Posttraumatic Headache with Ptosis, Miosis and Chronic Forehead Hyperhidrosis

Injury to the right lateral forehead was followed by headaches, and chronic ipsilateral ptosis, miosis, and forehead hyperhidrosis. Episodes of headache were accompanied by an increase in ptosis, miosis and forehead hyperhidrosis. The headaches abated within 6 weeks but the ptosis and miosis, due to postganglionic sympathetic insufficiency, were persistent. Spontaneous forehead hyperhidrosis, was also persistent at the time of last follow-up, 15 months later. Autonomic assessment of the oculocephalic sympathetic dysfunction, localization of the lesion and possible explanation of the autonomic findings are discussed.     

Headache Rounds: Sudden,Transient Neurologic Symptoms in a Woman With Migraine

The following article is a Graham Headache Center headache rounds presentation at the Brigham and Women's Faulkner Hospital by fellows Roni Sharon and Melissa Rayhill with special guest Tobias Kurth. It summarizes the case of a 36‐year‐old female with no history of migraine in the past, presenting with several transient neurological episodes associated with headache. Her history, symptoms, imaging workup is reviewed. Following the case is a discussion of the differential diagnosis for the patient's symptoms along with a review of the association of migraine with and without aura with vascular neurological insult such as stroke. The article also discusses the clinical implications of migraine as a risk factor for stroke along with possible treatment recommendations.     

Cervicogenic Headache: A Review Comparison with Migraine,Tension-Type Headache,and Whiplash

Cervicogenic headache (CEH) is a well-recognized syndrome. Proposed diagnostic criteria differentiate CEH from migraine and tension-type headache (TTH) in most of the cases. The best differentiating factors include side-locked unilateral pain irradiating from the back and evidence of neck involvement—attacks may be precipitated by digital pressure over trigger spots in the cervical/nuchal areas or sustained awkward neck positions. Migrainous traits may be present in some cases. Cervical lesions are not necessarily seen, and most common cervical lesions do not produce CEH. Whiplash may occasionally induce headaches. This is suspected when the pain onset and the whiplash trauma are close in time. Whiplash-related headaches tend to be short-lasting, admitting mostly a TTH or a CEH-like phenotype. Neuroimaging abnormalities are not necessarily expected in CEH. Whiplash patients must undergo cervical imaging mostly in connection with the trauma, as no abnormalities are pathognomonic in chronic cases.     

Unilateral Headache with Features of Hemicrania Continua and Cervicogenic Headache - A Case Report

A case is presented which has features of Cervicogenic Headache and of Hemicrania Continua. A sudden maneuver of the neck and later a greater occipital nerve block, both resulted in relief of the pain. A cervical cause is suggested.     

A Young Immigrant Woman with Pelvic Pain

Gathering an accurate and complete patient history in a timely manner can be paramount in guiding a plan of care for newly established patients. Nurse practitioners must use their clinical judgment and intuition to identify the nuances of the information being relayed and to compose a complete picture of the patient. Using motivational interviewing and open-ended questions will enable the clinician to engage the patient to make potentially life-saving behavior changes. Obtaining an essential history is not only important for the patient, but also has a legal and ethical effect on the nurse practitioner.     

Behavioral Response to Headache: A Comparison Between Migraine and Tension-type Headache

OBJECTIVE: To compare patients with migraine and tension-type headache in their behavior during the attacks and the maneuvers used to relieve the pain. BACKGROUND: Patients with headache often perform nonpharmacological measures to relieve the pain, but it is not known if these behaviors vary with the diagnosis, clinical features, and pathogenesis. METHODS: One hundred consecutive patients with either migraine (n = 72 ) or tension-type headache (n = 28) were questioned (including the use of a checklist) concerning their usual behavior during the attacks and nonpharmacological maneuvers performed to relieve the pain. The results of the two types of headache were compared. RESULTS: Patients with migraine tended to perform more maneuvers than individuals with tension-type headache (mean, 6.2 versus 3). These maneuvers included pressing and applying cold stimuli to the painful site, trying to sleep, changing posture, sitting or reclining in bed (using more pillows than usual to lay down), isolating themselves, using symptomatic medication, inducing vomiting, changing diet, and becoming immobile during the attacks. The only measure predominantly reported by patients with tension-type headache was scalp massage. However, the benefit derived from these measures was not significantly different between the two groups (except for a significantly better response to isolation, local pressure, local cold stimulation, and symptomatic medication in migraineurs). CONCLUSIONS: The behavior of patients during headache attacks varies with the diagnosis. Measures that do not always result in pain relief are performed to prevent its worsening or to improve associated symptoms. These behavioral differences may be due to the different pathogenesis of the attacks or to different styles of dealing with the pain. They can also aid the differential diagnosis between headaches in doubtful cases.