Abnormal pressure waves in headache sufferers with bilateral transverse sinus stenosis

Bono, Francesco; Salvino, Dania; Tallarico, Tiziana; Cristiano, Dario; Condino, Francesca; Fera, Francesco Saverio; Lanza, P.; Lavano, Angelo; Quattrone, Aldo

doi:10.1177/0333102410370877

Cited by 61 publications

(64 citation statements)

References 26 publications

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“…Topiramate, a drug with documented efficacy in CM [51,52] that shares with acetazolamide the inhibition of carbonic anhydrase isoenzyme [53], has been found as effective as acetazolamide in IIH treatment [54], suggesting that the topiramate efficacy in CM could be mediated, at least partially, by an acetazolamide-like CSF pressure lowering effect. Finally, significant dural sinus stenosis, a marker of IIH, has recently been found highly prevalent also in CM [55][56][57].…”

Section: Idiopathic Intracranial Hypertensionmentioning

confidence: 96%

“…In a consecutive series of 98 chronic headache patients, an MRV and LP with 1 h ICP monitoring were performed [55]. Sinus stenosis was present in 48.9 % of the sample.…”

Section: Idiopathic Intracranial Hypertensionmentioning

confidence: 99%

“…These observations confirm the high prevalence of IIHWOP in chronic headache sufferers and its strict association with sinus stenosis. However, the lack of venous outflow disturbances and of raised ICP in more than half of patients with chronic headache [55] and the high prevalence of sinus stenosis-associated raised ICP found in subjects without chronic headache [25] indicate that IIHWOP is neither a necessary nor a sufficient condition for chronic headache development but has to be considered a risk factor for progression and refractoriness of pain in primary headacheprone individuals.…”

Section: Idiopathic Intracranial Hypertensionmentioning

confidence: 99%

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The role of intracranial hypertension in the chronification of migraine

Simone

Ranieri

2015

Neurol Sci

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Besides a similar clinical presentation, idiopathic intracranial hypertension (IIH) and chronic migraine (CM) also share relevant risk factors, show a higher prevalence of allodynic symptoms and both respond to topiramate. Moreover, sinus stenosis, a radiological marker of IIH, in CM patients is much more prevalent than expected. As a consequence of these striking similarities, IIH without papilledema (IIHWOP) may be easily misdiagnosed as CM. Actually, IIHWOP has been found in up to 14 % of CM clinical series. Considering that, on one hand, an asymptomatic sinus stenosis-associated raised intracranial pressure (ICP) may be highly prevalent in the general population, and on the other, that IIH clinical presentation with chronic headache may require a migraine predisposition, we have proposed that an overlooked IIHWOP could represent a risk factor for migraine progression. This hypothesis prompted us to investigate the prevalence of IIHWOP and its possible role in the process of migraine chronification in a consecutive series of CM patients selected for unresponsiveness to medical treatment and evidence of significant sinus stenosis. The main finding of our study is that the large majority of such patients actually suffer from a chronic headache secondary to IIHWOP. This implies that an IIHWOP mimicking CM is much more prevalent than believed, is commonly misdiagnosed as CM on the basis of ICHD criteria and is strictly predicted by refractoriness to preventive treatments. However, our data fully comply with the alternative hypothesis that an overlooked IIHWOP, although highly prevalent amongst healthy individuals, in migraine-prone subjects is a powerful (and modifiable) risk factor for the progression and the refractoriness of pain. The normalization of ICP by even a single LP with CSF withdrawal may be effective in a significant proportion of patients with a long history of refractory chronic headache, who represent about one-fifth of the patients screened in our study. We suggest that IIHWOP should be considered in all patients with almost daily migraine pain, with evidence of sinus stenosis and unresponsive to medical treatment, referred to specialized headache clinics.

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Section: Idiopathic Intracranial Hypertensionmentioning

confidence: 96%

“…In a consecutive series of 98 chronic headache patients, an MRV and LP with 1 h ICP monitoring were performed [55]. Sinus stenosis was present in 48.9 % of the sample.…”

Section: Idiopathic Intracranial Hypertensionmentioning

confidence: 99%

Section: Idiopathic Intracranial Hypertensionmentioning

confidence: 99%

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The role of intracranial hypertension in the chronification of migraine

Simone

Ranieri

2015

Neurol Sci

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“…-Chafic Karam, MD, and Robert C. Griggs, MD Intracranial pressure (ICP) monitoring [2][3][4][5] demonstrated that ICP shows large diurnal fluctuations in IIH/IIHWOP patients, ranging from normal to definitely pathologic values. Many patients with papilledema fulfilling Friedman criteria A-D might be classified as "definite" or "probable" depending on the timing of their unstable ICP estimation.…”

mentioning

confidence: 99%

Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children

Simone

Ranieri²,

Montella³

et al. 2014

Neurology

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“…Such asymptomatic and, therefore, largely undiagnosed IIHWOP only occurs in subjects showing sinus stenosis, a condition observed in about 23 % of healthy people [13]. In primary chronic headache clinical series, the prevalence of cerebral venous outflow abnormalities was 48.9 % and almost all patients (91.6 %) showed a continuous or intermittent IIHWOP; conversely, all patients with normal MRV had an ICP within normal limits [14]. Based on the above observations, we recently proposed that a sinus stenosis-associated intracranial hypertension (ss-IHWOP), although very common among healthy subjects, is a powerful risk factor for progression and refractoriness of pain in primary headache prone individuals [7].…”

Section: Discussionmentioning

confidence: 99%

Primary stabbing headache: a new dural sinus stenosis-associated primary headache?

et al. 2013

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Primary stabbing headache (PSH) is a primary syndrome of unknown aetiology, characterised by brief, jabbing stabs predominantly felt in the orbital, temporal and parietal areas, whose frequency may vary from one to many per day, usually responding to indomethacin. PSH frequency in the general population is not well defined, but recent evidence suggests it could be more frequent than previously thought. In clinical series, PSH incidence was 33/100,000 per year, while in a population study 35.2 % prevalence was found. PSH was previously described as isolated or associated to other headache syndromes, most frequently with migraine. There is evidence that an idiopathic intracranial hypertension without papilledema, a condition usually associated to significant stenosis of dural sinuses (93 % sensitivity and specificity), is much more prevalent than believed and may run asymptomatically in up to 11 % of otherwise healthy individuals. In migrainous prone people, a sinus stenosis-associated intracranial hypertension without papilledema (ss-IHWOP) comorbidity may represent a powerful risk factor for progression of pain. Besides migraine, significant sinus stenosis has been found overrepresented also in chronic tension type headache as well as in exertional, cough, sexual activity-associated headaches (all indomethacin responsive primary headaches) and in altitude headache (an acetazolamide responsive condition). To explore the possible association between venous outflow disturbances and PSH, we retrospectively investigated the co-occurrence of sinus venous stenosis in patients referring to our headache centre since 2004 diagnosed with PSH who completed the diagnostic protocol. Out of 50 consecutive patients reporting PSH as the main or as accessory complaint, 8 (6 females, 2 males) performed MR venography (MRV). All MRV revealed significant unilateral or bilateral sinus stenosis. Mean age at PSH onset was 35.3 ± 18.9 years (range 11-67 years). Duration of attacks ranged 1-3 s. Median daily frequency of attacks was 4 (range 2-20); median number of days per month with PSH presentation was 14 (range 4-30). Six patients described attacks in temporal or parietal areas, one at the top of the head, and one in the occipital area. Only one patient had isolated PSH; all the others were diagnosed also with migraine without aura. Seven out of eight patients responded to indomethacin 75 mg/die, and one to topiramate 100 mg/die. Interestingly, both drugs share with acetazolamide a CSF pressure lowering effect. Our findings indicate that PSH is associated with central sinus stenosis and suggest that an undiagnosed ss-IHWOP might be involved in PSH pathogenesis.

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Abnormal pressure waves in headache sufferers with bilateral transverse sinus stenosis

Cited by 61 publications

References 26 publications

The role of intracranial hypertension in the chronification of migraine

The role of intracranial hypertension in the chronification of migraine

Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children

Primary stabbing headache: a new dural sinus stenosis-associated primary headache?

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