Contingent negative variation in childhood migraine

Adult migraineurs without aura have an increased amplitude of the Contingent Negative Variation (CNV) between attacks. Given the potential diagnostic importance of this finding and the difficulties associated with diagnosing migraine in childhood it seemed important to assess CNV in children suffering from this disorder. Ninety-seven children aged between 8 and 14 years were recruited. Forty-two suffered from migraine, 34 from tension-type headache. Twenty-one healthy controls were also studied. CNV was recorded from Fz, Cz and Pz referenced to linked earlobes during 20 trials consisting of two tones of moderate intensity with an interstimulus interval (ISI) of 4 sec and an intertrial interval (ITI) of 10 to 14 sec. The second tone of each trial required a button press. EOG was recorded from the left eye. The 10 CNV responses with the least EOG artefact were selected and averaged. Children with migraine had a highly significantly more negative mean CNV amplitude at all three electrode sites than children with tension-type headache and also a more pronounced Post-Imperative-Negative-Variation (PINV). Migrainous children differed from controls only at Cz (ISI). There was also a highly significant increase of mean CNV amplitude and PINV at all three electrode sites in the control group compared to the tension headache group.     

Disorders in the Lower Cervical Spine. A Cause of Unilateral Headache?

Various pathoanatomical disorders may underlie cervicogenic headache. We present a patient who, after 15 years of unilateral headache and neck pain, developed radiating pain in the ipsilateral (left) arm. Cervical myelography demonstrated herniation of the C6-C7 intervertebral disc with involvement of the left C7-root. After decompression of this root, with disappearance of the radiating symptoms, the left-sided unilateral headache also disappeared. The follow-up time is 38 months.     

Headache Due to an Extra Joint Between Head and Neck

A girl, born in 1973, started having headache in preschool age. After a head trauma in 1985, there was a clear worsening of the headache, and the headache became chronic at around 14 years, making regular school attendance impossible. The headache was "symptom poor," bilateral-occipital, but with a clear left-sided preponderance and occasionally spreading to the forehead. The headache was always worst in the morning hours, easing up by noontime. Neck rotation to the right could provoke long-lasting exacerbations.
Neck movement was restricted on rotation to the left. A sore bony structure was discovered on palpation just underneath the mastoid process of the left side. This proved to correspond to a bony "bridge" with an extra joint between the first vertebra on the left side and the skull, medially to the mastoid process that could be demonstrated on x-ray tomography and CT scanning. This bony bridge was removed surgically more than 2 years ago, and the pain disappeared on the day of operation and has not recurred in the intervening time. Such bony bridges have in the past been considered to be innocuous and not symptom producing. Although this may be the general rule, the present case tends to show that even to this rule, there are exceptions.     

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.     

以孤立性头痛为主要表现的颅内静脉窦血栓1例并文献复习

目的 探讨本病的病因、临床表现、影像学特征、治疗方法.方法 回顾性分析1例以反复孤立性头痛为主要表现的颅内静脉窦血栓病例,并复习相关文献.结果 患者男性,28岁,主因头痛10天,加重4天入院.头部MRI平扫+增强提示左侧乙状窦及横窦充盈缺损,T1及Flair呈高信号.数字减影血管造影证实为左侧横窦、乙状窦血栓.经抗感染...     

Daily migraine with visual aura associated with an occipital arteriovenous malformation

A 51-year-old woman with daily attacks of migraine with visual aura is described. The aura always occurred on the right and the headache always on the left side of the head, suggesting a structural lesion in the left occipital lobe. The lesion appeared to be an arteriovenous malformation of which almost full obliteration resulted in a decrease in frequency of the aura and in intensity of the headache. Subsequent treatment of borderline hypothyroidism with levothyroxine brought about a dramatic improvement in frequency of both the aura and the headache. The case is discussed in the light of our present understanding of the pathogenesis of the migraine attack.     

Swollen and bloodshot eye following headache

A ruptured cavernous carotid aneurysm (CCA) with carotid cavernous fistula can appear as a benign headache but progress to a swollen and bloodshot eye overnight. A 66-year-old woman visited emergency department with sudden onset of pain behind her left forehead and vomiting. She was treated for a migraine-like headache and discharged. She presented again on the next day with a persistent headache and a swollen left eye with blurred vision. An ophthalmologic examination revealed erythema of the left lid and chemosis at the temporal and lower bulbar conjunctiva. A cranial nonenhanced computed tomography (CT) scan had been performed at her previous visit. The scan exhibited a nodular mass lesion involving the left cavernous sinus. CT angiography was subsequently used to determine that the lesion was a giant aneurysm in the left cavernous internal carotid artery, causing enlargement of the left ophthalmic veins. The symptoms of her left eye rapidly progressed to severe chemosis, edematous change over periocular region, and limited movements after 8?h. The patient received emergent lateral canthotomy and inferior cantholysis to avoid acute orbital compartment syndrome and was subsequently treated with stent-assisted coil embolization. A ruptured CCA is an urgent condition that requires rapid assessment of both cranial vascular and ocular lesions. A history of sudden onset headache with a nonpainful acute unilateral red eye may serve as a clue to prompt additional diagnostic studies and ophthalmologist evaluation. Adequate radiological studies and early endovascular intervention can reduce the likelihood of permanent ocular injury and vision impairment.     

Diagnosis,epidemiology, and impact of tension-type headache

Although tension-type headache is the most prevalent headache and affects 78% of the general population, the substantial societal and individual burden associated with this primary headache has been overlooked. In contrast to migraine headache, there has been limited focus on tensiontype headache. Most patients with the chronic form of tension-type headache, which affects 3% of the population, are left virtually without any specific treatment. Chronic tensiontype headache differs from the episodic form in frequency, lack of effect to most treatment strategies, more medication overuse, and more loss of quality of life. Daily or near daily headaches also constitute a major diagnostic and therapeutic problem and distinguishing chronic tension-type headache from migraine headache and from medication-induced headache is a substantial diagnostic challenge because management strategies are completely different. Considerable benefits for the society can be gained by specific strategies leading to reductions in the amount of sickness absence and impaired working abilities. The burden on the affected patients’ and their families’ quality of life also may be improved by a general acceptance of the disorder and by the development of a specific treatment strategy.     

Cluster headache associated with moyamoya

A 34-year-old man with right-sided cluster headache presented with a stroke from right-sided moyamoya. Following surgery on the right, both moyamoya and cluster headache remitted, but eighteen months later a cluster attack and symptoms of cerebral ischemia from moyamoya recurred on the left. Again, following surgery on the left, both moyamoya symptoms and cluster attacks disappeared. Cluster headache secondary to moyamoya has not previously been described. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users. An erratum to this article can be found at     

Force production and EMG activity of neck muscles in adolescent headache

Purpose. This study compared the maximal force, EMG/force ratio and co-activation characteristics of the neck-shoulder muscles between 30 adolescents with migraine-type headache, 29 with tension-type headache, and 30 headache-free controls.

Method. Force was measured with surface electromyography (EMG) from the cervical erector spinae (CES), the sternocleidomastoid (SCM) and trapezius muscles during the maximal isometric neck flexion, neck extension and shoulder flexion.

Results. Girls with migraine-type headache had higher EMG/force ratios between the EMG of the left agonist SCM muscle and the corresponding maximal neck flexion (p = 0.030) and neck rotation force to the right side (p = 0.024) than the girls with tension-type headache. Migrainous girls had more co-activation of right antagonist CES muscle during maximal neck flexion force than the girls without headache (p = 0.015). Neck force production showed no significant differences between girls. Girls with tension-type headache displayed lower left shoulder flexion force than girls with migraine-type headache (p = 0.005) or with no headache (p = 0.005). In boys, no significant differences were observed.

Conclusions. Girls with tension-type headache and migraine-type headache have differences in neuromuscular function in the neck-shoulder muscles. The data amplify our knowledge of the neck-shoulder muscle dysfunction in adolescent headache, and may encourage the use of specific rehabilitation methods in the management of different types of headache.     

Color Doppler sonography of orbital and vertebral arteries in migraineurs without aura

PURPOSE: The objective of this study was to investigate whether the retrobulbar hemodynamics in the ophthalmic (OA), posterior ciliary (PCA), central retinal (CRA), and vertebral (VA) arteries are affected in migraineurs without aura. METHODS: The eyes of migraineurs without aura and those of healthy control subjects were evaluated during both headache and headache-free periods. Retrobulbar and vertebral blood flow velocities in the OA, PCA, CRA, and the extracranial part of the VA were measured bilaterally using color Doppler sonography. The peak systolic and end-diastolic flow velocities and the pulsatility (PI) and resistance (RI) indices were determined for all arteries. RESULTS: In total, we enrolled 30 migraineurs and 31 healthy control subjects. Statistically significant differences between headache-free migraineurs and control subjects were observed in the PI and RI of both right and left PCAs and in the RI of both right and left CRAs. The PI and RI of the left VA of the migraineurs were significantly lower during both headache and headache-free periods than were those of the control subjects. Among the migraineurs, the peak systolic and end-diastolic velocities of the left VA were increased during headache periods relative to those found during the headache-free periods. CONCLUSIONS: The retrobulbar circulation and flow hemodynamics in the left VA may be altered in both headache and headache-free periods in migraineurs without aura. The differences found between migraineurs and control subjects may implicate autonomic dysfunction in migraineurs.     

MRI Angiography of a Patient Before and During Alcohol-Induced Cluster Headache

SYNOPSIS
A 25-year-old man, subject to bouts of left supraorbital cluster headache on an annual basis over the previous 8 years, volunteered for MRI angiography during an active period. Studies were conducted before and during a typical cluster headache attack induced by alcohol. MRI angiography failed to show dilatation of the ophthalmic artery on either the symptomatic side, or the non-symptomatic side during headache, nor was there observed any dilatation of the anterior cerebral arteries on either side.     

Case Report: Shortest Course of Pediatric Paroxysmal Hemicrania

Paroxysmal hemicrania (PH) is a rare primary headache disorder, especially among children. We describe herein a case with the shortest course of pediatric PH among previously reported cases, and the first case report of Japanese pediatric PH. An 11-year-old boy was referred to our clinic by his primary care physician for a headache evaluation. He had been complaining of severe, sharp, pulsating headache for 5 days. Attacks were restricted to the left side with a duration ranging from 2 to 20 minutes, 20-30 times a day. Attacks were associated with left autonomic symptoms (conjunctival injection, lacrimation, nasal congestion, eyelid edema, and ptosis). Two days after we prescribed indomethacin at 0.9 mg/kg/day, the patient was headache free. He stopped taking indomethacin 14 days after consultation because of drug eruptions. As of the time of writing, more than 1 year later, he has experienced no recurrence of headache. This case indicates the importance of improving awareness among general doctors regarding PH in children, and of conducting further investigations about low-dose, short-term indomethacin treatment.     

Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache

OBJECTIVE: To assess the presence of trigger points (TrPs) in several head and neck muscles in subjects with chronic tension-type headache (CTTH) and in healthy subjects; and to evaluate the relationship of these TrPs with forward head posture (FHP), headache intensity, duration, and frequency. BACKGROUND: Tension-type headache (TTH) is a headache in which myofascial TrPs in head and neck muscles might play an important etiologic role. DESIGN: A blinded, controlled, pilot study. METHODS: Twenty-five CTTH subjects and 25 matched controls without headache were studied. TrPs in bilateral upper trapezius, sternocleidomastoids, and temporalis muscles were identified according to Simons et al's diagnostic criteria: tenderness in a hyperirritable spot within a palpable taut band, local twitch response elicited by snapping palpation, and elicited referred pain with palpation. A TrP was considered active if the subject recognized the evoked referred pain as familiar headache. If the evoked referred pain was not recognized as familiar headache, the TrP was considered as latent. Side-view pictures of each subject were taken in both sitting and standing positions in order to assess FHP by measuring the cranio-vertebral angle. Both measurements were made by a blinded assessor. A headache diary was kept for 4 weeks in order to assess headache intensity, frequency, and duration. RESULTS: The mean number of TrPs on each CTTH subject was 3.9 (SD: 1.2), of which 1.9 (SD: 1.2) were active TrPs and 1.9 (SD: 0.8) were latent TrPs. Control subjects only exhibited latent TrPs (mean: 1.4; SD: 0.8). There was a significant difference between the CTTH group and the controls for active TrPs (P < .001), but not for latent TrPs (P > .05). Differences in the distribution of active and latent TrPs within each muscle were also significant for all the analyzed muscles (P < .01). CTTH subjects with active TrPs in the right upper trapezius muscle or left sternocleidomastoid muscle showed a greater headache intensity and duration, but not headache frequency, compared to those with latent TrPs (P < .05). Active TrPs in the right temporalis muscle were associated with longer headache duration (P < .01), whereas active TrPs in the left temporalis muscle were associated with greater headache intensity (P < .05). CTTH subjects with active TrPs in the analyzed muscles had a greater FHP than those with latent TrPs in both sitting and standing positions. Differences were only significant for TrPs in the left sternocleidomastoid and FHP in the sitting position (P < .01). CONCLUSIONS: Active TrPs in upper trapezius, sternocleidomastoid, and temporalis muscles were associated with CTTH. CTTH subjects with active TrPs usually reported a greater headache intensity and longer headache duration than those with latent TrPs. CTTH subjects with active TrPs tended to have a greater FHP than CTTH subjects with latent TrPs.     

Cluster headache-like headache, Hageman trait deficiency, retrobulbar neuritis, and giant aneurysm

A 56-year-old, previously reported woman with cluster headache-like headache with bouts of unilateral (the side of predominance changing through the years) severe headache had a familial history (three generations) of partial Hageman factor deficiency and bleeding episodes. A giant aneurysm was found to be lodged in the anterior communicating artery on the left side. Clinically, the features were atypical for cluster headache: onset at a young age (14 years), episodes of retrobulbar neuritis appearing at the side of pain, etc. Studies of forehead sweating indicated that the right side was the pathologic one, from an autonomic point of view, as did pupillometric studies. However, during attacks, which were left-sided at the time, forehead sweating was marked laterally on the left side and on the upper eyelid, but not on the right. The "signal" usually reaching the autonomically stigmatized side during attacks of cluster headache, therefore, did not seem to reach the sweat glands on that (the right) side during the attack in the present case. This headache may, therefore, be distinct from cluster headache, both from a clinical and from an autonomic function point of view.     

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.     

Pheochromocytoma: Paroxysmal Hypertensive Headaches

SYNOPSIS
A thirty-year-old female reported episodic vascular headaches for one year. On physical examination during a headache her average systolic and diastolic blood pressure rose 33 mm Hg and 18 mm Hg respectively. Her headaches ceased after removal of a 100 g left intra-adrenal tumor located by abdominal CAT scan. Details of the patient's diagnosis and the general evaluation of headache patients for pheochromocytoma are discussed.     

IgG4相关性疾病的临床病例评析

目的提高对IgG4相关性疾病颅内病变的认识。 方法描述1例IgG4相关性疾病（IgG4-RD）颅内病变患者的诊治过程,总结其临床、影像学、病理特点,诊断和鉴别诊断,治疗和预后。 结果22岁女性,头痛、左眼视力下降10个月。6个月前左眼失明,眼球固定,左眼球后占位,病理示大量淋巴浆细胞浸润,IgG4＋浆细胞>50/高倍视野,IgG4（＋）/IgG比值>10%,予足量激素及小剂量免疫抑制剂治疗病情维持原状。2个月前停药。半月前突发右眼视力下降伴头痛加重,5天前右眼失明伴烦渴多尿,高钠血症。头颅MRI提示右侧视神经、鼻窦、鞍区、左侧颞叶及邻近脑膜异常信号。脑脊液压力、细胞学、生化均正常。予大剂量激素冲击治疗,序贯减量,联合环磷酰胺冲击治疗,患者右眼视力逐步恢复至0.3,头痛完全缓解,尿量改善,血钠正常。40余天后复查头颅MRI本次新发病灶明显好转。 结论IgG4-RD颅内病变可同时累及多个部位,但不伴颅外表现,可出现病情快速进展,及时治疗可避免不可逆损害。     

Thunderclap headache from complicated sinusitis

We report a case of complicated pansinusitis presenting with thunderclap headache. The patient quickly developed left ophthalmoplegia and imaging demonstrated extension of inflammation from the sphenoid sinus into the sellar region. Thunderclap headache is well known to occur from a variety of intracranial events, but complicated sinusitis presenting this way is seldom described. The patient recovered completely with appropriate treatment.