M. Ruiz

Non-traumatic supraorbital neuralgia: a clinical study of 13 cases.

Introduction: Supraorbital neuralgia (SON) is an uncommon disorder characterized by pain in the area supplied by the supraorbital nerve, which covers the medial aspect of the forehead, together with tenderness over the supraorbital notch or along the course of the nerve. Few hospital-based series of non-trauma SON have been published. Methods and results: We prospectively analyzed 13 patients (11 females, two males) diagnosed with SON in a headache outpatient clinic over a four-year period. Background pain was mostly dull and of moderate intensity. In addition, nine patients reported sharp, burning or stabbing exacerbations of severe intensity. Eight cases were treated with an anesthetic blockade and achieved complete relief lasting from two to six months. Three patients also received gabapentin, with no or only slight improvement. Conclusion: Non-traumatic SON is an uncommon disorder in our headache clinic. Female preponderance and clinical features are comparable to the data collected in previous studies. A spontaneously remitting pattern is not uncommon, and anesthetic blockades are not always required.

Cefaleas en la persona mayor: características de una serie de 262 pacientes

INTRODUCTION Although headache prevalence decreases in patients older than 65, headaches are a common complaint and their different clinical and therapeutic features must be understood. This article analyses the clinical characteristics of elderly patients treated in an outpatient headache unit. METHODS We collected demographic and clinical data from patients treated in a tertiary hospital headache unit between January 2008 and May 2013. Headaches were codified according to the International Classification of Headache Disorders, 2nd edition (ICHD-2). RESULTS Of a total of 1868 patients treated, 262 patients (14%, 189 women and 73 men) were older than 65 years. Ninety-nine (68 women, 31 men, 5.3% of the total) were over 75. Headaches began after the age of 65 in only 136 patients (51.9%). The 362 headaches were codified as follows: 23.8% as Group 1 (Migraine) and 28.7% as Group 2 (Tension-type headache). We diagnosed 58 (16%) secondary headaches; 26 (7.2%) were classified as Group 13 (Cranial neuralgias) and 23 (6.4%) in Group 14 (Other headaches). Symptomatic medication overuse was detected in 38 patients (14.5%). We also identified headaches considered typical in the elderly, including chronic migraine (41 cases), hypnic headache (6), occipital neuralgia (4), SUNCT (2), cervicogenic headache (1), primary cough headache (1), and giant cell arteritis (2). CONCLUSIONS Elderly patients were frequently treated in our outpatient headache unit. Tension-type headache was the most common diagnosis in this population. Geriatric headache syndromes such as hypnic headache or occipital neuralgia were also represented in our series.

Diferencias entre migraña crónica con y sin uso excesivo de medicación: experiencia en una serie hospitalaria de 434 pacientes

INTRODUCTION Chronic migraine (CM) is a complication of episodic migraine, favored by risk factors as medication overuse (MO). We intend to compare demographic and clinic characteristics of a series of CM patients, with and without MO. METHODS The study included patients with CM (2006 revised criteria) attended in a headache outpatient office located in a tertiary hospital between January 2008 and May 2012. We recorded demographic characteristics, age at migraine onset, time from onset, previous use of symptomatic or preventive therapy, and headache impact measured with six-item headache impact test (HIT-6). RESULTS A total of 434 patients (357 women, 77 men) were diagnosed with CM out of the 1868 (23.2%) that attended our clinic. Of these, 258 (72.2%) fulfilled criteria of MO, and 59.8% of those with MO, and 41.1% of cases without MO had previously received preventative treatment (P<.001). Age at onset of migraine was lower in MO patients (21.2±10.1 vs 23.8±12.5 years, P=.02) and time from onset to headache clinic consultation was higher in MO cases (23.8±14.1 vs 18.3±14.8 years, P<.001). We found no difference between both groups in average HIT-6 score and the percentage of patients with a HIT-6 score over 55. CONCLUSIONS CM, with or without MO, is a burdensome group of patients in our headache clinic. Patients with MO are referred later and have more frequently received preventive treatments.

Auriculotemporal Neuralgia: Eight New Cases Report

BACKGROUND Auriculotemporal neuralgia (ATN) is an infrequent syndrome consisting in strictly unilateral pain in the temporal region associated with nerve tenderness, which can be successfully treated with anesthetic blockade. We analysed clinical characteristics and treatment response in a series of eight patients. METHODS Series of consecutive patients diagnosed with ATN at Headache Clinics of two university hospitals in Spain. Data on demographic and pain characteristics, as well as response to treatment are presented. RESULTS Eight patients (seven women). Mean age at onset was 52.8 ± 14.3 years. Pain was strictly unilateral (left-sided in five cases, right-sided in three), and triggered by pressing the preauricular area. Four patients presented background pain, mostly dull in quality, with an intensity of 5.75 ± 1.2 on the verbal analogical scale (VAS). In six, burning exacerbations occurred, ranging from 2 seconds to 30 minutes, with intensity 7.3 ± 1.5 on VAS. Complete relief was achieved with gabapentin in three cases, anaesthetic blockade in three and spontaneously in two. CONCLUSION ATN is uncommon in headache units. Gabapentin is a good alternative therapeutic option to anesthetic blockade.

From Wakefulness to Sleep: Migraine and Hypnic Headache Association in a Series of 23 Patients

We analyzed characteristics of hypnic headache (HH), migraine and the relationship between both headaches in 23 patients. HH is an uncommon primary headache characterized by exclusively sleep‐related attacks. Concurrence of other headaches, mainly migraine, has been reported, but relationship between both syndromes has rarely been considered.

Atypical nummular headache or circumscribed migraine: the utility of pressure algometry.

Nummular headache is a type of headache that can be identified by continuous or intermittent pain occuring in a well-circumscribed area. The symptoms of nummular headache can overlap with those of migraine headache, and a failure to reach an accurate diagnosis can affect the choice of treatment. The authors report a case involving a 21-year-old woman with headache symptoms that appeared to represent nummular headache, for whom treatment with the typical first-line agent was unsuccessful. The authors subsequently generated a pressure algometry map of the painful area, leading to clarification of the diagnosis.

Características de los 2.000 primeros pacientes registrados en una consulta monográfica de cefaleas

OBJECTIVES Headache is a common cause of medical consultations. We aim to analyze demographic characteristics of first two thousand patients in our register, and the incidence of their different headaches coded according to the International Classification of Headache Disorders, ii edition (ICHD-II). PATIENTS AND METHODS On January 2008 a headache outpatient clinic was established in a tertiary hospital. Patients could be referred by general practitioners according to previously consensused criteria, as well as by general neurology or other specialities clinics. The following variables were prospectively collected on all patients; age, sex, referral source, complementary tests required, and the previously prescribed symptomatic or prophylactic therapies. All headaches were classified accordingly to ICHD-II. When a patient fulfilled criteria for more than one type of headache, all of them were diagnosed and classified. RESULTS In October 2012, 2000 patients (ratio women/men 2.59/1) had been seen in our headache clinic. The median age was 42 years (range: 11-94), 55.3% were referred from primary care, and 68.1% did not require complementary tests. A total of 3095 headaches were recorded in these 2000 patients, of which 2222 (71.8%) were considered primary headaches, 382 (12.3%) secondary headaches, with 117 (3.8%) corresponding to cranial neuralgias, 136 (4.3%) were unclassified headaches, and 238 (7.7%) were included in the research Appendix of the ICHD-II. The most represented group was 1 (migraine) with 53% of all headaches. CONCLUSIONS The characteristics of first 2000 patients in our register were comparable to those previously described in other types of headache outpatient clinics. Migraine was the most frequent diagnosis, and secondary headaches were not as frequent in our series. Most headaches could be coded according to ICHD-II criteria.

Differences in Topographical Pressure Pain Sensitivity Maps of the Scalp Between Patients With Migraine and Healthy Controls

To investigate differences in topographical pressure pain sensitivity maps of the scalp between patients with migraine and healthy controls considering the chronicity (episodic/chronic) and side (strictly unilateral/bilateral) of the symptoms.

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.

Epicrania Fugax with Sagittal Trajectory of the Pain

Dear Editor, Epicrania fugax (EF) was first described by Pareja et al in 2008 ⇓. It has been recently included in the Appendix of the 3rd edition of The International Classification of Headache Disorders (ICHD-III, beta version) ⇓. It is characterized by ultrabrief paroxysms of unilateral pain spreading from the posterior scalp to the ipsilateral eye or nose, along a linear or zigzag trajectory, and lasting less than 10 s. Pain intensity can be moderate or severe, and pain quality has been described as electric or stabbing. Autonomic symptoms can be present. Pain frequency is extremely variable and most attacks are spontaneous, but some of them can be provoked by tactile stimulation. Between paroxysms, mild pain or hyperesthesia could remain in the stemming area but complete disappearance of pain is also possible ⇓. As the first description of EF, there have been several publications supporting this new entity. A total of 66 cases have been reported up to now, 48 of them sharing the original forward radiation. Conversely, a backward radiation from frontal or periorbital areas toward the occipital region has been described in 18 cases ⇓. Pain paroxysms are strictly unilateral, although some patients have shifting sides ⇓. Associations with other headaches, mainly nummular …