Continuum : lifelong learning in neurology
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This article highlights painful conditions involving the eyes that are encountered in practice, emphasizing those that do not have obvious findings on the neurologic examination. ⋯ Eye pain is a common concern and one of the most difficult symptoms for the clinician to evaluate. Eye pain may be a manifestation of a primary headache disorder, as is common in migraine, the trigeminal autonomic cephalalgias, and primary stabbing headache. Secondary headache disorders, such as posterior communicating artery aneurysm, Tolosa-Hunt syndrome, and microvascular ocular motor neuropathies, frequently produce eye pain. Ophthalmic conditions producing eye pain include orbital masses, angle-closure glaucoma, intraocular inflammation, and ocular surface (corneal) disease. Of these, corneal problems are the most commonly encountered.
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This article reviews the clinical features of and treatment options for the trigeminal autonomic cephalalgias (TACs). ⋯ Although much less common than other headache disorders seen in clinical practice, recognition of the TACs is especially important as they are among the most severe and disabling syndromes in headache medicine.
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Spontaneous intracranial hypotension results from CSF volume depletion, nearly always from spontaneous CSF leaks. Spontaneous intracranial hypotension is increasingly diagnosed in practice; the number of atypical, unconfirmed, and doubtful cases is also increasing, as are treatment failures. These confront neurologists and create many challenges. This review provides neurologists with a guide to diagnosis, evaluation, and treatment of spontaneous intracranial hypotension. ⋯ This article outlines various clinical aspects of spontaneous intracranial hypotension, including headache characteristics, CSF changes, and imaging findings and their underlying mechanisms, as well as treatments and disease complications.
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Continuum (Minneap Minn) · Aug 2015
ReviewRisk Factors for and Management of Medication-Overuse Headache.
This review focuses on patients with migraine who frequently use acute medications. ⋯ Although the relationship of the primary headache disorder and the pattern of overuse varies, medication-overuse headache is a secondary disorder attributable to the overuse of acute medications. While distinguishing chronic migraine and medication-overuse headache may not always be possible, treatment approaches are similar for the two disorders.
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Pain arising from cranial neuralgias represents a significant health burden. Successful treatment depends on accurate diagnosis, which requires knowledge of neuroanatomy and pathophysiology as well as familiarity with the varied clinical presentations encountered in neurologic practice. This article delineates the relevant anatomy, clinical features, and management of the most common primary and secondary cranial neuralgias. ⋯ In patients presenting with a cranial neuralgia, unless the etiology is apparent (eg, herpes zoster), cranial imaging studies should be undertaken to look for structural abnormalities such as neoplasm, granulomatous disease, demyelinating disease, or vascular malformations. Management of both common and rare cranial neuralgias is often challenging and is best guided by the most recent available evidence.