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Fifteen healthy individuals and 17 patients with episodic exertional headaches were examined before and after treatment with citalopram using P300 event-related potentials. Unlike healthy controls, patients with headaches before treatment displayed an increase in P300 amplitude and the loss of its habituation, which correlated with a decrease in cognitive functions. The treatment lowered the degree of pain and vegetative syndromes, normalized P300 parameters, and improved cognitive functions. The use of P300 method may be an additional criterion of the effectiveness of therapy in patients with exertional headaches.

Despite the fact that headache is one of the commonest of medical complaints seen in practice, most headache patients continue to be suboptimally managed. Probably because recent advances in the field of headache are written about more in specialty journals, many physicians even today feel that nothing much can be done for their headache patients! And, since more than 90% of headaches seen in practice are primary headaches, we need to realize that there is enough evidence now to show that primary headaches are a potentially treatable biological problem. It is therefore important that we do not err in the diagnosis and choice of the right drug options. This article discusses some of the reasons for suboptimal management of primary headaches and suggests measures to avoid these 'Pitfalls'. Secondary headaches where there is an underlying cause identifiable on examination or investigation are outside the scope of this review.

We report the case of a woman with an apparent primary thunderclap headache which occurred frequently until she achieved a therapeutic dosage of gabapentin. Primary thunderclap headache is a rare type of headache that warrants significant testing to rule out more ominous possibilities. Whether gabapentin may help other primary thunderclap headache sufferers or not remains unclear. Further research is needed.

Nummular headache is proposed as a distinct type of headache in the Appendix of the second edition of the International Classification of Headache Disorders (ICHD-II). It is a chronic condition, with the following characteristics: pain is felt on a small circumscribed cranial area; pain is of mild to moderate intensity; there is no evidence of a structural abnormality. Herein, three cases fulfilling the ICHD-II proposed criteria (code A13.7.1) for nummular headache are reported.

Objective: To evaluate the safety and efficacy of a repetitive intranasal (IN) dihydroergotamine (DHE) burst protocol for treatment of refractory headaches., Research Design and Methods: Patients with refractory headaches were enrolled in a prospective, open-label, pilot study. Patients were instructed to self-administer IN DHE every 8 hours for 3 days; each IN DHE dose consisted of one 0.5-mg spray in each nostril that was repeated 15 minutes later, for a total of 2.0 mg DHE per dose. Follow-up visits were scheduled approximately 3 weeks later., Main Outcome Measures: Efficacy and safety measurements were collected during patient interviews. Primary efficacy measures were the change in headache frequency, duration, and severity (rated from 0 [none] to 5 [extremely severe]) between the initial and follow-up visits. Safety was assessed at the follow-up visits through the occurrence of adverse events (AEs)., Results: Twenty-six patients were enrolled in the study. Follow-up visits were completed by 24 patients whose mean headache frequency at study entry was 6.6 d/wk. The IN DHE burst protocol was associated with significant mean decreases in headache frequency (2.6 d/wk, p < 0.001), duration (5.8 hours, p = 0.03), and severity (1.2 units, p < 0.001) between study entry and the follow-up visit. One patient discontinued IN DHE use early because of an AE (nasal stuffiness); two additional patients each reported one AE (fatigue and increased headache) that was attributed to IN DHE., Conclusions: The results of this pilot study suggest that the IN DHE burst protocol may be an effective and safe treatment for refractory headaches; interpretation of these results is limited by the open-label, uncontrolled design and the small number of patients. The development of a double-blind, placebo-controlled study to further evaluate this treatment regimen is warranted.

Thunderclap headache describes a rare headache syndrome characterized by abrupt-onset severe headache mimicking subarachnoidal bleeding, which has to be excluded by adequate diagnostic procedures such as digital subtraction angiography. The pathophysiology is still not clear but there are an increasing number of reports which describe some kind of vasospasm of the intracranial arteries during the headache episode. Here we describe a patient with a thunderclap headache and a mid-basilar narrowing due to a reversible vasospasm.

Objective: To explore prevalence of aberrant medication-taking behaviors (AMTB) among headache patients and treating physician's awareness of such behaviors., Methods: Fifty patientphysician dyads were surveyed on patients' AMTB., Results: The most frequently endorsed behaviors by patients and physicians, respectively, were going to the ER for pain medication (n = 19) and continuing to take pain medication despite minimal relief (n = 23). For the majority of AMTB, phi coefficients indicating level of patient-physician agreement were equal to chance., Conclusions: Headache patients perform a wide range of AMTB. Low rates of patient-physician agreement indicate that physicians possess limited knowledge of patients' AMTB.

Until recently, primary headache disorders, such as migraine and cluster headache were considered to be vascular in origin. However, advances in neuroimaging techniques, such as positron emission tomography, single photon emission computed tomography and functional magnetic resonance imaging have augmented the growing clinical evidence that these headaches are primarily driven from the brain. This review covers functional imaging studies in migraine, cluster headache, rarer headache syndromes and experimental head pain. Together with newer techniques, such as voxel-based morphometry and magnetic resonance spectrometry, functional imaging continues to play a role in elucidating and targeting the neural substrates in each of the primary headache syndromes.

Aim: To determine the rate of prevalence and the clinical-epidemiological and therapeutic characteristics of primary headaches in Zimbabwe., Subjects and Methods: A descriptive study was carried out on the working population at the National Psychiatric Hospital in Zimbabwe. The International Headache Society classification was used. Sample size, which was calculated by means of the program EpiInfo 2002, was 175 workers, who were selected by simple random sampling., Results: The rate of prevalence of primary headaches was 37.1%. 66.1% of cases were between 20 and 39 years old. 29.2% had a family history of headaches. Tension-type headaches (47.7%) and common migraine (30.8%) were the predominant types. Onset of headaches occurred before the age of 15 years in 46.12% of patients. The most frequent location was cervical, which was found in 40% of cases. The most frequent precipitating factors were menstruation (24.6%) and stress (21.5%). The most frequent accompanying symptom was tearing (27.7%). 40% suffered headaches three or more times a month. The predominant symptomatic treatment was paracetamol (83.1%) and non-steroidal anti-inflammatory drugs (52.3%). Beta blockers and amitriptyline were used as prophylactic therapy for the episodes of headache in 18.5% and 13.8% of cases, respectively., Conclusions: The prevalence of primary headaches is high among the working population under study.

Hypnic headache is a rare cause of benign headache in the elderly. This is a clinical report of a 67-year-old housewife, suffering from hypnic headache, in which topiramate yielded a successful prophylactic effect at 100 mg/day.

The need for novel therapeutic strategies for the treatment of migraine and other primary headaches is well recognised. Although the underlying mechanism(s) and the molecular targets that should be tackled by novel medicines are still uncertain, significant improvements have been made in the last decade in the treatment of migraine. Strong evidence in experimental animal models and clinical investigation focus on drugs that limit the phenomena promoted by activation of neurons of the trigeminal ganglion at the level of both their central and peripheral perivascular endings. Identification of compounds that abort the migraine attack by precisely targeting different mechanisms should also help to recompose the puzzle of migraine pathogenesis.

Purpose: We describe a series of patients with hemicrania continua, a rare indomethacin-responsive primary headache syndrome, who presented for evaluation with neuro-ophthalmologic signs and symptoms., Design: Observational case series., Methods: Nine patients between the ages of 29 and 58 years were seen with various neuro-ophthalmologic findings and a unilateral continuous headache. A detailed history was taken from each patient, followed by a focused ophthalmologic and neurologic examination. The risks and benefits of treatment with indomethacin were discussed. Patients were instructed to call after several days of treatment to report any change in their headache and neuro-ophthalmologic symptoms, in addition to any adverse side effects., Results: All patients responded favorably to indomethacin, with rapid near-complete or complete resolution of headache and autonomic symptoms, and treatment was initiated as early as possible., Conclusions: Because of its absolute response to indomethacin, recognizing the neuro-ophthalmologic symptoms of hemicrania continua as a component of the headache syndrome is critical for prompt initiation of treatment.

Benign coital headache is known as a rare type of primary headache related to sexual activity. The pathogenesis of this type of headache remains unknown. Clinical manifestation is typical and connected with three phases of sexual activity. Coital cephalalgia is divided into two subtypes: preorgasmic and orgasmic headache. Some authors specifie the third type--postural type. Preorgasmic headache starts as a dull bilateral ache and increases with sexual excitement. Orgasmic headache has sudden, intense character and occurs at orgasm. Postural headache has been reported to develop after coitus. The author describes four cases of different types of sexual headache, which were effectively treated. Indomethacin was effective in all patients as direct treatment and propranolol was effective in patients to whom it was administrated as preventive treatment.

Primary headache especially migraine is very common disorder. The mainstay in the acute treatment of migraine is triptans (sumatriptan, zolmitriptan, eletriptan, naratriptan) and analgesics or NSAIDs. However, it is still unclear the appropriate usage of triptans and analgesics or NSAIDs for migraine treatment. Mild attacks may be managed with analgesics or NSAIDs while severe disabling ones usually respond better to specific antimigraine drugs, triptans. Analgesics or NSAIDs administration is always plagued with the potential of subsequent drug induced headache phenomenon. Therefore usage of analgesics or NSAIDs should be restricted only for young and typical type patients with migraine. As triptan medication method corresponding to various life style, in addition to tablet formulation, there are subcutaneous injector and nasal spray formulation in sumatriptan, rapid melt tablet formulation in zolmitriptan (rapimelt) and naratriptan (rapidisk). These different type of formulation are valuable for patient's needs.

Medication-overuse headache(MOH) is a clinically important entity and it is well documented that the regular use of acute symptomatic medication by patients with migraine or tension type headache increases the risk of aggravation of the primary headache disorders. MOH is one of the most common causes of chronic refractory headache. The pathophysiological mechanism of MOH is still unclear. But as in most of the headache entities, several different aspects, such as genetic background, peripheral and central nervous system interaction, specific psychotropic effects, appear to play key roles. Management of MOH is a difficult problem. The education for patients with MOH is very important.

We investigated prevalence and character of primary headache for 2,462 examples of high school student. An overall headache prevalence was 41.0 in boys, 55.3% in girls, and average of the headache onset was 12.7 in boys, 12.9 in girls years old. A prevalence of migraine is 5.5 in boys, 6.1% in girls according to ICHD-I and 13.7 in boys, 17.5% in girls according to modified ICHD-II diagnosis criteria. For the tension type headache, it was 23.0 in boys, 30.6% in girls according to modified ICHD-I diagnosis criteria. High school students with primary headache tend take painkillers easily, but are much less likely visit physicians (only 15.0%). Our data showed that the prevalence of headache especially migraine in Japanese high school student was almost similar to past world wide findings, and suggest that its impact on the quality of life can not be ignored. Therefore, headache education must be important and necessary in a high school.

The objective was to study the demographics, diagnostic procedures and therapies employed in order to provide guidelines to Emergency Department (ED) physicians. A six-month retrospective analysis of the records of all patients presenting with nontraumatic headache (NTH) to the EDs of the Province of Trieste was performed. Of 38,238 patients screened, 300 (0.8%) presented with NTH and 49.7% were referred to specialists. Patients were classified as having secondary headache (41.3%), primary headache (24.3%) and headache with no obvious source (NOS) (34.4%). One hundred and seventy patients were treated with mono- or polytherapy. Of 50 patients with migraine, 36 were treated with NSAIDs and 4 with triptans. 68.4% of patients were referred to a general practitioner and 31.6% were admitted. The frequency of NTH was lower than in other studies. NOS headache was frequent. Only 10% of migraineurs received triptans. Diagnostic and therapeutic guidelines for ED physicians are needed.

The headache problem with its debilitation and pain has been noted throughout medical history. It is one of the most common outpatient complaints and affects more than 45 million Americans. The lost days to work and family and the immeasurable suffering of patients can be lessened with the understanding and knowledge of a caring physician. Osteopathic physicians with expertise in holistic and musculoskeletal concepts are particularly well prepared to help. The establishment of an accurate diagnosis through a careful history and physical examination is essential before the physician can develop an effective treatment plan. Treatment can be abortive, prophylactic, or symptomatic, or a combination. Abortive treatment is geared to reverse the headache once begun; prophylactic treatment usually involves the use of daily medications to prevent, decrease frequency, or lessen severity of attacks; and symptomatic treatment is for relief of pain or accompanying symptoms. Most headaches experienced are of the tension type, whereas most debilitating headaches are of the migraine type. Cluster headache, though experienced by a small percentage of sufferers, is especially severe, and is useful in differential diagnosis.

Calcitonin gene-related peptide (CGRP) is a potent neuromodulator that is expressed in the trigeminovascular system and is released into the cranial circulation in various primary headaches. CGRP is released in migraine, cluster headache and paroxysmal hemicrania. The blockade of its release is associated with the successful treatment of acute migraine and cluster headache. CGRP receptor blockade has recently been shown to be an effective acute anti-migraine strategy and is non-vasoconstricting in terms of the mechanism of action. The prospect of a non-vasoconstricting therapy for acute migraine offers a real opportunity to patients, and perhaps more importantly, provides a therapeutic rationale to reinforce migraine as a neurological disorder.

Background: Only a minor part of headaches are associated with an organic abnormality in the nervous system. In case of migraine and tension headache, the main provoking factor is psychological stress. Furthermore, these syndromes often occur together with depression and anxiety disorders, and when these comorbid conditions are present headache attacks tend to be more frequent, longer and stronger, causing an increase in the consumption of antimigraine agents, and at the same time increase the consumption of antidepressant and anxiolytic agents. Further to drugs, modified versions of Schultz-type autogenic training is also frequently used for anxiolysis. The aim of our research was to study the effect of the cognitive and symbol therapy enhanced autogenic training on headache and related drug consumption in three different types of primary headaches., Method: Twenty five female patients with migraine, tension-type headache or mixed headache participated in an eight-month follow-up study. Headache frequency, analgesic, antimigraine and anxiolytic consumption were measured by means of a headache diary. During the first four months (observation phase) patients became familiar with using the diary, and in the second four months they participated in autogenic training. The data of the second, third and fourth months were considered as baseline data., Results and Conclusion: Our method decreased headache frequency and drug consumption in all three headache groups. This means that the cognitive and symbol therapy enhanced autogenic training is an effective alternative for medications in the treatment of primary headaches.