The case of a 38- year-old woman with continuous unilateral side-locked headache is reported. She had continuous right-sided periorbital pain of mild to moderate intensity for the past 5 months. She also reported a fe...The case of a 38- year-old woman with continuous unilateral side-locked headache is reported. She had continuous right-sided periorbital pain of mild to moderate intensity for the past 5 months. She also reported a few episodes of pain exacerbations every day. She had no autonomic features. Based on a normal CT scan ordered by her general physician, we started indomethacin (150 mg/day) as well as celecoxib (400 mg/day) for 2 weeks, without relief. Oral prednisone for 6 days provided important relief, and she stayed on daily use of steroids, refusing other forms of therapy. After 5 months she developed orbital and eyelid edema, with painful restrictions to eye movement. Orbital MRI and pathological exam demonstrated inflammatory orbital pseudotumor (myositic form).展开更多
Objectives.- To compare the second edition of the International Classificati on of Headache Disorders (ICHD- 2) and the Silberstein- Lipton (S- L) criteri a in the classification of adolescents with chronic daily head...Objectives.- To compare the second edition of the International Classificati on of Headache Disorders (ICHD- 2) and the Silberstein- Lipton (S- L) criteri a in the classification of adolescents with chronic daily headache (CDH). Method s.- We reviewed the clinical records and the headache diaries of 170 adolescent s (13 to 17 years) seen between 1998 and 2003 at a headache center. Relevant inf ormation was transferred to a standardized form that included operational criter ia for the ICHD- 2. CDH subtypes were classified according the criteria propose d by S- L into transformed migraine (TM) with (TM+ ) and without medication ov eruse (TM- ), chronic tension- type headache (C- TTH), new daily persistent h eadache (NDPH), and he micrania continua (HC). Results.- From the 69 patients with TM- according t he S- L criteria, most (71% ) could be classified as chronic migraine (CM), wh ile a minority of patients required a combination of diagnosis, mainly migraine and CTTH (14.4% ). Of the patients with TM+ , just 39.6% met the criteria fo r probable CM (PCM) with probable medication overuse (PMO). If instead of 15 mig raine days per month, we considered 15 or more days of migraine or probable migr aine, 84% of the subjects with TM- and 68.7% of those with TM+ could be classified. Of the 27 subjects classified as NDPH without medication overuse acc ording to the S- L system, the majority (51.2% ) were also classified as NDPH according the ICHD- 2. Interestingly, three (11.1% of the subjects with NDPH without medication overuse) were classified as CM in the ICHD- 2 because these patients had an abrupt onset of 15 or more days of migraine per month. All patie nts with NDPH with medication overuse according to the S- L criteria required a combination of diagnoses in the ICHD- 2. All subjects with CTTH received a sin gle diagnosis in both classification systems. Conclusions.- (i) Among adolescen ts with TM, the majority (58.1% ) could be classified as CM, according to the I CHD- 2. These results were driven by TM without medication overuse, (ii) If the ICHD- 2 criteria for CM are revised to require 15 days of migraine or probable migraine, the proportion of patients with TM- who meet the criteria for CM inc reases from 71% to 84% ; for TM+ , the proportion with probable chronic migr aine and PMO increases from 30% to 68% . (iii) About half of the patients wit h NDPH according to the S- L criteria have too many migraine features to meet I CHD- 2 criteria for NDPH.展开更多
Contact point headaches have been attributed to intranasal contact between opp osing mucosal surfaces, resulting in referred pain in the distribution of the tr igeminal nerve. In subjects with primary headaches, conta...Contact point headaches have been attributed to intranasal contact between opp osing mucosal surfaces, resulting in referred pain in the distribution of the tr igeminal nerve. In subjects with primary headaches, contact points may be associ ated with treatment refractoriness. We aimed to assess the benefits of surgical correction in patients with refractory migraine or transformed migraine, and rad iographic evidence of contact points in the sinonasal area. We reviewed charts o f patients who underwent endoscopic sinus surgery and septoplasty for contact po int in the same surgical facility, from October 1998 through August 2003. Subjec ts eligible for surgery had: (i) refractory migraine (failed to standard pharmac ological headache treatments) or refractory transformed migraine; (ii) contact p oints demonstrated by computed tomography scan; (iii) reported significant heada che improvement after topical anaesthesia to the contact area. Headache characte ristics were assessed preoperatively and at follow-up (6-62 months after surge ry) using a standardized questionnaire. A total of 21 subjects (72.5%women) wer e assessed. Mean headache frequency was reduced from 17.7 to 7.7 headache days p er month (P=0.003). Mean headache severity was reduced from 7.8 to 3.6 on a 0-1 0 scale (P=0.0001). Headache-related disability was reduced from 5.6 (10-point scale) to 1.8 (P < 0.0001). A total of 16 subjects (76.2%) had their headache scores improved by 50%or more; nine (42.9%) were pain free at the last follow -up. A total of 18 (95.8%) had at least a 25%reduction in their headache scor es. Two patients (9.5%) had increase in their headache score by less than 25%. For selected patients with refractory headaches, demonstrable contact points, a nd positive response after topical anaesthesia, surgical approach toward the tri ggering factor may be useful. Prospective studies are necessary to confirm our r esults.展开更多
Background: Chronic migraine (CM) is characterized by 15 or more migraine days per month. Most adults with chronic daily headache (CDH) that evolved from migraine have < 15 days of migraine/month. They are often cl...Background: Chronic migraine (CM) is characterized by 15 or more migraine days per month. Most adults with chronic daily headache (CDH) that evolved from migraine have < 15 days of migraine/month. They are often classified as transformed migraine (TM), a disorder not addressed in the International Headache Society cl assification. Objective: To test the hypothesis that early in the course of migr aine chronification, the frequency of migraine attacks is high and that as illne ss progresses the frequency of nonmigraine headaches increases. Methods: Informa tion was collected on 402 adults with TM and was divided into two groups. Group 1 TM had a 15 days of migraine/month, whereas Group 2 TM had < 15 days of migrai ne/month. Risk factors were modeled for number of migraine days per month using logistic regression. Results: Of 402 subjects with TM, 121 (30.1%) were in Grou p 1. The proportion of Group 1 subjects decreased with age, from 71%below age 3 0 to 22%age 60 or above. The correspondent proportion of Group 2 increased from 29 to 78%. More than 15 days of migraine per month was independently predicted by younger ages ( < 40 years; p = 0.002), shorter interval from episodic to CDH ( < 5 years; p = 0.003), and shorter time since the development of CDH ( < 6 ye ars; p < 0.0001). Conclusion: Chronic migraine is an earlier stage of transforme d migraine.展开更多
文摘The case of a 38- year-old woman with continuous unilateral side-locked headache is reported. She had continuous right-sided periorbital pain of mild to moderate intensity for the past 5 months. She also reported a few episodes of pain exacerbations every day. She had no autonomic features. Based on a normal CT scan ordered by her general physician, we started indomethacin (150 mg/day) as well as celecoxib (400 mg/day) for 2 weeks, without relief. Oral prednisone for 6 days provided important relief, and she stayed on daily use of steroids, refusing other forms of therapy. After 5 months she developed orbital and eyelid edema, with painful restrictions to eye movement. Orbital MRI and pathological exam demonstrated inflammatory orbital pseudotumor (myositic form).
文摘Objectives.- To compare the second edition of the International Classificati on of Headache Disorders (ICHD- 2) and the Silberstein- Lipton (S- L) criteri a in the classification of adolescents with chronic daily headache (CDH). Method s.- We reviewed the clinical records and the headache diaries of 170 adolescent s (13 to 17 years) seen between 1998 and 2003 at a headache center. Relevant inf ormation was transferred to a standardized form that included operational criter ia for the ICHD- 2. CDH subtypes were classified according the criteria propose d by S- L into transformed migraine (TM) with (TM+ ) and without medication ov eruse (TM- ), chronic tension- type headache (C- TTH), new daily persistent h eadache (NDPH), and he micrania continua (HC). Results.- From the 69 patients with TM- according t he S- L criteria, most (71% ) could be classified as chronic migraine (CM), wh ile a minority of patients required a combination of diagnosis, mainly migraine and CTTH (14.4% ). Of the patients with TM+ , just 39.6% met the criteria fo r probable CM (PCM) with probable medication overuse (PMO). If instead of 15 mig raine days per month, we considered 15 or more days of migraine or probable migr aine, 84% of the subjects with TM- and 68.7% of those with TM+ could be classified. Of the 27 subjects classified as NDPH without medication overuse acc ording to the S- L system, the majority (51.2% ) were also classified as NDPH according the ICHD- 2. Interestingly, three (11.1% of the subjects with NDPH without medication overuse) were classified as CM in the ICHD- 2 because these patients had an abrupt onset of 15 or more days of migraine per month. All patie nts with NDPH with medication overuse according to the S- L criteria required a combination of diagnoses in the ICHD- 2. All subjects with CTTH received a sin gle diagnosis in both classification systems. Conclusions.- (i) Among adolescen ts with TM, the majority (58.1% ) could be classified as CM, according to the I CHD- 2. These results were driven by TM without medication overuse, (ii) If the ICHD- 2 criteria for CM are revised to require 15 days of migraine or probable migraine, the proportion of patients with TM- who meet the criteria for CM inc reases from 71% to 84% ; for TM+ , the proportion with probable chronic migr aine and PMO increases from 30% to 68% . (iii) About half of the patients wit h NDPH according to the S- L criteria have too many migraine features to meet I CHD- 2 criteria for NDPH.
文摘Contact point headaches have been attributed to intranasal contact between opp osing mucosal surfaces, resulting in referred pain in the distribution of the tr igeminal nerve. In subjects with primary headaches, contact points may be associ ated with treatment refractoriness. We aimed to assess the benefits of surgical correction in patients with refractory migraine or transformed migraine, and rad iographic evidence of contact points in the sinonasal area. We reviewed charts o f patients who underwent endoscopic sinus surgery and septoplasty for contact po int in the same surgical facility, from October 1998 through August 2003. Subjec ts eligible for surgery had: (i) refractory migraine (failed to standard pharmac ological headache treatments) or refractory transformed migraine; (ii) contact p oints demonstrated by computed tomography scan; (iii) reported significant heada che improvement after topical anaesthesia to the contact area. Headache characte ristics were assessed preoperatively and at follow-up (6-62 months after surge ry) using a standardized questionnaire. A total of 21 subjects (72.5%women) wer e assessed. Mean headache frequency was reduced from 17.7 to 7.7 headache days p er month (P=0.003). Mean headache severity was reduced from 7.8 to 3.6 on a 0-1 0 scale (P=0.0001). Headache-related disability was reduced from 5.6 (10-point scale) to 1.8 (P < 0.0001). A total of 16 subjects (76.2%) had their headache scores improved by 50%or more; nine (42.9%) were pain free at the last follow -up. A total of 18 (95.8%) had at least a 25%reduction in their headache scor es. Two patients (9.5%) had increase in their headache score by less than 25%. For selected patients with refractory headaches, demonstrable contact points, a nd positive response after topical anaesthesia, surgical approach toward the tri ggering factor may be useful. Prospective studies are necessary to confirm our r esults.
文摘Background: Chronic migraine (CM) is characterized by 15 or more migraine days per month. Most adults with chronic daily headache (CDH) that evolved from migraine have < 15 days of migraine/month. They are often classified as transformed migraine (TM), a disorder not addressed in the International Headache Society cl assification. Objective: To test the hypothesis that early in the course of migr aine chronification, the frequency of migraine attacks is high and that as illne ss progresses the frequency of nonmigraine headaches increases. Methods: Informa tion was collected on 402 adults with TM and was divided into two groups. Group 1 TM had a 15 days of migraine/month, whereas Group 2 TM had < 15 days of migrai ne/month. Risk factors were modeled for number of migraine days per month using logistic regression. Results: Of 402 subjects with TM, 121 (30.1%) were in Grou p 1. The proportion of Group 1 subjects decreased with age, from 71%below age 3 0 to 22%age 60 or above. The correspondent proportion of Group 2 increased from 29 to 78%. More than 15 days of migraine per month was independently predicted by younger ages ( < 40 years; p = 0.002), shorter interval from episodic to CDH ( < 5 years; p = 0.003), and shorter time since the development of CDH ( < 6 ye ars; p < 0.0001). Conclusion: Chronic migraine is an earlier stage of transforme d migraine.
