Primary headaches, especially migraines, are a common problem for adults and children who present to the emergency department. Migraine headaches have been challenging to diagnose, especially in the pediatric population.
The opening of ATP-sensitive potassium channels by levcromakalim triggered migraine headaches in all migraineurs. In healthy volunteers, levcromakalim induced milder headaches associated with long-lasting dilation of extracerebral arteries.
Concussion is now known to be a significant public health issue, with high rates of emergency department visits and hospitalizations. Much of the current concern surrounding concussions revolves around recognition, early diagnosis, treatment modalities, return-to-play, and prevention of recurrent concussions.
Clinical features of patients with spontaneous intracranial hypotension and bilateral subdural fluid collections differ from patients who sustained previous head trauma vs. those with cerebrospinal fluid leaks.
Vertigo is a common and integral component of migraine and occurs with neuro-otologic abnormalities and psychiatric comorbidities. Treatment of episodic vertigo suspected to be due to vestibular migraine should mirror the multimodality treatment of migraine.
The degree of unexpectedness or “surprisal” associated with known migraine triggers is a predictor of headache attacks. Social avoidance behavior is positively correlated with headache disability, pain, and depression, but there is a negative correlation between headache pain endurance and anxiety.
Migraines occur in young children, but may be challenging to diagnose. Migraines can have a great impact on pediatric patients’ quality of life with school absence and limitations on extracurricular activities. Treatment of pediatric migraines or possible migraines is difficult secondary to the lack of evidence for effective therapies in pediatric patients. Treatment includes traditional therapy with dopamine receptor antagonists (DRAs), nonsteroidal anti-inflammatory drugs (NSAIDs), triptans, and combination therapies. Newer therapies include magnesium, valproic acid (VPA), and peripheral nerve blocks. The authors review the clinical presentation of migraines in children, guidelines for diagnosis, and therapeutic options.
This article will explore the subtle and enigmatic presentations of stroke. These patients often will present with nonspecific symptoms, such as vision problems, headache, a subtle language deficit, dizziness, or amnesia.