New daily-persistent headache and International Headache Society criteria: A retrospective analysis of 62 patients

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "New daily-persistent headache and International Headache Society criteria: A retrospective analysis of 62 patients"

Transcription

1 ARTIGO ORIGINAL New daily-persistent headache and International Headache Society criteria: A retrospective analysis of 62 patients Novo critério da Sociedade Internacional de Cefaléia para cefaléia persistente e diária desde o início: análise retrospectiva de 62 pacientes Monzillo PH, Baise-Zung C, Nemoto PH, Costa AR Headache ambulatory of Discipline of Neurology of Santa Casa de São Paulo - Brazil Monzillo PH, Baise-Zung C, Nemoto PH, Costa AR. New daily-persistent headache and International Headache Society criteria: A retrospective analysis of 62 patients. Migrâneas cefaléias 2007;10(3):77-81 ABSTRACT Introduction. New Daily-Persistent Headache (NDPH) is described as a type of daily headache that becomes continuous in a short period of time (a maximum of three days). As any newly recognised headache condition, there is a paucity of reports. Therefore, its characteristics in different populations must be further described. Objectives. To describe the characteristics of NDPH in a Brazilian out-patient population. Methods. Sixty-two patients with a diagnosis of New Daily- Persistent Headache (NDPH), out of 1,348 records of outpatients regularly cared for at the Headache Clinic of Irmandade da Santa Casa de São Paulo - Brazil, had their charts reviewed. Results. Clinical characteristics were: female gender 58.1%; whole head pain=72.6%; moderate/strong intensity=93.6% and throbbing quality=43.5%. Of the 62 patients with the diagnosis of NDPH, only 19.4% did not have any clinical improvement when submitted to treatment. Diagnostic exams carried out in 56.5% of the patients contributed very little to the detection of an underlying organic substrate. Conclusion. Our results conflicted with those of the literature and with the IHS 2004 criteria regarding pain intensity, pain quality and the associated phenomena, isolated or in combinations. Perhaps the NDPH IHS 2004 diagnostic criteria should be revised. Key words: Chronic daily headaches; migraine; Chronic Tension-type headache; migraine; New daily-persistent headache; International Headache Society criteria. RESUMO Introdução. Cefaléia persistente e diária desde o início (CPDI) é descrita como um tipo de cefaléia diária que se torna continua em um curto período de tempo (máximo de três dias). Como toda condição recém-reconhecida, ainda há uma pequena quantidade de descrições. Assim sendo, suas características em diferentes populações devem ser descritas. Objetivos. Descrever as características da CPDI em uma população de pacientes brasileiros ambulatoriais. Mé- todos: Foram revisados os prontuários de 62 pacientes com o diagnóstico de CPDI, oriundos de uma população de pacientes do ambulatório de cefaléias da Irmandade da Santa Casa de São Paulo - Brasil. Resultados. As características clínicas foram: gênero feminino=58,1%; cefaléia holocraniana=72,6%; dor moderada a intensa=93,6%, qualidade pulsátil=43,5%. Dos 62 pacientes com o diagnóstico de CPDI, apenas 19,4% não apresentaram melhora ao serem submetidos a tratamento. A investigação complementar, realizada em 56,5% dos pacientes pouco contribuiu para a detecção de um substrato orgânico. Conclusão. Nossos resultados foram discordantes daqueles da literatura dos critérios da IHS de 2004, no que tange a intensidade da dor, sua qualidade e fenômenos concomitantes, isolados ou em combinação. Talvez os critérios diagnósticos da IHS/2004 devam ser revisados. Palavras alavras-chave: Cefaléia crônica diária; migrânea; cefaléia tipo-tensão crônica; cefaléia persistente e diária desde o início; critérios da International Headache Society. Migrâneas cefaléias, v.10, n.3, p.77-81, jul./ago./set

2 PAULO HÉLIO MONZILLO ET AL INTRODUCTION Vanast 2 first described New Daily-Persistent Headache (NDPH) in 1986 as a benign Chronic Daily Headache (CDH). In 1996, Silberstein and cols. 3 suggested diagnostic criteria for this entity as NDPH was not part of the 1988 IHS classification. 4 New daily-persistent headache, according to the International Headache Society (IHS 2004), 1 is described as a type of daily headache that becomes continuous in a short period of time (a maximum of three days). The pain is typically a pressing or tight non-pulsating throb, bilateral and of mild to moderate intensity. Photophobia, phonophobia, nausea and the attack intensity are not aggravated by routine physical exercises. The symptoms must be present for more than three months and not attributable to other causes. Headaches secondary to Cerebral Spinal Fluid (CSF) hypotension, CSF hypertension, post-traumatic headache and headaches secondary to infectious clinical conditions (particularly where infecting agents are present) must always be diagnosed through appropriate investigations when suspected. In compliance with IHS 2004, NDPH can evolve during a period of time in two clinical ways: one autolimited presentation that disappears spontaneously after a few months without treatment and a chronic and normally intractable headache regardless of the therapeutic approach utilized. The IHS closes its comments suggesting that further research studies should be undertaken that better characterize its clinical features and propose possible pathophysiological mechanisms, and conclude definitively the separation from Chronic Tension-Type Headache (CTTH). Few reports are available in the literature involving large NDPH patient samples. 2,5 Its etiology remains unknown, 6 although some authors have tried to imply a temporal relationship to infectious clinical conditions, particularly Epstein-Barr virus (EBV). 7,8 We conducted a retrospective analysis of a large database of headache patients to describe the demographic data and clinical caractheristics of NDPH. PATIENTS AND METHODS We carried out a retrospective analysis consisting of a total of 1,348 records. Of this group, 241 patients presented a headache with a frequency of 15 days or more a month, for at least three months. Sixty-two patients had an NDPH diagnosis in accordance with Silberstein's proposed criteria for new daily persistent headache. 3 Data were recorded regarding the demographic aspects, clinical characteristics of the headache attacks, as well as the presence of accompanied symptoms. More than half the patients were submitted to secondary investigations. Patients with previously diagnosed headache conditions were excluded even if they presented with a clinical picture compatible with NDPH, in order not to include CTTH or CDH bearers. We also recorded the therapeutic recommendations given at the first appointment in our out-patient clinic (abortive or prophylactic) that resulted in clinical improvement, or the treatment scheme substituted when patients did not present any improvement. RESULTS Thirty-six patients (58.1%) were female. The average age at the beginning of the symptoms was of 40.5 years, slightly lower among women (36.7) when compared to men (44.3) (Figure1). Female Male Figure1: Age at the beginning of symptoms The average time delay between initial symptoms and the first appointment at our clinic was 5.9 years. The bilateral localization of the attack occurred in 45 patients (72.6%). Pulsating-type pain was present in 43% of the patients, followed by stabbing pain in 14 (22.6%), pressing in 12 (19.4%), tightening in 4 (6.5%) and burning in 3 (4.8%). Two patients (3.2%) cited different pain types in separate attacks (tightening and pulsating) (Table 1). Strong to moderately intensive attacks were found in equal percentages (46.8%) in our sample, and mild attacks in four patients (6.4%) (Figure 2). Only 11 patients (17.7%) did not refer to any 78 Migrâneas cefaléias, v.10, n.3, p.77-81, jul./ago./set. 2007

3 NEW DAILY-PERSISTENT HEADACHE AND INTERNATIONAL HEADACHE SOCIETY CRITERIA: A RETROSPECTIVE ANALYSIS OF 62 PATIENTS Table 1. Analysis related to pain quality Pain quality N (62) % Pulsating Stabbing Pressing Tightening Burning Tightening + Pulsating Figure 2: Pain Intensity Table 2. Symptoms related to headaches Symptoms N(62) % Pt N Pn + Pt Pn + Pt + N Pn+ Pt+ N+ V N + V Pt + N Pt + Pn + O Pt + N + O Pt + Pn + D N + D Pt + Pn + N + V + O AP D Absence of symptoms Pt: photophobia; N: nausea Pn: phonophobia; V: vomit; O: osmophobia; D: dizziness; AP: autonomic phenomenae; AS: absence of symptoms symptoms associated with their attacks. All other patients presented isolated or associated symptoms that usually accompany migraine attacks. Two patients reported the presence of autonomic symptoms related to their attacks (Table 2). Fifty-five patients (56.5%) were submitted to further investigation. Within this group, it was possible to establish a factor temporally related to the initial symptoms in only three patients. Two patients reported a history of headaches after cranial-cerebral trauma and one patient had headaches following an otomastoiditis infection. Head computed tomography (Head CT-scan) was not useful in detecting abnormalities that justified the clinical symptoms. In the mastodectomized patient, the CT evidenced only a hypoattenuated area in the right temporal region adjacent to the mastoidectomy. In the remaining patients, radiological and laboratorial findings include the following: a venous angioma (right frontal) and a left frontal cavernoma, revealed by Magnetic -Ressonance Imaging (MRI). Onepatient, had a positive serology testfor HIV virus, however without an AIDS-defining clinical picture. Despite the daily frequency and the intensity of the attacks being predominantly moderate to strong, only 28 patients (45.2%) of our sample constantly and abusively used abortive medication on the occasion of their first appointment. Different prophylactic schemes were used, as monotherapy or in different combinations. It is important to point out that the majority of the patients had already used at least one of the prophylactic medicines - at the moment of their first evaluation at our clinic. The list of prophylactic medicines used by those patients during their treatments is illustrated in Table 3. Only ten patients (16.1%) remained totally asymptomatic and twelve patients (19.4%) did not respond to any of the proposed treatments. Twenty-six patients (41.9%) reported a partial improvement of symptoms; in ten of the patients the improvement obtained was related to the attack frequency, in two patients to the attack duration and in 14 patients to the pain intensity. In 14 (22.6%) records it was not possible to obtain data regarding therapeutic efficiency. Table 3. Prophylactic Medication Used Drug Number of patients (%) Amitriptyline 44 (71.0) Flunarizine 19 (30.6) Sodium Valproate 17 (27.4) Propranolol 12 (19.3) Nortriptylin 11 (17.7) Atenolol 06 (9.7) Topiramate 03 (4.8) Clorpromazin 03 (4.8) Carbamazepine 02 (3.2) Prednisone 02 (3.2) Pizotifen 02 (3.2) Oxcarbazepine 01 (1.6) Lithium Carbonate 01 (1.6) Migrâneas cefaléias, v.10, n.3, p.77-81, jul./ago./set

4 PAULO HÉLIO MONZILLO ET AL DISCUSSION Although there are few reports refering to this type of headache in the literature, the NDPH has been a part of the IHS classification since 2004, included in group 4 - Other primary headaches 1. The major characteristic of the NDPH is that the headaches are persistentfrom the onset. Although many patients can't relate the initial symptoms to any cause, a majority are able to pinpoint the start date, even though time has past. Some authors suggest that the initial headache occurs in relation to temporal viral conditions, infections, extracranial surgeries or stressing life events. 6,9,10,11,15 Li and Rozen 6 observed that more than 80% of the patients could recallthe exact date of the initial symptoms and 54% correlated the start of the symptoms to a precipitating event, generally a flu type illness. Other authors go further, linking these infectious conditions to the Influenzae 9 virus or to the Epstein-Baar 7,8 virus with the intention of attributing the NDPH to an infectious etiopathogenesis. This did not occur in any of our cases. There was no (spontaneous) mention suggesting viral infections at the time of the initial symptoms. More than half of the patients (56.5%) of our sample were submitted to imaging and laboratory exams that did little to contribute to the diagnostic elucidation. The rest of the patients did not follow the investigation protocol because they were refered to our clinic many years after the start of symptoms (average of 5.9 years). Only in three patients was it possible to link the start of the symptoms to a putative causal factor. In this analysis, we observed the predominance of female NDPH, as previously shown by the Vanast report and Li and Rozen's. In only one recent research study was it reported that males had a preponderance of NDPH. The IHS diagnostic criteria does not take into consideration the disparity between males and females. 2,6,11 In our study, the average age for the onset of NDPH was 40.5 years, women had their initial headache symptoms earlier than men, and this data is in accordance with the literature. 6 This demographic data is also not mentioned in the IHS criteria. The majority of our patients presented a headache localized bilaterally, which parallels the observations by Li and Rozen, and Takase and cols. They also described the pain bilateral in accordance with the IHS criteria, although this is not obligatory. 6,11,1 Pain referred to as pulsating was reported in 43.5% of our sample. Various authors also consider this as the most common related pain. 5,6,11,12 We call attention to the fact that this conflicts directly with the current IHS 2004 classification that describes the type of pain of NDPH as being pressing or tightening but never pulsating. 1 Nearly half the sample (46.8%) classified the intensity of their attack as being strong but when combined with those who refered to the pain as moderate, the amount increases to 93.5%. Li and Rozen 6,5 had already suggested as one of the diagnostic criteria of NDPH a pain intensity variation between moderate and strong. Therefore, we question the IHS criteria that refers to the pain intensity of the NDPH as being mild, as fluctuations can occur. 1 In contradiction to the IHS 2004 criteria, 82.3% of our patients presented similar migraine attacks as opposed to CTTH, evidenced by the association of pain with: nausea, photophobia and phonophobia, isolated or in different combinations. These three symptoms were the most relevant in our experience. Our results are in total 2,6, 9,12 accordance with the literature. Few reports in the literature make a recommendation regarding the treatment of NDPH. Various therapeutic strategies were used by the patients in our out-patient clinic in monotherapy or in association. We observed clinical improvements in 36 patients (58%) and complete remission of pain symptoms in 10 patients (16.1%). That percentage of partial and complete therapeutic response is significant, considering the degree of the symptoms. Vanast 2 describes that a number of patients can improve with medical therapy treatment, however, he emphasizes that they may have difficulty accessing that treatment. Rozen also reiterates the difficulty to define the best treatment strategy for NDPH, emphasizing that succesful responses occurred in a limited amount of patients with the use of gabapentin and topiramate. 13 CONCLUSION For nearly two decades, publications are available for this intriguing type of headache. Clinical and demographic data involving large series of patients are still lacking, not to mention a total non-acquaintance of the etiopatogenesis of this entity. In this article, we emphasize that the NDPH holds a clinical similarity with migraines but cannot be confused with the CTTC, since the latter is an evolution of the Tension-Type Headache (TTH) according to the IHS 2004 diagnostic criteria. There are relevant conflicts in the clinical aspects observed in our sample research and in the literature, 2,6,9,12 80 Migrâneas cefaléias, v.10, n.3, p.77-81, jul./ago./set. 2007

5 NEW DAILY-PERSISTENT HEADACHE AND INTERNATIONAL HEADACHE SOCIETY CRITERIA: A RETROSPECTIVE ANALYSIS OF 62 PATIENTS when compared with the diagnostic criteria established by IHS 2004 such as: pain intensity, pain quality and the concomitant phenomena present in migraine attacks: nausea, photophobia and phonophobia, in an isolated way or in different combinations. Therefore we suggest that the diagnostic criteria established by IHS 2004 should be revised in the future. Additional clinical characterization and pathophysiological research must be stimulated in order to improve our understanding of this particular entity. REFERENCES 1. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd Edition. Cephalalgia. 2004;24(suppl): Vanast WJ. New daily persistent headaches: definition of a benign syndrome. Headache. 1986;26: Silberstein SD; Lipton RB; Sliwinski M. Classification of daily and near-daily headaches: field trial of revised HIS criteria. Neurology. 1996;47: Headache Classification Subcommittee of the International Headache Society. Classification and Diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia. 1988;8(supp7): Rozen TD. New daily persistent headache. Curr Pain Headache Rep. 2003;7: Li D, Rozen TD. The clinical characteristics of new daily persistent headache. Cephalalgia. 2002;22: Diaz-Mitoma F; Vanast WJ; Tyrrel DLJ. Increased frequency of Epstein-Barr virus excretion in patients with new daily persistent headaches. The Lancet. 1987;1: Hamada T, Oshima K, Ide Y, Sakato S, Takamori M. A case of new daily persistent headache with elevated antibodies to Epstein-Barr virus (abstract). Jpn J Med. 1991;30(2):161:3. 9. Evans, RW; Rozen, TD. Etiology and treatment of new daily persistent headache. Headache. 2001;41: Takase Y, Nakano M, Tatsumi C. Primary new daily persistent Headache (NDPH): clinical characteristics of forty-three cases in Japan. Rinsho Shinkeigaku. 2003;43(9): Abstract. 11. Takase Y, Nakano M, Tatsumi C, Matsuyama T. Clinical features, effectiveness of drug-based treatment, and prognosis of new daily persistent headache (NDPH): 30 cases in Japan. Cephalagia. 2004;24: Goadsby, PJ; Boes, C. New daily persistent headache. J Neurol Neurosurg Psychiatry. 2002;72: ii6-ii Rozen TD. Succesful treatment of new daily persistent headache with gabapentin and topiramate. Headache. 2002;42:433. Disclosure: The authors have reported no conflicts of interest Recebido: 29/08/ 2007 Aceito: 31/ Endereço paa correspondência Dr. Paulo H. Monzillo Av. Albert Einstein, 627 room 1306 São Paulo-Brazil Tel-55(11) ; Fax: 55(11) Migrâneas cefaléias, v.10, n.3, p.77-81, jul./ago./set

Clinical Characteristics of Chronic Daily Headache Patients Visit to University Hospital

Clinical Characteristics of Chronic Daily Headache Patients Visit to University Hospital Clinical Characteristics of Chronic Daily Headache Patients Visit to University Hospital Jin-Kuk Do, M.D., Hee-Jong Oh, M.D., Dong-Kuck Lee, M.D. Department of Neurology, Taegu Hyosung Catholic University

More information

Prevalence of new daily persistent headache in the general population. The Akershus study of chronic headachecha_

Prevalence of new daily persistent headache in the general population. The Akershus study of chronic headachecha_ doi:10.1111/j.1468-2982.2009.01842.x Prevalence of new daily persistent headache in the general population. The Akershus study of chronic headachecha_1842 1149..1155 RB Grande 1,2, K Aaseth 1,3, C Lundqvist

More information

New daily persistent headache: Should migrainous features be incorporated?

New daily persistent headache: Should migrainous features be incorporated? Original Article New daily persistent headache: Should migrainous features be incorporated? Cephalalgia 31(15) 1561 1569! International Headache Society 2011 Reprints and permissions: sagepub.co.uk/journalspermissions.nav

More information

Differentiating Migraine from Other Headache Types to Target Treatment Peter J. Goadsby, MD, PhD

Differentiating Migraine from Other Headache Types to Target Treatment Peter J. Goadsby, MD, PhD Differentiating Migraine from Other Headache Types to Target Treatment Peter J. Goadsby, MD, PhD University of California, San Francisco San Francisco, CA King's College London London, England Learning

More information

By Nathan Hall Associate Editor

By Nathan Hall Associate Editor By Nathan Hall Associate Editor 34 Practical Neurology March 2005 These new rules may change the definition of head pain, but some practitioners may find the new guidelines themselves to be a source of

More information

Headache Mary D. Hughes, MD Neuroscience Associates

Headache Mary D. Hughes, MD Neuroscience Associates Headache Mary D. Hughes, MD Neuroscience Associates Case 1 22 year old female presents with recurrent headaches. She has had headaches for the past 3 years. They start on the right side of her head and

More information

Cluster headache (CH): epidemiology, classification and clinical picture

Cluster headache (CH): epidemiology, classification and clinical picture Cluster headache (CH): epidemiology, classification and clinical picture Toomas Toomsoo, M.D. Head of the Center of Neurology East Tallinn Central Hospital 1 INTRODUCTION Cluster headache - known as trigeminal

More information

New Daily Persistent Headache in Children and Adolescents

New Daily Persistent Headache in Children and Adolescents Curr Neurol Neurosci Rep (2010) 10:127 132 DOI 10.1007/s11910-010-0097-3 New Daily Persistent Headache in Children and Adolescents Eric P. Baron & A. David Rothner Published online: 24 February 2010 #

More information

10/17/2017 CHRONIC MIGRAINES BOTOX: TO INJECT OR NOT INJECT? IN CHRONIC MIGRAINE PROPHYLAXIS OBJECTIVES PATIENT CASE EPIDEMIOLOGY EPIDEMIOLOGY

10/17/2017 CHRONIC MIGRAINES BOTOX: TO INJECT OR NOT INJECT? IN CHRONIC MIGRAINE PROPHYLAXIS OBJECTIVES PATIENT CASE EPIDEMIOLOGY EPIDEMIOLOGY BOTOX: TO INJECT OR NOT INJECT? IN CHRONIC MIGRAINE PROPHYLAXIS OBJECTIVES JENNIFER SHIN, PHARMD PGY2 AMBULATORY CARE PHARMACY RESIDENT COMMUNITYCARE HEALTH CENTERS PHARMACOTHERAPY ROUNDS OCTOBER 20, 2017

More information

Does repeated subcutaneous administration of sumatriptan produce an unfavorable evolution in cluster headache?

Does repeated subcutaneous administration of sumatriptan produce an unfavorable evolution in cluster headache? J Headache Pain (2004) 5:110 114 DOI 10.1007/s10194-004-0078-5 ORIGINAL Virginie Dousset Virginie Chrysostome Bruno Ruiz S. Irachabal Magalie Lafittau Françoise Radat Bruno Brochet Patrick Henry Does repeated

More information

6/2/2017. Objectives. Statement of Problem: Migraine Headaches Are Common. Chronic Headache In Pediatrics, Botox and Beyond

6/2/2017. Objectives. Statement of Problem: Migraine Headaches Are Common. Chronic Headache In Pediatrics, Botox and Beyond Chronic Headache In Pediatrics, Botox and Beyond Ken Mack MD PhD Mayo Clinic 2015 MFMER slide-1 Objectives Understand pediatric chronic headache presentations Review evidence for the treatment of chronic

More information

Original Article INTRODUCTION

Original Article INTRODUCTION 58 REVISTA PAULISTA DE MEDICINA Original Article Marcelo Bigal Carlos Alberto Bordini José Geraldo Speciali Headache in an emergency room in Brazil Department of Neurology, São Paulo University, School

More information

Headache Master School Japan-Osaka 2016 II. Management of refractory headaches Case Presentation 2. SUNCT/SUNA: concept, management and prognosis

Headache Master School Japan-Osaka 2016 II. Management of refractory headaches Case Presentation 2. SUNCT/SUNA: concept, management and prognosis Headache Master School Japan-Osaka 2016 II. Management of refractory headaches Case Presentation 2. SUNCT/SUNA: concept, management and prognosis Noboru Imai(Department of Neurology, Japanese Red Cross

More information

Clinical case. Clinical case 3/15/2018 OVERVIEW. Refractory headaches and update on novel treatment. Refractory headache.

Clinical case. Clinical case 3/15/2018 OVERVIEW. Refractory headaches and update on novel treatment. Refractory headache. OVERVIEW Refractory headaches and update on novel treatment Definition of refractory headache Treatment approach Medications Neuromodulation In the pipeline Juliette Preston, MD OHSU Headache Center Refractory

More information

Inpatient Treatment of Status Migraine With Dihydroergotamine in Children and Adolescents

Inpatient Treatment of Status Migraine With Dihydroergotamine in Children and Adolescents Headache 2008 the Authors Journal compilation 2008 American Headache Society ISSN 0017-8748 doi: 10.1111/j.1526-4610.2008.01293.x Published by Wiley Periodicals, Inc. Brief Communication Inpatient Treatment

More information

PPH AND BIOLOGICAL GLUE IN PATIENTS WITH HIGH RISK OF BLEEDING IN STAPLED HEMORRHOIDOPEXY

PPH AND BIOLOGICAL GLUE IN PATIENTS WITH HIGH RISK OF BLEEDING IN STAPLED HEMORRHOIDOPEXY PPH AND BIOLOGICAL GLUE IN PATIENTS WITH HIGH RISK OF BLEEDING IN STAPLED HEMORRHOIDOPEXY The Harvard community has made this article openly available. Please share how this access benefits you. Your story

More information

UCNS Course A Review of ICHD-3b

UCNS Course A Review of ICHD-3b UCNS Course A Review of ICHD-3b Andrew D. Hershey, M.D., Ph.D., FAHS Endowed Chair and Director of Neurology Director, Cincinnati Children s Headache Center Professor of Neurology and Pediatrics University

More information

Migraine Migraine Age Specific Prevalence in the United States. Headache International Headache Society Classification

Migraine Migraine Age Specific Prevalence in the United States. Headache International Headache Society Classification 28 Primary Care Medicine Principles and Practice 29 October 28 Professor Peter J. Goadsby Peter.Goadsby@headache.ucsf.edu Department of Neurology Headache International Headache Society Classification

More information

UNDERSTANDING CHRONIC MIGRAINE. Learn about diagnosis, management, and treatment options for this headache condition

UNDERSTANDING CHRONIC MIGRAINE. Learn about diagnosis, management, and treatment options for this headache condition UNDERSTANDING CHRONIC MIGRAINE Learn about diagnosis, management, and treatment options for this headache condition 1 What We re Going to Cover Today The symptoms and phases of migraine Differences between

More information

Is Topiramate Effective in Preventing Pediatric Migraines?

Is Topiramate Effective in Preventing Pediatric Migraines? Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2013 Is Topiramate Effective in Preventing

More information

Disease Description and Statistics Current State: Medicare Denial of Coverage Expert Opinion Clinical Studies Gap in Medical Care Cost to US

Disease Description and Statistics Current State: Medicare Denial of Coverage Expert Opinion Clinical Studies Gap in Medical Care Cost to US Oxygen Therapy Disease Description and Statistics Current State: Medicare Denial of Coverage Expert Opinion Clinical Studies Gap in Medical Care Cost to US Taxpayers Recommendations Cluster headaches are

More information

Tension-type Headaches

Tension-type Headaches Stress-related Diseases Tension-type Headaches JMAJ 45(5): 202 206, 2002 Koji TSUBOI Professor, Department of Psychosomatic Medicine, School of Medicine, Toho University Abstract: Tension-type headaches

More information

PREVALENCE BY HEADACHE TYPE

PREVALENCE BY HEADACHE TYPE CLINICAL CLUES AND CLINICAL RULES: PRIMARY VS SECONDARY HEADACHE * Based on a presentation by David W. Dodick, MD ABSTRACT Headache is a common condition, accounting for many specialist office visits annually.

More information

MEASURE #3: PREVENTIVE MIGRAINE MEDICATION PRESCRIBED Headache

MEASURE #3: PREVENTIVE MIGRAINE MEDICATION PRESCRIBED Headache MEASURE #3: PREVENTIVE MIGRAINE MEDICATION PRESCRIBED Headache Measure Description Percentage of patients age 18 years old and older diagnosed with migraine headache whose migraine frequency is 4 migraine

More information

Dr Barry Snow. Neurologist Auckland District Health Board

Dr Barry Snow. Neurologist Auckland District Health Board Dr Barry Snow Neurologist Auckland District Health Board Dizzy and Headache Barry Snow Dizzy Pre-syncope Dys-equilibrium Vertigo Vertigo Neurological Findings (except horizontal nystagmus) No other neurology

More information

Venlafaxine versus amitriptyline in the prophylactic treatment of migraine: randomized, double-blind, crossover study

Venlafaxine versus amitriptyline in the prophylactic treatment of migraine: randomized, double-blind, crossover study Clinical Neurology and Neurosurgery 107 (2004) 44 48 Venlafaxine versus amitriptyline in the prophylactic treatment of migraine: randomized, double-blind, crossover study Serpil Bulut a,, M. Said Berilgen

More information

ARTICLE DOI: / X

ARTICLE DOI: / X DOI: 10.1590/0004-282X20140148 ARTICLE Amitriptyline and aerobic exercise or amitriptyline alone in the treatment of chronic migraine: a randomized comparative study Amitriptilina e exercício aeróbico

More information

Specific features of migraine syndrome in children

Specific features of migraine syndrome in children J Headache Pain (2006) 7:206 210 DOI 10.1007/s10194-006-0312-4 RAPID COMMUNICATION Marija Knezevic-Pogancev Specific features of migraine syndrome in children Received: 16 April 2006 Accepted in revised

More information

Patient with Lots of NTERNATIONAL CLASSIFICATION. Headaches HEADACHE DISORDERS. R. Allan Purdy, MD, FRCPC,FACP

Patient with Lots of NTERNATIONAL CLASSIFICATION. Headaches HEADACHE DISORDERS. R. Allan Purdy, MD, FRCPC,FACP Patient with Lots of NTERNATIONAL CLASSIFICATION Headaches of R. Allan Purdy, MD, FRCPC,FACP HEADACHE DISORDERS Professor of Medicine (Neurology) Dalhousie University, Halifax, Canada 2nd edition (ICHD-II)

More information

Article. Arq Neuropsiquiatr 2011;69(1):79-84

Article. Arq Neuropsiquiatr 2011;69(1):79-84 Article Arq Neuropsiquiatr 2011;69(1):79-84 ABSTRACT Background: Ventricular drainage has played an important role in the management of traumatic brain-injured patients. The aim of the present study was

More information

Outpatient Headache Care Guideline

Outpatient Headache Care Guideline 1 Outpatient Care Guideline Inclusion criteria: children > 3 yrs with headaches Is urgent emergency department, neuroimaging, or Neurology consultation indicated? Referral to ED if: New severe headache

More information

Neurotrophic factors in tension-type headache

Neurotrophic factors in tension-type headache ARTICLE DOI: 0.590/0004-282X2050000 Neurotrophic factors in tension-type headache Fatores neurotróficos na cefaleia do tipo tensional Renan B. Domingues, Halina Duarte, Natália P. Rocha 2, Antonio L. Teixeira,2

More information

23 How Cluster Headache and Other Trigeminal Autonomic Cephalalgias Present

23 How Cluster Headache and Other Trigeminal Autonomic Cephalalgias Present 23 How Cluster Headache and Other Trigeminal Autonomic Cephalalgias Present Henrik Winther Schytz 1. Cristina Tassorelli 2. Messoud Ashina 1 1 Glostrup Hospital, University of Copenhagen, Glostrup, Copenhagen,

More information

Conflicts of interest statements

Conflicts of interest statements Demographic and clinical profile of headache in a low income population at headache center in Bogotá -Colombia Marta Liliana Ramos Romero Neurologist athospital Occidente de Kennedy University of La Sabana

More information

Combination of pharmacotherapy and lidocaine analgesic block of the peripheral trigeminal branches for trigeminal neuralgia: a pilot study

Combination of pharmacotherapy and lidocaine analgesic block of the peripheral trigeminal branches for trigeminal neuralgia: a pilot study ARTICLE DOI: 10.1590/0004-282X20150077 Combination of pharmacotherapy and lidocaine analgesic block of the peripheral trigeminal branches for trigeminal neuralgia: a pilot study Combinação de farmacoterapia

More information

Headache Treatment Hans-Christoph Diener Department of Neurology and Headache Center University Hospital Essen Germany

Headache Treatment Hans-Christoph Diener Department of Neurology and Headache Center University Hospital Essen Germany Headache Treatment 2014 Hans-Christoph Diener Department of Neurology and Headache Center University Hospital Essen Germany Conflict of Interest Statement German Research Council German Ministry of Education

More information

MEASURE #4: Overuse of Barbiturate Containing Medications for Primary Headache Disorders Headache

MEASURE #4: Overuse of Barbiturate Containing Medications for Primary Headache Disorders Headache MEASURE #4: Overuse of Barbiturate Containing Medications for Primary Headache Disorders Headache Measure Description Percentage of patients age 18 years old and older with a diagnosis of primary headache

More information

Faculty Disclosure. Karen L. Bremer, MD. Dr. Bremer has listed no financial interest/arrangement that would be considered a conflict of interest.

Faculty Disclosure. Karen L. Bremer, MD. Dr. Bremer has listed no financial interest/arrangement that would be considered a conflict of interest. Faculty Disclosure Karen L. Bremer, MD Dr. Bremer has listed no financial interest/arrangement that would be considered a conflict of interest. HEADACHE UPDATE Karen L. Bremer, MD November 10, 2017 karen.bremer@creighton.edu

More information

Tension-Type Headache

Tension-Type Headache Chronic Headache Tension-Type Headache Its mechanism and treatment JMAJ 47(3): 130 134, 2004 Manabu SAKUTA Chief Professor, First Internal Medicine (Neurology), Kyorin University Abstract: Tension-type

More information

OH, MY ACHING HEAD! I HAVE NO DISCLOSURES OR CONFLICTS OF INTERESTS TO DECLARE MANAGING HEADACHE IN THE OUTPATIENT SETTING SECONDARY HEADACHES

OH, MY ACHING HEAD! I HAVE NO DISCLOSURES OR CONFLICTS OF INTERESTS TO DECLARE MANAGING HEADACHE IN THE OUTPATIENT SETTING SECONDARY HEADACHES 1 JUSTIN A. OSSMAN, MD CHATTANOOGA FAMILY MEDICINE UPDATE OH, MY ACHING HEAD! MANAGING HEADACHE IN THE OUTPATIENT SETTING 2 I HAVE NO DISCLOSURES OR CONFLICTS OF INTERESTS TO DECLARE OBJECTIVES International

More information

They are updated regularly as new NICE guidance is published. To view the latest version of this NICE Pathway see:

They are updated regularly as new NICE guidance is published. To view the latest version of this NICE Pathway see: bring together everything NICE says on a topic in an interactive flowchart. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published. To view the latest

More information

Headache and Facial Pain. Mohammed ALEssa MBBS, FRCSC Assistant Professor Consultant Otolaryngology,Head & Neck Surgical Oncology

Headache and Facial Pain. Mohammed ALEssa MBBS, FRCSC Assistant Professor Consultant Otolaryngology,Head & Neck Surgical Oncology Headache and Facial Pain Mohammed ALEssa MBBS, FRCSC Assistant Professor Consultant Otolaryngology,Head & Neck Surgical Oncology Introduction It is the most common neurologic complain The diagnosis usually

More information

Quality of life of chronic renal patients on hemodialysis in Marília, SP, Brazil

Quality of life of chronic renal patients on hemodialysis in Marília, SP, Brazil Original Article Artigo Original Quality of life of chronic renal patients on hemodialysis in Marília, SP, Brazil A qualidade de vida dos pacientes renais crônicos em hemodiálise na região de Marília,

More information

Headaches in Children and Adolescents. Paul Shillito

Headaches in Children and Adolescents. Paul Shillito Headaches in Children and Adolescents Paul Shillito Topics For Discussion What s different about childhood migraine Chronic daily headache (CDH) Tumours and other things to worry about Management of childhood

More information

Common Headaches. Types and Natural Treatments

Common Headaches. Types and Natural Treatments Common Headaches Types and Natural Treatments by Heidi Fritz, MA, ND Bolton Naturopathic Clinic 64 King St W, Bolton, Ontario, L7E1C7 www.boltonnaturopathic.ca Three Common Types of Headaches Headaches

More information

Migraine Controversies in Women s Health. Professor Peter J. Goadsby 5 December Department of Neurology

Migraine Controversies in Women s Health. Professor Peter J. Goadsby 5 December Department of Neurology Migraine 2008 Controversies in Women s Health 5 December 2008 Professor Peter J. Goadsby Peter.Goadsby@headache.ucsf.edu Department of Neurology Headache International Headache Society Classification Primary

More information

Refractory Headache Challenges and Strategies. David W. Dodick, M.D. Department of Neurology Mayo Clinic Phoenix Arizona USA

Refractory Headache Challenges and Strategies. David W. Dodick, M.D. Department of Neurology Mayo Clinic Phoenix Arizona USA Refractory Headache Challenges and Strategies David W. Dodick, M.D. Department of Neurology Mayo Clinic Phoenix Arizona USA Headache Masters School, Tokyo 2013 Definition of refractory/intractability depends

More information

Headache Syndrome. Karen Alvarez, D.O Nemours Children s Specialty Care Jacksonville, FL

Headache Syndrome. Karen Alvarez, D.O Nemours Children s Specialty Care Jacksonville, FL Headache Syndrome Karen Alvarez, D.O Nemours Children s Specialty Care Jacksonville, FL What is a headache? A headache or cephalgia is defined as pain anywhere in the region of head or neck Where does

More information

10/31/2017 PRIMARY CARE AND HEADACHE DISCLOSURES WHERE DO THOSE WITH HEADACHE SEEK MEDICAL CARE? Primary Care 67%

10/31/2017 PRIMARY CARE AND HEADACHE DISCLOSURES WHERE DO THOSE WITH HEADACHE SEEK MEDICAL CARE? Primary Care 67% PRIMARY CARE AND HEADACHE Sonja Potrebic MD PhD Regional Headache Specialist Kaiser LAMC 1 WHERE DO THOSE WITH HEADACHE SEEK MEDICAL CARE? Column1 Primary Care 67% Primary Care Headache Specialty Other

More information

Trigeminal Autonomic. Trigeminal Autonomic Cephalalgias (TACs) María-Carmen Wilson,MD

Trigeminal Autonomic. Trigeminal Autonomic Cephalalgias (TACs) María-Carmen Wilson,MD Trigeminal Autonomic Cephalalgias (TACs) María-Carmen Wilson,MD Director, Headache and Facial Pain Program Ochsner, North Shore Region Trigeminal Autonomic Cephalgias gwith autonomic features gcluster

More information

EMERGENCY PHYSICIAN S DIAGNOSIS OF STROKE SUBTYPE

EMERGENCY PHYSICIAN S DIAGNOSIS OF STROKE SUBTYPE Arq Neuropsiquiatr 1998;56(3-B):523-527 EMERGENCY PHYSICIAN S DIAGNOSIS OF STROKE SUBTYPE AN ACCURACY STUDY MARLEIDE DA MOTA GOMES*, MONICA FONSECA COSTA**, CHARLES ANDRÉ*, RAQUEL GOMES***, SÉRGIO A. P.

More information

Risk Factors for Chronic Daily Headache

Risk Factors for Chronic Daily Headache Risk Factors for Chronic Daily Headache Ann I. Scher, PhD, Richard B. Lipton, MD, and Walter Stewart, PhD Address Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, 7201

More information

Chapter 2 Diagnosis of Trigeminal Autonomic Cephalalgias

Chapter 2 Diagnosis of Trigeminal Autonomic Cephalalgias Chapter 2 Diagnosis of Trigeminal Autonomic Cephalalgias Mark J. Stillman Introduction The trigeminal autonomic cephalalgias (TACs) refer to a specific group of primary headaches characterized by unilaterality,

More information

Case Presentation. Case Presentation. Case Presentation. Truths about Headaches (2017) Most headaches were muscle-tension headaches

Case Presentation. Case Presentation. Case Presentation. Truths about Headaches (2017) Most headaches were muscle-tension headaches Agenda Case presentation Migraine Morphology Primary and Premonitory Phase Secondary Headache Aura Headache Primer on Pain Medication Overuse Headache Case Presentation RT is a 25 year old woman with daily

More information

ORIGINAL ARTICLE SCREENING FOR ABDOMINAL AORTIC ANEURYSMS

ORIGINAL ARTICLE SCREENING FOR ABDOMINAL AORTIC ANEURYSMS REV. HOSP. CLÍN. FAC. MED. S. PAULO 58(2):63-68, 2003 ORIGINAL ARTICLE SCREENING FOR ABDOMINAL AORTIC ANEURYSMS Telmo Pedro Bonamigo and Iara Siqueira BONAMIGO TP et al. - Screening for abdominal aortic

More information

St. Gallen ASCO Carlos H. Barrios, MD

St. Gallen ASCO Carlos H. Barrios, MD St. Gallen ASCO 2013 Carlos H. Barrios, MD PUCRS School of Medicine LACOG, LA Cooperative Group Instituto do Câncer, Hospital Mãe de Deus Porto Alegre, Brazil %Disease Free Survival 100% 50% Breast Cancer

More information

Minwoo Lee 1, Min Kyung Chu 2, Juyoung Lee 1, Jinhyuk Yoo 1 and Hong Ki Song 1*

Minwoo Lee 1, Min Kyung Chu 2, Juyoung Lee 1, Jinhyuk Yoo 1 and Hong Ki Song 1* Lee et al. The Journal of Headache and Pain (2016) 17:21 DOI 10.1186/s10194-016-0615-z RESEARCH ARTICLE Open Access Field testing primary stabbing headache criteria according to the 3rd beta edition of

More information

OTHER PRIMARY HEADACHES: TENSION-TYPE, STABBING, HYPNIC AND NUMMULAR HEADACHE

OTHER PRIMARY HEADACHES: TENSION-TYPE, STABBING, HYPNIC AND NUMMULAR HEADACHE OTHER PRIMARY HEADACHES: TENSION-TYPE, STABBING, HYPNIC AND NUMMULAR HEADACHE TENSION-TYPE HEADACHE Deborah I. Friedman, MD, MPH University of Texas Southwestern Medical Center Dallas, TX The most common

More information

Post-Operative Cluster Headache Following Carotid Endarterectomy

Post-Operative Cluster Headache Following Carotid Endarterectomy Review Received: October 31, 2016 Accepted: January 11, 2017 Published online: February 3, 2017 Post-Operative Cluster Headache Following Carotid Endarterectomy Thijs H.T. Dirkx Peter J. Koehler Department

More information

The University of Arizona Pediatric Residency Program. Primary Goals for Rotation. Neurology

The University of Arizona Pediatric Residency Program. Primary Goals for Rotation. Neurology The University of Arizona Pediatric Residency Program Primary Goals for Rotation Neurology 1. GOAL: Understand the role of the pediatrician in preventing neurological diseases, and in counseling and screening

More information

Management of chronic headache. Author. Published. Journal Title. Copyright Statement. Downloaded from. Link to published version

Management of chronic headache. Author. Published. Journal Title. Copyright Statement. Downloaded from. Link to published version Management of chronic headache Author Beran, Roy Published 2014 Journal Title Australian Family Physician Copyright Statement 2014 Australian Family Physician. Reproduced with permission. Permission to

More information

Headache and chronic facial pain

Headache and chronic facial pain Khorat Farooq MBBS FCARCSI Peter Williams MBBS FRCA Key points Headache has been described as the most common medical complaint known to man. The majority of patients presenting with headache and chronic

More information

Migraine. Case (patient DA) Migraine Associated Vertigo (Vestibular Migraine) Case Study (patient DA) MAV Migraine Associated Vertigo

Migraine. Case (patient DA) Migraine Associated Vertigo (Vestibular Migraine) Case Study (patient DA) MAV Migraine Associated Vertigo Migraine Associated Vertigo (Vestibular Migraine) Timothy C. Hain, MD Professor (Emeritus) Northwestern University Medical School, Chicago Il, USA Clinical Professor, University of Chicago, Chicago IL,

More information

Affiliation: 1- Departments of Anesthesiology/ Pain Management and Neurology, UCSF School of Medicine 2- Thrive Clinic, LLC, Santa Rosa, CA

Affiliation: 1- Departments of Anesthesiology/ Pain Management and Neurology, UCSF School of Medicine 2- Thrive Clinic, LLC, Santa Rosa, CA Author Information Prasad Shirvalkar MD, PhD 1 Jason E. Pope MD 2 Affiliation: 1- Departments of Anesthesiology/ Pain Management and Neurology, UCSF School of Medicine 2- Thrive Clinic, LLC, Santa Rosa,

More information

Adult with headache. Problem-specific video guides to diagnosing patients and helping them with management and prevention

Adult with headache. Problem-specific video guides to diagnosing patients and helping them with management and prevention Adult with headache Problem-specific video guides to diagnosing patients and helping them with management and prevention London Strategic Clinical Networks London Neuroscience Strategic Clinical Network

More information

MIGRAINE A MYSTERY HEADACHE

MIGRAINE A MYSTERY HEADACHE MIGRAINE A MYSTERY HEADACHE The migraine is a chronic neurological disease that is characterized by moderate to severe episodes of headache that is mostly associated with other central nervous system (CNS)

More information

New generation anti-epileptics for facial pain and headache

New generation anti-epileptics for facial pain and headache Acta neurol. belg., 2001, 101, 42-46 New generation anti-epileptics for facial pain and headache Valérie DELVAUX and Jean SCHOENEN University Department of Neurology, University of Liège, Liège, Belgium

More information

2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Efficiency

2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Efficiency Quality ID #419: Overuse Of Neuroimaging For Patients With Primary Headache And A Normal Neurological Examination National Quality Strategy Domain: Efficiency and Cost Reduction 2018 OPTIONS FOR INDIVIDUAL

More information

Differential Diagnosis of Orthostatic Headache

Differential Diagnosis of Orthostatic Headache Differential Diagnosis of Orthostatic Headache MORRIS LEVIN, MD PROFESSOR OF NEUROLOGY CHIEF, DIVISION OF HEADACHE MEDICINE, UCSF Disclosures Consulting for Amgen, Lilly, Allergan, Supernus, Pernix No

More information

Idiopathic stabbing headache in the juvenile population: a clinical study and review of the literature

Idiopathic stabbing headache in the juvenile population: a clinical study and review of the literature J Headache Pain (2002) 3:21 25 Springer-Verlag 2002 REVIEW Vincenzo Raieli Giovanni Luca Eliseo Michela La Vecchia Girolama La Franca Eleonora Pandolfi Domenico Puma Donatella Ragusa Mario Eliseo Idiopathic

More information

Headache A Practical Approach

Headache A Practical Approach Headache A Practical Approach Integrated Pain Symposium December 1, 2017 Alyssa Lettich. MD Neurosciences Institute/Neurosciences Clinical Program Medical Director Headache and Pain Development Teams Disclosures:

More information

Management options for Migraine. Prof. Dr. Khwaja Nazimuddin Head Dept. of Internal Medicine BIRDEM

Management options for Migraine. Prof. Dr. Khwaja Nazimuddin Head Dept. of Internal Medicine BIRDEM Management options for Migraine Prof. Dr. Khwaja Nazimuddin Head Dept. of Internal Medicine BIRDEM Assessment The Migraine Disability Assessment Score MIDAS Complete loss of work Partial loss of work Off

More information

2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Efficiency

2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Efficiency Quality ID #333: Adult Sinusitis: Computerized Tomography (CT) for Acute Sinusitis (Overuse) National Quality Strategy Domain: Efficiency and Cost Reduction 2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY

More information

Medical Policy. Description/Scope. Position Statement. Rationale

Medical Policy. Description/Scope. Position Statement. Rationale Subject: Document#: Current Effective Date: 06/28/2017 Status: Reviewed Last Review Date: 05/04/2017 Description/Scope This document addresses occipital nerve stimulation (ONS), which involves delivering

More information

The tentorial nerve is a branch from V1. Do you think, diagnostic neuroimaging

The tentorial nerve is a branch from V1. Do you think, diagnostic neuroimaging Radiology in headache: your patient wants a scando you want it too? The tentorial nerve is a branch from V1 Arne May, Dept. of Systems Neuroscience, University of Hamburg (UKE) (Feindel et al., Neurology

More information

MIGRAINE CLASSIFICATION

MIGRAINE CLASSIFICATION MIGRAINE CLASSIFICATION Nada Šternić At most, only 30% of migraineurs have classic aura The same patient may have migraine headache without aura, migraine headache with aura as well as migraine aura without

More information

Idiopathic Photosensitive Occipital Lobe Epilepsy

Idiopathic Photosensitive Occipital Lobe Epilepsy Idiopathic Photosensitive Occipital Lobe Epilepsy 2 Idiopathic photosensitive occipital lobe epilepsy (IPOE) 5, 12, 73, 75, 109, 110 manifests with focal seizures of occipital lobe origin, which are elicited

More information

Smoking and its relation to the histological type, survival, and prognosis among patients with primary lung cancer

Smoking and its relation to the histological type, survival, and prognosis among patients with primary lung cancer Flavio Xavier, Lucelia de Azevedo Henn, Marja Oliveira, Luciane Orlandine Smoking and its relation to the histological type, survival, and prognosis among patients with primary lung cancer Servifo de Pneumologia

More information

Planning sample size for impact evaluations

Planning sample size for impact evaluations Planning sample size for impact evaluations David Evans, Banco Mundial Basado en slides de Esther Duflo (J-PAL) y Jed Friedman (Banco Mundial) Size of the sample for impact evaluations Pergunta geral De

More information

Translation and validation of Hyperhidrosis Disease Severity Scale

Translation and validation of Hyperhidrosis Disease Severity Scale ORIGINAL ARTICLE Translation and validation of Hyperhidrosis Disease Severity Scale Translation and validation of Hyperhidrosis Disease Severity Scale Andrea Yasbek Monteiro Varella 1, Juliana Maria Fukuda

More information

Classification of headaches

Classification of headaches Classification of headaches Primary headaches OR Idiopathic headaches Secondary headaches OR Symptomatic headaches THE HEADACHE IS ITSELF THE DISEASE NO ORGANIC LESION IN THE BEACKGROUND TREAT THE HEADACHE!

More information

The Clinical Profile of Sumatriptan: Cluster Headache Key Words

The Clinical Profile of Sumatriptan: Cluster Headache Key Words Paper Eur Neurol 1994;34(suppl 2):35-39 P.J. Peter J. Goadsby Department of Neurology, The Prince Henry Hospital, Little Bay, Sydney, NSW, Australia The Clinical Profile of Sumatriptan: Cluster Headache

More information

Aleksandra Radojičić. Headache Center, Neurology Clinic, Clinical Center of Serbia

Aleksandra Radojičić. Headache Center, Neurology Clinic, Clinical Center of Serbia European Headache School Belgrade 2012 MEDICATION OVERUSE HEADACHE Aleksandra Radojičić Headache Center, Neurology Clinic, Clinical Center of Serbia Historical data First cases were described in XVII century

More information

Original Policy Date

Original Policy Date MP 7.01.105 Occipital Nerve Stimulation Medical Policy Section Surgery Issue 12/2013 Original Policy Date 12/2013 Last Review Status/Date Reviewed with literature search/12/2013 Return to Medical Policy

More information

Chronic migraine classification: current knowledge and future perspectives

Chronic migraine classification: current knowledge and future perspectives J Headache Pain (2011) 12:585 592 DOI 10.1007/s10194-011-0393-6 REVIEW ARTICLE Chronic migraine classification: current knowledge and future perspectives Gian Camillo Manzoni Vincenzo Bonavita Gennaro

More information

Diagnosis of Acute HCV Infection

Diagnosis of Acute HCV Infection Hepatitis C Online PDF created December 20, 2017, 7:54 pm Diagnosis of Acute HCV Infection This is a PDF version of the following document: Module 1: Screening and Diagnosis of Hepatitis C Infection Lesson

More information

PRIORITIES AND CLINICAL EFFECTIVENESS FORUM MANAGEMENT OF ADULT HEADACHE

PRIORITIES AND CLINICAL EFFECTIVENESS FORUM MANAGEMENT OF ADULT HEADACHE PRIORITIES AND CLINICAL EFFECTIVENESS FORUM MANAGEMENT OF ADULT HEADACHE o This is a new guideline produced jointly by GPs and Consultant Neurologists. o The aim is to reduce referrals to Consultants for

More information

Original Article ABSTRACT INTRODUCTION

Original Article ABSTRACT INTRODUCTION 192 Original Article Werther Brunow de Carvalho, Paulo Sérgio Lucas da Silva, Chiu Seing Tsok Paulo, Marcelo Machado Cunio Fonseca, Luiz Antônio Belli Comparison between the Comfort and Hartwig sedation

More information

Safety and efficacy of cervical 10 khz spinal cord stimulation in chronic refractory primary headaches: a retrospective case series

Safety and efficacy of cervical 10 khz spinal cord stimulation in chronic refractory primary headaches: a retrospective case series Lambru et al. The Journal of Headache and Pain (2016) 17:66 DOI 10.1186/s10194-016-0657-2 The Journal of Headache and Pain SHORT REPORT Open Access Safety and efficacy of cervical 10 khz spinal cord stimulation

More information

Migraine in Children. Germano Falcao, MD Pediatric Neurology 03/07/2014

Migraine in Children. Germano Falcao, MD Pediatric Neurology 03/07/2014 Migraine in Children Germano Falcao, MD Pediatric Neurology 03/07/2014 Headaches in Children One of the most common concerns reported by children 3% for children age 3-7 years 4-11% for children age 7-11

More information

Headache. László Oláh

Headache. László Oláh Headache László Oláh www.i-h-s.org Pain sensitive structures Skin, subcutaneous tissue, periosteum, arteries, muscles, eye, ear, pharynx, sinuses, basal dura, nerves Pain sensitive structures Skin, subcutaneous

More information

Neuroimaging in Migraine Critically Appraised Topic (CAT)

Neuroimaging in Migraine Critically Appraised Topic (CAT) Neuroimaging in Migraine Critically Appraised Topic (CAT) PICOT Question: Does a head CT scan compared to no head CT scan change the management of a child with migraine? Clinical bottom line based on literature

More information

REVISTA BRASILEIRA DE MEDICINA INTERNA

REVISTA BRASILEIRA DE MEDICINA INTERNA REVISTA BRASILEIRA DE MEDICINA INTERNA www.rbmi.com.br Case Report Systemic Giant Cell Arteritis: unusual clinical manifestation and challenges in management Arterite de células gigantes sistêmica: manifestação

More information

ORIGINAL INVESTIGATION. Headache Evaluation and Treatment by Primary Care Physicians in an Emergency Department in the Era of Triptans

ORIGINAL INVESTIGATION. Headache Evaluation and Treatment by Primary Care Physicians in an Emergency Department in the Era of Triptans Headache Evaluation and Treatment by Primary Care Physicians in an Emergency Department in the Era of Triptans Morris Maizels, MD ORIGINAL INVESTIGATION Background: Despite advances in treatment, patients

More information

Original Article. Keywords Migraine Sodium valproate Sumatriptan. Introduction

Original Article. Keywords Migraine Sodium valproate Sumatriptan. Introduction IJMS Vol 39, No 2, Supplement March 2014 Original Article Comparison between Intravenous Sodium Valproate and Subcutaneous Sumatriptan for Treatment of Acute Migraine Attacks; Double- Blind Randomized

More information

GREATER OCCIPITAL NERVE BLOCKADE IN CERVICOGENIC HEADACHE

GREATER OCCIPITAL NERVE BLOCKADE IN CERVICOGENIC HEADACHE Arq Neuropsiquiatr 1998;56(4):720-725 GREATER OCCIPITAL NERVE BLOCKADE IN CERVICOGENIC HEADACHE MAURICE B. VINCENT*, RENATO A. LUNA**, DENISE SCANDIUZZI***, SÉRGIO A. P. NOVIS**** ABSTRACT - Cervicocogenic

More information

PET and PET/CT Imaging for the Earliest Detection and Treatment of Colorectal Carcinoma

PET and PET/CT Imaging for the Earliest Detection and Treatment of Colorectal Carcinoma 169 Vol.48, Special : pp. 169-174, October 2005 ISSN 1516-8913 Printed in Brazil BRAZILIAN ARCHIVES OF BIOLOGY AND TECHNOLOGY AN INTERNATIONAL JOURNAL PET and PET/CT Imaging for the Earliest Detection

More information

Treatment of Giant Arachnoid Cysts on Spinal Cord - Relevant Surgical Aspects

Treatment of Giant Arachnoid Cysts on Spinal Cord - Relevant Surgical Aspects 212 Review Article Artigo de Revisão Treatment of Giant Arachnoid Cysts on Spinal Cord - Relevant Surgical Aspects Tratamento do cisto aracnóideo gigante em medula espinhal - aspectos cirúrgicos relevantes

More information

The validity of recognition-based headache diagnoses in adolescents. Data from the Nord-Trøndelag Health Study , Head-HUNT-Youth

The validity of recognition-based headache diagnoses in adolescents. Data from the Nord-Trøndelag Health Study , Head-HUNT-Youth Blackwell Science, LtdOxford, UKCHACephalalgia0333-1024Blackwell Science, 200323Original Article Recognition-based headache diagnoses in adolescentsj-a Zwart et al. The validity of recognition-based headache

More information

Correlation of Computed Tomography findings with Glassgow Coma Scale in patients with acute traumatic brain injury

Correlation of Computed Tomography findings with Glassgow Coma Scale in patients with acute traumatic brain injury Journal of College of Medical Sciences-Nepal, 2014, Vol-10, No-2 ABSTRACT OBJECTIVE To correlate Computed Tomography (CT) findings with Glasgow Coma Scale (GCS) in patients with acute traumatic brain injury

More information