Headache in Systemic Diseases

Abstract

A right-hand 47-year-old man, officer at the Hellenic Navy, has been presented at the outpatient headache clinic complaining of new-onset headaches. Headaches started 3–4 months ago gradually; they were mild to severe (rated 5–8/10), located within the whole head, pressing, lasting from 30 min to 2 h and worsening by physical activity but not associated with nausea, vomiting, phonophobia, photophobia or osmophobia. Headache attacks were more frequent during the morning and responded to paracetamol 500 mg in the beginning but later on did not any more. Two months ago he had visited the emergency room at the Athens Naval Hospital to report those headaches. Physical and neurological examination was normal at that time. He had a brain CT scan that did not show any abnormality. He was advised to keep a headache diary, treat the headache attacks with naproxen 500 mg and schedule appointment with the headache clinic. In the diary, headaches followed the pattern the patient reported in the emergency room, responded to naproxen, but slowly the intensity and frequency increased. Headaches became pulsating and accompanying with face flush. When the pain was severe, it was accompanied with nausea but not vomiting. He reported no photophobia or phonophobia. Physical activity typically triggered headaches, and during the attack, pain severity did not change by body position. The mean frequency was 25 days with headache per month. He reported no recent or previous trauma. His wife, who was present at the interview, did not mention snoring. Sleep was normal as usual and he reported no anxiety or depressive symptoms. Recent blood tests in the context of the annual check-up were normal. He described no recent surgical or dental procedure or regional or general anaesthesia. At the time of interview, the Hamilton rating scales for anxiety and depression scores were 12 and 8 (normal values). No medication overuse was noted in the headache diary nor reported by the patient. His wife agreed on this.