Biomedical subjects
Publications and source records attributed to Randolph W Evans.
The following interesting and uncommon headache disorders are presented through case studies: exploding head syndrome, hypnic headache, neck-tongue syndrome, "Alice in Wonderland" syndrome, nummular headache, red ear syndrome, burning mouth syndrome, spontaneous intracranial hypotension syndrome, and cardiac cephalalgia.
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Phosphodiesterase-5 inhibitors commonly trigger migraines but rarely trigger cluster headaches. Two cases of cluster headaches triggered by sildenafil are described.
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A 26-year-old patient is described with a unique migraine aura. She described an 8-year history of episodes occurring 1 to 2 times yearly of exploding head syndrome followed by sleep paralysis followed by a migraine headache. She also had identical headaches without aura about once per week. Both aura symptoms, which may occur in the brainstem, resulted in activation of the trigeminovascular system through an unknown mechanism.
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Two patients are reported who developed palinopsia while taking topiramate for migraine prevention which resolved or decreased in frequency or duration on lower doses, but recurred or increased in frequency or duration on higher doses. Both patients had complete resolution of palinopsia when topiramate was discontinued. A third patient is described who developed the "Alice in Wonderland" syndrome about 1 week after starting topiramate for migraine prevention with complete resolution of symptoms about 1 month after stopping. Topiramate use may cause palinopsia and may be associated with the Alice in Wonderland syndrome through an unknown mechanism.
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Review of the literature on prevention of post-lumbar puncture headaches (PLPHAs) since the publication of the original assessment in 2000 yielded one study comparing use of cutting to atraumatic needles in diagnostic lumbar punctures, providing Class I evidence in favor of the atraumatic needle. Taken in conjunction with data from most studies in the anesthesiology literature, the Therapeutics and Technology Assessment Subcommittee concluded that use of an atraumatic spinal needle in adult patient populations reduces the frequency of PLPHA (Level A recommendation). It affirmed a previous conclusion that smaller needle size is associated with reduced frequency of PLPHA (Level A recommendation).
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