Spontaneous cervicocephalic arterial dissection with headache and neck pain as the only symptom

Background and objective  

Cervicocephalic arterial dissection can cause both ischemic stroke and hemorrhagic stroke. However, spontaneous cervicocephalic arterial dissection presenting only with headache and neck pain has rarely been reported. The clinical features of patients with spontaneous cervicocephalic arterial dissection presenting only with headache and neck pain were investigated.     

Migraine-like headache as the presenting symptom of basilar artery occlusion

If migraine or a migrainelike headache and stroke occur together, it is difficult to determine whether migraine is the cause of the stroke or stroke is the cause of symptomatic migraine. We report the case of a 19-year-old woman without a history of migraine who presented with a migraine-like headache, nausea and desire for tranquility and dimmed lighting. Initial neurological examination, computed tomography and cerebrospinal fluid analysis were normal, leading to the presumptive diagnosis of first manifestation of migraine. Persistence of dizziness and transient diplopia, however, prompted a magnetic resonance imaging examination, which revealed major stroke in the posterior circulation due to occlusion of the basilar artery. The symptoms resolved spontaneously and treatment with antiplatelet inhibitor was prescribed. Smoking and use of oral contraceptives were identified as vascular risk factors. Stroke in the posterior circulation due to occlusion of the basilar artery may show rather inconspicuous symptoms and provoke migrainous headache. Received: 19 August 2002, Accepted in revised form: 2 December 2002 Correspondence to J.G. Heckmann     

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.     

Superior sagittal sinus thrombosis as unusual cause of headache: case report

Headache is the most frequent symptom in patients with cerebral venous thrombosis. However, patients presenting with headache due to cerebral venous thrombosis are uncommon. The association between oral contraceptives and cerebral venous thrombosis is well known. We report the case of a young woman who was admitted to our department for sudden onset of headache. She had been taking oral contraceptives for 6 months. Early pharmacological approach with analgesics failed to elleviate symptoms. Magnetic resonance imaging (MRI) showed thrombosis of the posterior and middle thirds of the superior sagittal sinus (SSS). Because the patient was oligosymptomatic, medical treatment with high-dose heparin was started. A clinical follow-up showed headache regression after 2 weeks of therapy. Subsequent MRI showed partial recanalization of the SSS. The patient continued oral anticoagulants for 3 months. Eighteen months after discharge, the patient was symptom-free. We conclude that new, persistent or atypical headaches in patients taking oral contraceptives should be carefully evaluated for cerebral venous thrombosis. Received: 9 May 2001 / Accepted in revised form: 4 September 2001     

椎动脉夹层超声表现1例

<正>患者男,29岁,发现高血压病伴眩晕半年,血压160/100 mm Hg(1 mm Hg=0.133 k Pa)。否认头痛、恶心、呕吐、肢体活动不灵、言语含糊、意识丧失及呛咳等症状。无高血压家族史。实验室检查未见明显异常。超声检查:双肾、肾动脉、肾上腺及腹部大血管均未见明显异常。右侧椎动脉起始段管腔内径约2.8 mm,腔内无回声区清晰,CDFI示血流充盈良好;椎动脉C6~C5、C5~C4及     

De novo headache in ischemic stroke patients treated with thrombectomy: a prospective study

Background and aimHeadache attributed to intracranial endovascular procedures is described in the ICHD-3. Our aim was to study the frequency and characteristics of headache specifically related to thrombectomy in patients with ischemic stroke.MethodsProspective evaluation of clinical features of headache after thrombectomy using an ad hoc questionnaire.ResultsOne hundred seventeen patients were included (52.1% females). Most had an anterior circulation artery occlusion (91.5%). 93 (79.5%) received general anaesthesia. 111 (94.9%) required stent retriever, 21 (24.4%) angioplasty and 19 (16.2%) aspiration thrombectomy. 31 (26.5%; 95% CI 18.8–35.5%) had headache related to thrombectomy, and it was associated with a history of primary headache (p = 0.004). No differences about sex, initial NIHSS score, or the type or complexity of the procedure were observed. Headache was usually moderate and oppressive, ipsilateral to the artery occlusion and usually lasted less than 48 hours.ConclusionsAlmost one-third of patients with ischemic stroke who undergo endovascular thrombectomy experience headache in the first 24 hours, occurring more frequently in patients who had a previous history of headaches regardless of the procedure complexity.Supplementary InformationThe online version contains supplementary material available at 10.1186/s10194-022-01455-3.     

Dorsolateral medullary ischemic infarction causing autonomic dysfunction and headache: a case report

Stroke can present, among other signs, with headache. Here, we describe the case of a man suffering from severe orbitary pain and autonomic dysfunction secondary to dorsolateral medullary ischemia. The anatomical relationship between lesion and symptomatology could be an indirect sign of hypothalamospinal tract involvement in the genesis of autonomic dysfunction and headache resembling a trigeminal autonomic cephalalgia.     

The applicability research of the diagnostic criteria for 6.7.2 angiography headache in the international classification of headache disorders-3rd edition

BackgroundAngiography headache (AH) is common but not negligible, and the criteria for AH have been based on only a few studies. The purpose of this study was to investigate the incidence, risk factors and possible mechanism of AH and reappraise the diagnostic criteria for AH in the International Classification of Headache Disorders 3 (ICHD-3).MethodsTwo hundred and seventy-nine patients completed this prospective, non-randomized study, including 107 patients who underwent cerebral angiography, 101 patients who underwent coronary intervention and 71 patients who underwent extremities arterial intervention. Patients were followed up with questionnaires immediately after the procedure and 24 h, 72 h, 1 week and 2 weeks after the procedure.ResultsThe incidence of headache was 22.4% (24/107) in cerebral angiography group, 23.8% (24/101) in coronary intervention group, and 16.9% (12/71) in extremities arterial intervention group. Headache still occurred in 12.1% (13/107), 14.9% (15/101) and 11.3% (8/71) of patients 24 h after the procedure in the three groups, respectively. Two types of headache were observed in cerebral angiography group and coronary intervention group, one during and one after the procedure, while only postoperative headache was observed in extremities arterial intervention group. Previous headache history was a risk factor for headache in the three groups (p = 0.003 in cerebral angiography group, p = 0.006 in coronary intervention group, and p = 0.016 in extremities arterial intervention group). In addition, female (p = 0.008) was a risk factor for cerebral angiography group. Headache characteristics were described in detail.ConclusionsThe diagnostic criteria for 6.7.2 angiography headache in ICHD-3 may miss a number of cerebral AH with onset later than 24 h after the procedure. Therefore, it is recommended to revise it according to the literature and further studies. The incidence of headache was high during and after angiography and interventional procedure. It was suggested that the definition of headache due to coronary intervention and headache due to extremities arterial intervention should be added in ICHD.     

Isolated headache as the presenting clinical manifestation of intracranial tumors: a prospective study

Isolated headache as the presenting clinical manifestation of intracranial tumors: a prospective study. Cephalalgia 1994;1'4:270-1. Oslo. ISSN 0333-1024We prospectively studied over two years the incidence of headache as the initial and isolated clinical manifestation of adult patients suffering from intracranial tumors ( n = 183). Fifteen patients (8%) exhibited headache as their first and isolated clinical manifestation. Age, sex, neoplasm localization, or pathological diagnosis did not correlate with the presence of headache. Posterior fossa location and hydrocephalus, though not reaching statistical significance, were more frequent in patients who presented with headache as the first symptom. At the moment of diagnosis, 59 (31%) of the patients admitted to headache, though only I out of the 15 patients starting as headache still had this symptom as the only manifestation. From our experience in adults, isolated headache for longer than 10 weeks will only exceptionally be secondary to an intracranial neoplasm.     

Long-term relief of posttraumatic headache by sphenopalatine ganglion pulsed radiofrequency lesioning: a case report

Posttraumatic headache is a common and disabling pain syndrome in patients who sustain a head injury. Unfortunately, conventional treatments may fail or cause intolerable side effects. Because chronic headache may be mediated by central and peripheral neural processes, these structures may be therapeutic targets. One target, the sphenopalatine ganglion (SPG), is implicated in several headache disorders and has been lesioned for headache relief. Because of the risks of neurolytic procedures, nonablative procedures that provide pain relief would be useful. We present a case wherein a man in his late twenties with posttraumatic headache obtained more than 17 months of relief with SPG pulsed-mode radiofrequency lesioning. SPG pulsed-mode radiofrequency is a nonablative, neural lesioning method that may be useful in the treatment of posttraumatic headache.     

儿童头痛的脑电图分析

目的 通过分析头痛儿童脑电图变化,提高临床对儿童头痛脑电图癫痫的认识。方法 对120例发作性头痛患儿进行脑电图检查。结果 本组120例中常规描记111例,其中正常40例（36%）,非特异性异常68例（61%）,痫性放电3例（3%）;长程电脑图监测9例,其中正常2例（22%）,非特异性异常5例（56%）,痫性放电3例（3%）;长程脑电图监测9例,其中正常2例（22）,非特异性异常5例（56%）;痫性放电2例（22%）。结论 脑电图（或长程脑电图）检查对发作性头痛患儿诊断有一定意义。     

Hemicrania continua. The first Spanish case: a case report

The case of a patient suffering from strictly unilateral continuous headache, absolutely responsive to indomethacin is reported. This is the first Hemicrania continua case to be documented in Spain. The tyramine test resulted in anisocoria with the smaller pupil on the symptomatic side. A second tyramine test after one week on 75 mg indomethacin per day failed to produce anisocoria. Treatment was reduced to 25 mg indomethacin per day, and this dose was sufficient to control the headache completely.     

Unusual visual symptoms in a patient with bilateral vertebral artery dissection: a case report

We present a previously unreported set of symptoms in a patient found to have bilateral vertebral dissections. Although visual symptoms are common in vertebral dissection, their pattern does not typically mimic those that commonly precede or accompany migraine headache. When they do occur, they usually take the form of diplopia or blurred vision. The patient we describe had visual symptoms that varied over three episodes of headache and included transient visual field loss and scintillations ("lightning bolts"), both common in migraine. However, our patient's new visual symptoms represented a change in pattern from those that had accompanied her previous migraines. This detailed history-taking prompted an evaluation for an etiology other than migraine and prevented a further delay in diagnosis and treatment.     

Tornwaldt's cyst presenting only as occipital headache: a case report

Tornwaldt's cyst (sometimes called Thornwaldt's cyst) is a rare cause of occipital headache. Owing to the rare occurrence of occipital headache as a symptom of Tornwaldt's cyst, if the patient presented only with occipital headache, this clinical symptom may be falsely perceived as a sign of neurologic disease leading to time-consuming diagnostic examinations that delay the establishment of a correct diagnosis.     

主动脉夹层误诊为肾绞痛1例分析

病例：患者，男，54岁、因阵发双侧腰背部疼痛1h来我院泌尿外科就诊，考虑其为“肾绞痛”可能,予解痉等治疗。30min后，患者疼痛无缓懈,并出现大汗、头晕、胸闷等症状,转急诊抢救室。再次询问病史，发现此前患者曾有胸背部疼痛,疼痛向腰背部发展。     

Adult aqueductal stenosis presenting as a thunderclap headache: a case report

Thunderclap headache is well known to be a presenting feature of a variety of causal events. Indeed, a primary form is considered in the International Classification of Headache Disorders-II, but such diagnosis must be made only after exclusion of a possible secondary cause. We report a case of late-onset idiopathic aqueductal stenosis presenting with thunderclap headache, in the absence of abnormal neurological findings or indirect signs of raised intracranial pressure. The patient recovered completely after endoscopic third ventriculostomy. This case indicates primary aqueduct stenosis as a possible, never previously reported, cause of thunderclap headache.