Rare Primary Headaches
Rare Primary Headaches
Primary stabbing headache (PSH) is characterized by spontaneously occurring single stabs or series of stabs that last up to few seconds. The frequency is irregular reaching from one to many painful stabs every day. The pain is predominantly localized in the distribution of the first division of the trigeminal nerve, that is, orbital, temporal or parietal. Primary stabbing headache is a rare headache disorder and its prevalence is unclear. Ramón et al. analyzed 100 patients with strictly unilateral headaches in a tertiary headache centre. One of the 100 patients suffered from a primary stabbing headache. The underlying pathophysiology of this headache disorder is still enigmatic. One study investigated a possible association between venous outflow disturbances and the occurrence of primary stabbing headache. A higher prevalence of stenosis of dural sinuses was diagnosed in other headache disorders such as migraine, tension-type headache, intracranial hypertension without papilledema (ss-IHWOP), exertional, cough and sexual activity associated headache. Eight patients with symptoms of PSH were analyzed retrospectively. In all patients, magnetic resonance venography showed a significant unilateral or bilateral sinus stenosis. The authors of the study hypothesize that there might be an association between PSH and sinus stenosis and that an undiagnosed ss-IHWOP might be involved in the underlying pathophysiology. A different study confirmed these results, showing venous stenosis in five out of seven patients but in none of the control subjects. However, these results have to be reproduced in a larger patient population. Additionally, the causality between these two observations has to be proven as it might be only by association. A good clinical response to treatment with indometacin was reported.
Primary Stabbing Headache
Primary stabbing headache (PSH) is characterized by spontaneously occurring single stabs or series of stabs that last up to few seconds. The frequency is irregular reaching from one to many painful stabs every day. The pain is predominantly localized in the distribution of the first division of the trigeminal nerve, that is, orbital, temporal or parietal. Primary stabbing headache is a rare headache disorder and its prevalence is unclear. Ramón et al. analyzed 100 patients with strictly unilateral headaches in a tertiary headache centre. One of the 100 patients suffered from a primary stabbing headache. The underlying pathophysiology of this headache disorder is still enigmatic. One study investigated a possible association between venous outflow disturbances and the occurrence of primary stabbing headache. A higher prevalence of stenosis of dural sinuses was diagnosed in other headache disorders such as migraine, tension-type headache, intracranial hypertension without papilledema (ss-IHWOP), exertional, cough and sexual activity associated headache. Eight patients with symptoms of PSH were analyzed retrospectively. In all patients, magnetic resonance venography showed a significant unilateral or bilateral sinus stenosis. The authors of the study hypothesize that there might be an association between PSH and sinus stenosis and that an undiagnosed ss-IHWOP might be involved in the underlying pathophysiology. A different study confirmed these results, showing venous stenosis in five out of seven patients but in none of the control subjects. However, these results have to be reproduced in a larger patient population. Additionally, the causality between these two observations has to be proven as it might be only by association. A good clinical response to treatment with indometacin was reported.
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