J. Porta-Etessam

Clusterlike Headache as First Manifestation of a Prolactinoma

We report a case of cluster headache in a patient with a macroprolactinoma. Symptomatic cluster headache was suspected because of an unsatisfactory response to medications that are usually effective in idiopathic cluster headache. The neurological examination was normal. However, magnetic resonance imaging demonstrated a large pituitary tumor. One year after starting treatment with cabergoline, the patient remains asymptomatic. Symptomatic cluster headache should be suspected when the clinical features of the headache are atypical. By inducing vascular mechanisms, the parasellar lesion may have played a role in initiating the cluster headache.

Epicrania fugax : an ultrabrief paroxysmal epicranial pain

Ten patients (one man and nine women, mean age 48.8 ± 20.1) presented with a stereotypical and undescribed type of head pain. They complained of strictly unilateral, shooting pain paroxysms starting in a focal area of the posterior parietal or temporal region and rapidly spreading forward to the ipsilateral eye (n = 7) or nose (n = 3) along a lineal or zigzag trajectory, the complete sequence lasting 1-10 s. Two patients had ipsilateral lacrimation, and one had rhinorrhoea at the end of the attacks. The attacks could be either spontaneous or triggered by touch on the stemming area (n = 2), which could otherwise remain tender or slightly painful between the paroxysms (n = 5). The frequency ranged from two attacks per month to countless attacks per day, and the temporal pattern was either remitting (n = 5) or chronic (n = 5). This clinical picture might be a variant of an established headache or represent a novel syndrome.

One-year prevalence of migraine in Spain: a nationwide population-based survey.

Aim: The purpose of the study was to estimate the one-year prevalence of migraine among a population-based sample of Spanish adults. Method: Men and women aged 18−65 years were selected at random according to quotas for age, sex, size of habitat (<10,000 inhabitants, 10,001−50,000 inhabitants, 50,001−200,000 inhabitants and >200,000 inhabitants) and residence proportional to the population size of the geographical location. A random-digit-dial, computer-assisted telephone interview (CATI) survey was conducted between April and July 2006. The 2004 International Headache Society operational diagnostic criteria were applied. Results: From a total of 70,692 telephone calls and 26,255 (31.7%) valid contacts, 5,668 (21.6%) respondents completed the CATI survey. A total of 476 subjects (8.4%, 95% confidence interval [CI] 7.7−9.1%) with strict migraine and 236 with probable migraine (4.2%, 95% CI 3.7−4.7%) were recorded. The 1-year prevalence of total migraine (N = 712) was 12.6% (95% CI 11.6−13.6) (17.2% in females, 8.0% in males). The prevalence rates showed significant geographic variations, from 7.6% in Navarra to 18% in the Canary Islands. One-half of the subjects had migraine with aura. One-third of subjects were never diagnosed for migraine. Conclusions: The one-year prevalence of migraine in Spain is 12.6%, with a prevalence of migraine with and without aura of 8.4% and probable migraine of 4.2%. These findings add data to the current understanding of migraine.

Magnetic resonance image-reversible findings in a patient with general paresis

Material and Methods: We describe clinical, cerebrospinal fluid (CSF), and magnetic resonance imaging (MRI) findings in a patient with general paresis. MRI demonstrated cortical–subcortical atrophy and broad-coalescent high-intensity T2 lesions in right frontotemporal lobes. Results: After intravenous penicillin therapy, the size of these lesions diminished dramatically. That regression correlated with improvement in neuropsychologic test and CSF analysis. Conclusion: To our knowledge, this is the first case reported in the literature of MRI-reversible lesions in a patient with general paresis. We suggest that MRI is of prognostic value in patients with general paresis. Severe atrophy, especially in the temporal lobe, could be a marker of bad clinical outcome.

Mirrored-self misidentification in a patient without dementia: evidence for right hemispheric and bifrontal damage

Mirrored-self misidentification, often referred as the ‘mirror sign’, is a delusion characterized by the inability to recognize ones own reflected image, often associated with the intact capacity to recognize others in the mirror. It has been described mainly in moderate or severe dementia, especially Alzheimers disease. In the few reported cases without global cognitive impairment, right hemispheric and frontal dysfunctions have been described. We report a 90-year-old man with abrupt onset of the mirror sign after a minor right hemispheric ischemic stroke. Neuropsychological testing revealed preserved cognitive capacities, except for mild to moderate impairment of visuospatial skills, suggesting right hemisphere dysfunction. Neuroimaging showed a small right dorsolateral frontal infarct, and bifrontal encephalomalacia, consistent with a past history of head trauma. Scattered ischemic white matter lesions in posterior periventricular regions were also seen. It seems that the mirror sign is a multifactorial phenomenon that usually requires right hemispheric dysfunction (perceptual abnormalities, loss of familiarity) and frontal damage (loss of judgement and inability to correct wrong beliefs). The right frontal dorsolateral prefrontal cortex seems to have a crucial role in self-recognition.

Epicrania Fugax: Ten New Cases and Therapeutic Results

(Headache 2010;50:451‐458)

Shaky-Leg Syndrome and Vitamin B12 Deficiency

To the Editor: A 68-year-old man presented with a three-year history of trembling of the legs. The tremor began immediately after he stood and subsided when he began walking. His medical history wa...

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.

Bifocal nummular headache: a series of 6 new cases.

(Headache 2011;51:1161‐1166)

Gabapentin (neuronetin) in the treatment of SUNCT syndrome.

Dear Sir Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT syndrome) is a primary headache, marked by trigeminal pain in association with autonomic symptoms (1, 2). The pain is of short duration (5–250 s), stabbing or burning in quality, abrupt, frequent (one per day to 30 per hour) accompanied by lacrimation, nasal stiffness, rhinorrhea and conjunctival injection (2). Several types of drugs (carbamazepine, sumatriptan, prednisolone and non-steroidal anti-inflammatory drugs) have shown little benefit (1–3). Recently, Graff-Radford (4) reported a SUNCT patient who responds to gabapentin. We describe a woman with SUNCT who was treated successfully treated with this drug. A 55-year-old woman presented with a 1-year history of headache. The pain was described as unilateral severe and throbbing located in the right retro-orbital area. The pain occurs in paroxysms lasting 60 s. The pain was accompanied by ipsilateral lacrimation of the eye, swelling of the brow, nasal stiffness and conjunctival injection. No phonoor photophobia or nausea was present. No precipitating mechanisms were identified. The frequency of attacks was three to four episodes per day. Clinical and neurological examination and MRI of the brain were normal. The patient had tried multiple medications without success, including daily non-steroidal anti-inflammatory drugs, serotonin re-uptake inhibitors and flunarizine. Her mother and one sister suffered from migraine. Anamnesis was unremarkable except for glaucoma. Because of the glaucoma we decided not to attempt treatment with carbamazepine, and we decided to treat the patient with gabapentin 300 mg t.i.d. After 1 month the attacks were abolished. Three months later gabapentin was stopped without any recurrence of the pain. SUNCT appears to be refractory to medical therapy. There are isolated cases reporting sumatriptan alleviation of SUNCT, but these probably reflect spontaneous attack remissions rather than drug-induced remissions. Preventive agents that have been tried in SUNCT include paracetamol, aspirin, naproxen, indomethacin, prednisone, ergotamine, dihydroergotamine, methysergide, sumatriptan, verapamil, valproate, lithium, propranolol, amitriptyline, azathioprine, carbamazepine and lamotrigine (1–4). Only carbamazepine alone or in combination with corticosteroids, lamotrigine, gabapentin and percutaneous trigeminal ganglion compression have shown partial effect in some patients (3–7). Gabapentin (GBP), as well as carbamazepine and lamotrigine, is an antiepileptic drug used in the treatment of diabetic neuropathy pain, post-herpetic neuralgia and trigeminal neuralgia. GBP has demonstrated an analgesic effect for the treatment of neuropathic pain. Because GBP has a favourable side-effects profile, some authors consider GBP a first-line treatment for neuropathic pain. GBP mechanisms of action are still not thoroughly defined (8). These observations have to be confirmed with other cases. If so, we consider that GBP could be an option in treatment of patients with SUNCT syndrome.