Hypnic headache syndrome: excessive periodic limb movements in polysomnography

We report a patient with hypnic headache syndrome associated with excessive periodic limb movements in sleep, which is a unique finding for this syndrome recorded in polysomnography. She had had daily hypnic headache attacks history for 10 years. Her headache attacks ceased immediately after lithium carbonate therapy and she has been headache-free for 5 months.     

10例睡眠性头痛临床分析

目的分析睡眠性头痛的临床特点,提高对睡眠性头痛的认识和改善治疗效果。方法分析2006年7月至2010年10月诊治的10例睡眠性头痛的临床表现及治疗结果,并结合文献进行总结。结果10例病例中男4例,女6例,发病年龄从24至61岁,全部病例中6例使用了碳酸锂口服治疗,5例头痛发作完全停止,1例无效而改用氟桂利嗪口服治疗,发作停止;3例则使用了洛美利嗪治疗,头痛发作停止;2例(包括上述提到的1例)使用氟桂利嗪治疗发作停止。结论应提高对睡眠性头痛的认识,首选碳酸锂治疗,如果碳酸锂无效或因药物副作用或其它原因不能使用碳酸锂,则可使用洛美利嗪或氟桂利嗪亦有效。     

Hypnic headache as a primary short-lasting night headache: a report of two cases

Hypnic headache is a rare type of primary short-lasting headache related to sleep. The pathogenesis of hypnic headache still remains unknown, but it may be a chronobiological disturbance or a response to a pineal circadian irregularity in which melatonin may play a role in resynchronizing biological rhythms to lifestyle. It is a moderate headache that appears during sleep with almost an alarm clock regularity and lasts up to 60 minutes. The headache is boring, unilateral or with diffuse location. Lithium carbonate and flunarizine show the best efficacy, caffeine and melatonin may also be useful. The author describes two cases of hypnic headache, which were effectively treated. A 45-year-old woman was treated with flunarizine and melatonin and a 65-year-old man was treated with flunarizine. The efficacy of flunarizine may be associated with the activation of D2 receptor and the added treatment with melatonin may hasten the good effect similar to that seen in our patient.     

Hypnic headache responsive to indomethacin: second Italian case

We report a case of hypnic headache (HH) fulfilling the criteria proposed by the revised IHS headache classification and rapidly responsive to indomethacin. The patient is a 70-year-old housewife who presented with a 7-year history of strictly nocturnal headache attacks. The headache occurred every night with a frequency of 1 to 2 attacks occurring between 03.00 and 04.00 a.m. Indomethacin was prescribed at a daily dose of 150 mg/day for 30 days and tapered down in 15 days. Pain did not occur thereafter and at follow up, nine months after discontinuation of the drug, the patient was still pain-free with no relapses. This is the second Italian HH patient responsive to indomethacin, indicating that indomethacin may be a useful alternative treatment in HH patients, and providing further evidence in favour of a common pathophysiological mechanism in HH and other indomethacin-responsive primary headaches.     

Shy-Drager syndrome: a case report with polysomnography

The authors report a case of Shy-Drager syndrome in a 53 year-old male patient. Autonomic failure was made evident by physical examination as well as laboratory tests. A sleep recording showed decreased percentage of REM sleep and apneas of the central type. The possible mechanisms for this sleep disorder are discussed.     

Hypnic headache: an update

Neurological Sciences - Hypnic headache (HH) is a rare sleep-associated primary headache disorder, usually affecting aged people, first described by Raskin in 1988. The headache attacks, single or...     

Cervicogenic headache: report of a case

It has been known for many years that headaches can originate from abnormalities in the neck. However, their clinical pictures were never sufficiently systematized, at least not in order to permit the research on their pathogenesis. Sjaastad et al. described in 1983 a group of patients with a very uniform and stereotyped headache. Attacks of mild, longlasting, unilateral head pain without sideshift, occurred every few weeks. The headache could be provoked by neck movements, such as extension, rotation or lateral flexion, as well as by external pressure towards trigger points in the neck. It usually started back in the neck, eventually spreading to the ipsilateral orbito-frontal-temporal or facial areas. The denomination "cervicogenic headache" (CH) was proposed. Its pathophysiology is presently unknown. The C2 and occipital nerve blockages eliminate the pain. We present a CH case and make some comments on its clinical picture, pathophysiology, and treatment.     

Hypnic headache: clinical features,pathophysiology, and treatment

Hypnic headache has been described in several case reports since 1981 and is regarded as an idiopathic headache disorder. In this review of 71 cases in the literature, the clinical features, neurophysiologic including polysomnographic findings, and treatment procedures are analyzed and the pathophysiology of this condition, which remains however speculative, is discussed. There is some evidence that hypnic headache is related to REM sleep. The analysis shows that hypnic headache most probably is an entity among the idiopathic headache disorders unassociated with structural lesions and does not belong to the trigeminal-autonomic cephalalgias. Lithium shows the best efficacy; indomethacin, flunarizine, and caffeine may also be useful.     

Hypnic headache: PSG evidence of both REM- and NREM-related attacks

Hypnic headache (HH) occurs exclusively during sleep. Six attacks were recorded during nocturnal polysomnographic (PSG) monitoring of 10 HH patients. The PSG data obtained indicate that the attacks arose directly from sleep: four from non-REM and two from REM sleep. In no patient were the HH attacks found to show any close temporal relationship with sleep-related breathing abnormalities.     

Refractory migraine headache controlled with alprazolam: case report

A woman with major depressive disorder and refractory, incapacitating migraine headaches responded to alprazolam in a double-blind, placebo-controlled study. Migraine, but not depression, recurred following tapering of the drug, suggesting efficacy of alprazolam for control of refractory migraine.     

Cerebral non-Langerhans cell histiocytosis in a 17-year-old patient with a headache: case report

Journal of Neurology -     

Effectiveness of aripiprazole for medication overuse headache: a case report

Aripiprazole, a dopamine D2 receptor partial agonist, has been used to treat schizophrenia and might be effective for alcohol dependence and craving. We treated a 53-year-old woman with refractory medication overuse headache, which was successfully treated with aripiprazole. Our experience suggests that aripiprazole may be effective for patients with medication overuse headache.     

Prolonged polysomnography in a case with recurrent hypersomnia

Abstract An 18-year-old male patient with recurrent hypersomnia (RH) was evaluated using prolonged polysomnography (PSG). During symptomatic period (SMP), the patient showed both 'dissociated stage REM' (DREM), REM sleep without muscle atonia and 'dissociated stage 1' (DSt-1), and stage 1 sleep with rapid eye movement. These stages were observed in the morning or following daytime record. They decreased during asymptomatic period (ASMP). It has been said that RH is caused by dysfunction of the hypothalamus and midbrain limbic system. The present result suggests also that RH involves dysfunction of the brain stem.     

Cluster-like headache and head injury: case report

This appears to be the first report of cluster-like headache secondary to posttraumatic subdural hematoma. A 39 year old man consulted us for cluster-like headache on the right side following an injury to the right frontotemporal region some 45 days before. A CT scan revealed a chronic subdural hematoma in the right frontotemporal region. We discuss the possibile relationship between the head injury and the headache and sugĝest the value of CT scanning in patients with cluster headache.

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Sommario Per quanto noto, una cefalea a grappolo non è mai stata riportata come secondaria ad ematoma sottodurale post-traumatico. Un uomo di 39 anni giungeva alla nostra osservazione con una sintomatologia tipo “cluster headache” a destra, a seguito di una trauma cranico in regione fronto-temporale dx, che avveniva circa 45 giorni prima della nostra osservazione. Una TAC cerebrale dimostrava la presenza di un ematoma cronico sottodurale fronto-temporale dx. Le correlazioni tra trauma cranico e cefalea a grappolo sono discusse, in rapporto all'utilità di eseguire una TAC cerebrale nei pazienti con cefalea a grappolo.

     

Spontaneous subdural spinal haematoma presenting as occipital headache: a case report

Spinal subdural hematoma (SSDH) with no underlying pathology is a very rare condition and has been rarely reported. Our patient presented with severe occipital headache as isolated symptom during the first 4 days. SSDH slowly enlarges with time, and first determines tension of the pain-sensitive dural membrane, resulting in cervicogenic-like headache. Therefore, spontaneous SSDH should be considered in the differential diagnosis of recent occipital headache.     

Coexistance of cluster headache and hemicrania continua: a case report]

We reported a 36-year-old man, who suffered from cluster headache (CH) associated with hemicrania continua (HC). The continuous, dull or pressure-type headache appeared on the same side of the CH during the third month of a prolonged cluster period, and fluctuated in the severity of pain. This headache was aggravated when the CH was ameliorated by the administration of lithium carbonate. This converse relationship between CH and HC persisted during an on-off trial of the lithium carbonate, and the HC was exacerbated again after the complete cessation of CH. Retrobulbar pain and nasal congestion were present as components of HC similarly to CH, but they subsided gradually and the pressure-type vascular headache over the temporal area predominated later. The continuous headache lasted more than 3 months, and responded significantly to the indomethacin at a dose of 75mg/d. The clinical course of this patient suggests that HC and CH have a common pathomechanism including hyperactivation of the trigemino-vascular reflex, and may be different in the involvement of other central pathway of pain generation. Indomethacin may deserve consideration for the treatment of continuous headache that appears during an atypical course of other primary headaches.