Opinion of...

Rare primary headaches

Carlo Lisotto - Centro Cefalee, Azienda per l’Assistenza Sanitaria n. 5 “Friuli Occidentale”, Pordenone

In a clinic or headache center, over 90% of patients are diagnosed with migraine, in its various subtypes, or with tension-type headache. In the remaining cases, secondary headaches, painful cranial neuropathies, cluster headache and rare primary headaches, in a percentage not yet well defined, can be found. The latter include the remaining TACs and other primary headaches, well defined and described in the ICHD-3 Classification published in January 2018. Data on the prevalence of rare primary headaches in the general population or in headache centers are not available. It would be interesting and a source of valuable information to conduct a SISC independent research study dedicated to this specific topic to fill this epidemiological gap. The collection and processing of data would be useful not only from an epidemiological point of view, but also for clinical practice. In the presence of a rare headache, in fact, the diagnostic path can also vary considerably among the different specialists. If, in the vast majority of rare primary headaches it is reasonable to undergo a MR scan, in other cases, such as in primary stabbing headache, a neuroradiological examination may seem superfluous. In my personal database, with over 5,000 cases of primary headaches evaluated in the last 10 years, rare primary headaches are distributed as follows: 3.2 Paroxysmal hemicrania - 4 cases (in 2 cases uncertain diagnosis was due to poor indomethacin response), 3.3 Short-lasting unilateral neuralgiform headache attacks - 1 case (SUNA), 3.4...

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