The journal of headache and pain
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The neuroimaging of headache patients has revolutionised our understanding of the pathophysiology of primary headaches and provided unique insights into these syndromes. Modern imaging studies point, together with the clinical picture, towards a central triggering cause. ⋯ No structural changes have been found for migraine and medication overuse headache, whereas patients with chronic tension-type headache demonstrated a significant grey matter decrease in regions known to be involved in pain processing. Modern neuroimaging thus clearly suggests that most primary headache syndromes are predominantly driven from the brain, activating the trigeminovascular reflex and needing therapeutics that act on both sides: centrally and peripherally.
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The notion that disorders of the cervical spine can cause headache is more than a century old, yet there is still a great deal of debate about cervicogenic headache (CEH) in terms of its underlying mechanisms, its signs and symptoms, and the most appropriate treatments for it. CEH is typically a unilateral headache that can be provoked by neck movement, awkward head positions or pressure on tender points in the neck. The headaches can last hours or days, and the pain is usually described as either dull or piercing. ⋯ Anaesthetic blocks may be necessary to confirm the diagnosis of CEH, showing that the source of pain is in the neck. Differential diagnosis is sometimes a challenge because CEH can be mistaken for other forms of unilateral headache, especially unilateral migraine without aura. Neuroimaging and kinematic analysis of neck motion may aid in diagnosing difficult CEH.
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Case Reports
Chronic paroxysmal hemicrania, hemicrania continua and SUNCT: the fate of the three first described cases.
The first patient with chronic paroxysmal hemicrania has been followed for 45 years, and for 33 years with indomethacin treatment. The headache became less severe with time; there was no indomethacin tachyphylaxis. The first patient with SUNCT was followed for 28 years, until his demise at 89. ⋯ And both had gastric surgery. Indomethacin therapy may be a life-long affair. The risk of gastric complications may be substantial.
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Comparative Study
Economic impact of primary headaches in Turkey: a university hospital based study: part II.
This study was planned to investigate the economic impact of headache on Turkish headache sufferers attending a tertiary care outpatient headache clinic. A total of 937 headache patients were included in this study and questioned using a questionnaire for the profile of patients and headache, quality of life of patients and economic impact of headache. The median total direct cost was found to be 88.0 USD and the median total cost was 160.7 USD. ⋯ The average lost and inefficient work/school days was 1.5 (0-45) and 8.4 (0-100) days for one year. It was shown that loss of productivity was higher for migraine without aura group when compared with the episodic and chronic tension-type headache groups. The results of this nationwide university hospital based study methshowed that headache, especially migraine, has considerable economic impact on patients.
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Comparative Study
The association between headache and Val158Met polymorphism in the catechol-O-methyltransferase gene: the HUNT Study.
The catechol-O-methyltransferase (COMT) gene contains a functional polymorphism, Val158Met, that has been found to influence human pain perception, and one study has found that migraine was less likely among those with the Val/Val polymorphism. In the 1995-97 Nord-Trøndelag Health (HUNT) Study, the association between the Val158Met polymorphism and headache was evaluated in a random sample of 2451 individuals. ⋯ Among women, a lower prevalence of non-migrainous headache was found among individuals with the Val/Val genotype than among those with other genotypes (26.2% vs. 33.6%, p = 0.04). That non-migrainous headache was less likely among women with the Val/Val genotype may be an incidental finding, but should be investigated in further studies.