Carlos M. Ordás

Epicrania Fugax: 19 Cases of an Emerging Headache

Epicrania fugax (EF) is a primary headache of recent description. We aimed to report 19 new cases of EF, and thus contribute to the characterization of this emerging headache.

Increase in Body Temperature During Migraine Attacks

INTRODUCTION Intermittent fever has been occasionally related to migraine, either as a migraine equivalent or as a migraine accompaniment. We present a case of recurrent increase in body temperature consistently associated with migraine headaches. METHODS A 15-year-old girl reported a 3-year lasting history of migraine without aura, with a feeling of warmth occurring in each episode. Ancillary tests did not show any evidence of secondary headaches or any systemic disease. A 2-month headache diary was obtained, with daily records of headache intensity (0, no headache; 1, mild pain; 2, moderate pain; 3, severe pain) and simultaneous measurements of axillary temperature. Both parameters were registered in the evening, at 6:00 pm every day. The distribution of headache intensity and body temperature as well as the relationship between both variables over time were analyzed with nonparametric tests. RESULTS The number of days without pain was 28 (45.2%); a mild headache was present on 13 days (21%), a moderate headache on 15 days (24.2%), and a severe headache on 6 days (9.7%). Headache days were associated with higher body temperature than headache-free days (median values: 37.3°C vs 36.6°C; Mann-Whitney U-test, P < 0.001). Moreover, a positive correlation was found between headache intensity and body temperature (Spearmans rho coefficient: 0.83, P < 0.001). CONCLUSIONS Recurrent increase in body temperature may be another manifestation of the complex clinical spectrum of migraine. This symptom is probably related to hypothalamic involvement.

Migraine-triggered hemifacial spasm: three new cases

Background: The occurrence of hemifacial spasm (HFS) during an episode of migraine has been seldom reported. Here we describe three new cases presenting with HFS in association with migraine attacks. Case results: Three patients (one woman and two men, aged 31–36 years) developed HFS in close temporal relationship with migraine headaches. All of them started having the muscle spasms after pain onset. Two of them had electromyographic evidence of facial nerve damage, and continued having HFS once the pain abated. Conclusions: Migraine attacks may be associated with HFS. The appearance of HFS could be related to migraine activity. A mechanism of central hyperexcitability in connection with nociceptive inputs on the trigeminal nucleus caudalis and/or a dilation of vessels compressing the facial nerve at the root exit zone could lead to the development of HFS in predisposed patients. ‘Migraine-triggered hemifacial spasm’ could possibly be regarded as a complication of migraine.

Pain Paroxysms With Coronal Radiation: Case Series and Proposal of a New Variant of Epicrania Fugax.

We aim to report 4 patients with brief pain paroxysms whose clinical features remind of typical epicrania fugax (EF), except for the direction along a transverse trajectory.

Nummular Headache in a Patient with Craniosynostosis: One More Evidence for a Peripheral Mechanism

Dear Editor, Nummular headache (NH) is a normally mild-to-moderate pain felt in a coin-shaped or elliptical area of the head, typically 1 to 6 cm in diameter. The affected area may show several combinations of sensory signs, such as hypoesthesia, paresthesia, dysesthesia, and tenderness [1,2]. In addition, a few patients develop local alopecia or other trophic changes [3]. NH was described in 2002 [1], and has already been reported in 238 cases according to a recent review [4]. Although NH emerged as a primary disorder, we have to pay attention to possible symptomatic or secondary cases. Here we report a case of NH associated with craniosynostosis. A 41-year-old woman was admitted to our department due to a 1-year long headache. It was localized in her left tuber parietal region, in a well-demarcated round zone measuring 3 cm in diameter, with no changes in size or location. She …

Síndrome de encefalopatía posterior reversible recurrente con respuesta a nimodipino

from country to country. Some of the confusion arises from the way the term ‘brain death’, as defined by the Harvard criteria published in 1968, has been translated in Spanish. We are fully aware of the neuroanatomical differences between whole brain death, brainstem death, and neocortical or cerebral death. The first two definitions of death (based on neurological criteria) are the most widespread, and also the most polemic. All of these definitions revolve around what they consider to be the ‘brain’ in ‘brain death’. On this topic, Spanish law as cited by Iriarte et al. clearly establishes that death must be diagnosed and certified based on ‘‘irreversible cessation of cardiopulmonary functions or brain functions’’. For this reason, we feel that using ‘cerebral death’ as a synonym for whole brain death is confusing to both health care professionals and society at large. We understand that ‘muerte cerebral’ or ‘cerebral death’ is widely used by Spanish speakers, but the term should not be employed in medicine. If the concepts employed in our definitions are inappropriately explained, the definitions themselves are more likely to be misunderstood.

Stress, Coping, and Personality in Patients with Epicrania Fugax, and Their Relation to the Clinical Characteristics of Pain

Objective. The aim of the present work is to analyze certain psychological features in a group of patients diagnosed with Epicrania fugax (EF; that has been recently included in the appendix of the International Classification of Headache Disorders, third edition, beta version), as well as their association with diverse demographic and clinical characteristics of the sample. Design. Case-control. Method. Perceived Stress Scale (PSS), Stress Coping (COPE), Big Five Personality Traits (NEO-FFI), Depression (BDI-II), and Trait Anxiety (STAI) were evaluated in 23 patients with EF and 23 matched healthy controls. Differences between EF patients and controls were analyzed using the Mann-Whitney U test. Differences in psychological features as a function of the demographic and clinical characteristics were examined using one-way Analysis of Variance (ANOVA), Mann-Whitney U test, or Pearson’s correlations. Results. The two groups differed significantly from each other in Denial, Trait anxiety, and Depression. Low-frequency epicrania patients scored significantly higher than controls in Perceived stress, Neuroticism, Denial, Self-blame, Trait anxiety, and Depression and higher than high-frequency EF in Venting. Conclusions. The results initially suggest the absence of substantial differences between patients suffering of EF and healthy controls. On the contrary, low-frequency EF patients show a distinctive “negative (unhealthy) psychological profile,” in opposition to high-frequency EF patients. This circumstance highlights the potential need to consider low- frequency EF patients as a target for psychological intervention in combination with the most common medical procedures. Longitudinal studies are necessary to correctly elucidate the influence of these psychological variables on the course of EF.