Raquel Gil-Gouveia

Secondary “hypnic headache-

Hypnic headache is a rare form of primary headache with attacks occurring exclusively with sleep. As it is typical of the elderly, a wide range of alternative diagnosis must be considered. We present a case report of a 54-year-old woman with unsuspected secondary hypnic headache that was relieved by anti-hypertensive therapy. We reviewed the literature to evaluate the usual diagnostic workup performed in hypnic headache patients. We suggest that 24 h ambulatory blood pressure monitoring may be included in the evaluation of nocturnal headache complaints especially in the elderly, in whom essential hypertension is a very frequent comorbidity.

Headaches associated with refractive errors: myth or reality?

Introduction.—Headache and refractive errors are very common conditions in the general population, and those with headache often attribute their pain to a visual problem. The International Headache Society (IHS) criteria for the classification of headache includes an entity of headache associated with refractive errors (HARE), but indicates that its importance is widely overestimated.

Cognitive dysfunction during migraine attacks: A study on migraine without aura

Background Cognitive difficulties contribute to patients’ disability during migraine attacks and have been overlooked in migraine research. Neuropsychological studies performed during attacks have produced inconsistent findings due to design differences and limitations. Objective Our objective is to document changes in cognitive performance of migraine patients during migraine attacks with a comprehensive battery of cognitive/behavioral tests, while controlling for potential confounders. Method A prospective two-period, randomized, cross-over study compared within-subject neuropsychological evaluation in two conditions—during a naturally occurring untreated migraine attack and a headache-free period. Results Thirty-nine patients with episodic migraine (37 females, average 38 years old) were included and 24 completed the study. Participants performed worse during the attack in the majority of cognitive tests, compared to the headache-free status, and significantly so in word reading speed (p = 0.013), verbal learning (p = 0.01), short-term verbal recall with (p = 0.01) and without (p = 0.013) semantic cueing and delayed recall with (p = 0.003) and without (p = 0.05) semantic cues. Differences found were unrelated to age, gender, literacy, condition order, interval between evaluations, anxiety, pain intensity or duration of the attack. Discussion Cognitive performance decreases during migraine attacks, especially in reading and processing speed, verbal memory and learning, supporting patients’ subjective complaints. These findings suggest the existence of a reversible brain dysfunction during attacks of migraine without aura, which can relate specifically to migraine or be a consequence of acute pain processing by the brain.

Pleomorphic xanthoastrocytoma of the cerebellum: illustrated review

SummaryAlthough rarely, the usually benign, supratentorial, grade II astrocytic tumour pleomorphic xanthoastrocytoma (PXA) may arise from the cerebellum. A review of the published cases of these PXAs is made including the author’s own case of a 40 years-old man with a right cerebellopontine angle tumour, which recurred after a gross total resection.The major clinical and histopathological features of cerebellar PXAs are discussed, and factors playing a role in their biological behaviour, like post-surgical medical treatment, genetics and extent of leptomeningeal seeding are stressed.

Migraine, headaches, and cognition.

Objectives and Background.— The possible effects of migraine on executive abilities remain controversial; hence, we studied inter‐ictal cognitive performance of individuals with migraine and non migraine headaches (NMH) compared with headache free controls.

Neuropsychiatric Side-Effects of Lidocaine: Examples from the Treatment of Headache and a Review

Lidocaine has been used in treatment of patients with refractory headache. Personal observations of neuropsychiatric toxicity in these patients led us to review our cases and the literature systematically for lidocaine side-effects, especially neuropsychiatric symptoms. In our series of 20 patients, side-effects were observed in all, the most frequent being neuropsychiatric (75%) and cardiological (50%). When reviewing published series on intravenous lidocaine use, reports of side-effects range from 0 to 100%, with neuropsychiatric symptoms being reported in 1.8–100%. Thirty-six case reports of lidocaine-induced psychiatric symptoms were also analysed. Psychiatric symptoms of toxicity were similar in most patients, despite their differing ages, pathologies, co-therapies and lidocaine dosages. In conclusion, lidocaine neuropsychiatric toxicity has a well-recognized stereotypical clinical presentation that is probably unrecognized in headache series. As lidocaine represents an emerging alternative therapy in headache, particularly in short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing, clinicians and patients should be aware of the extent of this problem.

Validation of the Portuguese Version of ID‐Migraine™

(Headache 2010;50:396‐402)

Assessment of cognitive dysfunction during migraine attacks: a systematic review

Patients consistently report cognitive impairment during migraine attacks, yet the documentation of such dysfunction by neuropsychological evaluation has lacked similar consistency. This incongruence may be due to discrepant study designs, assessment tools and small samples sizes. To search for evidence of decline in cognitive functions during a migraine attack, compared to headache-free performance. The secondary objective was to determine if the eventual decline had a consistent neuropsychological pattern. Systematic review of the medical literature using PubMed and Cochrane library databases without limitations or restrictions from inception to March 2014, using the search terms “migraine”, “cognition”, “neuropsychological”. We included studies in episodic migraine that had a neuropsychological evaluation performed during an attack. From 1,023 titles screened, a total of 10 articles met criteria for inclusion and were fully reviewed. Only five of these studies, comprising a total of 163 individuals, had enough data to allow an appraisal of the study question. All five studies were positive in documenting some type of reversible cognitive impairment during the migraine attack. The pattern of cognitive impairment most often documented was of executive dysfunction, but the presence of bias induced by the choice of tests and of small samples prevents this finding from being conclusive. This review supports the existence of reversible cognitive dysfunction during the migraine attack, corroborating patients’ subjective descriptions. Further work is needed to establish the pattern of cognitive dysfunction, their underling pathophysiological mechanisms and the impact of these symptoms in migraine-associated disability.

A subjective cognitive impairment scale for migraine attacks. The MIG-SCOG: development and validation.

Background: The burden of migraine is determined by impairment during attacks due to pain or non-painful symptoms such as cognitive symptoms. Objective: Development of a questionnaire to measure self-reported subjective cognitive symptoms during migraine attacks. Methods: Item generation was accomplished through structured patient interviews analysed by a panel of experts. A set of 43 candidate items was applied to consecutive migraine patients. Test construction with factor analysis retained nine items. Internal consistency was assessed with Cronbach’s alpha and Spearman’s rho, and convergent and construct validity by correlation to spontaneous cognitive complaints, and the 43-item and the Cognitive Failures Questionnaires. Results: The nine-item Mig-SCog covers two domains, executive functions and language. Cronbach’s alpha was 0.82. It correlates with spontaneous cognitive complaints (p < 0.001), the 43-item (rho = 0.69) and the Cognitive Failures Questionnaires (rho = 0.61). Test–retest reliability (Cohen’s kappa) was 0.55. Conclusions: Mig-SCog is a valid, reliable, consistent working instrument of fast self-administration that quantifies subjective cognitive symptoms during migraine attacks.

Headaches during angiography and endovascular procedures

BackgroundThe occurrence of headaches during cerebral angiography or endovascular procedures is an ill-defined issue, as limited information is available to define its frequency, risk factors, pathogenesis and implications for future pain management.PurposeTo determine the frequency of headaches during endovascular procedures (HdEVP) and to define their characteristics and risk factors for their occurrence.MethodsProspective cross-sectional observational study of adult patients undertaking cerebral angiography or endovascular procedures, recording HdEVP clinical features, previous headache history and procedural variables.ResultsOne hundred and twenty two procedures were evaluated. HdEVP occurred in 13 patients, both in diagnostic and therapeutic procedures. Pain was described as brief, stabbing or localized pressure of mild to moderate intensity, felt ipsilaterally to the manipulated vessel. Its occurrence was associated with therapeutic interventions (p = 0.007), female gender (p = 0.015) and previous history of more than 4 headache episodes per month (p = 0.018).ConclusionHdEVP is an uncommon brief headache that should be further evaluated in the future. Its pathogenesis is probably related to mechanical vessel distension, which activates the trigeminovascular nociceptive system in susceptible individuals.