Primary stabbing headache: clinical characteristics and response to treatment in a series of 67 patients
*Correspondencia: Dr. Ángel Luis Guerrero Peral. Servicio de Neurología. Hospital Clínico Universitario de Valladolid. Ramón y Cajal, 3. E-47005 Valladolid.
E-mail: gueneurol@gmail.com
Introduction: Primary stabbing headache (PSH) is defined by the presence of short stabbing pains in the first branch of the trigeminal nerve. According to population-based studies, it is very prevalent, but most cases present stabbing pains with low frequencies and intensities that do not lead the patient to seek medical attention.
Aims: We report on 67 cases of PSH attended in the headache service of a tertiary hospital. In the study, the demographic and clinical characteristics are studied, treatment response is reviewed and the features of PSH are compared in terms of whether it was the only headache or was accompanied by others.
Patients and methods: The study involved 67 patients (51 females and 16 males) diagnosed with PSH between January 2008 and January 2012, of a total number of 1668 (4%) patients attended in the above-mentioned service.
Results: Age at onset: 34.5 ± 16.7 years. Forty-nine cases (73.1%) were associated to another headache, above all migraine. Stabbing pains were often bilateral; 38 (56.7%) patients suffered more than one a day and 11 (16.4%) had more than 10 per day. They lasted less than five seconds in 48 patients (71.6%) and more than 10 seconds in 11 of them (16.4%), with an intensity of 6.8 ± 1.5. The age of onset of PSH was higher if it was the only type of headache than if it was accompanied by others. Twenty-six (38.8%) patients required preventive treatment for the associated headache and 16 (23.8%) took indomethacin, with a similar response in the two groups (73 versus 75%). CONCLUSIONS; PSH is not infrequent in headache clinics, but its phenotype differs from that reported in population-based studies. The characteristics of PSH vary depending on whether it is the only headache or is associated with others. Preventive treatment is often required and patients respond well to it.
Objetivos Presentar 67 casos de CPP de la consulta de cefaleas de un hospital terciario, analizar las características demográficas y clínicas, revisar la respuesta al tratamiento y comparar las características de la CPP según sea cefalea única o se acompañe de otras.
Pacientes y métodos Muestra de 67 pacientes (51 mujeres y 16 varones) diagnosticados de CPP entre enero de 2008 y enero de 2012, de un total de 1.668 (4%) atendidos en dicha consulta.
Resultados Edad al inicio: 34,5 ± 16,7 años. Cuarenta y nueve casos (73,1%) asociaban otra cefalea, sobre todo migraña. Las punzadas eran frecuentemente bilaterales; 38 pacientes (56,7%) sufrían más de una al día y 11 (16,4%) más de 10 al día. Su duración era menor de cinco segundos en 48 (71,6%) pacientes y mayor de 10 segundos en 11 (16,4%), con una intensidad de 6,8 ± 1,5. La edad de inicio de la CPP era mayor si era cefalea única que si acompañaba a otras. Veintiséis (38,8%) pacientes requirieron un preventivo para la cefalea asociada y 16 (23,8%) indometacina con respuesta similar en los dos grupos (73 frente a 75%).
Conclusiones La CPP no es infrecuente en una consulta de cefaleas, pero su fenotipo difiere del descrito en estudios de base poblacional. Las características de la CPP son diferentes en función de si es cefalea única o asocia otras. Se requiere tratamiento preventivo con frecuencia y la respuesta es buena.
