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Clinical Characteristics of Headache and Diagnosis of Primary and Secondary Headache Disorders

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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: 31 August 2024 | Viewed by 21660

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Prof. Dr. Elena R. Lebedeva

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Department of Neurology, International Headache Centre Europe-Asia, the Ural State Medical University, Yekaterinburg, Russia
Interests: headache; migraine; stroke; transient ischemic attacks; intracranial aneurysms

Special Issue Information

Dear Colleagues,

Clinical characteristics of headache represent an important diagnostic tool in distinguishing between primary and secondary headache disorders. Taking a headache history is a simple method in the diagnosis of many disorders. It is crucially important to perform a detailed analysis of previous and current characteristics of headache and their comparisons. Changes in the characteristics of headache can alert us to new disorders such as stroke, aneurysm, hematoma, tumor, vasculitis, and many other disorders which can provoke secondary headache. This is an indication for additional examination, first of all neuroimaging. The purpose of this Special Issue is to demonstrate typical characteristics of headache in different primary and secondary headache disorders and their role in the diagnosis.

We are pleased to invite you to submit your manuscripts on primary and secondary headache disorders with an emphasis on detailed description of their clinical characteristics and their role in the diagnosis. Research areas may include (but are not limited to) the following: differential diagnosis of migraine with aura, differential diagnosis of migraine-like headache and tension-type-like headache, headache attributed to stroke, headache in cerebral venous thrombosis, post-traumatic headache, headache after vaccination, headache attributed to idiopathic intracranial hypertension, medication overuse headache, and others.

We look forward to receiving your contribution.

Prof. Dr. Elena R. Lebedeva
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

primary headache disorders
secondary headache disorders
migraine-like headache
tension-type headache
migraine
headache
characteristics of headache

Published Papers (9 papers)

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Research

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11 pages, 775 KiB

Open AccessArticle

Pericranial Muscle Stiffness, Pain Thresholds, and Tenderness during a Treatment Cycle of OnabotulinumtoxinA for Chronic Migraine Prevention

by Sebastian Worsaae Dalby, Jeppe Hvedstrup, Louise Ninett Carlsen, Sait Ashina, Lars Bendtsen and Henrik Winther Schytz

Diagnostics 2024, 14(3), 330; https://doi.org/10.3390/diagnostics14030330 - 03 Feb 2024

Viewed by 723

Abstract

Background: Treatment with OnabotulinumtoxinA (BoNT-A) is effective as a preventive treatment for chronic migraine (CM). Preclinical studies suggest that the mechanism of action of BoNT-A in migraine is based on blocking unmyelinated C fibers. We aimed to investigate whether the muscle-relaxing effect of BoNT-A is associated with the preventive mechanism in patients with chronic migraine by measuring the stiffness, pain thresholds, and tenderness of the BoNT-A-applied muscles. Methods: A total of 22 patients with CM who were already in BoNT-A treatment participated in this longitudinal prospective study. Pericranial muscle stiffness was measured using ultrasound shear wave elastography, which measures the speed of shear waves propagating through the muscle. Pressure pain thresholds (PPT) were obtained via algometry, and muscle tenderness was measured via manual palpation. Measurements were made before BoNT-A injections and six weeks after the treatment. The measurements were performed while the muscles were maximally relaxed. The patients also completed daily diaries on headache and neck pain. Results: No change was observed in muscle stiffness (p = 0.737) or pericranial muscle tenderness (p = 0.400). The PPT over the trapezius muscles increased from 250 kPa before treatment to 304 kPa six weeks after treatment (p = 0.027). No change was observed on the temporalis muscles (p = 0.200) nor the non-dominant index finger (p = 0.067). BoNT-A decreased neck pain (p = 0.008) and headache (p = 0.007). Conclusions: The findings suggest that BoNT-A leads to the desensitization of cutaneous and muscle nociceptors in the head and neck regions, whereas muscle relaxation might not be an important part of the anti-migraine effect. Full article

(This article belongs to the Special Issue Clinical Characteristics of Headache and Diagnosis of Primary and Secondary Headache Disorders)

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10 pages, 474 KiB

Open AccessArticle

Validation of a Digital Headache Calendar at a Tertiary Referral Center

by Amalie Kjerrumgaard, Jeppe Hvedstrup, Louise Ninett Carlsen, Kristine Dyre and Henrik Schytz

Diagnostics 2024, 14(1), 21; https://doi.org/10.3390/diagnostics14010021 - 22 Dec 2023

Viewed by 681

Abstract

Background: Headache calendars are essential tools in monitoring changes in headache frequency and type. They are used in clinical practice for long-term monitoring, but their validation remains limited. The aim of this study was to validate the use of a digital calendar in monitoring single migraine and tension-type headache attacks. Methods: From July 2022 to February 2023, patients diagnosed with migraine and tension-type headache were enrolled. The validation of the digital calendar involved the comparison of self-reported single headache attacks in the digital calendar with the diagnostic headache diary based on the ICHD-3 criteria for migraine and tension-type headache. Sensitivity and specificity were calculated to assess reliability, and the level of agreement was calculated using kappa statistics. Results: This study included 30 patients (87% women) diagnosed with migraine and tension-type headache. The level of agreement in the classification of a single migraine attack revealed a sensitivity of 82% and a specificity of 78%, representing a substantial level of agreement (κ = 0.60). The classification of a single tension-type headache attack revealed a sensitivity of 84% and a specificity of 72%, with a moderate level of agreement (κ = 0.54). Conclusions: The digital calendar proves effective in monitoring single headache attacks in patients with migraine and tension-type headache. In clinical practice, we recommend using the digital calendar as a monitoring tool for headache patients, as they can accurately identify true migraine and tension-type headache days. Full article

(This article belongs to the Special Issue Clinical Characteristics of Headache and Diagnosis of Primary and Secondary Headache Disorders)

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10 pages, 1175 KiB

Open AccessArticle

Clinical Utility of Leeds Dependence Questionnaire in Medication-Overuse Headache

by Yen-Feng Wang, Yi-Shiang Tzeng, Chia-Chun Yu, Yu-Hsiang Ling, Shih-Pin Chen, Kuan-Lin Lai and Shuu-Jiun Wang

Diagnostics 2023, 13(3), 472; https://doi.org/10.3390/diagnostics13030472 - 27 Jan 2023

Cited by 1 | Viewed by 975

Abstract

Dependence behaviors are common in patients with medication-overuse headache (MOH). This prospective study aimed to characterize dependence behaviors in MOH by using Leeds dependence questionnaire (LDQ), and to determine the clinical utility of LDQ in the diagnosis of MOH. In total, 563 consecutive chronic migraine (CM) patients (451F/112M, mean age 41.7 ± 12.0 years) were recruited, including 320 with MOH (56.8%) (254F/66M, mean age 42.3 ± 11.6 years). LDQ scores were positively correlated with the monthly frequency of acute medication use (Spearman’s rho = 0.680, p < 0.001). When compared with patients without, those with MOH scored higher on LDQ (13.0 ± 7.6 vs. 3.9 ± 5.1, p < 0.001). By using a receiver operating characteristics curve, the cutoff value of LDQ was determined at 7 (sensitivity = 77.5%, specificity = 77.4%, area under curve = 0.85) for a diagnosis of MOH. An LDQ score of ≥7 was predictive of MOH (odds ratio = 11.80, 95% confidence interval = 7.87–17.67, p < 0.001). In conclusion, the presence of MOH in patients with CM is associated with more severe dependence behaviors. An LDQ score of ≥7 is useful in the detection of MOH in CM patients. Full article

(This article belongs to the Special Issue Clinical Characteristics of Headache and Diagnosis of Primary and Secondary Headache Disorders)

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Review

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13 pages, 905 KiB

Open AccessReview

Migraine Aura—Catch Me If You Can with EEG and MRI—A Narrative Review

by Franz Riederer, Johannes Beiersdorf, Adrian Scutelnic and Christoph J. Schankin

Diagnostics 2023, 13(17), 2844; https://doi.org/10.3390/diagnostics13172844 - 02 Sep 2023

Cited by 1 | Viewed by 2253

Abstract

Roughly one-third of migraine patients suffer from migraine with aura, characterized by transient focal neurological symptoms or signs such as visual disturbance, sensory abnormalities, speech problems, or paresis in association with the headache attack. Migraine with aura is associated with an increased risk for stroke, epilepsy, and with anxiety disorder. Diagnosis of migraine with aura sometimes requires exclusion of secondary causes if neurological deficits present for the first time or are atypical. It was the aim of this review to summarize EEG an MRI findings during migraine aura in the context of pathophysiological concepts. This is a narrative review based on a systematic literature search. During visual auras, EEG showed no consistent abnormalities related to aura, although transient focal slowing in occipital regions has been observed in quantitative studies. In contrast, in familial hemiplegic migraine (FHM) and migraine with brain stem aura, significant EEG abnormalities have been described consistently, including slowing over the affected hemisphere or bilaterally or suppression of EEG activity. Epileptiform potentials in FHM are most likely attributable to associated epilepsy. The initial perfusion change during migraine aura is probably a short lasting hyperperfusion. Subsequently, perfusion MRI has consistently demonstrated cerebral hypoperfusion usually not restricted to one vascular territory, sometimes associated with vasoconstriction of peripheral arteries, particularly in pediatric patients, and rebound hyperperfusion in later phases. An emerging potential MRI signature of migraine aura is the appearance of dilated veins in susceptibility-weighted imaging, which may point towards the cortical regions related to aura symptoms (“index vein”). Conclusions: Cortical spreading depression (CSD) cannot be directly visualized but there are probable consequences thereof that can be captured Non-invasive detection of CSD is probably very challenging in migraine. Future perspectives will be elaborated based on the studies summarized. Full article

(This article belongs to the Special Issue Clinical Characteristics of Headache and Diagnosis of Primary and Secondary Headache Disorders)

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11 pages, 514 KiB

Open AccessReview

Evaluating Headache and Facial Pain in a Headache Diagnostic Laboratory: Experiences from the Danish Headache Center

by Henrik Winter Schytz and Jeppe Hvedstrup

Diagnostics 2023, 13(16), 2671; https://doi.org/10.3390/diagnostics13162671 - 14 Aug 2023

Cited by 1 | Viewed by 665

Abstract

Background: Diagnostic tests are not routinely used for the diagnosis of primary headaches. It is possible that laboratory tests could be developed and implemented at tertiary headache centers to be an integrated part of the diagnosis and management of headache patients, and laboratory tests that can be used on-site at headache centers could help in evaluating patients with secondary headache disorders. Methods: In this narrative review, we present some of the studies that have been made so far at the Headache Diagnostic Laboratory at the Danish Headache Center that aim to investigate and phenotype primary headaches and investigate secondary headaches as well as improve management. Results: Semi-structured interviews and deep phenotyping, quantitative sensory testing, and provocation studies have been shown to be valuable in categorizing primary and secondary headache subtypes, possible pathophysiology, and defining needs for further research. In patients suspected of increased intracranial pressure, transorbital ultrasound with measurement of the optic sheath diameter may be useful in monitoring patients. The management of headache patients needs to be critically evaluated to optimize treatment continuously. Conclusion: A Headache Diagnostic Laboratory is very useful and should be an integrated part of headache care and management at tertiary headache centers. Full article

(This article belongs to the Special Issue Clinical Characteristics of Headache and Diagnosis of Primary and Secondary Headache Disorders)

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12 pages, 320 KiB

Open AccessReview

Cranial Autonomic Symptoms and Neck Pain in Differential Diagnosis of Migraine

by Beatriz Nunes Vicente, Renato Oliveira, Isabel Pavão Martins and Raquel Gil-Gouveia

Diagnostics 2023, 13(4), 590; https://doi.org/10.3390/diagnostics13040590 - 05 Feb 2023

Cited by 3 | Viewed by 2078

Abstract

Cranial autonomic symptoms and neck pain have been reported to be highly prevalent in migraine, although they are rarely considered in clinical evaluation. The aim of this review is to focus on the prevalence, pathophysiology, and clinical characteristics of these two symptoms, and their importance in the differential diagnosis between migraines and other headaches. The most common cranial autonomic symptoms are aural fullness, lacrimation, facial/forehead sweating, and conjunctival injection. Migraineurs experiencing cranial autonomic symptoms are more likely to have more severe, frequent, and longer attacks, as well as higher rates of photophobia, phonophobia, osmophobia, and allodynia. Cranial autonomic symptoms occur due to the activation of the trigeminal autonomic reflex, and the differential diagnosis with cluster headaches can be challenging. Neck pain can be part of the migraine prodromal symptoms or act as a trigger for a migraine attack. The prevalence of neck pain correlates with headache frequency and is associated with treatment resistance and greater disability. The convergence between upper cervical and trigeminal nociception via the trigeminal nucleus caudalis is the likely mechanism for neck pain in migraine. The recognition of cranial autonomic symptoms and neck pain as potential migraine features is important because they often contribute to the misdiagnosis of cervicogenic problems, tension-type headache, cluster headache, and rhinosinusitis in migraine patients, delaying appropriate attack and disease management. Full article

(This article belongs to the Special Issue Clinical Characteristics of Headache and Diagnosis of Primary and Secondary Headache Disorders)

14 pages, 11304 KiB

Open AccessReview

Differential Diagnosis of Visual Phenomena Associated with Migraine: Spotlight on Aura and Visual Snow Syndrome

by Eliseo Barral, Elisa Martins Silva, David García-Azorín, Michele Viana and Francesca Puledda

Diagnostics 2023, 13(2), 252; https://doi.org/10.3390/diagnostics13020252 - 09 Jan 2023

Cited by 7 | Viewed by 10919

Abstract

Migraine is a severe and common primary headache disorder, characterized by pain as well as a plethora of non-painful symptoms. Among these, visual phenomena have long been known to be associated with migraine, to the point where they can constitute a hallmark of the disease itself. In this review we focus on two key visual disorders that are directly or indirectly connected to migraine: visual aura and visual snow syndrome (VSS). Visual aura is characterized by the transient presence of positive and negative visual symptoms, before, during or outside of a migraine attack. VSS is a novel stand-alone phenomenon which has been shown to be comorbid with migraine. We discuss key clinical features of the two disorders, including pathophysiological mechanisms, their differential diagnoses and best treatment practices. Our aim is to provide an aid for clinicians and researchers in recognizing these common visual phenomena, which can even appear simultaneously in patients with an underlying migraine biology. Full article

(This article belongs to the Special Issue Clinical Characteristics of Headache and Diagnosis of Primary and Secondary Headache Disorders)

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Other

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22 pages, 743 KiB

Open AccessSystematic Review

Headache Attributed to Reversible Cerebral Vasoconstriction Syndrome (RCVS)

by Vasileios Tentolouris-Piperas, Loukas Lymperopoulos, Argyro Tountopoulou, Sophia Vassilopoulou and Dimos D. Mitsikostas

Diagnostics 2023, 13(17), 2730; https://doi.org/10.3390/diagnostics13172730 - 22 Aug 2023

Viewed by 1385

Abstract

Reversible cerebral vasoconstriction syndrome (RCVS) is a condition with variable outcomes presenting a new onset thunderclap headache accompanied by focal neurological symptoms or seizures. It can be idiopathic or arise secondarily to a variety of trigger factors. The condition is increasingly recognized in clinical practice, but many facets remain poorly understood. This article aims to clarify the headache characteristics in RCVS, the temporal association of angiographic findings, the potential association of the condition with SARS-CoV-2 infection, and the clinical presentation of RCVS in children and is based on a systematic PRISMA search for published analytical or large descriptive observational studies. Data from 60 studies that fulfilled specific criteria were reviewed. Most people with RCVS exhibit a typical thunderclap, explosive, or pulsatile/throbbing headache, or a similar acute and severe headache that takes longer than 1 min to peak. Atypical presentations or absence of headaches are also reported and may be an underrecognized phenotype. In many cases, headaches may persist after resolution of RCVS. Focal deficits or seizures are attributed to associated complications including transient ischemic attacks, posterior reversible encephalopathy syndrome, ischemic stroke, cerebral edema, and intracranial hemorrhage. The peak of vasoconstriction occurs usually within two weeks after clinical onset, possibly following a pattern of centripetal propagation, and tends to resolve completely within 3 months, well after symptoms have subsided. There are a few reports of RCVS occurring in relation to SARS-CoV-2 infection, but potential underlying pathophysiologic mechanisms and etiological associations have not been confirmed. RCVS occurs in children most often in the context of an underlying disease. Overall, the available data in the literature are scattered, and large-scale prospective studies and international collaborations are needed to further characterize the clinical presentation of RCVS. Full article

(This article belongs to the Special Issue Clinical Characteristics of Headache and Diagnosis of Primary and Secondary Headache Disorders)

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10 pages, 1271 KiB

Open AccessCase Report

Diagnosis of Migrainous Infarction: A Case Report and Analysis of Previously Published Cases

by Elena R. Lebedeva, Natalia M. Gurary and Jes Olesen

Diagnostics 2023, 13(15), 2502; https://doi.org/10.3390/diagnostics13152502 - 27 Jul 2023

Viewed by 935

Abstract

Migrainous infarction (MI) is a rare disorder. The precise diagnostic criteria for this diagnosis have been available in the International Classification of Headache Disorders (ICHD) since 1988, but many cases do not fulfil these criteria. This paper describes a good example of MI and analyzes previously published case reports. We report a very special case of MI in an 18-year-old woman who had a recurrent episode of migraine with a similar aura with numbness of the right arm and speech disturbances which had an unusually long duration (>120 min). On admission to the headache centre “Europe-Asia”, she complained of slowness of speech and problems with choice of words. An MRI showed acute lacunar infarcts in the left parietal subcortical area. Ischemic infarcts were localized in a relevant area on the left side and the aura symptoms were right-sided. The patient, therefore, fulfilled the ICHD-3 diagnostic criteria for “Migrainous infarction”. An analysis of 35 previously published articles with case reports about MI showed that 22 did not meet the diagnostic criteria of the ICHD for migrainous infarction. Using all this, we developed diagnostic recommendations for migrainous infarction which can help to improve the quality of diagnosis when used together with the diagnostic criteria of the ICHD for migrainous infarction. Full article

(This article belongs to the Special Issue Clinical Characteristics of Headache and Diagnosis of Primary and Secondary Headache Disorders)

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