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Background. Headache is a common symptom in brain tumors. In agreement with the International Headache Society, tumor headache belongs to the headache attributed to neoplasia. It has nonspecific characteristics regarding the type of pain that is diffused or localized in correspondence with the site of the tumor. In this study, we describe two cases of migraine-like headache in occipital lobe tumors, hypothesizing possible mechanisms involving cortical spreading depression. Methods. The study concerns a series of 38 brain tumors, with headache as an onset symptom. It had the characteristics of a traction headache, typical of brain tumors. Headache occurred with typical migraine symptoms in two occipital lobe tumors. This is a singular occurrence, observing the literature data. The patients underwent surgical treatment, with the disappearance of the headache. Results. This study showed the correlation between migraine aura-like headache and occipital lobe brain tumor. Migraine headache was the onset symptom in the patients affected by occipital lobe brain tumors. They underwent surgical treatment with disappearance of headache. Conclusions. In the cases described in this work, a correlation was found between the occipital tumor and migraine-like headache. It is a singular case, confirming the involvement of the occipital cortex in migraine with visual aura-related headache, through the start of spreading depression.

Background. We describe the unusual case of a person suffering from lumbar pain, by herniated disc, treated with betamethasone. The abrupt suspension of the drug caused so called steroid withdrawal syndrome that may occur when receiving a glucocorticoid hormone for a long time it is abruptly stopped. Method. We administered it to a patient suffering from intense lumbar pain. The drug was suspended abruptly a few days after the onset of therapy. Results. The reaction to the suspension of the steroid was the onset of a severe migraine headache, which disappeared with the re-administration of betamethasone. Conclusions. What are the causal hypotheses of this event? An increase in endocranial pressure, of pseudotumor cerebri type? A case of delayed hypersensitivity, since the subject had already taken on betamethasone, without reporting any side effects? We think that the disorder is due to a condition of late hypersensitivity to the steroids, from unknown cause.

Comorbid depression in tension-type headache is a condition well known. A link correlates the two disorders, but the mechanism is not perfectly clear. The purpose of this work is to give our experience on the subject and to compare it with the literature data We investigated a number of cases of tension-type headache patients, with the aim of finding signs of depression as comorbidity. The results showed a depression comorbidity in tension-type headache, with a 67% percentage, in line with the literature data. There is evidence of comorbidity of depression in tension-type headache. The mechanisms that bind the two disorders appear to be explained by the activity of neurotransmitters common to both.

Background. We report a rare association of Alice in Wonderland syndrome and brucellosis. Alice in Wonderland syndrome is a term applied to altered perceptions of the size or shape of own body or other objects. It can occur in a variety of disorders, including migraine, epilepsy, infections, and brain lesions. Brucellosis is a contagious zoonosis caused by infected milk or meat from animals, mainly goats. It causes a fever known as undulant or Malta fever, associated with gastrointestinal symptoms. Case. A young 16-year-old male manifests Alice in Wonderland syndrome and migraine headache after suffering from brucellosis. Symptoms are represented by distortion of objects, animals, humans, which appear deformed, so called metamorphopsias. This is a strange case in which a somatosensory syndrome appears after suffering from an infectious disease. Conclusions. Mechanisms of this case are unclear, we hypothesize a toxic-infective cause, targeting brain parietal lobe. responsible for somesthesic functions.

Objective. The aim of this study was to establish the prevalence of hemodialysis headache in a population of Calabrian subjects, in Italy. Methods. We observed a sample of hemodialysis subjects, studied at the University Hospital of Catanzaro and the Hospital of Melito PS, Reggio Calabria. The patients were investigated for the search for hemodialysis headache. The inclusion criteria of the subjects in the study were respected, such as the characteristics of the headache and the close relationship with dialysis. Results. The results showed a percentage of hemodialysis headache around 5% of cases. The percentage we found was very low compared with some literature data revealing percentages up to 70% of cases. Conclusions. This discrepancy of data is unclear, the results we obtained are in line with few cases of literature. However, our results pose important reflections on the actual prevalence of hemodialysis headache.

Nummular headache is a very rare form of epilepsy. The main characteristics are the intensity of pain and rarity. The case we have described is the third one discovered in Italy, while only 200 cases have been reported worldwide. The response to drugs is not always effective. We treated the patient with a combination of palmitoylethanolamide and topiramate, the treatment was successful and the patient had a significant improvement in headache. Today, after 3 years we report the case, we are describing the course of headache. Three years later, the patient is almost free from painful attacks and shows a qualitatively better life. In addition, the improvement of headache has allowed the reduction of the topiramate, to avoid the appearance of adverse effects.