Cerebral magnetic resonance imaging was performed on 63 patients with chronic primary headache (28 with migraine with and without aura, 35 with tension-type headache). Fifty-four headache-free individuals of the same age range were used as controls. The headache sufferers showed an incidence of focal white matter abnormalities on T2-weighted magnetic resonance imaging significantly higher than the age-matched control group (33.3% vs 7.4%). The incidence of white matter abnormalities did not correlate with age (except for patients older than 60 years), sex, headache history, headache status, or ergotamine consumption. Migraine (with and without aura) and tension-type headache patients had similar prevalence of white matter abnormalities (32.1% vs 34.3%). The lesions were predominantly distributed in the frontal region, independent of the side of usual aura or headache. Our findings indicate that both migraine and tension-type headache may be associated with early pathologic changes in the brain and may share, at least in part, common pathogenic pathways.

Tumours of the fifth cranial nerve are very rare, comprising only 0.2% of all intracranial neoplasms. The authors critically review the literature, and report on 12 personal cases of trigeminal tumours (nine neurinomas, one meningioma, one epidermoid, one osteochondroma). General pathology, symptoms, and signs are analyzed, and compared with cases from the literature. Because of their insidious onset and slow "illogical" progression of misleading symptoms, trigeminal tumours often prove to be a diagnostic challenge. As a consequence they usually reach a large size before causing sufficient symptoms to lead the patient to a neurosurgical clinic. The diagnosis is therefore likely to be made by radiological investigations. The typical radiological feature (on plain skull films, pneumoencephalography, and angiography) are described, and differential diagnosis is discussed. All the patients in the present series were operated on. Surgical procedures and postoperative results are discussed.

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