Headache

A39-year-old man with a history of AIDS and nonadherence to highly active antiretroviral therapy (HAART) presented with frontal headache and scalp pain of 2 weeks' duration. These symptoms were accompanied by nausea, weight loss, and generalized weakness. Physical examination revealed a small, tender scalp lump, 2 × 2 cm over the left parietal area. The findings from the rest of the examination were unremarkable.

A 26-year-old woman at 30 weeks’ gestation presented to the emergency department with a throbbing frontal headache of 1 month’s duration. She had also had peripheral blurred vision for the past 2 weeks. Acetaminophen initially decreased her pain but was no longer effective. She had had a previous miscarriage.

Several days earlier, a 69-year-old man had a mild headache, fatigue, and tingling and prickly facial sensations. Shortly afterward, this painful, “weepy” rash developed on his forehead, upper cheek, and nasolabial folds and vision in the right eye became blurry. The patient’s history included type 2 diabetes mellitus, hypertension, and childhood varicella.

2009 IHC Podcasts

Migraine and chronic daily headache may be risk factors for the development of complex regional pain syndrome, according to the results of a study led by B. Lee Peterlin, DO, assistant professor of neurology, Drexel University College of Medicine in Philadelphia.

Results of a large survey show that many patients with cluster headaches (CH) are not receiving treatment with acute and preventive therapies.

Did Pablo Picasso suffer from migraine? And did these episodes influence his artwork? Not likely, said Joost Haan, MD, PhD, a member of the department of neurology at Leiden University Medical Centre, Leiden, the Netherlands. He discussed migraine and the works of master painters at the 14th annual International Headache Congress in Philadelphia.

Results of a landmark study showed that onabotulinumtoxinA effectively reduced headache symptoms, episodes, disability, and health-related quality of life in patients with chronic migraine.

Patients with migraine accompanied by depression or anxiety disorders had greater improvements in headache-related disability than those without a psychiatric disorder, according to results of the Treatment of Severe Migraine trial.

About 20% of soldiers returning from Iraq and Afghanistan who have a history of concussion or blast exposure experience chronic daily headache, according to a results of study presented at the 14th annual International Headache Congress in Philadelphia.

The portrayal of headache in film may contribute to patients’ misconceptions and fears about their illness, according to Bert B. Vargas, MD, clinical professor of neurology at the Mayo Clinic in Phoenix.

Tonabersat is effective in the prophylaxis of aura in patients with migraine, according to a recent study led by Jes Olesen, MD, a professor of neurology at the Danish Headache Center at Glostrup Hospital, University of Copenhagen, Glostrup, Denmark.

Patients with migraine are more likely than nonmigraineurs to have temporomandibular disorder (TMD). According to the results of a new study presented at the 14th annual International Headache Conference in Philadelphia, TMD may also be associated with increased headache frequency.

It is only within the past 40 years that the term "migraine art" was introduced; yet artists may have been creating works inspired by migraine aura since the Stone Age. Early depictions of migraine continue to influence newer artists with this illness. This is a natural progression that is common in all types of art, according to Klaus Podoll, MD, senior physician in the department of psychiatry and psychotherapy, University Hospital Aachen, RWTH Aachen University, Germany. But Dr Podoll has found that artists with migraine are often particularly attracted to the works of other artists who share their migraine experiences. These shared experiences "act like a filter," contributing to the an artist's perspective and leading to "elective affinities between migraine-inspired artists," he said.

Progressively worsening nasal congestion and headaches with diplopia and left proptosis for 2 months prompted an ophthalmology consultation for a 67-year-old woman. She had been evaluated multiple times for allergic rhinitis and recurrent sinusitis.

A 35-year-old woman presented to the emergency department (ED) with 2 black eyes, facial swelling, and other injuries (Figure 1). She said that she had been in an all-terrain vehicle accident the day before, in which she hit her face on the handlebar. She said she had lost consciousness for an unknown period and since the accident had experienced headache, dizziness, nausea, and pain over much of her body.

A 37-year-old man was brought to the emergency department (ED) after he had 2 near-syncopal events. The first occurred in the morning and rapidly resolved; the second occurred later in the day at work. The night before he had a headache and neck pain. In the ED, he reported left arm and leg weakness and was noted to have left facial droop.

Losing weight can significantly reduce intracranial pressure and the complications it causes, including headache and optic nerve anomalies.

A 22-year-old man seeks medical attention at his college’s infirmary. He had been in excellent health until 1 week earlier, when he noted onset of fever, headache, and malaise.

The patient has a small-fiber sensory neuropathy that is managed with lamotrigine. She is a physical therapy student who has frequent patient contact. She drinks alcohol occasionally but denies smoking and illicit drug use; she says she is not sexually active.

A 47-year-old Hispanic woman with severe headaches of 1 month’s duration presents to the emergency department (ED). The pain encompasses the entire head, is constant and crushing (10 on a scale of 1 to 10), and has progressively worsened.

Two weeks before admission, he had visited the emergency department (ED) because of the headache. Migraine was diagnosed and ibuprofen had been prescribed. The headache persisted despite NSAID therapy, and the patient returned to the ED 2 days later.

A previously healthy 16-year-old boy presents for evaluation of a slightly pruritic, nontender, generalized rash.

A 14-year-old boy presents with frequent severe headaches characterized by sharp, throbbing pain behind his left eye and left temple.

A 28-year-old woman presents with milky discharge in both breasts and throbbing occipital headaches of 4 months' duration. The headaches begin gradually, do not radiate, and have no apparent triggers or relieving factors.

Depression was diagnosed 6 years earlier in a 37-year-old woman; it has been successfully managed since then with fluoxetine and outpatient psychotherapy. Since her teenage years, the patient has also experienced sporadic (fewer than 3 or 4 per year) mild or occasionally severe headaches, which she has usually self-treated with over-thecounter (OTC) agents or "just slept off."

A 47-year-old woman complains of severe headaches that involve only the right orbital, temporal, and occipital areas. She describes the pain as sharp and stabbing, and she rates its severity as 9 or 10 on a 10-point visual analog scale.

LONDON -- Headache patients receiving prophylactic high-dose verapamil face a risk of heart rhythm disturbances that warrants EKG monitoring of all patients on the therapy, investigators here concluded.

A 50-year-old man with end-stage renal disease secondary to long-standing hypertension had an elevated hematocrit and progressively increasing hemoglobin levels. For the past 7 years, he had been receiving hemodialysis 3 times a week. He denied headache, flushing, easy bruising, bleeding, nausea, vomiting, chest pain, dyspnea, and other symptoms. He was not receiving exogenous erythropoietin.

The headaches vary in severity, but she usually has severeheadaches (8 on a 10-point visual analog scale[VAS]) once or twice a week; she describes the latter assevere throbbing or pounding pain on the top of thehead but also involving the occipital and frontalareas and occasionally one or the other temple.