DOCSLIB.ORG

Clinical Evaluation of Headache in Pa- Tients with Epilepsy in a Tertiary Care

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Clinical Evaluation of Headache in Pa- Tients with Epilepsy in a Tertiary Care Stanley Medical Journal ORIGINAL ARTICLE - NEUROLOGY CLINICAL EVALUATION OF HEADACHE IN PA- TIENTS WITH EPILEPSY IN A TERTIARY CARE HOSPITAL K.Mugundhan (1), T.C.R.Ramakrishnan (2). Abstract Aim: The aim of the study is to analyse and classify headaches occurring in patients with epilepsy and study the pattern of headaches associated with different types of epilepsies . Setting and design : It is a Cross Sectional Descriptive study of Patients with epilepsy who have headache either inter- ictally or periictally or both were taken up for the study. Materials and Methods | 2016 4 | October-December 3 | Issue Vol Study Design: Cross Sectional Descriptive study. Study Population: Patients with epilepsy who have headache either interictally or peri ictally or both who attended Neurology O.P. Government General Hospital, Chennai during the study period (July 2003 to August 2005) were taken up for the study. Inclusion Criteria: Patients with epilepsy who have inter ictal headache of >3 months duration antecedent to or after the onset of seizures and Patients with epilepsy who have peri ictal headache Exclusion Criteria: Patients with epilepsy who developed sudden onset severe headache, headache with systemic signs such as fever, neck stiffness, cutaneous rash, headache with papilloedema, headache triggered by cough, exertion or valsalva maneuver were excluded from the study. Patients with epilepsy who have either interictal or perictal headaches who did not have any features of exclusion criteria were selected for the study. Statistical analysis used : SPSS software Results : The total number of patients studied were 124 of which males comprised 33% (n=42) and females 66% (n= 82). The most common type of seizures seen were generalised tonic clonic seizures which is 42% of patients (n=52) and 38.7% of patients (n=48) have secondary generalised tonic-clonic seizures. Among 48 patients with 2*GTCS, 27 cases were of simple partial seizures with secondary generalisation and 21 were of complex partial in nature with secondary generaliza- tion. Interictal headache was present in 82 patients (66.6%) and seizure associated headache in 42 patients (33.4%) with epilepsy. Among 77 patients with primary headache, migraine type headache was seen in 54% (n=45) of patients and Tension type headache occurred in 30.4% (n=25) of patients, Episodic cluster headache was seen in one patient and pri- mary stabbing headache was seen in 6 patients with epilepsy. Secondary headache was seen in 6% (n=5) of patients with epilepsy. Among 42 patients with seizure associated headache, 24 (19.3%) had headache which might be an ictus without accompanying seizure activity classified as headache which could not be elsewhere classified (14.1) and 18 had (14.5%) pre ictal, ictal or post ictal headache. Conclusion : The most common type of seizures seen in patients with headache is primary generalized tonic-clonic seizures with primary headache seen in 94% of patients and secondary headache in the remaining. Migraine without aura type of headache is the most common primary headache seen interictally in patients with epilepsy. There is no specific correlation between headache subtype and type of epilepsy. Seizure associated headaches is seen in 14.5% of patients either as pre ictal, ictal or post ictal headache. Key Words : Headache,Epilepsy postulated pathophysiological mechanism of migraine and INTRODUCTION epileptic seizures may be the link between these two autono- Epilepsy and headache are common neurological mous disorders6. An association between migraine and epi- problems seen in neurological practice. The relationship be- lepsy has been demonstrated in several studies 5,7. But the tween headache and epilepsy remains unresolved1. In the data are complicated, and the studies have been limited by last century Gowers first advanced the clinical hypothesis small numbers. As there are only few studies evaluating the of a relationship between epilepsy and migraine 2. since the characteristics of headache in patients with epilepsy we have two conditions show a well-recognized clinical, pathophysi- done a study in our centre to analyse headache characteris- ological and therapeutic overlap 3. Neuronal hyperexcit- tics in patients with epilepsy. ability might explain the co morbidity between headache and epilepsy, such as Na + −K + ATPase pump impairment, converging on a common final pathway represented by neu- Please Scan this QR Code to ronal membrane hyperexcitability, could manifest as either View this Article Online 95 epilepsy or headache/migraine 4 . Spreading depression a DOI: 11th January 2017 Article ID: 2017:03:04:18:174 1. DEPT.OF NEUROLOGY, GOVT.MOHAN KUMARAMANGALAM MEDICAL COLLEGE HOSPITAL, SALEM,TAMILNADU. 2. CONSULTANT NEUROPHYSICIAN,KG HOSPITAL& PG INSTITUTE,COIMBATORE. Stanley Medical Journal MATERIALS AND METHODS ated headache) on the basis of its relationship with epilepsy. STUDY DESIGN: Cross Sectional Descriptive study. Patients with interictal headache, who have structural le- STUDY POPULATION: Patients with epilepsy who sions or other recognisable causes such as sinusitis, cervi- have headache either interictally or peri ictally or both who cal spine disease were classified as secondary headache as attended Neurology O.P. Government General Hospital, recommended in the International Headache society clas- Chennai during the study period (July 2003 to August 2005) sification and those without a recognisable cause as having were taken up for the study. primary headache. All patients in the study were examined INCLUSION CRITERIA: Patients with epilepsy who clinically for focal neurological deficit. Otorhinolaryngolo- have inter ictal headache of >3 months duration antecedent gist and dentist opinion were sought whenever necessary. to or after the onset of seizures and Patients with epilepsy Patients who had headaches along with the onset of seizures who have peri ictal headache and continued throughout the ictus which resolves with Vol 3 | Issue 4 | October-December | 2016 4 | October-December 3 | Issue Vol EXCLUSION CRITERIA : Patients with epilepsy subsidence of seizure activity were classified as ictal head- who developed sudden onset severe headache, headache aches or hemicrania epileptica. Peri ictal headaches were with systemic signs such as fever, neck stiffness, cutaneous subdivided into postictal headache and pre ictal headache rash, headache with papilloedema, headache triggered by based on their relationship with seizures. Patients who have cough, exertion or valsalva maneuver were excluded from headache just preceding the onset of seizures were classi- the study. Patients with epilepsy who have either interictal fied as preictal headache. Patients who had headaches with or perictal headaches who did not have any features of ex- varying characteristics and severity which develops within clusion criteria were selected for the study. 3 hours of seizure and lasts for less than 72 hours are clas- DEFINITIONS AND CLASSIFICATIONS sified as postictal headaches. Patients who initially had sei- Headache were classified according to interna- zures and in whom seizures got controlled with drugs with tional headache society classification (IHS-2)8 and their new onset headache or persistence of precedent headache duration noted in the study. The International classification which are of short duration lasting for 5-10 minutes, severe of Headache disorders, 2nd edition, groups headache disor- in intensity stabbing or bounding in nature associated with ders into primary and secondary headaches. The four cate- transient unawareness or incontinence were classified as gories of primary headaches include migraine, Tension Type headache not classified elsewhere. Primary headaches were Headache (TTH), Cluster Headache (CH) other Trigeminal further analysed based on the frequency and duration of Autonomic Cephalalgias (TAC’s) and other primary head- headache episodes. On the basis of frequency they were sub- aches. There are also eight categories of secondary headache divided into low to moderate frequency headaches. On the and a third group that includes central and primary causes basis of duration they were subdivided into shorter duration of facial pain and other headaches. The criteria for primary or longer duration headaches. Headaches were classified ac- headaches are clinical and descriptive with a few exceptions cording to the predominant headache type if the patient had not based on etiology. multiple headache types. The classification is hierarchical, allowing diagno- sis with varying degrees of specificity, using up to four digits RESULTS AND ANALYSIS for coding at subordinate levels. The first digit specifies the The total number of patients studied were 124.Out of major diagnostic type e.g. migraine (1). The second digit this, the age of patients ranged from 9 to 54 years. The age indicates a subtype within the category, e.g., migraine with range and sex distribution of patients within each age range aura (1.2) subsequent digits permit more specific diagnosis is shown in Table No.1. Males comprised 33% (n=42) and for some subtypes of headache according to circumstantial females 66% (n= 82)of the total study population. requirements, FHM for example could be coded as 1.2.4. SEIZURE TYPES: The most common type of seizures In clinical practice patients should receive a diagnosis for seen were generalised tonic clonic seizures. 42% of patients each headache type or subtype they currently have. Multiple (n=52) had primary generalised tonic- clonic
Load more

Recommended publications
  • An Atypical Presentation of Epilepsy; What a Headache! J Neurol Transl Neurosci 5(1): 1078
    Central Journal of Neurology & Translational Neuroscience Bringing Excellence in Open Access Case Report Corresponding author Sarah Seyffert, Trinity School of Medicine, 505 Tadmore court Schaumburg, Illinois 60194, USA, Tel: 847-217-4262; An Atypical Presentation of Email: Submitted: 13 April 2017 Epilepsy; What a Headache! Accepted: 07 June 2017 Published: 09 June 2017 Sarah Seyffert* and Wade Kvatum ISSN: 2333-7087 Trinity School of Medicine, USA Copyright © 2017 Seyffert et al. Abstract OPEN ACCESS The relationship between headache and seizure is a poorly understood and controversial topic; however, the literature has recently suggested that the two conditions may be related. Keywords The interplay between these conditions seems to be even more complex in a group of • Epilepsy patients with epilepsy related headaches. It has been proposed that the association could • Headache be classified into preictal, ictal, postictal, or interictal headaches. Here we present a case • Ictal epileptic headache report of a 62 year old male who presented with a chief complaint of new onset severe headache and subsequently underwent multiple diagnostic testing modalities before he was finally diagnosed and treated for epilepsy, which lead to the resolution of his headache. We conclude with a short discussion of how to subcategorize seizure related headaches based on their temporal relationship and why they can pose such a difficult diagnostic challenge. ABBREVIATIONS afebrile with a normal CBC and CMP. On arrival to the hospital he underwent a non-contrast head CT scan; however, no evidence of EEG: Electroencephalogram; CBC: Complete Blood Count; acute intracranial abnormality was seen. Additionally, a lumbar CMP: Complete Metabolic Panel; CT scan: Computerized puncture was performed which was negative for xanthochromia Tomography Scan; CTA: Computed Tomographic Angiography; and showed a protein count of 27, glucose 230, and 2 white MRI: Magnetic Resonance Imaging blood cells.
    [Show full text]
  • Pure Epileptic Headache and Related Manifestations: a Video-EEG Report and Discussion of Terminology
    Journal Identification = EPD Article Identification = 0552 Date: March 26, 2013 Time: 2:54 pm Clinical commentary with video sequences Epileptic Disord 2013; 15 (1): 84-92 Pure epileptic headache and related manifestations: a video-EEG report and discussion of terminology Carlo Cianchetti 1, Dario Pruna 1, Lucia Porcu 1, Maria Teresa Peltz 2, Maria Giuseppina Ledda 1 1 Child and Adolescent Neuropsychiatry, University, Epilepsy Unit, Azienda Ospedaliero-Universitaria 2 Diagnostic Imaging Department, AOB, Cagliari, Italy Received June 28, 2012; Accepted January 9, 2013 ABSTRACT – We present the first video-EEG recording of episodes of “epileptic headache”. The case reported is that of a 9-year-old girl with brief episodes (of a few minutes) of severe frontal headache, which cor- responded to the presence of concurrent spikes and slow waves, starting in the right temporal area. A dysplastic lesion of the right temporal lobe was observed by MRI and the patient received surgery, with subsequent dis- appearance of headaches. This case highlights ictal EEG as the main dia- gnostic tool for epileptic headache. We discuss the terminology regarding this type of manifestation and believe that cases without subsequent epileptic manifestations, as in the present case, should be more appropri- ately referred to as “pure ictal epileptic headache” or simply “pure epileptic headache”. [Published with video sequences] Key words: epilepsy, headache, migraine, seizure, pain, video-EEG The terms “epileptic headache” patients and occur independently. (Nymgard, 1956; Grossman et al., As a rule, migraine is not an epileptic 1971) and “ictal headache” (Laplante phenomenon, however, headache et al., 1983) were used in the first can follow an epileptic seizure reports of the rare condition of (postictal headache).
    [Show full text]
  • Migraine Mimics
    ISSN 0017-8748 Headache doi: 10.1111/head.12518 © 2015 American Headache Society Published by Wiley Periodicals, Inc. Expert Opinion Migraine Mimics Randolph W. Evans, MD The symptoms of migraine are non-specific and can be present in many other primary and secondary headache disorders, which are reviewed. Even experienced headache specialists may be challenged at times when diagnosing what appears to be first or worst, new type, migraine status, and chronic migraine. Key words: migraine, migraine mimic, symptomatic migraine, hemicrania continua (Headache 2015;55:313-322) The symptoms of migraine are non-specific and She had seen 2 headache specialists previously. can be present in many other primary and secondary She had been tried on sumatriptan p.o. and subcuta- headache disorders.1,2 Even experienced headache neously, diclofenac powder, ketorolac oral and intra- specialists may be challenged at times when diagnos- muscular, dihydroergotamine nasal spray, and had an ing what appears to be first or worst, new type, occipital nerve block without benefit. Gabapentin migraine status, and chronic migraine. Another diag- and pregabalin did not help. She was placed on indo- nosis may be responsible when physicians use the term methacin 75 mg sustained release once a day for 8 “atypical migraine.” days without benefit. Prednisone 60 mg daily for 10 days did not help.An intravenous dihydroergotamine CASE HISTORIES regimen for 5 days did not help. Case 1.—This 48-year-old woman was seen for a A magnetic resonance imaging (MRI) and mag- third opinion with a 20-year history of only menstrual netic resonance angiogram (MRA) of the brain and headaches always preceded by a visual aura followed cervical spine and magnetic resonance venogram by a generalized throbbing with an intensity of 5–6/10 (MRV) of the brain were negative.
    [Show full text]
  • Post-Epileptic Headache and Migraine
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.50.9.1148 on 1 September 1987. Downloaded from Journal ofNeurology, Neurosurgery, and Psychiatry 1987;50:1148-1152 Post-epileptic headache and migraine F SCHON, J N BLAU From the National Hospitalsfor Nervous Diseases, Maida Vale Hospital, London, UK SUMMARY One hundred epileptic patients were questioned about their headaches. Post-ictal head- aches occurred in 51 of these patients and most commonly lasted 6-72 hours. Major seizures were more often associated with post-epileptic headaches than minor attacks. Nine patients in this series of 100 also had migraine: in eight of these nine a typical, albeit a mild, migraine attack was provoked by fits. The post-ictal headache in the 40 epileptics who did not have migraine was accompanied by vomiting in 11 cases, photophobia in 14 cases and vomiting with photophobia in 4 cases. Further- more, post-epileptic headache was accentuated by coughing, bending and sudden head movements and relieved by sleep. It is, therefore, clear that seizures provoke a syndrome similar to the headache phase of migraine in 50% of epileptics. It is proposed that post-epileptic headache arises intra- cranially and is related to the vasodilatation known to follow seizures. The relationship of post- epileptic headache to migraine is discussed in the light of current ideas on migraine pathogenesis, in particular the vasodilation which accompanies Leao's spreading cortical depression. Protected by copyright. Little is known about post-epileptic headaches, al- including nausea and vomiting, photophobia, phonophobia, though their occurrence is accepted by patients and and visual disturbances were also noted.
    [Show full text]
  • Seizure 18 (2009) 309–312
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Seizure 18 (2009) 309–312 Contents lists available at ScienceDirect Seizure journal homepage: www.elsevier.com/locate/yseiz Review Why is migraine rarely, and not usually, the sole ictal epileptic manifestation? Pasquale Parisi * Child Neurology and Pediatric Headache Centre, Department of Pediatrics, ‘‘La Sapienza’’ University, Viale Regina Elena 324, 00161 Rome, Italy ARTICLE INFO ABSTRACT Article history: Purpose and methods: Migraine, with or without aura, affects from 10% to 14% of the population, and is as Received 14 September 2008 such one of the most common headache disorders. A unified hypothesis for the physiopathology of Received in revised form 8 November 2008 migraine and its relationship with epileptic migraine and migralepsy has yet to be formulated. Accepted 16 January 2009 Trigemino-vascular system (TVS) activation is believed to play a crucial role in the ‘‘pain phase’’ in migraine; cortical spreading depression (CSD) is considered to be the primary cause of TVS activation. Keywords: On the basis of data in the literature, I would like to stress that TVS activation may originate at Migraine different cortical and subcortical levels. For example, as recently reported, an epileptic focus, originating Epilepsy and propagating along cortical non-eloquent/silent areas, through CSD, rarely causes TVS activation with Hemicrania epileptica Ictal epileptic headache migraine as the sole ictal epileptic manifestation. Cortical spreading depression Results and conclusion: The multiple considerations that arise from this hypothesis, including the under- CSD diagnosed ictal epileptic headache, are discussed; EEG (ictal and inter-ictal) recording with intermittent Trigemino-vascular theory photic stimulation (IPS), according to the standardized international protocol, is strongly recommended in selected migraine populations.
    [Show full text]
  • Headache in Epilepsy: Prevalence and Clinical Features
    Mainieri et al. The Journal of Headache and Pain (2015) 16:72 DOI 10.1186/s10194-015-0556-y RESEARCH ARTICLE Open Access Headache in epilepsy: prevalence and clinical features G Mainieri1,2, S Cevoli1, G Giannini1,2, L Zummo1,2,3, C Leta1,2, M Broli1,2, L Ferri1,2, M Santucci1,2, A Posar1,2, P Avoni1,2, P Cortelli1,2, P Tinuper1,2 and Francesca Bisulli1,2* Abstract Background: Headache and epilepsy are two relatively common neurological disorders and their relationship is still a matter of debate. Our aim was to estimate the prevalence and clinical features of inter-ictal (inter-IH) and peri-ictal headache (peri-IH) in patients with epilepsy. Methods: All patients aged ≥ 17 years referring to our tertiary Epilepsy Centre were consecutively recruited from March to May 2011 and from March to July 2012. They underwent a semi-structured interview including the International Classification Headache Disorders (ICHD-II) criteria to diagnose the lifetime occurrence of headache.χ2-test, t-test and Mann–Whitney test were used to compare clinical variables in patients with and without inter-IH and peri-IH. Results: Out of 388 enrolled patients 48.5 % had inter-IH: migraine in 26.3 %, tension-type headache (TTH) in 19.1 %, other primary headaches in 3.1 %. Peri-IH was observed in 23.7 %: pre-ictally in 6.7 %, ictally in 0.8 % and post-ictally in 19.1 %. Comparing patients with inter-ictal migraine (102), inter-ictal TTH (74) and without inter-IH (200), we found that pre-ictal headache (pre-IH) was significantly represented only in migraineurs (OR 3.54, 95 % CI 1.88-6.66, P < 0.001).
    [Show full text]
  • The International Classification of Headache Disorders, 3Rd Edition (Beta Version)
    ICHD-3 beta Cephalalgia 33(9) 629–808 ! International Headache Society 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0333102413485658 cep.sagepub.com Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition (beta version) Copyright Translations The International Classification of Headache Disorders, The International Headache Society expressly permits 3rd edition (beta version), may be reproduced freely for translations of all or parts of ICHD-3 beta for purposes scientific, educational or clinical uses by institutions, of field testing and/or education, but will not endorse societies or individuals. Otherwise, copyright belongs them. Endorsements may be given by member national exclusively to the International Headache Society. societies; where these exist, such endorsement should be Reproduction of any part or parts in any manner for sought. All translations are required to be registered commercial uses requires the Society’s permission, with the International Headache Society. Before which will be granted on payment of a fee. Please con- embarking upon translation, prospective translators tact the publisher at the address below. are advised to enquire whether a translation exists ß International Headache Society 2013. already. All translators should be aware of the need Applications for copyright permissions should be sub- to use rigorous translation protocols. Publications mitted to Sage Publications Ltd, 1 Oliver’s Yard, 55 reporting studies making use of translations of all or City Road, London EC1Y 1SP, United Kingdom (tel: any part of ICHD-3 beta should include a brief descrip- þ44 (0) 20 7324 8500; fax: þ44 (0) 207 324 8600) tion of the translation process, including the identities (www.sagepub.co.uk).
    [Show full text]
  • Painful Seizures: a Review of Epileptic Ictal Pain
    Current Pain and Headache Reports (2019) 23: 83 https://doi.org/10.1007/s11916-019-0825-6 HOT TOPICS IN PAIN AND HEADACHE (N ROSEN, SECTION EDITOR) Painful Seizures: a Review of Epileptic Ictal Pain Sean T. Hwang1 & Tamara Goodman1 & Scott J. Stevens1 Published online: 10 September 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Purpose of Review To summarize the literature regarding the prevalence, pathophysiology, and anatomic networks involved with painful seizures, which are a rare but striking clinical presentation of epilepsy. Recent Findings Several recent large case series have explored the prevalence of the main cephalgic, somatosensory, and abdominal variants of this rare disorder. Research studies including the use of electrical stimulation and functional neuroimaging have demonstrated the networks underlying painful somatosensory or visceral seizures. Improved understanding of some of the overlapping mechanisms between migraines and seizures has elucidated their common pathophysiology. Summary The current literature reflects a widening range of awareness and understanding of painful seizures, despite their rarity. Keywords Ictal . Pain . Somatosensory . Abdominal . Headache . Seizure Introduction feature, though not specific. Ictal pain may be a diagnostic challenge as it may occur in isolation, unaccompanied by Epileptic ictal pain is a rare phenomenon which is classically other clinical findings. In addition, there may be an emotional categorized as mainly cephalic, abdominal, or unilateral reaction to the pain leading to vocalization or crying out which (truncal or peripheral) in location and is mostly seen in the mayappearsomewhatbizarre.Tocomplicatematters,focal setting of focal onset seizures [1, 2]. While post-ictal head- sensory seizures with preserved awareness may transpire with aches are common in patients with epilepsy (PWE), true ictal little or no electrographic correlate.
    [Show full text]
  • Painful Seizures: a Review of Epileptic Ictal Pain
    Current Pain and Headache Reports (2019) 23:83 https://doi.org/10.1007/s11916-019-0825-6 HOT TOPICS IN PAIN AND HEADACHE (N ROSEN, SECTION EDITOR) Painful Seizures: a Review of Epileptic Ictal Pain Sean T. Hwang1 & Tamara Goodman1 & Scott J. Stevens1 # Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Purpose of Review To summarize the literature regarding the prevalence, pathophysiology, and anatomic networks involved with painful seizures, which are a rare but striking clinical presentation of epilepsy. Recent Findings Several recent large case series have explored the prevalence of the main cephalgic, somatosensory, and abdominal variants of this rare disorder. Research studies including the use of electrical stimulation and functional neuroimaging have demonstrated the networks underlying painful somatosensory or visceral seizures. Improved understanding of some of the overlapping mechanisms between migraines and seizures has elucidated their common pathophysiology. Summary The current literature reflects a widening range of awareness and understanding of painful seizures, despite their rarity. Keywords Ictal . Pain . Somatosensory . Abdominal . Headache . Seizure Introduction feature, though not specific. Ictal pain may be a diagnostic challenge as it may occur in isolation, unaccompanied by Epileptic ictal pain is a rare phenomenon which is classically other clinical findings. In addition, there may be an emotional categorized as mainly cephalic, abdominal, or unilateral reaction to the pain leading to vocalization or crying out which (truncal or peripheral) in location and is mostly seen in the mayappearsomewhatbizarre.Tocomplicatematters,focal setting of focal onset seizures [1, 2]. While post-ictal head- sensory seizures with preserved awareness may transpire with aches are common in patients with epilepsy (PWE), true ictal little or no electrographic correlate.
    [Show full text]
  • (IHS) the International Classification of Headache Disorders
    ICHD-3 Cephalalgia 2018, Vol. 38(1) 1–211 ! International Headache Society 2018 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0333102417738202 journals.sagepub.com/home/cep Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition Copyright Translations The 3rd edition of the International Classification of Headache Disorders (ICHD-3) may be reproduced The International Headache Society (IHS) expressly freely for scientific, educational or clinical uses by insti- permits translations of all or parts of ICHD-3 for the tutions, societies or individuals. Otherwise, copyright purposes of clinical application, education, field testing belongs exclusively to the International Headache or other research. It is a condition of this permission Society. Reproduction of any part or parts in any that all translations are registered with IHS. Before manner for commercial uses requires the Society’s per- embarking upon translation, prospective translators mission, which will be granted on payment of a fee. are advised to enquire whether a translation exists Please contact the publisher at the address below. already in the proposed language. ßInternational Headache Society 2013–2018. All translators should be aware of the need to Applications for copyright permissions should be sub- use rigorous translation protocols. Publications report- mitted to Sage Publications Ltd, 1 Oliver’s Yard, 55 ing studies making use of translations of all or any part City Road, London EC1Y 1SP, United Kingdom of ICHD-3 should include a brief description of the (tel: þ44 (0) 207 324 8500; fax: þ44 (0) 207 324 8600; translation process, including the identities of the trans- [email protected]) (www.uk.sagepub.com).
    [Show full text]
  • The International Classification of Headache Disorders 2Nd Edition
    The International Classification of Headache Disorders 2nd edition ੽ᄬᏞമॽॾ˷ᘸ ڎ஑ʠڎ̜˛ ͮដড༄ደደ๼ Ꮮമደ஢ᚍ 2004Б8̢ ڎ஑ʠڎ̜˛ ੽ᄬᏞമॽॾ˷ᘸ άᏃ ӕ //////////////////////////////////////////////////////////////////////////////////// 5ڎ̜˛ڎ஑ʙ ڎ஑ʙ ӕ ///////////////////////////////////////////////////////////////////////////////////// 6ڎ̜˛ڎ஑ʠ ڎ஑ʠ Ր ///////////////////////////////////////////////////////////////////////////////////////////// 8܉ڎ஑ʙ ڎ஑ʠ Ր ///////////////////////////////////////////////////////////////////////////////////////////// 9܉ڎ஑ʠ ڎ஑ʠ ᕚᚍ૲ᜌप ////////////////////////////////////////////////////////////////////////////////////////////////////////// : ᕚᚍʡࢷϪ౐ /////////////////////////////////////////////////////////////////////////////// 21 ڎ஑ʠڎ̜˛ Ѱˉ஢Ϫ౐ /////////////////////////////////////////////////////////////////////////////// 22ˎ ڎ஑ʠڎ࠼̜ ˷ᘸ˭஝ ///////////////////////////////////////////////////////////////////////////////////////////////////////////// 24 ЃѤպ΢௻˷ᘸ ////////////////////////////////////////////////////////////////////////////////////////////////// 26 28 ///////////////////////////////////////////// ےᏞമ˷ᘸჄ੽ᄬ቏Ρ஢ᕑ ICD-10NA ˷ᘸሆဇັ ʙăࢨവؒᏞമ (The primary headache) ////////////////////////////////////////////////////////////// 24 1. ੑᏞമ (Migraine) ////////////////////////////////////////////////////////////////////////////////////// 25 2. ႧᑻܮᏞമ (Tension-type headache) ////////////////////////////////////////////////////////// 38 ᔎവؒᏞമჄ֏͂ʭʾьݡড༄Ꮮമ .3 (Cluster headache and other trigeminal autonomic cephalalgias) //////////////////////// 45 ֏͂ࢨവؒᏞമ
    [Show full text]
  • Lateralizing Value of Peri-Ictal Headache: a Study of 100 Patients with Partial Epilepsy A
    Lateralizing value of Article abstract—To determine the lateralizing value of peri-ictal headache, the authors conducted a standardized interview of 100 patients with partial peri-ictal headache: A epilepsy, 60 with temporal lobe epilepsy (TLE) and 40 with extratemporal study of 100 patients epilepsy (ETE). Peri-ictal headache occurred in 47 of 100 (47%) patients. Peri-ictal headache was more likely to be ipsilateral to the seizure onset in with partial epilepsy TLE (27 of 30 ϭ 90%) than in ETE (two of 17 ϭ 12%; pϽ 0.001). For both groups, peri-ictal headache usually conformed to the diagnostic criteria for common migraine (18 of 30 ϭ 60% in TLE; 7 of 17 ϭ 41% in ETE). NEUROLOGY 2001;56:130–132 A. Bernasconi, MD; F. Andermann, MD, FRCP(C); N. Bernasconi, MD; D.C. Reutens, MD, FRACP; and F. Dubeau, MD FRCP(C) Postictal headache is a common feature of general- ral lobes. Seizures in the 40 patients with extratemporal ized tonic-clonic seizures. In a study of 100 epileptic epilepsy (ETE) emanated from the frontal lobe (n ϭ 13), patients,1 postictal headache was found in approxi- centroparietal region (n ϭ 19), and the occipital lobe (n ϭ mately 50% of patients, and seizures provoked a syn- 8). Two patients had bifrontal epileptic foci. drome similar to migraine in 50% of them. The standardized interview was administered during Unilateral cephalic pain of epileptic origin was re- the patients’ stay in the telemetry unit by one of the au- ported in few patients and was found to be associ- thors (A.B.), a neurologist (table 1).
    [Show full text]