Cases reported "Headache Disorders"

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1/68. Pediatric dental treatment for children with headache.

    This case demonstrates the safe step by step approach to treatment of pediatric patients with muscle spasm headache. If there are any neurologic signs or the LiteSplint is not effective, then a laboratory orthopedic appliance therapy may not be effective and a neurologic referral is necessary. It is always required to review the latest physical exam with the parent and physician if the symptoms do not improve in an orderly sequence. The LiteSplint acts as a screening and diagnostic aid in determining the source of head pain. For very young patients (three to six years of age) who may not be able to easily tolerate an appliance, an extra heavy coating of flowable composite that can act as a sealant on the primary molars, e.g. Revolution, may open the bite enough to alleviate headache or earache symptoms. Dental clinicians can perform a valuable service for their patients if headaches from deep bite malocclusions can be diagnosed and treated at an early age. ( info)

2/68. Coexistence of cervicogenic headache and migraine without aura (?).

    It is well known that migraine with aura may coexist with various unilateral headaches, like cluster headache and chronic paroxysmal hemicrania. It may also coexist with cervicogenic headache. The diagnosis of migraine without aura ("common migraine") poses greater problems than the diagnosis of migraine with aura. Cervicogenic headache diagnosis also poses problems when these two headaches coexist, since they have symptoms in common. Therefore, the scientific demonstration of coexistence of migraine without aura and cervicogenic headache is bound to be a difficult task. In the present study, migraine without aura and cervicogenic headache seemed to coexist in 4 patients (3 F and 1 M, mean age 50). Attacks with migraine characteristics fulfilled the IHS and IASP migraine criteria. Out of a maximum of 13 migraine characteristics based on the IHS/IASP migraine criteria, such as unilaterality, aggravation on minor physical activity, etc., none of the patients presented less than 11, as opposed to a mean of < or = 4 of these criteria in the cervicogenic type attacks. A similar system, based on criteria such as: reduction of range of motion in the neck, mechanical precipitation of attacks, etc., was also developed for cervicogenic headache. The mean number of cervicogenic headache criteria was 4.3 (out of a total of 5) in the "cervicogenic part of the picture", as opposed to 1.5 (1.8 if laterality is considered, see text) in the "migraine part of the picture". Drug regimens and anaesthetic blocks also showed different results in the two different headaches in the same patient. All in all, this study seems to support a coexistence of the two headache types. ( info)

3/68. Postpartum headache after epidural blood patch: investigation and diagnosis.

    Use of an epidural blood patch to treat spinal headache after accidental dural puncture is well recognized. The high success rate associated with this practice has been questioned and it is not uncommon for patients to suffer recurring headaches after a supposedly successful blood patch. We describe a patient in labour who suffered accidental dural puncture, and whose headache was treated twice with an epidural blood patch. Despite this, the headache persisted. The case highlights the difficulty in the diagnosis of headache in the postnatal period in patients who have had regional analgesia and the importance of considering an alternative pathology, even if epidural blood patching has been successful. In this case, a diagnosis of cortical vein thrombosis was made. The incidence, presentation, aetiology and treatment of this rare condition is described. ( info)

4/68. Cervicogenic headache: clinical aspects.

    Cervicogenic headache (CEH) is a relatively common but often overlooked disorder. There is sufficient evidence to support this category and the existing diagnostic criteria are adequate. Subgroups may exist and the clinical picture sometimes may be similar to that of other headache disorders, however. The pathophysiology of this condition and its relationship with other headache syndromes remain to be determined. Migrainous features may occur in some patients. ( info)

5/68. Transitional interpersonality thunderclap headache.

    OBJECTIVE: To report a patient with multiple personality disorder who experienced severe acute headaches without warnings, solely during the transition between her host personality and her pain-prone personality. BACKGROUND: The initial detailed description of headache in multiple personality disorder was made by Packard and Brown and published in this journal 15 years ago. methods: Clinical history, neurologic examination, electroencephalogram, and brain magnetic resonance imaging. RESULTS: A 54-year-old holocaust survivor with an established diagnosis of multiple personality disorder had recurrent, excruciating, acute ("thunderclap") headaches only when switching between her domineering personality and her pain-prone personality, who suffered from chronic back pain. None of her personalities otherwise suffer from headaches. Electroencephalogram and brain magnetic resonance imaging were normal. CONCLUSION: This is an independent and current confirmation of the existence of transitional headaches in a patient with multiple personality disorder. They may occur as an isolated event during the switch process and have features of benign thunderclap headache. ( info)

6/68. Two family members with a syndrome of headache and rash caused by human parvovirus B19.

    Human parvovirus B19 infection can cause erythema infectiosum (EI) and several other clinical presentations. central nervous system (CNS) involvement is rare, and only a few reports of encephalitis and aseptic meningitis have been published. Here, we describe 2 cases of B19 infection in a family presenting different clinical features. A 30 year old female with a 7-day history of headache, malaise, myalgias, joint pains, and rash was seen. physical examination revealed a maculopapular rash on the patient's body, and arthritis of the hands. She completely recovered in 1 week. Two days before, her 6 year old son had been admitted to a clinic with a 1-day history of fever, headache, abdominal pain and vomiting. On admission, he was alert, and physical examination revealed neck stiffness, Kerning and Brudzinski signs, and a petechial rash on his trunk and extremities. cerebrospinal fluid analysis was normal. He completely recovered in 5 days. Acute and convalescent sera of both patients were positive for specific IgM antibody to B19. Human parvovirus B19 should be considered in the differential diagnosis of aseptic meningitis, particularly during outbreaks of erythema infectiosum. The disease may mimic meningococcemia and bacterial meningitis. ( info)

7/68. Severe headache associated with occupational exposure to Stoddard solvent.

    We report a case of recurrent headaches in a woman with a workplace exposure to airborne (misted) lubricating fluid containing Stoddard solvent. For 2 months, the employee was seen by her family physician, a neurologist and an ophthalmologist. All attempted to diagnose the cause of and treat her headaches. Despite extensive testing, no etiology was discovered. Her headaches continued despite the use of medications. The employee, suspecting an occupational connection, changed the lubricating fluid at her workstation to a non-Stoddard solvent. Within 2 days she reported the complete resolution of her headaches with no further recurrences. A thorough occupational history and literature review supported exposure to Stoddard solvent as the probable source of her headaches. ( info)

8/68. indomethacin-responsive headaches in children and adolescents.

    Headache is a common symptom in childhood and adolescence. Effective therapy for this symptom is based on the specific headache syndrome. This article presents examples of the four recognized indomethacin-responsive headache syndromes encountered in pediatrics including exertional headache, cyclic-cluster migraine, chronic paroxysmal hemicrania, and hemicrania continua. Although uncommon conditions, successful treatment depends on recognition of these indomethacin-responsive headache syndromes. ( info)

9/68. Remitting form of hemicrania continua with seasonal pattern.

    Hemicrania continua is a primary headache syndrome characterized by a continuous, unilateral headache that is completely responsive to indomethacin. Hemicrania continua exists in continuous and remitting forms. Ten cases of the remitting form have been reported, none of which have had a seasonal pattern. We report a patient with remitting hemicrania continua with a clear seasonal predilection. ( info)

10/68. Hypnic headache: report of two cases.

    Hypnic headache constitutes one rare type of primary short-lasting headache related to sleep. The authors describe two cases of hypnic headache that had a very good response to lithium carbonate. Although these two cases do not fulfill the proposed criteria for hypnic headache, as the pain was not bilateral, and, in case 2, it had a longer duration than previously described, we believe that the very good response to lithium carbonate favors this diagnosis. We believe that it is important to consider a diagnosis of hypnic headache because of the remarkable response to lithium carbonate shown by some patients with this condition. ( info)
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