Post Gamma Knife Headache: A New Headache Syndrome?

Gamma knife surgery has become an effective alternative to microsurgery in the treatment of cerebral arteriovenous malformations. In a number of patients, a de novo headache syndrome has been produced after gamma knife surgery. A case report is presented of a 62-year-old man who developed a migrainous type headache 15 months after gamma knife surgery. The current neurosurgical literature has very poor documentation of postsurgical headaches. A review of the literature was made to try to identify a stereotypic "post gamma knife headache," as well as hypothesize about its mechanism of induction.     

Posttraumatic Headache: A Review

There has been intense controversy about postconcussion syndrome (PCS) since Erichsen’s publication in 1866 on railway brain and spine. Headache as a result of trauma is one of the most common secondary headache types. Posttraumatic headache (PTH) remains a very controversial disorder, particularly with relation to chronic PTH following mild closed-head injury. PTH is one of several symptoms of PCS, and therefore may be accompanied by additional cognitive, behavioral, and somatic problems. PTH also is an important public health issue due to its associated disability and often refractory clinical course. While current awareness of PTH has become more prominent due to increased scrutiny given to both combat-related and sports-related head injuries, directed treatment remains a difficult challenge for physicians. Because of the frequently associated medicolegal aspects, PTH is one of physicians’ least favorite types to treat. The article reviews both PCS and PTH.     

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.     

Pathogenesis of Posttraumatic Headache and Migraine: A Common Headache Pathway?

In recent years, research implicating biochemical abnormalities in various pathological conditions has spiraled. Headache is an area in which numerous research studies have been conducted examining biochemical alterations. We have noticed several similarities in biochemical changes reported to occur in migraine and in experimental traumatic brain injury. The most common symptom in mild head injury or mild traumatic brain injury is headache which, in many instances, resembles migraine but has a poorly understood pathophysiology. Biochemical mechanisms believed to be similar in both conditions include: increased extracellular potassium and intracellular sodium, calcium, and chloride; excessive release of excitatory amino acids; alterations in serotonin; abnormalities in catecholamines and endogenous opioids; decline in magnesium levels and increase in intracellular calcium; impaired glucose utilization; abnormalities in nitric oxide formation and function; and alterations in neuropeptides. In this paper, these preposed biochemical alterations will be reviewed and compared. Very similar alterations suggest posttraumatic headache associated with mild head injury and migraine may share a common headache pathway.     

Headache in Stroke: A Review

Headache is a common accompanying symptom in cerebrovascular diseases. Several specific conditions and etiologies are reviewed with emphasis on distinguishing characteristics. Recognition of these conditions can help identify underlying causes of these “secondary headache syndromes” and facilitate disease‐appropriate treatment.     

A Psychophysiological Investigation of Tension Headache

SYNOPSIS
In a psychophysiological investigation of tension headache cases (n = 23) with migraine headache controls (n = 10) and non-headache controls (n = 30), both tonic and phasic activity of the key muscles (frontalis and temporalis) and the temporal artery pulse were examined. Although all headache cases had significantly elevated levels of temporalis tension, tension headache sufferers were not differentiated from migraine in this respect. A substantial subgroup of tension sufferers (30%) had no detectable muscular or arterial abnormality associated with their severe pain. Idiosyncratic stress stimuli evoked significant frontalis reactivity in all headache cases (tension and migraine). These responses were triggered only by potent stimuli. Migraine cases had higher level of temporal artery abnormality at rest, in response to stress, and during pain episodes than tension cases. The implications of these results were discussed with respect to the prevailing view of tension headaches. An alternative model of this disorder was considered.     

Sinus Headache: A Psychophysiological Study

SYNOPSIS
A psychophysiological investigation of sinus headache was performed using low frequency headache controls and high frequency muscle-contraction headache subjects as comparison groups. Two cardiovascular and two electromyograph (EMG) measures were recorded across rest, stress and post-stress adaptation periods. The results indicated no significant differences between groups on either the cardiovascular or EMG measures, however, trial effects were found on the blood volume pulse (BVP) measure. In addition, an interaction effect of trial by headache type on the BVP cognitive stressor was found. Finally, suggestions are advanced for future sinus headache research.     

Lumbar Puncture Headache: A Review

August Bier, the father of spinal anesthesia, suffered and reported the first lumbar puncture (LP) headache. On August 24, 1898 his assistant, a Dr. Hildebrandt, attempted to administer a spinal anesthetic to Dr. Bier; it was never completed because the syringe did not fit the already implanted spinal needle. Bier himself suggested that continued leakage of cerebrospinal fluid (CSF) through the dural puncture site was the cause of headache, a theory that has been embraced by the medical community; however, the mechanism is probably more complex. Nearly 50 years ago, J. Lawrence Pool, using an endoscopic technique to visualize the surface of the spinal cord and the cauda equina, frequently observed large collections of epidural fluid two to four days following lumbar puncture in patients without headache. Evidence that will be presented below suggests that CSF volume alterations may be the signal closest to the headache mechanism.     

Headache

Headache is one of the commonest problems to face the family doctor and hospital practitioners. Though migraine and tension headaches are the most common, other types could reflect serious underlying structural causes. Accurate diagnosis can usually be made from a complete history and examination. However, referral of some patients to a specialist clinic is inevitable.     

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.     

Headache

This article examines the different types of headache that patients may experience, distinguishing between common types of headache and those that are life-threatening.