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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 32-year-old woman, gravida 0, para 0, was admitted for delivery at 40 weeks of gestation. She had no history of headache, hypertension, and toxemia. She was delivered of a healthy boy. Although she was given no medication during normal delivery, she suddenly became drowsy and developed left hemiparesis immediately after delivery. Computed tomographic (CT) scan of the brain performed on the admission day revealed a subarachnoid hemorrhage and right putaminal hemorrhage. A 4-vessel cerebral angiogram demonstrated multiple irregular narrowing of the anterior cerebral arteries, middle cerebral arteries, and posterior cerebral arteries. Her conditions seemed to improve without any medication, and the multiple stenoses were no longer observed by angiography in a follow-up examination. On the basis of these observations, she was diagnosed as having postpartum cerebral angiopathy (PCA). Pathogenesis of PCA still remaing unclear to date an ergot alkaloid derivate (ergonovine) and the hydrogenated form of the powerful vasoconstrictor ergot (bromocriptine) have been reported as cause of PCA. We will classify PCA into 3 categories: eclampsia, secondary PCA, and primary PCA. "Primary PCA" is of unknown etiology, "secondary PCA" results from a known etiology such as drugs, and "eclampsia" is a PCA with toxemia of pregnancy. We report here, that PCA may occur even in a normal pregnant woman who was given no medication, and should be considered in the diagnosis of postpartum cerebral vascular diseases in women.
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PMID:[A case of postpartum cerebral angiopathy with intracranial hemorrhage and subarachnoid hemorrhage immediately after delivery]. 1596 Jan 76

Benign cerebral angiopathy and postpartum cerebral angiopathy are reversible cerebral arterial vasoconstriction syndromes. Presentation includes recurrent severe headaches, altered consciousness, and focal neurologic deficits; ischemic and/or hemorrhagic strokes can occur. No standard management has been established, but most authors agree that 1) acute-phase treatment includes cessation of vasoconstrictors, treatment of associated conditions, vasospasm treatment (calcium channel antagonists), and corticosteroids; 2) other measures include headache relief, blood pressure control, and stroke, cerebral edema, and seizure treatment; 3) definitive diagnosis requires conventional angiography and exclusion of alternative diagnosis; 4) a second arterial examination after 4 to 6 weeks is mandatory to confirm reversibility of vasoconstriction; 5) brain biopsy is indicated to rule out cerebral vasculitis in severe cases with clinical deterioration under steroid treatment or atypical findings; 6) immunosuppression should be reserved for patients with brain-leptomeningeal biopsy-proven vasculitis or used while waiting for a brain biopsy result; and 7) long-term measures include secondary stroke prevention and treatment of complications.
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PMID:Benign cerebral angiopathy; postpartum cerebral angiopathy: characteristics and treatment. 1663 39

Migraine is a common and disabling neurological disorder. Studies have shown that patients with migraine (especially those with typical aura with migraine) have an unfavorable cardiovascular risk profile and an increased risk of early-onset (<45 years) ischemic stroke. Statins are effective hypolipidemic drugs that reduce cardiovascular-related morbidity and death in patients with or without established atherosclerotic vascular disease. We report a patient whose frequent attacks of typical aura with migraine completely resolved after the initiation of treatment with a statin. In this context, we comment on the possible effects of statins on the pathophysiology of migraine. We suggest that statins may be useful drugs in the treatment of migraine because they could reduce the increased cardiovascular risk in these patients and also attenuate migraine attacks. Only a randomized prospective study in this population could provide a definite answer to these speculations.
Headache 2006 Apr
PMID:Could statins be useful in the treatment of patients with migraine? 1737 68

Subarachnoid haemorrhage in pregnancy is often the result of aneurysmal rupture or severe hypertension. A young woman with postpartum eclampsia and 'normal' blood pressure developed sudden-onset head pain, and was found to have minor biconvexity subarachnoid hemorrhages. Serial angiograms of the cervicocranial vessels revealed no evidence of aneurysm or arteriovenous malformation. A follow-up angiogram revealed diffuse vessel narrowing, consistent with postpartum angiopathy. Treatment consisted only of nimodipine for the prevention of vasospasm. The patient made an excellent recovery, without residual neurological deficits.
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PMID:Eclamptic subarachnoid haemorrhage without hypertension. 1667 28

The papers describing the secondary headache attributed simultaneously to vascular disorder beyond the head and neck and use of drug are lacking. There is no adequate position for that type of headache in the current classification of headache, either. The case of secondary headache induced by metoprolol in a 57-year-old patient with superior vena cava syndrome (SVCS) is reported. He suffered from chronic paroxysmal headache with accompanying rash and the superficial jugular veins were over-flown about 30 minutes after an intake of 25 mg of metoprolol. At the seventh day of hospital stay, the sudden death occurred. Postmortem examination showed the limited cardiac tamponade caused by aortal perforation and adhesive pericarditis SVCS produced by chronic, limited cardiac tamponade revealed after oral intake of metoprolol can be the cause of secondary headache that might be defined as "headache attributed to vascular disorder beyond the head and neck and related to medication for other indications".
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PMID:[Headache induced by oral intake of metoprolol in a patient with chronic and limited cardiac tamponade]. 1696 57

Apparent central nervous system vasculitis could have a benign course in a subset of patients and is referred to as benign angiopathy of the central nervous system (BACNS). This is mostly is seen in young women and presents with acute onset of neurologic symptoms, usually in the form of severe headache and/or a focal neurologic event. Cerebrospinal fluid analysis could be normal or nearly normal. Brain angiogram typically shows segmental narrowing, ectasia, or beading in multiple vascular territories on brain angiogram. Like in all cases of CNS vasculitis, exclusion of other systemic diseases or its mimickers associated with cerebral involvement is important.BACNS could respond favorably to treatment with corticosteroids alone or in combination with a calcium channel blocker, thereby avoiding unnecessary and prolonged treatment with other immunosuppressants like cyclophosphamide with their side effects. Little is published in the literature about BACNS, but is a rapidly emerging concept. It is thus important to recognize. We report a patient with classic presentation of BACNS to highlight the significance of distinguishing benign angiopathy from the more aggressive form of CNS vasculitis, because the treatment and response varies in these 2 entities.
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PMID:Benign angiopathy of the central nervous system. 1704 71

Reversible cerebral angiopathy (RCA) is responsible for disabling headache and potential stroke complications. Most patients respond poorly to analgesics. We describe four patients with typical RCA whose headache rapidly disappeared after IV nimodipine treatment was initiated.
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PMID:Reversible cerebral angiopathy: efficacy of nimodipine. 1706 16

The migraine-ischemia relationship is best understood in the context of the pathophysiology of migraine. Potential mechanisms of migrainous infarction (stroke occurring during migraine) include vasospasm, hypercoagulability, and vascular changes related to cortical spreading depression. Stroke occurring remote for the migraine attack may be related to arterial dissection, cardioembolism, and endothelial dysfunction. Endothelial dysfunction, a process mediated by oxidative stress, may be a cause or a consequence of migraine, and explain the relationship of migraine to vascular factors and ischemic heart disease. It remains uncertain whether stroke or myocardial infarction can be prevented by migraine prophylaxis, endothelial repair, platelet inhibition, or a combination of these strategies. Although triptans are generally considered safe for use in migraine, caution is warranted in those with multiple vascular risk factors. Known vascular disease is a contraindication to triptan use.
Cephalalgia 2007 Aug
PMID:Migraine and ischaemic heart disease and stroke: potential mechanisms and treatment implications. 1766 75

Postpartum reversible cerebral vasoconstriction syndrome, also known as postpartum cerebral angiopathy, is clinically characterized by headache and focal neurologic deficits, and angiographically by transient, fully reversible cerebral vasoconstriction. A 26-year-old woman was brought to the emergency room with a 3-day history of confusion, agitation, and headache. She was 2 weeks postpartum. She went on to develop right leg weakness two days after admission. A cerebral angiogram showed diffuse irregularities of all intracerebral vessels, and MRI showed multiple acute infarcts. Her clinical condition improved significantly over the next several days without any intervention, and she was discharged. MRA 3 months after initial presentation was normal. It is important to consider this syndrome in the differential diagnosis in patients presenting with headache and focal neurologic deficits in the postpartum period.
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PMID:Postpartum reversible cerebral vasoconstriction syndrome. 1787 40

Several hereditary disorders induce angiopathy in the intracranial cerebrovasculature and thus cause ischemic strokes. MELAS is a maternally inherited mitochondrial disorder that produces stroke-like events. Sickle cell disease, which is the result of a single base pair substitution, is a major cause of strokes in children. Homocystinuria, an autosomal recessive syndrome, produces premature atherosclerosis. Hereditary cerebroretinal vasculopathy is an autosomal dominant disorder that causes retinal and brain infarctions. Fabry disease is an x-linked disorder that can cause stroke in adults. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy is an autosomal dominant syndrome that is associated with ischemic stroke and migraine-like headaches. The clinical presentation, stroke pathophysiology, and gene defects associated with these heritable disorders are reviewed.
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PMID:Mendelian and mitochondrial disorders associated with stroke. 1790 83


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