Expert review of neurotherapeutics
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Headaches of the thunderclap variety become severe in intensity within seconds to a minute of onset. Patients with thunderclap headache are to be evaluated in an emergent fashion as many of the underlying causes are associated with significant morbidity and mortality. ⋯ In accordance with the increased utilization of cerebral imaging, availability of noninvasive techniques to image the cerebral vasculature and interest in identifying causes of thunderclap headaches, the list of potential causes is growing rapidly. Included in this growth are the reversible cerebral vasoconstriction syndromes, terminology recently introduced to unify several disorders all presenting with thunderclap headache and similar diagnostic findings including reversible vasoconstriction of the intracranial arteries.
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Medication-overuse headache (MOH) has developed into the third most common type of headache after tension-type headache and migraine. The prevalence reaches approximately 1% of the world's population and shows an increasing trend. ⋯ Several large population-based longitudinal studies clearly demonstrated that overuse of any kind of acute headache medication is the main risk factor leading to the development of chronic headache. Management of MOH remains difficult; the only effective treatment concept is consequent withdrawal therapy.