Pierric Giraud

Behavioral Dependence in Patients With Medication Overuse Headache: A Cross‐Sectional Study in Consulting Patients Using the DSM‐IV Criteria

Objective.— The aim of this study was to assess behavioral dependence on migraine abortive drugs in medication‐overuse headache (MOH) patients and identify the predisposing factors.

Rating of olfactory judgements in migraine patients

The aim of this study was to evaluate olfactory hypersensitivity (OHS) between attacks in migraine patients. Seventy-four migraine patients and 30 controls were enrolled. The presence of OHS was evaluated using an oral questionnaire and a chemical odour intolerance index. Subjects had to rate the intensity and hedonicity of 12 odourants using a linear rating scale. Twenty-six patients (35.2±) but no control subjects reported an interictal OHS (P < 0.001). Logistic regression analysis showed that patients with OHS presented a greater attack frequency, a higher number of odour-induced migraines and visual hypersensitivity when compared with other patients. Disease duration, age, gender and auditory hypersensitivity were not associated with OHS. OHS patients judged odours less pleasant than did other patients and controls, whereas the intensity scores were identical in both groups. OHS between attacks was significantly associated with odour-triggered migraine and an alteration of hedonic judgement.

Increased detection of 14-3-3 protein in cerebrospinal fluid in sporadic Creutzfeldt-Jakob Disease during the disease course

Diagnosis of Creutzfeldt-Jakob Disease (CJD) is based on neurological signs associated with characteristic electroencephalographic activity or detection of 14-3-3 protein in cerebrospinal fluid. However, the time course of 14-3-3 protein release during sporadic CJD is unknown. We report two observations in which the level of the detected 14-3-3 protein increased significantly with time. These preliminary cases suggest that there may be an increased release of 14-3-3 protein during the course of CJD as already proven for iatrogenic CJD.

One or Several Types of Triptan Overuse Headaches

Background.— Whereas the clinical features of pure triptan overuse headache (TOH) are well known, there are insufficient data regarding the semiological pattern of headaches when triptan overuse is associated with other types of medication overuse.

Cluster-like headache: literature review

Abstract Cluster headache (CH) is the most frequent primary trigeminal autonomic cephalalgia (Goadsby, 2001). Clinical symptoms have been clearly identified and are described in the IHS classification. Cluster-like headache (CLH), or symptomatic cluster headache, is a rare syndrome in which CH is associated with or disclosed by another neurological disease. The relationship between the two diseases is debated on a spatial and temporal bases. Relief of CH symptoms on treatment of the associated disease is a further argument. However, the simultaneous occurrence of the two diseases may be coincidental. First, the characteristics and pathogenesis of CH are reviewed. Second, published examples of CLH are described, including the pathophysiology proposed by the authors in each particular situation. In the final part, criteria for the identification of CLH in clinical practice are developed.

Is migraine with cranial nerve palsy an ophthalmoplegic migraine

Ophthalmoplegic migraine (OM) is a rare form of primary headache. Because of its rarity, only a few cases, mostly symptomatic, are reported. We analyse nine cases among 52 973 adults who suffer from headaches with an oculomotor palsy firstly considered as OM. The study was retrospective and multicentric in a database set up in France. The aim of our investigation was to describe the clinical and radiological aspects of these cases and to discuss the diagnosis of OM. We demonstrate that the characteristics of the headaches were identical to usual migraine without oculomotor nerve palsy for each case. The study emphasises the difficulty of the OM diagnosis even with the new IHS criteria because of the rarity of having all characateristics. A wide heterogeneity was noted in cranial imagery and blood tests. We suggest adding the code of probable OM in the IHS classification to increase the knowledge and detection of this type of headache. A biological blood test and an MRI are systematically required to help clinicians in their diagnosis and to exclude alternative aetiology of headache with palsy.

Occipital nerve stimulation improves the quality of life in medically-intractable chronic cluster headache: Results of an observational prospective study.

Background Occipital nerve stimulation (ONS) has been proposed to treat chronic medically-intractable cluster headache (iCCH) in small series of cases without evaluation of its functional and emotional impacts. Methods We report the multidimensional outcome of a large observational study of iCCH patients, treated by ONS within a nationwide multidisciplinary network (https://clinicaltrials.gov NCT01842763), with a one-year follow-up. Prospective evaluation was performed before surgery, then three and 12 months after. Results One year after ONS, the attack frequency per week was decreased >30% in 64% and >50% in 59% of the 44 patients. Mean (Standard Deviation) weekly attack frequency decreased from 21.5 (16.3) to 10.7 (13.8) (p = 0.0002). About 70% of the patients responded to ONS, 47.8% being excellent responders. Prophylactic treatments could be decreased in 40% of patients. Functional (HIT-6 and MIDAS scales) and emotional (HAD scale) impacts were significantly improved, as well as the health-related quality of life (EQ-5D). The mean (SD) EQ-5D visual analogic scale score increased from 35.2 (23.6) to 51.9 (25.7) (p = 0.0037). Surgical minor complications were observed in 33% of the patients. Conclusion ONS significantly reduced the attack frequency per week, as well as the functional and emotional headache impacts in iCCH patients, and dramatically improved the health-related quality of life of responders.

Laughing Headache With Giant Pacchionian Granulations

Laughing is recognized as a provoking factor for headache, certainly underestimated among the general population and few cases have been published to date. We report a single case of severe headache, provoked almost exclusively by outbursts of laughing, where venous magnetic resonance imaging revealed the presence of giant Pacchioni granulations in both right and transverse sinuses. Reviewing published cases of laughing headache, we discuss possible mechanisms of pain and the role of giant Pacchionian granulations.