摘要:

Patients with temporomandibular disorders frequently suffer from headache. The purpose of this study was to develop a simple screening exam which would allow the physician to identify headache patients with coexisting temporomandibular disorders. Twenty‐eight migraine and 27 tension headache patients were identified by board certified neurologist and then were examined by a dentist for signs of temporomandibular disorders. These patients were then compared to 63 patients with temporomandibular internal derangements and 62 patients with myofascial pain dysfunction. Comparisons of the clinical signs showed that the temporomandibular internal derangement and myofascial pain dysfunction patients differed significantly from the headache patients in regards to specific signs of jaw dysfunction. The presence of reciprocal clicking of the temporomandibular joint or pain with maximum jaw opening and pain upon palpation of the temporomandibular joint distinguished temporomandibular internal derangement patients from headache patients. These criteria have a sensitivity of 92% and specificity of 91%. Pain on palpation over the temporomandibular joint, or pain with maximum jaw opening using passive stretch, and pain with lateral movement of the jaw, distinguished myofascial pain dysfunction patients from headache patients. These criteria have a sensitivity of 77% end specificity of 85%. By using these screening tests, the physician can identify the concurrent existence of temporomandibuler disorders in headache patients and triage the patient to a clinician knowledgeable in the diagnosis and treatment of temporomandibular disorders for further evaluatio

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3503121.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

We reviewed 49 patients consecutively hospitalized for neurologic Lyme disease to determine the frequency and characteristics of recent onset headaches in this group. All patients had positive serum Lyme ELlSAs and other neurologic illness excluded. Recent‐onset headache occurred in 26 of 49 patients (53%). Patients with headache more commonly had central nervous system involvement (54% vs 19%, P<.05) and flu‐like illness (58% vs 19%, P<.0005). Eight of 26 (31%) met criteria for meningitis or encephalitis with abnormal CSF examinations. All 8 had focal findings (6), cognitive dysfunction (1), or both (1). The remaining 18 patients had recent‐onset headaches resembling migraine (9), tension‐type headache (5), or neither (4). Antibiotic treatment resulted in complete headache resolution in 11 of 14 patients with available follow‐up data. Based on these findings, we conclude that recent‐onset headaches are common in patients hospitalized with Lyme disease. Of those with meningitis or encephalitis requiring intravenous antibiotics, all had focal neurologic findings or cognitive abnormalities, not jus

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3503125.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

The quantification of the social and economic handicaps caused by headache is a complex problem, especially given the great variability of headache patients' clinical pictures. In the present study, 400 patients, consecutively admitted to Headache Centers in Pavia and Milan, were interviewed on the relationship between headache and their work and social activities, in order to evaluate their socioeconomic handicap due to headache. The analysis of the data primarily focused on attack‐type headaches (migraine, cluster headache, and episodic tension‐type headache) and chronic or daily headaches (chronic tension‐type headache and migraine combined with tension‐type headache). These latter types were often characterized by the daily use or abuse of analgesics.The overall profile which emerged from the study reveals relatively low levels of handicap or disability in work and social activities. These low levels can be mainly attributed to timely, and at times excessive, use of ana

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3503131.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

Nine patients with the SUNCT syndrome (Spanish and Norwegian patients) have, over many years, been given several drugs effective in the cluster headache syndrome, trigeminal neuralgia, and other headaches, as well as drugs not previously used in headache. Various cranial nerves were also anesthetized in an endeavor to ameliorate the suffering of those patients.Although a partial effect was obtained with carbamazepine and corticosteroids in some patients, none of the drugs or anesthetic blockades had consistent, lasting, complete effect on headache paroxysms in SUNCT. The essentially negative outcome of this study aids in further characterizing SUNCT as a separate disorder, and, above all, in distinguishing it from trigeminal neuralgia and the cluster headache syndrome.

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3503138.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

Two patients with SUNCT syndrome (short‐lasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing) were investigated. Blood flow velocity in the middle cerebral artery was monitored before, during, and outside four spontaneous attacks. An interhemispheric asymmetry was observed. In the second case, velocity decreased significantly on both sides during attacks in comparison with preattack values, Cerebral SPECT (single photon emission computed tomography) images were obtained during a bout and between attacks in one patient. The radiocompound was injected 5 to 10 seconds after the start of an attack. In both patients, normal tracer uptake and symmetric perfusion was observed during headache period

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3503143.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

Seven hundred nineteen young patients attending 21 Italian headache care settings were evaluated by a diagnostic headache interview and a neurological examination. Headache disorders were classified according to the current 1988 criteria of the International Headache Society (IHS); 54.9% of the patients suffered from migraine, 33.9% from tension‐type headache, 1.9% from secondary headache, and 3.4% had non‐classifiable headache. A further 5.9% of the patients were not classified due to incomplete questionnaires.Of the 395 patients with migraine, 44.5% were affected by migraine without aura, 29.9% by migraine with aura, 1.3% from other migraine forms, and 24.3% by migrainous disorders which do not fulfill the 1988 IHS diagnostic criteria for headache.Among the 244 patients with tension‐type headache, 51.6% had episodic tension‐type headache, 15.2% chronic tension‐type headache, and 33.2% headache of the tension‐type which does not fulfill the 1988 IHS criteria for episodic and chronic tension‐type headache.In young migraine patients, pain was of a pulsating type in 55.7%, severe in 57.8%, unilateral in 42.6%, and aggravated by routine physical activity in 38.9%. Tension‐type headache was described as pressing in 73.8%, mild or moderate in 75.7%, bilateral in 87.4%, and not aggravated by routine physical activity in 85.5%. The duration of pain was leas than 2 hours in 35% of the cases in migraine sufferers and less than 30 minutes in 26.7% of tension‐type headache sufferers. Nausea, phonophobia, and photophobia were present in at least half of the migraine patients and in one third of tension‐type headache patients, respectively. Vomiting occurred in 47.8% of migraine patients and 9% of tension‐type headache patients.On the basis of the above results, a modification of the current 1988 IHS criteria can be proposed to increase their sensitivity for diagnosing migraine and tension‐type headache in children and adolescents. This should take into account that the attacks are of a shorter duration, the character of pain is not necessarily pulsating, and the location of pain may often be bilateral. The number of headache episodes should be reduced to less than five for the diagnosis of migraine and less than 10 for the diagnosis of tension‐type headache. Moreover, functional disability should not be considered a mandatory criterion for migraine in children and adolescents.Differentiating migraine and tension‐type headache could be improved by the use of a grading system for accompanying symptoms (nausea, vomiting, phonophobia, and photo‐phobia) rather than merely the use of crit

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3503146.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

We have compared the migraine‐inducing effect of nitroglycerin ointment applied to the frontotemporal region of the head, which is innervated by the ophthalmic and maxillary divisions of the trigeminal nerve, with that of nitroglycerin applied to the chin (innervated by the mandibular division), the posterolateral region of the neck (innervated by the second and third cervical roots), the lateral surface of the proximal third of the forearm (innervated by the sixth cervical root), and the medial surface of the upper‐arm region (second dorsal root). One hundred patients suffering from migraine without aura were randomly divided into five equal groups. Each group received an application of 5 mg nitroglycerin in 2% ointment on a preselected body area for 2 hours. Frontotemporal nitroglycerin induced a significantly greater number of early onset migraine attacks with respect to the arm and forearm regions. In all cases, nitroglycerin applied to the frontotemporal region resulted in subsequent migraine, whereas there was a significant number of negative trials with nitroglycerin applied to the neck, arm, and forearm vs the frontotemporal area. It, therefore, appears that the trigeminal nerve endings in the affected frontotemporal region are particularly sensitive to the migraine‐inducing effect of the nitrate. This suggests a peripheral neurogenic hypothesis of migraine ge

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3503154.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

A Hungarian patient with short‐lasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is presented in this paper. This male patient was first diagnosed as having first division trigeminal neuralgia. The location and duration of the attacks and the prominent accompanying autonomic feature on the symptomatic aide, such as conjunctival injection, lacrimation, nasal stuffiness, and the inefficacy of drugs, led to a reconsideration of the diagnosis. The pain paroxysms occurred frequently during a 3‐to 4‐month period, followed by a longer remission phase. Mechanical precipitating maneuvers were observed during bouts of pain. The clinical picture is reminiscent of the SUNCT syndrome, first described by Sjaastad et al in 1978.SUNCT and trigeminal neuralgia are in many ways similar, although, some decisive differences have also been noted. Further observations are needed to distinguish the two disorders and to clarify this syndrome as a new headache type or as a trigeminal neuralgia va

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3503158.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

It is known that in hemicrania continua the chronic stage may be preceded by a remitting stage. In the present communication, the reverse sequence has been demonstrated, ie, a transition from the chronic to the remitting stage. The headache was characterized by a chronic pattern from the beginning until the commencement of indomethacin treatment, which provided long‐lasting relief. Withdrawal of the drug resulted in reappearance of headaches with the same clinical features but in a remitting fashion. Resumption of indomethacin treatment had a dramatic effect on the remitting headaches. Such a temporal evolution of symptoms is consistent with the prevailing view that in a patient with hemicrania continua, there may be two temporal pattern

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3503161.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

A 52‐year‐old man presented with unilateral left periorbital and frontotemporal pain associated with a partial ipsilateral Horner's syndrome of the postganglionic type and representing a pericarotid syndrome. MRI demonstrated a perivascular subacute hematoma at the level of the cervical portion of the left internal carotid artery with a markedly reduced flow‐void signal. MR angiography confirmed the narrowed lumen of the dissected cervical internal carotid artery. There was also a right‐sided precavernous carotid aneurysm. Three months later the left‐sided pain had subsided, with complete resolution of the hematoma and incomplete restoration of the left carotid lumen seen on MR angiography. Dissection of the carotid wall may cause the oculosympathetic paralysis by producing a lesion of the superior cervical ganglion, the internal carotid nerve, or the perivascular sympathetic plexus. Whereas in pericarotid syndrome the most common cause is cervical carotid dissection, Raeder's syndrome additionally involving parasellar cranial nerves, may be caused by any paracavernous/cavernous lesion, including neoplasms and intracranial carotid aneurysms. The clinical distinction is useful to determine the appropriate diagnostic investigation, in view of the different pathoanatomical localization and different disease spectrum. As demonstrated in the present case, the combination of MRI and MR angiography is a reliable noninvasive tool to investigate the differential diagnosis of pericarotid syndrome, accurately depicting occlusive, stenotic or aneurysmal lesions of the carotid artery. We suggest that intraarterial angiography is no longer

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3503163.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY