Handbook of clinical neurology
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Activity-related headaches can be brought on by Valsalva maneuvers ("cough headache"), prolonged exercise ("exertional headache"), and sexual excitation ("orgasmic headache"). These headaches account for 1-2% of the consultations due to headache in a general neurological department. These entities are a challenging diagnostic problem as they can be primary or secondary and as their etiologies differ depending on the headache type. ⋯ The mean age at onset for primary headaches provoked by physical exercise and sexual activity is similar (40 years); they share clinical characteristics (bilateral, pulsating) and respond to beta-blockers. In conclusion, provoked headaches account for a low proportion of headache consultations. Cough headache is a different condition when compared to headache due to physical exercise and sexual activity, which are clinical variants of the same entity.
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Historical Article
Chapter 12: the anatomical foundations of clinical neurology.
The chapter provides an itinerary of knowledge on nervous system anatomy as one of the pillars of clinical neurology. The journey starts from the Renaissance explosion on the approach to the human body, its functions and its diseases, dealing with the seminal contributions of Leonardo da Vinci and Vesalius. ⋯ The chapter also includes sections on the contributions of developmental neuroanatomy to neurology, on the history of tract tracing, and on the cytoarchitecture of the cerebral cortex. The never-ending story of the anatomical foundations of clinical neurology continues to evolve at the dawn of the 21st century, including knowledge that guides deep brain stimulation, and novel approaches to the anatomy of the living brain based on rapidly developing neuroimaging technology.
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Insight into the molecular mechanisms involved in primary headaches is important to identify drug targets for improving treatment of patients, but essentially lacking. Genetic research is increasingly successful in pinpointing these mechanisms. Most progress has been made for Familial Hemiplegic Migraine, a rare subtype of migraine with aura. ⋯ Except for the MTHFR gene no gene variant has been identified yet. Convincingly demonstrated genetic findings in other primary headaches such as cluster headache and tension-type headache are even rarer. However, with current technical possibilities of massive genotyping and international efforts to collect large well-phenotyped patient cohorts, the first gene variants for various primary headache types are likely to be discovered in the coming decade.
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New daily persistent headache (NDPH) is a unique form of chronic daily headache (CDH) which is marked by a daily headache from onset, typically occurring in individuals without a significant prior history of headaches. There are two subforms of NDPH: one which is self-limited and normally goes away without therapy, and a more chronic refractory form which is unresponsive to typical headache treatment strategies. The pathogenesis of NDPH is unknown but recent observations suggest a connection with cervical spine hypermobility and elevation of proinflammatory cytokines in the cerebrospinal fluid (CSF). ⋯ The syndrome appears to affect women in their teens and 20s, while males develop NDPH later in life in their 50s or 60s. There are no recognized treatments for this condition, although treatment options will be discussed. Secondary mimics of NDPH will also be touched upon in this chapter.