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Miedl M, Baumgartner P, Disse LR, Weber KP, Pohl H, Wegener S. Harlequin syndrome in a patient with probable hemicrania continua and exertional headache - is there a link? a case report. BMC Neurol 2024; 24:247. [PMID: 39020271 PMCID: PMC11253322 DOI: 10.1186/s12883-024-03731-y] [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] [Received: 11/29/2023] [Accepted: 06/14/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND The harlequin syndrome is a rare disorder of the autonomic nervous system characterized by unilateral diminished flushing and sweating of the face following exposure to heat or physical activity. It results from sympathetic dysfunction and most commonly occurs idiopathically. A secondary development due to an underlying pathology (e.g., carotid artery dissection, tumors) must be excluded at first appearance. There is evidence that the cranial autonomic system is involved in the pathophysiology of trigeminal autonomic headaches like hemicrania continua. Therefore, an overlap in the pathophysiology of harlequin syndrome and trigeminal autonomic headache disorders seems plausible. However, the association of a harlequin syndrome with hemicrania continua was never reported. CASE PRESENTATION This work describes the case of a 42-year-old female patient presenting to our headache unit. The patient reported persisting unilateral headache of the right side of dragging or squeezing character accompanied by trigeminal autonomic symptoms, including lacrimation, nasal congestion, conjunctival injection and Horner's syndrome, and was responsive to treatment with 75mg/d indomethacin. Five months after the initial consultation, the patient noted that the upper right quadrant of her face was pale after jogging. A harlequin syndrome was diagnosed. Further, she developed a short-lasting, bilateral headache of pulsatile character during strenuous exercise consistent with exertional headache. Comprehensive diagnostic evaluations, encompassing cranial and cervical MRI scans, laboratory tests, and biopsies, culminated in the diagnosis of Sjögren's syndrome. This finding suggests that the trigemino-autonomic dysfunction may either be idiopathic or a direct manifestation of Sjögren's syndrome. CONCLUSIONS This report documents the case of a rare combination of a headache resembling probable hemicrania continua and the harlequin syndrome (and even exertional headache). It illustrates the underlying anatomy of the autonomic nervous system in a clinical context and emphasizes the hypothesis of a pathophysiological link between abnormal sympathetic activity and trigeminal autonomic headaches.
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Affiliation(s)
- Markus Miedl
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | | | - Leah Raffaela Disse
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
| | - Konrad Peter Weber
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
| | - Heiko Pohl
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Susanne Wegener
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland.
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Sowanou A, Ungureanu A, Aguesse C. Recurrent reversible cerebral vasoconstriction syndrome and antiphospholipid syndrome. Acta Neurol Belg 2024; 124:329-334. [PMID: 37392321 DOI: 10.1007/s13760-023-02324-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/21/2023] [Indexed: 07/03/2023]
Affiliation(s)
- Arlos Sowanou
- Neurology Department, Centre Hospitalier Alpes-Léman, Contamine Sur Arve, France
| | - Aurelian Ungureanu
- Neurology Department, Centre Hospitalier Alpes-Léman, Contamine Sur Arve, France.
| | - Claire Aguesse
- Neurology Department, Centre Hospitalier Alpes-Léman, Contamine Sur Arve, France
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Nandyala A, Zhang N. Primary Cough Headache. Curr Pain Headache Rep 2023; 27:679-684. [PMID: 37747622 DOI: 10.1007/s11916-023-01171-w] [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] [Accepted: 08/28/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE OF REVIEW In this review article, we summarize the most recent findings and observations in patients experiencing primary cough headache. RECENT FINDINGS Recent studies draw attention to further characterization of patients with primary cough headache in a pulmonology clinic. There have also been recent case studies describing new therapy considerations, including noninvasive vagus nerve stimulation and lumbar punctures. Primary cough headache has been a recognized entity since as early as 1932. Patients generally report a sudden onset, sharp headache lasting a few hours that is precipitated by Valsalva maneuver or coughing. It remains an uncommon diagnosis, and secondary causes are crucial to rule out with imaging studies. Additionally, there can be an overlap with other primary headache disorders such as primary exercise headache and headache associated with sexual activity, thus requiring a detailed history. Many hypotheses exist regarding the pathophysiology including relative pressure gradients and a crowded posterior fossa. Generally, patients are responsive to indomethacin, but more recent case reports have suggested benefits of other medications and procedures that may offer patients an alternative option, including vagus nerve stimulation, lumbar punctures, and beta blockers. Future case series and studies should focus on management of these patients, with a specific focus on individuals who do not tolerate indomethacin.
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Affiliation(s)
- Arathi Nandyala
- Department of Neurology, Stanford University, 211 Quarry Road, Palo Alto, CA, 94304, USA.
| | - Niushen Zhang
- Department of Neurology, Stanford University, 211 Quarry Road, Palo Alto, CA, 94304, USA
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Xie YJ, Tian L, Hui SSC, Qin J, Gao Y, Zhang D, Ma T, Suen LKP, Wang HH, Liu ZM, Hao C, Yang L, Loke AY. Efficacy and feasibility of a 12-week Tai Chi training for the prophylaxis of episodic migraine in Hong Kong Chinese women: A randomized controlled trial. Front Public Health 2022; 10:1000594. [PMID: 36582390 PMCID: PMC9792997 DOI: 10.3389/fpubh.2022.1000594] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/23/2022] [Indexed: 12/15/2022] Open
Abstract
Background Tai Chi has been broadly applied as alternative treatment for many neurological and psychological disorders. Whereas no study using Tai Chi as prophylactic treatment for migraine. The purpose of this study was to preliminarily examine the efficacy and feasibility of a 12-week Tai Chi training on migraine attack prevention in a sample of Chinese women. Methods A two-arm randomized controlled trial was designed. Women aged 18 to 65 years and diagnosed with episodic migraine were randomized to either Tai Chi group (TC group) or the waiting list control group. A modified 33-short form Yang-style Tai Chi training with 1 h per day, 5 days per week for 12 weeks was implemented in the TC group, with a 12-week follow up period. The control group received a "delayed" Tai Chi training at the end of the trial. The primary outcome was the differences in attack frequency between 4 weeks before baseline and at the 9-12 weeks after randomization. The intensity and duration of headache were also measured. The feasibility was evaluated by the maintenance of Tai Chi practice and satisfactory level of the participants toward training. Results Eighty-two women were randomized, finally 40 in TC group and 33 in control group were involved in the analysis. On average, women in TC group had 3.0 times (95% CI: -4.0 to -2.0, P < 0.01) and 3.6 days (95% CI: -4.7 to -2.5, P < 0.01) reduction of migraine attack per month. Compared with the control group, the differences were statistically significant (-3.7 attacks/month, 95% CI: -5.4 to -1.9; and -3.0 migraine days/month, 95% CI: -4.5 to -1.5; both P < 0.001). The intensity and duration of headache had 0.6 (95% CI: -1.2 to -0.0, P < 0.05) units and 1.2 (IQR: -5.0 to 1.1, P < 0.05) hours reduction in TC group, respectively. Most of the participants (69.2%-97.4%) were satisfied with the training. At the end of 24 weeks, on average, the participants maintained 1.5 times of practice per week and 20 min for each practice. Conclusion The 12-week Tai Chi training significantly decreased the frequency of migraine attack. It was acceptable and practicable among female migraineurs. Clinical trial registration www.ClinicalTrials.gov, identifier: NCT03015753.
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Affiliation(s)
- Yao Jie Xie
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China,Research Center for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China,*Correspondence: Yao Jie Xie
| | - Longben Tian
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Stanley Sai-Chuen Hui
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jing Qin
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Yang Gao
- Department of Sport, Physical Education, and Health, Hong Kong Baptist University, Hong Kong, Hong Kong SAR, China
| | - Dexing Zhang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Tongyu Ma
- Department of Health Sciences, Franklin Pierce University, Rindge, NH, United States
| | | | - Harry Haoxiang Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China,College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, United Kingdom
| | - Zhao-Min Liu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chun Hao
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Lin Yang
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Alice Yuen Loke
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
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Kang K, Kim JH, Kim BK. Exercise Headache Associated With an Arteriovenous Fistula of the External Carotid Artery. J Clin Neurol 2022; 18:93-95. [PMID: 35021283 PMCID: PMC8762513 DOI: 10.3988/jcn.2022.18.1.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Jae Hoon Kim
- Department of Neurosurgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Byung-Kun Kim
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea.
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Abstract
OBJECTIVE The purpose of this study was to pilot safety and tolerability of a 1-week aerobic exercise program during the post-acute phase of concussion (14-25 days post-injury) by examining adherence, symptom response, and key functional outcomes (e.g., cognition, mood, sleep, postural stability, and neurocognitive performance) in young adults. METHOD A randomized, non-blinded pilot clinical trial was performed to compare the effects of aerobic versus non-aerobic exercise (placebo) in concussion patients. The study enrolled three groups: 1) patients with concussion/mild traumatic brain injury (mTBI) randomized to an aerobic exercise intervention performed daily for 1-week, 2) patients with concussion/mTBI randomized to a non-aerobic (stretching and calisthenics) exercise program performed daily for 1-week, and 3) non-injured, no intervention reference group. RESULTS Mixed-model analysis of variance results indicated a significant decrease in symptom severity scores from pre- to post-intervention (mean difference = -7.44, 95% CI [-12.37, -2.20]) for both concussion groups. However, the pre- to post-change was not different between groups. Secondary outcomes all showed improvements by post-intervention, but no differences in trajectory between the groups. By three months post-injury, all outcomes in the concussion groups were within ranges of the non-injured reference group. CONCLUSIONS Results from this study indicate that the feasibility and tolerability of administering aerobic exercise via stationary cycling in the post-acute time frame following post-concussion (14-25 days) period are tentatively favorable. Aerobic exercise does not appear to negatively impact recovery trajectories of neurobehavioral outcomes; however, tolerability may be poorer for patients with high symptom burden.
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Concussion in the Athletic Training Room: a Team Physician Narrative. Curr Pain Headache Rep 2021; 25:24. [PMID: 33738547 DOI: 10.1007/s11916-021-00937-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF THE REVIEW Concussion evaluation and management has changed significantly. Understanding proper recognition, evaluation, and management allows for improved provision of care to patients. This paper will approach this topic from a sideline to training room management versus the traditional clinic evaluation RECENT FINDINGS: Research is continuing to refine and examine tools to assist in proper concussion evaluation. Concussion recovery protocols are becoming more conservative as patients are taking longer to recover than previously thought. Treatment of concussion is becoming more sophisticated and patient involved. Concussion research has increased dramatically over the last 30 years changing our approach to diagnosis and treatment. The area of concussion will continue to evolve as research continues to look at effective tools and markers for diagnosis and effective treatment protocols become substantiated through research.
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Tarperi C, Sanchis-Gomar F, Montagnana M, Danese E, Salvagno GL, Gelati M, Skroce K, Schena F, Lippi G. Effects of endurance exercise on serum concentration of calcitonin gene-related peptide (CGRP): a potential link between exercise intensity and headache. ACTA ACUST UNITED AC 2020; 58:1707-1712. [DOI: 10.1515/cclm-2019-1337] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/09/2020] [Indexed: 01/31/2023]
Abstract
Abstract
Background
Calcitonin gene-related peptide (CGRP) is a powerful neuropeptide that is strongly involved in headache pain pathogenesis by triggering vasodilation, mast cell degranulation and neurogenic inflammation. This evidence has prompted us to investigate the acute influence of endurance exercise on CGRP concentration in blood.
Methods
The study population consisted of 48 male amateur runners, who ran a half-marathon distance at 75%–85% of maximal oxygen uptake. Blood was drawn before the run (pre-run) and immediately after each runner ended his trial (post-run). The serum concentration of CGRP was measured with a commercial enzyme-linked immunosorbent assay (ELISA) technique.
Results
Overall, 22/48 subjects (45.8%) reported suffering from headache, three of whom (6.2%) had an exertional headache, whilst 26/48 (54.2%) subjects did not report at least one headache episode during the previous 6 months (i.e. headache-free). All 48 athletes successfully covered the 21.1 km distance. Serum concentration of CGRP significantly increased by 1.5-fold in the entire group, as well as in the headache-positive and headache-free cohorts. Univariate Spearman’s correlation revealed that post-run variation of serum CGRP was significantly and inversely associated with running time (r = −0.30; p = 0.036).
Conclusions
The serum concentration of CGRP is significantly enhanced by medium-distance endurance exercise and the post-exercise increase is dependent on running intensity. Accordingly, high-exercise intensity might be directly related to triggering both exertional headache and/or migraine episodes.
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Affiliation(s)
- Cantor Tarperi
- School of Sport and Exercise Sciences, Department of Neuroscience, Biomedicine and Movement , University of Verona , Verona , Italy
| | - Fabian Sanchis-Gomar
- Department of Physiology, Faculty of Medicine , University of Valencia and INCLIVA Biomedical Research Institute , Av. Blasco Ibañez, 15 , 46010 Valencia , Spain
| | - Martina Montagnana
- Section of Clinical Biochemistry , University of Verona , Verona , Italy
| | - Elisa Danese
- Section of Clinical Biochemistry , University of Verona , Verona , Italy
| | - Gian Luca Salvagno
- Section of Clinical Biochemistry , University of Verona , Verona , Italy
| | - Matteo Gelati
- Section of Clinical Biochemistry , University of Verona , Verona , Italy
| | - Kristina Skroce
- School of Sport and Exercise Sciences, Department of Neuroscience, Biomedicine and Movement , University of Verona , Verona , Italy
| | - Federico Schena
- School of Sport and Exercise Sciences, Department of Neuroscience, Biomedicine and Movement , University of Verona , Verona , Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry , University of Verona , Verona , Italy
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