Articles related to HEADACHE

Navigate the complex world of diagnosing Chiari malformation in this insightful review of a clinical case. To understand Chiari malformation, let’s explore a clinical case. A mid-30s patient with a migraine history came to the ED with a sudden posterior headache. Accompanied by transient total body numbness, loss of coordination, and an inability to swallow with drooling, these symptoms started abruptly after violent sneezing. Although neurological symptoms faded after 20 seconds, the headache persisted. Regarding vital signs and physical examination, everything was normal. The patient had a head CT ordered. Interpreting the clinical picture and CT images with care is crucial in these cases. Even though a sudden onset headache could signify a ruptured berry aneurysm, no blood was detected on the CT cuts, minimizing that concern. Remember, an LP is seldom recommended if the CT is performed within 6 hours and hemoglobin exceeds 10 g/dL. However, the clinical presentation in this case, characterized by headache and drooling, didn’t match a typical migraine. Be mindful that many patients might loosely use the term “migraine” for any severe headache. The CT cut revealed a brainstem compressed by the cerebellum, indicative of a Chiari malformation type 1. Chiari malformation, characterized by an […]

A 29-member specialist interest group (SIG) was formed, comprising representation from neurology, neuroradiology, anesthesia, neurosurgery, and patient advocacy. The SIG unanimously agreed on the scope and purpose of the guideline. Using a modified Delphi method, the SIG then created guideline statements for a number of question themes. A rigorous literature study, surveys of patients and healthcare professionals, and a review by numerous international experts on SIH all contributed to this process. Any patient presenting with orthostatic headache should be evaluated for spontaneous intracranial hypotension (SIH) and its possible diagnosis. MRI of the brain with contrast and the whole spine should be used as first-line imaging. The non-targeted epidural blood patch (EBP) is the first-line treatment and should be performed as soon as possible. The authors discuss treatment ideas and present criteria for doing myelography based on the spine MRI result and response to EBP. There are also recommendations for conservative care, symptomatic headache treatment, and management of SIH consequences.

This course is intended to provide information from an unbiased viewpoint on managing headaches while treating Chiari malformation with either medication or surgical therapy. This course will combine lectures, patient insights, and expert panels. It will be offered in person, digitally through Microsoft Teams, and on-demand for all paid attendees for one month following the conference. After completing this course, participants will be able to identify more precise headache care techniques and understand when surgery is necessary, use logic and reason when treating patients with Chiari malformation and headaches, and determine the prevalence of headaches and Chiari malformation in the general population.

Headaches have increased in frequency from about once weekly to more than four-times-a-week in this patient with a 25-year headache history. He is on amitriptyline and has increased his sumatriptan dose to five times weekly. PE and contrast MRI are normal. What’s next?

Other than anterior cervical and occipital lymphadenopathy, the physical examination and vitals are unremarkable. The patient is also requesting HIV pre-exposure prophylaxis initiation. HIV testing negative. What’s the best management?

On examination, this young man, who was living on a farm, demonstrated papilledema. MRI demonstrated an approximately 6 cm multiloculated cyst in the right temporoparietal brain.