[vc_row css_animation="" row_type="row" use_row_as_full_screen_section="no" type="full_width" angled_section="no" text_align="left" background_image_as_pattern="without_pattern"][vc_column][vc_column_text]A new national survey released by the National Headache Foundation and funded by GlaxoSmithKline (GSK) identified a gap in doctor-patient migraine communication, impeding both from making the most of in-office medical visits.[/vc_column_text][vc_video link="https://www.youtube.com/watch?v=fLtbdqyNCds" el_width="50"][vc_column_text]A new national survey released...

By Edmund Messina, MD, Medical Director of the Michigan Headache Clinic in East Lansing, Michigan While headaches are typically thought to be located around the forehead or back of the head, there are types of headache that strike the face itself. Trigeminal neuralgia is a form of severe facial pain in which patients experience brief volleys of very painful electric shock sensations triggered by mild touch to the face or mouth. This touch can be from washing, shaving, eating, brushing the teeth or even talking. The trigger zones are particularly sensitive in the area between the nose and mouth or on the chin.

By Robert Kunkel, MD, Consultant, Center for Headache and Pain Neurological Institute, Cleveland Clinic, Cleveland, OH THE CASE I first saw George on March 12, 2008. He was 75 years old and had had a headache since December 12, 2007, when he slipped on ice and fell. He said he didn’t hit his head, but he had left-sided neck and head discomfort afterward, which had persisted. He had high blood pressure, which was well controlled, but no other significant medical problems. George described the head pain as “sharp” and constant in character. It was strictly on the left side and involved the left neck and upper shoulder area, the back of the head and spread forward above the left ear into the temple. It was not aggravated by neck motion, coughing or straining. He had a CT scan of the brain in January of 2008, which was negative, and a CT scan of his neck showed only mild degenerative arthritic changes. He was referred for physical therapy, which helped the neck pain but had no effect on his headache. In February, his primary care physician diagnosed him with occipital neuritis and he was put on a dose of prednisone (a cortisone) that was tapered over the course of seven days. His head pain was completely gone for a few days but recurred when he reduced the dose. In addition to the head discomfort, George reported that he felt tired and had a lack of stamina. While taking the prednisone, he “felt like a new man.” When I examined him, he had been off of prednisone for over two weeks. The exam was normal, including his blood pressure, except for mild tenderness with pressure over the left lower neck and at the base of the skull. His neck motion was slightly reduced. On the presumption that this was a form of occipital neuralgia, we injected his occipital nerve with a mixture of an injectable cortisone preparation and a local anesthetic. Following this procedure, he was free of pain for five days. Because this was a new headache for George, and because of his response to the prednisone, the diagnosis of temporal arteritis was also considered. On lab testing, he had an elevated sedimentation rate (sed rate), which reflects inflammation in the body. His sed rate was 70 while a normal level is between 0 and 20. Because of this elevated sed rate, we had a biopsy of the left temporal artery done one week after his first visit. His headache had returned by then and the biopsy showed active inflammation in the artery wall, which is typical of temporal arteritis. He was started on a daily dose of 60 mg. of prednisone along with extra calcium and vitamin D.

My constant daily headaches began 36-years ago and they continue. The onset was sudden and I remember the day very well with extreme pain one evening. My head has constant pressure 24/7 from the occipital area to the top of my head. As the day goes on, eye pressure pain builds as the headache tends to worsen. I always feel like I have a vice on my head...squeezing my skull and neck muscles. Sometimes, the intense pain is felt before I even open my eyes in the morning, but typically the pain grows stronger as the day goes on. I AM NEVER WITHOUT PAIN!

By Anne H. Calhoun, M.D. Partner and co-founder of the Carolina Headache Institute, Chapel Hill, North Carolina THE CASE For the last year, Janice has had frequent headaches with nausea and vomiting. The headaches vary throughout the day, from mild to severe and from steady to throbbing. They...

“Icepick” Headache Occur in About 2% of Population

By Anne Walling, M.D. Professor, Family and Community Medicine, University of Kansas School of Medicine – Wichita THE CASE Sometimes physicians make diagnoses in the produce aisle! I bumped into Mike, one of my patients, while grocery shopping. During our brief chat, he winced in pain about three times over approximately a two-minute period. Each episode was no more than a fleeting grimace, lasting less than a second. I knew Mike to be a very healthy young man apart from occasional migraines. When I asked him if he had a headache or any other symptoms, he described having sudden “flashes” of pain in his right temple. He had no other symptoms and otherwise felt fine. He appeared, spoke and acted normally. Mike recalled having a similar pain on one occasion about six weeks previously. That episode had lasted less than five minutes and had consisted of approximately five flashes of pain. Mike was unsure if a migraine attack had followed the previous episode. Mike made an office appointment and the first thing we did was rule out a serious brain condition by doing a combination of medical history, repeated careful physical examinations and tests including imaging. The most likely diagnosis was “icepick headache,” so named because the pain is typically described as like being stabbed with an ice pick or a needle. When he was offered this diagnosis, Mike said, “That’s it exactly!” After a long discussion, Mike decided that his icepick headaches were mainly a nuisance, so he decided not to take any specific treatment. His icepick headaches have only recurred once in the 18 months since that meeting in the grocery store.

By Mark W. Green, MD, Professor of Neurology, Director of Headache and Pain Medicine, Mount Sinai School of Medicine, New York, NY THE CASE A 21-year-old female consulted with me for both headaches and convulsions. She experienced headaches with light and sound sensitivity, as well as nausea, about three times a month. About three or four times a year, however, she experienced spells where she felt vaguely ill, then found herself on the floor with what witnesses described as convulsions that lasted a minute or two. Afterwards, she had a throbbing headache and some nausea, but no light or sound sensitivity. This lasted until she went to sleep in the evening. On occasion, she saw zigzag lines in the right side of her vision, which lasted about 10 minutes and preceded a headache. She believes she may have experienced the same phenomenon before some of her “fainting” spells. The seizures are more likely to occur during the time of menstruation, a time when she also experiences more severe headaches.

SUNCT (Short-lasting Unilateral Neuralgiform headache attacks with Conujuctival injection and Tearing)

By Sylvia Lucas MD, Ph.D. Director of the Headache Clinic, University of Washington Medical Center Seattle, WA THE CASE “My husband has the devil eye” is how Jay’s wife described his beet-red eye during his severe episodes of pain. With no prior history of headache, at age 26 Jay had a sudden onset of short bursts of pain around his left eye and temple. These episodes increased in frequency and, within six months, had become constant. The pain consists of sharp, stabbing episodes that last a few seconds, perhaps longer, and occur up to thirty times a day. After six months, Jay noticed a dull background of pain, which is now always present. During the stabbing episodes, his left eye becomes bright red and teary. He also has tinnitus (ringing in the ear), ear pain and vertigo (dizziness). His CT and MRI scans and neurologic exam were normal.

By Anne Walling, M.D. Professor, Family and Community Medicine, University of Kansas School of Medicine – Wichita THE CASE Al was a very healthy 28-year-old lawyer. The only indication of a potential health problem was a history of migraine in his mother and several family members. Al himself had never suffered from headaches. One day at work, Al felt unusually tired and had trouble concentrating. He found writing difficult and noticed he was “dropping things and tripping over my feet.” At the insistence of his boss, Al made an emergency appointment with his family physician. By then he had developed a headache on his left side and felt nauseated and tired. His arm and leg were weaker on the right side than the left. A neurological assessment, including MRI and other tests, was performed because of the possibility of a stroke. The tests were normal, but while they were being completed, Al appeared to have a typical left-sided migraine. The weakness disappeared as the headache, nausea and exhaustion progressed. After taking pain pills and a long nap, Al was completely back to normal within a few hours. Al’s physicians concluded that the weakness was a migraine aura.