Spotlight on Headache associated with illicit drug use

In general, most physicians are not familiar with headache syndromes induced by the use of illicit drugs such as cocaine, marijuana, and opioids. Some patients may develop thunderclap headache and reversible cerebral vasoconstriction syndrome.

In this article, Dr. Shuu-Jiun Wang of the Brain Research Center, National Yang-Ming University and the Neurological Institute, Taipei Veterans General Hospital, provides an update on the underlying pathophysiology and reviews the clinical aspects of headache syndromes induced by illicit drugs in light of the criteria presented in the International Classification of Headache Disorders, 3rd edition (ICHD-3). Also discussed is the high frequency of illicit drug use in patients with cluster headache and the possible mechanism for this association.

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Spotlight on Headache associated with acute substance use or exposure

Substance headache is a headache that develops de novo with the use or exposure of a substance. The clinical manifestations of substance-induced headache are variable. In this article, Dr. Marta Torres-Ferrus, Dr. Edoardo Caronna, and Patricia Pozo-Rosich of Vall d’Hebron University Hospital and Headache Research Group, VHIR in Barcelona update the current evidence regarding the clinical manifestations and pathophysiology of headache associated with the acute use or exposure of certain substances, with specific focus on nitric oxide donor, and carbon monoxide and calcitonin gene-related peptide, which provides a better understanding of headache biology.

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Spotlight on Headache in transplant patients

In this article, discusses the approach to headache when presenting in the context of solid organ or hematopoietic stem cell transplant patients, which can include both primary and secondary causes. In this article, Dr. Jeniffer Robblee of Barrow Neurological Institute outlines the epidemiology and etiologies of headache in the transplant population including pharmacotherapies, infection, vascular associations, and miscellaneous causes. Suggestions for management and possible pathophysiological mechanisms are discussed.

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Spotlight on Headache attributed to head trauma

Headache is common following head injury. Most individuals recover within days, weeks, or months, but a minority of subjects may suffer from intractable posttraumatic headache despite treatment. Posttraumatic headache remains a subject of controversy concerning its pathophysiology. Litigation and medicolegal problems further complicate this issue.

In this article, Dr. Jr-Wei Wu of Taipei Veterans General Hospital attempts to summarize current understanding of posttraumatic headache, including a brief historical review of the disease, the classification and diagnostic criteria, the epidemiology, clinical manifestations, pathophysiology, diagnostic evaluation, and management.

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Spotlight on Medication overuse headache

Medication overuse headache is a chronic headache that occurs in people with a pre-existing primary headache, such as migraine or tension-type headache, following overuse of any kind of acute headache medications. It is a common and disabling disorder that affects 1% to 2% of the general population, and it is extremely important to recognize and treat this condition. Generally, treatment of medication overuse headache requires a multidisciplinary setting and includes education of patients, discontinuation of the overused medication, and initiation of preventive treatment.

In this recently updated article, Dr. Chia-Chun Chiang of the University of California, San Diego provides an update on the definition, pathophysiology, clinical aspects, and treatment strategies of this headache type.

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Spotlight in Acupuncture in headache treatment

In 1997, the National Institutes of Health Consensus Development Panel suggested that acupuncture may be effective or useful in treating 14 disorders, including headache. In this article, Dr. Chong-hao Zhao of the California Headache and Pain Center, Los Angeles and Dr. Mark Stillman of the Cleveland Clinic Foundation review the history of the practice of acupuncture in the United States and the theoretical framework for acupuncture in Chinese medicine. The basic scientific background and clinical application of acupuncture in headache management are discussed.

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Spotlight on Headache in children: overview and treatment approaches

Primary headaches, particularly those that are recurrent or chronic, in childhood are increasingly being recognized as a significant neurologic health problem. The high incidence and prevalence of headaches in the pediatric population has a significant impact on children and their families. Migraine remains under-recognized, under-diagnosed, and ultimately under- or inappropriately treated in this population; this has potential long-term consequences with regards to disease progression.

In this article, Dr. Nina Schor of the National Institute of Neurological Disorders and Stroke has addressed the key issues of: (1) using practical diagnostic criteria for clinical practice, (2) which acute medication should be chosen, (3) when to use preventive therapy in childhood, and (4) which preventive therapies have the best therapeutic index. This article serves as a quick reference for the diagnosis and management of primary headache disorders in children and adolescents. Effective intervention may prevent progression and lifelong consequences, including the development of comorbidities. Early diagnosis and an integrative treatment approach are essential to minimize the impact on a child’s quality of life.

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Spotlight on Headache associated with intracranial infection

In this article, Dr. Jong-Ling Fuh of Taipei Veterans General Hospital and National Yang-Ming University School of Medicine discusses headache associated with intracranial infection. Headache is usually the first and most frequently encountered symptom in intracranial infection, but it only accounts for less than 1% of acute headache presentation to the emergency department.

Encephalitis is characterized by headache, fever, alteration of consciousness, focal neurologic deficit, and seizures (usually focal). Because the brain parenchyma has no sensory receptors, the headache of encephalitis and brain abscess may result from the meningeal inflammation that often accompanies these processes, including a nonspecific response to fever, increased intracranial pressure, or a mass-effect producing traction on pain-sensitive intracranial structures.

The most common predisposing conditions of brain abscesses are otitis or mastoiditis. Physical signs of meningeal inflammation do not help clinicians rule in or rule out meningitis accurately. Headache remits with resolution of the infection in most cases, and headache might persist for more than 3 months after resolution of the causative infection in only a few patients. However, one longitudinal study showed that the 1-year prevalence of headache suffering was not higher amongst patients with prior intracranial infection than in the general population.

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Spotlight on Headache in children: overview and treatment approaches

Primary headaches, particularly those that are recurrent or chronic, in childhood are increasingly being recognized as a significant neurologic health problem. The high incidence and prevalence of headaches in the pediatric population has a significant impact on children and their families. Migraine remains under-recognized, under-diagnosed, and ultimately under- or inappropriately treated in this population; this has potential long-term consequences with regards to disease progression.

In this article, Dr. Nina Schor of the University of Rochester Medical Center and Chair of the Department of Pediatrics at Golisano Children’s Hospital at Strong has addressed the key issues of: (1) using practical diagnostic criteria for clinical practice, (2) which acute medication should be chosen, and (3) when to use preventive therapy in childhood. This article serves as a quick reference for the diagnosis and management of primary headache disorders in children and adolescents. Effective intervention may prevent progression and lifelong consequences, including the development of comorbidities. Early diagnosis and an integrative treatment approach are essential to minimize the impact on a child’s quality of life.

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Spotlight on SUNCT syndrome

SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) is one of the rarest of all primary headache syndromes. It is one of the trigeminal autonomic cephalalgias, along with cluster headache and paroxysmal hemicrania. It is marked by frequent, short-lasting attacks of 1-sided headache with associated cranial autonomic symptoms. SUNCT forms the majority subset of SUNA (short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms), in which the combination of conjunctival injection and tearing are not required for diagnosis. Reports and series have shown therapeutic benefits with medical treatments. Structural imaging studies report an association with aberrant vessel in contact with the trigeminal nerve, and functional imaging studies report hypothalamic activation. Microvascular decompression, occipital nerve stimulation, posterior hypothalamic region deep brain stimulation, and focal radiation therapy have all been reported to be effective in medically intractable cases.

In this article, Dr. Hans-Christoph Diener of the University of Essen discusses the clinical manifestations, biological basis, diagnosis, and management of SUNCT syndrome.

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