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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A proportion of chronic headache patients become refractory to medical treatment and severely disabled. In such patients various neurostimulation methods have been proposed, ranging from invasive procedures such as deep-brain stimulation to minimally invasive ones like occipital nerve stimulation. They have been applied in single cases or small series of patients affected with varying headache disorders: cervicogenic headache, hemicrania continua, posttraumatic headache, chronic migraine, and cluster headache. ⋯ At this stage, it should be preferred as first-line invasive therapy for iCCH. Recent case reports mention the efficacy of supraorbital (SNS) and vagal (VNS) nerve stimulation. Whether these neurostimulation methods have a place in the management of iCCH patients remains to be determined.
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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.
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Headache is relatively common in patients with cerebrovascular disorders. The reported frequency of stroke-related headache ranges from 7% to 65% and different types of headache, such as onset headache, sentinel headache, or delayed headache, may be observed in association with stroke. Headache can be attributed to ischemic stroke, transient ischemic attack, or non-traumatic intracranial hemorrhage, including intracerebral and subarachnoid hemorrhage. ⋯ The suddenness of onset and not its severity is the characteristic feature of the headache in subarachnoid hemorrhage. Referring to unruptured vascular malformations, the headache can be attributed to saccular aneurysm, arteriovenous malformation, dural arteriovenous fistula, dural cavernous angioma, and encephalotrigeminal or leptomeningeal angiomatosis (Sturge-Weber syndrome). It is very important to recognize that in the latter forms the onset of headache may indicate an upcoming bleeding complication.
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Historical Article
Chapter 8: the development of neurology and the neurological sciences in the 17th century.
Circa 1660 several favorable factors, instrumental to the invention of neurology, converged at the University of Oxford. Animals and men were believed to have a material soul whose functions throughout the nervous system were accessible to research. In 1659 inductive methods were introduced in clinical medicine by Thomas Willis, the founder of English epidemiology and biochemistry. ⋯ There was a physiological part, a textbook of neurophysiology, and a pathological part, a compendium of neurological and psychiatric syndromes, with early descriptions of myasthenia, restless legs, narcolepsy, dissociative and bipolar disease, and general paralysis of the insane. In 1667 he published a book on convulsive diseases, in which he described the blood-brain barrier, epileptic and hysterical brain disorders, and Parkinson's disease. Thus Willis recognized and presented the key themes of the future specialty.