DOCSLIB.ORG

Diagnosis and Management of Headache in Children And

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Diagnosis and Management of Headache in Children And Review z Paediatric headache Diagnosis and management of headache in children and adolescents Ishaq Abu-Arafeh MBBS, MD, MRCP, FRCPCH As part of our series on managing neurological and psychiatric conditions in children and adolescents, Dr Abu-Arafeh discusses paediatric headaches. eadache is a common complaint in children 1. Migraine without aura Hand adolescents with an overall prevalence of 2. Migraine with aura around 60%. Tension-type headache and migraine • Migraine with typical aura are the most common types of primary headache. • Migraine with brainstem aura The diagnosis of headache disorders is usually made • Hemiplegic migraine on clinical assessment and the application of accept- • Retinal migraine able classification and diagnostic criteria, and inves- 3. Chronic migraine tigations are rarely necessary. 4. Complications of migraine Available and licensed medications for the treat- • Status migrainosus ment of headache in children are limited, but when • Persistent aura without infarction • Migrainous infarction used alongside non-pharmacological measures, chil- • Migraine aura-triggered seizure dren can achieve good control of their headache. 5. Probable migraine • Probable migraine without aura Introduction • Probable migraine with aura Headache affects children of all ethnic and socioeco- 6. Episodic syndromes that may be associated with nomic groups. In a systematic review of population- migraine based studies, around 60% of children and adolescents • Cyclical vomiting syndrome had headache over the past three to 12 months with • Abdominal migraine more girls affected than boys over the age of 12 years.1 • Benign paroxysmal vertigo Episodic tension-type headache (TTH) is the most • Benign paroxysmal torticollis common headache disorder with a prevalence of Table 1. Classification of migraine – ICHD-3 beta.11 12–25% followed by migraine at around 8%.1–4 Chronic TTH affects around 1% of children (mainly Classification of headache disorders adolescents).5 Other primary headaches are rare and The International Classification of Headache reliable data are hard to find. Chronic daily headache, Disorders, now in its third edition (ICHD-3 beta), pro- commonly due to TTH, is a common cause of refer- vides a comprehensive, reliable and most utilised tool ral to specialist clinics and may be disproportionately for the assessment of headache disorders.11 Although represented.6 ICHD-3 is heavily biased towards headache in adults, Primary headaches have a complex genetic basis the system is applicable and reliable in paediatric and follow the biopsychosocial model in clinical pres- practice with minor modifications. entation, trigger factors, comorbidity and in response Headache disorders are divided into primary to treatment.7 The trigeminocervical complex in the and secondary headaches. Primary headaches brainstem, with its extensive network of neuronal con- include: (1) migraine; (2) tension-type headache; (3) nections to the cerebral cortex, the thalamus, the vas- trigeminal autonomic cephalalgias; and (4) other cular system and the dura matter, plays an important rare primary headaches. Secondary headaches in chil- role in the pathogenesis of migraine attacks and pos- dren are uncommon, but it is essential to make sibly other headache disorders.8,9 Physiological, envi- early diagnosis of serious neurological disorders ronmental or emotional factors may trigger a such as brain tumours and idiopathic intracranial micro-neuroinflammation in genetically predisposed hypertension. individuals, causing an increase in vascular perme- The new classification of migraine (Table 1) intro- ability, plasma extravasation and neurotransmitters duces chronic migraine as an important subtype of release leading to the secondary neurological, sen- migraine and expands on the childhood abdominal sory and pain phenomena.10 migraine, cyclical vomiting, paroxysmal torticollis and 16 Progress in Neurology and Psychiatry July/August 2014 www.progressnp.com Paediatric headache z Review paroxysmal vertigo. TTH is classified according to the presentation, by excluding other conditions such as frequency of attacks as infrequent, frequent and occipital epilepsy and vascular malformations.12 chronic TTH. Hemiplegic migraine Causes of headache in children and adolescents Hemiplegic migraine is a type of migraine with motor The diagnosis of headache disorders is based on a clin- aura. During migraine attacks the patients report uni- ical history, clinical examination and prospective lateral weakness with or without slurring of speech. headache diaries. History should include: the duration Familial hemiplegic migraine (FHM) is autosomal of headache disorder; frequency and duration of attacks; dominant, but sporadic cases are also recognised. severity of pain; site of maximum pain; quality of pain if FHM1 is associated with at least 20 different missense the child is able to describe this; known trigger factors; mutations in the voltage gated calcium channel and warning symptoms. Enquiry is made on the pres- (CACNA1A) on chromosome 19p13. FHM2 is associ- ence or absence of anorexia, nausea, vomiting, light and ated with a mutation in the Na/K-ATPase gene ATPA2 noise intolerance and other sensory, motor or auto- on chromosome 1q21. The FHM3 form is associated nomic symptoms during attacks, and also on relieving with mutations in the sodium channel SCN1A on factors such as rest, sleep and medication. Treatment chromosome 2q24.13–15 The clinical presentation of history should also include dosages, format and route hemiplegic migraine may mimic a stroke. Full inves- of administration of rescue medications, and dosages tigation including magnetic resonance imaging and and length of courses of preventative treatment. magnetic resonance angiogram may be necessary before the diagnosis is made in order to exclude Migraine intracranial lesions and cerebrovascular diseases. Around 80% of children with migraine have migraine without aura.5 There are no clear triggers of migraine Chronic migraine attacks in the majority of children, but around one- Chronic migraine is characterised by headache third of patients may report stress, missing a meal, or attacks occurring on at least 15 days per month, of lack of sleep. Aura symptoms (commonly visual and which at least eight days per month are of typical less often sensory or motor) precede headache in migraine, over at least three months. Chronic 15–20% of patients. migraine often evolves from episodic migraine over The headache often builds up in severity over 30–60 an average period of two years and can be compli- minutes reaching maximum intensity within 1–2 hours. cated by medication overuse headache. Chronic The pain is described as severe (stops all activities) or migraine is associated with significant impact on qual- moderate (stops some but not all activities) and throb- ity of life, school attendance and education.16 bing in quality, but many children cannot describe pain. The site of maximum pain is often on the fore- Tension-type headache head unlike the unilateral headache in adult patients. TTH is characterised by mild (no interference with During attacks, the child is pale, loses appetite, feels normal activities) to moderate (interferes with some nauseated, may vomit, and complains of intolerance to but not all activities) intensity of headache. The pain light, noise and exercise. The child may feel better after A. At least 5 attacks fulfilling criteria B–D rest and sleep, and returns to normal self between B. Headache attacks lasting 2–72 hours (untreated or attacks. Criteria for the diagnosis of migraine without unsuccessfully treated) aura are shown in Table 2. Migraine with typical visual C. Headache has at least 2 of the following 4 charac- aura is easily distinguishable and relatively common, teristics: but in some children atypical aura and specific syn- 1. Unilateral location dromes can pose difficulties in diagnosis and treatment. 2. Pulsating quality 3. Moderate or severe pain intensity Alice in Wonderland syndrome 4. Aggravation by or causing avoidance of routine The Alice in Wonderland syndrome is a type of physical activity migraine with intense visual aura manifested by micro - D. During headache at least 1 of the following: 1. Nausea and/or vomiting psia (images look smaller than their real sizes), macro- 2. Photophobia and phonophobia psia (images look magnified), or a combination of both. E. Not better accounted for by another ICHD-3 The intensity of distorted images can be distressing to the child and may overshadow the pain and other asso- Table 2. Criteria for the diagnosis of migraine without aura – ICHD-3 ciated symptoms. Diagnosis is made, especially at early beta.11 www.progressnp.com Progress in Neurology and Psychiatry July/August 2014 17 Review z Paediatric headache A. At least 10 episodes of headache occurring on Investigations fulfilling criteria B–D Neuroimaging is not necessary in the majority of chil- B. Lasting from 30 minutes to 7 days dren with typical clinical history and in the absence C. At least 2 of the following 4 characteristics: of features of increased intracranial pressure or signs 1. Bilateral location of cerebellar dysfunction. 2. Pressing or tightening (non-pulsating) quality Measurement of cerebrospinal fluid opening pres- 3. Mild or moderate intensity sure is necessary if idiopathic intracranial hyperten- 4. Not aggravated by routine physical activity such as walking or climbing stairs sion is suspected. Electroencephalography is only D. Both of the
Load more

Recommended publications
  • Cluster Headache: a Review MARILYN J
    • Cluster headache: A review MARILYN J. CONNORS, DO ID Cluster headache is a debilitat­ consists of episodes of excruciating facial pain that ing neuronal headache with secondary vas­ is generally unilateraP and often accompanied by cular changes and is often accompanied by ipsilateral parasympathetic phenomena including other characteristic signs and symptoms, such nasal congestion, rhinorrhea, conjunctival injec­ as unilateral rhinorrhea, lacrimation, and con­ tion, and lacrimation. Patients may also experi­ junctival injection. It primarily affects men, ence complete or partial Horner's syndrome (that and in many cases, patients have distinguishing is, unilateral miosis with normal direct light response facial, body, and psychologic features. Sever­ and mild ipsilateral ptosis, facial flushing, and al factors may precipitate cluster headaches, hyperhidrosis).4-6 These autonomic disturbances including histamine, nitroglycerin, alcohol, sometimes precede or occur early in the headache, transition from rapid eye movement (REM) adding credence to the theory that this constella­ to non-REM sleep, circadian periodicity, envi­ tion of symptoms is an integral part of an attack and ronmental alterations, and change in the level not a secondary consequence. Some investigators of physical, emotional, or mental activity. The consider cluster headache to exemplify a tempo­ pathophysiologic features have not been com­ rary and local imbalance between sympathetic and pletely elucidated, but the realms of neuro­ parasympathetic systems via the central nervous biology, intracranial hemodynamics, endocrinol­ system (CNS).! ogy, and immunology are included. Therapy The nomenclature of this form of headache in is prophylactic or abortive (or both). Treat­ the literature is extensive and descriptive, includ­ ment, possibly with combination regimens, ing such terminology as histamine cephalgia, ery­ should be tailored to the needs of the indi­ thromelalgia of the head, red migraine, atypical vidual patient.
    [Show full text]
  • Pathophysiology of Migraine
    PathophysiologyPathophysiology ofof MigraineMigraine 1 MIGRAINEMIGRAINE PATHOPHYSIOLOGY:PATHOPHYSIOLOGY: AA NEUROVASCULARNEUROVASCULAR HEADACHEHEADACHE Objectives Review the neurobiology of migraine - Features of acute attack - neuroanatomical substrates Discuss the current understanding of migraine, vulnerability, initiation and activation of the trigeminocervical pain system Describe the modulation of head pain in the CNS 2 WHATWHAT ISIS MIGRAINE?MIGRAINE? Neurobiologically based, common clinical syndrome characterized by recurrent episodic attacks of head pain which serve no protective purpose The headache is accompanied by associated symptoms such as nausea, sensitivity to light, sound, or head movement The vulnerability to migraine if for many, an inherited tendency Migraine is a complex neurobiological disorder that has been recognized since antiquity. Many current books cover the subject in great detail. The core features of migraine are headache, which is usually throbbing and often unilateral, and associated features of nausea, sensitivity to light, sound, and exacerbation with head movement. Migraine has long been regarded as a vascular disorder because of the throbbing nature of the pain. However, as we shall explore here, vascular changes do not provide sufficient explanation of the pathophysiology of migraine. Up to one-third of patients do not have throbbing pain. Modern imaging has demonstrated that vascular changes are not linked to pain and diameter changes are not linked with treatment. This presentation aims to demonstrate that: • Migraine should be regarded as neurovascular headache. • Understanding the anatomy and physiology of migraine can enrich clinical practice. Lance JW, Goadsby PJ. Mechanism and Management of Headache. London, England: Butterworth-Heinemann; 1998. Silberstein SD, Lipton RB, Goadsby PJ. Headache in Clinical Practice. 2nd ed.
    [Show full text]
  • Prolonged Hemiplegic Migraine Associated with Irreversible Neurological Defcit and Cortical Laminar Necrosis in a Patient with Patent Foramen Ovale ：A Case Report
    Prolonged Hemiplegic Migraine Associated with Irreversible Neurological Decit and Cortical Laminar Necrosis in a Patient with Patent Foramen Ovale A case report Yacen Hu Xiangya Hospital Central South University https://orcid.org/0000-0002-1199-4659 Zhiqin Wang Xiangya Hospital Central South University Lin Zhou Xiangya Hospital Central South University Qiying Sun ( [email protected] ) Xiangya Hospital, Central South University https://orcid.org/0000-0002-2031-8345 Case report Keywords: Hemiplegic migraine, irreversible neurological decit, cortical laminar necrosis, patent foramen ovale, case report Posted Date: April 30th, 2021 DOI: https://doi.org/10.21203/rs.3.rs-439782/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/7 Abstract Background: Aura symptoms of hemiplegic migraine (HM) usually resolve completely, permanent attack-related decit and radiographic change are rare. Case presentation: We reported a HM case presented with progressively aggravated hemiplegic migraine episodes refractory to medication. He experienced two prolonged hemiplegic migraine attacks that led to irreversible visual impairment and cortical laminar necrosis (CLN) on brain MRI. Patent foramen ovale (PFO) was found on the patient. PFO closure resulted in a signicant reduction of HM attacks. Conclusions: Prolonged hemiplegic migraine attack could result in irreversible neurological decit with neuroimaging changes manifested as CLN. We recommend screening for PFO in patients with prolonged or intractable hemiplegic migraine, for that closure of PFO might alleviate the attacks thus preventing patient from disabling sequelae. Background Hemiplegic migraine (HM) is characterized by aura of motor weakness accompanied by visual, sensory, and/or speech symptoms followed by migraine headache[1].
    [Show full text]
  • Migraine; Cluster Headache; Tension Headache Order Set Requirements: Allergies Risk Assessment / Scoring Tools / Screening: See Clinical Decision Support Section
    Provincial Clinical Knowledge Topic Primary Headaches, Adult – Emergency V 1.0 © 2017, Alberta Health Services. This work is licensed under the Creative Commons Attribution-Non-Commercial-No Derivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. Disclaimer: This material is intended for use by clinicians only and is provided on an "as is", "where is" basis. Although reasonable efforts were made to confirm the accuracy of the information, Alberta Health Services does not make any representation or warranty, express, implied or statutory, as to the accuracy, reliability, completeness, applicability or fitness for a particular purpose of such information. This material is not a substitute for the advice of a qualified health professional. Alberta Health Services expressly disclaims all liability for the use of these materials, and for any claims, actions, demands or suits arising from such use. Revision History Version Date of Revision Description of Revision Revised By 1.0 March 2017 Topic completed and disseminated See Acknowledgements Primary Headaches, Adult – Emergency V 1.0 Page 1 of 16 Important Information Before You Begin The recommendations contained in this knowledge topic have been provincially adjudicated and are based on best practice and available evidence. Clinicians applying these recommendations should, in consultation with the patient, use independent medical judgment in the context of individual clinical circumstances to direct care. This knowledge topic will be reviewed periodically and updated as best practice evidence and practice change. The information in this topic strives to adhere to Institute for Safe Medication Practices (ISMP) safety standards and align with Quality and Safety initiatives and accreditation requirements such as the Required Organizational Practices.
    [Show full text]
  • Autonomic Headache with Autonomic Seizures: a Case Report
    J Headache Pain (2006) 7:347–350 DOI 10.1007/s10194-006-0326-y BRIEF REPORT Aynur Özge Autonomic headache with autonomic seizures: Hakan Kaleagasi Fazilet Yalçin Tasmertek a case report Received: 3 April 2006 Abstract The aim of the report is the criteria for the diagnosis of Accepted in revised form: 18 July 2006 to present a case of an autonomic trigeminal autonomic cephalalgias, Published online: 25 October 2006 headache associated with autonom- and was different from epileptic ic seizures. A 19-year-old male headache, which was defined as a who had had complex partial pressing type pain felt over the seizures for 15 years was admitted forehead for several minutes to a with autonomic complaints and left few hours. Although epileptic hemicranial headache, independent headache responds to anti-epilep- from seizures, that he had had for tics and the complaints of the pre- 2 years and were provoked by sent case decreased with anti- watching television. Brain magnet- epileptics, it has been suggested ౧ A. Özge ( ) • H. Kaleagasi ic resonance imaging showed right that the headache could be a non- F. Yalçin Tasmertek hippocampal sclerosis and elec- trigeminal autonomic headache Department of Neurology, troencephalography revealed instead of an epileptic headache. Mersin University Faculty of Medicine, Mersin 33079, Turkey epileptic activity in right hemi- e-mail: [email protected] spheric areas. Treatment with val- Keywords Headache • Non-trigemi- Tel.: +90-324-3374300 (1149) proic acid decreased the com- nal autonomic cephalalgias • Fax: +90-324-3374305 plaints. The headache did not fulfil Autonomic seizure • Valproic acid lateral autonomic phenomena and/or restlessness or agita- Introduction tion [3].
    [Show full text]
  • Headache: a Patient's Guide (Pdf)
    Headache A Patient’s Guide Kathleen Digre, MD • Susan Baggaley, APRN • K.C. Brennan, MD • Seniha Ozudogru, MD 729 Arapeen Drive Salt Lake City, Utah 84108 801.585.7575 headache.uofuhealth.org Headache: A Patient’s Guide eadache is an extremely common problem. It is estimated that 10-20% of all people have migraine. Headache is one of the most common reasons H people visit the doctor’s office. Headache can be the symptom of a serious problem, or it can be recurrent, annoying and disabling, without any underlying structural cause. WHAT CAUSES HEAD PAIN? Pain in the head is carried by certain nerves that supply the head and neck. The trigeminal system impacts the face as well as the cervical (neck) 1 and 2 nerves in the back of the head. Although pain can indicate that something is pushing on the brain or nerves, most of the time nothing is pushing on anything. We think that in migraine there may be a generator of headache in the brain which can be triggered by many things. Some people’s generators are more sensitive to stimuli such as light, noise, odor, and stress than others, causing a person to have more frequent headaches. THERE ARE MANY TYPES OF HEADACHES! Most people have more than one type of headache. The most common type of headache seen in a doctor's office is migraine (the most common type of headache in the general population is tension headache). Some people do not believe that migraine and tension headaches are different headaches, but rather two ends of a headache continuum.
    [Show full text]
  • Primary Headaches and Their Relationship with Sleep Cefaleias Primárias E Sua Relação Com O Sono
    Yagihara F, Lucchesi LM‚ Smith AKA, Speciali JG 28 REVIEW ARTICLE Primary headaches and their relationship with sleep Cefaleias primárias e sua relação com o sono Fabiana Yagihara1, Ligia Mendonça Lucchesi1, Anna Karla Alves Smith1, José Geraldo Speciali2 ABSTRACT pain control systems. In general, pain affects sleep and vice There is a clear association between primary headaches and sleep versa(1,2). We found that primary headaches with no clear disorders, especially when these headaches occur at night or upon etiology by clinical and laboratory tests can be triggered by waking. The primary headaches most commonly related to sleep either short or long periods of sleep, or by interrupted or are: migraine, cluster headache, tension type, hypnic headache and (3) chronic paroxysmal hemicrania. The objective of this review was to non-restorative sleep . Sleep is also effective in relieving describe the relationship between these types of headaches and sle- symptoms: 85% of individuals with migraine report that ep and to address sleep apnea headaches. There are various types of they choose to sleep or rest because of a headache, and demonstrated associations between sleep and headache disorders, many are forced to do it(4). Therefore, headaches and sleep and the mechanisms underlying these associations are complex, multi-factorial and poorly understood. Moreover, all sleep disorders disturbances are common and often coexist in the same may be related to headaches to some degree; therefore, the evalua- individual(3,5), and this association is especially observed tion of patients with headaches should include a brief investigation when these headaches occur at night or upon waking(6,7).
    [Show full text]
  • Headaches and Sleep
    P1: KWW/KKL P2: KWW/HCN QC: KWW/FLX T1: KWW GRBT050-134 Olesen- 2057G GRBT050-Olesen-v6.cls August 17, 2005 2:18 ••Chapter 134 ◗ Headaches and Sleep Poul Jennum and Teresa Paiva Headache and sleeping problems are both some of the maintaining sleep), hypersomnias (with excessive day- most commonly reported problems in clinical practice and time sleepiness), parasomnias (disorders of arousal, par- cause considerable social and family problems, with im- tial arousal, and sleep stage transition), or circadian portant socioeconomic impacts. There is a clear associa- disturbances. tion between headache and sleep disturbances, especially Sleep is regulated by a complex set of mechanisms headaches occurring during the night or early morning. including the hypothalamus and brainstem and involv- The prevalence of chronic morning headache (CMH) is ing a large number of neurotransmitters including sero- 7.6%; CMH is more common in females and in subjects tonin, adenosine, histamine, hypocretin, γ -aminobutyric between 45 and 64 years of age; the most significant asso- acid (GABA), norepinephrine, and epinephrine (65). How- ciated factors are anxiety, depressive disorders, insomnia, ever, the specific roles in the relation between sleep and and dyssomnia (75). headache disorders are only partly known. However, the cause and effect of this relation are not clear. Patients with headache also report more daytime symptoms such as fatigue, tiredness, or sleepiness and COMMON HEADACHE TYPES sleep-related problems such as insomnia (77,52). Identi- AND THE RELATION TO SLEEP fication of sleep disorders in chronic headache patients is worthwhile because identification and treatment of sleep Commonly reported headache disorders that show rela- disorders among chronic headache patients may be fol- tion to sleep are migraine, tension-type headache, cluster lowed by improvement of the headache.
    [Show full text]
  • Genetics CQ VIII-1
    VIII Genetics CQ VIII-1 Are there genetic factors associated with migraine? Recommendation Migraine occurs commonly among family members. The existence of genetic factors in migraine is almost certain from linkage analyses and twin studies. Multiple genes are speculated to be involved in the development of migraine. However, the definitive causative genes and susceptibility genes have not been identified. Grade B Background and Objective Many studies have been conducted with the aim to identify the causative genes and susceptibility genes of migraine. Three causative genes have been identified for familial hemiplegic migraine, but the association of these genes with “normal” migraine has been ruled out. Many association analyses using the candidate gene approach have also been conducted, and some of the findings have been subjected to meta-analysis. In addition, linkage analyses and large-scale genome-wide association studies (GWAS) are ongoing, and multiple chromosomal loci and genes have been reported. However, the detailed pathophysiological mechanisms remain unclear. Comments and Evidence Although it has long been noted that migraine commonly occurs within the family, whether this phenomenon is based on genetic factors or environmental factors, or simply due to coincidence because of the high prevalence of migraine has been much debated. More recently, pedigree analysis1) and twin analyses2)3) suggested that migraine is a multi-factorial genetic disease likely to be associated with a combination of multiple genetic factors and environmental
    [Show full text]
  • Stroke Mimic 2019 Few Pics
    polleverywhere.com • To Join: • Text KERRYAHRENS516 to 37607 • For all future texts, you text your choice A-E Kerry Ahrens MD, MS BayCare Clinic Emergency Physician Associate Professor EM UW School of Medicine Medflight Physician Medical Director Oshkosh Fire Dept Co-Chair Wisconsin Stroke Coalition Disclosures: • On speakers bureau Genentech Stroke Mimics OBJECTIVES • Discuss & learn the pathologies behind various stroke mimics • Distinguish stroke mimic vs ‘chameleon’ • Objective & subjective methods to distinguish a mimic from a stroke • Discuss medical & financial ramifications of mimics !5 Stroke is an Emergency! • 795,000/year !6 You wake up in the morning, look in the mirror… • !7 !8 = Rapid Stroke Activation !9 Target Stroke Best Practices Initial Patient Evaluation →10 min Stroke Team Available →15 min CT Scan & Lab initiated →25 min CT Scan & Lab eval →45 min Evaluate t-PA inclusion/exclusion criteria Administer t-PA → DTN goal 60 min *Target Stroke Elite DTN <45 min Pt transferred to inpatient setting → <3 hrs !10 !11 Case • 37 yo F pmh obesity, anxiety & depression here with numbness to her R hand/arm, with inability to move hand in addition to difficulty getting her words out. All symptoms began suddenly around 7:30am. Symptoms lasted 10 minutes then are now resolving - after numbness improved, her speech slowly returned. She also had some visual symptoms. Denies fevers, chills. no h/o cardiac issues. Denies abdominal pain, nausea, vomiting or diarrhea. No recent head injuries. !12 Stroke Mimics - a lot to consider… • Rate
    [Show full text]
  • Cluster Headacheheadache
    ClusterCluster HeadacheHeadache 1 OBJECTIVESOBJECTIVES Describe the clinical features and diagnosis of cluster headache Discuss the pathogenesis of cluster pain and autonomic features Review acute and preventive therapy Overview of new treatment horizons for refractory chronic cluster 2 IHSIHS CLASSIFICATIONCLASSIFICATION Cluster headache n Episodic type (80%) n Chronic type (20%) (Cluster period lasts for more than one year without remission or remission lasts less than 14 days) Episodic Chronic IHS Headache Classification Committee. Cephalalgia. 2004. Although the unique clinical features of cluster headache (CH) have been recognized since the 17th century, the striking periodicity was not articulated until the 1940s. The term “cluster headache” was coined in the 1950s, and since then the International Headache Society (IHS) has identified and classified two major temporal patterns of CH (1). The episodic type (ECH), by far the most common (90%), is characterized by discrete attack and remission phases. The chronic type (CCH) is defined by attacks that occur daily for more than one year without remission or with remission periods lasting less than 14 days. Cluster headache is rare (about 0.4% of the general population), and it predominates in males, although recent studies indicate that the rate in females is rising (2). Onset can occur at any age but usually begins between 30 and 50 years of age (3). In contrast to migraine headache, genetics in cluster headache is not thought to be important, although recent studies have shown a positive family history in about 7% of patients with cluster headache. When compared with prevalence of CH in the general population, first-degree relatives have about a 14-fold increased risk of developing CH.
    [Show full text]
  • A Retrospective, Epidemiological Review of Hemiplegic Migraines in a Military Population
    MILITARY MEDICINE, 00, 0/0:1, 2019 A Retrospective, Epidemiological Review of Hemiplegic Migraines in a Military Population Downloaded from https://academic.oup.com/milmed/advance-article-abstract/doi/10.1093/milmed/usz040/5382215 by AMSUS Member Access user on 22 April 2019 CPT Brian A. Moore, USAR*†; Willie J. Hale*; Paul S. Nabity†; CAPT Tyler R. Koehn, MC, USAF‡; Donald McGeary†; Lt Col Alan L. Peterson, BSC USAF (Ret.)*†§ ABSTRACT Introduction: Headaches are one of the world’s most common disabling conditions. They are also both highly prevalent and debilitating among military personnel and can have a significant impact on fitness for duty. Hemiplegic migraines are an uncommon, yet severely incapacitating, subtype of migraine with aura for which there has been a significant increase amongst US military personnel over the past decade. To date, there has not been a scientific report on hemiplegic migraine in United States military personnel. Materials and Methods: The aim of this study was to provide an overview of hemiplegic migraine, to analyze data on the incidence of hemiplegic migraine in US military service members, and to evaluate demographic factors associated with hemiplegic migraine diagnoses. First time diagnoses of hemiplegic migraine were extracted from the Defense Medical Epidemiological Database according to ICD-9 and ICD-10 codes for hemiplegic migraine. One sample Chi-Square goodness of fit tests were conducted on weighted demographic samples to determine whether significant proportional differences existed between gender, age, military grade, service component, race, and marital status. Results: From 1997 to 2007 there were no cases of hemiplegic migraine recorded in the Defense Medical Epidemiological Database.
    [Show full text]