Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
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In the past, cerebral venous thrombosis (CVT) was considered a rare, devastating disease. The widespread use of angiography, magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) over the years has made early diagnosis of CVT possible and has completely changed the perception of this condition. CVT is much more common than previously thought. ⋯ Our retrospective study, confirmed by preliminary results in the prospective multicentric study, showed that headache in CVT is as often acute as subacute, and that it is more frequently localised than diffuse. Finally, both studies showed a significant correlation between headache of acute onset and severe intensity and CVT. We then conclude that these headache features, especially in the presence of underlying prothrombotic conditions, should lead clinicians to consider the diagnosis of CVT and to require appropriate neuroimaging examinations.
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Headache is one of the most common symptoms that leads patients to the emergency room (ER) and is often related to diseases requiring prompt diagnosis and immediate treatment. This consideration brought us to consider the importance of the neurologist in improving the management of patients arriving in the ER with headache. We carried out a study for testing the degree of agreement between ER physician and neurologist using patient evaluation at headache centre (HC) as the gold standard. ⋯ There was no significant difference in the agreement of the three evaluators in patients with impairment of daily living activities or aged over 40. The agreement between the ER physician and the neurologist was lower (Kappa=0.58), especially in patients with their first headache episode. Based on our results, patients seen at the ER for a headache episode can be fairly successfully managed by the ER physician, except those who present a first attack, for whom neurological consultation is needed.
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The International Classification of Headache Disorders 2nd Edition (ICHD-II), published in 2004, marks an unquestionable progress from the preceding 1988 edition, but the in-depth analysis it offers is not immune from drawbacks and shortcomings. First of all, it is still basically a classification of attacks and not of syndromes. For the migraine group, while the revised classification more accurately characterises migraine with aura, it fails to provide a sufficiently structured description of those forms of migraine without aura that over the years evolve to so-called daily chronic forms. ⋯ The inclusion of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) in the cluster headache group is bound to generate some perplexity, while the recognition of new daily persistent headache (NDPH) included in the group of other primary headaches as a separate clinical entity appears somewhat premature. Doubts are also raised by the actual existence of triptan-overuse headache, which ICHD-II includes in Group 8 among medication-overuse headaches. Finally, the addition of headache attributed to psychiatric disorder, which is certainly a good option in perspective, is not yet supported by an adequate systematisation.
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The strictly unilateral headaches, more commonly known as trigeminal autonomic cephalalgias (TACs), are characterised by severe, strictly unilateral pain in the territory of the distribution of the trigeminal nerve, associated with autonomic manifestations. The recent International Headache Society classification lists the strictly unilateral headaches as cluster headache (CH), episodic and chronic paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing. ⋯ Convincing proposals for pathophysiologic mechanisms must explain the trigeminal distribution of the pain, the homolateral autonomic manifestations; and, for CH, the usually periodic recurrence of the crises and clusters. With regard to CH, (i) the pain is always located periorbitally-frontally, implicating nociceptive mechanisms involving the trigeminal nerve; (ii) the autonomic manifestations homolateral to the pain seem to be both parasympathetic (lacrimation and rhinorrhoea) and sympathetic (ptosis and miosis); and (iii) the periodicity of the attacks and seasonal recurrence of the cluster periods suggest involvement of a biological clock within hypothalamus.
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Headache can be either a late or early symptom of a brain tumour, depending on the location of the tumour. A constant, progressively increasing pain, or a change in the character of headache pain, may alert the physician to this occurrence. Fortunately most people with headache, even persistent or severe headaches, do not have a tumour. In this work we review the literature about prevalence of headache as an isolated/early symptom of brain tumour and report our experience.