Bücher zum Thema „Headache frequency“

Migraine is a common disorder that affects women of menstruating age, and it is frequently the chief complaint of women presenting in the neurology clinic. The prevalence of menstrually related migraine can range from 20–60%, while pure menstrual migraine occurs in less than 10% of women. In addition to utilizing non–gender-specific abortive and preventative strategies, understanding migraine and its relationship to hormones, particularly estrogen, can have clinical implications for optimal treatment. This chapter seeks to provide insight into diagnosing menstrually related migraine, the role of decreased estrogen just prior to menstrual cycle onset and migraine, as well as the therapeutic options that are available to treat and possibly prevent menstrual migraine attacks.

The case illustrates the classic clinical features of a low-pressure headache. The pathophysiology results from the loss of cerebrospinal fluid (CSF). This causes sagging of the brain, stretching of the bridging veins, and venodilatation. The clinical history is of a headache that is worse in the upright position and remits when the patient is supine. Due to the connection of the perilymphatic fluid and CSF, postural tinnitus is a frequent symptom. Risk factors for low-pressure headache include those that are patient-specific: female sex, low body mass index, prior history of a low-pressure headache, and an underlying headache disorder. Operator-specific factors that decrease the risk of a postdural puncture headache (PDPH) include greater operator experience and the use of a smaller-gauge, non-cutting lumbar puncture needle. The best treatment for low-pressure headache is a blood patch with resolution in over 90% of low-pressure headaches.

Leptospirosis is one of the most prevalent zoonotic diseases worldwide. Pathogenic spirochaetes are shed in the urine of infected mammals to the environment. Humans are infected through contact with contaminated material. Leptospirosis is more prevalent in tropical and subtropical areas, but exists in all continents except Antarctica. The disease is difficult to diagnose and hence frequently neglected. Its clinical picture ranges from a mild flu-like disease to a life-threatening form with pulmonary haemorrhage, liver failure and acute kidney injury (AKI), called Weil disease, which may affect 10% of those with clinical disease. Typically, fever, myalgia and headache progress to nausea and vomiting, jaundice, red eyes, and other manifestation affecting skin, brain, and other organs.Kidney involvement, characterized by acute tubulointerstitial nephritis, is nearly universal. It may be clinically manifested as a tubulopathy with urinary electrolytes wasting, hypokalaemia and hypomagnesaemia and/or as AKI, which is more frequently non-oliguric. Antibiotic therapy may reduce hospitalization time and AKI frequency. Otherwise management is supportive, including timely and adequate dialysis support.

Rickettsiae are obligate intracellular bacteria transmitted by arthropods to a vertebrate host. Clinically relevant rickettsioses have a similar clinical pattern, manifesting as an acute febrile disease accompanied by headache, articular and muscle pain, and malaise.Epidemic typhus is a worldwide distributed disease caused by the Rickettsia prowazekii, with a human louse as a vector. Data on epidemic typhus-related renal injury is extremely scarce.Murine typhus is caused by the Rickettsia typhi and has a rodent flea as the vector. It is one of the most frequent rickettsioses, and is usually a self-limited febrile illness. Proteinuria, haematuria, elevations in serum creatinine (SCr) and/or blood urea nitrogen (BUN) and AKI have been reported. The real frequency of renal involvement in murine typhus is unknown. Renal abnormalities recover after the infectious disease resolution.Scrub typhus, caused by the Orientia tsutsugamushi, has the Leptotrombidium mite larva as vector. It is endemic in the Tsutsugamushi triangle delimited by Japan, Australia, India, and Siberia. It can manifest either as a self-limiting disease or as a severe, life-threatening multiorgan illness. Early administration of adequate antibiotics is essential to prevent adverse outcomes. Proteinuria, haematuria, and acute kidney injury (AKI) are frequent.Tick-borne rickettsioses are caused by bacteria from the spotted fever group and have ticks as vectors. Rocky Mountain spotted fever (RMSF) is caused by Rickettsia rickettsii. It is the most severe of the spotted fever rickettsial diseases, causing significant morbidity and lethality. RMSF occurs in North, Central, and South America. Renal impairment is frequent in severe forms of RMSF. Mediterranean spotted fever is caused by Rickettsia conorii, and is endemic in the Mediterranean area. It is usually a benign disease, but may have a severe course, clinically similar to RMSF. Haematuria, proteinuria, increased serum creatinine, and AKI may occur. Japanese spotted fever is caused by Rickettsia japonica. Lethal cases are reported yearly and AKI has occurred in the context of multiple organ failure.

This case is illustrative of migraine during pregnancy. In pregnancy, due to changes in the level of estrogen, migraines are often more frequent in the first trimester. The natural history for migraine, especially migraine without aura, is that 70% get better by the second trimester. A general strategy for management of migraines during pregnancy is illustrated. In general, prophylactic medications are not used during pregnancy, and migraines are treated symptomatically. Tables of the usual migraine medications to treat both the acute headache and to prevent migraine are included, along with their pregnancy classification and breast feeding safety. The chapter is meant to be a practical guide to migraine management during pregnancy and postpartum.

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each of these cases highlights the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.

Spontaneous intracranial hypotension is a condition that affects young and middle-aged individuals. Women are more frequently affected than men. It is associated with severe positional headache without previous dural puncture and is often confused with other common headache conditions. Delay in diagnosis of the condition may predispose patients to severe complications. Many radiodiagnostic tools carry important risks to patients, including nerve injury and iatrogenic spinal cord injury. Imaging studies must be correlated with a detailed medical history and a thorough physical examination. Epidural blood patch, the mainstay of treatment, may require multiple attempts with increasing amounts of autologous blood. Increased awareness of spontaneous intracranial hypotension will likely contribute to its proper diagnosis and treatment.

Despite major advances in our understanding of its neurobiology, sleep remains an enigma. Its true function and even the amount needed for optimum brain performance remain uncertain (Frank 2006). However, the need to sleep is imperative, reflecting the fact that sleepiness, like hunger and thirst, is a true drive state. Sleepiness can only be satiated by sleep itself. Moreover, severely disordered sleep can profoundly affect cognition, mental health, and physical well-being.Although sleep medicine has a traditionally low profile in neurology teaching and practice, sleep-related phenomena are frequently associated with numerous neurological disorders. Conversely, sleep problems can adversely affect familiar conditions such as headache and epilepsy. Furthermore, in large surveys, sleep-related symptoms are undoubtedly common with 25 per cent of the population reporting problems that significantly and regularly impact on daily activities.

Mayo Clinic Essential Neurology, Second Edition, is designed to provide clinicians the necessary neurologic information for the diagnosis and management of these common neurologic problems. This book will be useful to all clinicians who evaluate patients who have neurologic problems. It will also be useful to medical students and residents in neurology, internal medicine, and psychiatry. The book also will be helpful to paramedical personnel who need a concise source of information on outpatient neurologic practice. The book addresses 3 main areas: the neurologic examination and diagnostic testing, common neurologic symptoms, and common neurologic diseases. Neurology is a rapidly changing specialty, with an increasing number of therapeutic options available for managing neurologic disease. Neurologic symptoms such as headache, backache, and dizziness are frequent complaints that cause patients to seek medical care.

Craniofacial pain, excluding the headache disorders, comprises a heterogeneous group of conditions. Some fall within the sphere of the neurologist, but many call for other specialist skills in diagnosis and management. The site of pain is not always a good guide to either the nature of the pain or the tissue of origin. Patients with craniofacial pain are frequently referred to the neurologist on an assumption that the pain is neuralgic, and for this reason neurologists need to be aware of the many potential causes and be prepared to collaborate closely with other specialists, including the ear, nose, and throat surgeon, ophthalmologist, dental surgeon, oral medicine physician, and psychiatrist. An accurate and detailed history is essential, because in many patients with facial pain, there will be no abnormal physical signs and the diagnosis rests entirely on the history.

Crimean-Congo haemorrhagic fever (CCHF) is an acute disease of humans, caused by a tick-borne virus which is widely distributed in eastern Europe, Asia and Africa. Cattle, sheep and small mammals such as hares undergo inapparent or mild infection with transient viraemia, and serve as hosts from which the tick vectors of the virus can acquire infection. Despite serological evidence that there is widespread infection of livestock in nature, infection of humans is relatively uncommon. Humans acquire infection from tick bite, or from contact with infected blood or other tissues of livestock or human patients, and the disease is characterized by febrile illness with headache, malaise, myalgia, and a petechial rash, frequently followed by a haemorrhagic state with necrotic hepatitis. The mortality rate is variable but averages about approximately 30 per cent. Inactivated vaccine prepared from infected mouse brain was used for the protection of humans in eastern Europe and the former Soviet Union in the past, but the development of a modern vaccine is inhibited by limited potential demand. The voluminous literature on the disease has been the subject of several reviews from which the information presented here is drawn, except where indicated otherwise (Chumakov 1974; Hoogstraal 1979; 1981; Watts et al. 1989; Swanepoel 1994; 1995; Swanepoel and Burt, 2004; Burt and Swanepoel, 2005; Whitehouse 2004; Ergunol and Whitehouse 2007; Ergunol 2008).

Psychiatric Aspects of Neurologic Diseases: Practical Approaches to Patient Care is targeted at neurologists, psychiatrists, and other physicians who care for patients with the most common neurologic diseases ranging from Alzheimer's to stroke to headaches to multiple sclerosis to epilepsy. The book provides a practical approach to the evaluation and treatment of the psychiatric conditions that affect the vast majority of these patients and are as disabling as the neurologic symptoms. Drawing from the collective wisdom and clinical expertise of the faculty of the Johns Hopkins Division of Geriatric Psychiatry and Neuropsychiatry, one of the largest and most well known faculties in this specialized field, the book provides a wealth of useful clinical information for physicians who care for these patients. The volume is divided into three parts: the first part (2 chapters) provides a detailed approach to the evaluation and differential diagnosis of the neurologic patient with psychiatric symptoms followed by a discussion of the common psychiatric syndromes seen in these patients. The second part discusses in detail the epidemiology, clinical presentation, and treatment of psychiatric conditions in 12 neurologic diseases, written by experts in each of these diseases. The third discusses in depth the range of psychiatric treatments, both pharmacologic and non-pharmacologic, available to treat the psychiatric aspects of neurologic diseases, specifically tailored to their use with the neurologic patient. The book is intended to serve as a practical reference for clinicians and is written in clear language, with distinct separated text segments, linked to the frequent use of tables. A glossary of terms, used throughout the book, is provided at the end for easy reference.

Large-vessel vasculitis includes giant cell arteritis (GCA) and Takayasu's arteritis (TAK). GCA affects patients aged over 50, mainly of white European ethnicity. GCA occurs together with polymyalgia rheumatica (PMR) more frequently than expected by chance. In both conditions, females are affected two to three times more often than males. GCA mainly involves large- and medium-sized arteries, particularly the branches of the proximal aorta including the temporal arteries. Vasculitic involvement results in the typical manifestations of GCA including temporal headache, jaw claudication, and visual loss. A systemic inflammatory response and a marked response to glucocorticoids is characteristic of GCA. GCA usually remits within 6 months to 2 years from disease onset. However, some patients have a chronic-relapsing course and may require long-standing treatment. Mortality is not increased, but there is significant morbidity mainly related to chronic glucocorticoid use and cranial ischaemic events, especially visual loss. The diagnosis of GCA rests on the characteristic clinical features and raised inflammatory markers, but temporal artery biopsy remains the gold standard to support the clinical suspicion. Imaging techniques are also used to demonstrate large-vessel involvement in GCA. Glucocorticoids are the mainstay of treatment for GCA, but other therapeutic approaches have been proposed and novel ones are being developed. TAK mainly involves the aorta and its main branches. Women are particularly affected with a female:male ratio of 9:1. In most patients, age of onset is between 20 and 30 years. Early manifestations of TAK are non-specific and include constitutional and musculoskeletal symptoms. Later on, vascular complications become manifest. Most patients develop vessel stenoses, particularly in the branches of the aortic artery, leading to manifestations of vascular hypoperfusion. Aneurysms occur in a minority of cases. There are no specific laboratory tests to diagnose TAK, although most patients have raised inflammatory markers, therefore, imaging techniques are required to secure the diagnosis. Glucocorticoids are the mainstay of treatment of TAK. However, many patients have an insufficient response to glucocorticoids alone, or relapse when they are tapered or discontinued. Immunosuppressive agents and, in refractory cases, biological drugs can often attain disease control and prevent vascular complications. Revascularization procedures are required in patients with severe established stenoses or occlusions.

Large-vessel vasculitis includes giant cell arteritis (GCA) and Takayasu’s arteritis (TAK). GCA affects patients aged over 50, mainly of white European ethnicity. GCA occurs together with polymyalgia rheumatica (PMR) more frequently than expected by chance. In both conditions, females are affected two to three times more often than males. GCA mainly involves large- and medium-sized arteries, particularly the branches of the proximal aorta including the temporal arteries. Vasculitic involvement results in the typical manifestations of GCA including temporal headache, jaw claudication, and visual loss. A systemic inflammatory response and a marked response to glucocorticoids is characteristic of GCA. GCA usually remits within 6 months to 2 years from disease onset. However, some patients have a chronic-relapsing course and may require longstanding treatment. Mortality is not increased, but there is significant morbidity mainly related to chronic glucocorticoid use and cranial ischaemic events, especially visual loss. The diagnosis of GCA rests on the characteristic clinical features and raised inflammatory markers, but temporal artery biopsy remains the gold standard to support the clinical suspicion. Imaging techniques are also used to demonstrate large-vessel involvement in GCA. Glucocorticoids are the mainstay of treatment for GCA, but other therapeutic approaches have been proposed and novel ones are being developed. TAK mainly involves the aorta and its main branches. Women are particularly affected with a female:male ratio of 9:1. In most patients, age of onset is between 20 and 30 years. Early manifestations of TAK are non-specific and include constitutional and musculoskeletal symptoms. Later on, vascular complications become manifest. Most patients develop vessel stenoses, particularly in the branches of the aortic artery, leading to manifestations of vascular hypoperfusion. Aneurysms occur in a minority of cases. There are no specific laboratory tests to diagnose TAK, although most patients have raised inflammatory markers, therefore, imaging techniques are required to secure the diagnosis. Glucocorticoids are the mainstay of treatment of TAK. However, many patients have an insufficient response to glucocorticoids alone, or relapse when they are tapered or discontinued. Immunosuppressive agents and, in refractory cases, biological drugs can often attain disease control and prevent vascular complications. Revascularization procedures are required in patients with severe established stenoses or occlusions.