Primary cough headache is associated with posterior fossa crowdedness: a morphometric MRI study

The aetiology of primary cough headache (PCH) is obscure. The aim of this study was to investigate the magnetic resonance (MR) morphometric characteristics of the posterior cranial fossa (PCF) in patients with PCH. Eighteen consecutive patients with PCH (14M/4F, mean age 75.1 +/- 6.0 years) and 18 sex- and age-matched control subjects were recruited for study. Based on the midline sagittal MR images, parameters indicating posterior fossa crowdedness were measured. Compared with controls, patients with PCH had a similar size of hindbrain tissue area but a significantly smaller PCF area, resulting in a higher mean hindbrain/PCF ratio (0.78 +/- 0.04 vs. 0.73 +/- 0.06, P = 0.005). In addition, these patients also had a lower position of the cerebellar tonsillar tip, a shorter clivus length and shorter distances from the clivus to the mid-pons and from the basion to the medulla than the control group. Patients with PCH were associated with a more crowded PCF, which might be a contributing factor for the pathogenesis of this headache syndrome.     

Cluster headache in the Taiwanese -- a clinic-based study

Cluster headache has not been fully investigated in Asians. One hundred and four patients (90M/14F; mean age 39.2 +/- 12.2 years) with cluster headache were recruited from two major headache clinics in Taiwan. They filled out a structured cluster headache questionnaire. All participants were diagnosed to have episodic cluster headache. Mean age of onset was 26.9 years; mean latency of diagnosis was 8.1 years. A trend of decrease in male/female ratio with time was noted. Seventy-three percent were ex- or current smokers (M: 79%, F: 36%). Restlessness was reported by 51% patients. Only 1 patient (1%) reported visual aura. Patients responded well to standard acute and prophylactic treatment. The monthly incidence of cluster period was inversely related to sunshine duration. Compared to Western series, our patients were different in several aspects including the absence of chronic cluster headaches and a low prevalence of restlessness and aura. Racial and geographical factors might contribute to these discrepancies.     

Headache profiles in patients with a dilatated cyst of the cavum septi pellucidi

The dilatated cyst of the cavum septi pellucidi (CSP) is rare and may be associated with headaches. We reviewed the computerized database of 54,000 patients' computed tomography or magnetic resonance images and found 22 cases (0.04%) involving a dilatated cyst of the CSP. Sixteen patients had a chief complaint of headache, which was classified as acute episodic headache (type I, n = 7, 43.7%), chronic daily headache (CDH) with acute onset (type II, n = 5, 31.3%), or CDH with insidious onset (type III, n = 4, 25%). Acute Valsalva-induced headaches were common with type I (85%) or II (100%); 70% of these responded to indomethacin. At follow-up, patients with type I headache had the highest remission rate (71%), and type III patients the lowest (0%). Dilatated cysts of the CSP should be considered a cause of acute Valsalva-induced headache or new daily persistent headache, and may respond to indomethacin. A protracted course (> or = 3 months) indicates a worse outcome.     

Cardiac cephalalgia. Case report and review of the literature with new ICHD-II criteria revisited

We report a patient with cardiac cephalalgia and review reported cases from the English-language literature based on the new diagnostic criteria published in the International Classification of Headache Disorders, ed 2. Twenty-two patients, including ours, with headaches of cardiac origin were reviewed. The cases fit three of the four new criteria well: Criteria B (acute myocardial ischemia has occurred, 100%), C (headache developed concomitantly with acute myocardial ischemia, 100%), and D (headache resolved and does not recur after effective medical or surgical treatment for myocardial ischemia, 83%). The cases in which we had exceptions were to the proposed headache features (criterion A), which were generally not fulfilled, with nausea as the least frequent finding (27%); this criterion might not be mandatory for diagnosis.     

Prolonged reversible vasospasm in cyclosporin A-induced encephalopathy

The mechanisms responsible for cyclosporin-induced encephalopathy remain controversial. Herein we present a case of cyclosporin-induced encephalopathy with unusually prolonged vasospasm, which might have contributed to the slow recovery of the patient.     

Frequency and predictors of physician consultations for headache

We conducted a population-based headache questionnaire survey including questions on physician consultation for headache in Taipei, Taiwan from August 1997 to June 1998. The participants comprised 3377 subjects aged > or = 15 years, of whom 328 (9.7%) had a diagnosis of migraine and 1754 (52%) had a diagnosis of non-migraine headache. Migraineurs had a higher physician consultation rate (once or more in the past year) than the subjects with non-migraine headache (54% vs. 31%, P < 0.0001). When frequency > or = 10 times was taken as 10 times, the analysis showed that migraineurs consulted physicians more often than non-migraine headache subjects (2.36 vs. 0.96, P = 0.04). A small proportion of the subjects with either migraine (12%) or non-migraine headache (6%) accounted for 50% of total consultations within their groups. In addition to old age, low education levels, living in a rural area, migrainous features (nausea and photophobia), and work day loss, predictors of physician consultations also included 'having been troubled with headache' (odds ratio (OR) = 1.7) and co-morbidity with hypertension (OR = 1.8) or heart disease (OR = 2.2). Low copayment and unrestricted access to medical care, as well as cultural factors played an important role in the high consultation rates in our headache subjects. Moreover, this study found self-perception of headache impact and co-morbid illnesses were important factors affecting the decision to consult physicians about headache.     

Persistent migrainous visual phenomena might be responsive to lamotrigine

Two patients with migraine reported having experienced persistent auralike visual phenomena for months to years. All laboratory investigations were normal except for occipital hypoperfusion on the brain single photon emission computed tomography. After lamotrigine treatment for 2 weeks, they both had a resolution of the visual symptoms. Persistent migrainous visual phenomena are potentially benign and probably a status of spontaneous aura.     

Associated risk factors for silent cerebral infarcts in sickle cell anemia: low baseline hemoglobin, sex, and relative high systolic blood pressure

The most common form of neurologic injury in sickle cell anemia (SCA) is silent cerebral infarction (SCI). In the Silent Cerebral Infarct Multi-Center Clinical Trial, we sought to identify risk factors associated with SCI. In this cross-sectional study, we evaluated the clinical history and baseline laboratory values and performed magnetic resonance imaging of the brain in participants with SCA (HbSS or HbSβ° thalassemia) between the ages of 5 and 15 years with no history of overt stroke or seizures. Neuroradiology and neurology committees adjudicated the presence of SCI. SCIs were diagnosed in 30.8% (251 of 814) participants who completed all evaluations and had valid data on all prespecified demographic and clinical covariates. The mean age of the participants was 9.1 years, with 413 males (50.7%). In a multivariable logistic regression analysis, lower baseline hemoglobin concentration (P < .001), higher baseline systolic blood pressure (P = .018), and male sex (P = .030) were statistically significantly associated with an increased risk of an SCI. Hemoglobin concentration and systolic blood pressure are risk factors for SCI in children with SCA and may be therapeutic targets for decreasing the risk of SCI. This study is registered at www.clinicaltrials.gov as #NCT00072761.     

Prognostic role of adjuvant radiotherapy in triple‐negative breast cancer: A historical cohort study

The value of adjuvant radiotherapy in triple‐negative breast cancer (TNBC) is currently debated. We assessed the association between adjuvant radiotherapy and survival in a large cohort of Asian women with TNBC. Women diagnosed with TNBC from 2006 to 2011 in five Asian centers (N = 1,138) were included. Survival between patients receiving mastectomy only, breast‐conserving therapy (BCT, lumpectomy and adjuvant radiotherapy) and mastectomy with radiotherapy were compared, and adjusted for demography, tumor characteristics and chemotherapy types. Median age at diagnosis was 53 years (range: 23–96 years). Median tumor size at diagnosis was 2.5 cm and most patients had lymph node‐negative disease. The majority of patients received adjuvant chemotherapy (n = 861, 76%) comprising predominantly anthracycline‐based regimes. In 775 women with T1‐2, N0‐1, M0 TNBCs, 5‐year relative survival ratio (RSR) was highest in patients undergoing mastectomy only (94.7%, 95% CI: 88.8–98.8%), followed by BCT (90.8%, 95% CI: 85.0–94.7%), and mastectomy with radiotherapy (82.3%, 95% CI: 73.4–88.1%). The adjusted risks of mortality between the three groups were not significantly different. In 363 patients with T3‐4, N2‐3, M0 TNBCs, BCT was associated with highest 5‐year RSR (94.1%, 95% CI: 81.3–99.4%), followed by mastectomy with radiotherapy (62.7%, 95% CI: 54.3–70.1%), and mastectomy only (58.6%, 95% CI: 43.5–71.6%). Following multivariable adjustment, BCT and mastectomy with radiotherapy remained significantly associated with lower mortality risk compared to mastectomy only. Overall, adjuvant radiotherapy was associated with higher survival in women aged <40 years, but not in older women. Adjuvant radiotherapy appears to be independently associated with a survival gain in locally advanced as well as in very young TNBC.     

Post-reversible cerebral vasoconstriction syndrome headache

BackgroundChronic headache may persist after the remission of reversible cerebral vasoconstriction syndrome (RCVS) in some patients. We aimed to investigate the prevalence, characteristics, risk factors, and the impact of post-RCVS headache.MethodsWe prospectively recruited patients with RCVS and collected their baseline demographics, including psychological distress measured by Hospital Anxiety and Depression scale. We evaluated whether the patients developed post-RCVS headache 3 months after RCVS onset. The manifestations of post-RCVS headache and headache-related disability measured by Migraine Disability Assessment (MIDAS) scores were recorded.ResultsFrom 2017 to 2019, 134 patients with RCVS were recruited, of whom, 123 finished follow-up interviews (response rate 91.8%). Sixty (48.8%) patients had post-RCVS headache. Migrainous features were common in post-RCVS headache. Post-RCVS headache caused moderate-to-severe headache-related disability (MIDAS score > 10) in seven (11.7%) patients. Higher anxiety level (odds ratio 1.21, p = 0.009) and a history of migraine (odds ratio 2.59, p = 0.049) are associated with post-RCVS headache. Survival analysis estimated that 50% post-RCVS headache would recover in 389 days (95% confidence interval: 198.5–579) after disease onset.ConclusionsPost-RCVS headache is common, affecting half of patients and being disabling in one-tenth. Higher anxiety level and migraine history are risk factors. Half of the patients with post-RCVS headache would recover in about a year.