80 Headache Medicine, v. 2, n.3, p. 80-81, Jul./Aug./Sep. 2011

Professor James Lance with Carlos Bordini and

Marcelo Valença

The functional anatomy of a headache - "invisible" pain

displayed in colors

EDITORIAL

ove, happiness, sadness, pain… all impalpable, unseen and so real in our lives.

We will try to display in colors the "invisible" pain via state-of-the-art imaging technology of

human anatomical specimen dissections. For that, a new section named 'The Functional

Anatomy of a Headache' was created in Headache Medicine (Journal of the Brazilian

Headache Society) with the object of showing a relationship between anatomo-functional

aspects and the genesis of facial and head pain. In the present issue a review of a relatively

frequent type of "catastrophic" headache, secondary to the expansion of an aneurysm of the

internal carotid artery-posterior communicating artery (ICA-PComA), was published. The

ICA-PComA is the most common site of aneurysm encountered in women, whereas for men

it is the second most frequent site for aneurysm. It is a known fact that during the lifespan of

the individual an intracranial aneurysm will develop in up to 10% of the population. In

addition, one third of intracranial aneurysms are located at ICA-PComA. The estimated

frequency of third-nerve palsy in patients with ICA-PComA aneurysm is 30% to 40% and it

may evolve with periorbital pain (sentinel headache) a few days before rupture. The authors

reviewed the anatomy of the circle of Willis, oculomotor nerve and its topographical

relationships in order to better understand the pathophysiology linked to pain and third-

nerve palsy caused by an expanding ICA-PComA aneurysm.

We would like also to comment about the success of the 15th Congress of the International

Headache Society that took place recently in Berlin, Germany (23-26 June, 2011), where

we had the opportunity to come across of a number of Brazilian colleagues. Moreover,

during the Congress two very special encounters occurred, with Professor James (Jim) Lance

and Professor Michael Anthony (both from Australia). During a recent interview in 2010

(Interviews with Australian Scientists series, Australian Academy of Science)

Professor Lance

was asked how he had "taken the opportunity presented by patients of studying the mechanisms

underlying their conditions". His answer was: "Look, there's an old saying that 'one patient

Professor Michael Anthony with Carlos Bordini

Headache Medicine, v. 2, n.3, p. 80-81, Jul./Aug./Sep. 2011 81

with a new symptom is interesting, two is a coincidence and three is a paper'. I have always

been a sort of collector of unusual things and have put them on the back-burner…". He has

received various awards and honors throughout his academic career, particularly in the area

of headache.

He, in association with Curran (1964), conducted the first trial of amitriptyline

to treat headache.

His University associate, Professor Anthony is well-known for his reports on the involvement

of serotonin in migraine attacks

and described the cervicogenic headache.

4,5

He reported

that methylprednisolone injections into the region of the greater and lesser occipital nerves

produced complete relief of pain in the majority of the patients with cervicogenic headache.

In addition, in the present issue the readers will find interesting articles dealing with the

association of migraine with fibromyalgia, and migraine with a special type of visual aura.

The reader will notice that some of the published articles received comments from experts in

the field of Headache Medicine. This is one of the ways we are trying to improve the quality

of our journal. The abstracts selected to oral or poster presentation at the XXV Brazilian

Congress of Headache are also published here.

ReferencesReferences

References

1. Valenca MM, Andrade-Valenca LPA, Martins C. Functional anatomy of headache:

circle of Willis aneurysms, third cranial nerve and pain. Headache Medicine. 2011;

2(3):82-8.

2. http://www.science.org.au/scientists/interviews/l/notes_lance.html

3. Anthony M, Hinterberger H, Lance JW. Plasma serotonin in migraine and stress.

Arch Neurology. 1967;16:544-5

4. Anthony M. Headache and the greater occipital nerve. Clin Neurol Neurosur. 1992;

94:297-300.

5. Anthony M. Cervicogenic headache: prevalence and response to local steroid therapy.

Clin Exp Rheumatol. 2000; 18(2 Suppl 19):S59-64.

Marcelo M. Valença, MD, PhD & Fernando Kowacs, MD, PhD

EDITORIAL