diagnoses. Treatment is targeted at the underlying migraine.
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Of the nearly 32 million Americans with migraine, 24 million are women. It is a disorder affecting women throughout their lifetimes, from childhood and puberty through the postmenopausal years. ⋯ There are numerous times when hormonal influences have an impact on migraine and its pattern, including menarche, oral contraceptive use, pregnancy, perimenopause, and menopause. Hence practitioners treating women with migraine need to have a clear understanding of these special considerations.
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This article reviews "other primary headaches," a classification of the International Headache Society that includes primary stabbing headaches, primary cough headache, primary exertional headache, primary headache associated with sexual activity, hypnic headache, primary thunderclap headache, and new daily persistent headache. Clinicians should be aware that these headaches may be symptomatic to structural lesions and therefore usually require careful neuroimaging evaluation.
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Neurologic symptoms are a prominent and often disturbing component of the migraine syndrome in many patients. Collectively termed "aura," migraine-related neurologic symptoms include visual, sensory, language, and motor disturbance. ⋯ Recently, motor symptoms previously included as a type of migraine aura have been reclassified as a component of hemiplegic migraine--a distinct migraine subtype. The tendency to aura is likely to be influenced by complex genetic and perhaps epigenetic factors.