Orthostatic headache as the presenting symptom of cervical spine metastasis

Orthostatic headache is a key symptom of intracranial hypotension; however, not all orthostatic headaches are caused by cerebrospinal fluid leaks leading to intracranial hypotension. We report here the unusual case of a 68-year-old man presenting with orthostatic headache in which compression of the C3 spinal nerve root by metastatic tumor invasion may contribute to the development of his orthostatic headache.     

Arterial Encroachment by an Electrode as a Cause of Referred Vascular Headache

SYNOPSIS
A case is reported of focal headache caused by traction on the left middle cerebral artery by an intracerebral electrode placed in the left amygdala. The character and location of the headache suggested the involvement of vascular structures. CT confirmed the diagnosis, and the headache was relieved by removal of the electrode. The features of pain referred from intracranial vessels are reviewed.     

鼻中隔偏曲致鼻源性头痛患者术前CT表现及手术治疗效果

  目的  分析鼻中隔偏曲致鼻源性头痛患者术前CT表现及手术治疗效果。  方法  选取2018年1月~2020年12月于我院收治的132例鼻中隔偏曲致鼻源性头痛患者作为研究对象,结合CT影像学检查分析鼻中隔偏曲部位、程度分布情况、CT表现及下鼻甲测量结果,比较患者头痛程度,分析不同头痛等级患者的手术治疗效果。  结果  CT影像学结果表明:132例鼻中隔偏曲患者中24例位于前部,62例位于中部,40例位于中下部,2例位于中上部,1例位于后下部,3例位于后下部;轻度偏曲者10例,中度偏曲者114例,重度偏曲者8例;CT结果显示:所有患者中呈“C”形62例（顶点变尖者2例）,反“C”形59例（顶点变尖者2例）,“S”形6例,反“S”形1例“, < ”形1例“,>”形2例,混合形1例。根据VAS评分对头痛等级分类,132例患者中,11例为Ⅰ级头痛,33例为Ⅱ级头痛,80例为Ⅲ级头痛,8例为Ⅳ级头痛;鼻中隔偏曲对侧下鼻甲角度及面积均大于同侧（P < 0.05）;治疗结束后随访结果显示,总治愈率为68.94%,无效率为7.58%,其中Ⅲ级及以下头痛治愈率均超过66.00%,治疗总有效率为92.42%。  结论  鼻中隔偏曲致鼻源性头痛患者术前进行CT检查可清晰准确的反映偏曲的真实情况,有助于手术有效进行,提高临床治疗效果。      

A case of spontaneous intracranial hypotension with typical magnetic resonance images

Spontaneous intracranial hypotension (SIH) is a rare syndrome defined by postural headache, associated with a low cerebrospinal fluid pressure, without history of previous dural trauma or invasive treatment on rachis. We reported a case of a patient with postural headache caused by SIH identified by magnetic resonance images and treated with saline solution infusion with complete remission of symptoms.     

Meningioma causing gabapentin-responsive secondary SUNCT syndrome

Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) is one of the rarest and most serious headache disorders. Cases of symptomatic SUNCT syndromes are reported, which demonstrate that brain imaging is very important for diagnosis. In this study, we describe the first case of secondary SUNCT syndrome caused by a meningioma. So far, a clearly effective therapy for SUNCT syndrome has not been known. In this case, however, SUNCT was completely responsive to gabapentin. This underlines that this drug is worthy of being considered as a potential therapeutic option in the treatment of SUNCT syndrome.     

A migraine-like headache induced by carotid-cavernous fistula

Carotid-cavernous fistula (CCF) generally causes periorbital aching with ocular symptoms due to high venous pressure in the cavernous sinus, while migraine is caused by arterial dilatation-stimulating trigeminal nerves around the vessels. The authors present a case of 47-year-old woman with a 4-month history of a temporal throbbing headache. As her symptoms were well controlled by triptans, her headache was considered to be migraine in type. However, a Barrow's type-D CCF was revealed by radiological examinations. Self-compression of common carotid artery method was initially tried for therapy of the CCF, but endovascular embolization was finally necessary due to intractable headache. Although the headache was considered arterial in origin, transvenous embolization of the left cavernous sinus successfully ameliorated the patient's symptoms. CCF should be considered as an unusual etiology of headaches that appear arterial in origin.     

Thunderclap Headache with Orgasm: A Case of Basilar Artery Dissection Associated with Sexual Intercourse

Background: Headaches associated with sexual intercourse (coital cephalgia) have many different causes and are often divided in the literature into pre-orgasmic and orgasmic headaches. Objective: To present a case of orgasmic headache caused by a basilar artery dissection and to present a literature-based guide to the diagnosis and management of patients presenting with headaches related to sexual activity. Case Report: We report the case of a 34-year-old man without significant past medical history who presented to the Emergency Department with two episodes of orgasmic headache caused by basilar artery dissection. Conclusions: The cause of headaches related to sexual activity range from the benign to the life-threatening. Due to the dynamics of cerebral blood flow during sexual intercourse, basilar artery dissections and aneurysms should be considered in patients with sudden-onset headaches during orgasm. Appropriate brain imaging and, possibly, lumbar puncture may assist in identifying potentially life-threatening causes of coital headaches.     

Epidural abscess caused by community-associated methicillin-resistant Staphylococcus aureus strain USA300 in Japan

We report a case of epidural abscess caused by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) strain USA300 in a previously healthy 25-year-old American woman who lived in Japan for more than 1 year. She started to complain of severe headache that continued for about 10 days after improvement of subcutaneous abscesses caused by MRSA. Computed tomography (CT) and magnetic resonance imaging (MRI) showed epidural abscess. As epidural abscess was not improved by treatment with vancomycin and ceftriaxone, craniotomy and drainage were performed, and the severe headache disappeared. Characteristics of the MRSA strain isolated from the abscess were identical to those of strain USA300; multilocus sequence typing sequence type 8, staphylococcal cassette chromosome mec type IVa, Panton–Valentine leukocidin positive, arginine catabolic mobile element positive, and pulsed-field gel electrophoresis type USA300. This may be the first report of epidural abscess caused by USA300 strain in Japan. Because CA-MRSA strains, including USA300, have begun to spread in Japan, epidural abscess should be taken into account in the diagnosis of previously healthy patients with persistent headache accompanied by skin lesions.     

Cluster headache: To scan or not to scan

By definition, cluster headache (CH) is not caused by underlying structural pathology. However, patients with CH or CH-like syndromes and an associated structural lesion have been described. In many cases it is difficult to establish a causal relation between the headache syndrome and the lesion. We reviewed the literature for symptomatic CH or CH-like cases in which causality was very likely, and we found that even typical CH with a typical episodic time pattern and a response to typical CH treatment can be caused by underlying structural pathology such as a pituitary tumor. Based on this small retrospective series of case reports, it is impossible to give advice about neuroimaging. If neuroimaging is considered, MRI (not CT) is the investigation of choice.     

手法治疗单纯枕下项线附着肌痉挛型头痛疗效分析

目的观察手法治疗单纯枕下项线附着肌痉挛型头痛的疗效。方法对36例单纯枕下项线附着肌痉挛引起头痛的患者,根据症状、体征,排除非软组织劳损所致的头痛,找准阿氏点,施以指压法或掌根环压法治疗。结果经手法治疗5～10次,36例患者痊愈25例、显效10例、有效1例,显效率97.22%。结论手法治疗单纯枕下项线附着肌痉挛引起的头痛效果满意且疗效稳定。     

Sumatriptan for headache caused by head and neck cancer

The use of sumatriptan for the treatment of migraine and cluster headache is well established. Sumatriptan has also been reported to be effective for the treatment of postdural puncture headache, postictal headache, and headache related to intravenous immunoglobulin infusion. We report two patients with headache caused by locally invasive head and neck cancer relieved by oral sumatriptan.     

Differential diagnosis and therapy of headache in HIV infection

HEADACHE AND HIV INFECTION: Headache is one of the most common pain syndromes in HIV infection. The prevalence of headache in HIV infected patients in the published cross-sectional and longitudinal studies is between 3.8% and 47.4% depending on the study methodology and the study subpopulation. In this review, we analyse these cross-sectional and longitudinal studies and the case reports of headache in HIV infection. Both primary headache, such as migraine or tension-type headache, and secondary headache, e. g. caused by opportunistic infections or neoplasms, can be observed. In addition, there is a so-called "HIV headache" which develops de novo during the HIV infection, the cause of this headache type is still unclear. Migraine shows an amelioration during the course of the HIV infection whereas tension-type headache shows a deteriotation. In some patients, however, tension-type headache cannot be differentiated from HIV-headache. THERAPY: The therapeutic management of headache during the HIV infection is the same as in non-infected subjects. However, tricyclic antidepressants and steroids as headache prophylactic agents are often more effective than in non-infected subjects and should be prescribed more generously. Some pharmacological interactions have to be considered, e. g. NSAID might increase the toxicity of antiretroviral substances.     

A rare cause of headache: cerebral venous sinus thrombosis due to hyperthyroidism

Headache represents up to 4% of all emergency department (ED) visits. Emergency physicians generally are concerned with identifying those patients whose headaches are caused by life-threatening conditions. Cerebral venous sinus thrombosis may be difficult to diagnose clinically because of its various and nonspecific manifestations. The most frequent but least specific symptom of sinus thrombosis is severe headache, which is present in more than 90% of adult patients. In the case report we present, a patient had severe headache and was diagnosed until third ED visit at different hospitals. He had one of the most unusual causes of headache, that is, cerebral venous sinus thrombosis due to hyperthyroidism.     

Post–traumatic headache from moderate head injury

The onset of post-traumatic headache occurs frequently in children, where it is often caused by severe head injuries, therefore, it is part of a post–traumatic syndrome, rather than of an independent headache and in this case no cause is clearly evident. The problem, conversely, arises in post–traumatic headache after a light trauma, since it is difficult to establish the cause–effect link. We have studied PTH incidence for one year in the patients of the emergency ward of the Saint Charles of Nancy Hospital, compared to the activity of 4 Italian headache centres. At the Saint Charles of Nancy Hospital of 98 patients with PTH after a moderate head trauma, 18 had acute and 26 chronic PTH, the majority ceased after six months. In the Italian headache centres 1,656 patients were examined, of these 3.2% suffered from PTH: 25 acute, 29 chronic. These data confirm the poor evidence of PTH after a light trauma and lead to doubt of the existence of this nosological entity.     

Greater occipital nerve neuralgia caused by pathological arterial contact: treatment by surgical decompression

Occipital nerve neuralgia is a rare cause of severe headache, and may be difficult to treat. We report the case of a patient with occipital nerve neuralgia caused by pathological contact of the nerve with the occipital artery. The pain was refractory to medical treatment. Surgical decompression yielded complete remission.     

Post Traumatic Headache Caused by Hematoma of the Corpus Callosum

SYNOPSIS
A patient with a hematoma of the corpus callosum producing transient memory, speech and motor defecits as well as post traumatic type 1 headaches is presented. This is the first known demonstration of a resolving hematoma of the corpus callosum by CT scan and the first case report of a post traumatic headache caused by hematoma of the corpus callosum.     

Hemiplegic migraine during pregnancy: unusual magnetic resonance appearance with SPECT scan correlation

OBJECTIVE: This article discusses the pathophysiology and implications for treatment of hemiplegic migraine within a case study presentation. BACKGROUND: We evaluated a 31-year-old white woman for hemiplegia in her 36th week of pregnancy. She initially presented with severe headache, dysarthria, lethargy, and left-sided numbness and weakness. Hemiplegic migraine remains a diagnosis made by exclusion; neurologic examination of these patients is localizing, but nonspecific. DESIGN: Magnetic resonance imaging and single photon emission computed tomography scanning were performed on this patient during an exacerbation of headache associated with dense hemiplegia. RESULTS: Magnetic resonance imaging showed a superficial cerebral hemispheric signal abnormality with enhancement. Single photon emission computed tomography scanning confirmed hyperperfusion of that hemisphere. CONCLUSIONS: We believe the imaging evidence in our patient suggests that hemiplegia was caused and sustained by hyperperfusion. This case lends supportive evidence to a primarily vasodilatory mechanism and hyperperfusion as an etiology of the paralysis in such headaches and perhaps migraine with aura.     

Autonomic headache with autonomic seizures: a case report

The aim of the report is to present a case of an autonomic headache associated with autonomic seizures. A 19-year-old male who had had complex partial seizures for 15 years was admitted with autonomic complaints and left hemicranial headache, independent from seizures, that he had had for 2 years and were provoked by watching television. Brain magnetic resonance imaging showed right hippocampal sclerosis and electroencephalography revealed epileptic activity in right hemispheric areas. Treatment with valproic acid decreased the complaints. The headache did not fulfil the criteria for the diagnosis of trigeminal autonomic cephalalgias, and was different from epileptic headache, which was defined as a pressing type pain felt over the forehead for several minutes to a few hours. Although epileptic headache responds to anti-epileptics and the complaints of the present case decreased with antiepileptics, it has been suggested that the headache could be a nontrigeminal autonomic headache instead of an epileptic headache.     

Parenteral chlorpromazine and a meningitis headache

Parenteral chlorpromazine is a frequently used agent in the acute management of tension and vascular headaches. However, headaches caused by other more serious diseases may also respond to this drug. This case report describes a patient with aseptic meningitis who experienced complete but temporary relief of her headache with parenteral chlorpromazine, prior to the eventual diagnosis.     

A case of SUNCT syndrome responsive to zonisamide

Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a rare headache syndrome that represents a subtype of trigeminal autonomic cephalalgia thought to be highly refractory to treatment. More recently, numerous anticonvulsant agents including lamotrigine, topiramate, gabapentin, and carbamazepine have been reported to be partially or completely effective for treating SUNCT. We report the case of a patient with SUNCT in whom symptoms were completely relieved with carbamazepine at 600?mg/day. However, carbamazepine had to be discontinued due to severe rash. Zonisamide was selected for continued treatment, as a Na-channel blocker like carbamazepine but with lower risk of producing skin rashes as caused by carbamazepine. Attacks ceased completely with 300?mg/day of zonisamide achieving a blood serum level of 19?μg/ml. This is the first case report to describe zonisamide alone completely eliminating SUNCT symptoms. Zonisamide should be considered a viable candidate drug for the treatment of SUNCT.