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Objective: To describe two patients with recurring unilateral brief headaches that fulfilled criteria for both primary cough headache (CH) and chronic paroxysmal hemicrania (CPH)., Background: CH is typically a bilateral headache, specifically triggered by cough, straining, or other Valsalva maneuvers. The report of cases sharing features with other primary headache disorders, such as CPH, suggest common pathogenic mechanisms., Methods: Case reports., Results: Two patients (one man), aged 55 and 64, had a two-year history of daily, unilateral, side-locked headache attacks, lasting about 15 minutes, and associated with ipsilateral tearing. Headaches were triggered by cough, sneezing, laughing, or bending forward. Both patients experienced a marked and sustained improvement with indomethacin, and both relapsed when it was interrupted., Conclusions: These cases suggest the existence of transitional phenotypes, or shared pathogenic mechanisms, between CH and CPH, two indomethacin-responsive headaches. A more comprehensive analysis of different CH subtypes is necessary to understand their relation with other primary headaches., (© 2017 American Headache Society.)

Ice pick headache, also called idiopathic or primary stabbing headache, is a unique headache type associated with ultra-brief stabs of pain, most commonly in the frontal or temporal area. It occurs predominantly in women and is estimated to affect 2-35% of the population. Unlike other headache types of short duration, such as short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT), ice pick headache is not associated with any cranial autonomic symptoms but has been known to occur with nausea, vomiting, photophobia, and dizziness. It exists in two forms: primary and secondary, with examples of secondary causes being herpes zoster meningoencephalitis, meningiomas, stroke, and multiple sclerosis. Ice pick headache is one of the "indomethacin responsive headaches," but up to 35% of patients fail to show significant benefit with that treatment. Other treatment options include gabapentin, cyclooxygenase-2 inhibitors, melatonin, and external hand warming.

Hypnic headache is a rare primary headache disorder affecting middle age and above with a dull pain exclusively at nighttime. This article aims to review and discuss the most recent articles published in the year 2012 regarding hypnic headache. We will also discuss specific cases of pharmacological and nonpharmacologic successes in treating this rare disorder.

Background: There are nonodontogenic headache disorders that mimic dental pain. One such headache disorder is hemicrania continua (HC). HC is a primary headache syndrome characterized by a continuous, unilateral headache that is completely responsive to indomethacin. Patients may have signs and symptoms that the dentist should differentiate from odontogenic pain and temporomandibular disorders. These symptoms can make the diagnostic process a challenge for dentists if patients' pain has multiple causes. Dentists, thus, must have thorough knowledge of odontogenic and nonodontogenic causes of pain so they can make accurate diagnoses and prepare treatment plans., Case Description: The authors describe the case of a 41-year-old woman with a six-year history of continuous headaches and a one-year history of temporomandibular dysfunction and odontogenic pain. She sought treatment from a number of dentists and received a diagnosis of right-side facial pain and headache on the basis of the results of clinical and radiologic examinations, which was followed by dental treatment. She did not experience any pain relief. Additional results of our examination led to a diagnosis of HC., Clinical Implications: Dentists must consider headache disorders in patients who have continuous headaches after undergoing dental treatment for odontogenic pain.

Hypnic headache (HH) is considered as a disorder of the circadian rhythm, mostly affecting the elderly and generally considered a benign disorder, but the pathophysiology of hypnic hedache remains unclear. Various treatments have been suggested for hypnic headache, especially lithium and indomethacin. We report the case of HH fulfilling The International Classification Headache Disorders, 2nd edition criteria (ICHD-II). A 64-year-old woman, who suffered from dull headaches strictly during the night for a period of 5 months. Attacks of headache lasted from 30 to 150 minutes, with a frequency usually 4 times per week. The patient was started on indomethacin 50 mg twice a day (BID). From day 25 on she was free of hypnic headache. On day 31 we tapered the daily dose of indomethacin to 50mg at bedtime, the patient was still without headache. On day 60 the treatment was stopped. 30 months after day 60, the patient was still headache free. We reported the first Czech patient with HH with very good therapeutic response to indomethacin. The effect of therapy with indomethacin 50mg BID was very fast and stable.

Hemicrania continua (HC) is a rare primary headache syndrome, characterized by unilateral pain and an absolute response to indometacin. Since the term was first coined in 1984, more than 100 cases have been described worldwide. Most recently, detailed case series that provide more detailed information concerning the sometimes complex clinical presentation of HC have been reported. Functional imaging studies suggest a unique pattern of subcortical involvement in HC: contralateral to the pain posterior hypothalamic region, ipsilateral dorsal pons and ipsilateral ventral midbrain, which, along with the particular effect of indometacin, probably justifies its classification as a unique entity. Increasing the awareness of this primary headache form among clinicians will aid in its diagnosis while further work is being undertaken to characterize the syndrome.

Hypnic headache is a rare primary headache disorder that is characterized by exclusively sleep-related headache attacks in patients usually beyond 50 years of age. Only 174 cases have been reported in the literature so far. Owing to its low prevalence, clinical features and therapeutic options, as well as underlying pathophysiologic mechanisms, are widely unknown or being controversially discussed. The association of hypnic headache with rapid-eye movement sleep was strongly contradicted in recent articles, while an association with hypothalamic dysfunction is thought to be one important pathophysiological mechanism. Common acute, as well as prophylactic, treatment is caffeine intake, either in the form of a cup of coffee or a caffeine tablet. Lithium, indomethacin and melatonin were promoted as potent medical treatments, while almost every other drug commonly used to treat headache or other pain syndromes was reported to be effective in single case reports on hypnic headache.

Hemicrania continua (HC) is a primary headache disorder characterized by a continuous, unilateral headache that varies in intensity, waxing and waning without disappearing completely. Ipsilateral cranial autonomic features and response to indomethacin are essential features for the diagnosis of HC. We hereby, describe three patients with the clinical phenotypes of HC in whom response to indomethacin was either incomplete or not sustained. We also review the literature especially for the presence of indomethacin response and ipsilateral cranial autonomic features.

A 67-year-old male and a 43-year-old female were referred to hospital with headaches after intracranial pressure increasing activities, such as coughing. Both patients were diagnosed with primary cough headache. In the case of the first patient, this diagnosis was considered shortly after presentation. His headache disappeared with the standard treatment for primary cough headache, consisting of indomethacin and a proton pump inhibitor. The second patient received medicinal and surgical treatment for rhinosinusitis. These treatments did not improve the headache symptoms. Eventually she was also diagnosed with primary cough headache, and became pain-free with indomethacin and a proton pump inhibitor. Primary cough headache should be differentiated from secondary cough headache, in which the symptoms are caused by structural abnormalities of the brain. Additional investigation is required to differentiate between the two. The diagnosis of primary cough headache is supported by a positive reaction to trial treatment with indomethacin.

Hypnic headache (HH) is a rare sleep-associated primary headache disorder that usually begins after the age of 60 years. Here we report a 19-year-old male with 4-year history of predominantly left sided HH. He is the youngest person reported who fulfills the IHS diagnostic criteria for HH. The patient had history of relapsing-remitting course. The headache occurred every night at a constant time in each relapse. It was non-throbbing, moderate to severe, for 30 min to 5 h, and usually after 3 h of sleep. The patient showed complete response to indomethacin (75 mg at bedtime). Frequent tapering of indomethacin was required to look for the remission phase.