Diagnostic Distribution of 100 Unilateral, Side-Locked Headaches Consulting a Specialized Clinic

Abstract

Objectives: We analyzed the diagnoses of patients consulting due to strictly unilateral headaches. Methods: We prospectively collected data from 100 consecutive patients. Diagnosis followed the ICHD-II criteria. Results: They accounted for 18.9% of the 528 patients seen in the study period. They were more frequent in males (58%). Age ranged from 19 to 81 years. Diagnostic distribution was: cluster headache (38 cases), a variety of secondary headaches (14 cases), migraine (11 cases), cervicogenic headaches (9 cases), hemicrania continua (8 cases), nummular headache (6 cases), psychiatric headache (5 cases), paroxysmal hemicranias (4 cases), short-lasting unilateral neuralgiform headache attacks syndrome (3 cases), stabbing headache (1 case), and hypnic headache (1 case). Mean ages at onset fell between 47 and 58 years for several diagnoses (cervicogenic, nummular, psychiatric, hemicrania continua and paroxysmal hemicrania headaches), and were 22 years for migraine, 32 for cluster and in general older than 55 years for secondary headaches. Conclusions: Strictly unilateral headaches account for almost 20% of headaches in subjects attending a headache clinic. Trigeminal-autonomic cephalgias in general (52%) and cluster headache in particular (38%) are the most frequent diagnoses, but secondary headaches account for 1 of 5 cases. Age at onset can be of help in their presumptive diagnosis.

A Cross‐Sectional Clinic‐Based Study in Patients With Side‐Locked Unilateral Headache and Facial Pain

“…In our clinic‐based study, strictly unilateral headaches accounted for 19.2% of all the headache cases. This observation is similar to the study by Ramón et al, which found a prevalence of 18.9% . In Leone et al observations, where the authors included only primary headaches of longer duration (>4 hours), the side‐locked pain was noted in about 15% patients …”

“…This observation is similar to the study by Ram on et al, which found a prevalence of 18.9%. 5 In Leone et al observations, where the authors included only primary headaches of longer duration (>4 hours), the side-locked pain was noted in about 15% patients. 2 Primary Headaches as Strictly Unilateral Pain.-Primary headache was noted in 58% patients in our study.…”

Errors in Recognition and Management are Still Frequent in Patients with Cluster Headache

“…These overlapping features include the development of aura (known to occur in up to 20% of CH cases) [14], the pain intensity (2/3 of migraine patients also have severe pain), the existence of cranial autonomic symptoms (at least one of these symptoms is known to occur in about half of migraine patients) [15,16,17,18,19,20,21,22] or the presence of associated ‘migraine' features in CH attacks (in a large German cohort CH attacks associated photo/phonofobia in 61% and nausea and vomiting in 28% of cases) [13]. The IHS criteria of ‘strictly unilateral pain' may also cause confusion as switching attack sides has been reported in at least 10% of CH cases [23] and also in up to 10% of cases migraine attacks are strictly unilateral for years [24]. Another factor that could have contributed to the long diagnostic delay is the male predominance of CH, as opposed to women who tend to consult more than men [25].…”

Місце Цервікогенного Головного Болю В Міжнародній Класифікації Головного Болю

“…ЦГГБ является наиболее распространенной формой вторичной головной боли и хронических ежедневных головных болей [12,19,20]. Доброкачественное парок-сизмальное позиционное головокружение в сочетании с ЦГГБ занимает 3-е место по частоте после головной боли напряжения с перикраниальной болезненностью и мигренью и без них и составляет 11 % [18].…”