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

The clinical features of SUNCT syndrome have been reviewed in 21 patients. There were 17 men and 4 women, rendering a clear male preponderance (ratio of 4.25). The mean age at onset was around 51 years. Attacks were experienced mostly in the orbital/periorbital area and always recurred on the same side, with an erratic temporal pattern and remissions of varying lengths. Most attacks were moderate to severe in intensity and burning, electrical, or stabbing in character. The attacks were regularly accompanied by prominent, ipsilateral, conjunctival injection; tearing; and rhinorrhea or nasal obstruction. There were many precipitating mechanisms. Exclusively spontaneous attacks were described in 3 patients. The usual duration of paroxysms ranged from 10 to 60 seconds, Whereas the longest duration varied from 60 to 300 seconds. The frequency of attacks during the symptomatic periods varied from less than 1 attack daily to more than 30 per hour. In the majority of patients, supplementary examinations failed to show any notable abnormality. However, 2 patients were documented to have a symptomatic form of SUNCT, with a vascular malformation in the ipsilateral cerebellopontine angle. A variety of drugs and local anesthetic blockades, inclusive of tic douloureux drugs, were tried, but a persistent, convincingly beneficial effect was generally lacking. SUNCT syndrome is in the differential diagnosis when encountering unilateral, orbital/periorbital headache syndromes.
Headache 1997 Apr
PMID:SUNCT syndrome. A clinical review. 915 Jun 13

Sinusitis affects up to 14% of Americans. Traditionally, most patients with sinusitis are evaluated and treated by either primary care physicians or otolaryngologists. In order to gain information regarding the characteristics at presentation and the outcome of treatment of sinusitis by an allergist, the records of 200 consecutive patients seen at the Institute for Asthma and Allergy at the Washington Hospital Center for chronic sinusitis were reviewed. The most common presenting symptoms were nasal congestion, postnasal drip, purulent rhinorrhea, headache, cough, facial pressure, anosmia or hyposmia, hypogeusia, and throat clearing. Initial abnormal physical exam findings included abnormal transillumination, purulent secretions, nasal mucosal swelling, nasal polyps, and nasal crusting. Treatment included 4 weeks of oral antibiotics, nasal corticosteroids, nasal lavage, and topical decongestants. All of the presenting symptoms (23-75% of the patients) and signs (50-84% of patients) improved with medical management. Patients have been followed for 1 to 27 months, with a mean of 6 months, and 6% have required surgery, with one complication of cerebrospinal fluid leak. These findings indicate that medical management of chronic sinusitis in an allergist's office is effective.
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PMID:Sinusitis in an allergist's office: analysis of 200 consecutive cases. 919 44

The term cephalocele indicates a rare congenital malformation in which intracranial contents are extended through a defect in the cranium and dura mater. Intranasal cephaloceles belong to the group of basal cephaloceles. They can easily be misdiagnosed as nasal polyps and this can be potentially fatal after erroneous polypectomy. Three cases of transethmoidal cephalocele are presented, each with intermittent cerebrospinal fluid (CSF) rhinorrhea. The presence of a positive 2-transferrin-band in the immunological tests performed on the nasal fluid proved particularly helpful in diagnosing CSF. Other clinical sings were nasal obstruction associated with a solid intranasal mass, recurrent sinusitis and extensive pneumocephalus associated with headache after forceful nose-blowing. In all cases CT-scan delineated the osseous defect in the anterior skull-base, although MRI proved superior in soft-tissue resolution and multiplanar scanning. In one case surgery was a frontal craniotomy combined with endonasal endoscopic ethmoidectomy while in the other two a transethmoid approach was used. The present report emphasizes the distinctive clinical features of congenital intranasal cephaloceles and indicates the diagnostic and surgical procedures.
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PMID:[Congenital intranasal cephalocele: diagnosis and treatment]. 919 90

A series of 19 patients with what originally had been diagnosed as a first division (V1) trigeminal neuralgia was collected. The inclusion criteria were severe, rather short-lasting pain attacks within the V1 area, combined with trigger mechanisms. There were 10 women and 9 men, and the mean age of onset was 57.8 years. Fifteen of 16 with adequate information on attack duration had paroxysms of a "few seconds" duration or less, whereas 10 patients had paroxysms lasting < or = 2 seconds. In an exceptional case, only "more long-lasting" attacks (greater than 30 seconds' duration) were experienced. In regard to autonomic phenomena, lacrimation was most frequently present (in a total of 8 patients; 3 rather regularly, 5 more irregularly). The combination of lacrimation, conjunctival injection, and rhinorrhea was present in only 2 (of 19), and in neither of them in a major way. Typically, autonomic phenomena occurred during the later stages of disease and during particularly severe and long-lasting attacks. Seven of 14 with adequate information also had nocturnal attacks. Initially, a more or less complete carbamazepine effect was reported by 10 of 13 patients. Precipitation mechanisms were the same as with second and third division tic, but were mainly located within the V1 area, particularly initially. A comparison with SUNCT syndrome has been made. SUNCT is a predominantly male disorder, with only exceptional attacks of < or = 10 seconds' duration, and generally with attacks of 15 seconds or longer. Autonomic symptoms and signs are more pronounced than in V1 tic. Carbamazepine generally provides minor, if any, benefit in SUNCT. The present work strongly indicates that the two disorders are essentially different.
Headache 1997 Jun
PMID:Trigeminal neuralgia. Clinical manifestations of first division involvement. 923 8

Approximately 45% of benign peripheral nerve sheath tumors occur in the head and neck region. Of these, schwannomas (neurilemomas) arising from the nasal cavity and paranasal sinuses account for less than 4%. Pathologic features of this subset are not well documented. We report a series of five cases of sinonasal schwannoma and one in the nasopharynx. The male-to-female ratio was equal, and the age at presentation ranged from 38 to 65 years of age (median, 52 yr). Four of the lesions were located within the nasal cavity, one arose from the maxillary sinus, and one originated in the nasopharynx, with extension into the Eustachian tube. Two cases showed local bony destruction, with intracranial extension. Presenting clinical symptoms included nasal obstruction, epistaxis, rhinorrhea, anosmia, facial swelling, headache, and serous otitis media; the two cases with intracranial spread also presented with visual disturbances. All of the six cases were treated by surgical excision. Clinical follow-up in five cases ranged from 6 to 48 months (median, 27 mo). Histologically, all of the lesions shared many cytomorphologic features common to schwannomas arising at other sites, and all of the six cases showed strong, diffuse immunoreactivity for S-100 protein. Four cases showed features of the cellular variant, and one showed focal granular cell change. An unusual and previously poorly documented histologic feature, distinct from schwannomas arising at most other anatomic sites, was a lack of encapsulation, which, when combined with hypercellularity, often raised suspicion of malignancy. Because none of the cases in this series has shown either local recurrence or postoperative metastasis to date, lack of encapsulation and locally destructive growth in an otherwise histologically typical schwannoma arising at this site should not suggest malignant potential.
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PMID:Schwannomas of the sinonasal tract and nasopharynx. 926 19

Fifteen bus drivers, operating diesel converted trolley buses, experienced symptoms including watery and itchy eyes, rhinorrhea, and headaches. A total of 49 buses were labeled as "problem buses" and operators refused to drive them. An investigation identified high fungal counts in some problem buses (> 70,000 colony forming units [CFU]/m3; n = 3) compared with control buses (< 220 CFU/m3; n = 4). The predominant species were Penicillium and Cladosporium (1/1). Remedial measures, including washing with a 0.17% solution of sodium hypochlorite and an ozone treatment, were not successful. Because fungal species are heat sensitive, two buses were subjected to a heat treatment of 55 degrees C for 4 hours. In one bus the fungal spores of Cladosporium appeared to be more heat sensitive than the spores of Penicillium. At this point the interior of one bus was completely renewed and another was given a formaldehyde treatment followed by heat treatments. Both strategies reduced fungal counts to 190 from > 107,000 CFU/m3 for the former and to 270 from > 71,000 CFU/m3 for the latter. Only the interior of the most heavily contaminated buses were refurbished prior to the heat treatment, which was done on all problem buses. All buses are still in active service 5 years later. The most frequent health symptoms reported by 88 exposed bus drivers were headache (36%), blocked/runny/itchy nose (26%), nausea (26%), and dry irritated throat (25%). No chronic health effects have been reported after 5 years, although some of these common fungal species are known to be opportunistic pathogens.
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PMID:Investigation and remediation of diesel converted trolley buses associated with extensive fungal growth and health complaints. 934 33

In winter, children with mold allergy may develop persistent cold-like symptoms (PCLS) that often defy conventional therapy. To investigate the cause of PCLS, we enrolled 44 children (25 with PCLS and 19 controls) in a 2-year study to compare their clinical symptoms and the mold count in their homes. Children with PCLS had a higher percent of eosinophils in nasal smears as compared with those without PCLS (32% vs 26%). On a scale of 0 to 3, the PCLS group had higher symptom scores (P < 0.001 for all symptoms): bloodshot eyes (2.92 vs 0.79), mouth breathing (2.04 vs 0.68), rhinorrhea (2.48 vs 0.89), nasal voice (2.68 vs 1.00), postnasal drip (2.64 vs 0.47), and headache (2.72 vs 0.53) than the non-PCLS group. The clinical scores also correlated significantly with the mold count in the home (the r value ranged from 0.6716 to 0.7450). We conclude that management of children with PCLS should include decreasing humidity and enforcing environmental control to eradicate mold from inside the homes.
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PMID:Mold allergy is a risk factor for persistent cold-like symptoms in children. 941 37

In order to provide an update of clinical, pathogenic, diagnostic and therapeutic aspects of chronic paroxysmal hemicrania (CPH), also known as Sjaastad syndrome, we review the relevant literature. The term CPH was proposed by Sjaastad in 1976. Although continuous and non continuous cases have been described, Sjaastad prefers to use the term "prechronic" for the non continuous form, given that the adjective "chronic" denotes an important defining feature of CPH. CPH, which has been included in International Headache Society classification system since 1988, is much less common than cluster headache. CPH can be defined as pain that mainly affects women, is unilateral, always on the same side, and generally oculo-fronto-temporal. It can appear at any hour of the day or night, can be triggered by various phenomena and is accompanied by dysautonomic phenomena, generally on the same side as the pain, such as red eyes, tearing, nasal congestion and sometimes rhinorrhea. This headache is distinguished by its response to indomethacin therapy. The pathogenesis of CPH is unknown, although it is believed to resemble cluster headache, at least in its final stages (involving the trigeminal vascular system). Differential diagnosis should include cluster headache, SUNCT syndrome, continuous hemicrania and cervical headache, as well as facial neuralgia.
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PMID:[Chronic paroxysmal hemicrania]. 949 56

We report a case of a 17-year-old male who had hit the front of his head in a traffic accident. CT scan revealed contusional hemorrhage and pneumocephalus of the left frontal lobe 10 hours after the accident. A month later he complained of rhinorrhea and CT scan revealed intracerebral pneumocephalus. One day he complained of headache and began to vomit after he sneezed. CT scan revealed that the pneumocephalus had become worse and air had spread throughout the subarachnoid space. Bone CT scan revealed the air communicated from the frontal sinus to the intracerebral air cavity. 3D-CT scan revealed bone defect in the roof of the ethmoid sinus. The intraoperative findings revealed that the intracerebral air cavity communicated with the frontal sinus and ethmoid sinus. Though the brain which dropped into the paranasal sinus, adhered to the dura mater around the bone defect, a part of the brain had come off from the dura mater around the frontal sinus. We suspected that the intracerebral air cavity communicated with the frontal sinus initially. When the air cavity communicated with the ethmoid sinus secondarily, intracranial pressure abated and air came into the subarachnoid space from the frontal sinus.
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PMID:[Traumatic intracerebral pneumocephalus communicating with two different paranasal sinuses: a case report]. 951

Airborne fungi have been postulated as a cause of symptoms among office workers. Using the MAST chemiluminescent system, this study evaluated 36 IgG and 36 IgE antibody levels in 47 office workers from an area with elevated airborne fungal concentrations and 44 office workers from an otherwise similar area with lower airborne fungal exposure. No difference was found in IgG antibody to fungi between the lower and higher exposure areas, but high IgG antibody to one or more of the fungi studied was detected in 67% of all the workers tested. IgE antibody to one or more antigens was detected in 40% of the participants. Workers who reported atopic symptoms (sneezing, runny nose, and itchy eyes) or "sick building" symptoms (any three of the following temporally related to work: headache, fatigue, stuffy nose, irritated eyes, or sore throat) were more likely to have one positive IgE antibody test. Type I hypersensitivity to aeroallergens besides fungi may play a role in some symptoms reported by some participants in this office building.
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PMID:The relationship between symptoms and IgG and IgE antibodies in an office environment. 951 63


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