Nöropsikiyatri Arşivi; 2013;50(1):82-83
Topiramata Cevaplı Sekonder Öksürük Başağrısı
S Dikici, G Kocaman, D Baltacı, N Ercan
Düzce Üniversitesi, Düzce
Cough headache is a type of headache lasting one minute to 30 minutes and
arising from activities, such as cough and Valsalva maneuver, which increase
intra-abdominal pressure. It is seen in adults aged forty years and older. It is
bilateral, intense and stabbing type of headache. Herein, we report the case of
a 65-year-old patient presented with severe headache which was aggravated
with defecation, lifting a heavy object and going up and downstairs. Her
neurologic examination was normal. Magnetic resonance imaging revealed
Arnold-Chiari malformation type 1. Surgical operation was planned, but she
denied surgical operation. Indomethacin was not administered due to
intractable dyspeptic complaints. Topiramate was administered to lower
intracranial pressure. Her headache symptom considerably disappeared.
Topiramate was stopped after 6 months, but her headache recurred. Hereupon,
topiramate was re-administered. Headache symptom was quite relieved. We
concluded that, topiramate could be medical alternative for secondary
headaches, such as cough headache in case of Arnold-Chiari malformation
type 1.
Secondary Cough Headache Responding to Topiramate
aktivitelerden sonra baslayan 1 ile 30 dakikada sonlanan bas agrisi tipidir.
Siklikla 40 yas ve üzeri eriskinlerde gözlenir. Genellikle iki tarafli, keskin,
saplanici özellik tasir. Primer veya sekonder olabilir. Bu vaka sunumunda 65
yasindaki bayan hasta, agirlik kaldirma, merdiven inip çikma ve defekasyon
yapma esnasinda belirginlesen siddetli basagrilari nedeniyle degerlendirildi.
Nörolojik muayenesi dogal olan olgunun, kranial magnetik rezonans
görüntülemesinde Arnold-Chiari tip I malformasyonu saptandi. Malformasyona
yönelik operasyon önerilen ancak kabul etmeyen olguya, intrakranial basinci
düsürme özelligi olan indometazin, dispeptik sikayetleri nedeniyle baslanamadi.
Intrakranial basinci düsürmeye yönelik topiramat baslandi. Olgunun sikayetleri
tama yakin azaldi. Tedaviye basladiktan 6 ay sonra topiramat kesildi. Ancak
basagrilari tekrarlayinca yeniden topiramat baslandi. Ikinci kez baslanan
topiramat sonrasinda da basagrilari belirgin bir sekilde azaldi. Herhangi bir
nedenle operasyonu ötelenen veya takibe alinan Arnold-Chiari tip I
malformasyonlu sekonder öksürük bas agrili olgularda topiramat medikal bir
seçenek olabilir.