Full recovery from chronic headache and hypopituitarism caused by lymphocytic hypophysitis:A case report

BACKGROUND Lymphocytic hypophysitis(LYH)is an important condition to consider in the differential diagnosis of patients with a pituitary mass.The main clinical manifestations of LYH include headache,symptoms related to sellar compression,hypopituitarism,diabetes insipidus and hyperprolactinemia.Headache,which is a frequent complaint of patients with LYH,is thought to be related to the occupying effect of the pituitary mass and is rapidly resolved with a good outcome after timely and adequate glucocorticoid treatment or surgery.CASE SUMMARY Here,we report a patient with LYH whose initial symptom was headache and whose pituitary function assessment showed the presence of secondary hypoadrenalism,central hypothyroidism and hypogonadotropic hypogonadism.Pituitary magnetic resonance imaging showed symmetrical enlargement of the pituitary gland with suprasellar extension in a dumbbell shape with significant homogeneous enhancement after gadolinium enhancement.The size of the gland was approximately 17.7 mm×14.3 mm×13.8 mm.The pituitary stalk was thickened without deviation,and there was an elevation of the optimal crossing.The lesion grew bilaterally toward the cavernous sinuses,and the parasternal dural caudal sign was visible.The patient presented with repeatedly worsening and prolonged headaches three times even though the hypopituitarism had fully resolved after glucocorticoid treatment during this course.CONCLUSION This rare headache regression suggests that patients with chronic headaches should also be alerted to the possibility of LYH.

Exploring cerebral structural and functional abnormalities in a mouse model of post-traumatic headache induced by mild traumatic brain injury

Mild traumatic brain injury(mTBI)-induced post-traumatic headache(PTH)is a pressing public health concern and leading cause of disability worldwide.Although PTH is often accompanied by neurological disorders,the exact underlying mechanism remains largely unknown.Identifying potential biomarkers may prompt the diagnosis and development of effective treatments for mTBI-induced PTH.In this study,a mouse model of mTBI-induced PTH was established to investigate its effects on cerebral structure and function during short-term recovery.Results indicated that mice with mTBI-induced PTH exhibited balance deficits during the early post-injury stage.Metabolic kinetics revealed that variations in neurotransmitters were most prominent in the cerebellum,temporal lobe/cortex,and hippocampal regions during the early stages of PTH.Additionally,variations in brain functional activities and connectivity were further detected in the early stage of PTH,particularly in the cerebellum and temporal cortex,suggesting that these regions play central roles in the mechanism underlying PTH.Moreover,our results suggested that GABA and glutamate may serve as potential diagnostic or prognostic biomarkers for PTH.Future studies should explore the specific neural circuits involved in the regulation of PTH by the cerebellum and temporal cortex,with these two regions potentially utilized as targets for non-invasive stimulation in future clinical treatment.

Impact of Tension-Type Headaches in the Workplace in Brazzaville

Introduction: Tension-type headaches are the most widespread of the primary headache disorders. Due to their high prevalence, tension-type headaches represent a major public health problem with an enormous socio-economic burden. Determining their impact remains a challenge. Objective: To assess the impact of occupational tension-type headache in Brazzaville and identify associated factors. Population and Methods: This was an analytical case-control study conducted in public and private companies in the city of Brazzaville over a period of four (04) months. The case population consisted of cephalalgic employees;the control population was drawn from the same companies and was free of tension-type headaches. Study variables were divided into socio-professional, clinical and individual impact variables. Individual impact variables were represented by: the HIT-6 score, which incorporates a very broad conception of disability, covering several domains, namely: severity of pain during attacks and the restrictive and limiting nature of attacks. Results: Individual impact was severe in 18 (62.1%) men and 11 (37.9%) women. Mean age was 36.3 6.14 years for cases with severe impact. The mean duration of headache was 40.3 32.7 months for cases with severe impact. Tension headache evolved in attacks in 22 (75.9%) cases with severe impact, and continuously in seven (24.1%) cases. The average number of attacks per month was 2.52 1.04 for cases with severe impact. Cases with severe impact included 14 (48.3%) with chronic headache and 15 (51.7%) with episodic headache. Pain of severe intensity present in 48.3% of cases was associated with a severe impact of tension-type headache: OR = 151.66 [2.36 - 44245.95] and p-value = 0.037. At least one days absence from work per year was observed in 47.4% of our cases. The number of days off work per year due to tension-type headache had an interquartile range between 0 and 3 days and extremes from 0 to 14 days. It was the consequence of a severe impact on daily and/or professional activities. Conclusion: The high frequency of tension-type headaches in the workplace and its impact on the condition of workers in Brazzaville represent a real public health problem. It was found that the number of days absent from work per year due to tension headaches was the consequence of a severe impact on daily and/or professional activities. An awareness-raising program in this environment seems necessary, as well as an assessment of working conditions.

Retrospective Analysis of the Correlation between TMD, Headache and Bruxism

Aims: To evaluate the association between bruxism, headaches, and temporomandibular disorder (TMD). Methods: A keyword search of the clinical notes of patients’ charts in AxiUmTM was performed using the search terms “TMD”, “headache”, and “sleep bruxism” to identify these patients. The inclusion criteria were patients with partial of full dentition, aged 18 to 65 years old who attended the UNLV School of Dental Medicine clinics between January 2014 and September 2018. Patients with incomplete records and those who were completely edentulous formed the exclusion criteria. Data were analyzed using the Pearson Correlation Coefficient. Results: The final sample was made up of 529 patients. The highest percentage of study subjects were in the age range of 29 - 34 (17.9%), with a statistically significant correlation to pain on opening (P = 0.0403). Females showed a statistically significant correlation to TMJ clicking (P = 0.0033). Caucasians also had a statistically significant correlation to TMJ clicking (P = 0.0001). In addition, a statistically significant correlation between pain on opening or chewing and headaches was also observed (P = 0.0081). Conclusion: Within the limitations of the present study, Caucasians, and females presented with more TMJ clicking than the other study subjects. Young adults, in particular, experienced more pain on opening or chewing.

Ultrasound-Guided Greater Occipital Nerve Hydrodissection for Treatment of Cervicogenic Headache: A Case Report

We describe an innovative technique of ultrasound-guided greater occipital nerve (GON) hydrodissection for treatment of cervicogenic headache and occipital neuralgia. A 35-year-old female presented to the pain clinic with severe chronic cervicogenic headache impacting her sleep, work and activities of daily living. Conservative management had failed to adequately resolve her pain. Ultrasound-guided suboccipital hydrodissection of the greater occipital nerve was performed with the patient in the prone position. After skin sterilization, the linear ultrasound transducer was oriented in a transverse orientation at the level of the C2-C3 vertebrae. The needle was advanced from medial to lateral “in-plane” under direct ultrasound visualization, until the needle was positioned at the C2 lamina. After confirming the needle tip position, 10 ml of hydrodissection fluid was injected with good visualization of distribution of the solution. The patient described immediate and significant improvement in her symptoms. She reported a sustained decrease in pain scores when followed up in the pain clinic at six and twelve weeks respectively. To the best of our knowledge this is the first application of ultrasound-guided hydrodissection of the GON for cervicogenic headache. It offers a novel, safe and effective technique to aid in the diagnosis and treatment of a common pain condition.

Headaches and Erectile Dysfunction Medications at UTH-Kara (Togo)

Introduction: Headaches are a common symptom affecting individuals worldwide, including in the tropical zone, and have been extensively studied in Togo. Phosphodiesterase-5 inhibitors, commonly prescribed for erectile dysfunction, are known to induce headaches, yet there is a lack of research on this topic in sub-Saharan Africa and Togo. Methods: A cross-sectional study conducted from February 1st to June 30th, 2023, including adult patients seeking erectile dysfunction treatment and prescribed PDE-5 inhibitors. Results: A total of 28 patients were included in the study, with an average age of 34.46 ± 7.5 years. The age group of 30 - 39 years was the most represented (53.57%). Among the participants, 67.86% had a history of chronic headaches. During the intake of PDE-5 inhibitors, 71.43% reported the onset of headaches. Among the 19 patients with chronic headaches, 68.42% developed headaches following PDE-5 inhibitor use (RR = 0.88, 95% CI: 0.55 - 1.40, p = 0.484). The characteristics of the induced headaches were similar to the patients’ pre-existing headaches in 78.95% of cases. Additional symptoms included nasal congestion (36.84%) and an urge to have a bowel movement (26.32%). Sildenafil (75.00%) and Tadalafil (25.00%) were the primarily prescribed PDE-5 inhibitors. The incidence of headaches did not significantly differ between the two groups (RR = 1.33, 95% CI: 0.67 - 2.64, p = 0.306). Treatment for the induced headaches involved self-medication with paracetamol (65.00%) and nonsteroidal anti-inflammatory drugs (NSAIDs) (35.00%). Conclusion: Headaches induced by PDE-5 inhibitors are a well-established reality, emphasizing the need for caution and warning in patients with pre-existing headache conditions, while individualized approaches are necessary to address the potential interplay between migraine medications and erectile dysfunction treatments.

Mechanism of Scalp Acupuncture Combined with Distal Acupoint Selection in the Treatment of Vascular Headache Caused by Hyperactivity of Liver-Yang

The clinical effect of acupuncture on vascular headache caused by hyperactivity of liver-yang has been shown, but the specific mechanism is not yet clear. This paper is intended to discuss the etiology and pathogenesis of vascular headache caused by hyperactivity of liver-yang and the mechanism of acupuncture, so as to provide a certain reference for clinical diagnosis and treatment of scalp acupuncture treatment of vascular headache caused by hyperactivity of liver-yang.

Myeloperoxidase-antineutrophil cytoplasmic antibody-associated vasculitis with headache and kidney involvement at presentation and with arthralgia at relapse:A case report

BACKGROUND Patients with proteinase 3-antineutrophil cytoplasmic antibody associated vasculitis(AAV)experience different manifestations at the initial onset and relapse.However,such cases of different initial and relapse manifestations have not been reported in myeloperoxidase(MPO)-AAV patients.CASE SUMMARY A 52-year-old woman was admitted to our hospital because of headache.Laboratory findings indicated nephrotic range proteinuria and microscopic hematuria,serum creatinine of 243μmol/L,anti-MPO antibody titer of>400 RU/mL,and positive perinuclearantineutrophil cytoplasmic antibody.Renal biopsy showed pauci-immune crescentic glomerulonephritis.The cerebrospinal fluid examination and brain magnetic resonance imaging did not show any abnormality.Therefore,MPO-AAV was diagnosed.Corticosteroids,plasmapheresis,and cyclophosphamide as induction therapy and mycophenolate mofetil(MMF)as maintenance therapy were administered.The patient’s headache disappeared;serum creatinine returned to normal;complete remission of microscopic hematuria and proteinuria was observed.Anti-MPO antibody titer reached normal limits after immunosuppressive treatment.Twenty-five months after stopping the immunosuppressive treatment,the patient relapsed with arthralgia,without neurological or renal involvement.The patient’s arthralgia improved after treatment with prednisone and MMF.CONCLUSION We have reported a rare case of MPO-AAV who initially presented with headache and kidney involvement.However,relapse presented with only arthralgia,which was completely different from the initial manifestations.This case suggests that AAV relapse should be highly suspected in MPO-AAV patients after remission,when clinical manifestations at relapse are different from those at onset.Prednisone and MMF may provide a good choice for refractory arthralgia during relapse in MPO-AAV patients.

Exploring the mechanism of action of Wuzhuyu Decoction for vascular headache based on network pharmacology and molecular docking

Background:The aim of this study is to explore the mechanism by which Wuzhuyu Decoction treats vascular headache.Methods:We utilized the TCMSP database to identify active ingredients and targets of the Chinese herbal medicine,and the Gendcars,OMIM,PharmGKB,TTD,and DrugBank databases were used to screen for disease targets.We constructed the PPI network of targets by utilizing the String database,and GO and KEGG analyses were performed.The"drug-ingredient-target-disease"network diagram was constructed using Cytoscape 3.8.0 software.We analyzed the topological parameters to identify the primary active ingredients and targets of Wuzhuyu Decoction,and subsequently confirmed the findings via molecular docking.Results:A total of 86 active ingredients were obtained,including Quercetin,Kaempferol,Beta-sitosterol,Stigmasterol,and Nuciferin.Fourteen core targets were identified,including JUN,TP53,AKT1,RELA,MAPK1,MAPK14,MYC,MAPK8,CCND1,ESR1,CTNNB1,FOS,NR3C1,and RB1.GO enrichment analysis involved biological processes such as response to drug,response to lipopolysaccharide,and response to molecule of bacterial origin.The cellular components were membrane raft and membrane microdomain,and the molecular functions were catecholamine binding and nuclear receptor activity.The KEGG pathway enrichment analysis demonstrated the potential regulation of 171 pathways by Wuzhuyu Decoction.including the Lipid and atherosclerosis signaling pathway,the Fluid shear stress and atherosclerosis signaling pathway,and the PI3K-AKT signaling pathway.Molecular docking showed that Nuciferin had good binding activity with AKT1(-9.9 kJ/mol),as did Quercetin with AKT1(-9.8 kJ/mol),Stigmasterol with MAPK1(-9.7 kJ/mol),and Kaempferol with AKT1(-9.5 kJ/mol).Conclusion:Wuzhuyu Decoction may exert its therapeutic effect on vascular headache by inhibiting neurogenic inflammation,providing analgesia,and modulating the immune system.

Glucose metabolism profile recorded by flash glucose monitoring system in patients with hypopituitarism during prednisone replacement

BACKGROUND Commonly used glucocorticoids replacement regimens in patients with hypopituitarism have difficulty mimicking physiological cortisol rhythms and are usually accompanied by risks of over-treatment,with adverse effects on glucose metabolism.Disorders associated with glucose metabolism are established risk factors of cardiovascular events,one of the life-threatening ramifications.AIM To investigate the glycometabolism profile in patients with hypopituitarism receiving prednisone(Pred)replacement,and to clarify the impacts of different Pred doses on glycometabolism and consequent adverse cardiovascular outcomes.METHODS Twenty patients with hypopituitarism receiving Pred replacement[patient group(PG)]and 20 normal controls(NCs)were recruited.A flash glucose monitoring system was used to record continuous glucose levels during the day,which provided information on glucose-target-rate,glucose variability(GV),period glucose level,and hypoglycemia occurrence at certain periods.Islet β-cell function was also assessed.Based on the administered Pred dose per day,the PG was then regrouped into Pred>5 mg/d and Pred≤5 mg/d subgroups.Comparative analysis was carried out between the PG and NCs.RESULTS Significantly altered glucose metabolism profiles were identified in the PG.This includes significant reductions in glucose-target-rate and nocturnal glucose level,along with elevations in GV,hypoglycemia occurrence and postprandial glucose level,when compared with those in NCs.Subgroup analysis indicated more significant glucose metabolism impairment in the Pred>5 mg/d group,including significantly decreased glucose-target-rate and nocturnal glucose level,along with increased GV,hypoglycemia occurrence,and postprandial glucose level.With regard to islet β-cell function,PG showed significant difference in homeostasis model assessment(HOMA)-β compared with that of NCs;a notable difference in HOMA-βwas identified in Pred>5 mg/d group when compared with those of NCs;as for Pred≤5 mg/d group,significant differences were found in HOMA-β,and fasting glucose/insulin ratio when compared with NCs.CONCLUSION Our results demonstrated that Pred replacement disrupted glycometabolic homeostasis in patients with hypopituitarism.A Pred dose of>5 mg/d seemed to cause more adverse effects on glycometabolism than a dose of≤5 mg/d.Comprehensive and accurate evaluation is necessary to consider a suitable Pred replacement regimen,wherein,flash glucose monitoring system is a kind of promising and reliable assessment device.The present data allows us to thoroughly examine our modern treatment standards,especially in difficult cases such as hormonal replacement mimicking delicate natural cycles,in conditions such as diabetes mellitus that are rapidly growing in worldwide prevalence.

Cluster headache due to structural lesions: A systematic review of published cases

BACKGROUND Cluster headache(CH)is a severe incapacitating headache disorder.By definition,its diagnosis must exclude possible underlying structural conditions.AIM To review available information on CLH caused by structural lesions and to provide better guides in the distinguishing process and to ensure that there is not a potentially treatable structural lesion.METHODS We conducted a systematic review of 77 published cases of symptomatic CH and cluster-like headache(CLH)in PubMed and Google Scholar databases.RESULTS Structural pathologies associated with CH were vascular(37.7%),tumoral(32.5%)and inflammatory(27.2%).Brain mass-like lesions(tumoural and inflammatory)were the most common diseases(28.6%),among which 77.3%lesions were at the suprasellar(pituitary)region.Cases of secondary CH related to sinusitis rose dramatically,occupying 19.5%.The third most common disease was internal carotid artery dissection,accounting for 14.3%.Atypical clinical features raise an early suspicion of a secondary cause:Late age at onset and eye and retroorbital pains were common conditions requiring careful evaluation and were present in at least one-third of cases.Abnormal neurological examination was the most significant red flag for impaired cranial nerves.CLH patients may be responsive to typical CH treatments;therefore,the treatment response is not specific.CLH can be triggered by contralateral structural pathologies.CLH associated with sinusitis and cerebral venous thrombosis required more attention.CONCLUSION Since secondary headache could perfectly mimick primary CH,neuroimaging should be conducted in patients in whom primary and secondary headaches are suspected.Cerebral magnetic resonance imaging scans is the diagnostic management of choice,and further examinations include vessel imaging with contrast agents and dedicated scans focusing on specific cerebral areas(sinuses,ocular and sellar regions).Neuroimaging is as necessary at follow-up visits as at the first observation.

Efficacy and Effect of SI17 Therapy on Pancreatic Polypeptide in Vascular and Tension-Type Headache

Background and purpose: Vascular and tension-type headache is most commonly encountered, and SI17 therapy has been tested to treat headache with good results. The efficacy of SI17 therapy for vascular and tension-type headache was compared and the effect of SI17 therapy on pancreatic polypeptide (PP) was studied. Materials and methods: 29 cases of vascular headache (20 cases in acute attack during the trial) and 27 cases of tension-type headache (19 cases in acute attack) were enrolled in the study. Plasma PP level before and 4th day after treatment was measured by radioimmunoassay. Results: SI17 therapy is better for the treatment of vascular headache. Vascular headache with higher PP level and tension-type headache with normal PP level had good therapeutic results. Conclusion: The clinical efficacy is better for vascular headache with the increase of vagus tension and for tension-type headache with normal vagus tension.

Case Studies on Acupuncture Principles in Headaches

Objective:This observational cohort pilot study aimed to evaluate the effects of the acupuncture methods,Jiu Cang Zhen(JCZ)and Huang Guan(HG),on changes in headache intensity in an inpatient,multimodal Zurzach Headache Programme(ZHP).Methods:Study participants consisted of patients diagnosed with chronic headache disorder(headache ds,30 days per month)or daily persistent headache.All patients received conventional therapies with active and passive approaches.The patient group was treated with JCZ and HG acupuncture methods,receiving a total of six to eight acupuncture sessions of 50 to 60 minutes each,during a 3–4-week multimodal ZHP at the RehaClinic Bad Zurzach.Pain intensity was quantified using a Numerical Rating Scale(NRS)before and after each acupuncture therapy session.Results:Ten patients were recruited,six women and four men,with a mean age of 41.7(standard deviation,[SD]=13.9).A reduction in headache intensity was reported by all patients in each of the sessions.The average NRS for pain was 4.21(SD=1.44)before acupuncture and 1.24(SD=0.93)after acupuncture(means first by number of sessions,then per n=10 patients).This resulted in a mean difference of 2.97(SD=1.04),corresponding to a standardized response mean of 2.85(95%confidence interval:2.11–3.60,one-tailed P<0.001),meaning there was a large effect.Conclusions:This pilot study shows that JCZ and HG are suitable acupuncture methods for reducing headache intensity in the treatment of headaches.A comparison with the conventional classical acupuncture methods from the acupuncture textbook for traditional Chinese medicine students in China,exploration with a larger patient group,and prolonged monitoring of pain behavior could be foci of follow-up investigations.

Post Dural Puncture Headache—Review and Suggested New Treatment

Objectives: After reading this article, readers should be able to recognize Post Dural Puncture Headache, understand its mechanism and diagnostic criteria, evaluate the different treatment options available, and be familiar with a novel treatment option. Background: Post-dural puncture headache is the most common serious complication resulting from lumbar puncture and epidural or spinal anesthetics. The syndrome is characterized by severe headache that occurs within 48 hours following the puncture, located in the frontal and/or occipital region, worsened in the upright position and refractory to routine analgesia. The syndrome incidence was reported to be approximately 1% with typical obstetric anesthesiology practice which reflects more than 20,000 cases per 2014 in the US. Two possible mechanisms are hypothesized as responsible for this syndrome;cerebrospinal fluid leakage and pneumocephalus. Multiple methods of treatment have been applied with wide-ranging results. Design or Methods: Review article with introduction of a novel treatment option. Results: We postulate that Hyperbaric Oxygen Therapy can be used to treat post-dural puncture headache. The rationale for treatment is dual: enhancement of fibroblast proliferation at the site of dural puncture to facilitate faster closure of the tear and compression of air bubbles in case of pneumocephalus according to Boyle’s law. We also claim that hyperbaric oxygen therapy should be considered a prophylactic treatment, if a dural tear is suspected.

Effects of Toutongning capsule on enkephalin expression in a rat migraine headache model

Toutongning capsule is used for the treatment of migraine headaches, and has yielded therapeutically beneficial effects. However, whether Toutongning capsule exerts its effects via endogenous opioid peptides remains poorly understood. This study investigated the effects of Toutongning capsule on enkephalin expression in the midbrain of rats with nitroglycerin-induced migraine headache at the mRNA and protein levels. Results confirmed that proenkephalin mRNA levels were significantly upregulated following treatment with Toutongning capsule. The numbers methionine-enkephalin and leucine-enkephalin-positive cells were significantly greater in the migraine headache rats following treatment with Toutongning capsule compared with the model group. Taken together, these results show that Toutongning capsule exerts potentially beneficial effects by promoting enkephalin expression in nitroglycerin-induced migraine headache rats.

Mild closed head traumatic brain injury-induced changes in monoamine neurotransmitters in the trigeminal subnuclei of a rat model:mechanisms underlying orofacial allodynias and headache

Our recent findings have demonstrated that rodent models of closed head traumatic brain injury exhibit comprehensive evidence of progressive and enduring orofacial allodynias, a hypersensitive pain response induced by non-painful stimulation. These allodynias, tested using thermal hyperalgesia, correlated with changes in several known pain signaling receptors and molecules along the trigeminal pain pathway, especially in the trigeminal nucleus caudalis. This study focused to extend our previous work to investigate the changes in monoamine neurotransmitter immunoreactivity changes in spinal trigeminal nucleus oralis, pars interpolaris and nucleus tractus solitaries following mild to moderate closed head traumatic brain injury, which are related to tactile allodynia, touch-pressure sensitivity, and visceral pain. Our results exhibited significant alterations in the excitatory monoamine, serotonin, in spinal trigeminal nucleus oralis and pars interpolaris which usually modulate tactile and mechanical sensitivity in addition to the thermal sensitivity. Moreover, we also detected a robust alteration in the expression of serotonin, and inhibitory molecule norepinephrine in the nucleus tractus solitaries, which might indicate the possibility of an alteration in visceral pain, and existence of other morbidities related to solitary nucleus dysfunction in this rodent model of mild to moderate closed head traumatic brain injury. Collectively, widespread changes in monoamine neurotransmitter may be related to orofacial allodynhias and headache after traumatic brain injury.

Recurrent headaches may be caused by cerebral toxoplasmosis

AIM: To establish seroprevalence and provide characteristics of Toxoplasma gondii(TG) infection in children with recurrent headaches. METHODS: The study was performed in 178 children aged 7-17 years admitted consecutively to the Department of Pediatric Neurology from November 2009 to July 2011. The children were surveyed with a questionnaire with the help and assistance of their parents and blood samples taken on admission were studied for the presence of specific anti-TG Ig M, Ig G antibodies and Ig G avidity using enzyme immunoassay Platelia Toxo Ig M, Ig G. RESULTS: The study showed that 19 children(8 boys, 11 girls; 8-17 years old, mean age 14.36 years) hadhigh serum anti-TG Ig G antibody levels(range: 32.2 > 240 UI/m L, mean 120.18 UI/m L; positive value for Ig G was ≥ 9 UI/m L). The avidity index(AI) ranged from 0.202 to 0.925(scale: ≥ 0.5 high AI). The results for Ig M antibodies were all negative and the obtained results ranged from 0.113 to 0.25 U/m L(mean = 0.191 IU/m L) and all values below 0.8 IU/m L were considered negative. The most frequent complaints found in the seropositive patients were headaches that affected the frontal(13 children), occipital(4) and parietal areas(5). Headaches usually had a pulsating(in 7 patients) and squeezing(6) character and rarely were piercing, dull or expanding. Interestingly, 8 children did not feel discomfort during the headaches, probably because they did not have sufficiently increased intracranial pressure yet. The headaches usually appeared 1-2 times/mo, lasted for 2-6 h, and had a mean intensity of 5.5 points in a 10 point subjective scale. The comorbidities included epilepsy(5 patients), various infections in 3 children(chronic eustachitis, chronic rhinitis, chronic purulent tonsillitis, streptococcal pharyngitis, meningitis, allergic diseases), disturbances of behavior, deficits of attention, and ocular and motor concentration disorders in 1 child. The electroencephalographic and neuroimaging studies performed in our patients had a very limited value in establishing cerebral toxoplasmosis.CONCLUSION: Ten point six seven percent of the studied children had markedly increased serum anti-TG Ig G antibodies and high AI indicated chronic infestation. It is suggested that tests for TG infection should be introduced to routine diagnostics in patients with recurrent headaches.

Headache:An unusual presentation of acute myocardial infraction

Acute myocardial infarction should be diagnosed as early as possible for the appropriate management to salvage ischemic myocardium. Accurate diagnosis is typically based on the typical symptoms of angina. Headache is an unusual symptom in patients with acute myocardial infraction. We report a patient with ST-segment elevation acute myocardial infarction who presented to the emergency department complaining of severe occipital headache without chest discomfort.

A Prospective Study of Headache after Carotid Endarterectomy: Incidence and Clinical Characteristics

Headache associated with Carotid Endarterectomy (CEA) is a known condition;however, its incidence and etiology are not well defined. In this study, we determined the incidence and evaluated the characteristics of headache following CEA. This prospective study was conducted between January and July 2009, in 32 patients submitted to CEA. 68.7% of patients were male;mean age was 67.3 years-old. Headache incidence was 37.5%, ipsilateral to the CEA in 91% of patients;pressure was the most common pain quality (81.2%) and affected the frontal region alone in 37.5% of headache episodes. All headache episodes were of mild intensity. No correlation (p > 0.05) was found between sexes and no significant value (p > 0.05) was determined between the presence of headache and the mean degree of stenosis in the ipsilateral and contralateral carotid operated. Headache following CEA is a common condition;in most cases it is ipsilateral to the procedure, pressure type, mild and self-limiting.

Prevalence of Chronic Pain, Especially Headache, and Relationship with Health-Related Quality of Life in Middle-Aged Japanese Residents

The aim of this study was to evaluate the prevalence of chronic pain (CP) and the relationship between CP, especially headache adjusted for CP at other sites, and health-related quality of life (HRQoL) in middle-aged Japanese residents. We examined the prevalence of CP (defined as pain persisting for 3 months or more) and HRQoL (SF-36) in 1117 middle-aged residents of Japan. We assessed the eight dimensions of health status and the 3 component SF-36 summary score to evaluate HRQoL. The prevalence of CP was 15.3% among men and 15.1% among women. Multiple linear regression analysis demonstrated that lumbar pain (p β = -0.132), knee pain (p β = -0.115), foot pain (p = 0.042, β = -0.065), and age (p β = -0.154) were independently correlated with a lower physical component score (PCS). Older age (ppβ = -0.096), knee pain (p β = -0.109), upper limb pain (p β = -0.098), and lumbar pain (p = 0.022, β = -0.077) all showed a significant negative correlation with MCS. The presence of chronic headache (p = 0.011, β = -0.082) was the only factor significantly correlated with a lower role component score (RCS). We identified a negative correlation between chronic headache and RCS, unlike the relation between musculoskeletal pain and PCS or MCS, suggesting that RCS was an independently influenced by CP differently from PCS or MCS in Japanese residents.