Headaches and Sleep
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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. -
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. -
CLINICAL PROFILE of HEADACHE in PATIENTS ATTENDING TERTIARY CARE CENTER Saurashtra University
ISSN 2320-5407 International Journal of Advanced Research (2018) Journal homepage: http://www.journalijar.com INTERNATIONAL JOURNAL OF ADVANCED RESEARCH CLINICAL PROFILE OF HEADACHE IN PATIENTS ATTENDING TERTIARY CARE CENTER A DISSERTATION SUBMITTED FOR THE DEGREE OF M.D. (BRANCH-I) GENERAL MEDICINE To Saurashtra University In partial fulfillment of the requirements For The Degree Of M.D. (BRANCH-I) GENERAL MEDICINE BY DR. MANSI P. SHAH Under The Guidance of DR. N. R. RATHOD, 1 ISSN 2320-5407 International Journal of Advanced Research (2018) Certificate This is to certify that DR. MANSI P. SHAH Has carried out the work to prepare This dissertation on CLINICAL PROFILE OF HEADACHE IN PATIENTS ATTENDING TERTIARY CARE CENTER ( A study 0f 100 cases ) Under my guidance, supervision and To utmost satisfaction For the degree of M.D. ( Bra n ch - I, General Medicine ) Date: Dr. N. R. Rathod M.D. ( Medicine ) Additional P rofessor, Department of M edicine, Shri M. P. Shah Medical College, and Guru GobindS i ngh Hospital, Jamnagar. 2 ISSN 2320-5407 International Journal of Advanced Research (2018) ACKNOWLEDGEMENT First and foremost I thank THE ALMIGHTY, for blessing this work, as a part of his generous help throughout my life. I have deep sense of gratitude for my Respected Teacher and Guide Dr. N. R. Rathod (M.D.), Additional Professor, Department of Medicine, Shri M.P. Shah Govt. Medical College, Jamnagar, for his invaluable guidance, constant inspiration, teaching and encouragement, without which this work would not have been materialized. I am indebted to Dr. M. N. Mehta (M.D.), Professor & Head of Medicine for his support and encouragement. -
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]. -
Migraine Mimics
HEADACHE Migraine Mimics Are we underdiagnosing migraines? By Cynthia E. Armand, MD; Alina Masters-Israilov, MD; and Richard B. Lipton, MD Migraine mimics are primary or listed in the Box.1 Although the diagnostic criteria are explicit, secondary headache disorders many migraine features are also found in other primary head- with features in common with ache disorders. For example, unilateral pain characterizes both migraine that may lead to errone- migraine and the trigeminal autonomic cephalalgias (TACs). ous, false-positive diagnosis of In addition, ICHD-3 diagnoses require that the headache migraine. For people seeking care disorder is not better accounted for by another condition. for severe recurrent headaches, migraine is the This seemingly simple statement means that meeting the most likely diagnosis, justifying a high index of symptom criteria for migraine is not sufficient to establish a suspicion for migraine. This can lead to errors of diagnosis. The clinician has to also ensure that there is no bet- overdiagnosis and missed opportunities to treat ter explanation for the patient’s symptoms. Diagnostic errors the disorder that is truly present. The possibility often lead to therapeutic delay. of migraine mimics should be considered: • at the time of the initial consultation Trigeminal Autonomic Cephalalgias • in anyone diagnosed with migraine who does not have the The TACs comprise a group of primary headache disorders expected response to treatment that have the hallmark of unilateral headache with ipsilateral • in anyone diagnosed with migraine whose headache fea- cranial autonomic symptoms, including tures change over time. • cluster headache (CH) Another factor is that more than a single diagnosis may be • paroxysmal hemicranias (PH) present (ie, migraine and another condition). -
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. -
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). -
Headache Associated with Sexual Activity—A Narrative Review of Literature
medicina Review Headache Associated with Sexual Activity—A Narrative Review of Literature Piotr Sci´slicki´ 1, Karolina Sztuba 1, Aleksandra Klimkowicz-Mrowiec 2 and Agnieszka Gorzkowska 3,* 1 Student’s Scientific Society, Department of Neurorehabilitation, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medyków 14, 40-752 Katowice, Poland; [email protected] (P.S.);´ [email protected] (K.S.) 2 Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, Jakubowskiego 2, 30-688 Krakow, Poland; [email protected] 3 Department of Neurorehabilitation, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medyków 14, 40-752 Katowice, Poland * Correspondence: [email protected] Abstract: Headache associated with sexual activity (HAWSA) has accompanied humanity since ancient times. However, it is only since the 1970s that it has become the subject of more extensive and detailed scientific interest. The purpose of this review is to provide an overview of the development of the concept of HAWSA, its clinical presentation, etiopathogenesis, diagnosis and treatment especially from the research perspective of the last 20 years. Primary HAWSA is a benign condition, whose etiology is unknown; however, at the first occurrence of headache associated with sexual activity, it is necessary to exclude conditions that are usually immediately life-threatening. Migraine, hypnic headache or hemicrania continua have been reported to co-occur with HAWSA, but their common pathophysiologic basis is still unknown. Recent advances in the treatment of HAWSA include the Citation: Sci´slicki,P.;´ Sztuba, K.; introduction of topiramate, progesterone, and treatments such as greater occipital nerve injection, Klimkowicz-Mrowiec, A.; arterial embolization, and manual therapy. -
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. -
Hypnic Headache Responds to Topiramate: a Case Report and a Review of Mechanisms of Action of Therapeutic Agents
Open Access Case Report DOI: 10.7759/cureus.13790 Hypnic Headache Responds to Topiramate: A Case Report and a Review of Mechanisms of Action of Therapeutic Agents Hassan Kesserwani 1 1. Neurology, Flowers Medical Group, Dothan, USA Corresponding author: Hassan Kesserwani, [email protected] Abstract Hypnic headaches are unique as they are exclusively nocturnal, occurring in rapid-eye movement (REM) and non-REM sleep. Their nocturnal nature suggests a role for cyclic mechanisms involving the hypothalamus despite conflicting imaging results for the role of the posterior hypothalamus. Nevertheless, pharmacological therapeutics acting as highly effective agents, such as caffeine and melatonin, can modulate the sleep-wake cycle. In addition, indole agents such as indomethacin that are anti-nociceptive and affect cerebral blood flow also prove to be efficacious. Gabanoids and topiramate also have reported efficacy. We report the case of a topiramate-responsive hypnic headache patient and outline in detail the potential mechanisms of topiramate and the other therapeutic agents and adumbrate on the neuronal networks of migraine, the trigeminal autonomic cephalgias and suggest a potential neural circuit for hypnic headaches. Categories: Neurology Keywords: headache disorders, medication therapy management Introduction Hypnic headaches are sleep-induced nocturnal headaches that are usually holocranial but can be bifronto- temporal and rarely bioccipital, dull and moderate-to-severe in intensity. Migrainous symptoms such as nausea, photophobia, and phonophobia may occur in 30% of patients. Some hypnic headaches can be associated with mild autonomic symptoms such as rhinorrhea or lacrimation. The average duration of the headache is 90 minutes with a mean frequency of 21 days per month. -
Focus on Therapy of Hypnic Headache
J Headache Pain (2010) 11:349–354 DOI 10.1007/s10194-010-0227-y TUTORIAL Focus on therapy of hypnic headache Carlo Lisotto • Paolo Rossi • Cristina Tassorelli • Enrico Ferrante • Giuseppe Nappi Received: 3 December 2009 / Accepted: 18 May 2010 / Published online: 29 June 2010 Ó Springer-Verlag 2010 Abstract Hypnic headache (HH) is a primary headache patients. Many patients reported a good response to indo- disorder, which occurs exclusively during sleep and usually methacin, but some could not tolerate it. Caffeine and begins after 50 years of age. There are no controlled trials melatonin treatments did not yield robust evidence to rec- for the treatment of HH. We reviewed all the available ommend their use as single preventive agents. Nevertheless, papers, including 119 cases published in literature up to their association with lithium or indomethacin seems to date, reporting the efficacy of the medications used to treat produce an additional therapeutic efficacy. A course of HH. Acute treatment is not recommended, since no drug lithium should be tried first, followed 3–4 months later by proved to be clearly effective and also because the intensity tapering. If headache recurs during tapering, a longer and the duration of the attacks do not require the intake of a duration of therapy may be needed. If lithium treatment medication in most cases. As for prevention, a wide variety does not provide a significant response, indomethacin can of medications were reported to be of benefit in HH. The be commenced as second-line approach. If these treatments drugs that were found to be effective in at least five cases prove to be ineffective or poorly tolerated, other agents, are: lithium, indomethacin, caffeine and flunarizine. -
Migraine and Tension Headache Guideline
Migraine and Tension Headache Guideline Major Changes as of May 2021 .................................................................................................................... 2 Medications Not Recommended for Headache Treatment .......................................................................... 2 Background ................................................................................................................................................... 2 Diagnosis Red flag warning signs ........................................................................................................................... 3 Differential diagnosis .............................................................................................................................. 3 Imaging ................................................................................................................................................... 3 Migraine versus tension headache ......................................................................................................... 4 Medication overuse headache ................................................................................................................ 4 Menstruation-related migraine ................................................................................................................ 4 Tension Headache Acute treatment ...................................................................................................................................... 5 Prophylaxis ............................................................................................................................................