The purported mechanism underlying the development and progression of cervicogenic HEADACHE (CEH) is the convergence of sensory inputs at the trigeminocervical nucleus.This mechanism explains the radiation of pain from the neck or the occipitonuchal area and its spread to the oculo-fronto-temporal region, it also explains the recurrent HEADACHEs caused by improper neck postures or external pressure to the structures in the neck and the occipital region. These neural connectivity mechanisms involving the trigeminal nucleus are also evident from the eye blink reflex and findings of quantitative sensory testing (QST). Understanding the mechanisms underlying the development of CEH is important because it will not only provide a better treatment outcome but will also allow practitioners to appreciate the variability of symptomatic presentations in these patients.

Objectives/Hypothesis: HEADACHE is a common symptom in the general population. Although it could be a symptom of acute sinusitis, chronic sinusitis is not considered as a usual cause of HEADACHE. In addition, vascular pain may be associated with related autonomic symptoms in the sinonasal region. These can be confusing and lead to an incorrect diagnosis of sinusitis. Study Design: A prospective cross-sectional study.Methods: Fifty-eight patients with diagnosis of “sinus HEADACHE” by primary care physicians were evaluated. Exclusion criteria were: previous diagnosis of migraine or tension-type HEADACHE; evidence of sinus infection during the past six months; and the mucopurulent secretions during the physical examination. After comprehensive otorhinolaryngologic and neurologic evaluations, an appropriate treatment was started according to the final diagnosis and the patient was visited monthly over a period of six months. Results: The final diagnoses were migraine, tension type HEADACHE, and chronic sinusitis with recurrent acute episodes in 68%, 27%, and 5% of the patients, respectively. Seventy-three percent of the patients with tension type HEADACHE and 66% of the patients with migraine had received recurrent antibiotic therapy. Sinus endoscopy had been performed in 26% of patients. Therapeutic nasal septoplasty had been performed for 16% of the patients with a final diagnosis of migraine, and 13% of the patients with tension type HEADACHE.Conclusion: Many patients with self-described or primary care physician labeled “sinus HEADACHE” have no sinonasal abnormalities. Instead, most of them meet the IHS criteria for migraine or tension HEADACHE.

Dear Editor: August Bier’s first report of spinal anesthesia in August 1898 impressively described the development of a poste dural puncture HEADACHE (PDPH). When asked for complications of spinal anesthesia today, patients often respond with PDPH. PDPH is defined as a constant HEADACHE that worsens in the sitting or upright position following lumbar puncture (LP). Its incidence after spinal anesthesia in obstetric anesthesia is 1% to 6% and 30% to 50% after a diagnostic LP and can reach 80% after inadvertent LP during epidural obstetric anesthesia.

Background and aim: HEADACHE is one of the most prevalent medical complaints and causes undesirable effects on the human kind feelings and life style. Regarding these complications, the scientific society requires methods to measure them. Therefore, the purpose of this study was to obtain factor structure, validity and reliability of the HEADACHE Disability Inventory (HDI).Methods: In an analytical-descriptive study, this inventory was administrated on 100 HEADACHE patients referred to a hospital in Shiraz. The patients selected randomly to fill in a questionnaire based on SCL-25. The validity of the inventory was investigated by three different methods: construct validity (factor analysis), concurrent validity and convergent validity. Factor analysis of the inventory was used through varimax rotation based on Skree test. The concurrent validity of the HDI was measured by SCL-25 and in convergent validity, correlation coefficients of emotional and functional subscales with total score was calculated. The reliability coefficients of the inventory were calculated- in spilt-half and internal consistency methods.Results: Factor analysis of the inventory showed that two factors labeled emotional and functional which covered 36 percent of the total variance. In concurrent validity, correlation coefficients of the total score, emotional and functional factors of the HDI and SCL-25 were 0.71, 0.51 and 0.55, respectively. In convergent validity, correlation coefficients of emotional and functional subscales with total score were 0.79 and 0.91, and together was 0.48. In reliability, the spilt-half reliability coefficient was 0.77 and Cronbah's alpha coefficients for total score, emotional factor and functional factor were 0.86, 0.68 and 0.83, respectively.Conclusion: Based on the results, this inventory (questionnaire) has appropriate reliability and validity in Iranian society and is a suitable scale for using in research and clinical situations.