Der Schmerz
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This article presents secondary headache syndromes caused by life-threatening disease as well as symptomatic headaches requiring immediate treatment to prevent irreversible deficits. Clinical signs and symptoms indicating a secondary headache syndrome are summarized in the so-called SNOOP list (SNOOP: systemic symptoms, neurological symptoms, acute onset, older patients and previous history). The main topic of this publication is the diagnostic procedure, with a discussion of the pitfalls of computed tomography and magnetic resonance imaging investigations and the specificities of other methods such as lumbar puncture and duplex sonography.
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Episodic tension type headache is considered to be the most prevalent primary headache. If tension type headache occurs on more than 15 days per month for at least 3 consecutive months, it is classified as chronic tension type headache. ⋯ In the paper, we discuss how the differential diagnosis can be more specific and which therapy is supported by the literature. In addition, we discuss differences and similarities of tension type headache and migraine and a possible similar pathophysiology of both (convergence hypothesis).
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The present article gives an update of relevant aspects in the diagnosis and therapy of trigeminal neuralgia from the neurological, neuroradiological and neurosurgical point of view. The diagnosis of trigeminal neuralgia is clinical, but high-quality imaging is mandatory to identify secondary causes and a neurovascular contact. ⋯ In patients insufficiently responding to medical treatment, there are neurosurgical treatment options giving very good results. The best long-term results have been described for microvascular decompression, but percutaneous and radiosurgical treatments also are good options, especially in patients with an increased surgical risk profile, in secondary trigeminal neuralgia, and in case of recurrence after microvascular decompression.
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Review
[Cluster headaches-proven and novel approaches : A critical evaluation of treatment studies].
Trigeminal autonomic cephalalgias are characterized by unilateral headaches accompanied by cranial autonomic symptoms and a sense of restlessness. Clinical trials have been conducted on acute therapy and prophylaxis of cluster headache in recent years. ⋯ Recent trials provide data on the efficacy of prednisolone, galcanezumab, fremanzeumab and noninvasive vagal nerve stimulation. Methodological difficulties arise in terms of patient recruitment for clinical trials, clinical endpoints and potential differences in the pathophysiology of episodic and chronic cluster headache.
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Digitalization offers support and innovative approaches in the diagnosis and therapy of headaches. With the German digital health care act (Digitale-Versorgung-Gesetz) it is now possible to integrate this into regular care for the first time. However, it is currently difficult to assess the various offers; quality standards and conclusive studies to determine the efficacy and safety are missing. ⋯ Different digital approaches could support practitioners and patients effectively in headache treatment and therapy guidance in the near future. However, high-quality studies are necessary to evaluate their benefits and efficacy.