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Kang MK, Cho SJ. SUNCT, SUNA and short-lasting unilateral neuralgiform headache attacks: Debates and an update. Cephalalgia 2024; 44:3331024241232256. [PMID: 38415675 DOI: 10.1177/03331024241232256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Short-lasting unilateral neuralgiform headache attacks (SUNHA) have the features of both short-lasting unilateral neuralgiform pain, such as trigeminal neuralgia or stabbing headache, and associated trigeminal autonomic symptoms, such as paroxysmal hemicrania or cluster headache. Recognizing and adequately treating SUNHA is essential but current treatment methods are ineffective in treating SUNHA. METHODS We reviewed the changes in the concept of short-lasting unilateral neuralgiform headache attacks and provide a narrative review of the current medical and surgical treatment options, from the first choice of treatment for patients to treatments for selective intractable cases. RESULTS Unlike the initial impression of an intractable primary headache disorder affecting older men, SUNHA affects both sexes throughout their lifespan. One striking feature of SUNHA is that the attacks are triggered by cutaneous or intraoral stimulation. The efficacy of conventional treatments is disappointing and challenging, and preventive therapy is the mainstay of treatment because of highly frequent attacks of a very brief duration. Amongst them, lamotrigine is effective in approximately two-third of the patients with SUNHA, and intravenous lidocaine is essential for the management of acute exacerbation of intractable pain. Topiramate, oxcarbazepine and gabapentin are considered good secondary options for SUNHA, and botulinum toxin can be used in selective cases. Neurovascular compression is commonly observed in SUNHA, and surgical approaches, such as neurovascular compression, have been reported to be effective for intractable cases. CONCLUSIONS Recent advances in the understanding of SUNHA have improved the recognition and treatment approaches for this unique condition.
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Affiliation(s)
- Mi-Kyoung Kang
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
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Telesca A, Proietti Cecchini A, Leone M, Piacentini S, Usai S, Grazzi L, Consonni M. Different personality profiles in patients with cluster headache: a data-driven approach. Neurol Sci 2023:10.1007/s10072-023-06713-z. [PMID: 36941517 DOI: 10.1007/s10072-023-06713-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 02/23/2023] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Cluster headache (CH) is usually comorbid to mood spectrum disorders, but the psychopathological aspects are poorly explored. We aimed at identifying discrete profiles of personality traits and their association with clinical features. METHODS Based on the personality scales of the Millon Clinical Multiaxial Inventory-III, principal component analysis (PCA) identified psychological patterns of functioning of 56 CH patients. PCA outcomes were used for hierarchical cluster analysis (HCA) for sub-groups classification. RESULTS Eighty-seven percent of patients had personality dysfunctions. PCA found two bipolar patterns: (i) negativistic, sadic-aggressive, borderline, and compulsive traits were distinctive of the psychological dysregulation (PD) dimension, and (ii) narcissistic, histrionic, avoidant, and schizoid traits loaded under the social engagement (SE) component. PD was associated with disease duration and psychopathology. SE was related to educational level and young age. HCA found three groups of patients, and the one with high PD and low SE had the worst psychological profile. CONCLUSIONS Personality disorders are common in CH. Our data-driven approach revealed distinct personality patterns which can appear differently among patients. The worst combination arguing against mental health is low SE and high PD. Linking this information with medical history may help clinicians to identify tailored-based therapeutic interventions for CH patients.
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Affiliation(s)
- Alessandra Telesca
- Neuroalgology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Ph.D. program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Massimo Leone
- Neuroalgology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sylvie Piacentini
- Clinical Neuropsychology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Susanna Usai
- Neuroalgology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Licia Grazzi
- Neuroalgology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
| | - Monica Consonni
- Neuroalgology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Zhou S, Badash I, Doherty JK. Nummular and Side-locked Headaches for the Otolaryngologist. Otolaryngol Clin North Am 2022; 55:697-706. [PMID: 35490038 DOI: 10.1016/j.otc.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Side-locked headaches are a common symptom having a wide-ranging differential. Unchanging in laterality, these headaches can represent neuralgias, trigeminal autonomic cephalgias, ophthalmologic disorders, otolaryngologic and craniofacial disorders, vascular disorders, and malignancy. In rarer situations, they have presented secondary to neurosurgical or dermatologic considerations. Loss of cranial nerves and visual changes warrant additional evaluation.
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Affiliation(s)
- Sheng Zhou
- LAC+USC Medical Center Otolaryngology Department, 1200 North State Street, Suite A2E, Los Angeles, CA 90033, USA.
| | - Ido Badash
- LAC+USC Medical Center Otolaryngology Department, 1200 North State Street, Suite A2E, Los Angeles, CA 90033, USA
| | - Joni K Doherty
- USC Caruso Department of Otolaryngology Head and Neck Surgery, 1450 San Pablo Street #5100, Los Angeles, CA 90033, USA
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Nägel S, Kraya T. [Trigeminal Autonomic Cephalgias]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2022; 90:121-134. [PMID: 35294984 DOI: 10.1055/a-1706-5952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Compared with migraine and tension-type headache, trigeminal autonomic cephalgias (TAC) are rare, but the resulting significant impairment and the not irrelevant prevalence (e. g., cluster headache 0.1%) make TACs important diagnoses. Unfortunately, the correct diagnosis is often delayed. This article provides an overview of the diagnostic approach and therapeutic options in TACs.
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Kikui S, Miyahara J, Sugiyama H, Kohashi M, Ota K, Danno D, Kashiwaya Y, Takeshima T. A Combination of Indomethacin Farnesyl and Amitriptyline Is Effective for Continuous Interictal Pain with Probable Chronic Paroxysmal Hemicrania. Intern Med 2022; 61:413-417. [PMID: 34176839 PMCID: PMC8866799 DOI: 10.2169/internalmedicine.7511-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 26-year-old woman with a history of migraine reported right-sided, severe stabbing orbital pain with cranial autonomic symptoms (CASs) for approximately 2 years. The attack duration was approximately 30 minutes, with a frequency of twice per day. Taking loxoprofen was ineffective. Six months earlier, moderate pressing continuous interictal pain without CASs had developed. Indomethacin farnesyl completely resolved the attacks but had no effect on the interictal pain. The patient was diagnosed with probable chronic paroxysmal hemicrania in accordance with the International Classification of Headache Disorders (ICHD-3) (third version). Continuous interictal pain gradually disappeared with a combination of indomethacin farnesyl and amitriptyline.
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Affiliation(s)
- Shoji Kikui
- Department of Neurology, Headache Center, Tominaga Hospital, Japan
| | - Junichi Miyahara
- Department of Neurology, Headache Center, Tominaga Hospital, Japan
| | - Hanako Sugiyama
- Department of Neurology, Headache Center, Tominaga Hospital, Japan
| | - Mutsuo Kohashi
- Department of Neurology, Headache Center, Tominaga Hospital, Japan
| | - Kuniko Ota
- Department of Neurology, Headache Center, Tominaga Hospital, Japan
| | - Daisuke Danno
- Department of Neurology, Headache Center, Tominaga Hospital, Japan
| | | | - Takao Takeshima
- Department of Neurology, Headache Center, Tominaga Hospital, Japan
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Mauritz MD, Enninger A, Wamsler C, Wager J, Zernikow B. Long-Term Outcome of Indomethacin Treatment in Pediatric Patients with Paroxysmal Hemicrania-A Case Series. CHILDREN-BASEL 2021; 8:children8020101. [PMID: 33546261 PMCID: PMC7913346 DOI: 10.3390/children8020101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 11/23/2022]
Abstract
Paroxysmal Hemicrania is a rare form of primary headache in children and adolescents, belonging to the group of trigeminal autonomic cephalalgias. Patients suffer from severe, short-lasting unilateral headaches accompanied by symptoms of the autonomic system on the same side of the head. The short duration of attacks distinguishes Paroxysmal Hemicrania from other trigeminal autonomic cephalalgias. Indomethacin is the treatment of choice, and its effectiveness provides a unique diagnostic criterion. However, the long-term outcomes in children are highly underreported. In this case-series, n = 8 patients diagnosed with Paroxysmal Hemicrania were contacted via telephone 3.1 to 10.7 years after initial presentation. A standardized interview was conducted. n = 6 patients were headache-free and no longer took indomethacin for 5.4 ± 3.4 years. The mean treatment period in these patients was 2.2 ± 1.9 years. Weaning attempts were undertaken after 1.7 ± 1.3 months; in n = 3 patients, more than one weaning attempt was necessary. n = 2 patients were still taking indomethacin (4.5 and 4.9 years, respectively). Both unsuccessfully tried to reduce the indomethacin treatment (two and six times, respectively). Adverse effects appeared in n = 6 (75%) patients and led to a discontinuation of therapy in n = 2 patients. Our long-term follow-up suggests that in a substantial proportion of pediatric patients, discontinuing indomethacin therapy is possible without the recurrence of Paroxysmal Hemicrania.
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Affiliation(s)
- Maximilian David Mauritz
- German Paediatric Pain Centre, Children′s and Adolescents′ Hospital, Witten/Herdecke University, 45711 Datteln, Germany; (C.W.); (J.W.); (B.Z.)
- Department of Children′s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany;
- Correspondence: ; Tel.: +49-2363-9750
| | - Anna Enninger
- Department of Children′s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany;
| | - Christine Wamsler
- German Paediatric Pain Centre, Children′s and Adolescents′ Hospital, Witten/Herdecke University, 45711 Datteln, Germany; (C.W.); (J.W.); (B.Z.)
- Centre for Rare Pain Disorders in Young People, Centre for Rare Diseases Ruhr (CeSER), 45711 Datteln, Germany
| | - Julia Wager
- German Paediatric Pain Centre, Children′s and Adolescents′ Hospital, Witten/Herdecke University, 45711 Datteln, Germany; (C.W.); (J.W.); (B.Z.)
- Department of Children′s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany;
| | - Boris Zernikow
- German Paediatric Pain Centre, Children′s and Adolescents′ Hospital, Witten/Herdecke University, 45711 Datteln, Germany; (C.W.); (J.W.); (B.Z.)
- Department of Children′s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany;
- Centre for Rare Pain Disorders in Young People, Centre for Rare Diseases Ruhr (CeSER), 45711 Datteln, Germany
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