Search

The headache histories obtained from clinical interviews of 600 patients were analysed by computer to see whether patients could be separated systematically into clinical categories and to see whether sets of symptoms commonly reported together differed in distribution among the categories. The computer classification procedure assigned 537 patients to the same category as their clinical diagnosis, the majority of discrepancies between clinical and computer classifications involving common migraine, tension-vascular and tension headache. Cluster headache emerged as a clearly-definable syndrome, and neurological symptoms during headache were most prevalent in the classical migraine group. However, the classical migraine, common migraine, tension-vascular and tension headache categories differed in terms of the number, rather than the nature, of common migraine features. Whether the two extremes of this migraine-tension headache spectrum are different disorders can be determined only by studies of their pathophysiology.

In 1942 a curve of skin conductibility to direct current was described in Prague. It is a slow or steep rising of intensity in the few seconds following the introduction of the 12 V current to the hand from the dorsum to the palm. This method has been called dermatophoria. This curve is characteristical for a given individual and it is different in paretic (central and peripheral) limbs, generally more flat. In children the curves are steeper. However, abnormally steep there are in 57% of juvenile vasomotor headaches. Dermatophoria is therefore promising to be an objective method in diagnosis of children's headache.

Erythroprosopalgia is characterized by severe unilaterally and periodically occurring attacks of headache. During these fits of pain there is an increase in blood flow in the homolateral eye, conjunctival injection and epiphora. Males aged between twenty and forty are most frequently affected. The clinical picture, therapy and differential diagnosis of this disease are discussed.

"Atypical facial pain" is the current label for a possibly heterogeneous group of discomforts localized in the lower half of the head and often confused with dental disease. As illustrated in seventeen cases reviewed here, the condition occurs mostly in women, and there are often neurotic problems in addition to the pain. The pain is dull or burning, incessant, and, in contrast to trigeminal neuralgia, relatively poorly relieved by carbamazepine or diphenylhydantoin sodium; antidepressants and psychotropic agents are worth considering. Although local pathology can occasionally be detected, in this condition the entire state of the patient and the emotional concomitants of the illness require particular attention.

The clinical definition of carotidynia is not a controversial one, whereas how its etiology should be interpreted is still uncertain. The study of the clinical features and the therapeutical results in 12 patients suffering from carotidynia reveals a marked resemblance to migraine. In particular, the case history reported points out a significant incidence of migraine as a familial disease, its special localization and the type of pain, the possible presence of a prodromal stage and the favourable response to the drugs that are known to be effective in migraine treatment. The theory that carotidynia should be ascribed to the group of vascular headaches is therefore suggested.

Using the method of rheoencephalography 182 children aged 8 to 16 years and suffering from functional headaches were examined. With regard to the clinical criteria they were divided into two groups: patients with migraine, and those with vasomotor headache. The control group consisted of 345 clinically healthy children of the same age. The standardized program included examinations in the prone, sedentary, and standing positions, as well as after hyperventilation and the orthostatic test (up to 10 minutes). Because of the wide range of the scatter of the amplitude parameters intraindividual relative values were calculated that reflected the vascular system response to hyperventilation and orthostasis. In the group of children with the vasomotor headaches the curve parameters differed substantially from the respective parameters found in the control group, and in some parameters there were also differences from the migraine group. During the intervals between the headache attacks, the differences in the parameters between the migraine and control groups were less distinct. The two forms of the headache can be differentiated with the aid of functional rheoencephalography.

Headaches, although common occurrences in the elderly, can be the symptoms of a serious problem. Specific headaches found in this population need careful consideration and diagnosis. When the diagnosis is elusive, or the headache is sudden, severe, and incapacitating, a neurologist or neurosurgeon should be consulted.

Numerous factors, such as location of pain, sex, frequency and pattern of occurrence, and symptoms, distinguish cluster headache from migraine. Cluster headache is characterized by severe unilateral periorbital pain. Attacks lasting from several minutes to several hours occur many times a day over a period of weeks to months. Opinions differ as to whether cluster headache is a variant of migraine or a completely different disorder. For relatively mild attacks, abortive treatment with ergotamine tartrate is usually successful. Cases which do not respond to abortive measures require prophylaxis.

Four hundred eighty-five patients between the ages of 15 and 89 made 631 visits to a medical center emergency department with a chief complaint of headache or head pain during a 12-month period from May 1977 to April 1978, accounting for 1.6% of all patient visits. One hundred ninety-three (40%) had subsequent follow-up data available for review. Muscle contraction-tension headache and migraine headache were the most common diagnoses, accounting for 54.5% of all patients. The female/male distribution was 3:2 for the entire group. Five percent of the overall group had serious neurological conditions. Analysis of the emergency department evaluations, results of follow-up, and reviews of other recent series are reported. Based on current literature, recommendations for the detailed laboratory evaluation of the suspicious headache are described.

A strategy based on the temporal patterns of disorder has been presented for the management of headache. Data derived from the clinical history and a knowledge of the common causes of headache enables the general practitioner to diagnose the problem in the majority of patients. Difficulty might occur when tension headache and migraine occur in the same patient. There is a variety of treatment options which offers a challenge for the family doctor in dealing with the problem. Symptoms are managed readily but the family doctor should recognise also the patient's life difficulties and their influence on the disorder. Such problems ensure the general practitioner remains the true family physician and not a mere dispenser of tablets.

In most cases, patients presenting with "the worst headache ever" are found to have a benign condition, notably migraine, toxic vascular headache, or exertion-induced headache. However, ominous causes first must be excluded by appropriate investigation, such as computed tomographic or magnetic resonance imaging scans and lumbar puncture. When an ominous cause has been ruled out, appropriate therapy can be started.

The authors analysed the clinical pattern of manifestations and electroencephalographic findings in 120 patients with vasomotor headache, who were attending the Migraine Treatment Centre at the Department of Neurology, Medical Academy in Lódź. During 5 years of observation these patients accounted for 20% of all cases of idiopathic headaches treated in this Centre. It was observed that the clinical manifestations and electroencephalographic findings in vasomotor headaches were non-characteristic. The diagnosis of this headache must be reached after ruling out all other idiopathic and symptomatic headaches.

The evaluation of central opiate activity could be of clinical value in the diagnosis and treatment of pain syndromes. The current approach via direct measurement of endogenous opioid peptides in cerebrospinal fluid (CSF) is not devoid of side effects and cannot be used in every-day practice. As an alternative to this method, we have studied the neuroendocrine response of plasma LH to an i.v. naloxone injection in 39 headache sufferers from different diagnostic subgroups, and in 12 age- and sex-matched healthy volunteers. Patients (19 females and 20 males) were affected by common migraine (CM, 11 cases), migraine with interparoxysmal headache (MIH, 9), classical migraine (CIM, 9), and chronic cluster headache (CH, 10). Headache lasted 3-36 years. Prior to naloxone challenge (4 mg i.v.), LH pulsatility was evaluated for 1 h. The next morning, the pituitary response to LH-RH (10 micrograms i.v.) was tested in 20 patients. Plasma LH was measured by RIA in every sample. The response to the tests was evaluated as secretion area of plasma LH minus the mean basal value. Controls (497.5 +/- 85.5 mIU/ml x 120 min), ClM (357.8 +/- 78.9) and CH (450.5 +/- 70.4) patients showed similar results, while in cases of CM (155.3 +/- 71.7, P less than 0.05) and MIH (104.1 +/- 53.7, P less than 0.01) the LH secretion after naloxone injection was significantly blunted. On the contrary, the response of LH to LH-RH was similar in controls and patient groups, thus excluding pituitary dysfunctions in this response.(ABSTRACT TRUNCATED AT 250 WORDS)

Headaches are a common cause of disability in childhood. Although the symptom of headache raises concerns about serious neurologic disease, the cause is most commonly vascular or due to muscle contraction. The differentiation between muscle-contraction and vascular headaches is clinical, and laboratory studies rarely are required. Treatment of muscle-contraction headaches is symptomatic. Migraine headaches sometimes require periods of prophylactic therapy. The chronic nature of headaches mandates a comprehensive approach to management of the child and family. This approach is best carried out in the primary care setting.

Cluster headache is a relatively common form of vascular headache. Its characteristic clinical pattern should allow definitive diagnosis in the vast majority of cases. Extensive diagnostic evaluations are not indicated. Treatment is generally unsatisfactory but helpful in a number of cases. It has a limited natural history and is essentially a benign condition.

A patient with necrosis of the tongue was found to have Horton's disease. The other typical manifestations of this disease, though present, were overshadowed by the lingual necrosis. Recovery occurred after relatively high doses of corticoids.

Pupillometric studies were carried out in eight patients with chronic paroxysmal hemicrania (CPH) and in age- and sex-matched controls in the basal condition and after instillation of 2% tyramine (CPH, n = 5; controls, n = 17), 1% OH-amphetamine (CPH, n = 6; controls, n = 12), and 1% phenylephrine (CPH, n = 6; controls, n = 17). The pupil on the symptomatic and non-symptomatic sides in CPH patients was significantly smaller in the basal condition than in controls, particularly on the symptomatic side. The mydriatic responses to pharmacologic stimulation were essentially similar on the symptomatic and non-symptomatic sides. An evaporimetric study of the forehead sweat glands, using the body heating and pilocarpine tests, was also carried out in these patients and in age- and sex-matched controls. "Early", "intermediate", and "late" measurements demonstrated symmetry of forehead sweating. The findings for both methods of examination thus contrast with those in cluster headache patients. Pupillometric and forehead sweating patterns therefore suggest differences in the pathogenesis of the two headache entities. These tests may be used to distinguish CPH and cluster headache clinically.