Dissanayake Kanishka P, Wanniarachchi Damindi P, Ranawaka Udaya K
University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.
Colombo North Teaching Hospital, Ragama, Sri Lanka.
BMC Res Notes. 2017 Jul 25;10(1):318. doi: 10.1186/s13104-017-2641-6.
Headache is one of the commonest complaints reported to physicians worldwide. Yet, arriving at the proper diagnosis can be a challenge in many patients. Although most headaches belong to common categories of migraine and tension-type headache, which are diagnosed and managed relatively easily, several uncommon headache disorders can lead to delays in diagnosis. Certain medications are more efficacious than others in managing these headache disorders, hence establishing the correct diagnosis is of paramount importance.
An 86-year-old female presented with chronic daily headache of 1 year duration. Her headaches were exclusively nocturnal and woke her up daily around midnight. Clinical examination was unremarkable. All basic investigations were normal. Subsequent gadolinium enhanced Magnetic Resonance Imaging (MRI) brain did not show any significant pathology. There was no satisfactory response to paracetamol, diclofenac sodium, mefenamic acid, tramadol, flunarizine and sodium valproate. Indomethacin was started with the provisional diagnosis of hypnic headache. There was absolute response by day 3 of indomethacin. She remains headache free on low dose indomethacin maintenance at 1 year after the diagnosis.
Better understanding of uncommon headache syndromes can help in early diagnosis and appropriate treatment. Hypnic headache should be considered in the differential diagnosis of chronic daily headaches, especially when nocturnal and occurs during sleep.
头痛是全球范围内向医生报告的最常见症状之一。然而，对许多患者来说，做出正确诊断可能是一项挑战。尽管大多数头痛属于偏头痛和紧张型头痛等常见类型，诊断和处理相对容易，但几种不常见的头痛疾病可能导致诊断延迟。某些药物在治疗这些头痛疾病方面比其他药物更有效，因此确立正确诊断至关重要。
一名86岁女性，有持续1年的慢性每日头痛症状。她的头痛仅在夜间发作，每天午夜左右将她疼醒。临床检查无异常。所有基本检查均正常。随后的钆增强磁共振成像（MRI）脑部检查未显示任何明显病变。对扑热息痛、双氯芬酸钠、甲芬那酸、曲马多、氟桂利嗪和丙戊酸钠均无满意疗效。以睡眠性头痛的初步诊断开始使用吲哚美辛治疗。使用吲哚美辛第3天即有明显疗效。诊断后1年，她在低剂量吲哚美辛维持治疗下一直未再头痛。
更好地了解不常见的头痛综合征有助于早期诊断和恰当治疗。在慢性每日头痛的鉴别诊断中应考虑睡眠性头痛，尤其是头痛发生在夜间且在睡眠期间出现时。
