Idiopathic stabbing headache and its clinical forms_ok.P65

Idiopathic stabbing headache and its clinical forms_ok.P65

ARTIGO ORIGINAL
Idiopathic stabbing headache and its clinical forms
Cefaleia em facadas idiopática e suas formas clínicas
Wilson Farias da Silva, Maria da Conceição F. Sampaio, Joaquim Costa Neto, Waldmiro D Serva,
Alexandre Medeiros Sampaio Januario, João Eudes Magalhães, Fabíola Lys Medeiros,
Hugo André de Lima Martins, Daniella Araújo Oliveira, Louana Cassiano da Silva, Marcelo Moraes Valença
Neurology and Neurosurgery Unit, Department of Neuropsychiatry,
Federal University of Pernambuco, Recife, PE, Brazil
Silva WF, Sampaio MCF, Costa Neto J, Serva WD, Januario AMS, Magalhães JE,
Medeiros FL, Martins HAL, Oliveira DA, Silva LC, Valença MM.
Idiopathic stabbing headache and its clinical forms. Migrâneas cefaleias 2008;11(4):250-252
ABSTRACT
The idiopathic stabbing headache (ISH) may occur as a primary
entity alone but usually it is associated with other types of
headache. The present paper has studied the clinical differences
between patients with isolated ISH (isolated-ISH, n=27) versus
patients with ISH associated with other type of primary headache
(associated-ISH, n=78). Regarding gender a significant higher
prevalence of male with isolated-ISH was observed when
compared with the group of women (50% versus 20%,
p=0.0098). No difference was observed in relation to the
age of the patients at the beginning of the headache. In the
group of patients with associated-ISH the temporal region was
the site where more frequently the pain was felt (33.3%) whereas
in the isolated-ISH group the headache was localized mostly
in the parietal area (44.4%). In conclusion, there is a higher
male prevalence and the parietal region is the preferential
place of location in patients with isolated-ISH.
Key words: Stabbing headache; gender; migraine; semiology.
RESUMO
A cefaleia em facadas idiopática (CFI) pode ocorrer como
uma entidade primária sozinha, mas usualmente ela está
associada com outro(s) tipo(s) de cefaleia primária. Este estudo avalia as diferenças clínicas encontradas entre pacientes com CFI isolada (CFI-isolada, n=27) versus pacientes
com CFI associada com outros tipos de cefaleia primária
(CFI-associada, n=78). Quando consideramos o gênero
houve uma maior prevalência do sexo masculino entre os
pacientes com CFI-isolada quando comparados com o grupo feminino (50% versus 20%, p=0,0098). Não houve diferença em relação à idade. A região temporal foi o local onde
a cefaleia mais apareceu no grupo de pacientes com CFIassociada (33,3%), enquanto no grupo de pacientes com
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CFI-isolada foi a região parietal a de maior frequência
(44,4%). Concluímos que há uma maior prevalência de homens e é a região parietal o local preferencial no grupo de
indivíduos com CFI-isolada.
Palavras
alavras-- chave: Cefaleia em facadas; gênero; migrânea;
semiologia.
INTRODUCTION
Idiopathic stabbing headache (ISH; also known as
"jabs and jolts syndrome") is a primary headache disorder
characterized by brief (seconds), sharp, short-lived attacks
of jabbing pain over the head.1-3 It is described as a
benign headache seen mainly in women, with pain
paroxysms ranging from one attack per year to more than
50 per day, which may be as often as one attack per
minute.3 A recent study4 demonstrated that over 30% of
the population may present ISH. Sjaastad et al.4 found
627 cases of jabs in a group of 1,838 individuals, whose
attacks were either single (68%), in volleys (4%), or a
mixture of both modalities (28%).
This variety of headache may occur as a primary
entity alone but usually it is associated with other types of
headache. However, it seems that ISH is more prevalent
in migraineurs. In this context, Piovesan et al.5 reported
that 40.4% of the migraine patients presented ISH.
The physiopathogenesis of the ISH remains ignored.
The short-lived and the sharp stabbing pain character, in
Migrâneas cefaleias, v.11, n.4, p.250-252, out./nov/dez. 2008
IDIOPATHIC STABBING HEADACHE AND ITS CLINICAL FORMS
association with its preferential location in the sensorial
ophthalmic division of the trigeminal nerve suggest a
neuronal discharge. This is either due to an irritation over
a peripheral branch of the nerve or to an intermittent deficit
in the central mechanisms of pain control, thus allowing
spontaneous synchronous discharges of neurons receiving
pulses from areas where the headache is referred.
Recent reports described secondary form of stabbing
headache.6-8 In this concern, we have diagnosed several
cases of patients with cranial abnormalities associated with
the stabbing headache, mainly pituitary tumor, intracranial
acoustic neurinoma and meningioma.9 All of them showed
a close contact of the neoplasm with the dura-mater. The
study of those patients with this type of secondary headache
will be addressed in a future publication.
We assessed the hypothesis that there are clinical
differences between patients with the isolated form and
those with ISH associated with other type of primary
headache. The present paper has studied the semiology
of both isolated and associated forms of ISH.
associated-ISH, 35±2 yr; male associated-ISH 28±6 yrold, p=0.5082, Anova; Figure 2).
Figure 1. Gender distribution between groups
MATERIAL AND METHODS
This is a transversal study of 105 patients with ISH,
seen consecutively, studied between 2002 and 2003 at
the Headache Outpatient Clinic at Federal University of
Pernambuco. The headache type was classified using
the International Headache Society diagnostic criteria
ICHD II.10 We also classified the stabbing headache as
(a) idiopathic or primary and (b) symptomatic or
secondary. The ISH was further subdivided into isolated
(isolated-ISH, n=27; 17 women) and associated with
other type of primary headache (associated-ISH, n=78;
68 women).
Migraine was present in 55 patients (50 women),
tensional headache in 26 patients (23 women), and in 5
individuals (3 women) other type of primary headache.
During statistical analysis of the data, it was used
either the Fisher's exact test or Anova, when applicable.
RESULTS
Considering gender a significant higher prevalence
of male with isolated-ISH was observed when compared
with the group associated-ISH [10/20 (50%) versus 17/
85 (20%), p=0.0098 in the Fisher's exact test; Figure 1].
No difference was observed in relation to the age of the
patients at the beginning of the headache (female isolatedISH, 36±6 yr; male isolated-ISH, 40±4 yr; female
Migrâneas cefaleias, v.11, n.4, p.250-252, out./nov/dez. 2008
Figure 2. Age of the patients at the beginning of the stabbing headache
in relation to genders and forms of stabbing headache
In the group of patients with associated-ISH the temporal region was the site where more frequently the pain
was felt (33.3%), following by: occipital, 26.9%, frontal
(34.4%), parietal (19.2%), vertex (7.7%), orbit (2.6%), and
localization erratic (25.6%). In the isolated-ISH group of
patients the headache was localized mostly in the parietal
area (44.4%), followed by temporal (40.7%), occipital
(40.7%), frontal (7.4%), vertex (3.7%), and the erratic
appearance all over the head (11.1%) (Figure 3).
It was observed that in 20% of the patients with
associated-ISH the stabbing headache occurred before,
40% concomitantly, and 40% after the other primary
headache, considering the age of the patient when the
ISH first started, comparing with the other primary
headache(s). In general, the ISH occurred after the other
associated headaches with a time interval of a few years.
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MARCELO MORAES VALENÇA E COLABORADORES
their patients also complained of headaches with different
forms. However, the majority of them had migraine.
In conclusion, the stabbing headache maybe
classified as isolated, associated with other types of
headache, or secondary to cephalic abnormalities. It
seems that there are some clinical particularities to be
considered when isolated-ISH is compared with
associated-ISH. There is a higher male prevalence and
the parietal region is the preferential place of location in
patients with isolated-ISH.
REFERENCES
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4. Sjaastad O, Pettersen H, Bakketeig LS. The Vågå study;
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5. Piovesan EJ, Kowacs PA, Lange MC, Pacheco C, Piovesan LR,
Werneck LC. Prevalence and semiologic aspects of the idiopathic
stabbing headache in a migraine population. Arq Neuropsiquiatr.
2001;59(2-A):201-5.
Figure 3. Site of the head where the idiopathic stabbing headache
(ISH) was felt in both groups of patients: associated-ISH (upper panel)
and isolated-ISH (lower panel)
6. Levy MJ, Matharu MS, Meeran K, Powell M, Goadsby PJ. The
clinical characteristics of headache in patients with pituitary
tumours. Brain. 2005;128(Pt 8):1921-30.
DISCUSSION
7. Mascellino AM, Lay CL, Newman LC. Stabbing headache as the
presenting manifestation of intracranial meningioma: a report
of two patients. Headache. 2001;41(6):599-601.
It seems that there are three forms of stabbing
headache with specific characteristics, as discussed
previously: (a) idiopathic stabbing headache in its two
forms - isolated and associated; and (b) secondary
stabbing headache. As far as we know, no one has studied
possible differences between patients with isolated-ISH
form and those with ISH who harbor other forms of primary
headaches. And indeed, there are different particularities
(i.e., gender and location) in each of these forms of ISH.
Differently from our study, Pareja et al.3 described
the orbital region as the preferential pain location in their
80-patient study. As it was emphasized in their paper, part
of those patients originated from an ophthalmologic clinic.
This may explain the difference.
The most frequent type of headache associated with
ISH in the present study was migraine followed by tensional
type of headache. Sjaastad et al.4 observed that 40% of
252
8. Valença MM, Cauas M, Martins MC, Souza JR, Oliveira DA,
Melo ACMG, Andrade-Valença LPA, Costa J, Farias da Silva W
(2005) Stabbing headache and its clinical forms. Migrâneas &
Cefaleias 8:99 (abstract)
9. Andrade-Valença L, Dodick D, Valença MM (2007) 'Alarm bell
headache': a sinister secondary headache. Cephalalgia 27:715
10. Headache Classification Subcommittee of the International
Headache Society. (2004) The International Classification of
Headache Disorders (2nd Edition). Cephalalgia 24(Suppl1):S1S151.
Endereço para correspondência
Marcelo M. V
alença
Valença
Doutorado em Neuropsiquiatria e Ciências do Comportamento,
Departamento de Neuropsiquiatria, Universidade Federal de
Pernambuco, Cidade Universitária, Recife
50670-420, PE, Brazil.
Phone/Fax 55 81 2126 8539
E-mail: [email protected]
Migrâneas cefaleias, v.11, n.4, p.250-252, out./nov/dez. 2008