No abstract

Recurrent painful ophthalmoplegic neuropathy (RPON) is a headache disorder classified as a cranial neuropathy. It is characterized by episodes of unilateral headache followed by ipsilateral ophthalmoplegia due to ocular cranial nerve palsy. Symptoms usually subside spontaneously within weeks to months. RPON commonly occurs in childhood, though it is overlooked at times as a possible differential diagnosis. The pathophysiology of RPON is not entirely clear. Typical magnetic resonance imaging (MRI) findings in children include nerve thickening and gadolinium enhancement. However, these findings are not specific to this condition. Nerve thickening in RPON can resemble schwannomas, thereby causing a diagnostic dilemma. Here, we present a 13-year-old boy with a history of unilateral headaches associated with ipsilateral ptosis and diplopia. The first MRI indicated thickening and gadolinium enhancement of the right oculomotor nerve, which was interpreted as a schwannoma. However, his symptoms resolved after a few weeks and the follow-up MRI showed resolution of nerve changes. This clinical presentation was consistent with RPON. This case demonstrates the need for a careful follow-up of RPON patients.

Cluster headache is a pain syndrome characterised by severe, unilateral and predominantly orbital pain which lasts 15 - 180 minutes. It is accompanied by a range of ipsilateral autonomic symptoms, such as lacrimation, rhinorrhoea and myosis. Cluster headaches can be episodic with periods of remission or chronic. Even though it is a relatively rare condition, the excruciating pain causes significant disruption of patients’ daily life. The pathophysiology behind cluster headaches is complex and despite making significant progress, the pathogenetic cascade of events hasn’t been entirely elucidated yet. However, research into this subject has discovered brain structures, peripheral pathways and neuropeptides which have key roles in pathogenesis. The basis of diagnosing cluster headaches is a detailed patient history and the exclusion of other primary headaches and potential secondary causes. Sex differences in clinical presentation need to be taken into consideration in order to avoid misdiagnosis. Treatment options are divided into three categories: acute, transitional and prophylactic treatment. Although there are a lot of treatment modalities available, further research is necessary in order to find new therapeutic targets and more effective prophylaxis, especially for chronic cluster headache.

Background: Studies reporting the prevalence of headaches in Croatia have methodological differences that make it difficult to consolidate their results. This study aimed to assess the prevalence of the most common primary headaches in a student population using the standardized HARDSHIP questionnaire (in Croatian). Methods: This cross-sectional epidemiological study collected data regarding the 1-year prevalence of headaches in a student population using the diagnostic algorithm of the HARDSHIP questionnaire. The chi-squared test was used to analyze gender differences, and Cramer’s V was used for effect size interpretation. Results: The questionnaire was administered to 1350 university students enrolled in health profession programs (81.3% female; 18.7% male; average age: 23 years). The 1-year prevalence of migraine was 38.9% (male: female ratio, 1:1.5), and that of tension-type headache was 35.6% (male: female ratio, 1:0.9). Overall, 91.0% of participants responded positively to the question regarding the incidence of headache in the past 12 months. Conclusions: We report a high prevalence of primary headaches among students of health professions in Croatia. The differences in prevalence may be attributed to various sociocultural, geographical, genetic, and methodological differences. Population-specific studies may facilitate a more accurate assessment of headache prevalence and enable more effective targeting of public health activities.