Elsevier

Neurologic Clinics

Volume 15, Issue 1, 1 February 1997, Pages 143-152
Neurologic Clinics

SHORT-LIVED HEAD PAINS

https://doi.org/10.1016/S0733-8619(05)70300-5Get rights and content

Most of the headache syndromes discussed in this article have a duration of less than 1 hour; some of them have a duration of seconds to minutes. Curiously and inexplicably, many of these paroxysmal syndromes are responsive to indomethacin prophylaxis.

Section snippets

ICEPICK HEADACHE

The author and Schwartz32 characterized the epidemiologic features of icepick headache among 100 randomly selected control subjects and among 100 migraineurs. Three of the control subjects reported sharp, jabbing pain about the head, and in all three it occurred at least once annually. One person noted that the jabs occurred only after strenuous running for several miles. Of the 100 migraineurs, 42 had experienced sharp, jabbing pain, and more than half of them experienced it more often than

HYPNIC HEADACHE SYNDROME

In a 9-year period, the author encountered six patients (5 men, 1 woman) in the seventh decade of life or beyond who were regularly awakened from sleep at a particular time of night, sometimes during a dream, by a diffuse headache that persisted for 30 to 60 minutes and was often associated with nausea but was without autonomic symptoms.31 Although amitriptyline and propranolol had been administered, among other drugs, to all six patients without benefit, headache ceased or was substantially

CHRONIC PAROXYSMAL HEMICRANIA

This syndrome is a rare subset of the chronic form of cluster headache and is characterized by 10 to 20 brief, intense, focal head pain attacks daily. It occurs more often in women, and attacks may be precipitated by head flexion or rotation.36

The age of onset is at about 30 years. The pain is usually unilateral, localized to the temple, forehead, eye, or periorbital area, and occasionally to the occiput. The attack is short-lived, lasting 3 to 46 minutes, averaging 13 minutes. The attack

COUGH HEADACHE

Transient, severe head pain on coughing, sneezing, weightlifting, bending, or stooping was regarded widely as an ominous syndrome indicative of a serious intracranial pathologic condition, until Symonds's report established it as a benign disorder in most instances.40 It is a disorder mainly affecting middle-aged men, and it runs its course in a few years. It is uncommon: only 93 diagnoses were made at the Mayo Clinic (Rochester, MN) in a 14-year interval.

COITAL HEADACHE

Coital headache is characterized by abruptly appearing, excruciating, throbbing, occipital headache, occurring just before or at orgasm. In a few patients, headache occurs fairly regularly with sexual activity, but in most it develops unpredictably and infrequently and correlates poorly with the level of sexual excitement and the physical exertion expended at these times. Lovemaking also may be a trigger mechanism for patients who are otherwise disposed to migraine or the cough headache

THUNDERCLAP HEADACHE

Among survivors of berry aneurysm rupture, 40% report unusual "sentinel" headaches in the few weeks before rupture. These warnings are intense and abrupt in onset (like an unexpected clap of thunder) and last for several hours. "Warning leak," which implies partial rupture of an aneurysm, has been accepted widely as the cause of such headaches. It has followed, therefore, that the presence or absence of blood in the CSF should be the end point of the diagnostic evaluation of the patient with a

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    Address reprint requests to Neil H. Raskin, MD, University of California, San Francisco, Department of Neurology, Box 0114, San Francisco, CA 94143

    *

    From the Department of Neurology, University of California, San Francisco School of Medicine, San Francisco, California

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    Copyright © 1997 W. B. Saunders Company. Published by Elsevier Inc. All rights reserved.