Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti
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Review Case Reports
[Airplane headaches--two new cases and a review of the literature].
We present two new cases of airplane headache and compare them with 13 cases described so far. The two new cases refer to a man and a woman, one each. The woman suffered from headache during the take off and throughout the flight, which is rarely encountered. ⋯ The etiology and pathophysiology of this type of headache have not yet been fully clarified. We presume that this type of headache may be connected with changes in the nasal mucous membrane with deviation of the nasal septum, as well as in ethmoidal sinuses and other paranasal cavities. The rise of atmospheric pressure in the airplane and barotrauma from activation of the trigeminovascular system certainly play a major role in the occurrence of this headache.
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A relationship between migraine with aura and patent foramen ovale (PFO) has been established in clinical studies, and is now related to previous observation that migraine and stroke are connected. Studies have shown that the prevalence of PFO in patients with migraine is about 2.5-fold than in patients without migraine. ⋯ Most nonrandomized studies (and 1 randomized placebo-controlled study) have shown that migraine attacks are reduced after PFO closure; however, recent studies show that a new onset or worsening of migraine headaches may occur after closure of PFO or atrial septal defects. Therefore, no definite conclusions can be made on the treatment of migraines by PFO closure.
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Some patients suffering from headache require neurologic examination. The objective of the guidelines for the treatment of headaches is to help physicians in their daily care for headache patients. In most patients, the diagnosis of migraine has not been made by a physician and they have not received appropriate care to treat migraine attacks. ⋯ Although rare, patients with cluster headaches suffer severe pain; oxygen inhalation or triptans are recommended for acute attack, and preventive therapy may be indicated in some cases. The guidelines provide classification, diagnostic criteria and therapeutic principles for primary headaches. All recommendations listed in the guidelines are based on meta-analyses and recommendations from the world literature, with special reference to therapeutic options available in Croatia.
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The aim of this report is to give information on the definition, clinical characteristics and therapy of cervical headache with comprehensive guidelines for patients on daily living activities with cervical pain and headache. This information has been designed to help the patients understand of their disability and in learn how to protect themselves.
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Neurophysiological methods used in the diagnosis of headache, especially migraine are: electroencephalography (EEG), evoked cortical potentials (VEP, BAER, ERP), reflex responses, autonomic tests and transcranial magnetic stimulation (TMS). Interpretation of EEG can be important for the differential diagnosis of some disorders with headache as a presenting symptom. Noninvasiveness, accessibility and ability to repeat the test due to exposure to harmful ionization are the main advantages of EEG. ⋯ Recent studies have shown changes in motor and occipital cortex during TMS interictal excitability. Neurophysiological tests are used in differential diagnosis of headache, follow up of possible complications in patients with symptomatic headache as well as in neurorehabilitation. In addition, electrophysiological diagnostic test can contribute to better understand the headache pathophysiology.