The yield of neuroimaging studies was higher in the group with indeterminate headache (3.7%) than in the migraine (0.4%) or tension-type headache (0.8%) groups. The study does not provide information on white matter abnormalities in migraineurs. MRI performed in 119 patients with normal CT revealed significant lesions in 2 cases: a small meningioma and an acoustic neurinoma. No saccular aneurysms were detected; MR angiography was not obtained. However, the studies do not give information about the detection of paranasal sinus MG-132 disease,
which may be the cause of some headaches. For example, sphenoid sinusitis may cause a severe, intractable, new-onset headache that interferes with sleep and is not relieved by simple analgesics. The headache may increase in severity with no specific location.
There may be associated pain or paresthesias in the facial distribution of the fifth nerve and photophobia or eye tearing with or without fever or nasal drainage. The headache may mimic other causes such as migraine or meningitis.24 Wang et al25 retrospectively reviewed the medical records and MRI images of 402 adult patients (286 women and 116 men) who had been evaluated by the neurology service with a primary complaint of chronic headache (a duration of 3 months or more) and no other neurologic symptoms or findings. Major abnormalities (a mass, Lumacaftor datasheet caused mass effect, or was believed to be the likely cause of the patient’s Cyclooxygenase (COX) headache) were found in 15 patients (3.7%) including a glioma, meningioma, metastases, subdural hematoma, arteriovenous malformation, 3 with hydrocephalus, and 2 Chiari I malformations. They were found in 0.6% of patients with migraine, 1.4% of those with tension headaches, 14.1% of those with atypical headaches, and 3.8% of those with other types of headaches. Finally, Lewis and Dorbad26 retrospectively reviewed records of children aged 6-18 years with migraine and chronic daily headache with normal examinations.
Of 54 patients with migraine who underwent either CT (42) or MRI (12) scans, the yield of abnormalities was 3.7%, none clinically relevant. Of 25 patients with chronic daily headache who underwent either CT (17) or MRI (8) scans, the yield of abnormalities was 16%, none clinically relevant. Secondary Headaches (NDPH Mimics).— Spontaneous intracranial hypotension (SIH) syndrome often presents with a headache that is present when a patient is upright but is relieved by lying down, or by an orthostatic headache. However, as SIH syndrome persists, a chronic daily headache may be present without orthostatic features. SIH syndrome may also present with other types of headaches, including exertional or cough without any orthostatic features, acute thunderclap onset, paradoxical orthostatic headaches (present in recumbency and relieved when upright), intermittent headaches due to intermittent leaks, and the acephalgic form with no headaches at all.
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