Muscle contraction headache.

This is the common "tension" or "nervous" headache. It is extracranial in origin, and is often precipitated by anxiety or depression. The headache is usually bilateral, nonpulsatile and of longer duration than migraine, with no focal signs or symptoms. While aspirin remains the most practical and useful analgesic for head pain of low intensity, combination agents are useful and drugs to control anxiety associated with headache are appropriate.     

Mechanisms of headache.

It is thus evident that the mechanisms of headache differ widely from one syndrome or symptom complex to another. Both intracranial and extracranial structures may be involved. Knowledge of headache mechanisms is indispensable to the clinician charged with the management of his patient's complaints. Such knowledge should guide the investigations which may be required, and the treatment program to be instituted. As knowledge of headache mechanisms is broadened and our current concepts are altered, we can expect to learn more, not only about the complicated nature of the subject, but also about patients. Future research on headache will almost certainly concentrate on headache mechanisms and will be concerned with molecular mechanisms, immunity and the biochemistry of vascular mediators. That is as it should be, as the pursuits become increasingly focused and scientific. Yet it must also be emphasized that headaches occur, so far as we know, only in man, that they are unique to the human situation, and they cannot be understood without considering the personality, environment, and hopes and aspirations of the individual. In the end, many headaches will be seen to be a problem of inappropriate life adjustment, of poor tempo, a type of conditioned response evoked by the individual's attempts to deal with the vicissitudes of life. This "headache mechanism," so frequently a part of the human condition, will be understood by the perceptive physician as a symptom of his patient's dysfunction, and treated accordingly.     

Cervicogenic headache, migraine, and tension-type headache. Pressure-pain threshold measurements.

Pressure-pain threshold (PPT) measurements were performed with a pressure algometer, at 22 specified points in the head in patients with cervicogenic headache (n = 32), migraine (with and without aura) (n = 26) and tension-type headache (n = 17). Comparisons were made with a group of healthy controls (n = 20). The average PPT differed significantly between the groups (ANOVA, F = 9.5, P < 0.0005), largely caused by the low threshold in cervicogenic headache patients. There were no significant differences between controls and the 2 other headache groups. In the cervicogenic headache group, the lowest PPT was found in the occipital part of the head on the side with pain predominance. The ratio between the dominant and non-dominant sides (all 11 points on each side) was 0.85 in cervicogenic headache, whereas it was 0.99 in migraine patients with side preponderance of the pain. The present results support the view that the pathogenesis of cervicogenic headache differs from that of migraine and tension-type headache. The results may further support the theory that fibres from the C2 level (innervating the occipital part of the head) may be included in the pathogenetic mechanism in cervicogenic headache.     

Psychiatric comorbidity in medication overuse headache patients with pre-existing headache type of episodic tension-type headache.

BACKGROUND: Medication overuse headache (MOH) mostly evolves from migraine and episodic tension-type headache (ETTH). Chronic tension-type headache (CTTH) is another headache type that evolves over time from ETTH. It is well known that psychiatric comorbidity is high in MOH patients. AIM: To investigate the frequency of psychiatric comorbidity, and the intensity of depression and anxiety in MOH patients evolving from ETTH and to compare results with CTTH patients and MOH patients evolving from migraine. METHODS: Twenty-eight CTTH (Group C) and 89 MOH patients were included into the study. MOH patients were divided into two groups according to their pre-existing headache types: MOH patients with pre-existing ETTH (Group E, n = 31), and with pre-existing migraine (Group M, n = 58). All patients were interviewed with a psychiatrist and SCID-CV and SCID-II were applied. Beck Anxiety Inventory and Beck Depression Inventory scales were also performed. RESULTS: Eleven patients (39.3%) in Group C, 21 patients (67.7%) in Group E, and 31 patients (53.7%) in Group M were diagnosed to have comorbid psychiatric disorders. The psychiatric comorbidity was found significantly higher in Group E than Group C. In Group E, mood disorders were found significantly higher, but the difference between the two groups with regard to anxiety disorders was insignificant. Mean depression scores were significantly higher in Group E than Group C. The mostly diagnosed type was obsessive-compulsive personality disorder in all the three groups, and was statistically significant in Group M than Group C. CONCLUSION: Psychiatric comorbidity in MOH patients with pre-existing ETTH is common as in those with pre-existing migraine headache and MOH with regard to developing psychiatric disorders should be interpreted as a risk factor in chronic daily headache patients.     

Cluster headache. Premonitory symptoms

The emergence of symptoms which may precede by days the onset of a series of painful attacks of cluster headache is not often reported in the medical literature. In this report, four patients who described these premonitory symptoms are presented. The importance of premonitory symptoms is emphasized, for they provide a means to institute an early prophylactic therapy and the possibility of clarifying the physiopathology of this primary headache.     

Droperidol for acute migraine headache.

The use of intramuscular droperidol to treat acute migraine headache has not been previously reported in the emergency medicine literature. It is a promising therapy for migraine. The authors performed a pilot review of all patients receiving droperidol for migraine in our emergency department (ED) to evaluate its efficacy. We used a retrospective case series, in a suburban ED with an annual patient census of 48,000. All patients with a discharge diagnosis of migraine headache who were treated with i.m. droperidol during a consecutive 5-month period in our ED were identified. All patients received droperidol 2.5 mg intramuscular. As per ED protocol, their clinical progress was closely followed and documented at 30 minutes after drug administration (t30). Demographic and clinical variables were recorded on a standardized, closed-question, data collection instrument. The primary outcome measurement was relief of symptoms at t30 to the point that the patient felt well enough to go home without further ED intervention (symptomatic relief). Thirty-seven patients were treated (84% female), with an ED diagnosis of acute migraine with droperidol during the study period. The mean age was 36 +/- 12 years. Analgesics had been used within 24 hours before ED presentation by 62% of patients. At t30, 30 (81%) patients had symptomatic relief, 2 (5%) felt partial relief but required rescue medication, and 5 (14%) had no relief of symptoms. Drowsiness (14%) and mild akathisia (8%) were the only adverse reactions observed following drug administration. Droperidol 2.5 mg intramuscular may be a safe and effective therapy for the ED management of acute migraine headache. Randomized, controlled trials are warranted to further validate the findings of this preliminary study.