William B. Young

Hemicrania continua is not that rare

Background: Hemicrania continua is an indomethacin-responsive headache disorder characterized by a continuous, moderate to severe, unilateral headache. More than 90 cases of hemicrania continua have been reported, but there is still uncertainty about its clinical features. Methods: The authors compared 34 new cases (24 women, 10 men) with previously reported cases. All the patients met Goadsby and Lipton’s proposed criteria. The authors compared baseline (continuous background headache) and exacerbation (attacks of severe periods of headaches). Results: The baseline headache was typically mild to moderate in intensity and usually not associated with severe disability. In contrast, the headache exacerbations were severe and associated with photophobia, phonophobia, nausea, and disability. At least one autonomic symptom was present in 25 patients (74%). Jabs and jolts were present in 14 patients (41%). The mean indomethacin dose was 136.7 ± 60 mg (range 25 to 225 mg). Twenty-four patients (70.6%) met International Headache Society criteria for migraine in their exacerbation period. Occipital tenderness was observed in 23 patients (67.6%). The temporal pattern was remitting in four patients (11.8%), continuous from onset in 18 (52.9%), and continuous evolving from remitting in 12 (35.3%). Conclusion: Hemicrania continua is not a rare disorder. All cases of chronic unilateral daily headaches should receive an indomethacin trial early if not first in treatment.

Greater occipital nerve blockade for cluster headache

Cluster headache is perhaps the most painful of the primary headache disorders. Its treatment includes acute, transitional, and preventive therapy. Despite the availability of many treatments, cluster headache patients can still be difficult to treat. We treated 14 cluster headache patients with greater occipital nerve block as transitional therapy (treatment initiated at the same time as preventive therapy). The mean number of headache-free days was 13.1+23.6. Four patients (28.5%) had a good response, five (35.7%) a moderate, and five (35.7%) no response. The greater occipital nerve block was well tolerated with no adverse events. Headache intensity, frequency and duration were significantly decreased comparing the week before with the week after the nerve block (P< 0.003, P = 0.003, P< 0.005, respectively). Greater occipital nerve blockade is a therapeutic option for the transitional treatment of cluster headache.

Quality-of-life differences between patients with episodic and transformed migraine.

Objective.—To determine whether there are any differences in health‐related quality of life between patients with migraine and those with transformed migraine.

Idiopathic intracranial hypertension without papilledema A case-control study in a headache center

Objective: To compare the clinical features of patients with chronic daily headache(CDH) with idiopathic intracranial hypertension without papilledema (IIHWOP) to those with normal CSF pressure. Methods: A case-control study was conducted at a tertiary headache center. Cases consisted of 25 consecutive patients (24 women, 1 man, 38 ± 6 years) with IIHWOP diagnosed between June 1989 and June 1996. IIHWOP was diagnosed if pressure was 200 mm CSF on two occasions and there was no papilledema. Control subjects consisted of patients with refractory CDH who had normal CSF pressure on lumbar puncture performed between June 1992 and June 1996 (n = 60, 50 women, 10 men, 36 ± 11 years). A structured telephone follow-up was done from July 1996 to March 1997. Comparisons made between the two groups included demographics and headache profiles, both at the initial evaluation and at follow-up. Results: The initial headache characteristics did not differ between the two groups: most had transformed migraine with analgesic overuse. Significant predictors of IIHWOP included pulsatile tinnitus (odds ratio [OR] = 13.0) and obesity (OR = 4.4). Visual symptoms did not differ significantly. The prognosis of the two groups of patients was similar. Conclusions: Pulsatile tinnitus and obesity suggest possible IIHWOP in patients with CDH. Treatment of patients with increased intracranial pressure was not satisfactory.

Cluster headache with aura

Article abstract Cluster headache with aura is rare. The authors retrospectively reviewed 101 cluster headache patient charts at the Jefferson Headache Center. Six patients had an associated aura, five visual and one olfactory, lasting 5 to 120 minutes. Only one had migraine (without aura). Auras always occurred with or were followed by a severe cluster headache. Two patients were related.

Open label trial of coenzyme Q10 as a migraine preventive

The objective was to assess the efficacy of coenzyme Q10 as a preventive treatment for migraine headaches. Thirty-two patients (26 women, 6 men) with a history of episodic migraine with or without aura were treated with coenzyme Q10 at a dose of 150 mg per day. Thirty-one of 32 patients completed the study; 61.3% of patients had a greater than 50% reduction in number of days with migraine headache. The average number of days with migraine during the baseline period was 7.34 and this decreased to 2.95 after 3 months of therapy, which was a statistically significant response (P < 0.0001). Mean reduction in migraine frequency after 1 month of treatment was 13.1% and this increased to 55.3% by the end of 3 months. Mean migraine attack frequency was 4.85 during the baseline period and this decreased to 2.81 attacks by the end of the study period, which was a statistically significant response (P < 0.001). There were no side-effects noted with coenzyme Q10. From this open label investigation coenzyme Q10 appears to be a good migraine preventive. Placebo-controlled trials are now necessary to determine the true efficacy of coenzyme Q10 in migraine prevention.

Fibromyalgia is common in patients with transformed migraine

Fibromyalgia (FM) and transformed migraine (TM) are common chronic pain disorders. The authors estimated the prevalence of FM in 101 patients with TM, and analyzed its relationship to depression, anxiety, and insomnia. FM was diagnosed in 35.6% of cases. Patients with FM had more insomnia, were older, and had headaches that were more incapacitating than patients without FM. Insomnia and depression predicted FM in patients with TM.

The Effects of Greater Occipital Nerve Block and Trigger Point Injection on Brush Allodynia and Pain in Migraine

Objective.—To evaluate the effect of GONB, with or without trigger point injection (TPI), on dynamic mechanical (brush) allodynia (BA) and on head pain in migraine.

Expert consensus recommendations for the performance of peripheral nerve blocks for headaches - A narrative review

To describe a standardized methodology for the performance of peripheral nerve blocks (PNBs) in the treatment of headache disorders.

Olanzapine in the Treatment of Refractory Migraine and Chronic Daily Headache

Background.—Olanzapine, a thienobenzodiazepine, is a new “atypical” antipsychotic drug. Olanzapines pharmacologic properties suggest it would be effective for headaches, and its propensity for inducing acute extrapyramidal reactions or tardive dyskinesia is relatively low. We thus decided to assess the value of olanzapine in the treatment of chronic refractory headache.