Retrospective study of postcraniotomy headaches in suboccipital approach: diagnosis and management.

Soumekh B, Levine SC, Haines SJ, Wulf JA.

Department of Otolaryngology, University of Minnesota, Minneapolis 55455, USA.

PURPOSE: The suboccipital approach used for cerebellopontine angle tumors, microvascular decompression, vestibular nerve section, and other procedures has been associated with significant postoperative headache. This study was undertaken to evaluate retrospectively the incidence and management of headaches in these patients. METHODS: Operation logs from 1988 through 1993 were reviewed to identify patients who underwent lateral suboccipital craniotomy or craniectomy. The nature of the operation, preoperative and postoperative complaints of headache, treatment for postoperative headache, and the use of primary cranioplasty were recorded from the medical records. RESULTS: Fifty-six suboccipital approaches were performed by the senior authors between 1988 and 1990. Seven patients had debilitating postoperative headaches. None responded to conservative management, and all underwent secondary cranioplasty. All seven patients showed significant improvement in their pain, with four of seven requiring no other treatment (follow-up from 15 to 38 months). Fifty patients underwent cranioplasty at the time of their initial operation, from 1991 to 1993. No case of debilitating headache was identified post-operatively in these patients. CONCLUSIONS: Cranioplasty at the time of lateral craniectomy appears to reduce the incidence of debilitating postoperative headache.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8841709&dopt=Abstract headache medicine




Pain subsequent to resection of acoustic neuromas via suboccipital and translabyrinthine approaches.

Ruckenstein MJ, Harris JP, Cueva RA, Prioleau G, Alksne J.

Department of Otolaryngology, Head and Neck Surgery, University of Tennessee, Memphis 38163, USA.

Prolonged headache subsequent to excision of acoustic neuromas via a suboccipital approach has been cited as a significant complication of this procedure. However, few studies have sought to compare the incidence of postoperative headaches in patients undergoing either translabyrinthine or suboccipital approaches with surgical techniques designed to minimize this complication. We performed a retrospective survey of 52 patients having undergone either a suboccipital or translabyrinthine resection of acoustic neuromas. Cranioplasties were performed on all patients having undergone resections via a suboccipital approach. The survey asked patients to categorize headache severity based on a numeric scale at 1 month, 6 months, and 1 year after surgery. Medications required to control headaches were also recorded. At 1 and 6 months after surgery, headache severity was significantly less in patients having undergone a translabyrinthine resection (p < 0.05). However, by 1 year after surgery, headache severity in the two groups of patients was essentially equivalent (p = 0.6). Data concerning the strength of analgesics required to control postoperative headaches paralleled these results. These results indicate that within the first postoperative year, patients undergoing suboccipital craniotomies have significantly more postoperative pain than do those patients having undergone translabyrinthine resections, despite the performance of a cranioplasty. However, by 1 year after surgery, these differences are no longer significant. Thus the complication of long-term postoperative headache is no more prevalent in patients undergoing a suboccipital resection than in those having undergone translabyrinthine surgery. These results are important to both the surgeon and the patient during preoperative counseling regarding the choice of surgical approach for acoustic neuroma excision.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8841710&dopt=Abstract headache medicine




Classification of daily and near-daily headaches: field trial of revised IHS criteria.

Silberstein SD, Lipton RB, Sliwinski M.

Comprehensive Headache Center, Germantown Hospital and Medical Center, Philadelphia, PA, USA.

Primary chronic daily headache can be subdivided into transformed migraine, chronic tension-type headache, hemicrania continua, and new daily persistent headache. We proposed and tested criteria in 150 consecutive outpatients with chronic daily headache. Based on preliminary analysis, we revised the criteria for transformed migraine. Using the International Headache Society criteria, 43% of the patients could not be classified; using our old criteria, 25% could not be classified; however, using our new criteria, we were able to classify 100%. Seventy-eight percent had transformed migraine, 15.3% had chronic tension-type headache, and 6.7% had other headache disorders.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8857711&dopt=Abstract headache medicine




Headache, snoring and sleep apnoea.

Ulfberg J, Carter N, Talback M, Edling C.

Sleep Disorders Center, Avesta Hospital, Sweden.

To evaluate reported headache prevalence among the general population and patients suffering from snoring and obstructive sleep apnoea syndrome (OSAS), a cross-sectional study was performed among those aged 30-64 years residing in Kopparberg county in central Sweden. Consecutive patients referred to the sleep laboratory in the catchment area who fulfilled objective diagnostic criteria (snorers = 448, OSAS = 324) and a random sample of the general population (n = 583) responded to the same questionnaire. Patients were selected following sleep apnoea screening with 100% specificity for both OSAS and snoring. Responders from the general population were divided into snorers or non-snorers on the basis of self-report. To validate the self-report question on snoring in the questionnaire, 50 males and 49 females, randomly selected from the sample of the general population, underwent sleep apnoea screening in their homes. Headache among both men and women was found to be more prevalent among heavy snorers and OSAS patients compared with the control group. Morning headache, in particular, was at least three times more common among male and female heavy snorers and OSAS patients then among the general population. Headache in the control group was more common among snorers than non-snorers. Among responders, 5% of the general population reported experiencing headache often or very often upon awakening. For the heavy snoring and OSAS groups, 18% reported experiencing headache often or very often upon awakening. The results indicate that headache is common among heavy snorers and OSAS patients regardless of gender.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8892061&dopt=Abstract headache medicine




Tension-type headache in different age groups at two headache centers.

Wober-Bingol C, Wober C, Karwautz A, Schnider P, Vesely C, Wagner-Ennsgraber C, Zebenholzer K, Wessely P.

Department of Neuropsychiatry of Childhood and Adolescence, University of Vienna, Austria.

At two headache centers, one for children and adolescents and the other for adults, we investigated patients aged 5-80 years with episodic or chronic tension-type headache to evaluate the relation between age and headache characteristics as well as analgesics intake. We found an increasing headache frequency and duration, an increasing variability of the headache location, and an increasing frequency of nausea with increasing age. All other headache features did not depend on age. Additionally, our study revealed a marked increase of analgesics use in adults compared to children and adolescents. In conclusion, children, adolescents, and adults referred for tension-type headache show minor differences in some headache features, but a marked change of analgesics intake. The different headache symptoms may be causally related to age, but an influence of medication or other factors must also be considered.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8895231&dopt=Abstract headache medicine




Serotonin receptor adaptation in patients with analgesic-induced headache.

Srikiatkhachorn A, Anthony M.

Institute of Neurological Sciences, Prince Henry and Prince of Wales Hospitals and School of Medicine, University of New South Wales, Sydney, Australia.

Analgesic abuse has recently been recognized as a cause of deterioration in primary headache patients. Although the pathogenesis of this headache transformation is still obscure, alteration of serotonin receptor function is one possible mechanism. To assess the plasticity of 5HT2 serotonin receptors in this condition, we investigated receptor binding by the platelet membrane in patients with analgesic-induced headache (AIH), migraine and non-headache controls. The technique involved radioligand binding with (phenyl-4-3H)spiperone and ketanserin. A greater density of receptor numbers (Bmax) was found in patients with AIH and in non-headache controls (96.47 +/- 10.21 and 92.01 +/- 13.15 fmol/mg protein), as compared to migraine patients (49.52 +/- 5.14 fmol/mg protein). The value of dissociation equilibrium constant (KD) remained unchanged (3.07 +/- 0.49, 2.24 +/- 0.24 and 2.91 +/- 0.42 nM for patients with AIH, migraine and non-headache controls, respectively). Based on these findings, we suggest that up-regulation of 5HT2 serotonin receptors may be a possible mechanism of headache transformation in patients with AIH.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8902250&dopt=Abstract headache medicine




Headache in transient ischaemic attacks.

Andre C, Neves FF, Vincent MB.

Department of Neurology, University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil.

Headaches were studied in a series of 49 patients with single or multiple transient ischaemic attacks (TIAs) followed up for 27 +/- 17 months. Forty-two patients had a CT scan and 38 had a Duplex-Scan. Twelve patients (24%) had TIA-related headaches, mostly in close temporal relation to the ischaemic onset. Headaches were more frequent in females and in vertebrobasilar TIA. Headache predominated in patients taking vasodilators when TIA occurred, or with orthostatic hypotension at the first clinical examination, suggesting that haemodynamic mechanisms are of importance in this respect. Bilateral/median pain predominated, especially but not exclusively in patients with vertebrobasilar territory TIAs. Arterial hypertension or a personal history of migraine were not more frequent in patients with headache. Patients with multiple TIAs had stereotyped headaches. Data suggest that headache and transient ischaemia are closely related. Reflex mechanisms may induce pain far from the ischaemic territory.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8934151&dopt=Abstract headache medicine




Migraine headaches in a group of medical students at the Kenyatta National Hospital, Nairobi.

Amayo EO, Jowi JO, Njeru EK.

Department of Medicine, College of Health Sciences, University of Nairobi.

A survey was carried out on 711 medical students from both the medical school and the Kenya Medical Training Centre on headaches using a closed ended questionnaire. Six hundred and twenty five (88%) of the students reported to have at least one episode of headache in the last six months. Two hundred and forty (33.8%) of these were classified as migraine using the International Headache Society case definition. Seventy (29%) had migraine with aura, the rest being migraine without aura. The mean age was 22.7 +/- 5 years with a male to female ratio of 1:1.3. The majority of the respondents (43%) had an average of two to three headache episodes per month. The major triggering factors for the headache were physical activities, emotional disturbance and studying, each occurring in 21% of the student respondents. It was reported by 43.6% of the respondents that there was a member of their nucleus family with a similar headache. Only 40% of the respondents had sought medical attention for their headache in the last one year. The main reason for not seeking medical services was self medication in 56% of those who did not attend medical services. Only 27 (11%) of the respondents were currently on medication which consisted of simple analgesics and antimalarials. There were only two students who were on specific drugs for migraine. The majority of the respondents continued to be inadequately treated despite the development of wide range of effective treatment.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8991241&dopt=Abstract headache medicine