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Tension-type headache with aura

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Information about Tension-type headache with aura
Health & Medicine

Published on March 16, 2009

Author: enxaqueca

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Blackwell Science, LtdOxford, UKCHACephalalgia0333-1024Blackwell Science, 2005263349350Clinical CorrespondenceTension-type headache with auraMFP Peres & DS Vieira CLINICAL CORRESPONDENCE Tension-type headache with aura MFP Peres1 & DS Vieira2 1 Hospital Israelita Albert Einstein, Instituto de Ensino e Pesquisa, and 2Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, Brazil Mario Fernando Prieto Peres MD, PhD, Hospital Israelita Albert Einstein, Instituto de Ensino e Pesquisa, Av Albert Einstein, 627/701, CEP:05651-901 São Paulo, SP Brazil. Tel. + 55 11 9606 6184, fax + 55 11 3285 5726, e-mail marioperes@yahoo.com Received 2 January 2005, accepted 15 April 2005 There has been considerable discussion in the scien- a bean-shaped format. The symptoms resolved tific community on the relation between migraine completely. headache and aura over the last few years and the As soon as the visual phenomena disappeared, controversy remains. Auras do not appear to be a a mild intensity headache started. The pain was migraine-dependent phenomenon. described as a dull type headache, in the frontal Auras have been shown to occur with cluster region bilaterally. The headache was felt as mild headaches (1), hemicrania continua (2) and chronic for 90% of the time; occasional exacerbation might paroxysmal hemicrania (3). The International Head- occur, escalating to a moderate to severe intensity, ache Society Classification for Headache Disorders, and the frequency was on average two to three times published in 1988 (4), did not accept aura with other per month. It was never throbbing in nature, even headache types, but with the current classification when the severity increased. No photophobia, published in 2004 (5) another headache type with phonophobia, osmophobia, nausea or vomiting aura (other than migraine) can be classified and were reported. Physical activity did not worsen the coded as 1.2.2 Typical aura with non-migraine symptoms. Stress was reported as the only trigger headache. for the headaches. A family history of similar TTH Tension-type headaches (TTH) are one of the was positive in a brother, but no aura symptoms most common headache disorders in the general occurred. The patient denied smoking or heavy alco- population (6). TTH is now classified as 2.1 Infre- hol consumption. quent episodic tension-type headache, 2.2 Frequent A Diagnostic and Statistical Manual of Mental Dis- episodic tension-type headache, 2.3 Chronic ten- orders (DSM)-IV-based diagnosis of generalized anx- sion-type headache, and 2.4 Probable tension-type iety disorder was made. Clinical and neurological headache. All can be subclassified as with or with- examination were normal. Ophthalmology did not out pericranial tenderness. Tension-type headache disclose any ocular disorder. A brain and neck mag- with aura has never been reported in the literature. netic resonance imaging and magnetic resonance We report a patient with typical aura with episodic angiography, computed tomography and EEG were TTH. all normal. A cardiovascular work-up was also neg- ative, which included ECG, echocardiogram, screen- ing for dyslipidaemias, coagulopathies and diabetes. Case report Previous treatment for anxiety with venlafaxine A 55-year-old white male had a 20-year history of 75 mg and bromazepan 6 mg did not alleviate the episodic headaches, preceded half of the time by headaches. Topiramate was started with total reso- visual symptoms characterized by zig-zag lines, lution of both headaches and auras with 50 mg/day, starting in the left or right inferior quadrant of but was not tolerated by the patient due to cognitive the visual field, slowly progressive, increasing the side-effects. Amytriptiline 75 mg/day has satisfacto- affected area, with a total duration of 15 min. The rily controlled the symptoms. No acute treatment is lines were white and bright followed by a negative needed for the headaches most of the time, simple scotoma right below the initial aura region, with analgesics being taken once a month. © Blackwell Publishing Ltd Cephalalgia, 2006, 26, 349–350 349

350 MFP Peres & DS Vieira nomenology in this case is not linked to any Discussion migraine feature. It is unlikely that the patient’s aura is linked to migraine. The modular headache theory This appears to be the first description of aura with is a way of understanding TTH with aura, accepting TTH. Nevertheless, we think that TTH with aura that the modules bilateral headache, dull pain type may not be a rare syndrome. In previous epidemio- and aura may coexist. logical studies many ‘unclassifiable’ patients have Further studies on patients with other primary been reported. Some of these patients may fit the headaches than migraine linked to aura are needed TTH with aura diagnosis. The current second edition for a better understanding of the issue. Genetic and of the headache classification now includes the 1.2.2 functional imaging studies may help clarify the Typical aura with non-migraine headache. Another mechanisms underlying aura and headaches. explanation for this syndrome never having been reported is that if patients presented one migraine feature, they would fit the probable migraine (previ- References ous migrainous disorder) diagnosis rather than TTH 1 Silberstein SD, Niknam R, Rozen TD, Young WB. Cluster with aura. In this case, we could not find any of the headache with aura. Neurology 2000; 54:219–21. classical migrainous symptoms leading to the diag- 2 Peres MF, Siow HC, Rozen TD. Hemicrania continua with nosis proposed. aura. Cephalalgia 2002; 22:246–8. The reported case may have implications in the 3 Matharu MJ, Goadsby PJ. Post-traumatic chronic paroxys- controversy on the relation between migraine mal hemicrania (CPH) with aura. Neurology 2001; 56:273–5. headache and aura. This case may represent a new 4 Headache Classification Committee of the International primary headache entity linked to the aura Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. phenomenology. Cluster headache, hemicrania con- Cephalalgia 1988; 8 (Suppl. 7):1–96. tinua, and chronic paroxysmal hemicrania have been 5 Headache Classification Subcommittee of the International described with aura, the existence of TTH with aura Headache Society. The International Classification of Head- adding to the concept that aura is independent of ache Disorders, 2nd edn. Cephalalgia 2004; 24 (Suppl. 1):1– migraine. Migraine aura with non-migraine head- 160. ache or TTH with migraine aura are also possible 6 Rasmussen BK, Olesen J. Epidemiology of migraine and diagnoses for this patient; however, the aura phe- tension-type headache. Curr Opin Neurol 1994; 7:264–71. © Blackwell Publishing Ltd Cephalalgia, 2006, 26, 349–350

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