Airplane flights triggering spontaneous intracranial hypotension:Observations from the Danish headache centre

OBJECTIVE: Spontaneous intracranial hypotension (SIH) manifests as orthostatic headache, which can be confirmed by radiological signs of low intracranial pressure on magnetic resonance imaging of the brain. The most common mechanisms of SIH are ruptured meningeal diverticula, ventral dural tears and CSF‐venous fistulas. SIH is associated with connective tissue disorders, and cases of SIH onset after trivial trauma have been reported. As SIH is often underdiagnosed, the aim of this study is to identify possible new risk factors of SIH onset in a case series of SIH patients. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 36 patients diagnosed with SIH. We reviewed and identified potential factors that led to or presented at headache onset in SIH patients. RESULTS: We identified 4/36 (11%) patients that had a close temporal relationship between the onset of SIH symptoms and airplane travel. In all four patients, the clinical and imaging features confirmed the diagnosis of SIH. CONCLUSION: This is the first report of a case series of four patients with SIH that could be related to airplane travel. Describing four cases (11%) is not proof but should alert us to a possible causal relationship, which calls for further research. We suggest that when taking medical history, thorough details about the patient's activities, such as headache onset, should be documented because of their importance in correctly diagnosing SIH, which is a debilitating, yet treatable, disease

The PACAP receptor: a novel target for migraine treatment

The origin of migraine pain has not yet been clarified, but accumulating data point to neuropeptides present in the perivascular space of cranial vessels as important mediators of nociceptive input during migraine attacks. Pituitary adenylate cyclase-activating polypeptide (PACAP) is present in sensory trigeminal neurons and may modulate nociception at different levels of the nervous system. Human experimental studies have shown that PACAP-38 infusion induces marked dilatation of extracerebral vessels and delayed migraine-like attacks in migraine patients. PACAP selectively activates the PAC(1) receptor, which suggests a possible signaling pathway implicated in migraine pain. This review summarizes the current evidence supporting the involvement of PACAP in migraine pathophysiology and the PAC(1) receptor as a possible novel target for migraine treatment

Validation of the Temporomandibular Disorder Pain Screener in a Specialized Headache Center

Aims: To investigate the sensitivity and specificity of the TMD pain screener in a headache population. Methods: A cross-sectional study was conducted at the Danish Headache Center (DHC). Patients were included if they had primary or secondary headache, trigeminal neuralgia, or facial pain. The pain screener was compared to the outcome of a full Diagnostic Criteria for TMD (DC/TMD) examination. Results: A total of 62 headache patients were included (77% women). The sensitivity of the pain screener short version (three questions) was 85% (95% CI: 70% to 94%), and the specificity was 64% (95% CI: 41% to 83%). In the full version (six questions), the sensitivity was 83% (95% CI: 67% to 93%), and the specificity was 82% (95% CI: 60% to 95%). Conclusion: The TMD pain screener seems to be a valid tool to accurately screen for the presence of TMD to provide the most optimal treatment for headache patients. These findings should however be confirmed in a larger sample with migraine, tension-type headache, and trigeminal neuralgia. J Oral Facial Pain Headache 2021;35:150–156, doi: 10.11607/ofph.278