AIM: To compare the elasticity of the sternocleidomastoid and trapezius muscles in patients with cervicogenic headache and in healthy volunteers. METHODS: The medical history of 23 patients with cervicogenic headache was taken with a focus on pain characteristics. Elasticity of the sternocleidomastoid and trapezius muscles was measured by using shear wave elastography. Results were then compared with 23 healthy volunteers. RESULTS: The sternocleidomastoid muscle was significantly stiffer in patients with cervicogenic headache compared to healthy volunteers. The stiffness increased gradually from the parasternal area, where it was negligible, to the area near the mastoid process where it reached over 20 kPa. There was no difference in the stiffness of the trapezius muscle. The stiffness of the sternocleidomastoid muscle does show a significant dependence on headache characteristics (e.g., laterality, severity, or frequency). CONCLUSION: The results of this pilot study show that patients with cervicogenic headache have a higher stiffness of the sternocleidomastoid muscle than healthy volunteers. These findings suggest that elastography could be used as a diagnostic tool in cervicogenic headache.

• MeSH
• Elasticity Imaging Techniques * methods   MeSH
• Neck Muscles diagnostic imaging   physiology   MeSH
• Humans MeSH
• Pilot Projects MeSH
• Post-Traumatic Headache * diagnostic imaging   MeSH
• Elasticity MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

Neck-tongue syndrom je vzácně se vyskytující onemocnění, které je zahrnuto a definováno v Mezinárodní klasifikaci bolestí hlavy (ICHD-3). Klinickými projevy neck-tongue syndromu (NTS) jsou náhle vzniklá bolest hlavy v zátylku a senzo-motorické příznaky z postižené inervace jazyka, vzniklé v návaznosti na prudký pohyb hlavou. Diagnóza je v klinické praxi stanovena per exclusionem, tedy po vyloučení frekventnějších a potenciálně závažnějších stavů, zejména cévních patologií (disekce pre/intracerebrálních tepen a subarachnoidální krvácení). Dominantně se v terapii uplatňují nefarmakologické přístupy, které jsou reprezentovány fyzioterapií subokcipitální a krční krajiny. Prezentuji kazuistiku 53leté pacientky, přijaté pro akutně vzniklou dysartrii a silnou cefaleu, vzniklou ve vazbě na usilovné kýchnutí.

Neck-tongue syndrome is a rarely occurring disease which is included and defined in the International Classification of Headache Disorders (ICHD-3). The clinical manifestations of neck-tongue syndrome (NTS) are sudden-onset headache at the back of the neck and sensory-motor signs due to impairment of tongue innervation, occurring as a result of vigorous head movement. In the clinical practice, the diagnosis is made by exclusion, that is after ruling out more frequent and potentially more serious conditions, particularly vascular pathologies (pre/intracerebral artery dissection and subarachnoid haemorrhage). The treatment predominantly involves nonpharmacological approaches represented by physiotherapy of the suboccipital and cervical regions. A case report is presented of a 53-year-old female patient admitted for acute-onset dysarthria and severe headache, occurring as a result of sneezing hard.

• Keywords
• neck-tongue syndrom, pseudoatetóza,
• MeSH
• Atlanto-Axial Joint MeSH
• Dysarthria etiology   MeSH
• Tongue MeSH
• Neck MeSH
• Middle Aged MeSH
• Humans MeSH
• Post-Traumatic Headache * etiology   physiopathology   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

BACKGROUND: According to the International Classification of Headache Disorders 3, post-traumatic headache (PTH) attributed to traumatic brain injury (TBI) is a secondary headache reported to have developed within 7 days from head injury, regaining consciousness following the head injury, or discontinuation of medication(s) impairing the ability to sense or report headache following the head injury. It is one of the most common secondary headache disorders, and it is defined as persistent when it lasts more than 3 months. MAIN BODY: Currently, due to the high prevalence of this disorder, several preclinical studies have been conducted using different animal models of mild TBI to reproduce conditions that engender PTH. Despite representing a simplification of a complex disorder and displaying different limitations concerning the human condition, animal models are still a mainstay to study in vivo the mechanisms of PTH and have provided valuable insight into the pathophysiology and possible treatment strategies. Different models reproduce different types of trauma and have been ideated in order to ensure maximal proximity to the human condition and optimal experimental reproducibility. CONCLUSION: At present, despite its high prevalence, PTH is not entirely understood, and the differential contribution of pathophysiological mechanisms, also observed in other conditions like migraine, has to be clarified. Although facing limitations, animal models are needed to improve understanding of PTH. The knowledge of currently available models is necessary to all researchers who want to investigate PTH and contribute to unravel its mechanisms.

• MeSH
• Brain Concussion complications   diagnosis   physiopathology   MeSH
• Humans MeSH
• Migraine Disorders diagnosis   etiology   physiopathology   MeSH
• Disease Models, Animal * MeSH
• Post-Traumatic Headache diagnosis   etiology   physiopathology   MeSH
• Prevalence MeSH
• Reproducibility of Results MeSH
• Animals MeSH
• Check Tag
• Humans MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

BACKGROUND: Headache is a common complication of traumatic brain injury. The International Headache Society defines post-traumatic headache as a secondary headache attributed to trauma or injury to the head that develops within seven days following trauma. Acute post-traumatic headache resolves after 3 months, but persistent post-traumatic headache usually lasts much longer and accounts for 4% of all secondary headache disorders. MAIN BODY: The clinical features of post-traumatic headache after traumatic brain injury resemble various types of primary headaches and the most frequent are migraine-like or tension-type-like phenotypes. The neuroimaging studies that have compared persistent post-traumatic headache and migraine found different structural and functional brain changes, although migraine and post-traumatic headache may be clinically similar. Therapy of various clinical phenotypes of post-traumatic headache almost entirely mirrors the therapy of the corresponding primary headache and are currently based on expert opinion rather than scientific evidence. Pharmacologic therapies include both abortive and prophylactic agents with prophylaxis targeting comorbidities, especially impaired sleep and post-traumatic disorder. There are also effective options for non-pharmacologic therapy of post-traumatic headache, including cognitive-behavioral approaches, onabotulinum toxin injections, life-style considerations, etc. CONCLUSION: Notwithstanding some phenotypic similarities, persistent post-traumatic headache after traumatic brain injury, is considered a separate phenomenon from migraine but available data is inconclusive. High-quality studies are further required to investigate the pathophysiological mechanisms of this secondary headache, in order to identify new targets for treatment and to prevent disability.

• MeSH
• Analgesics therapeutic use   MeSH
• Cognitive Behavioral Therapy methods   trends   MeSH
• Humans MeSH
• Migraine Disorders complications   diagnostic imaging   epidemiology   therapy   MeSH
• Brain diagnostic imaging   MeSH
• Neuroimaging trends   MeSH
• Post-Traumatic Headache diagnostic imaging   epidemiology   therapy   MeSH
• Headache Disorders, Secondary diagnostic imaging   epidemiology   therapy   MeSH
• Brain Injuries, Traumatic diagnostic imaging   epidemiology   therapy   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

• MeSH
• Botulinum Toxins administration & dosage   therapeutic use   MeSH
• Stroke complications   prevention & control   therapy   MeSH
• Chronic Pain prevention & control   therapy   MeSH
• Diabetic Neuropathies complications   prevention & control   therapy   MeSH
• Diagnostic Techniques, Neurological MeSH
• Drug Therapy MeSH
• Herpes Zoster * complications   prevention & control   therapy   MeSH
• Cognitive Behavioral Therapy methods   MeSH
• Comorbidity MeSH
• Congresses as Topic MeSH
• Humans MeSH
• Spinal Cord Stimulation methods   utilization   MeSH
• Neuralgia * etiology   prevention & control   therapy   MeSH
• Post-Traumatic Headache * diagnosis   etiology   therapy   MeSH
• Surveys and Questionnaires MeSH
• Multiple Sclerosis complications   prevention & control   therapy   MeSH
• Statistics as Topic MeSH
• Transcranial Magnetic Stimulation methods   utilization   MeSH
• Transcutaneous Electric Nerve Stimulation methods   utilization   MeSH
• Check Tag
• Humans MeSH

Bolesti hlavy jsou velmi častým symptomem. Patří mezi nejčastější stesky pacientů v ordinaci neurologa. Bolesti hlavy dělíme na primární a sekundární. Sekundární bolesti hlavy jsou příznakem jiného, cerebrálního či extracerebrálního onemocnění. V článku uvádíme varovné příznaky, při jejichž výskytu je nutné řádné vyšetření pacienta. Dále jsou uvedena diagnostická kritéria a příznaky nejčastějších typů primárních bolestí hlavy. Jde o bolesti, u nichž nezjistíme žádné cerebrální či extracerebrální onemocnění, jež by s nimi bylo v přímé souvislosti. Při diagnostice primárních cefalalgií je nejdůležitější pečlivá anamnéza. Stručně je uvedena i léčba primárních bolestí hlavy.

Headache is a very common symptom. It is one of the most frequent patient complaints in a neurological clinic. We distinguish between primary and secondary headaches. Secondary headaches are symptoms of another – either cerebral or extracerebral – condition. “Red flag” signs, the presence of which warrants detailed examination, are discussed in this paper. Diagnostic criteria and symptoms of the most common primary headaches are also presented. These are headaches not accompanied by any cerebral or extracerebral disease directly related to them. In primary headaches, the most important diagnostic procedure consists of meticulous history taking. Management of primary headaches is also briefly mentioned.

• Keywords
• primární bolest hlavy, sekundární bolest hlavy, aura, tenzní typ bolesti hlavy, triptany, antiepileptika,
• MeSH
• Medical History Taking MeSH
• Anticonvulsants MeSH
• Arteritis MeSH
• Headache diagnosis   classification   therapy   MeSH
• Vascular Headaches MeSH
• Cluster Headache MeSH
• Diagnosis, Differential MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Migraine with Aura MeSH
• Migraine Disorders MeSH
• Head and Neck Neoplasms MeSH
• Trigeminal Neuralgia MeSH
• Facial Pain MeSH
• Paroxysmal Hemicrania MeSH
• Tomography, X-Ray Computed MeSH
• Post-Traumatic Headache MeSH
• Headache Disorders, Primary MeSH
• Headache Disorders, Secondary MeSH
• Tension-Type Headache MeSH
• Therapeutics MeSH
• Tryptamines MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Cervikokraniální (CC) syndrom (cervikogenní bolest hlavy) je přenesená bolest hlavy z oblasti krční páteře. Jde typicky o asymetrické a někdy i jednostranné bolesti, které mohou být provokovány pohybem krku, nevhodnou polohou hlavy nebo tlakem na spoušťové body na krku. Jsou prezentována současná diagnostická kritéria Mezinárodní společnosti pro bolesti hlavy a Mezinárodní studijní skupiny pro cervikogenní bolesti hlavy. V diferenciální diagnóze je třeba vyloučit sekundární organické příčiny, zejména expanzivní procesy v zadní jámě lební nebo subarachnoidální krvácení. Neurologické vyšetření u CC syndromu by mělo být normální a speciální manuální myoskeletální vyšetření často prokáže abnormitu krční páteře. Zobrazovací vyšetření výpočetní tomografií (CT) nebo magnetickou rezonancí (MR) je důležité právě pro diagnostiku sekundárních příčin bolesti, kde jsou indikovány jiné terapeutické postupy. Úspěšná léčba CC syndromu obvykle vyžaduje komplexní multifaktoriální přístup s využitím farmakologické léčby i nefarmakologických postupů (rehabilitační a manuální terapie).

Cervicogenic headache is a referred pain from the cervical spine. It is typically an asymmetric or unilateral headache that can be provoked by neck movement, awkward head positions or pressure on tender points in the neck. The current International Headache Society and Cervicogenic Headache International Study Group diagnostic criteria are presented. In the differential diagnosis secondary organic disorders such as a space-occupying lesion particularly in the posterior cranial fossa or subarachnoid hemorrhage should be excluded. Neurologic examination in cervicogenic headache should be normal and special manual musculoskeletal assessment will most often suggest an underlying cervical spine abnormality. Computed tomography (CT) or magnetic resonance imaging (MRI) is primarily used to search for secondary causes of pain that may require other form management. The successful treatment of cervicogenic headache usually requires a complex multifactorial approach using pharmacological treatment, and non-pharmacological approaches (rehabilitation and manual therapy).

• Keywords
• cervikogenní bolest hlavy, diagnostická kritéria, krční páteř, fasetové klouby, cervikální závrať, léčba,
• MeSH
• Pain etiology   MeSH
• Intervertebral Disc Degeneration complications   pathology   MeSH
• Diagnosis, Differential MeSH
• Drug Therapy MeSH
• Neck innervation   physiopathology   pathology   MeSH
• Humans MeSH
• Pain Management MeSH
• Nociceptors physiology   MeSH
• Spine innervation   physiopathology   pathology   MeSH
• Post-Traumatic Headache diagnosis   etiology   physiopathology   MeSH
• Physical Therapy Modalities MeSH
• Dizziness etiology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Některé typy primárních bolestí hlavy se ve starším věku vyskytují méně častěji (migréna, cluster headache), jiné jsou pro toto období typické (hypnická bolest hlavy). Narůstá výskyt sekundárních bolestí hlavy. Red flags napomáhají v diferenciální diagnostice závažných sekundárních cefalgií. V textu jsou popsány nejvýznamnější typy primárních a sekundárních bolestí hlavy v seniorském věku. V terapii využíváme častěji nižší dávky léků. Některá léčiva jsou ve stáří nevhodná (triptany, amitriptylin), nutno věnovat pozornost kombinacím léků vzhledem k rozvoji vedlejších účinků (warfarin).

Some types of primary headaches in the elderly age occur less often (migraine, cluster headache), others are typical for this period (hypnic headache). The occurence of secondary headaches increases. Red flags help in differential diagnostic of serious secondary headaches. The most important kinds of primary and secondary headaches in senior age are described in the text. Lower doses of medication are used more frequently. Some drugs (triptans, amitriptylin) are inappropriate in elderly age. It is necessary to pay attention to the combinations of drugs with regard to the occurence of sides effects (warfarin).

• Keywords
• red flags,
• MeSH
• Headache diagnosis   etiology   classification   MeSH
• Diagnosis, Differential MeSH
• Drug Therapy methods   MeSH
• Drug Therapy, Combination methods   MeSH
• Comorbidity MeSH
• Drug Interactions MeSH
• Humans MeSH
• Migraine Disorders diagnosis   epidemiology   MeSH
• Brain Diseases diagnosis   etiology   complications   MeSH
• Trigeminal Neuralgia diagnosis   drug therapy   MeSH
• Drug-Related Side Effects and Adverse Reactions MeSH
• Giant Cell Arteritis diagnosis   drug therapy   MeSH
• Neuralgia, Postherpetic epidemiology   drug therapy   MeSH
• Post-Traumatic Headache diagnosis   etiology   drug therapy   MeSH
• Headache Disorders, Primary diagnosis   epidemiology   MeSH
• Headache Disorders, Secondary etiology   drug therapy   classification   MeSH
• Aged MeSH
• Check Tag
• Humans MeSH
• Aged MeSH
• Publication type
• Review MeSH

The aim of this pilot study was to compare the efficacy of pulsed radiofrequency to the greater occipital nerve versus a greater occipital nerve block with a mixture of local anaesthetic and steroid in the management of refractory cervicogenic headache. We enrolled 30 patients suffering from refractory cervicogenic headache. Patients were randomly allocated into two groups of fifteen. A greater occipital nerve block with steroid was utilised in group A, while a pulsed radiofrequency treatment was employed in group B. Success of both procedures was evaluated by comparing pre and post intervention Visual Analogue Scale of pain, Medication Quantification Scale – III. and Global Perceived Effect at three and 9 months after the procedures. At three months post therapy a significant decrease in Visual Analogue Scale (p<0.001) was identified (3.2 points in group A, 3.3 points in group B respectively). In group B pain remained reduced even after 9 months (p<0.001) when compared to pre treatment scores. The consumption of analgesic medication was reduced significantly in both groups at three months (p<0.001) and 9 months (p<0.01), respectively. No serious complication was noted. Greater occipital nerve block is a safe, efficient technique in the management of cervicogenic headaches. Despite the lack of high quality scientific evidence (level III or IV) in the literature, we have extensive experience with steroid application and pulsed radiofrequency to the greater occipital nerve and report the beneficial results in our study.

• MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Pain Measurement MeSH
• Young Adult MeSH
• Nerve Block MeSH
• Post-Traumatic Headache MeSH
• Pulsed Radiofrequency Treatment MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Randomized Controlled Trial MeSH
• Comparative Study MeSH

Práce se zabývá sekundárními bolestmi hlavy. Sekundární bolesti hlavy jsou příznakem určité strukturální léze nebo organického onemocnění intra- nebo extrakraniálně nebo mohou být projevem metabolické poruchy, podání nebo odnětí některé látky. Práce se soustřeďuje na závažné život nebo zdraví ohrožující sekundární bolesti hlavy a jejich charakteristické znaky. Jsou rozděleny do několika skupin: bolesti hlavy v souvislosti s vaskulárními poruchami, potraumatické bolesti hlavy, bolesti hlavy u expanzivních procesů nitrolebních, v souvislosti s infekcí a při onemocněních oka, nosu a paranazálních dutin. Práce je doplněna 9 kazuistikami.

The paper deals with secondary headaches. Secondary headaches are symptoms of a certain structural lesion or organic disorder intraor extracranially or they may be the manifestation of a metabolic disorder, application or removal of a certain substance. The paper focuses on serious life or health – threatening secondary headaches and their characteristic features. They are divided in several groups: headaches associated with vascular disorders, posttraumatic headaches, headaches associated with space – occupying lesions, with infection, and disorders of eye, nose and paranasal sinuses. The paper is completed with 9 case reprorts. mass, meningitis, HIV infection.

• Keywords
• intracerebrální krvácení, epidurální a subdurální hematom, expanzivní proces nitrolební, meningitis,
• MeSH
• Hematoma, Subdural, Acute diagnosis   therapy   MeSH
• Headache etiology   classification   MeSH
• Vascular Headaches diagnosis   etiology   therapy   MeSH
• Hematoma, Subdural, Chronic diagnosis   therapy   MeSH
• Vertebral Artery Dissection diagnosis   therapy   MeSH
• Child MeSH
• Adult MeSH
• Hematoma, Epidural, Cranial diagnosis   therapy   MeSH
• HIV Infections MeSH
• Intracranial Hemorrhages diagnosis   therapy   MeSH
• Intracranial Thrombosis diagnosis   therapy   MeSH
• Middle Aged MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Meningitis diagnosis   MeSH
• Brain Neoplasms diagnosis   MeSH
• Tomography, X-Ray Computed MeSH
• Post-Traumatic Headache diagnosis   etiology   therapy   MeSH
• Headache Disorders, Secondary diagnosis   etiology   classification   MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Subarachnoid Hemorrhage diet therapy   therapy   MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Case Reports MeSH
• Review MeSH