EpidemiologyHeadaches are the most prevalent neurological disorders and are among the most frequent symptoms seen in general practice. The headache is about 30% of neurological specialist visits and continues to be a frequent cause of ED use, accounting for 2% of all visits. 4 50% of the general population have headaches during any given year, and more than 90% of them report a lifetime history of headache. 5 The only Italian epidemiological study (PACE study) 6 showed that 52% of men a and 43% of women interviewed suffered from headache in the last year. 7
Primary headache Migraine
IntroductionMigraine is a common, debilitating headache disor-
ABSTRACTHeadaches are the most prevalent neurological disorders and continue to be a frequent cause of Emergency Department use, accounting for 2% of all visits. Although it is a neurological disease it must be also a clinical competence of internist for its nature and frequency. The keys to effective management of these syndromes are differential diagnosis through history, physical examination, and diagnostic studies when necessary. This monograph highlights the importance of establishing whether headache is a secondary symptom of another disease process or a primary condition. The goal of headache management is for patients and healthcare professionals to work together to minimize pain and improve quality of life.
A 45-year-old male noticed progressive weakness of the right lower limb with gait disturbance. Over the following months, motor deficits worsened, spreading to the right upper limb. Electromyography showed active denervation in the upper and lower limb muscles. A diagnosis of amyotrophic lateral sclerosis (ALS) was made. About 2 years after symptom onset, gradual improvement occurred. Cerebrospinal fluid analysis performed about 3 years after the beginning of symptoms identified Cronobacter sakazakii. Since no other possible causes were identified, we suggest that an almost completely reversible ALS-like syndrome had been triggered by Cronobacter infection in our immunocompetent patient.
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