Cervical spine joint hypermobility: a possible predisposing factor for new daily persistent headache.

The objective of this study was to suggest that joint hypermobility (specifically of the cervical spine) is a predisposing factor for the development of new daily persistent headache (NDPH). Twelve individuals (10 female, 2 male) with primary NDPH were evaluated by one of two physical therapists. Each patient was tested for active cervical range of motion and for the presence of excessive intersegmental vertebral motion in the cervical spine.

Melatonin responsive hemicrania continua.

Hemicrania continua is one of the indomethacin-responsive headache syndromes. There are very few effective alternative therapies for hemicrania continua, thus patients may require daily indomethacin for years. The risks of long-term indomethacin include gastrointestinal and renal dysfunction.

Acute therapy for migraine headaches.

The migraine attack is made up of phases, which include the prodrome, aura, and the headache itself. Not every migraineur experiences each phase. Each phase has its own distinct pathogenesis and its own unique acute therapy.

Neuropsychologic aspects of post-traumatic headache and chronic daily headache.

The management of patients with chronic refractory head pain remains a treatment challenge. Treatment focus should be multidisciplinary as patients evolve into a deteriorated status with psychologic, social, vocational, and cognitive dysfunction. The neuropsychologist will gather premorbid and comorbid information, assess cognitive functioning, and be involved in every behavioral medicine and treatment decision.

Non-hypothalamic cluster headache: the role of the greater occipital nerve in cluster headache pathogenesis.

Cluster headache is marked by its circadian rhythmicity and the hypothalamus appears to have a significant influence over cluster pathogenesis. However, as not all cluster patients present in the same manner and not all respond to the same combination of medications, there is likely a nonhypothalamic form of cluster headache. A patient is presented who began to develop cluster headaches after receiving bilateral greater occipital nerve (GON) blockade.

Headache and psychiatric comorbidity: historical context, clinical implications, and research relevance.

The comorbidity of headache and psychiatric disorders is a well-recognized clinical phenomenon warranting further systematic research. Affective disorders occur with at least three-fold greater frequency among migraineurs than among the general population, and the prevalence increases in clinical populations, especially with chronic daily headache. When present, psychiatric comorbidity complicates headache management and portends a poorer prognosis for headache treatment.

Management of chronic daily headache: challenges in clinical practice.

Chronic daily headache (CHD) refers to a category of headache disorders that are characterized by headaches occurring on more than 15 days per month. This category is subdivided into long- and short-duration (>4 or <4 hours) CDH disorders based on the duration of individual headache attacks. Examples of long-duration CDH include transformed migraine (TM), chronic migraine (CM), new daily persistent headache (NDPH), acute medication overuse headache, and hemicrania continua (HC).

Cluster headache: diagnosis and treatment.

Cluster headache is a primary headache syndrome that is underdiagnosed and in many instances undertreated. The pain produced during a cluster headache is more severe than that generated by any other primary headache. Cluster headache is very stereotyped in its presentation and fairly easy to diagnose with an in depth headache history.

Cluster headache: diagnosis and treatment.

Cluster headache is a primary headache syndrome that is under-diagnosed and in many instances under-treated. The pain produced during a cluster headache is more severe than that generated by any other primary headache. Cluster headache is very stereotyped in its presentation and fairly easy to diagnose with an in-depth headache history.

Abrupt onset and termination of cutaneous allodynia (central sensitization) during attacks of SUNCT.

The presence of central sensitization and cutaneous allodynia has not been readily studied in other primary headache syndromes outside of migraine. If central sensitization does occur, is the temporal profile any different in the short-lasting more aggressive syndromes such as SUNCT than in migraine? A patient with SUNCT was examined during and in between attacks looking for the presence and duration of cutaneous allodynia.

Comprehensive/tertiary care for headache: a 6-month outcome study.

Objective: To assess programwide (outpatient plus inpatient) outcome using prospective measures for the first 6 months of treatment at a comprehensive headache center. Background.-There is little published data on the overall programwide efficacy of comprehensive, multidisciplinary treatment centers for severe, refractory headache disorders.

Complete but transient relief of chronic cluster headache with mycophenolate mofetil.

Chronic cluster headache is one of the most disabling of all neurologic conditions. New effective therapies for refractory chronic cluster headache are needed. The unique sensitivity of most cluster headache patients to corticosteroid treatment suggests that steroid-sparing immunosuppressive drugs may show benefit as cluster headache preventives.

Short-lasting headache syndromes and treatment options.

A number of primary headache syndromes are marked by their short duration of pain. Many of these syndromes have their own unique treatment, so they must be recognized by practicing physicians. In this article, a number of the short-lasting headache disorders are reviewed, including chronic paroxysmal hemicrania, SUNCT syndrome, hypnic headache, exploding head syndrome, primary stabbing headache, and cough headache.

Study of mitochondrial DNA mutations in patients with migraine with prolonged aura.

Ten patients with migraine with prolonged aura were studied for the presence of mitochondrial DNA point mutations utilizing DNA isolated from blood and hair samples. We analyzed for nine point mutations reported in patients with MELAS (A3243G, C3256T, T3271C, T3291C, A5814G, T8356C, T9957C, G13513A, and A13514G) and three secondary LHON mutations (T4216C, A4917G, and G13708A). None of the patients tested had any of these mutations in mitochondrial DNA.

Daily scheduled opioids for intractable head pain: long-term observations of a treatment program.

Background: Daily scheduled opioids (DSO) have been employed in some instances to remediate intractable headache. However, long-term studies of effectiveness, sequelae over several years, predictors of long-term benefit, comparisons of pain-related outcome measures, and prevalence of problematic drug behavior are not available.

Methods: The authors evaluated the results of a treatment program at their institution designed to treat and monitor intractable headache patients administered DSO.

Trigeminal neuralgia and glossopharyngeal neuralgia.

Trigeminal neuralgia and glossopharyngeal neuralgia are extremely painful conditions that typically afflict an older population. Distinct clinical characteristics guide the diagnosis of these unique syndromes. Treatment involves medication first and then surgical procedures if a patient is refractory to medicinal therapy.

Psychological and neuropsychological integration in multidisciplinary pain management after TBI.

The intersection of traumatic brain injury and posttraumatic chronic pain poses a significant challenge for the health practitioner. Effective intervention requires psychological and neuropsychological evaluation, multidisciplinary teamwork, and an understanding of a wide range of pain disorders and their relationship to traumatic brain injury. Assessment must include documentation of both current functioning and premorbid history.