Nilima D. Shah

The prevalence of headache may be related with the latitude: a possible role of Vitamin D insufficiency?

According to recent observations, there is worldwide vitamin D insufficiency (VDI) in various populations. A number of observations suggest a link between low serum levels of vitamin D and higher incidence of chronic pain. A few case reports have shown a beneficial effect of vitamin D therapy in patients with headache disorders. Serum vitamin D level shows a strong correlation with the latitude. Here, we review the literature to delineate a relation of prevalence rate of headaches with the latitude. We noted a significant relation between the prevalence of both tension-type headache and migraine with the latitude. There was a tendency for headache prevalence to increase with increasing latitude. The relation was more obvious for the lifetime prevalence for both migraine and tension-type headache. One year prevalence for migraine was also higher at higher latitude. There were limited studies on the seasonal variation of headache disorders. However, available data indicate increased frequency of headache attacks in autumn–winter and least attacks in summer. This profile of headache matches with the seasonal variations of serum vitamin D levels. The presence of vitamin D receptor, 1α-hydroxylase and vitamin D-binding protein in the hypothalamus further suggest a role of vitamin D deficiency in the generation of head pain.

Chronic Tension‐Type Headache With Vitamin D Deficiency: Casual or Causal Association?

The prevalence of tension‐type headache and vitamin D deficiency are both very high in the general population. The inter‐relations between the two have not been explored in the literature. We report 8 patients with chronic tension‐type headache and vitamin D deficiency (osteomalacia). All the patients responded poorly to conventional therapy for tension headache. The headache and osteomalacia of each of the 8 patients responded to vitamin D and calcium supplementation. The improvement in the headache was much earlier than the improvements in the symptom complex of osteomalacia. We also speculate on the possible mechanisms for headache in the patients with vitamin D deficiency.

Secondary hemicrania continua: Case reports and a literature review.

Hemicrania continua (HC) is an indomethacin responsive primary headache disorder. Secondary or symptomatic HC is associated with another neurological or non-neurological disease. We report three patients with secondary HC. We also review the literature to identify the clinical predictors of an underlying disease entity. Intracranial structural lesion, head and neck vessel pathology, and carcinoma lung should be suspected in every patient. The factors that may suggest a secondary pathology are: elderly age, male sex, smoking habit, constitutional symptoms, symptoms related to respiratory system, frequent and short-lived exacerbation, nocturnal exacerbation, HC evolving from remitting form, recent neck and/or head trauma, miosis, elevated ESR, and fading effect of indomethacin. We recommend MRI brain in all the patients presenting with HC or HC like headache. Angiography and CT chest are two other investigations that may be supplemented in patients with high risk for head/neck vessel pathology and carcinoma lung.

Is there need to search for alternatives to indomethacin for hemicrania continua? Case reports and a review

Hemicrania continua (HC) is a daily continuous unilateral headache of moderate intensity with super imposed exacerbations of more severe pain accompanied by migrainous and cranial autonomic features. Response to indomethacin is an essential feature in the IHS diagnostic criteria. However, indomethacin is associated with a number of side effects. HC is a life long condition, and skipping of a single dose of indomethacin usually leads to reappearance of headache. Various drugs have been tried as alternatives to indomethacin in the patients intolerant to indomethacin. We report two cases of HC responsive to topiramate and review the available alternatives for the patients of HC. We also discuss the side effects of indomethacin in the various headache disorders and other painful conditions, and suggest the need for trial of other drugs for the patients of HC.

Hemicrania continua unresponsive or partially responsive to indomethacin: does it exist? A diagnostic and therapeutic dilemma

Hemicrania continua (HC) is a primary headache disorder characterized by a continuous, unilateral headache that varies in intensity, waxing and waning without disappearing completely. Ipsilateral cranial autonomic features and response to indomethacin are essential features for the diagnosis of HC. We hereby, describe three patients with the clinical phenotypes of HC in whom response to indomethacin was either incomplete or not sustained. We also review the literature especially for the presence of indomethacin response and ipsilateral cranial autonomic features.

Coexistence of cluster headache and paroxysmal hemicrania: does it exist? A case report and literature review

The coexistence of different types of trigeminal autonomic cephalalgias is a rare phenomenon. The two different types of headache may occur either at two different periods or simultaneously at the same time. We report a 22-year-old male who had cluster headache (CH) and chronic paroxysmal hemicrania (CPH) since the onset of symptoms. Both types of headache responded to indomethacin. Review of the literature suggests that simultaneous occurrence of CH and CPH in a patient may be both over and under reported.

Delayed response of indomethacin in patients with hemicrania continua: real or phantom headache?

Hemicrania continua (HC) is an indomethacin-responsive primary headache disorder. Response to indomethacin is an essential criterion for the diagnosis of HC. The response to indomethacin is usually prompt and enduring (1). However, HC-like headache unresponsive or partially responsive to indomethacin is also described in the literature (2,3). HC patients usually respond dramatically to a therapeutic dose of indomethacin, usually within 24 h. A reduction of the dose may be successful after some time (4). Here we report three patients with HC in whom complete response to indomethacin was noted a few months after the initiation of indomethacin therapy.

Restless legs syndrome with carbamazepine-induced osteomalacia: causal or casual association

Restless legs syndrome (RLS) is a sensorimotor sleep-related disorder which can be idiopathic or secondary. Secondary RLS is associated with a variety of conditions. Here we report a 16-year-old girl with RLS secondary to vitamin D deficiency (VDD) caused by chronic administration of carbamazepine. We also speculate on the possible mechanisms for the development of RLS in patient with VDD.

Migrainous vertigo responsive to intravenous methylprednisolone: case reports.

Migrainous vertigo (MV) is a newer evolving concept in which vertigo is causally related to migraine. We report 4 patients with MV. Episodes of severe MV of more than 1‐day duration were successfully terminated by intravenous methylprednisolone (IV MPS) in 2 patients. Two other patients who had attacks of MV almost daily also showed complete response to IV MPS.

Recurrent limb pain and migraine: case reports and a clinical review

Recurrent limb pain (RLP) is a well-known entity in childhood. It is considered a precursor of migraine. The temporal relationship of RLP with headache in childhood is lacking in the literature. However, there are many cases with limb pain in a close temporal relationship with migraine headache in adults. We report six female patients with RLP and migraine and delineate the temporal relationship between the two. Three patients had a history of RLP in childhood and developed migraine headache after many years. Conversely, two patients had a long history of migraine headache and later developed RLP. One patient developed RLP and migraine headache at the same age. Isolated limb pain was frequent in all six patients. It was mild to severe, for a few minutes to a few days, and predominantly located in the upper extremities. Only one patient reported allodynia. The patients showed response to preventive measures (all six patients) and abortive therapies (four patients), even in those attacks of RLP that were not associated with headache episodes. We also review the clinical profiles of the patients in whom RLP and migraine were related to each other, and speculate on the possible mechanisms for RLP in the patients with migraine.