Secondary stabbing headache associated with intracranial tumors, aneurysms, and arteriovenous malformation: An alarming warning sign.

Autor: Valença MM; Neurology and Neurosurgery Unit, Hospital das Clínicas, Federal University of Pernambuco, Recife, Brazil., de Azevedo Filho HRC; Department of Neurosurgery, Hospital da Restauração, Universidade de Pernambuco, Recife, Brazil., de Souza Ferreira MR; Neurology and Neurosurgery Unit, Hospital das Clínicas, Federal University of Pernambuco, Recife, Brazil., Valença MA; Neurology and Neurosurgery Unit, Hospital das Clínicas, Federal University of Pernambuco, Recife, Brazil., Krymchantowski AV; Headache Center of Rio, Rio de Janeiro, Brazil., Valença MF; INI International Neuroscience Institute, Hannover, Germany., Andrade-Valença LPA; Neurology and Neurosurgery Unit, Hospital das Clínicas, Federal University of Pernambuco, Recife, Brazil.
Jazyk: angličtina
Zdroj: Headache [Headache] 2021 Jan; Vol. 61 (1), pp. 80-89. Date of Electronic Publication: 2021 Jan 08.
DOI: 10.1111/head.14045
Abstrakt: Background: Stabbing headache (SH) is considered as a pure primary headache, but according to a few clinical observations it could also be secondary. Over the past decades, we have been observing the complaint of SH in patients with intracranial vascular and neoplastic lesions.
Objective: To describe a series of patients with intracranial lesions who experienced SH.
Methods: This is a cross-sectional, retrospective study of 34 patients with intracranial lesions associated with SH, admitted at Hospital das Clínicas, Federal University of Pernambuco, Brazil.
Results: In this series of 34 patients [29 women, 44 ± 12 years (mean ± SD)] with secondary SH, the causes were intracranial neoplasms (n = 31), cerebral aneurysms (n = 2), or arteriovenous malformation (n = 1). Pituitary tumor (n = 18), meningioma (n = 6), and vestibular schwannomas (n = 4) were the most prevalent types of intracranial neoplasms. All these lesions had intimate contact with the dura mater, including an oligodendroglioma, the only intra-axial tumor in the series. A characteristic in the secondary SH is the crescendo pattern (12/34, 35%), progressing from infrequent attacks to recurrent crises occurring several times a day. The SH lasted from 5 days to 60 months (15 ± 18 months, mean ± SD) until the correct diagnosis [16/34 (47%) of the patients ≤6 months]. The SH was triggered by the movement of the head (5/34, 15%) or Valsalva maneuver (1/34). After surgery, suppression of the SH was observed. In a few of the patients to whom dexamethasone was prescribed, the SH subsided within a few days.
Conclusion: This study was able to identify clinical red flags associated with intracranial lesions and secondary SH, for example, recent onset of SH, exclusively unilateral (ipsilateral) at the same location, crescendo pattern, triggered by head movements, or Valsalva maneuver.
(© 2021 American Headache Society.)
Databáze: MEDLINE
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