Hemicrania continua is an uncommon primary headache disorder, characterized by continuous unilateral pain, where pain exacerbations are associated with cranial autonomic features. The hallmark of this condition is the absolute response to indometacin. We describe the phenotype of this condition in a large series of patients. Thirty-six (92%) patients had side-locked pain and 3 (8%) had side-alt...

Migraine is characterized by attacks of moderate to severe intensity headache, associated with some combination of severe disability, autonomic dysfunction such as gastric stasis, poor absorption from the small bowel, and associated symptoms such as nausea, vomiting, phonophobia, photophobia and worsening with exertion [1,2]. Oral medications may not be ideally suited for those migraineurs with...

OBJECTIVE The primary objective of this retrospective chart review is to describe 1 year's experience of an academic emergency department (ED) in treating a wide spectrum of headache classifications with intramuscular injections of 0.5% bupivacaine bilateral to the spinous process of the lower cervical vertebrae. BACKGROUND Headache is a common reason that patients present to an ED. While the...

Migraine is a constellation of neurological symptoms with variable disease progression. Despite the standardization of migraine diagnosis with the International Headache Society (IHS) criteria, its etiology eludes medical research because its complexity as a disease lies in the multiple factors involved in migraine onset. The study of migraine genetics is providing important clues to the pathop...

CASE PRESENTATION A 67-year-old woman presented to the emergency department for the evaluation of a new suddenonset headache. The headache began suddenly while she was seated at a meeting on July 30, 2008. No preceding event was identified before the onset of the headache such as trauma, infection, coughing, sexual activity, Valsalva maneuver, exertion, or sleep. The headache was excruciating a...

A 43-year-old woman with bipolar type II disorder and comorbid migraine without aura had experienced recurrent depressive episodes since age 30 (some with complete, spon tan eous recovery) and had taken various classes of antidepressants. During the past 5 years, she had a rapid-cycling course of illness, with depressive episodes of 3 weeks’ duration and a week of hypomanic symptoms each month....

The orexinergic system comprises the neuropeptides, orexin A and B, which are exclusively produced in the posterior, lateral and paraventricular parts of the hypothalamus (1–3). Orexins act via G-protein-coupled OX1 and OX2 receptors on projections to the prefrontal cortex, thalamus and other subcortical areas to promote arousal (4) and exert modulating effects on nociceptive neurotransmission,...

Several recent studies have examined whether patient description of headache “direction” may predict treatment response, specifically to onabotulinumtoxinA (Botox) injections. The association between headache directionality and response to Botox was first published in a triple-blinded prospective and retrospective study in 2006.1 This study examined a variety of neurologic symptoms associated w...

The presence of hemichorea associated with a lesion in the cortex is exceedingly rare. We report a case of a 62-year-old female who developed delayed left hemichorea after an ischemic infarct in the right temporal–occipital lobe. This case is unique because of the location of infarct and expands our knowledge of hemichorea arising after an ischemic stroke. A 62-year-old female patient was initi...

Migraine – a suitable case for treatment? Headache disorders are common, with a lifetime prevalence of over 90% in all populations where they have been measured. So common, in fact, that a Global Campaign to Reduce the Burden of Headache was launched in 2004 to educate health care providers, the general public, and national governments to recognize that headache disorders are not trivial, that ...