bluuebunny/crossref_metadata_2025_split huggingface dataset:
Orgasmic Headaches
Authors: Newman Lawrence C. , Levin Morris , Halker Singh Rashmi B. , Michael Rebecca L. 
Published: March 2022

Abstract
A severe abrupt headache occurring with exertion is suggestive of subarachnoid hemorrhage, other intracranial hemorrhage, or arterial dissection. Thus, it must be aggressively worked up. Recurring exertional or sex-induced headaches are usually more benign. Nevertheless, it is imperative to rule out serious causes of ANY sudden or “thunderclap headache.” In this chapter, the wide range of possible causes of thunderclap headache is discussed, including both primary and secondary causes. A parsimonious diagnostic path is outlined, aimed at quickly discovering dangerous causes of these headaches. Treatment options for orgasmic headache are also presented.
Sinus Headache
Authors: Newman Lawrence C. , Levin Morris , Halker Singh Rashmi B. , Michael Rebecca L. 
Published: March 2022

Abstract
Migraine and other primary headache types are often misdiagnosed as “sinus headache” because of their sometimes midfrontal location and nasal/sinus symptoms. However, there are some rhinological and sinus conditions, such as inadequately treated sinusitis, that do lead to head and/or facial pain. Imaging can help but can also be misleading because some degree of paranasal sinus pathology is common. Imaging findings suggestive of sinus-related headaches include filling opacity in one or more sinus cavities; air–fluid levels in maxillary, ethmoid, frontal, or sphenoid sinuses; and evidence of bony changes involving the surrounding osseous structures. A more controversial cause of rhinological head pain—the “nasal contact point headache”—may be underdiagnosed. The causes and best approaches to diagnosing headache due to rhinosinusitis and related conditions are discussed in this chapter.
White Matter Abnormalities on Magnetic Resonance Imaging
Authors: Newman Lawrence C. , Levin Morris , Halker Singh Rashmi B. , Michael Rebecca L. 
Published: March 2022

Abstract
White matter hyperintensities (WMH) are a common incidental finding on brain magnetic resonance imaging (MRI). The prevalence of WMH increases with age, and they are also seen more commonly in individuals with hypertension, diabetes, hypercholesterolemia, cerebrovascular and cardiovascular disease, multiple sclerosis, and collagen vascular and other autoimmune disorders. Because the causes of WMH are so extensive, determining their etiology can be difficult. This chapter on white matter abnormalities on MRI provides a detailed discussion on the nonspecific T2 hyperintensities commonly seen on brain MRI in people who have migraine. The chapter discusses the differential diagnosis for this MRI finding, and it also reviews when to consider a workup for secondary causes.
Giant Cell Arteritis
Authors: Newman Lawrence C. , Levin Morris , Halker Singh Rashmi B. , Michael Rebecca L. 
Published: March 2022

Abstract
This chapter discusses giant cell arteritis (GCA), which affects medium and large arteries and is the most common primary vasculitis in adulthood. This inflammatory arteritis has its onset almost always after age 50 years, and the highest incidence occurs in the seventh and eighth decades of life. Clinically, GCA may present in a variety of ways, but headache is the most common initial symptom. Additional findings include abnormalities of the temporal artery (beading, prominence, tenderness, and pulselessness), jaw claudication, scalp tenderness, tongue or scalp necrosis, diplopia, elevated erythrocyte sedimentation rate (ESR), and visual changes. GCA can also cause a rapidly sequential, bilateral blindness. If GCA is considered likely by clinical history and physical examination, a workup demonstrating elevations in ESR and C-reactive protein should be done. Corticosteroids are considered the preferred treatment of GCA. Tocilizumab, an interleukin-6 receptor blocker, has been shown to lessen total steroid dosage and duration of steroid treatment.
Spontaneous Intracranial Hypotension
Authors: Newman Lawrence C. , Levin Morris , Halker Singh Rashmi B. , Michael Rebecca L. 
Published: March 2022

Abstract
This chapter evaluates spontaneous intracranial hypotension (SIH), which is a well-recognized syndrome that is characterized by orthostatic headaches in association with a variety of other symptoms. It results from an occult leakage of cerebrospinal fluid (CSF) through weakness of the dura from nerve root sleeves, dural rents caused by herniated discs or osteophytic microspurs, or by CSF-venous fistulas. In the majority of cases, the cause of SIH is unclear, but possible precipitants include a history of trivial trauma and weakness of the dural sac. The characteristic clinical feature of SIH is headache, which is usually throbbing, bilateral, and worsened by Valsalva maneuvers. The diagnosis of SIH may be established in several ways, but there is not a single modality that consistently reveals the answer. Treatment of SIH includes conservative measures such as bed rest and hydration and caffeine administration (by mouth or intravenously). Epidural blood patching may provide relief.
Migraine with Persistent Aura
Authors: Newman Lawrence C. , Levin Morris , Halker Singh Rashmi B. , Michael Rebecca L. 
Published: March 2022

Abstract
Approximately 20% of individuals with migraine experience an aura with their attacks. Auras are characterized by transient episodes of fully reversible focal neurological disturbances that may precede or accompany the headache onset. Occasionally, auras may occur without headache. In general, auras develop gradually over 5–20 minutes and resolve within 1 hour or less. The migraine aura may manifest as a visual, sensory, or language disturbance and may be simple or complex. This chapter on migraine with persistent aura defines migraine with aura and differentiates persistent aura from typical aura. The chapter provides tools to help with the diagnostic workup when a patient presents with persistent aura and also provides differential diagnosis and management recommendations.
Vestibular Migraine
Authors: Newman Lawrence C. , Levin Morris , Halker Singh Rashmi B. , Michael Rebecca L. 
Published: March 2022

Abstract
Vertigo and migraine have a number of associations. Vertigo is a relatively common, although generally mild, aura symptom in patients with migraine with aura. There are some migraine disorders with very prominent vertigo, such as basilar-type migraine and benign positional vertigo of childhood. Many patients with migraine suffer from motion sickness, including the visually induced variety. The diagnosis of vestibular migraine (previously termed migrainous vertigo) in the absence of the accompanying headache is challenging but crucial if these patients are to receive effective treatment. Criteria for diagnosing vestibular migraine are summarized in this chapter, and the overall differential diagnosis of vertigo is presented. Management of vestibular migraine is also reviewed.
Nummular Headache
Authors: Newman Lawrence C. , Levin Morris , Halker Singh Rashmi B. , Michael Rebecca L. 
Published: March 2022

Abstract
Nummular (“coin-shaped”) headache (NH) is characterized by generally continuous but usually not severe pain limited to a small area of the scalp. There can be sharp pains (lancinations) superimposed upon baseline aching pain. Diagnosing NH rests on identifying a small consistently located painful area in the scalp. The underlying pathophysiology is thought to be due to a local neuropathic process, perhaps akin to distal trigeminal or cervical root painful neuropathy. There is no definitive laboratory test for NH, and location can vary, although often the focal area is in the parietal scalp region. Pain can be bothersome, and treatment options (including local anesthetic procedures) are discussed in this chapter.
Thunderclap Headache
Authors: Newman Lawrence C. , Levin Morris , Halker Singh Rashmi B. , Michael Rebecca L. 
Published: March 2022

AbstractThis chapter discusses thunderclap headache, which is an excruciating headache that reaches maximal intensity in less than 1 minute. Given the potentially serious outcome of its possible underlying causes, thunderclap headache should always be considered a medical emergency. The initial diagnostic assessment must be focused on first ruling out subarachnoid hemorrhage with noncontrast computed tomography of the brain and lumbar puncture. Further diagnostic testing including magnetic resonance imagining of the brain with vascular imaging may be necessary. Treatment of thunderclap headache is dependent on the underlying etiology. If reversible cerebral vasoconstriction syndrome is diagnosed, indicated treatment is thought to include the calcium channel blockers nimodipine or verapamil, and possibly corticosteroids. If no underlying etiology is identified, a diagnosis of either primary thunderclap headache or primary cough, exertional, or sexual headache should be considered.
Trigeminal Neuralgia
Authors: Newman Lawrence C. , Levin Morris , Halker Singh Rashmi B. , Michael Rebecca L. 
Published: March 2022

Abstract
The pain of trigeminal neuralgia (TN) pain is typically lancinating but can include more long-lasting aching or burning pain as well. There are several categories of TN, and its differential diagnosis also includes a number of mimics, from pain of other nerve origin to local inflammatory or other disease and certain primary headache disorders. Determining the category into which a patient’s trigeminal pain fits can often lead to optimal treatment. Although prophylactic pharmacological treatment can usually prevent most pain due to TN, surgical options may be helpful in refractory cases. This chapter summarizes the appropriate workup of presumptive TN, including examination details and imaging testing, and presents best management approaches to refractory pain.
Headache and Allergy
Authors: Newman Lawrence C. , Levin Morris , Halker Singh Rashmi B. , Michael Rebecca L. 
Published: March 2022

Abstract
This chapter addresses the relationship between headache and allergy. Over-the-counter medications such as nonsteroidal anti-inflammatory drugs and, in particular, combination medications such as acetaminophen–aspirin–caffeine can lead to medication overuse headache, which can mimic chronic migraine. Food and other environmental allergies are rarely causes of headaches in the absence of other symptoms. Nonpharmacological therapies that are evidence-based include cognitive–behavioral therapy, relaxation techniques, and biofeedback. Biofeedback and massage have some support. Herbal/vitamin headache therapies that have some scientific support include magnesium, vitamin B2, feverfew, butterbur, and coenzyme Q10. The so-called energy therapies—including reiki, craniosacral therapy, qi gong, and meditation—are also proposed widely, but scientific support is not yet available.
Headache Treatment in Human Immunodeficiency Virus Infection
Authors: Newman Lawrence C. , Levin Morris , Halker Singh Rashmi B. , Michael Rebecca L. 
Published: March 2022

Abstract
This chapter describes headache treatment in human immunodeficiency virus (HIV) infection. Antivirals used in HIV-infected patients can lead to headaches. The virus can cause headaches itself, perhaps on the basis of active central nervous system infection or due to the fact that the metabolism of serotonin and tryptophan seems to be altered in HIV infection. However, primary headaches in patients with HIV infection are very common and usually not related to the antiretroviral drug therapy. In general, beta-blockers, tricyclic antidepressants, topiramate, and perhaps calcium channel blockers can make good choices in patients with HIV naïve to headache prophylactic treatment, but there are risks. One should carefully consider medication interactions as well as comorbidities when choosing the most appropriate acute and preventive medications in HIV patients on antiretroviral medications.
Idiopathic Intracranial Hypertension
Authors: Newman Lawrence C. , Levin Morris , Halker Singh Rashmi B. , Michael Rebecca L. 
Published: March 2022

Abstract
This chapter explores idiopathic intracranial hypertension (IIH), which is seen predominantly in obese women of childbearing age but can occur in other groups as well. Diagnosing IIH is based on elevated cerebrospinal fluid pressure as well as the characteristic features of global headache, pulsatile tinnitus, and papilledema. Differential diagnosis includes cerebral venous thrombosis, so magnetic resonance imaging should also include venography in atypical cases. Rheumatological and hormonal workup is also worthwhile because lupus and endocrinological disease can lead to increased intracranial pressure. The only morbidity in IIH is preventable visual loss, so close monitoring of visual acuity and visual fields is imperative. Moreover, because obesity is clearly a risk factor for IIH, weight loss in obese patients is considered a key treatment goal.
Postdural Puncture Headache
Authors: Newman Lawrence C. , Levin Morris , Halker Singh Rashmi B. , Michael Rebecca L. 
Published: March 2022

Abstract
This chapter discusses postdural puncture headache (PDPH), which may be the result of a lumbar puncture, myelogram, or an inadvertent dural puncture during neuraxial anesthesia. PDPH results from decreased cerebrospinal fluid volume from a leak at the dural puncture site, which causes sinking of the brain in the skull. This “brain sag” induces traction on the pain-sensitive suspending and anchoring structures of the brain and is responsible for the headaches and associated signs and symptoms of this disorder. These headaches are usually throbbing, bilateral, localized to the occipital or suboccipital areas, and worsened with Valsalva maneuvers. Because symptoms can spontaneously remit in the majority of patients within 2 weeks, the treatment of PDPH includes conservative measures such as bed rest and hydration, simple analgesics, and caffeine administration (by mouth or intravenously). If conservative measures fail, or in cases in which the pain and disability are high, epidural blood patching should be performed.
Refractory Chronic Migraine
Authors: Newman Lawrence C. , Levin Morris , Halker Singh Rashmi B. , Michael Rebecca L. 
Published: March 2022

Abstract
This chapter discusses refractory chronic migraine (CM), which is defined as ≥15 headache days/month for more than 3 months and on at least 8 days/month the headache has the features of migraine headache. CM has been shown to cause greater headache-related disability, headache impact, societal burden, and lower quality of life scores compared with episodic migraine. In general, all patients with CM require preventive therapy; only onabotulinumtoxinA (OBTA) is approved for the prevention of CM. Many patients receiving treatment with OBTA experience a “wearing off” of the beneficial effects before their next dose is due, often within the past 2 weeks. Increasing the OBTA dose from 155 units to 195 units or redosing at 10 rather than 12 weeks may prevent wear-off. Meanwhile, bridge therapies include occipital nerve or sphenopalatine nerve blocks at the 10-week mark. Adding oral preventive medications or injectable calcitonin gene-related peptide monoclonal antibodies to the OBTA may reduce migraine attacks.
High-Altitude Headache
Authors: Newman Lawrence C. , Levin Morris , Halker Singh Rashmi B. , Michael Rebecca L. 
Published: March 2022

Abstract
High-altitude headache (HAH) is classified as a disorder of homeostasis. It tends to occur when ascending altitudes higher than 2500 m and resolves within 24 hours of descending to less than 2500 m. More than 30% of mountaineers will experience a headache at elevations, particularly with rapid ascent and at very high altitudes. HAH can accompany acute mountain sickness, with other symptoms part of this syndrome being nausea, fatigue, dizziness, loss of appetite, dyspnea, and sleep disturbance. This chapter defines the etiology of HAH as well as the related problem of acute mountain sickness. Readers are provided with an understanding of the pathophysiology of HAH, as well as practical management options.
Headache Treatment in Depression and Anxiety
Authors: Newman Lawrence C. , Levin Morris , Halker Singh Rashmi B. , Michael Rebecca L. 
Published: March 2022

Abstract
This chapter discusses headache treatment in depression and anxiety. The most common mood disorders seen in headache patients include depression, anxiety, and bipolar disorder. It is crucial to screen for psychiatric comorbidities in all headache patients because these seem to increase the risk of development of headache chronicity, decrease quality of life, and complicate management. Of utmost importance is to recognize a patient who may be at risk for harm to themself or others. Suicide attempts seem to be more frequent in patients suffering from migraine than in the general population, especially in women and in those who have migraine with aura. As such, it is important that clinicians have a clear strategy for dealing with a suicidal patient. Although monotherapy for mood disorder and migraine can be considered for mild cases, often a collaborative approach with psychiatry is necessary to ensure both psychiatric disease and headache are adequately managed.
Menstrual Headaches
Authors: Newman Lawrence C. , Levin Morris , Halker Singh Rashmi B. , Michael Rebecca L. 
Published: March 2022

Abstract
This chapter discusses menstrually related migraine (MRM), which are typical from 2 days prior to the onset of menses to the third day of flow. The majority of women with migraine, in fact, experience MRM. The headaches are generally not associated with auras, for unclear reasons. The two main proposed pathophysiological mechanisms of MRM are a drop in estrogen blood levels and prostaglandin release. Many women report that their menstrual migraines are more severe, disabling, and refractory to treatment compared to migraines at other times of the month. Focused “miniprophylaxis” treatments during the perimenstrual period can be very successful, but acute treatments are generally necessary as well, including triptans. Estrogenic agents are contraindicated in younger women who have migraine with aura because of postulated increased stroke risks, although their use can sometimes be justified if low doses are used and other risk factors are minimized.
Headache in the Elderly
Authors: Newman Lawrence C. , Levin Morris , Halker Singh Rashmi B. , Michael Rebecca L. 
Published: March 2022

Abstract
In the United States, people older than age 65 years comprise the fastest growing segment of the population. Migraine is typically thought of as a disease of young people, and although it is true that migraine rarely has its onset after age 50 years and that many individuals with migraine report that their headaches improve as they grow older, the prevalence of migraine in the elderly is significant. Estimates suggest that 3–10% of those older than age 65 years suffer from migraine, report migraine-related disability, and require treatment. This chapter summarizes the differential diagnosis of headaches in the older patient population and also discusses considerations when selecting acute migraine treatment for older patients. Although many patients have contraindications to triptan therapy, new acute treatments including gepants and lasmiditan are now available for patients who previously had limited options.
Recurring Headaches in Medication-Averse Patients
Authors: Newman Lawrence C. , Levin Morris , Halker Singh Rashmi B. , Michael Rebecca L. 
Published: March 2022

Abstract
This chapter discusses recurring headaches in medication-averse patients. When patients are averse to pharmaceutical intervention, it is worthwhile exploring their reasons, many of which are quite valid, including previous intolerable adverse effects. Overaggressive attempts to alter their preferences might be counterproductive, leading to a lack of trust and poor compliance. On the other hand, listening to their specific concerns and addressing them when possible might set the stage for introducing low-risk and well-tolerated medication, perhaps starting with very low dosages, in conjunction with nonpharmaceutical measures. These options include nutriceuticals, behavioral treatments, electrical and magnetic stimulation, and physical techniques such as massage.
COVID-19 Cephalalgia
Authors: Newman Lawrence C. , Levin Morris , Halker Singh Rashmi B. , Michael Rebecca L. 
Published: March 2022

Abstract
This chapter assesses COVID-19 cephalalgia. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus can attack essentially any part of the nervous system; central nervous system manifestations include headache, meningitis, encephalitis, seizures, and stroke. Headaches are reported in as many as 40% of those affected by the SARS-CoV-2 virus and are usually resistant to analgesics. COVID-19–related headaches may be caused by activation of the trigeminal–vascular pathways by viral entry into the brain through the olfactory bulb, direct viral infection across the blood–brain barrier, or as the result of the cytokine storm that follows SARS-CoV-2 infection. The headache of COVID-19 may have characteristics that resemble migraine or be nonspecific like other headaches associated with systemic viral infections. If abnormalities are found on the neurological exam, a workup for sinister causes of headaches must be undertaken.
Case 12
Authors: Burri Haran , Johansen Jens Brock , Linker Nicholas J. , Theuns Dominic 
Published: March 2022

Abstract
A 45-year-old man presented to the emergency room with several episodes of presyncope. The majority of these were unprovoked episodes, but he was able to reproduce his symptoms by leaning forwards. He had a dual-chamber PM implanted 9 years previously following iatrogenic AVB during ablation for atrioventricular nodal reciprocating tachycardia. He was otherwise fit and well.
Case 55
Authors: Burri Haran , Johansen Jens Brock , Linker Nicholas J. , Theuns Dominic 
Published: March 2022

Abstract
A patient with a CRT-D was seen at follow-up. The patient did not have any complaints. Biventricular pacing was delivered in 97% of the time, with 3% VS events. There were no VT/VF episodes (VT monitor zone 150–188 bpm, fast VT zone 188–240 bpm, VF zone &gt;240 bpm).
Case 69
Authors: Burri Haran , Johansen Jens Brock , Linker Nicholas J. , Theuns Dominic 
Published: March 2022

Abstract
A 60-year-old man presented to the pacing department for a routine device check 6 months following an implant of a primary prevention CRT-D. This was implanted for persisting severe LV systolic dysfunction due to aortic regurgitation, treated with a mechanical aortic valve replacement. He had NYHA class III dyspnoea and LBBB.
Alternative Ketogenic Diets
Authors: Neal Elizabeth 
Published: March 2022

AbstractAs the classic ketogenic diet celebrates its centennial anniversary, the wider ketogenic landscape has expanded considerably both in application and implementation. As less restrictive dietary approaches have been developed, including the low-glycemic-index treatment and the modified Atkins diet, these approaches are now being used worldwide. The advantages of a more liberal ketogenic diet have been recognized, especially for adults and older children, and are supported by an increasing body of scientific data. The choice of a specific diet will depend on the patient’s age, lifestyle, food preferences, and feeding method. In view of its reduced demands on time for training and supervision, the modified Atkins diet is often the first choice in centers with fewer dietitians.