Headache Medicine

"I feel an irresistible urge to bang my head against the wall": a case series highlighting agitation and severe pain in cluster headache

2025-10-20T11:26:16+00:00

Abstract
Introduction
Cluster headache is a primary headache disorder characterized by severe, unilateral pain, typically associated with cranial autonomic symptoms, including conjunstival injection, lacrimation, nasal congestion, rhinorrhea, eyelid oedema, forehead and facial sweating, miosis and ptosis. Beyond these hallmark features, patients often exhibit marked psychomotor agitation, sometimes expressing the wish to engage in head-banging behaviors as an instinctive response to unbearable pain. This case series highlights three such patients.
Cases report
In all cases, appropriate preventive therapies reduced both the frequency of attacks and the desire for self-injurious behavior.
Conclusion
These reports highlight the extreme suffering associated with cluster headache and emphasize the importance of timely recognition and effective management strategies.

Cluster headache with perimenstrual trigger mimicking chronic migraine: a case report and diagnostic challenge

2025-10-20T11:26:20+00:00

Introduction
Cluster headache (CH) is a trigeminal autonomic cephalalgia known for its excruciating unilateral pain and strong male predominance. Its triggers are rarely hormonal, contrasting with migraine, which is frequently modulated by the menstrual cycle. This discrepancy creates a potential for diagnostic confusion in female patients.
Case report
A 28-year-old woman presented with a two-year history of excruciating, right-sided periorbital attacks lasting 60-90 minutes. Bouts occurred for 4-6 weeks, exclusively triggered premenstrually. She exhibited prominent psychomotor agitation and ipsilateral autonomic symptoms. Initially diagnosed as refractory menstrual migraine, she was unresponsive to standard migraine treatments. A detailed anamnesis led to a revised diagnosis of episodic CH.
Discussion
The menstrual trigger, typical of migraine, masked a classic CH presentation, leading to a diagnostic delay. The correct diagnosis was established by focusing on attack phenomenology, particularly the patient's behavior (agitation vs. rest) and autonomic signs. The patient achieved complete resolution of attacks with high-flow oxygen and verapamil. This case highlights how gender and trigger-related biases can impede correct diagnosis and reinforces the need to consider CH in women with cyclical headaches

SUNCT syndrome associated with pituitary Rathke's cyst and responsive to indomethacin: a case report

2025-10-20T11:26:19+00:00

Introduction

Short-lasting unilateral neuralgiform headache attacks (SUNCT/SUNA) is a rare group of headaches classified by the International Classification of Headache Disorders (ICHD-3) in its group 3, the trigeminal-autonomic headaches, and, therefore a primary headache. Rathke’s cleft cysts are sellar or suprasellar non-neoplastic cystic lesions arising from remnants of Rathke’s pouch. These cysts are asymptomatic, but when large, they compress adjacent structures and may present with headache, visual disturbance, and pituitary dysfunction. Cases of secondary SUNCT/SUNA have been reported; however, this is the first report of SUNCT/SUNA associated with a Rathke's cleft cyst.

Case Report

A 47-year-old, other while healthy male has been experiencing for the last five years a strictly right sided pain in the orbital and in the frontoparietal area. The pain was felt as if a nail was being driven into his cranium slowly for 5-15 seconds, with intense pain persisting in the area for a few more seconds. Pain intensity was described as excruciating (10/10), a frequency of 4-18 a day, duration of 4- 30 seconds, associated to 2-3 eardrops and moderate conjunctival hyperemia ipsilateral to the pain. Attacks never could be attacks triggered by cutaneous stimuli. Physical and neurological examinations were normal. MRI showed a cystic lesion in the anterior pituitary gland consistent with a Rathke's cleft cyst. The pain was refractory to carbamazepine, amitriptyline, topiramate, and methadone, but was responsive to indomethacin.

Comment

To the best of our knowledge, this case report appears to be the first on SUNCT: a) associated with Rathke's cleft cyst; and b) responsive to indomethacin.

“Perceiving myself small: a body volume regression to age three” — a new manifestation of Alice in Wonderland Syndrome in a migraine patient

2025-10-20T11:26:17+00:00

Introduction

Alice in Wonderland Syndrome (AIWS) is a rare neurological condition often associated with migraine and characterized by perceptual distortions of body image, time, and space.

Case report

We report the case of a 33-year-old woman with a history of migraine since adolescence who presented with recurrent episodes of AIWS. During severe migraine attacks, she experienced microsomatognosia, perceiving her body as shrinking to the size of a child when her eyes were closed, along with temporal distortion described as “slow motion” of her surroundings. Neurological examination, brain MRI, and angiography were unremarkable. Despite prophylactic therapy with topiramate and acute treatment with triptans, disabling attacks persisted.

Conclusion

This case highlights the complex relationship between migraine and AIWS, reinforcing the need for clinicians to recognize AIWS manifestations as part of the migraine spectrum. Early identification can prevent misdiagnosis and improve patient management.

Corpalgia associated with migraine: a case report

2025-10-20T11:26:14+00:00

Introduction
Corpalgia is a phenomenon associated with chronic migraine, in which the patient experiences painful hypersensitivity in the cephalic and extracephalic regions.
Objective
To describe the case of a patient with chronic migraine who experienced an episode of corpalgia.
Case report
This is a 19-year-old woman with chronic migraine for over two years. The patient reports that upon waking, in the midst of a migraine episode, she felt intense pressure in the upper and lower limbs corresponding to the side of the headache, lasting approximately 8 hours.
Conclusion
Corpalgia is a rare phenomenon that differs from other symptoms in its characteristics, such as intensity and duration. It can manifest itself uniquely for each patient.

Headache and mental disorders in practice

2025-10-20T11:26:21+00:00

Introduction

Migraine is a major cause of global functional disability and is frequently associated with psychiatric disorders such as anxiety and depression. Although the literature highlights this association, few studies have explored these relationships in real-life contexts, outside controlled clinical environments.

Objective

To analyze the relationship between anxiety and depression levels and the impact of headache on the quality of life of patients with migraine in a real-life context.

Methods

A prospective longitudinal observational study was conducted between January and December 2024, involving 46 patients treated at a tertiary headache center. Data were collected using the REBRACEF questionnaire. Statistical analyses included correlation tests and comparisons between the MIDAS, PHQ-9, and GAD-7 scales, as well as the variables sex and age.

Results

The majority of participants were female (87%), with a mean age of 44.5 years. A significant negative correlation was found between age and MIDAS score (p=0.036), suggesting greater functional impact in younger patients. No significant correlation was found between MIDAS and PHQ-9 or GAD-7 scores. However, a positive correlation was observed between PHQ-9 and GAD-7 scores (p<0.001), indicating comorbidity between depression and anxiety.

Conclusion

The findings suggest that younger patients experience greater functional impairment due to migraine. Despite the high prevalence of anxiety and depression symptoms, these comorbidities did not show a direct association with the functional impact of pain. The results underscore the importance of multidimensional approaches and highlight the need for studies with larger samples and longitudinal designs.

Migraine in children and adolescents: the clinical impact of allodynia

2025-10-20T11:26:19+00:00

Introduction

The pathophysiology of migraine is strongly associated with central sensitization, the presence of which is related to cutaneous allodynia and cervical musculoskeletal dysfunction. However, these aspects remain understudied in children and adolescents. Thus, this study aimed to evaluate differences in clinical variables, sensitization, and musculoskeletal alterations between children (CR) and adolescents (AD) with migraine, considering the presence or absence of cutaneous allodynia.

Methods

One hundred and one participants aged 6 to 16 years with a clinical diagnosis of migraine were evaluated. Outcomes included cervical range of motion (ROM), pressure pain threshold (PPT) of cranio-cervical muscles, and presence of cutaneous allodynia.

Results

Significant differences were observed between CR and AD for age (p<0.001) and PPTs of the sternocleidomastoid (p=0.002), levator scapulae (p=0.006), suboccipital (p=0.006), trapezius (p<0.001), and anterior scalene (p<0.001) muscles. The subgroups CR and AD with and without allodynia showed significant differences in the PPTs of the sternocleidomastoid (p=0.020), levator scapulae (p=0.016), suboccipital (p=0.038), trapezius (p<0.001), anterior scalene (p<0.001) muscles, and in cervical ROM in the sagittal plane (p=0.016). The main differences were observed between adolescents and children with and without allodynia. No differences were found within the children and adolescents’ subgroups.

Conclusion

The presence of cutaneous allodynia is associated with increased muscle sensitivity and reduced cervical sagittal mobility. These findings highlight the importance of early assessment of allodynia and musculoskeletal sensitivity in children and adolescents with migraine.

Headache in Vale do Taquari: a retrospective study

2025-10-20T11:26:18+00:00

Introduction

Primary headaches are highly prevalent neurological disorders and represent a global public health issue, with a significant impact on functionality and quality of life. Despite this, studies indicate that a considerable portion of sufferers, especially those with migraine, remain without a formal diagnosis, which hinders adequate clinical management. In this context, understanding the epidemiological profile at regional levels is essential.

Objective

Therefore, the aim of this study is to describe the profile of patients presenting with headache complaints at a specialized neurology center in Vale do Taquari (Lajeado/RS), to support healthcare strategies for this population.

Methods

Observational, descriptive, and retrospective study based on the review of medical records from a specialized clinical center in Vale do Taquari, Rio Grande do Sul. Patients aged 18 years or older, attended for primary headache complaints between August 2017 and February 2024 were included. Sociodemographic, clinical (ICHD-3 diagnosis), and treatment variables were collected and analyzed using descriptive statistics. The project was approved by the Research Ethics Committee.

Results

The sample consisted of 111 patients, with a mean age of 48 years and a predominance of females (n=91, 82%). Most self-identified as white (n=96, 87%), and (n=18, 35%) had a low level of education (5 to 8 years). The most prevalent diagnosis was migraine without aura (n=54, 48.6%), followed by cervicogenic headache (n=22, 19.8%) and tension-type headache (n=17, 15.3%). Neurological examination abnormalities were detected in some patients, mainly in cranial nerves and sensory function. Magnetic resonance imaging was the most requested imaging exam (n=51, 45.9%). Acute treatment was predominantly monotherapy, with common analgesics being the most prescribed. Prophylaxis was instituted in 74 (66.4%) of cases, mainly with tricyclic antidepressants and beta-blockers.

Conclusion

This study allowed the characterization of the clinical and sociodemographic profiles of patients presenting with headache complaints at a specialized center in Vale do Taquari, highlighting a predominance of females, a mean age of 48 years, and a higher prevalence of migraine without aura. A high rate of imaging requests was observed, not always aligned with guidelines, as well as predominant use of common analgesics for acute treatment and tricyclic antidepressants and beta-blockers for prophylaxis.

BrainParade – Art and Science giving visibility to migraine

2025-10-20T11:26:15+00:00

Short-lasting unilateral neuralgiform headache attacks: case reports and review

2025-10-20T11:26:22+00:00

Background
Short-lasting unilateral neuralgiform headache attacks are the rarest type of trigeminal-autonomic cephalalgias (TACs), typically classified into two subtypes: SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) and SUNA (with cranial autonomic symptoms). These disorders are characterized by brief, unilateral headache attacks accompanied by cranial parasympathetic symptoms and can be difficult to diagnose and manage in clinical practice.
Objective
To present two clinical cases of SUNCT and provide a comprehensive review of the current diagnostic criteria, pathophysiology, and treatment options, while distinguishing SUNCT/SUNA from other headache syndromes.
Methods
We describe two patients diagnosed with SUNCT at our outpatient headache clinic. A literature review was conducted focusing on clinical features, diagnostic criteria from the International Classification of Headache Disorders (ICHD-3), proposed pathophysiological mechanisms, and available treatment strategies.
Results
Both patients presented with multiple daily, short-lasting, unilateral headache attacks accompanied by cranial autonomic symptoms. Diagnostic workup ruled out secondary causes. The clinical presentation aligned with SUNCT criteria as defined in ICHD-3. Treatment approaches varied and included pharmacological interventions with partial symptom relief. The review highlights the challenges in differentiating SUNCT/SUNA from other headache disorders such as trigeminal neuralgia and cluster headache.
Conclusion
Accurate recognition of SUNCT/SUNA is essential for appropriate management, as misdiagnosis is common due to symptom overlap with other headache syndromes. Improved awareness and understanding of these rare conditions can lead to better diagnosis, targeted treatment, and patient outcomes.