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Oliveira KD, Dhondt N, Englesakis M, Goel A, Hoydonckx Y. Pulsed Radiofrequency Neuromodulation of the Greater Occipital Nerve for the Treatment of Headache Disorders in Adults: A Systematic Review. Can J Pain 2024; 8:2355571. [PMID: 38915302 PMCID: PMC11195485 DOI: 10.1080/24740527.2024.2355571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/11/2024] [Indexed: 06/26/2024]
Abstract
Background Pulsed radiofrequency neuromodulation (PRFN) of greater occipital nerve (GON) is considered in patients with headaches failing to achieve sustained analgesic benefit from nerve blocks with local anesthetic and steroids. However, the evidence supporting this practice is unclear. Aims This narrative systematic review aims to explore the effectiveness and safety of GON PRFN on headaches. Methods Databases were searched for studies, published up to February 1, 2024, investigating PRFN of GON for adults with headaches. Abstracts and posters were excluded. Primary outcome was change in headache intensity. Secondary outcomes included effect on monthly headache frequency (MHF), mental and physical health, mood, sleep, analgesic consumption, and side-effects. Two reviewers screened and extracted data. Results Twenty-two papers (2 randomized controlled trials (RCT), 11 cohort, and 9 case reports/series) including 608 patients were identified. Considerable heterogeneity in terms of study design, headache diagnosis, PRF target and settings, and image-guidance was noted. PRFN settings varied (38-42°C, 40-60 V, and 150-400 Ohms). Studies demonstrated PRFN to provide significant analgesia and reduction of MHF in chronic migraine (CM) from 3 to 6 months; and significant pain relief for ON from six to ten months. Mild adverse effects were reported in 3.1% of cohort. A minority of studies reported on secondary outcomes. The quality of the evidence was low. Conclusions Low-quality evidence indicates an analgesic benefit from PRFN of GON for ON and CM, but its role for other headache types needs more investigation. Optimal PRFN target and settings remain unclear. High-quality RCTs are required to further explore the role of this intervention. PROSPERO ID CRD42022363234.
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Affiliation(s)
- Kyle De Oliveira
- Department of Anesthesia and Pain Management, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Nina Dhondt
- Department of Pain Medicine, Multidisciplinary Pain Center, VITAZ, Sint-Niklaas, Belgium
| | - Marina Englesakis
- The Institute of Education Research, Library & Information Services, University Health Network, Toronto, Ontario, Canada
| | - Akash Goel
- Department of Anesthesia and Pain Management, St Michael's Hospital, Unity Health, Toronto, Ontario, Canada
| | - Yasmine Hoydonckx
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, Toronto, Ontario, Canada
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Basedau H, May A, Mehnert J. Cerebellar somatotopy of the trigemino-cervical complex during nociception. Eur J Pain 2024; 28:719-728. [PMID: 38013614 DOI: 10.1002/ejp.2212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION The somatotopic organization of the human cerebellum processes somato-motoric input. Its role during pain perception for nociceptive input remains ambiguous. A standardized experimental trigeminal nociceptive input in functional imaging might clarify the role of the cerebellum in trigeminal nociception. Also of interest is the greater occipital nerve, which innervates the back of the head, and can influence the trigeminal perception due to functional coupling within the brainstem, forming the so-called trigemino-cervical complex. METHODS In our preregistered study (clinicaltrials.gov: NTC03999060), we stimulated the greater occipital as well as the three main branches of the trigeminal nerve during functional magnetic resonance imaging in two independent cohorts of young healthy volunteers without psychiatric, neurological or pain-related disorders to disentangle overlapping somatotopic cerebellar organization of the nerves innervating the human head. RESULTS We found a dominant effect of the first trigeminal branch in the cerebellum, underpinning its particular role for headache diseases, and somatotopic representations in bilateral cerebellar lobules I-IV, V, VIIb, VIIIa and Crus I as well as in the brainstem. SIGNIFICANCE The study expands the current knowledge on facial and head pain processing by the cerebellum and provides an initial somatotopic map of the trigemino-cervical complex in the human cerebellum with a predominant representation of the first trigeminal branch.
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Affiliation(s)
- Hauke Basedau
- Department of Systems Neuroscience, University Medical Center Eppendorf, Hamburg, Germany
| | - Arne May
- Department of Systems Neuroscience, University Medical Center Eppendorf, Hamburg, Germany
| | - Jan Mehnert
- Department of Systems Neuroscience, University Medical Center Eppendorf, Hamburg, Germany
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Safronov BV, Szucs P. Novel aspects of signal processing in lamina I. Neuropharmacology 2024; 247:109858. [PMID: 38286189 DOI: 10.1016/j.neuropharm.2024.109858] [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: 11/24/2023] [Revised: 01/12/2024] [Accepted: 01/25/2024] [Indexed: 01/31/2024]
Abstract
The most superficial layer of the spinal dorsal horn, lamina I, is a key element of the nociceptive processing system. It contains different types of projection neurons (PNs) and local-circuit neurons (LCNs) whose functional roles in the signal processing are poorly understood. This article reviews recent progress in elucidating novel anatomical features and physiological properties of lamina I PNs and LCNs revealed by whole-cell recordings in ex vivo spinal cord. This article is part of the Special Issue on "Ukrainian Neuroscience".
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Affiliation(s)
- Boris V Safronov
- Neuronal Networks Group, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.
| | - Peter Szucs
- Department of Anatomy, Histology and Embryology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; HUN-REN-DE Neuroscience Research Group, Debrecen, Hungary
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Jafari M, Bahrpeyma F, Togha M, Hall T, Vahabizad F, Jafari E. Can upper cervical manual therapy affect the blink reflex in subjects with migraine and neck pain? J Man Manip Ther 2024; 32:190-197. [PMID: 37655399 PMCID: PMC10956906 DOI: 10.1080/10669817.2023.2250172] [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: 05/20/2023] [Accepted: 08/14/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Neck pain is a common complaint among migraineurs possibly due to the anatomic connections between cervical and trigeminal afferents in the trigeminocervical complex (TCC). Manual therapy (MT) is used in the management of headache disorders, with demonstrable neurophysiological effects. The blink reflex (BR) is one method of analyzing neurophysiological effects in headache patients. The purpose of this study was to investigate the effect of upper cervical spine MT on BR in subjects with migraine and neck pain. METHODS & MATERIALS Twenty subjects were assigned to a medication plus MT (MedMT) group (n = 10) and medication plus sham MT (sham MT) group (n = 10). After random assignment, all patients underwent testing for the BR (R1, R2, R2c responses). Then, subjects in group MedMT and group sham MT received either 4 sessions of MT or sham MT to the upper cervical spine. After completion of the intervention, BR testing was repeated. RESULTS There were no significant differences in both side R1 latency between group MT and group sham MT (P > 0.050). For both sides, R2 latencies were significantly prolonged in MedMT group compared with sham MT group (P < 0.050). Subjects in MedMT group showed significant prolongation in right and left R2c latency compared with sham MT group (P < 0.050). DISCUSSION The present study demonstrated that upper cervical MT affected trigeminal nociceptive neurotransmission in subjects with migraine and neck pain as reflected by changes in the BR. The increase in BR late response latencies of BR indicates an inhibitory effect of upper cervical spine MT on the TCC in these subjects. Trial Registration: The trial design was registered at the Iranian Registry of Clinical Trials (IRCT ID: IRCT20160621028567N2, url: https://www.irct.ir/) before the first patient was enrolled.
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Affiliation(s)
- Mehdi Jafari
- Department of Physiotherapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Farid Bahrpeyma
- Department of Physiotherapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mansoureh Togha
- Headache Department, Neurology Ward, Sina University Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Toby Hall
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Fahimeh Vahabizad
- Headache Department, Neurology Ward, Sina University Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Jafari
- Headache Department, Neurology Ward, Sina University Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Headache Fellowship Assistant, Sina University Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Mehnert J, Tinnermann A, Basedau H, May A. Functional representation of trigeminal nociceptive input in the human periaqueductal gray. SCIENCE ADVANCES 2024; 10:eadj8213. [PMID: 38507498 PMCID: PMC10954197 DOI: 10.1126/sciadv.adj8213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 02/13/2024] [Indexed: 03/22/2024]
Abstract
The periaqueductal gray (PAG) is located in the mesencephalon in the upper brainstem and, as part of the descending pain modulation, is considered a crucial structure for pain control. Its modulatory effect on painful sensation is often seen as a systemic function affecting the whole body similarly. However, recent animal data suggest some kind of somatotopy in the PAG. This would make the PAG capable of dermatome-specific analgesic function. We electrically stimulated the three peripheral dermatomes of the trigemino-cervical complex and the greater occipital nerve in 61 humans during optimized brainstem functional magnetic resonance imaging. We provide evidence for a fine-grained and highly specific somatotopic representation of nociceptive input in the PAG in humans and a functional connectivity between the individual representations of the peripheral nerves in the PAG and the brainstem nuclei of these nerves. Our data suggest that the downstream antinociceptive properties of the PAG may be rather specific down to the level of individual dermatomes.
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Affiliation(s)
| | | | - Hauke Basedau
- Department of Systems Neuroscience, University Medical Center Eppendorf, 20146 Hamburg, Germany
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Bertotti G, Gil-Martínez A, Matesanz-García L, Angulo-Díaz-Parreño S, Rodríguez-Vico J, Díaz-de-Terán J, Elizagaray-García JI. Somatosensory Profiling of Patients With Cluster Headache: A Systematic Review and Meta-analysis. THE JOURNAL OF PAIN 2024:S1526-5900(24)00379-1. [PMID: 38367655 DOI: 10.1016/j.jpain.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 01/25/2024] [Accepted: 02/06/2024] [Indexed: 02/19/2024]
Abstract
The objectives were 1) to synthesize quantitative sensory testing results in cluster headache (CH) patients and to identify somatosensory differences from healthy subjects (HS), and 2) between symptomatic and asymptomatic sides in CH patients. Two independent reviewers conducted a literature search in MEDLINE, EMBASE, Web of Science, and CINAHL databases. Studies with observational designs were included. Methodological quality and risk of bias were assessed with the Newcastle Ottawa Scale. The selected studies underwent qualitative and quantitative analyses. The qualitative analysis showed inconsistent findings among multiple studies. Meta-analysis showed lower pressure pain thresholds (PPTs) on the symptomatic side of CH patients than HS in V2 (standardized mean difference [SMD] -1.01 [95% confidence interval (CI) -1.79, -.23], P = .01, I2 = 73%, n = 114), V3 (SMD -1 [95% CI -1.54, .45], P < .01, I2 = 82%, n = 354), and cervical region (SMD -1.25 [95% CI -2.07, -.44], P < .01, I2 = 84%, n = 194). Furthermore, lower PPTs than those detected in HS were found on the asymptomatic side in V3 (SMD -.77 [95% CI -1.27, -.27], P < .01, I2 = 79%, n = 354) and in the cervical region (SMD -1.13 [95% CI -1.97, -.3], P < .01, I2 = 85%, n = 194). However, no differences were found in V1 or the extratrigeminal points between these groups. No significant changes were found between symptomatic and asymptomatic sides in trigeminal and extratrigeminal regions. Mechanical hyperalgesia in the trigemino-cervical region of patients with CH could suggest the presence of central pain mechanisms. These results are of clinical relevance because their presence could be associated with a poorer prognosis, chronification, and treatment response. PERSPECTIVES: This study provides consistent findings on the somatosensory profile characterizing patients with CH. Clinicians should assess PPTs and other quantitative sensory testing variables in the trigeminal and extratrigeminal (cervical) regions.
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Affiliation(s)
- Gabriele Bertotti
- School of Physiotherapy, Faculty of Health Sciences, Universidad Francisco de Vitoria, Madrid, Spain; CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Alfonso Gil-Martínez
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Unit of Physiotherapy, Hospital Universitario La Paz-Carlos III, IdiPAZ, Madrid, Spain
| | - Luis Matesanz-García
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Jaime Rodríguez-Vico
- Headache Unit, Neurology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Javier Díaz-de-Terán
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Headache Unit, Neurology Department, Hospital Universitario La Paz-Carlos III, IdiPAZ, Madrid, Spain
| | - Juan Ignacio Elizagaray-García
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
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Porter M, Griswold D, Gargano F, Ickert E, Learman K. Immediate effects of superficial dry needling of the trigeminal nerve innervation field for participants with cervicogenic headache. A randomized controlled trial. Physiother Theory Pract 2024; 40:253-261. [PMID: 36047014 DOI: 10.1080/09593985.2022.2118560] [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: 04/08/2022] [Accepted: 08/23/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Cervicogenic headache (CGH) is a common condition with a neuroanatomical basis involving the trigeminal nerve. Dry needling (DN) is a safe and effective treatment for CGH but most studies involve deep DN to cervical musculature. OBJECTIVE The aim of this study was to investigate immediate effects of superficial DN of the trigeminal nerve innervation field on numeric pain rating scale (NPRS), flexion-rotation test (FRT), cervical range of motion (AROM), and pain-pressure threshold (PPT) of right (R) and left (L) supraorbital (SO), and right (R) and left (L) greater occipital (GO) nerves in participants with CGH. METHODS A parallel controlled randomized design involving 30 participants with CGH received either superficial DN (N = 17) or sham DN (N = 13). Participants and outcome assessors were blind to group assignment. Wilcoxon signed rank analyzed within-group effects and Mann-Whitney U analyzed between-group. RESULTS Statistically significant between-group differences were observed for NPRS (P < .001) and AROM (P < .006) favoring DN and were clinically meaningful. Right and left Flexion rotation tests (FRT) outcomes were non-significant (P = .137) but clinically meaningful. No differences were observed for PPT over: R SO (P = .187); L SO (P = .052); R GO (P = .187); or L GO (P = .052). Between-group effect sizes across variables were moderate to large (0.53-1.4) but confidence intervals were wide. CONCLUSION Superficial DN targeting the innervation field of the trigeminal nerve improves clinical outcomes in patients with CGH. Only the immediate effects were analyzed and the sample size was small. Larger, longer-term assessments are needed comparing superficial DN of the trigeminal innervation field and other conservative interventions for CGH.
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Affiliation(s)
- Megan Porter
- Department of Graduate Studies in Health and Rehabilitation Sciences, Youngstown State University, One University Plaza, Youngstown, OH, USA
| | - David Griswold
- Department of Graduate Studies in Health and Rehabilitation Sciences, Youngstown State University, One University Plaza, Youngstown, OH, USA
| | | | - Edmund Ickert
- Department of Graduate Studies in Health and Rehabilitation Sciences, Youngstown State University, One University Plaza, Youngstown, OH, USA
| | - Ken Learman
- Department of Graduate Studies in Health and Rehabilitation Sciences, Youngstown State University, One University Plaza, Youngstown, OH, USA
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Ornello R, Andreou AP, De Matteis E, Jürgens TP, Minen MT, Sacco S. Resistant and refractory migraine: clinical presentation, pathophysiology, and management. EBioMedicine 2024; 99:104943. [PMID: 38142636 PMCID: PMC10788408 DOI: 10.1016/j.ebiom.2023.104943] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/09/2023] [Accepted: 12/13/2023] [Indexed: 12/26/2023] Open
Abstract
Migraine is a leading cause of disability worldwide. A minority of individuals with migraine develop resistant or refractory conditions characterised by ≥ 8 monthly days of debilitating headaches and inadequate response, intolerance, or contraindication to ≥3 or all preventive drug classes, respectively. Resistant and refractory migraine are emerging clinical definitions stemming from better knowledge of the pathophysiology of migraine and from the advent of migraine-specific preventive treatments. Resistant migraine mostly results from drug failures, while refractory migraine has complex and still unknown mechanisms that impair the efficacy of preventive treatments. Individuals with resistant migraine can be treated with migraine-specific preventive drugs. The management of refractory migraine is challenging and often unsuccessful, being based on combinations of different drugs and non-pharmacological treatment. Future research should aim to identify individuals at risk of developing treatment failures, prevent the condition, investigate the mechanisms of refractoriness to treatments, and find effective treatment strategies.
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Affiliation(s)
- Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Anna P Andreou
- Headache Research-Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Headache Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Eleonora De Matteis
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Tim P Jürgens
- Headache Center North-East, Department of Neurology, University Medical Center Rostock, Rostock, Germany; Department of Neurology, KMG Hospital Güstrow, Güstrow, Germany
| | - Mia T Minen
- Departments of Neurology and Population Health, NYU Langone Health, New York, USA
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
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Boos A, Nader A. Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation of C2 Dorsal Root Ganglion for the Treatment of Refractory Atypical Facial Pain: A Technical Report and Case Series. Neuromodulation 2024; 27:130-134. [PMID: 37480924 DOI: 10.1016/j.neurom.2023.06.005] [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: 03/10/2023] [Revised: 04/29/2023] [Accepted: 06/12/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Chronic craniofacial pain can be difficult to manage clinically. This technical report documents the peripheral nerve stimulation of the C2 dorsal root ganglion as an effective modality to treat refractory atypical facial pain. MATERIALS AND METHODS In this case series, three patients with chronic refractory atypical facial pain and p >50% pain relief following diagnostic C2 dorsal root ganglion blockade underwent ultrasound-guided percutaneous placement of a peripheral nerve stimulator adjacent to the C2 dorsal root ganglion. Patients were then observed clinically and monitored for improvement in symptoms and adverse events. RESULTS Three patients underwent peripheral nerve stimulator placement. At follow-up, there were no reported adverse events, and all patients reported satisfactory improvement in pain. CONCLUSION The neuromodulation of C2 dorsal root ganglion via ultrasound-guided percutaneously implanted peripheral nerve stimulator is a novel and potentially effective approach for the management of chronic refractory craniofacial pain.
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Affiliation(s)
- Austin Boos
- Department of Physical Medicine and Rehabilitation, McGaw Medical Center of Northwestern University, Chicago, IL, USA.
| | - Antoun Nader
- Department of Anesthesiology and Pain Medicine, Northwestern University, Chicago, IL, US
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Ozudogru Celik T, Gorgulu U, Kenar SG, Koca N, Yalcin E, Koymen I, Yasar E. Evaluation of forward head posture and thoracic kyphosis in migraine. J Clin Neurosci 2024; 119:17-21. [PMID: 37976910 DOI: 10.1016/j.jocn.2023.11.018] [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: 08/16/2023] [Revised: 10/12/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND The purpose of the current study was to investigate the forward head posture (FHP), thoracic kyphosis and their relationships between individuals with migraine and healthy controls using the DIERS Formetric 4D motion imaging system. METHODS In this observational case-control study, a total of 39 migraine patients and 44 healthy subjects were enrolled. FHP and thoracic kyphosis were assessed by using the 4D Formetric DIERS system. The visual analogue scale (VAS) and Neck Disability Index (NDI) was used to evaluate neck pain and neck disability. Headache status were evaluated through Migraine Disability Assessment (MIDAS) and Numeric Pain Rating Scale (NPRS) questionnaires. RESULTS The fleche cervicale (57.72 ± 13.72 mm vs. 40.00 ± 4.75 mm; p < 0.001) and kyphotic angle (57.39 ± 8.76° vs. 38.21 ± 5.67°; p < 0.001) were significantly higher in patients with migraine compared to control group. When NDI categories were compared, the migraine group showed significantly increase in the number of patients with moderate or severe disability (p < 0.001). A positive correlation was found between fleche cervicale and thoracic kyphosis (r = 0.71, p < 0.001). CONCLUSIONS This study revealed that patients with migraine exhibited a greater FHP and thoracic kyphosis compared to the control group. A 3-dimensional objective measurement may be a reliable diagnostic tool to evaluate posture analysis in clinical practice in the future.
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Affiliation(s)
- Tugba Ozudogru Celik
- Department of Physical Medicine and Rehabilitation, Ankara City Hospital, University of Health Sciences Turkey, Ankara, Turkey.
| | - Umit Gorgulu
- Department of Neurology, Ankara City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Safiye Gul Kenar
- Department of Neurology, Ankara City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Nadide Koca
- Department of Physical Medicine and Rehabilitation, Ankara Education and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Elif Yalcin
- Department of Physical Medicine and Rehabilitation, Ankara City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Ipek Koymen
- Department of Physical Medicine and Rehabilitation, Ankara City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Evren Yasar
- Department of Physical Medicine and Rehabilitation, Ankara City Hospital, University of Health Sciences Turkey, Ankara, Turkey
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Hyung JW, Son BC. Generalized Extension of Referred Trigeminal Pain due to Greater Occipital Nerve Entrapment. Case Rep Neurol Med 2023; 2023:1099222. [PMID: 38025301 PMCID: PMC10657245 DOI: 10.1155/2023/1099222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
We report a very rare case of referred pain caused by greater occipital nerve (GON) entrapment, inducing spontaneous pain in the whole body as well as in the trigeminal nerve region of the face and head. It has already been reported that entrapment of the GON can induce referred pain in the ipsilateral limb as well as the ipsilateral hemiface. A 42-year-old female patient presented with chronic pain in her gums, jaw angle, submandibular region, retro-auricular suboccipital, and temporo-occipital vertex that had been ongoing for four years. As the patient's head pain and facial pain became severe, severe spontaneous pain occurred in the arm, waist, and both lower extremities. This patient's pain in the occipital and neck, spontaneous pain in the face, jaw, and whole body improved with decompression of the GON. Anatomical basis of pain referral to the facial trigeminal area caused by chronic GON entrapment is convergence of nociceptive inflow from high cervical C1-C3 structures and trigeminal orofacial area in the dorsal horn of the cervical spinal cord from the C2 segment up to the medullary dorsal horn (MDH). The major afferent contribution among the suboccipital and high cervical structure is mediated by spinal root C2 that is peripherally represented by the GON. Chronic noxious input from GON entrapment can cause sensitization and hypersensitivity in second order neurons in the trigeminocervical complex (TCC) and MDH in the caudal trigeminal nucleus and high cervical cord. Generalized extension of referred pain due to GON entrapment is thought to involve two possible pathophysiologies. One is the possibility that generalized pain is caused by sensitization of third-order nociceptive neurons in the thalamus. Another speculation is that spontaneous pain may occur throughout the body due to dysfunction of the descending brain stem pain-modulating pathway by sensitization and hyperexcitation of the MDH and trigeminal brainstem sensory nuclear complex (TBSNC).
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Affiliation(s)
- Jung-woo Hyung
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung-chul Son
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Catholic Neuroscience Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Börner-Schröder C, Lang M, Urban G, Zaidenstadt E, Staisch J, Hauser A, Hannibal I, Huß K, Klose B, Lechner MF, Sollmann N, Landgraf MN, Heinen F, Bonfert MV. Neuromodulation in Pediatric Migraine using Repetitive Neuromuscular Magnetic Stimulation: A Feasibility Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1764. [PMID: 38002855 PMCID: PMC10670480 DOI: 10.3390/children10111764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023]
Abstract
Migraine has a relevant impact on pediatric health. Non-pharmacological modalities for its management are urgently needed. This study assessed the safety, feasibility, acceptance, and efficacy of repetitive neuromuscular magnetic stimulation (rNMS) in pediatric migraine. A total of 13 patients with migraine, ≥6 headache days during baseline, and ≥1 myofascial trigger point in the upper trapezius muscles (UTM) received six rNMS sessions within 3 weeks. Headache frequency, intensity, and medication intake were monitored using headache calendars; headache-related impairment and quality of life were measured using PedMIDAS and KINDL questionnaires. Muscular involvement was assessed using pressure pain thresholds (PPT). Adherence yielded 100%. In 82% of all rNMS sessions, no side effects occurred. All participants would recommend rNMS and would repeat it. Headache frequency, medication intake, and PedMIDAS scores decreased from baseline to follow-up (FU), trending towards statistical significance (p = 0.089; p = 0.081, p = 0.055). A total of 7 patients were classified as responders, with a ≥25% relative reduction in headache frequency. PPT above the UTM significantly increased from pre- to post-assessment, which sustained until FU (p = 0.015 and 0.026, respectively). rNMS was safe, feasible, well-accepted, and beneficial on the muscular level. The potential to reduce headache-related symptoms together with PPT changes of the targeted UTM may underscore the interplay of peripheral and central mechanisms conceptualized within the trigemino-cervical complex.
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Affiliation(s)
- Corinna Börner-Schröder
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany; (C.B.-S.); (I.H.); (M.N.L.); (F.H.)
- LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany;
- TUM-Neuroimaging Center, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Magdalena Lang
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany; (C.B.-S.); (I.H.); (M.N.L.); (F.H.)
- LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany
| | - Giada Urban
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany; (C.B.-S.); (I.H.); (M.N.L.); (F.H.)
- LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany
| | - Erik Zaidenstadt
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany; (C.B.-S.); (I.H.); (M.N.L.); (F.H.)
- LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany
| | - Jacob Staisch
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany; (C.B.-S.); (I.H.); (M.N.L.); (F.H.)
- LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany
| | - Ari Hauser
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany; (C.B.-S.); (I.H.); (M.N.L.); (F.H.)
- LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany
| | - Iris Hannibal
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany; (C.B.-S.); (I.H.); (M.N.L.); (F.H.)
- LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany
| | - Kristina Huß
- LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany
| | - Birgit Klose
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany; (C.B.-S.); (I.H.); (M.N.L.); (F.H.)
- LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany
| | - Matthias F. Lechner
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany; (C.B.-S.); (I.H.); (M.N.L.); (F.H.)
- LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany;
- TUM-Neuroimaging Center, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Mirjam N. Landgraf
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany; (C.B.-S.); (I.H.); (M.N.L.); (F.H.)
- LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany
| | - Florian Heinen
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany; (C.B.-S.); (I.H.); (M.N.L.); (F.H.)
- LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany
| | - Michaela V. Bonfert
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany; (C.B.-S.); (I.H.); (M.N.L.); (F.H.)
- LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany
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Towne BV, Girgiss CB, Schuster NM. Use of spinal cord stimulation in treatment of intractable headache diseases. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:S6-S10. [PMID: 37833045 DOI: 10.1093/pm/pnad090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/17/2023] [Accepted: 06/27/2023] [Indexed: 10/15/2023]
Abstract
Headache diseases remain one of the leading causes of disability in the world. With the development of neuromodulation strategies, high cervical spinal cord stimulation (hcSCS) targeting the trigeminocervical complex has been deployed to treat refractory headache diseases. In this article, we review the proposed mechanism behind hcSCS stimulation, and the various studies that have been described for the successful use of this treatment strategy in patients with chronic migraine, cluster headache, and other trigeminal autonomic cephalalgias.
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Affiliation(s)
- Brooke V Towne
- Department of Anesthesiology, University of California San Diego Health, San Diego, CA 92037, United States
| | - Carol B Girgiss
- School of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Nathaniel M Schuster
- Department of Anesthesiology, University of California San Diego Health, San Diego, CA 92037, United States
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14
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Huang SY, Salomon M, Eikermann-Haerter K. Advanced brain MRI may help understand the link between migraine and multiple sclerosis. J Headache Pain 2023; 24:113. [PMID: 37596546 PMCID: PMC10439604 DOI: 10.1186/s10194-023-01645-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/04/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND There is a clinical association between migraine and multiple sclerosis. MAIN BODY Migraine and MS patients share similar demographics, with the highest incidence among young, female and otherwise healthy patients. The same hormonal constellations/changes trigger disease exacerbation in both entities. Migraine prevalence is increased in MS patients, which is further enhanced by disease-modifying treatment. Clinical data show that onset of migraine typically starts years before the clinical diagnosis of MS, suggesting that there is either a unidirectional relationship with migraine predisposing to MS, and/or a "shared factor" underlying both conditions. Brain imaging studies show white matter lesions in both MS and migraine patients. Neuroinflammatory mechanisms likely play a key role, at least as a shared downstream pathway. In this review article, we provide an overview of the literature about 1) the clinical association between migraine and MS as well as 2) brain MRI studies that help us better understand the mechanistic relationship between both diseases with implications on their underlying pathophysiology. CONCLUSION Studies suggest a migraine history predisposes patients to develop MS. Advanced brain MR imaging may shed light on shared and distinct features, while helping us better understand mechanisms underlying both disease entities.
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Affiliation(s)
- Susie Y Huang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Marc Salomon
- Department of Radiology, New York University Langone Medical Center, 660 First Ave, New York, NY, 10016, USA
| | - Katharina Eikermann-Haerter
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Radiology, New York University Langone Medical Center, 660 First Ave, New York, NY, 10016, USA.
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Jin GY, Jin LL, Jin BX, Zheng J, He BJ, Li SJ. Neural control of cerebral blood flow: scientific basis of scalp acupuncture in treating brain diseases. Front Neurosci 2023; 17:1210537. [PMID: 37650106 PMCID: PMC10464620 DOI: 10.3389/fnins.2023.1210537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/03/2023] [Indexed: 09/01/2023] Open
Abstract
Scalp acupuncture (SA), as a modern acupuncture therapy in the treatment of brain diseases, especially for acute ischemic strokes, has accumulated a wealth of experience and tons of success cases, but the current hypothesized mechanisms of SA therapy still seem to lack significant scientific validity, which may not be conducive to its ultimate integration into mainstream medicine. This review explores a novel perspective about the mechanisms of SA in treating brain diseases based on its effects on cerebral blood flow (CBF). To date, abundant evidence has shown that CBF is significantly increased by stimulating specific SA points, areas or nerves innervating the scalp, which parallels the instant or long-term improvement of symptoms of brain diseases. Over time, the neural pathways that improve CBF by stimulating the trigeminal, the facial, and the cervical nerves have also been gradually revealed. In addition, the presence of the core SA points or areas frequently used for brain diseases can be rationally explained by the characteristics of nerve distribution, including nerve overlap or convergence in certain parts of the scalp. But such characteristics also suggest that the role of these SA points or areas is relatively specific and not due to a direct correspondence between the current hypothesized SA points, areas and the functional zones of the cerebral cortex. The above evidence chain indicates that the efficacy of SA in treating brain diseases, especially ischemic strokes, is mostly achieved by stimulating the scalp nerves, especially the trigeminal nerve to improve CBF. Of course, the mechanisms of SA in treating various brain diseases might be multifaceted. However, the authors believe that understanding the neural regulation of SA on CBF not only captures the main aspects of the mechanisms of SA therapy, but also facilitates the elucidation of other mechanisms, which may be of greater significance to further its clinical applications.
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Affiliation(s)
- Guan-Yuan Jin
- International Institute of Systems Medicine, Inc., Milwaukee, WI, United States
- Ace Acupuncture Clinic of Milwaukee, LLC, Milwaukee, WI, United States
| | - Louis Lei Jin
- The Woodlands Acupuncture and Herbal Clinic, The Woodlands, TX, United States
| | - Bonnie Xia Jin
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jin Zheng
- HCA Houston Healthcare Conroe, Conroe, TX, United States
| | - Belinda Jie He
- The Woodlands Acupuncture and Herbal Clinic, The Woodlands, TX, United States
| | - Shi-Jiang Li
- Medical College of Wisconsin, Milwaukee, WI, United States
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Peng KP, Burish MJ. Management of cluster headache: Treatments and their mechanisms. Cephalalgia 2023; 43:3331024231196808. [PMID: 37652457 DOI: 10.1177/03331024231196808] [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: 09/02/2023]
Abstract
BACKGROUND The management of cluster headache is similar to that of other primary headache disorders and can be broadly divided into acute and preventive treatments. Acute treatments for cluster headache are primarily delivered via rapid, non-oral routes (such as inhalation, nasal, or subcutaneous) while preventives include a variety of unrelated treatments such as corticosteroids, verapamil, and galcanezumab. Neuromodulation is becoming an increasingly popular option, both non-invasively such as vagus nerve stimulation when medical treatment is contraindicated or side effects are intolerable, and invasively such as occipital nerve stimulation when medical treatment is ineffective. Clinically, this collection of treatment types provides a range of options for the informed clinician. Scientifically, this collection provides important insights into disease mechanisms. METHODS Two authors performed independent narrative reviews of the literature on guideline recommendations, clinical trials, real-world data, and mechanistic studies. RESULTS Cluster headache is treated with acute treatments, bridge treatments, and preventive treatments. Common first-line treatments include subcutaneous sumatriptan and high-flow oxygen as acute treatments, corticosteroids (oral or suboccipital injections) as bridge treatments, and verapamil as a preventive treatment. Some newer acute (non-invasive vagus nerve stimulation) and preventive (galcanezumab) treatments have excellent clinical trial data for episodic cluster headache, while other newer treatments (occipital nerve stimulation) have been specifically tested in treatment-refractory chronic cluster headache. Most treatments are suspected to act on the trigeminovascular system, the autonomic system, or the hypothalamus. CONCLUSIONS The first-line treatments have not changed in recent years, but new treatments have provided additional options for patients.
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Affiliation(s)
- Kuan-Po Peng
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mark J Burish
- Department of Neurosurgery, UTHealth Houston, Houston, Texas, USA
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Di Antonio S, Arendt-Nielsen L, Castaldo M. Cervical musculoskeletal impairments and pain sensitivity in migraine patients. Musculoskelet Sci Pract 2023; 66:102817. [PMID: 37451884 DOI: 10.1016/j.msksp.2023.102817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Currently, examination of migraine patients relies on a clinical interview investigating symptoms characteristics. Despite this, to help identify distinct migraine subtypes and allow a personalized treatment approach, biomarkers to profile distinct migraine subtypes should be utilized in clinical and research settings. Therefore, there is a need to include physical and psychophysical examinations aimed at assessing migraine features quantitatively. PURPOSE This paper aimed to discuss if increased pressure pain sensitivity and impaired cervical musculoskeletal function could be considered 1) as quantitative features of migraine and 2) if they could be used as biomarkers to profile migraine patients in distinct subtypes. IMPLICATION Increased pain sensitivity and cervical musculoskeletal impairments have been suggested as quantitative biomarkers to phenotype and subgroup migraine patients in clinical and research settings. This could provide the first step for a mechanistically-driven and personalized treatment approach according to migraine phenotypes.
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Affiliation(s)
- Stefano Di Antonio
- Department of Health Science and Technology, Center for Pain and Neuroplasticity (CNAP), SMI, School of Medicine, Aalborg University, 9220, Aalborg, Denmark; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, 16132, Genoa, Italy
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Center for Pain and Neuroplasticity (CNAP), SMI, School of Medicine, Aalborg University, 9220, Aalborg, Denmark; Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, 9220, Aalborg, Denmark; Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, 9220, Aalborg, Denmark
| | - Matteo Castaldo
- Department of Health Science and Technology, Center for Pain and Neuroplasticity (CNAP), SMI, School of Medicine, Aalborg University, 9220, Aalborg, Denmark.
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Schulz M, Xu W, Treleaven J, Thomas L, Liang Z. Individual perceptions on the relationship between migraine and neck pain. Musculoskelet Sci Pract 2023; 66:102812. [PMID: 37414673 DOI: 10.1016/j.msksp.2023.102812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Despite neck pain being a common complaint for people with migraine, little is known about how individuals perceive the relationship between their migraine and neck pain. Exploring their beliefs and perceptions could provide valuable understanding to improve overall management and reduce the burden of migraine and neck pain. OBJECTIVES To investigate individual perspectives on how migraine and neck pain relate. METHODS A retrospective qualitative study was performed. Seventy participants (mean age 39.2, 60 female) were recruited via community and social media advertisements, and interviewed by an experienced physiotherapist using a semi-structured interview framework. An Inductive thematic analysis was used to analyse the responses. RESULTS Five themes were identified from the interviews: (i) the timing of neck pain and migraine, (ii) causality beliefs, (iii) burden of neck pain and migraine, (iv) experiences with treatment and (v) mismatched perspectives. Diverse views emerged, revealing links between the first two themes of timing and causality, showing increased burden in those suffering from both neck pain and migraine, and providing insights into apparently ineffective or even aggravating treatments. CONCLUSIONS Valuable insights for clinicians emerged. Due to the complex relationship, clinicians should discuss the aetiology of neck pain in migraine with patients. For some individuals, neck treatment may not produce long-term relief and may even aggravate migraine, but the value of short-term relief in a chronic condition must be considered individually. Clinicians are ideally placed to have discussions with patients individually to tailor individual decisions about management.
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Affiliation(s)
- Michael Schulz
- The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, Qld, Australia.
| | - Wenrui Xu
- The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, Qld, Australia.
| | - Julia Treleaven
- The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, Qld, Australia.
| | - Lucy Thomas
- The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, Qld, Australia.
| | - Zhiqi Liang
- The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, Qld, Australia.
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Al-Khazali HM, Krøll LS, Ashina H, Melo-Carrillo A, Burstein R, Amin FM, Ashina S. Neck pain and headache: Pathophysiology, treatments and future directions. Musculoskelet Sci Pract 2023; 66:102804. [PMID: 37394323 DOI: 10.1016/j.msksp.2023.102804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 05/27/2023] [Accepted: 06/10/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Neck pain is a prevalent neurologic and musculoskeletal complaint in the general population and is often associated with primary headache disorders such as migraine and tension-type headache (TTH). A considerable proportion, ranging from 73% to 90%, of people with migraine or TTH also experience neck pain, and there is a positive correlation between headache frequency and neck pain. Furthermore, neck pain has been identified as a risk factor for migraine and TTH. Although the exact underlying mechanisms linking neck pain to migraine and TTH remain uncertain, pain sensitivity appears to play an important role. People with migraine or TTH exhibit lower pressure pain thresholds and higher total tenderness scores compared with healthy controls. PURPOSE This position paper aims to provide an overview of the current evidence on the relationship between neck pain and comorbid migraine or TTH. It will encompass the clinical presentation, epidemiology, pathophysiology, and management of neck pain in the context of migraine and TTH. IMPLICATIONS The relationship between neck pain and comorbid migraine or TTH is incompletely understood. In the absence of robust evidence, the management of neck pain in people with migraine or TTH relies mostly on expert opinion. A multidisciplinary approach is usually preferred, involving pharmacologic and non-pharmacologic strategies. Further research is necessary to fully dissect the linkage between neck pain and comorbid migraine or TTH. This includes the development of validated assessment tools, evaluation of treatment effectiveness, and exploration of genetic, imaging, and biochemical markers that might aid in diagnosis and treatment.
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Affiliation(s)
- Haidar M Al-Khazali
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lotte Skytte Krøll
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Håkan Ashina
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Brain and Spinal Cord Injury, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, MA, USA
| | - Agustin Melo-Carrillo
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, MA, USA
| | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, MA, USA
| | - Faisal Mohammad Amin
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Brain and Spinal Cord Injury, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Sait Ashina
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Comprehensive Headache Center, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, MA, USA.
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Liang Z, Thomas L, Jull G, Treleaven J. Subgrouping individuals with migraine associated neck pain for targeted management. Musculoskelet Sci Pract 2023; 66:102801. [PMID: 37331924 DOI: 10.1016/j.msksp.2023.102801] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/05/2023] [Accepted: 06/10/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Neck pain is one of the most common and burdensome symptoms associated with migraine. Many individuals with migraine and neck pain seek neck treatment, but evidence for such treatment is limited. Most studies have treated this population as a homogenous group, providing uniform cervical interventions that have yet to show clinically important effects. However, different neurophysiological and musculoskeletal mechanisms can underlie neck pain in migraine. Targeting treatment to specific underlying mechanisms may therefore be the key to improving treatment outcomes. Our research characterised neck pain mechanisms and identified subgroups based on cervical musculoskeletal function and cervical hypersensitivity. This suggests that specific management aimed towards addressing mechanisms relevant to each subgroup might be beneficial. PURPOSE This paper explains our research approach and findings to date. Potential management strategies for the identified subgroups and future research directions are discussed. IMPLICATIONS Clinicians should perform skilled physical examination with the aim of identifying if patterns of cervical musculoskeletal dysfunction and or hypersensitivity are present in the individual patient. There is currently no research into treatments differentiated for subgroups to address specific underlying mechanisms. It is possible that neck treatments addressing musculoskeletal impairments may be most beneficial for those subgroups where neck pain is primarily due to musculoskeletal dysfunction. Future research should define treatment aims and select specific subgroups for targeted management to determine which treatments are most effective for each subgroup. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Zhiqi Liang
- School of Health and Rehabilitation Sciences, Therapies Annexe, 84A, The University of Queensland, St Lucia, QLD, 4072, Australia.
| | - Lucy Thomas
- School of Health and Rehabilitation Sciences, Therapies Annexe, 84A, The University of Queensland, St Lucia, QLD, 4072, Australia.
| | - Gwendolen Jull
- School of Health and Rehabilitation Sciences, Therapies Annexe, 84A, The University of Queensland, St Lucia, QLD, 4072, Australia.
| | - Julia Treleaven
- School of Health and Rehabilitation Sciences, Therapies Annexe, 84A, The University of Queensland, St Lucia, QLD, 4072, Australia.
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Anarte-Lazo E, Rodriguez-Blanco C, Bernal-Utrera C, Falla D. Headache production during physical examination in patients with and without headache attributed to a whiplash injury: A case-control study. Musculoskelet Sci Pract 2023; 66:102779. [PMID: 37271677 DOI: 10.1016/j.msksp.2023.102779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Provocation of headache on physical examination of the neck may reflect a role of cervical structures in the presence of acute whiplash-associated headache (WAH). OBJECTIVE To determine differences in headache provocation during physical tests in people with and without WAH after a whiplash injury. DESIGN Case-control study. METHODS Forty-seven people with acute whiplash-associated disorders participated, 28 with WAH. Passive accessory intervertebral movement over the tubercle of C1, the spinous processes of C2-C3 and facet joints of C0-C4, the flexion-rotation test (FRT), manual palpation of cranio-cervical muscles and the upper limb neurodynamic test + cranio-cervical flexion were assessed bilaterally twice by a blinded examiner; headache provocation was determined. Cohen's kappa and Chi-squared were determined to evaluate the intra-rater reliability of test results and differences between groups, respectively. A logistic regression model was also performed. RESULTS Intra-rater reliability of headache provocation was good or excellent for most tests. Significant differences between groups were found with higher positive tests in WAH for the assessment of C2 (68%), the most painful side of C0-C1 (57%), C1-C2 (75%) and C2-C3 (53%), most (79%) and least (25%) restricted sides of the FRT, and manual palpation of the most painful side for the trapezius (53%), masseter (50%) and temporalis (46%) muscles. Provocation of headache during the assessment of C2 and C1-C2 on the most painful side demonstrated the highest association with WAH. CONCLUSION Mechanical provocation of headache is more frequent in people with WAH than in those without headache soon after a whiplash injury.
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Affiliation(s)
- E Anarte-Lazo
- Doctoral Program in Health Sciences, University of Seville, Seville, Spain; Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - C Rodriguez-Blanco
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - C Bernal-Utrera
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain.
| | - D Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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22
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Di Antonio S, Arendt-Nielsen L, Ponzano M, Bovis F, Torelli P, Pelosin E, Finocchi C, Castaldo M. Migraine patients with and without neck pain: Differences in clinical characteristics, sensitization, musculoskeletal impairments, and psychological burden. Musculoskelet Sci Pract 2023; 66:102800. [PMID: 37344290 DOI: 10.1016/j.msksp.2023.102800] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/07/2023] [Accepted: 06/10/2023] [Indexed: 06/23/2023]
Abstract
AIMS This study aims to assess differences in clinical characteristics across healthy controls and migraine patients with (MNP) and without (MwoNP) neck pain. METHOD This study assessed: headache frequency; headache disability index (HDI); central sensitization inventory (CSI); Hospital Anxiety (HADS-A) and Depression (HADS-D) scale; active range of motion (AROM); flexion rotation test (FRT); activation pressure score (APS); number of active/latent myofascial trigger points (MTrPs) in head/neck muscles; number of positive cervical vertebral segments (C1/C2) who reproduce migraine pain; wind-up ratio (WUR); mechanical pain threshold (MPT) and static pressure pain threshold (sPPT) over the trigeminal area; sPPT and dynamic PPT (dPPT) over the cervical area; sPPTs and MPT over the hand. RESULTS Compared to controls, MNP had: worse CSI, HADS-A, and HADS-D (all, p < 0.002); reduced AROM (flexion, extension, left lateral-flexion, and right-rotation), FRT, APS, and a higher number of MTrPs and positive cervical vertebral segments (all, p < 0.020); reduced trigeminal MPT and sPPT, cervical sPPT and dPPT, hand MPT and sPPT (all, p < 0.006). Compared to controls, MwoNP had: worse CSI, and HADS-A (all, p < 0.002); reduced AROM (flexion, and left lateral-flexion), FRT, APS, and a higher number of MTrPs and positive cervical vertebral segments (all, p < 0.017); reduced trigeminal MPT and cervical dPPT (all, p < 0.007). Compared to MwoNP, MNP had higher headache frequency, worse HDI and CSI (all, p < 0.006); reduced AROM (flexion, and right rotation) (all, p < 0.037); reduced cervical dPPT (all, p < 0.002). CONCLUSION MNP had worse headache characteristics, more pronounced cervical musculoskeletal impairments, enhanced signs and symptoms related to sensitization, and worse psychological burden compared to MwoNP.
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Affiliation(s)
- Stefano Di Antonio
- Department of Health Science and Technology, Center for Pain and Neuroplasticity (CNAP), SMI, School of Medicine, Aalborg University, 9220, Aalborg, Denmark; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, 16132, Genoa, Italy
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Center for Pain and Neuroplasticity (CNAP), SMI, School of Medicine, Aalborg University, 9220, Aalborg, Denmark; Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, 9220, Aalborg, Denmark; Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, 9220, Aalborg, Denmark
| | - Marta Ponzano
- Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genoa, 16132, Genoa, Italy
| | - Francesca Bovis
- Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genoa, 16132, Genoa, Italy
| | - Paola Torelli
- Headache Centre, Department of Medicine and Surgery, University of Parma, 43126, Parma, Italy
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, 16132, Genoa, Italy; IRCCS, Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Cinzia Finocchi
- IRCCS, Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Matteo Castaldo
- Department of Health Science and Technology, Center for Pain and Neuroplasticity (CNAP), SMI, School of Medicine, Aalborg University, 9220, Aalborg, Denmark.
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23
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Sollmann N, Schandelmaier P, Weidlich D, Stelter J, Joseph GB, Börner C, Schramm S, Beer M, Zimmer C, Landgraf MN, Heinen F, Karampinos DC, Baum T, Bonfert MV. Headache frequency and neck pain are associated with trapezius muscle T2 in tension-type headache among young adults. J Headache Pain 2023; 24:84. [PMID: 37438700 DOI: 10.1186/s10194-023-01626-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/05/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Tension-type headache (TTH) is the most prevalent primary headache disorder. Neck pain is commonly associated with primary headaches and the trigemino-cervical complex (TCC) refers to the convergence of trigeminal and cervical afferents onto neurons of the brainstem, thus conceptualizes the emergence of headache in relation to neck pain. However, no objective biomarkers exist for the myofascial involvement in primary headaches. This study aimed to investigate the involvement of the trapezius muscles in primary headache disorders by quantitative magnetic resonance imaging (MRI), and to explore associations between muscle T2 values and headache frequency and neck pain. METHODS This cohort study prospectively enrolled fifty participants (41 females, age range 20-31 years): 16 subjects with TTH only (TTH-), 12 with mixed-type TTH plus migraine (TTH+), and 22 healthy controls (HC). The participants completed fat-suppressed T2-prepared three-dimensional turbo spin-echo MRI, a headache diary (over 30 days prior to MRI), manual palpation (two weeks before MRI), and evaluation of neck pain (on the day of MRI). The bilateral trapezius muscles were manually segmented, followed by muscle T2 extraction. Associations between muscle T2 and the presence of neck pain as well as the number of days with headache (considering the 30 days prior to imaging using the headache calendar) were analyzed using regression models (adjusting for age, sex, and body mass index). RESULTS The TTH+ group demonstrated the highest muscle T2 values (right side: 31.4 ± 1.2 ms, left side: 31.4 ± 0.8 ms) as compared to the TTH- group or HC group (p < 0.001). Muscle T2 was significantly associated with the number of headache days (β-coefficient: 2.04, p = 0.04) and the presence of neck pain (odds ratio: 2.26, p = 0.04). With muscle T2 as the predictor, the area under the curve for differentiating between HC and the TTH+ group was 0.82. CONCLUSIONS Increased T2 of trapezius muscles may represent an objective imaging biomarker for myofascial involvement in primary headache disorders, which could help to improve patient phenotyping and therapy evaluation. Pathophysiologically, the increased muscle T2 values could be interpreted as a surrogate of neurogenic inflammation and peripheral sensitization within myofascial tissues.
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Affiliation(s)
- Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany.
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
| | - Paul Schandelmaier
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Pediatrics - Dr. von Hauner Children's Hospital, Division of Pediatric Neurology and Developmental Medicine, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity - iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Dominik Weidlich
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jonathan Stelter
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Gabby B Joseph
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Corinna Börner
- Department of Pediatrics - Dr. von Hauner Children's Hospital, Division of Pediatric Neurology and Developmental Medicine, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity - iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Severin Schramm
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Mirjam N Landgraf
- Department of Pediatrics - Dr. von Hauner Children's Hospital, Division of Pediatric Neurology and Developmental Medicine, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity - iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Florian Heinen
- Department of Pediatrics - Dr. von Hauner Children's Hospital, Division of Pediatric Neurology and Developmental Medicine, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity - iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michaela V Bonfert
- Department of Pediatrics - Dr. von Hauner Children's Hospital, Division of Pediatric Neurology and Developmental Medicine, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity - iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
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24
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Shaffer SM, Naze GS. Evaluation and management of temporomandibular disorders. Part 1: an orthopedic physical therapy update on examination and clinical reasoning. J Man Manip Ther 2023; 31:133-142. [PMID: 36245265 PMCID: PMC10288910 DOI: 10.1080/10669817.2022.2123171] [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: 10/24/2022] Open
Abstract
Temporomandibular (TM) disorders afflict many people globally and, despite the presence of existing peer-reviewed material that assists conservative orthopedic providers, recent advances in knowledge indicate that updated resources are required for students, clinicians, and educators. This two-part series builds off previously published material to present newer supplementary information that can be useful during the evaluation and management processes. Content in Part 1 of this series includes a discussion about the factors that have been shown to contribute to TM disorders, an updated perspective of relevant pain science, a discussion of self-report outcome measures, and various different topics related to the examination of patients with TM disorders. Part 2 addresses information related to the temporomandibular joint disc, joint hypermobility, oral splints, and clinical reasoning. In combination with other available publications, this two-part series provides clinicians an opportunity to improve their delivery of effective and efficient clinical services for people diagnosed with TM disorders.
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Affiliation(s)
- Stephen M. Shaffer
- College of Education, Nursing, and Health Professions, Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, USA
| | - Garrett S. Naze
- Congdon School of Health Sciences, Department of Physical Therapy, High Point University, High Point, NC, USA
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25
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Ong Sio LC, Hom B, Garg S, Abd-Elsayed A. Mechanism of Action of Peripheral Nerve Stimulation for Chronic Pain: A Narrative Review. Int J Mol Sci 2023; 24:ijms24054540. [PMID: 36901970 PMCID: PMC10003676 DOI: 10.3390/ijms24054540] [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: 01/12/2023] [Revised: 02/08/2023] [Accepted: 02/22/2023] [Indexed: 03/02/2023] Open
Abstract
The use of stimulation of peripheral nerves to test or treat various medical disorders has been prevalent for a long time. Over the last few years, there has been growing evidence for the use of peripheral nerve stimulation (PNS) for treating a myriad of chronic pain conditions such as limb mononeuropathies, nerve entrapments, peripheral nerve injuries, phantom limb pain, complex regional pain syndrome, back pain, and even fibromyalgia. The ease of placement of a minimally invasive electrode via percutaneous approach in the close vicinity of the nerve and the ability to target various nerves have led to its widespread use and compliance. While most of the mechanism behind its role in neuromodulation is largely unknown, the gate control theory proposed by Melzack and Wall in the 1960s has been the mainstay for understanding its mechanism of action. In this review article, the authors performed a literature review to discuss the mechanism of action of PNS and discuss its safety and usefulness in treating chronic pain. The authors also discuss current PNS devices available in the market today.
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Affiliation(s)
- Lady Christine Ong Sio
- Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Brian Hom
- Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Shuchita Garg
- Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
- Correspondence: ; Tel.: +1-608-263-8100; Fax: +1-608-263-0575
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26
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Human Brain Organoids in Migraine Research: Pathogenesis and Drug Development. Int J Mol Sci 2023; 24:ijms24043113. [PMID: 36834522 PMCID: PMC9961184 DOI: 10.3390/ijms24043113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
Human organoids are small, self-organized, three-dimensional (3D) tissue cultures that have started to revolutionize medical science in terms of understanding disease, testing pharmacologically active compounds, and offering novel ways to treat disease. Organoids of the liver, kidney, intestine, lung, and brain have been developed in recent years. Human brain organoids are used for understanding pathogenesis and investigating therapeutic options for neurodevelopmental, neuropsychiatric, neurodegenerative, and neurological disorders. Theoretically, several brain disorders can be modeled with the aid of human brain organoids, and hence the potential exists for understanding migraine pathogenesis and its treatment with the aid of brain organoids. Migraine is considered a brain disorder with neurological and non-neurological abnormalities and symptoms. Both genetic and environmental factors play essential roles in migraine pathogenesis and its clinical manifestations. Several types of migraines are classified, for example, migraines with and without aura, and human brain organoids can be developed from patients with these types of migraines to study genetic factors (e.g., channelopathy in calcium channels) and environmental stressors (e.g., chemical and mechanical). In these models, drug candidates for therapeutic purposes can also be tested. Here, the potential and limitations of human brain organoids for studying migraine pathogenesis and its treatment are communicated to generate motivation and stimulate curiosity for further research. This must, however, be considered alongside the complexity of the concept of brain organoids and the neuroethical aspects of the topic. Interested researchers are invited to join the network for protocol development and testing the hypothesis presented here.
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Meise R, Carvalho GF, Thiel C, Luedtke K. Additional effects of pain neuroscience education combined with physiotherapy on the headache frequency of adult patients with migraine: A randomized controlled trial. Cephalalgia 2023; 43:3331024221144781. [PMID: 36739510 DOI: 10.1177/03331024221144781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Aim To assess the efficacy of pain neuroscience education combined with physiotherapy for the management of migraine.Background Physiotherapy can significantly reduce the frequency of migraine, but the evidence is based only on a few studies. Pain neuroscience education might pose a promising treatment, as it addresses migraine as a chronic pain disease.Methods In this non-blinded randomized controlled trial, migraine patients received physiotherapy + pain neuroscience education or physiotherapy alone, preceded by a three-month waiting period. Primary outcomes were frequency of headache (with and without migraine features), frequency of migraine and associated disability.Results Eighty-two participants were randomized and analyzed. Both groups showed a decrease of headache frequency (p = 0.02, d = 0.46) at post-treatment (physiotherapy: 0.77 days, 95%CI: -0.75 to 2.29 and physiotherapy + pain neuroscience education: 1.25 days, 95%CI: -0.05 to 2.55) and at follow-up (physiotherapy: 1.93, 95%CI: 0.07 to 3.78 and physiotherapy + pain neuroscience education: 3.48 days, 95%CI: 1.89 to 5.06), with no difference between groups (p = 0.26, d = 0.26). Migraine frequency was reduced significantly in the physiotherapy + pain neuroscience education group, and not in the physiotherapy group, at post-treatment (1.28 days, 95%CI: 0.34 to 2.22, p = 0.004) and follow-up (3.05 days, 95%CI: 1.98 to 5.06, p < 0.0001), with a difference between groups at follow-up (2.06 days, p = 0.003). Migraine-related disability decreased significantly in both groups (physiotherapy: 19.8, physiotherapy + pain neuroscience education: 24.0 points, p < 0.001, d = 1.15) at follow-up, with no difference between groups (p = 0.583). Secondary outcomes demonstrated a significant effect of time with no interaction between time and group. No harm or adverse events were observed during the study.Conclusion In comparison to physiotherapy alone, pain neuroscience education combined with physiotherapy can further reduce the frequency of migraine, but had no additional effect on general headache frequency or migraine-related disability.Trial Registration The study was pre-registered at the German Clinical Trials Register (DRKS00020804).
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Affiliation(s)
- Ruth Meise
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck, Universitaet zu Luebeck, Luebeck, Germany
| | - Gabriela Ferreira Carvalho
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck, Universitaet zu Luebeck, Luebeck, Germany
| | - Christian Thiel
- Department of Applied Health Sciences, Hochschule fuer Gesundheit (University of Applied Sciences), Bochum, Germany.,Faculty of Sports Science, Ruhr-University Bochum, Bochum, Germany
| | - Kerstin Luedtke
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck, Universitaet zu Luebeck, Luebeck, Germany
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28
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Schramm S, Börner C, Reichert M, Baum T, Zimmer C, Heinen F, Bonfert MV, Sollmann N. Functional magnetic resonance imaging in migraine: A systematic review. Cephalalgia 2023; 43:3331024221128278. [PMID: 36751858 DOI: 10.1177/03331024221128278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Migraine is a highly prevalent primary headache disorder. Despite a high burden of disease, key disease mechanisms are not entirely understood. Functional magnetic resonance imaging is an imaging method using the blood-oxygen-level-dependent signal, which has been increasingly used in migraine research over recent years. This systematic review summarizes recent findings employing functional magnetic resonance imaging for the investigation of migraine. METHODS We conducted a systematic search and selection of functional magnetic resonance imaging applications in migraine from April 2014 to December 2021 (PubMed and references of identified articles according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines). Methodological details and main findings were extracted and synthesized. RESULTS Out of 224 articles identified, 114 were included after selection. Repeatedly emerging structures of interest included the insula, brainstem, limbic system, hypothalamus, thalamus, and functional networks. Assessment of functional brain changes in response to treatment is emerging, and machine learning has been used to investigate potential functional magnetic resonance imaging-based markers of migraine. CONCLUSIONS A wide variety of functional magnetic resonance imaging-based metrics were found altered across the brain for heterogeneous migraine cohorts, partially correlating with clinical parameters and supporting the concept to conceive migraine as a brain state. However, a majority of findings from previous studies have not been replicated, and studies varied considerably regarding image acquisition and analyses techniques. Thus, while functional magnetic resonance imaging appears to have the potential to advance our understanding of migraine pathophysiology, replication of findings in large representative datasets and precise, standardized reporting of clinical data would likely benefit the field and further increase the value of observations.
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Affiliation(s)
- Severin Schramm
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Corinna Börner
- LMU Hospital, Dr. von Hauner Children's Hospital, Department of Pediatric Neurology and Developmental Medicine, Munich, Germany.,LMU Center for Children with Medical Complexity, iSPZ Hauner, Ludwig Maximilian University, Munich, Germany
| | - Miriam Reichert
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Florian Heinen
- LMU Hospital, Dr. von Hauner Children's Hospital, Department of Pediatric Neurology and Developmental Medicine, Munich, Germany
| | - Michaela V Bonfert
- LMU Hospital, Dr. von Hauner Children's Hospital, Department of Pediatric Neurology and Developmental Medicine, Munich, Germany.,LMU Center for Children with Medical Complexity, iSPZ Hauner, Ludwig Maximilian University, Munich, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
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Gawde P, Shah H, Patel H, Bharathi KS, Patel N, Sethi Y, Kaka N. Revisiting Migraine: The Evolving Pathophysiology and the Expanding Management Armamentarium. Cureus 2023; 15:e34553. [PMID: 36879707 PMCID: PMC9985459 DOI: 10.7759/cureus.34553] [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: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
Migraine affects about one billion people worldwide yearly and is one of the most common neurologic illnesses, with a high prevalence and morbidity, particularly among young adults and females. Migraine is associated with many comorbidities, including stress, sleep difficulties, and suicidal ideation. Migraine, despite its widespread occurrence, is underdiagnosed and undertreated. Because of the complicated and primarily unknown mechanisms of migraine formation, several social and biological risk factors, such as hormone imbalances, genetic and epigenetic impacts, and cardiovascular, neurological, and autoimmune illnesses, have been proposed. Through the mid-20th century diversion of the now-defunct vascular theory, the pathophysiology of migraine has developed from a historical study of the "humours" to a distinct entity as a neurological disorder. The range of therapeutic targets has broadened significantly, increasing the number of specialized clinical trials. Understanding the biology of migraine through careful research has resulted in the identification of major therapeutic classes: (i) triptans, serotonin 5-HT1B/1D receptor agonists, (ii) gepants, calcitonin gene-related peptide (CGRP) receptor antagonists, (iii) ditans, 5-HT1F receptor agonists, (iv) CGRP monoclonal antibodies, and (v) glurants, mGlu5 modulators, with further targets being explored. This review provides a comprehensive overview of the most recent literature on epidemiology and risk factors and exposes knowledge gaps.
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Affiliation(s)
- Prathamesh Gawde
- Medicine and Surgery, Lokmanya Tilak Municipal Medical College, Mumbai, IND
| | - Harsh Shah
- Medicine and Surgery, Pandit Deendayal Upadhyay Medical College, Rajkot, IND
| | - Harsh Patel
- Internal Medicine, GMERS (Gujarat Medical Education and Research Society) Medical College, Sola, Ahmedabad, IND
| | | | - Neil Patel
- Medicine and Surgery, GMERS (Gujarat Medical Education and Research Society) Medical College, Himmatnagar, IND
| | - Yashendra Sethi
- Medicine and Surgery, Government Doon Medical College, Dehradun, IND
| | - Nirja Kaka
- Medicine and Surgery, GMERS (Gujarat Medical Education and Research Society) Medical College, Himmatnagar, IND
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30
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Chowdhury D, Tomar A, Deorari V, Duggal A, Krishnan A, Koul A. Greater occipital nerve blockade for the preventive treatment of chronic migraine: A randomized double-blind placebo-controlled study. Cephalalgia 2023; 43:3331024221143541. [PMID: 36739512 DOI: 10.1177/03331024221143541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Greater occipital nerve blockade for the prevention of chronic migraine has a limited evidence base. A robust randomized double-blind, placebo-controlled trial is needed. METHODS This double-blind, placebo-controlled, parallel-group trial, following a baseline period of four weeks, randomly assigned patients of chronic migraine 1:1 to receive four-weekly bilateral greater occipital nerve blockade with either 2 ml of 2% (40 mg) lidocaine (active group) or 2 ml of 0.9% saline (placebo) injections for 12 weeks. The primary and key secondary efficacy endpoints were a change from the baseline in the mean number of headache and migraine days and the achievement of ≥50% reduction in headache days from baseline across the weeks 9-12 respectively. Safety evaluations included the documentation and reporting of serious and other adverse events. RESULTS Twenty-two patients each were randomly allocated to the active and placebo group. Baseline demography and clinical characteristics were similar between the two groups. Mean headache and migraine days at baseline (±SD) were 23.4 ± 4.4 and 15.6 ± 5.7 days in the active group and 22.6 ± 5.0 and 14.6 ± 4.6 days in the placebo group respectively. The active group compared to the placebo had a significantly greater least-squares mean reduction in the number of headache and migraine days (-4.2 days [95% CI: -7.5 to -0.8; p = 0.018] and -4.7 days [95%CI: -7.7 to -1.7; p = 0.003] respectively). 40.9% of patients in the active group achieved ≥50% reduction in headache days as compared with 9.1% of patients receiving a placebo (p = 0.024). Overall, 64 mild and transient adverse events were reported by 16 patients in the active group and 15 in the placebo. No death or serious adverse events were reported. CONCLUSION Four-weekly greater occipital nerve blockade with 2% lidocaine for 12 weeks was superior to placebo in decreasing the average number of headache and migraine days in patients with chronic migraine with a good tolerability profile.Clinical trial.gov no. CTRI 2020/07/026709.
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Affiliation(s)
- Debashish Chowdhury
- Department of Neurology, G B Pant institute of Post Graduate Medical Education and Research, Maulana Azad Medical College, New Delhi, India
| | - Apoorva Tomar
- Department of Neurology, G B Pant institute of Post Graduate Medical Education and Research, Maulana Azad Medical College, New Delhi, India
| | - Vaibhav Deorari
- Department of Neurology, G B Pant institute of Post Graduate Medical Education and Research, Maulana Azad Medical College, New Delhi, India
| | - Ashish Duggal
- Department of Neurology, G B Pant institute of Post Graduate Medical Education and Research, Maulana Azad Medical College, New Delhi, India
| | - Anand Krishnan
- Department of Community Medicine, All India Institute of Medical sciences, New Delhi, India
| | - Arun Koul
- Department of Neurology, G B Pant institute of Post Graduate Medical Education and Research, Maulana Azad Medical College, New Delhi, India
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Ashina S, Bendtsen L, Burstein R, Iljazi A, Jensen RH, Lipton RB. Pain sensitivity in relation to frequency of migraine and tension-type headache with or without coexistent neck pain: an exploratory secondary analysis of the population study. Scand J Pain 2023; 23:76-87. [PMID: 36137215 DOI: 10.1515/sjpain-2022-0030] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/30/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES We aimed to investigate whether coexistent self-reported neck pain influences cephalic and extracephalic pain sensitivity in individuals with migraine and tension-type headache (TTH) in relation to diagnosis and headache frequency. METHODS A population of 496 individuals completed a headache interview based on ICHD criteria, providing data collected by self-administered questionnaires, assessments of pericranial total tenderness score (TTS) and pressure pain thresholds (PPT). Stimulus-response (SR) functions for pressure vs. pain were recorded. Presence of neck pain in the past year was assessed by the self-administered questionnaire. We categorized participants by primary headache type. We also categorized participants into 3 groups by headache frequency: chronic (≥15) or episodic (<15 headache days/month) headache and controls. TTS, PPTs and the area under the SR curve were compared between subgroups using Generalized Linear Models with pairwise comparisons controlling for age and sex. RESULTS Individuals with chronic followed by episodic headache had higher TTS than controls (overall p≤0.001). The difference between chronic and episodic headache subgroups was significant in the group with neck pain (p≤0.001) but not in the group without neck pain. In individuals with neck pain, mean TTS was higher in coexistent headache (migraine and TTH), 23.2 ± 10.7, and pure TTH, 17.8 ± 10.3, compared to pure migraine, 15.9 ± 10.9 and no headache 11.0 ± 8.3 (overall p<0.001). Temporal and finger PPTs did not statistically differ among the chronic headache, the episodic headache and controls in individuals with and without neck pain. Temporalis and trapezius SR-functions showed that tenderness was increased in individuals with chronic headache to higher degree than in those with episodic headache, and more so in those with neck pain. CONCLUSIONS Coexistent neck pain is associated with greater pericranial tenderness in individuals with chronic headache and to a lesser degree in those with episodic headache. Sensitization may be a substrate or consequence of neck pain and primary headache, but a longitudinal study would be needed for further clarification.
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Affiliation(s)
- Sait Ashina
- BIDMC Comprehensive Headache Center, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars Bendtsen
- Danish Headache Center, Department of Neurology, Faculty of Health Sciences, University of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Rami Burstein
- BIDMC Comprehensive Headache Center, Harvard Medical School, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Afrim Iljazi
- Department of Orthopedic Surgery, University of Copenhagen, Copenhagen, Denmark
| | - Rigmor Hoejland Jensen
- Danish Headache Center, Department of Neurology, Faculty of Health Sciences, University of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine and Montefiore Headache Center, Bronx, NY, USA
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Göbel N. Auswirkungen manueller Therapie am Kiefergelenk und der oberen Halswirbelsäule auf die Kopfschmerzen von Patienten mit kraniomandibulärer Dysfunktion. MANUELLE MEDIZIN 2023. [DOI: 10.1007/s00337-022-00933-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Niraj G, Critchley P. Management and outcomes of persistent headache after accidental dural puncture in the obstetric population: A 9-year prospective audit. Headache 2023; 63:71-78. [PMID: 36651506 DOI: 10.1111/head.14447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To assess the effectiveness and safety of a novel management pathway in the obstetric population presenting to a pain medicine clinic with persistent headache after accidental dural puncture (PHADP). BACKGROUND Accidental dural puncture (ADP) can result in headaches that persist for months to years. These headaches can be a therapeutic challenge, often cause severe disability, and management pathway remains obscure. METHODS Obstetric patients with PHADP referred to a pain medicine physician were prospectively followed up in a longitudinal audit of a novel management pathway. ADP reports dated from 2008 until 2019. Initial management included brain imaging and pharmacological agents. Patients who failed to respond were offered greater occipital nerve (GON) block with depot methylprednisolone followed by pulsed radiofrequency (PRF) treatment. A headache diary was completed for 4 weeks prior to commencing treatment and maintained for 24 weeks following an intervention. Data collected included use of epidural blood patch to manage postdural puncture headache, past history of headache, severity of headache, duration of persistent headache, low back pain, and employment status. RESULTS Over the 9-year period, a cohort of 54 obstetric patients with PHADP with a 16-gauge Tuohy needle were reviewed in the pain clinic. Forty patients presented with chronic daily headache (40/54, 74%). Brain imaging did not reveal any sign of intracranial hypotension in 50 patients (50/54, 93%). Mean follow-up period was 5.7 years. Two patients were lost to follow-up (2/54, 4%). Pharmacological management was effective in 17 patients (17/52, 33%). Medical management failed to improve symptoms in 35 patients (35/52, 67%), and they were offered GON block. Fourteen (14/35, 40%) patients refused the intervention. Nerve block was performed in 21 patients and produced durable benefit lasting 24 weeks in 18 patients (18/21, 86%). Three patients underwent PRF treatment to GONs and all three (100%) reported durable benefit. At final follow-up, mean monthly headache frequency was 5.9 for the medical management group, 8.6 for the refused nerve block group, and 4.1 in patients who received GON treatment (p < 0.001). CONCLUSION ADP can cause chronic headaches that persist beyond 3 years. Interventions targeting the GONs appear to have a role in the management of PHADP.
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Affiliation(s)
- G Niraj
- Clinical Research Unit in Pain Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Peter Critchley
- Clinical Research Unit in Pain Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
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Andreou AP, Pereira AD. Migraine headache pathophysiology. HANDBOOK OF CLINICAL NEUROLOGY 2023; 198:61-69. [PMID: 38043971 DOI: 10.1016/b978-0-12-823356-6.00018-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
In both episodic and chronic migraine, headache is the most disabling symptom that requires medical care. The migraine headache is the most well-studied symptom of migraine pathophysiology. The trigeminal system and the central processing of sensory information transmitted by the trigeminal system are of considerable importance in the pathophysiology of migraine headache. Glutamate is the main neurotransmitter that drives activation of the ascending trigeminal and trigeminothalamic pathways. The neuropeptide, calcitonin gene-related peptide (CGRP) that is released by the trigeminal system, plays a crucial role in the neurobiology of headache. Peripheral and central sensitizations associated with trigeminal sensory processing are neurobiologic states that contribute to both the development of headache during a migraine attack and the maintenance of chronic migraine.
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Affiliation(s)
- Anna P Andreou
- Headache Research-Wolfson Centre for Age-Related Diseases (CARD), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Headache Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Ana D Pereira
- Headache Research-Wolfson Centre for Age-Related Diseases (CARD), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Robertson CE, Benarroch EE. The anatomy of head pain. HANDBOOK OF CLINICAL NEUROLOGY 2023; 198:41-60. [PMID: 38043970 DOI: 10.1016/b978-0-12-823356-6.00001-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Pain-sensitive structures in the head and neck, including the scalp, periosteum, meninges, and blood vessels, are innervated predominantly by the trigeminal and upper cervical nerves. The trigeminal nerve supplies most of the sensation to the head and face, with the ophthalmic division (V1) providing innervation to much of the supratentorial dura mater and vessels. This creates referral patterns for pain that may be misleading to clinicians and patients, as described by studies involving awake craniotomies and stimulation with electrical and mechanical stimuli. Most brain parenchyma and supratentorial vessels refer pain to the ipsilateral V1 territory, and less commonly the V2 or V3 region. The upper cervical nerves provide innervation to the posterior scalp, while the periauricular region and posterior fossa are territories with shared innervation. Afferent fibers that innervate the head and neck send nociceptive input to the trigeminocervical complex, which then projects to additional pain processing areas in the brainstem, thalamus, hypothalamus, and cortex. This chapter discusses the pain-sensitive structures in the head and neck, including pain referral patterns for many of these structures. It also provides an overview of peripheral and central nervous system structures responsible for transmitting and interpreting these nociceptive signals.
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Affiliation(s)
- Carrie E Robertson
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, United States.
| | - Eduardo E Benarroch
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
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Abanoz Y, Gülen Abanoz Y, Gündüz A, Karadeniz D, Erdemir Kızıltan M. Long latency trigemino-cervical reflex in restless legs syndrome. Int J Neurosci 2022:1-7. [PMID: 36533413 DOI: 10.1080/00207454.2022.2158826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 10/27/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The trigemino-cervical complex (TCC) seems under dopaminergic inhibitory control and the abnormalities of trigemino-cervical reflex (TCR) have been reported in disorders associated with the dopaminergic system and various pain disorders. If the inhibitory response in TCC is likely dopaminergic, we hypothesized that TCR, which has never been evaluated in restless legs syndrome (RLS) patients before, would be also abnormal. METHODS TCR was recorded from bilateral sternocleidomastoid and splenius capitis muscles in consecutive 15 drug-naive RLS patients and 16 age- and sex-matched healthy subjects. The right and left infraorbital branches of the trigeminal nerve were stimulated by percutaneous electrical stimulation separately. The presence rates, onset latencies, amplitudes, and durations of responses were measured and compared between patients with RLS and controls. RESULTS The presence rates, onset latencies and amplitudes of TCR responses were similar between RLS patients and controls, however, the durations of responses were bilaterally longer in RLS patients compared to healthy volunteers. CONCLUSIONS Hyperexcitability of TCR suggests defective sensory processing in the brainstem probably due to impairment of descending inhibitory dopaminergic system in RLS. The sensitization of TCC in RLS patients may also be a possible factor that might explain the association of RLS and pain disorders.
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Affiliation(s)
- Yasin Abanoz
- Department of Electroneurophysiology, Advanced Vocational School, Doğuş University, Istanbul, Turkey
| | - Yeşim Gülen Abanoz
- Department of Electroneurophysiology, Advanced Vocational School, Doğuş University, Istanbul, Turkey
| | - Ayşegül Gündüz
- Department of Neurology, School of Medicine, İstanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Derya Karadeniz
- Department of Neurology, School of Medicine, İstanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Meral Erdemir Kızıltan
- Department of Neurology, School of Medicine, İstanbul University-Cerrahpaşa, Istanbul, Turkey
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Ipsilateral Limb Extension of Referred Trigeminal Facial Pain due to Greater Occipital Nerve Entrapment: A Case Report. Case Rep Neurol Med 2022; 2022:9381881. [PMID: 36505755 PMCID: PMC9734007 DOI: 10.1155/2022/9381881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 08/17/2022] [Accepted: 11/07/2022] [Indexed: 12/05/2022] Open
Abstract
We report a very rare case of referred pain associated with entrapment of the greater occipital nerve (GON) occurring not only in the ipsilateral hemiface but also in the ipsilateral limb. There is an extensive convergence of cutaneous, tooth pulp, visceral, neck, and muscle afferents onto nociceptive and nonnociceptive neurons in the trigeminal nucleus caudalis (medullary dorsal horn). In addition, nociceptive input from trigeminal, meningeal afferents projects into trigeminal nucleus caudalis and dorsal horn of C1 and C2. Together, they form a functional unit, the trigeminocervical complex (TCC). The nociceptive inflow from suboccipital and high cervical structures is mediated with small-diameter afferent fibers in the upper cervical roots terminating in the dorsal horn of the cervical cord extending from the C2 segment up to the medullary dorsal horn. The major afferent contribution is mediated by the spinal root C2 that is peripherally represented by the greater occipital nerve (GON). Convergence of afferent signals from the trigeminal nerve and the GON onto the TCC is regarded as an anatomical basis of pain referral in craniofacial pain and primary headache syndrome. Ipsilateral limb pain occurs long before the onset of the referred facial pain. The subsequent severe hemifacial pain suggested GON entrapment. The occipital nerve block provided temporary relief from facial and extremity pain. Imaging studies found a benign osteoma in the ipsilateral suboccipital bone, but no direct contact with GON was identified. During GON decompression, severe entrapment of the GON was observed by the tendinous aponeurotic edge of the trapezius muscle, but the osteoma had no contact with the nerve. Following GON decompression, the referred trigeminal and extremity pain completely disappeared. The pain referral from GON entrapment seems to be attributed to the sensitization and hypersensitivity of the trigeminocervical complex (TCC). The clinical manifestations of TCC hypersensitivity induced by chronic entrapment of GONs are diverse when considering the occurrence of extremity pain as well as facial pain.
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Stern JI, Chiang C, Kissoon NR, Robertson CE. Narrative review of peripheral nerve blocks for the management of headache. Headache 2022; 62:1077-1092. [DOI: 10.1111/head.14385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/21/2022] [Accepted: 07/18/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Jennifer I. Stern
- Headache Division, Department of Neurology Mayo Clinic Rochester Minnesota USA
| | - Chia‐Chun Chiang
- Headache Division, Department of Neurology Mayo Clinic Rochester Minnesota USA
| | - Narayan R. Kissoon
- Headache Division, Department of Neurology Mayo Clinic Rochester Minnesota USA
- Division of Pain Medicine, Department of Anesthesiology Mayo Clinic Rochester Minnesota USA
| | - Carrie E. Robertson
- Headache Division, Department of Neurology Mayo Clinic Rochester Minnesota USA
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Fu C, Zhang Y, Ye Y, Hou X, Wen Z, Yan Z, Luo W, Feng M, Liu B. Predicting response to tVNS in patients with migraine using functional MRI: A voxels-based machine learning analysis. Front Neurosci 2022; 16:937453. [PMID: 35992927 PMCID: PMC9388938 DOI: 10.3389/fnins.2022.937453] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMigraine is a common disorder, affecting many patients. However, for one thing, lacking objective biomarkers, misdiagnosis, and missed diagnosis happen occasionally. For another, though transcutaneous vagus nerve stimulation (tVNS) could alleviate migraine symptoms, the individual difference of tVNS efficacy in migraineurs hamper the clinical application of tVNS. Therefore, it is necessary to identify biomarkers to discriminate migraineurs as well as select patients suitable for tVNS treatment.MethodsA total of 70 patients diagnosed with migraine without aura (MWoA) and 70 matched healthy controls were recruited to complete fMRI scanning. In study 1, the fractional amplitude of low-frequency fluctuation (fALFF) of each voxel was calculated, and the differences between healthy controls and MWoA were compared. Meaningful voxels were extracted as features for discriminating model construction by a support vector machine. The performance of the discriminating model was assessed by accuracy, sensitivity, and specificity. In addition, a mask of these significant brain regions was generated for further analysis. Then, in study 2, 33 of the 70 patients with MWoA in study 1 receiving real tVNS were included to construct the predicting model in the generated mask. Discriminative features of the discriminating model in study 1 were used to predict the reduction of attack frequency after a 4-week tVNS treatment by support vector regression. A correlation coefficient between predicted value and actual value of the reduction of migraine attack frequency was conducted in 33 patients to assess the performance of predicting model after tVNS treatment. We vislized the distribution of the predictive voxels as well as investigated the association between fALFF change (post-per treatment) of predict weight brain regions and clinical outcomes (frequency of migraine attack) in the real group.ResultsA biomarker containing 3,650 features was identified with an accuracy of 79.3%, sensitivity of 78.6%, and specificity of 80.0% (p < 0.002). The discriminative features were found in the trigeminal cervical complex/rostral ventromedial medulla (TCC/RVM), thalamus, medial prefrontal cortex (mPFC), and temporal gyrus. Then, 70 of 3,650 discriminative features were identified to predict the reduction of attack frequency after tVNS treatment with a correlation coefficient of 0.36 (p = 0.03). The 70 predictive features were involved in TCC/RVM, mPFC, temporal gyrus, middle cingulate cortex (MCC), and insula. The reduction of migraine attack frequency had a positive correlation with right TCC/RVM (r = 0.433, p = 0.021), left MCC (r = 0.451, p = 0.016), and bilateral mPFC (r = 0.416, p = 0.028), and negative with left insula (r = −0.473, p = 0.011) and right superior temporal gyrus/middle temporal gyrus (r = −0.684, p < 0.001), respectively.ConclusionsBy machine learning, the study proposed two potential biomarkers that could discriminate patients with MWoA and predict the efficacy of tVNS in reducing migraine attack frequency. The pivotal features were mainly located in the TCC/RVM, thalamus, mPFC, and temporal gyrus.
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Affiliation(s)
- Chengwei Fu
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yue Zhang
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yongsong Ye
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoyan Hou
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zeying Wen
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Radiology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Zhaoxian Yan
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wenting Luo
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Menghan Feng
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bo Liu
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Bo Liu
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Börner C, Renner T, Trepte-Freisleder F, Urban G, Schandelmaier P, Lang M, Lechner MF, Koenig H, Klose B, Albers L, Krieg SM, Baum T, Heinen F, Landgraf MN, Sollmann N, Bonfert MV. Response Predictors of Repetitive Neuromuscular Magnetic Stimulation in the Preventive Treatment of Episodic Migraine. Front Neurol 2022; 13:919623. [PMID: 35989916 PMCID: PMC9384696 DOI: 10.3389/fneur.2022.919623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundRepetitive neuromuscular magnetic stimulation (rNMS) of the trapezius muscles showed beneficial effects in preventing episodic migraine. However, clinical characteristics that predict a favorable response to rNMS are unknown. The objective of this analysis is to identify such predictors.MethodsThirty participants with a diagnosis of episodic migraine (mean age: 24.8 ± 4.0 years, 29 females), who were prospectively enrolled in two non-sham-controlled studies evaluating the effects of rNMS were analyzed. In these studies, the interventional stimulation of the bilateral trapezius muscles was applied in six sessions and distributed over two consecutive weeks. Baseline and follow-up assessments included the continuous documentation of a headache calendar over 30 days before and after the stimulation period, the Migraine Disability Assessment Score (MIDAS) questionnaire (before stimulation and 90 days after stimulation), and measurements of pain pressure thresholds (PPTs) above the trapezius muscles by algometry (before and after each stimulation session). Participants were classified as responders based on a ≥25% reduction in the variable of interest (headache frequency, headache intensity, days with analgesic intake, MIDAS score, left-sided PPTs, right-sided PPTs). Post-hoc univariate and multivariate binary logistic regression analyses were performed.ResultsLower headache frequency (P = 0.016) and intensity at baseline (P = 0.015) and a migraine diagnosis without a concurrent tension-type headache component (P = 0.011) were significantly related to a ≥25% reduction in headache frequency. Higher headache frequency (P = 0.052) and intensity at baseline (P = 0.014) were significantly associated with a ≥25% reduction in monthly days with analgesic intake. Lower right-sided PPTs at baseline were significantly related to a ≥25% increase in right-sided PPTs (P = 0.0.015) and left-sided PPTs (P =0.030). Performance of rNMS with higher stimulation intensities was significantly associated with a ≥25% reduction in headache intensity (P = 0.046).ConclusionsClinical headache characteristics at baseline, the level of muscular hyperalgesia, and stimulation intensity may inform about how well an individual patient responds to rNMS. These factors may allow an early identification of patients that would most likely benefit from rNMS.
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Affiliation(s)
- Corinna Börner
- Division of Pediatric Neurology and Developmental Medicine and LMU Center for Children With Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Tabea Renner
- Division of Pediatric Neurology and Developmental Medicine and LMU Center for Children With Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Florian Trepte-Freisleder
- Division of Pediatric Neurology and Developmental Medicine and LMU Center for Children With Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Giada Urban
- Division of Pediatric Neurology and Developmental Medicine and LMU Center for Children With Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Paul Schandelmaier
- Division of Pediatric Neurology and Developmental Medicine and LMU Center for Children With Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Magdalena Lang
- Division of Pediatric Neurology and Developmental Medicine and LMU Center for Children With Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Matthias F. Lechner
- Division of Pediatric Neurology and Developmental Medicine and LMU Center for Children With Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Helene Koenig
- Division of Pediatric Neurology and Developmental Medicine and LMU Center for Children With Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Birgit Klose
- Division of Pediatric Neurology and Developmental Medicine and LMU Center for Children With Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Lucia Albers
- Division of Pediatric Neurology and Developmental Medicine and LMU Center for Children With Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sandro M. Krieg
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Florian Heinen
- Division of Pediatric Neurology and Developmental Medicine and LMU Center for Children With Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Mirjam N. Landgraf
- Division of Pediatric Neurology and Developmental Medicine and LMU Center for Children With Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- *Correspondence: Nico Sollmann
| | - Michaela V. Bonfert
- Division of Pediatric Neurology and Developmental Medicine and LMU Center for Children With Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität, Munich, Germany
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Gaul C, Gräter H, Weiser T, Michel MC, Lampert A, Plomer M, Förderreuther S. Impact of the Neck and/or Shoulder Pain on Self-reported Headache Treatment Responses – Results From a Pharmacy-Based Patient Survey. Front Neurol 2022; 13:902020. [PMID: 35923833 PMCID: PMC9339896 DOI: 10.3389/fneur.2022.902020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/21/2022] [Indexed: 01/10/2023] Open
Abstract
Neck and/or shoulder pain (NSP) frequently occurs together with headache. Therefore, we explored how patients with and without concomitant NSP differ in their baseline characteristics and in perceived treatment responses to an analgesic. An anonymous survey was performed among 895 patients with headache (735 self-reported tension-type headache [TTH]) who used an analgesic fixed-dose combination containing 400 mg ibuprofen and 100 mg caffeine as a non-prescription treatment. NSP was abundant among patients in our survey (60%) and was associated with >1 additional day of headache per month. Patients with NSP reported predominantly sedentary work more frequently than those without (40 vs. 29%); they also reported physical tension/poor posture as a perceived trigger factor more frequently (70 vs. 16%). The reported pain reduction was comparable in those with and without concomitant NSP regardless of whether assessed as mean pain rating (from about 6 to 1.5 on a 10-point rating scale), patients experiencing a ≥50% in pain reduction (89.6 vs. 88.8%) or becoming pain-free within 2 h (57 vs. 64%). However, recurrence of pain and use of another dose within the same day were more frequent with than without NSP. We conclude that concomitant NSP is frequent in patients with headache but does not substantially alter responses to a non-prescription medication.
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Affiliation(s)
- Charly Gaul
- Headache Center Frankfurt, Frankfurt am Main, Germany
| | - Heidemarie Gräter
- Medical Consumer Healthcare, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - Thomas Weiser
- Medical Consumer Healthcare, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - Martin C. Michel
- Department of Pharmacology, Johannes Gutenberg University, Mainz, Germany
- *Correspondence: Martin C. Michel
| | - Anette Lampert
- Medical Consumer Healthcare, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - Manuel Plomer
- Medical Consumer Healthcare, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
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Börner C, Staisch J, Lang M, Hauser A, Hannibal I, Huß K, Klose B, Lechner MF, Sollmann N, Heinen F, Landgraf MN, Bonfert MV. Repetitive Neuromuscular Magnetic Stimulation for Pediatric Headache Disorders: Muscular Effects and Factors Affecting Level of Response. Brain Sci 2022; 12:brainsci12070932. [PMID: 35884738 PMCID: PMC9320292 DOI: 10.3390/brainsci12070932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 02/04/2023] Open
Abstract
Repetitive neuromuscular magnetic stimulation (rNMS) for pediatric headache disorders is feasible, safe, and alleviates headache symptoms. This study assesses muscular effects and factors affecting response to rNMS. A retrospective chart review included children with headaches receiving six rNMS sessions targeting the upper trapezius muscles. Pressure pain thresholds (PPT) were measured before and after rNMS, and at 3-month follow-up (FU). Mean headache frequency, duration, and intensity within the last 3 months were documented. In 20 patients (14.1 ± 2.7 years), PPT significantly increased from pre- to post-treatment (p < 0.001) sustaining until FU. PPT changes significantly differed between primary headache and post-traumatic headache (PTH) (p = 0.019−0.026). Change in headache frequency was significantly higher in patients with than without neck pain (p = 0.032). A total of 60% of patients with neck pain responded to rNMS (≥25%), while 20% of patients without neck pain responded (p = 0.048). 60% of patients receiving rNMS twice a week were responders, while 33% of patients receiving rNMS less or more frequently responded to treatment, respectively. Alleviation of muscular hyperalgesia was demonstrated sustaining for 3 months, which was emphasized in PTH. The rNMS sessions may positively modulate headache symptoms regardless of headache diagnosis. Patients with neck pain profit explicitly well. Two rNMS sessions per week led to the highest reduction in headache frequency.
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Affiliation(s)
- Corinna Börner
- LMU Hospital, Department of Pediatrics—Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians Universität, Lindwurm Str. 4, 80337 Munich, Germany; (C.B.); (J.S.); (M.L.); (A.H.); (I.H.); (K.H.); (B.K.); (M.F.L.); (F.H.); (M.N.L.)
- LMU Center for Children with Medical Complexity, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians Universität, Lindwurm Str. 4, 80337 Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany;
- TUM-Neuroimaging Center, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Jacob Staisch
- LMU Hospital, Department of Pediatrics—Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians Universität, Lindwurm Str. 4, 80337 Munich, Germany; (C.B.); (J.S.); (M.L.); (A.H.); (I.H.); (K.H.); (B.K.); (M.F.L.); (F.H.); (M.N.L.)
- LMU Center for Children with Medical Complexity, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians Universität, Lindwurm Str. 4, 80337 Munich, Germany
| | - Magdalena Lang
- LMU Hospital, Department of Pediatrics—Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians Universität, Lindwurm Str. 4, 80337 Munich, Germany; (C.B.); (J.S.); (M.L.); (A.H.); (I.H.); (K.H.); (B.K.); (M.F.L.); (F.H.); (M.N.L.)
- LMU Center for Children with Medical Complexity, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians Universität, Lindwurm Str. 4, 80337 Munich, Germany
| | - Ari Hauser
- LMU Hospital, Department of Pediatrics—Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians Universität, Lindwurm Str. 4, 80337 Munich, Germany; (C.B.); (J.S.); (M.L.); (A.H.); (I.H.); (K.H.); (B.K.); (M.F.L.); (F.H.); (M.N.L.)
- LMU Center for Children with Medical Complexity, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians Universität, Lindwurm Str. 4, 80337 Munich, Germany
| | - Iris Hannibal
- LMU Hospital, Department of Pediatrics—Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians Universität, Lindwurm Str. 4, 80337 Munich, Germany; (C.B.); (J.S.); (M.L.); (A.H.); (I.H.); (K.H.); (B.K.); (M.F.L.); (F.H.); (M.N.L.)
- LMU Center for Children with Medical Complexity, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians Universität, Lindwurm Str. 4, 80337 Munich, Germany
| | - Kristina Huß
- LMU Hospital, Department of Pediatrics—Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians Universität, Lindwurm Str. 4, 80337 Munich, Germany; (C.B.); (J.S.); (M.L.); (A.H.); (I.H.); (K.H.); (B.K.); (M.F.L.); (F.H.); (M.N.L.)
- LMU Center for Children with Medical Complexity, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians Universität, Lindwurm Str. 4, 80337 Munich, Germany
| | - Birgit Klose
- LMU Hospital, Department of Pediatrics—Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians Universität, Lindwurm Str. 4, 80337 Munich, Germany; (C.B.); (J.S.); (M.L.); (A.H.); (I.H.); (K.H.); (B.K.); (M.F.L.); (F.H.); (M.N.L.)
- LMU Center for Children with Medical Complexity, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians Universität, Lindwurm Str. 4, 80337 Munich, Germany
| | - Matthias F. Lechner
- LMU Hospital, Department of Pediatrics—Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians Universität, Lindwurm Str. 4, 80337 Munich, Germany; (C.B.); (J.S.); (M.L.); (A.H.); (I.H.); (K.H.); (B.K.); (M.F.L.); (F.H.); (M.N.L.)
- LMU Center for Children with Medical Complexity, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians Universität, Lindwurm Str. 4, 80337 Munich, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany;
- TUM-Neuroimaging Center, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Florian Heinen
- LMU Hospital, Department of Pediatrics—Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians Universität, Lindwurm Str. 4, 80337 Munich, Germany; (C.B.); (J.S.); (M.L.); (A.H.); (I.H.); (K.H.); (B.K.); (M.F.L.); (F.H.); (M.N.L.)
- LMU Center for Children with Medical Complexity, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians Universität, Lindwurm Str. 4, 80337 Munich, Germany
| | - Mirjam N. Landgraf
- LMU Hospital, Department of Pediatrics—Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians Universität, Lindwurm Str. 4, 80337 Munich, Germany; (C.B.); (J.S.); (M.L.); (A.H.); (I.H.); (K.H.); (B.K.); (M.F.L.); (F.H.); (M.N.L.)
- LMU Center for Children with Medical Complexity, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians Universität, Lindwurm Str. 4, 80337 Munich, Germany
| | - Michaela V. Bonfert
- LMU Hospital, Department of Pediatrics—Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians Universität, Lindwurm Str. 4, 80337 Munich, Germany; (C.B.); (J.S.); (M.L.); (A.H.); (I.H.); (K.H.); (B.K.); (M.F.L.); (F.H.); (M.N.L.)
- LMU Center for Children with Medical Complexity, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians Universität, Lindwurm Str. 4, 80337 Munich, Germany
- Correspondence:
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Staisch J, Börner C, Lang M, Hauser A, Hannibal I, Huß K, Klose B, Lechner MF, Sollmann N, Heinen F, Landgraf MN, Bonfert MV. Repetitive neuromuscular magnetic stimulation in children with headache. Eur J Paediatr Neurol 2022; 39:40-48. [PMID: 35660103 DOI: 10.1016/j.ejpn.2022.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/20/2022] [Accepted: 04/27/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Repetitive neuromuscular magnetic stimulation (rNMS) was previously applied in adult patients with episodic migraine, showing beneficial effects on headache characteristics, high safety, and convincing satisfaction. This study aims to assess rNMS as a personalized intervention in pediatric headache. METHODS Retrospective chart review including patients with migraine, TTH, mixed type headache, or PTH, who had received at least one test rNMS session targeting the upper trapezius muscles (UTM). RESULTS 33 patients (13.9 ± 2.5 years; 61% females) were included in the primary analysis, resulting in a total of 182 rNMS sessions. 43 adverse events were documented for 40 of those sessions (22%). Most common side effects were tingling (32.6%), muscle sore (25.5%), shoulder (9.3%) and back pain (9.3%). Secondly, in patients (n = 20) undergoing the intervention, headache frequency (p = 0.017) and minimum and maximum intensities (p = 0.017; p = 0.023) significantly decreased from baseline to 3-month after intervention. 11 patients (44%) were classified as ≥25% responders, with 7 patients (28%) experiencing a ≥75% reduction of headache days. After 73% of interventions, patients reported rNMS helped very well or well. A majority of patients would repeat (88.5%) and recommend rNMS (96.2%) to other patients. CONCLUSION rNMS seems to meet the criteria of safety, feasibility, and acceptance among children and adolescents with three age-typical headache disorders. A significant reduction in headache frequency and intensity during a 3 months follow-up was documented. Larger, prospective, randomized, sham-controlled studies are urgently needed to confirm if rNMS may become a new valuable non-invasive, non-pharmacological treatment option for pediatric headache disorders.
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Affiliation(s)
- Jacob Staisch
- LMU Hospital, Department of Pediatrics - Dr. von Hauner Children's Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians University, Munich, Germany; LMU Center for Children with Medical Complexity - iSPZ Hauner, Ludwig-Maximilians University, Munich, Germany
| | - Corinna Börner
- LMU Hospital, Department of Pediatrics - Dr. von Hauner Children's Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians University, Munich, Germany; LMU Center for Children with Medical Complexity - iSPZ Hauner, Ludwig-Maximilians University, Munich, Germany; Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; TUM-Neuroimaging Center, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Magdalena Lang
- LMU Hospital, Department of Pediatrics - Dr. von Hauner Children's Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians University, Munich, Germany; LMU Center for Children with Medical Complexity - iSPZ Hauner, Ludwig-Maximilians University, Munich, Germany
| | - Ari Hauser
- LMU Hospital, Department of Pediatrics - Dr. von Hauner Children's Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians University, Munich, Germany; LMU Center for Children with Medical Complexity - iSPZ Hauner, Ludwig-Maximilians University, Munich, Germany
| | - Iris Hannibal
- LMU Hospital, Department of Pediatrics - Dr. von Hauner Children's Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians University, Munich, Germany; LMU Center for Children with Medical Complexity - iSPZ Hauner, Ludwig-Maximilians University, Munich, Germany
| | - Kristina Huß
- LMU Hospital, Department of Pediatrics - Dr. von Hauner Children's Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians University, Munich, Germany; LMU Center for Children with Medical Complexity - iSPZ Hauner, Ludwig-Maximilians University, Munich, Germany
| | - Birgit Klose
- LMU Hospital, Department of Pediatrics - Dr. von Hauner Children's Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians University, Munich, Germany; LMU Center for Children with Medical Complexity - iSPZ Hauner, Ludwig-Maximilians University, Munich, Germany
| | - Matthias F Lechner
- LMU Hospital, Department of Pediatrics - Dr. von Hauner Children's Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians University, Munich, Germany; LMU Center for Children with Medical Complexity - iSPZ Hauner, Ludwig-Maximilians University, Munich, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; TUM-Neuroimaging Center, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Florian Heinen
- LMU Hospital, Department of Pediatrics - Dr. von Hauner Children's Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians University, Munich, Germany; LMU Center for Children with Medical Complexity - iSPZ Hauner, Ludwig-Maximilians University, Munich, Germany
| | - Mirjam N Landgraf
- LMU Hospital, Department of Pediatrics - Dr. von Hauner Children's Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians University, Munich, Germany; LMU Center for Children with Medical Complexity - iSPZ Hauner, Ludwig-Maximilians University, Munich, Germany
| | - Michaela V Bonfert
- LMU Hospital, Department of Pediatrics - Dr. von Hauner Children's Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians University, Munich, Germany; LMU Center for Children with Medical Complexity - iSPZ Hauner, Ludwig-Maximilians University, Munich, Germany.
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Fernandes EC, Carlos-Ferreira J, Luz LL, Safronov BV. Presynaptic Interactions between Trigeminal and Cervical Nociceptive Afferents Supplying Upper Cervical Lamina I Neurons. J Neurosci 2022; 42:3587-3598. [PMID: 35318285 PMCID: PMC9053849 DOI: 10.1523/jneurosci.0025-22.2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/08/2022] [Accepted: 03/07/2022] [Indexed: 11/21/2022] Open
Abstract
Cervical and trigeminal afferents innervate neighboring cranial territories, and their convergence on upper cervical dorsal horn neurons provides a potential substrate for pain referral in primary headache syndromes. Lamina I neurons are central to this mechanism, as they relay convergent nociceptive input to supraspinal pain centers. Unfortunately, little is known about the interactions between trigeminal and cervical afferents supplying Lamina I neurons. Here, we used rats of both sexes to show that cervical and trigeminal afferents interact via presynaptic inhibition, where monosynaptic inputs to Lamina I neurons undergo unidirectional as well as reciprocal presynaptic control. This means that afferent-driven presynaptic inhibition shapes the way trigeminal and cervical Aδ-fiber and C-fiber input reaches Lamina I projection neurons (PNs) and local-circuit neurons (LCNs). We propose that this inhibition provides a feedforward control of excitatory drive to Lamina I neurons that regulates their convergent and cervical-specific or trigeminal-specific processing modes. As a consequence, disruption of the trigeminal and cervical afferent-driven presynaptic inhibition may contribute to development of primary headache syndromes.SIGNIFICANCE STATEMENT Cervical and trigeminal afferents innervate neighboring cranial territories, and their convergence on upper cervical dorsal horn neurons provides a potential substrate for pain referral in primary headache syndromes. Lamina I neurons are central to this mechanism as they relay convergent nociceptive input to supraspinal pain centers. Here, we show that cervical and trigeminal afferents interact via presynaptic inhibition, where inputs to Lamina I neurons undergo unidirectional as well as reciprocal control. The afferent-driven presynaptic inhibition shapes the trigeminocervical Aδ-fiber and C-fiber input to Lamina I neurons. This inhibition provides control of excitatory drive to Lamina I neurons that regulates their convergent and cervical-specific or trigeminal-specific processing modes. Disruption of this control may contribute to development of primary headache syndromes.
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Affiliation(s)
- Elisabete C Fernandes
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto 4200-135, Portugal
- Neuronal Networks Group, Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Porto 4200-135, Portugal
| | - José Carlos-Ferreira
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto 4200-135, Portugal
- Neuronal Networks Group, Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Porto 4200-135, Portugal
| | - Liliana L Luz
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto 4200-135, Portugal
- Neuronal Networks Group, Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Porto 4200-135, Portugal
| | - Boris V Safronov
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto 4200-135, Portugal
- Neuronal Networks Group, Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Porto 4200-135, Portugal
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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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Di Antonio S, Arendt-Nielsen L, Ponzano M, Bovis F, Torelli P, Finocchi C, Castaldo M. Cervical musculoskeletal impairments in the 4 phases of the migraine cycle in episodic migraine patients. Cephalalgia 2022; 42:827-845. [PMID: 35332826 DOI: 10.1177/03331024221082506] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess cervical musculoskeletal impairments during the 4 phases of a migraine cycle in episodic migraine patients, controlling for the presence of concomitant neck pain. METHODS Differences in cervical musculoskeletal impairments were assessed during the 4 migraine phases in episodic migraine patients and compared with healthy controls controlling for concomitant neck pain. Cervical musculoskeletal impairments were assessed as follow: cervical active range of motion; flexion rotation test; craniocervical flexion test and calculation of activation pressure score; the total number of myofascial trigger points in head/neck muscles; the number of positivevertebral segments (headache's reproduction) during passive accessory intervertebral movement; pressure pain thresholds over C1, C2, C4, C6 vertebral segments bilaterally, trigeminal area, hand, and leg. Signs of pain sensitization were assessed by evaluating mechanical pain threshold over trigeminal area and hand, pressure pain thresholds, and the wind-up ratio. The Bonferroni-corrected p-value (05/4 = 0.013) was adopted to assess the difference between groups, while a p-value of 0.05 was considered significant for the correlation analysis. RESULTS A total of 159 patients and 52 controls were included. Flexion rotation test and craniocervical flexion test were reduced in all 4 phases of the migraine cycle versus healthy controls (p < 0.001). The number of myofascial trigger points and positive vertebral segments was increased in all 4 phases of the migraine cycle versus healthy controls (p < 0.001). Flexion, extension, and total cervical active range of motion and cervical pressure pain thresholds were reduced in episodic migraine in the ictal phase versus controls (p < 0.007) with no other significant differences. Outside the ictal phase, the total cervical active range of motion was positively correlated with trigeminal and leg pressure pain threshold (p < 0.026), the number of active myofascial trigger points and positive positive vertebral segments were positively correlated with higher headache frequency (p=0.045), longer headache duration (p < 0.008), and with headache-related disability (p = 0.031). Cervical pressure pain thresholds were positively correlated with trigeminal, hand, and leg pressure pain threshold (p < 0.001), and trigeminal and leg mechanical pain thresholds (p < 0.005), and negatively correlated with the wind-up ratio (p < 0.004). CONCLUSION In all phases of the migraine cycle, independent of the presence of concomitant neck pain, episodic migraine patients showed reduced flexion rotation test and craniocervical flexion test and an increased number of myofascial trigger points and passive accessory vertebral segments. These impairments are correlated with enhanced headache duration, headache-related disability, and signs of widespread pain sensitization. Reduction in active cervical movement and increased mechanical hyperalgesia of the cervical was consistent in ictal episodic migraine patients and the subgroups of episodic migraine patients with more pronounced widespread sensitization.
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Affiliation(s)
- Stefano Di Antonio
- Department of Health Science and Technology, Center for Pain and Neuroplasticity (CNAP), School of Medicine, Aalborg University, Denmark.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, Genoa, Italy
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Center for Pain and Neuroplasticity (CNAP), School of Medicine, Aalborg University, Denmark.,Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
| | - Marta Ponzano
- Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genoa, Italy
| | - Francesca Bovis
- Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genoa, Italy
| | - Paola Torelli
- Headache Centre, Department of Medicine and Surgery, University of Parma, Italy
| | - Cinzia Finocchi
- Headache Centre, IRCCS, Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Castaldo
- Department of Health Science and Technology, Center for Pain and Neuroplasticity (CNAP), School of Medicine, Aalborg University, Denmark
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Christiansen IM, Edvinsson JCA, Reducha PV, Edvinsson L, Haanes KA. Dual action of the cannabinoid receptor 1 ligand arachidonyl-2′-chloroethylamide on calcitonin gene-related peptide release. J Headache Pain 2022; 23:30. [PMID: 35189809 PMCID: PMC8903492 DOI: 10.1186/s10194-022-01399-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Based on the current understanding of the role of neuropeptide signalling in migraine, we explored the therapeutic potential of a specific cannabinoid agonist. The aim of the present study was to examine the effect of the synthetic endocannabinoid (eCB) analogue, arachidonyl-2′-chloroethylamide (ACEA), on calcitonin gene-related peptide (CGRP) release in the dura and trigeminal ganglion (TG), as cannabinoids are known to activate Gi/o-coupled cannabinoid receptors type 1 (CB1), resulting in neuronal inhibition. Methods The experiments were performed using the hemi-skull model and dissected TGs from male Sprague-Dawley rats. CGRP release was induced by either 60 mM K+ (for depolarization-induced stimulation) or 100 nM capsaicin (for transient receptor potential vanilloid 1 (TRPV1) -induced stimulation) and measured using an enzyme-linked immunosorbent assay. The analysis of CGRP release data was combined with immunohistochemistry in order to study the cellular localization of CB1, cannabinoid receptor type 2 (CB2), CGRP and receptor activity modifying protein 1 (RAMP1), a subunit of the functional CGRP receptor, in the TG. Results CB1 was predominantly expressed in neuronal somas in which colocalization with CGRP was observed. Furthermore, CB1 exhibited colocalization with RAMP1 in neuronal Aδ-fibres but was not clearly expressed in the CGRP-immunoreactive C-fibres. CB2 was mainly expressed in satellite glial cells and did not show substantial colocalization with either CGRP or RAMP1. Without stimulation, 140 nM ACEA per se caused a significant increase in CGRP release in the dura but not TG, compared to vehicle. Furthermore, 140 nM ACEA did not significantly modify neither K+- nor capsaicin-induced CGRP release. However, when the TRPV1 blocker AMG9810 (1 mM) was coapplied with ACEA, K+-induced CGRP release was significantly attenuated in the TG and dura. Conclusions Results from the present study indicate that ACEA per se does not exhibit antimigraine potential due to its dual agonistic properties, resulting in activation of both CB1 and TRPV1, and thereby inhibition and stimulation of CGRP release, respectively. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01399-8.
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Cheng YC, Zeng BY, Hung CM, Su KP, Wu YC, Tu YK, Lin PY, Stubbs B, Carvalho AF, Liang CS, Chen TY, Hsu CW, Brunoni AR, Suen MW, Shiue YL, Tseng PT, Wu MK, Li CT. Effectiveness and acceptability of noninvasive brain and nerve stimulation techniques for migraine prophylaxis: a network meta-analysis of randomized controlled trials. J Headache Pain 2022; 23:28. [PMID: 35184742 PMCID: PMC8903676 DOI: 10.1186/s10194-022-01401-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/07/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Current pharmacologic prophylactic strategies for migraine have exhibited limited efficacy, with response rates as low as 40%-50%. In addition to the limited efficacy, the acceptability of those pharmacologic prophylactic strategies were unacceptable. Although noninvasive brain/nerve stimulation strategies may be effective, the evidence has been inconsistent. The aim of this network meta-analysis (NMA) was to compare strategies of noninvasive brain/nerve stimulation for migraine prophylaxis with respect to their effectiveness and acceptability. METHODS The PubMed, Embase, ScienceDirect, ProQuest, ClinicalTrials.gov , ClinicalKey, Cochrane CENTRAL, Web of Science, and ClinicalTrials.gov databases were systematically searched to date of June 4th, 2021 for randomized controlled trials (RCTs). Patients with diagnosis of migraine, either episodic migraine or chronic migraine, were included. All NMA procedures were conducted under the frequentist model. RESULTS Nineteen RCTs were included (N = 1493; mean age = 38.2 years; 82.0% women). We determined that the high frequency repetitive transcranial magnetic stimulation (rTMS) over C3 yielded the most decreased monthly migraine days among all the interventions [mean difference = - 8.70 days, 95% confidence intervals (95%CIs): - 14.45 to - 2.95 compared to sham/control groups]. Only alternating frequency (2/100 Hz) transcutaneous occipital nerve stimulation (tONS) over the Oz (RR = 0.36, 95%CIs: 0.16 to 0.82) yielded a significantly lower drop-out rate than the sham/control groups did. CONCLUSIONS The current study provided a new direction for the design of more methodologically robust and larger RCTs based on the findings of the potentially beneficial effect on migraine prophylaxis in participants with migraine by different noninvasive brain/nerve stimulation, especially the application of rTMS and tONS. TRIAL REGISTRATION CRD42021252638. The current study had been approval by the Institutional Review Board of the Tri-Service General Hospital, National Defense Medical Center (TSGHIRB No. B-109-29).
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Affiliation(s)
- Yu-Chen Cheng
- Department of Neurology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan.,Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Community & Rehabilitation Psychiatry, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Bing-Yan Zeng
- Department of Internal Medicine, E-DA Dachang Hospital, Kaohsiung, Taiwan
| | - Chao-Ming Hung
- Division of General Surgery, Department of Surgery, E-Da Cancer Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Kuan-Pin Su
- Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan.,An-Nan Hospital, China Medical University, Tainan, Taiwan
| | - Yi-Cheng Wu
- Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist, Kaohsiung City, 833, Taiwan.,Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.,Positive Ageing Research Institute (PARI), Faculty of Health, Social Care Medicine and Education, Anglia Ruskin University, Chelmsford, UK
| | - Andre F Carvalho
- Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist, Kaohsiung City, 833, Taiwan
| | - Andre R Brunoni
- Service of Interdisciplinary Neuromodulation, National Institute of Biomarkers in Psychiatry, Laboratory of Neurosciences (LIM-27), Departamento e Instituto de Psiquiatria, Faculdade de Medicina da USP, São Paulo, Brazil.,Departamento de Ciências Médicas, Faculdade de Medicina da USP, São Paulo, Brazil
| | - Mein-Woei Suen
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan.,Gender Equality Education and Research Center, Asia University, Taichung, Taiwan.,Department of Medical Research, Asia University Hospital, Asia University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yow-Ling Shiue
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Ping-Tao Tseng
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan. .,Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan. .,Prospect Clinic for Otorhinolaryngology & Neurology, No. 252, Nanzixin Road, Nanzi District, Kaohsiung City, 81166, Taiwan.
| | - Ming-Kung Wu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist, Kaohsiung City, 833, Taiwan.
| | - Cheng-Ta Li
- Division of Community & Rehabilitation Psychiatry, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan. .,Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan. .,Division of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City, 11267, Taiwan. .,Institute of Brain Science and Brain Research Center, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. .,Functional Neuroimaging and Brain Stimulation Lab, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City, 11267, Taiwan.
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49
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Al-Khazali HM, Younis S, Al-Sayegh Z, Ashina S, Ashina M, Schytz HW. Prevalence of neck pain in migraine: A systematic review and meta-analysis. Cephalalgia 2022; 42:663-673. [PMID: 35166137 DOI: 10.1177/03331024211068073] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Neck pain is a frequent complaint among patients with migraine and seems to be correlated with the headache frequency. Neck pain is more common in patients with chronic migraine compared to episodic migraine. However, prevalence of neck pain in patients with migraine varies among studies. OBJECTIVE To estimate the prevalence of neck pain in patients with migraine and non-headache controls in observational studies. METHODS A systematic literature search on PubMed and Embase was conducted to identify studies reporting prevalence of neck pain in migraine patients. This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data was extracted by two independent investigators and results were pooled using random-effects meta-analysis. The protocol was registered with PROSPERO (CRD42021264898). RESULTS The search identified 2490 citations of which 30 contained relevant original population based and clinic-based data. Among these, 24 studies provided data eligible for the analysis. The meta-analysis for clinic-based studies demonstrated that the pooled relative frequency of neck pain was 77.0% (95% CI: 69.0-86.4) in the migraine group and 23.2% (95% CI:18.6-28.5) in the non-headache control group. Neck pain was more frequent in patients with chronic migraine (87.0%, 95% CI: 77.0-93.0) compared to episodic migraine (77.0%, 95% CI: 69.0-84.0). Neck pain was 12 times more prevalent in migraine patients compared to non-headache controls and two times more prevalent in patients with chronic migraine compared to episodic migraine. The calculated heterogeneity (I2 values) ranged from 61.3% to 72.0%. CONCLUSION Neck pain is a frequent complaint among patients with migraine. The heterogeneity among the studies emphasize important aspects to consider in future research of neck pain in migraine to improve our understanding of the driving mechanisms of neck pain in a major group of migraine patients.
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Affiliation(s)
- Haidar Muhsen Al-Khazali
- Danish Headache Center, 70590Rigshospitalet Glostrup, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Samaira Younis
- Danish Headache Center, 70590Rigshospitalet Glostrup, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Zainab Al-Sayegh
- Danish Headache Center, 70590Rigshospitalet Glostrup, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Sait Ashina
- Danish Headache Center, 70590Rigshospitalet Glostrup, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Comprehensive Headache Center, Departments of Neurology and Anesthesia, 1859Beth Israel Deaconess Medical Center, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Messoud Ashina
- Danish Headache Center, 70590Rigshospitalet Glostrup, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Henrik W Schytz
- Danish Headache Center, 70590Rigshospitalet Glostrup, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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50
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Di Antonio S, Castaldo M, Ponzano M, Bovis F, Hugo Villafañe J, Torelli P, Finocchi C, Arendt‐Nielsen L. Trigeminal and cervical sensitization during the four phases of the migraine cycle in patients with episodic migraine. Headache 2022; 62:176-190. [DOI: 10.1111/head.14261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Stefano Di Antonio
- Department of Health Science and Technology Center for Pain and Neuroplasticity School of Medicine Aalborg University Aalborg Denmark
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health University of Genoa Genoa Italy
| | - Matteo Castaldo
- Department of Health Science and Technology Center for Pain and Neuroplasticity School of Medicine Aalborg University Aalborg Denmark
| | - Marta Ponzano
- Department of Health Sciences Section of Biostatistics University of Genoa Genoa Italy
| | - Francesca Bovis
- Department of Health Sciences Section of Biostatistics University of Genoa Genoa Italy
| | | | - Paola Torelli
- Headache Centre Department of Medicine and Surgery University of Parma Parma Italy
| | - Cinzia Finocchi
- Headache Centre IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Lars Arendt‐Nielsen
- Department of Health Science and Technology Center for Pain and Neuroplasticity School of Medicine Aalborg University Aalborg Denmark
- Department of Medical Gastroenterology Mech‐Sense Aalborg University Hospital Aalborg Denmark
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