Cerebral magnetic resonance imaging was performed on 63 patients with chronic primary headache (28 with migraine with and without aura, 35 with tension-type headache). Fifty-four headache-free individuals of the same age range were used as controls. The headache sufferers showed an incidence of focal white matter abnormalities on T2-weighted magnetic resonance imaging significantly higher than the age-matched control group (33.3% vs 7.4%). The incidence of white matter abnormalities did not correlate with age (except for patients older than 60 years), sex, headache history, headache status, or ergotamine consumption. Migraine (with and without aura) and tension-type headache patients had similar prevalence of white matter abnormalities (32.1% vs 34.3%). The lesions were predominantly distributed in the frontal region, independent of the side of usual aura or headache. Our findings indicate that both migraine and tension-type headache may be associated with early pathologic changes in the brain and may share, at least in part, common pathogenic pathways.
This study investigated the role of major stressful life events vs. minor life events (i.e., daily hassles) in the persistence of primary headache. It was hypothesized that chronic headache patients (n = 83) would be characterized not so much by exposure to a continued surfeit of inherently major life events as by a tendency to appraise cognitively and emotionally any ongoing microstressor or daily hassle as being more arousing or impactful than headache-free controls (n = 51). As predicted, chronic headache patients reported a significantly higher frequency (P < 0.01) and density (P < 0.01) of daily hassles, but not of major life events, than controls. Furthermore, minor life events were significantly correlated with headache frequency (P < 0.001) and density (P < 0.001) but not with gender, age and headache history. In terms of item content, health-related hassles (e.g., trouble relaxing) were perceived as being the most stressful. Significant differences between headache subgroups (chronic tension-type headache, migraine, mixed headache) were found, with tension-type and mixed headache sufferers reporting a higher incidence and density of daily hassles than migrainous patients. It was concluded that daily hassles were significantly associated with the persistence of headache and might be a better life event approach to chronic headache than major stressful events.
A 62-year-old male patient with 2 years of SUNCT syndrome is described. The patient presented with long-lasting periods of frequent attacks of intense orbital pain with a duration of about 1 min, associated with ipsilateral conjunctival injection, lacrimation and rhinorrhea. Cranial MRI and cerebral angiography demonstrated an ipsilateral cavernous angioma of the pons, involving the trigeminal roots. As the pain was refractory to most treatments, including carbamazepine, the patient asked for, and eventually underwent, direct surgical excision of the malformation. Following the operation, his neurological conditions rapidly deteriorated and he died of postoperative complications (haemorrhage).
This study investigated the relationship between stressful life events and the onset of chronic primary headache (CPH), using both normative group ratings and self-report ratings of the desirability and the perceived impact of stressful events. We hypothesized that CPH patients (n = 63) would report significantly more stressful life events with negative impact on their life style in the year prior to headache onset compared with headache-free controls (n = 44). The prediction was fully confirmed. CPH patients were exposed to a significant increase (P less than 0.001) in their final year life change unit (LCU) totals prior to headache onset as compared to the previous corresponding time interval and to headache-free controls. Furthermore, a highly significant peaking (P less than 0.001) of negative change scores, based on personal ratings of the distress concerning life events in the same time interval, was observed in the CPH group. In terms of event content, exits or losses were prominent in being perceived as stressful. Significant differences between headache subgroups (chronic tension-type headache, migraine, mixed headache and psychogenic headache) were not found, although mixed headache sufferers reported a higher incidence of interpersonal arguments and difficulties than migrainous patients. We conclude that a sudden increase in the frequency and magnitude of stressful life events, associated with a cognitive-emotional appraisal of their negative impact on life patterns, appears to herald the onset of headache, independently of the developing clinical headache syndrome.
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