Headaches Associated with Organic Diseases of the Nervous System

This chapter discusses several forms of headache. The chapter includes hemicrania continua, idiopathic stabbing headache, exertional and cough headaches, and others. The chapter also discusses short-lasting unilateral neuralgiform headache with conjunctival injection and tearing. Hemicrania continua is a rare, indomethacinresponsive headache disorder characterized by a continuous, moderate to severe, unilateral headache that varies in intensity, waxing ,and waning without disappearing completely. Although the essential feature of hemicrania continua is unilateral headache, some bilateral or alternating side cases have been reported. Hemicrania continua almost invariably has a prompt and enduring response to indomethacin. However, the requirement of a therapeutic response to make a diagnosis is problematic, as it excludes the diagnosis of hemicrania continua in patients who were never tried on or who failed to respond to indomethacin. Hemicrania continua exists in continuous and remitting forms. In the remitting variety, distinct headache phases last weeks to months, with prolonged pain-free remissions. In the continuous variety, headaches occur on a daily, continuous basis, sometimes for years. The continuous variety can be sub classified into: an evolutive, unremitting form that arises from the remitting form, and an unremitting form characterized by continuous headache from the onset.

Physical exertion can cause migraine or the benign exertional headache. The case is presented of a 30-year-old male weight lifter who experienced excruciating headache while doing leg presses on a weight machine. Physical examination was normal, as were subsequent examinations. The patient resumed training with lighter weights and did not again experience headaches. Some experts estimate that up to 4% of the adult population engages in weight lifting occasionally, and thus this malady may be more common than is realized.

Instead of representing two sharply different entities, migraine and tension headache may best be thought of as occupying the two ends of a continuum, with mixed tension and vascular headache in the center. The author's assessment of current knowledge of mechanisms, symptoms, and acute and prophylactic treatments supports his statement that the major clinical difference between the variants of headache is differential pharmacologic effectiveness of the drugs used.