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Veilleux C, Khousakoun D, Kwon CS, Amoozegar F, Girgis F. Efficacy of Occipital Nerve Stimulation in Trigeminal Autonomic Cephalalgias: A Systematic Review. Neurosurgery 2023; 93:755-763. [PMID: 37712710 DOI: 10.1227/neu.0000000000002490] [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: 10/23/2022] [Accepted: 02/14/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Trigeminal autonomic cephalalgias (TACs) are a group of highly disabling primary headache disorders. Although pharmacological treatments exist, they are not always effective or well tolerated. Occipital nerve stimulation (ONS) is a potentially effective surgical treatment. OBJECTIVE To perform a systematic review of the efficacy of ONS in treating TACs. METHODS A systematic review was performed using Medline, Embase, and Cochrane databases. Primary outcomes were reduction in headache intensity, duration, and frequency. Secondary outcomes included adverse event rate and reduction in medication use. Because of large differences in outcome measures, data for patients suffering from short-lasting, unilateral, and neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and cranial autonomic symptoms (SUNA) were reported separately. Risk of bias was assessed using the NIH Quality Assessment Tools. RESULTS A total of 417 patients from 14 published papers were included in the analysis, of which 15 patients were in the SUNCT/SUNA cohort. The mean reduction in headache intensity and duration was 26.2% and 31.4%, respectively. There was a mean reduction in headache frequency of 50%, as well as a 61.2% reduction in the use of abortive medications and a 31.1% reduction in the use of prophylactic medications. In the SUNCT/SUNA cohort, the mean decrease in headache intensity and duration was 56.8% and 42.8%. The overall responder rate, defined as a >50% reduction in attack frequency, was 60.8% for the non-SUNCT/non-SUNA cohort and 66.7% for the SUNCT/SUNA cohort. Adverse events requiring repeat surgery were reported in 33% of cases. Risk of bias assessment suggests that articles included in this review had reasonable internal validity. CONCLUSION ONS may be an effective surgical treatment for approximately two thirds of patients with medically refractory TACs.
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Affiliation(s)
- Catherine Veilleux
- Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Calgary , Alberta , Canada
| | - Devon Khousakoun
- Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Calgary , Alberta , Canada
| | - Churl-Su Kwon
- Departments of Neurology, Epidemiology, Neurosurgery and the Gertrude H. Sergievsky Center, Columbia University, New York , New York , USA
| | - Farnaz Amoozegar
- Department of Clinical Neurosciences, Division of Neurology, University of Calgary, Calgary , Alberta , Canada
| | - Fady Girgis
- Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Calgary , Alberta , Canada
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Beltramone M, Redon S, Fernandes S, Ducros A, Avouac A, Donnet A. The teaching of headache medicine in France: A questionnaire-based study. Headache 2022; 62:1177-1186. [PMID: 36200808 PMCID: PMC9828409 DOI: 10.1111/head.14395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The treatment of patients with headache represents an important part of a neurologist's activity. It requires sufficient training for neurology residents. In France, residents in neurology can complete this training by attending specialized consultations or by participating in a postgraduate training program called "Diplôme Inter-Universitaire Migraine et Céphalées" (DIUMC). OBJECTIVE The objective of this cross-sectional study was to investigate the French residents' knowledge in headache medicine and the impact of different types of training in headache medicine that are available in France. METHODS An anonymous survey was carried out among 548 French residents in neurology. RESULTS The questionnaires of 121 residents (22.1%) were analyzed. Among them, 54.5% (66/121) had no complementary training apart from the internship (Group 1), 21.5% (26/121) had attended only specialized consultations (Group 2), and 24% (29/121) had participated in the DIUMC (Group 3). There was no difference between all groups regarding the knowledge of the prevalence of primary or chronic headaches. There was almost no difference between the groups in the management of episodic migraine. In contrast, the management of tension-type headache and chronic headache was better known by residents of Group 3 than residents of Group 1. In these two diseases, residents of Group 3 offered prophylactic treatment more often. Almost 29% of the residents (35/121) had read the French guidelines for the diagnosis and management of migraine. In Group 3, residents had read them significantly more often (1.6% in Group 1, 38.5% in Group 2 and 62.1% in Group 3, p < 0.001). CONCLUSION This study shows the lack of knowledge among French neurology residents regarding headache medicine. It highlights the interest of specific training programs that could improve the practical and theoretical knowledge of future neurologists.
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Affiliation(s)
- Marion Beltramone
- Department of Evaluation and Treatment of PainFHU INOVPAIN, CHU Timone, AP‐HMMarseilleFrance
| | - Sylvain Redon
- Department of Evaluation and Treatment of PainFHU INOVPAIN, CHU Timone, AP‐HMMarseilleFrance
| | - Sara Fernandes
- Service d'Epidémiologie et d'Economie de la Santé, Unité de Recherche Clinique, Direction de la Recherche en SantéAix Marseille Univ, APHM, Hôpital de la TimoneMarseilleFrance
| | - Anne Ducros
- Neurology DepartmentCHU de MontpellierMontpellierFrance
| | - Alexandre Avouac
- Department of Evaluation and Treatment of PainFHU INOVPAIN, CHU Timone, AP‐HMMarseilleFrance
| | - Anne Donnet
- Department of Evaluation and Treatment of PainFHU INOVPAIN, CHU Timone, AP‐HMMarseilleFrance,INSERM U‐1107, CHU de Clermont‐FerrandClermont‐FerrandFrance
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Pohl H, Gantenbein AR, Sandor PS, Schoenen J, Andrée C. The impact of the disease burden on the quality of life of cluster headache patients. CEPHALALGIA REPORTS 2021. [DOI: 10.1177/25158163211029909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background: Cluster headache cannot be cured, and not all attacks can be aborted or prevented. Nevertheless, therapeutic guidelines focus solely on the attacks and ignore reverberations of the disorder on patients’ lives. However, it is likely that not only pain reduces patients’ quality of life (QoL). Objective: To investigate whether the interictal burden independently influence the QoL of subjects suffering from cluster headache. Methods: In this cross-sectional study, we asked patients with a self-reported cluster headache diagnosis to answer a modified EUROLIGHT questionnaire that included the EURO-HIS QoL scale. We built a generalised linear model and included the QoL as the dependent variable. Independent variables comprised both the ictal and the interictal burden. Results: The data of 625 participants entered the analysis. Several aspects of the interictal burden independently reduced the QoL. Among them were fear of pain, self-concealment, and private life difficulties due to the disorder. Conclusion: Both the ictal and the interictal burden of cluster headache independently reduce patients’ QoL. We advocate adopting a more holistic approach to cluster headache management extending the focus towards the afflicted person and their QoL, which would generate novel therapeutic goals and strategies, complementary to treating and preventing cluster headache attacks.
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Affiliation(s)
- Heiko Pohl
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Andreas R Gantenbein
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- Department of Neurology & Neurorehabilitation, ZURZACH Care, Bad Zurzach, Switzerland
| | - Peter S Sandor
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- Department of Neurology & Neurorehabilitation, ZURZACH Care, Bad Zurzach, Switzerland
| | - Jean Schoenen
- Headache Research Unit, Department of Neurology, Citadelle Hospital, University of Liège, Liège, Belgium
| | - Colette Andrée
- Migraine Action, Bottmingen, Switzerland
- Department of Pharmaceutical Sciences, University Basel, Basel, Switzerland
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Bulsei J, Leplus A, Donnet A, Regis J, Lucas C, Buisset N, Raoul S, Guegan-Massardier E, Derrey S, Jarraya B, Valade D, Roos C, Creach C, Chabardes S, Giraud P, Voirin J, Colnat-Coulbois S, Caire F, Rigoard P, Fontas E, Lanteri-Minet M, Fontaine D. Occipital Nerve Stimulation for Refractory Chronic Cluster Headache: A Cost-Effectiveness Study. Neuromodulation 2021; 24:1083-1092. [PMID: 33886139 DOI: 10.1111/ner.13394] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/15/2021] [Accepted: 02/24/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Occipital nerve stimulation (ONS) is proposed to treat refractory chronic cluster headache (rCCH), but its cost-effectiveness has not been evaluated, limiting its diffusion and reimbursement. MATERIALS AND METHODS We performed a before-and-after economic study, from data collected prospectively in a nation-wide registry. We compared the cost-effectiveness of ONS associated with conventional treatment (intervention and postintervention period) to conventional treatment alone (preintervention period) in the same patients. The analysis was conducted on 76 rCCH patients from the French healthcare perspective at three months, then one year by extrapolation. Because of the impact of the disease on patient activity, indirect cost, such as sick leave and disability leave, was assessed second. RESULTS The average total cost for three months was €7602 higher for the ONS strategy compared to conventional strategy with a gain of 0.07 quality-adjusted life-years (QALY), the incremental cost-effectiveness ratio (ICER) was then €109,676/QALY gained. The average extrapolated total cost for one year was €1344 lower for the ONS strategy (p = 0.5444) with a gain of 0.28 QALY (p < 0.0001), the ICER was then €-4846/QALY gained. The scatter plot of the probabilistic bootstrapping had 80% of the replications in the bottom right-hand quadrant, indicating that the ONS strategy is dominant. The average indirect cost for three months was €377 lower for the ONS strategy (p = 0.1261). DISCUSSION This ONS cost-effectiveness study highlighted the limitations of a short-time horizon in an economic study that may lead the healthcare authorities to reject an innovative strategy, which is actually cost-effective. One-year extrapolation was the proposed solution to obtain results on which healthcare authorities can base their decisions. CONCLUSION Considering the burden of rCCH and the efficacy and safety of ONS, the demonstration that ONS is dominant should help its diffusion, validation, and reimbursement by health authorities in this severely disabled population.
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Affiliation(s)
- Julie Bulsei
- Delegation of Clinical Research, CHU de Nice, Université Côte d'Azur, Nice, France
| | - Aurélie Leplus
- Department of Neurosurgery, Université Côte d'Azur, CHU de Nice, Nice, France.,Université Côte d'Azur, CHU de Nice, FHU INOVPAIN, Nice, France.,UR2CA, Université Côte d'Azur, Nice, France
| | - Anne Donnet
- Université Côte d'Azur, CHU de Nice, FHU INOVPAIN, Nice, France.,Pain Clinic, Hopital La Timone, Marseille, France
| | - Jean Regis
- Department of Functional Neurosurgery, Aix-Marseille University, Hopital La Timone, Marseille, France
| | | | - Nadia Buisset
- Department of Neurosurgery, CHU de Lille, Lille, France
| | - Sylvie Raoul
- Department of Neurosurgery, CHU de Nantes, Nantes, France
| | | | | | - Bechir Jarraya
- Department of Neurosurgery, Hopital Foch, Suresnes, France.,Université de Versailles Saint-Quentin en Yvelines/Université Paris-Saclay, Versailles, France
| | - Dominique Valade
- Department of Neurosurgery, Hopital Pitié-Sapêtrière, Paris, France
| | - Caroline Roos
- Emergency Headache Centre, Hopital Lariboisière, Paris, France
| | | | | | - Pierric Giraud
- Department of Neurology, Hopital d'Annecy, Annecy, France
| | - Jimmy Voirin
- Department of Neurosurgery, Hopitaux Civils de Colmar, Colmar, France
| | | | - Francois Caire
- Department of Neurosurgery, CHU de Limoges, Limoges, France
| | | | - Eric Fontas
- Delegation of Clinical Research, CHU de Nice, Université Côte d'Azur, Nice, France
| | - Michel Lanteri-Minet
- Université Côte d'Azur, CHU de Nice, FHU INOVPAIN, Nice, France.,UR2CA, Université Côte d'Azur, Nice, France.,Pain Department, Université Cote d'Azur, CHU de Nice, Nice, France.,INSERM/UdA, U1107, Neuro-Dol, Auvergne University, Clermont-Ferrand, France
| | - Denys Fontaine
- Department of Neurosurgery, Université Côte d'Azur, CHU de Nice, Nice, France.,Université Côte d'Azur, CHU de Nice, FHU INOVPAIN, Nice, France.,UR2CA, Université Côte d'Azur, Nice, France
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Leplus A, Fontaine D, Donnet A, Regis J, Lucas C, Buisset N, Blond S, Raoul S, Guegan-Massardier E, Derrey S, Jarraya B, Dang-Vu B, Bourdain F, Valade D, Roos C, Creach C, Chabardes S, Giraud P, Voirin J, Bloch J, Colnat-Coulbois S, Caire F, Rigoard P, Tran L, Cruzel C, Lantéri-Minet M. Long-Term Efficacy of Occipital Nerve Stimulation for Medically Intractable Cluster Headache. Neurosurgery 2021; 88:375-383. [PMID: 32985662 DOI: 10.1093/neuros/nyaa373] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 06/27/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Occipital nerve stimulation (ONS) has been proposed to treat refractory chronic cluster headache (rCCH) but its efficacy has only been showed in small short-term series. OBJECTIVE To evaluate ONS long-term efficacy in rCCH. METHODS We studied 105 patients with rCCH, treated by ONS within a multicenter ONS prospective registry. Efficacy was evaluated by frequency, intensity of pain attacks, quality of life (QoL) EuroQol 5 dimensions (EQ5D), functional (Headache Impact Test-6, Migraine Disability Assessment) and emotional (Hospital Anxiety Depression Scale [HAD]) impacts, and medication consumption. RESULTS At last follow-up (mean 43.8 mo), attack frequency was reduced >50% in 69% of the patients. Mean weekly attack frequency decreased from 22.5 at baseline to 9.9 (P < .001) after ONS. Preventive and abortive medications were significantly decreased. Functional impact, anxiety, and QoL significantly improved after ONS. In excellent responders (59% of the patients), attack frequency decreased by 80% and QoL (EQ5D visual analog scale) dramatically improved from 37.8/100 to 73.2/100. When comparing baseline and 1-yr and last follow-up outcomes, efficacy was sustained over time. In multivariable analysis, low preoperative HAD-depression score was correlated to a higher risk of ONS failure. During the follow-up, 67 patients experienced at least one complication, 29 requiring an additional surgery: infection (6%), lead migration (12%) or fracture (4.5%), hardware dysfunction (8.2%), and local pain (20%). CONCLUSION Our results showed that long-term efficacy of ONS in CCH was maintained over time. In responders, ONS induced a major reduction of functional and emotional headache-related impacts and a dramatic improvement of QoL. These results obtained in real-life conditions support its use and dissemination in rCCH patients.
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Affiliation(s)
- Aurélie Leplus
- Department of Neurosurgery, Université Côte d'Azur, CHU de Nice, Nice, France.,Université Côte d'Azur, FHU INOVPAIN, CHU de Nice, Nice, France
| | - Denys Fontaine
- Department of Neurosurgery, Université Côte d'Azur, CHU de Nice, Nice, France.,Université Côte d'Azur, FHU INOVPAIN, CHU de Nice, Nice, France
| | - Anne Donnet
- Université Côte d'Azur, FHU INOVPAIN, CHU de Nice, Nice, France.,Pain Clinic, Hopital La Timone, Marseille, France
| | - Jean Regis
- Department of Functional Neurosurgery, Aix-Marseille University, Hopital La Timone, Marseille, France
| | - Christian Lucas
- Pain Clinic, Department of Neurosurgery, CHU de Lille, Lille, France.,INSERM U1171, Lille, France
| | - Nadia Buisset
- Pain Clinic, Department of Neurosurgery, CHU de Lille, Lille, France
| | - Serge Blond
- Pain Clinic, Department of Neurosurgery, CHU de Lille, Lille, France
| | - Sylvie Raoul
- Department of Neurosurgery, CHU de Nantes, Nantes, France
| | | | | | - Bechir Jarraya
- Department of Neurosurgery, Hopital Foch, Suresnes, France.,Université de Versailles Saint-Quentin en Yvelines/Université Paris-Saclay, Versailles, France
| | | | | | | | - Caroline Roos
- Emergency Headache Centre, Hopital Lariboisière, Paris, France
| | - Christelle Creach
- Department of Neurology, CHU de Saint Etienne, Saint Etienne, France
| | | | - Pierric Giraud
- Department of Neurology, Hopital d'Annecy, Annecy, France
| | - Jimmy Voirin
- Department of Neurosurgery, Hopitaux Civils de Colmar, Colmar, France
| | | | | | - François Caire
- Department of Neurosurgery, CHU de Limoges, Limoges, France
| | | | - Laurie Tran
- Université Côte d'Azur, FHU INOVPAIN, CHU de Nice, Nice, France
| | - Coralie Cruzel
- Université Côte d'Azur, Délégation à la Recherche et à l'Innovation, CHU de Nice, Nice, France
| | - Michel Lantéri-Minet
- Université Côte d'Azur, FHU INOVPAIN, CHU de Nice, Nice, France.,Pain Department, Université Cote d'Azur, CHU de Nice, Nice, France.,INSERM/UdA, U1107, Neuro-Dol, Auvergne University, Clermont-Ferrand, France
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6
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A retrospective observation on 105 patients with chronic cluster headache receiving indomethacin. Neurol Sci 2021; 42:4175-4182. [PMID: 33547540 DOI: 10.1007/s10072-021-05114-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Indomethacin (IMC) as a prophylactic treatment is considered to be ineffective in cluster headache (CH). However, small series suggested the interest of IMC in CH. Some authors support that an IMC test is useful in all trigeminal autonomic cephalalgias. We described clinical features of IMC responders in a retrospective cohort of chronic cluster headache (CCH). METHODS This single-center and retrospective study was conducted in a tertiary care specialist headache center in France. Patients were selected between January 2007 and December 2008. We included all patients fulfilling CCH criteria (ICHD-3-beta). Data were collected from medical records. We recorded all the prescriptions of IMC as a prophylactic treatment. Responders were defined by 50% reduction in attack frequency; complete response was defined by disappearance of the attacks. The non-responders must have received at least 100 mg daily during 7 days. RESULTS The study consisted of 324 CCH, 121 female (37%) and 203 males (63%) with an average age at onset of 33.93 (± 14.71) years. Of the patients, 105 were treated with IMC. Thirty patients (29%) were responders. Thirty-four patients (32%) were non-responders. Responding status was undefined for 41 patients (39%). Twelve patients (11%) had a complete response. Responders were composed by 18 women (60%) and 12 men (40%) and had on average 44.89 (± 12.88) years. The minimal effective dose was 86.11 mg daily (± 48.72). DISCUSSION This study shows the interest of IMC in CCH patients. We recommend an IMC test as a third-line treatment in CCH.
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Grangeon L, O'Connor E, Danno D, Ngoc TMP, Cheema S, Tronvik E, Davagnanam I, Matharu M. Is pituitary MRI screening necessary in cluster headache? Cephalalgia 2021; 41:779-788. [PMID: 33406848 PMCID: PMC8166405 DOI: 10.1177/0333102420983303] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective To determine the prevalence and clinical predictors of pituitary adenomas in cluster headache patients, in order to determine the necessity of performing dedicated pituitary magnetic resonance imaging in patients with cluster headache. Methods A retrospective study was conducted of all consecutive patients diagnosed with cluster headache and with available brain magnetic resonance imaging between 2007 and 2017 in a tertiary headache center. Data including demographics, attack characteristics, response to treatments, results of neuroimaging, and routine pituitary function tests were recorded. Results Seven hundred and eighteen cluster headache patients attended the headache clinic; 643 underwent a standard magnetic resonance imaging scan, of whom 376 also underwent dedicated pituitary magnetic resonance imaging. Pituitary adenomas occurred in 17 of 376 patients (4.52%). Non-functioning microadenomas (n = 14) were the most common abnormality reported. Two patients, one of whom lacked the symptoms of pituitary disease, required treatment for their pituitary lesion. No clinical predictors of those adenomas were identified after multivariate analysis using random forests. Systematic pituitary magnetic resonance imaging scanning did not benefit even a single patient in the entire cohort. Conclusion The prevalence of pituitary adenomas in cluster headache is similar to that reported in the general population, thereby precluding an over-representation of pituitary lesions in cluster headache. We conclude that the diagnostic assessment of cluster headache patients should not include specific pituitary screening. Only patients with standard brain magnetic resonance imaging findings or symptoms suggestive of a pituitary disorder require brain magnetic resonance imaging with dedicated pituitary views.
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Affiliation(s)
- Lou Grangeon
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, Queen Square, London, UK.,Headache and Facial Pain Group, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Emer O'Connor
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Daisuke Danno
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | | | - Sanjay Cheema
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Erling Tronvik
- Mathematics Institute of Orsay, Paris Sud University, Orsay, France.,Department of Neurology, St Olav's University Hospital, Trondheim, Norway.,NTNU (University of Science and Technology), Department of Neuromedicine and Movement Science, Trondheim, Norway
| | | | - Manjit Matharu
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, Queen Square, London, UK
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8
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Donnet A. Algia vascolare del volto. Neurologia 2020. [DOI: 10.1016/s1634-7072(20)44228-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Ponté C, Giron A, Crequy M, Lapeyre-Mestre M, Fabre N, Salles J. Cluster Headache in Subjects With Substance Use Disorder: A Case Series and a Review of the Literature. Headache 2019; 59:576-589. [PMID: 30957220 DOI: 10.1111/head.13516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To describe a case series of 7 patients presenting cluster headache (CH) criteria and a substance use disorder, reported to a French Addictovigilance center. Then, to assess clinical, pharmacological, and neurobiological linkages between substance use and CH onset. BACKGROUND CH patients are presenting a higher prevalence of comorbidities, among which the use of psychoactive substances, licit or illicit, have been explored by a few authors. Recently, 3 cases of CH in patients seen in the hospital-based addiction care center have been reported to the Toulouse addictovigilance center. METHODS Other cases have been identified in the same tertiary hospital after a collaborative investigation done with the departments of neurology and psychiatry and included in the case series. A narrative review was performed to assess the potential of psychoactive substance consumption to induce or facilitate CH. RESULTS From 2016 to 2018, 6 males and 1 female aged between 26 and 54 years old, presenting CH criteria and a substance use disorder, were included in our case series. Among substances used, there are: (1) daily use of tobacco and alcohol in 5/7 subjects; (2) daily or almost daily use of cocaine in 5/7 subjects; (3) regular use of cannabis before attacks beginning in 4/7 subjects; and (4) opioids, as a substitutive medication or abused, in 5/7 subjects. The intranasal route administration is reported by all the subjects and precedes the beginning of attacks for 5/7 subjects. CONCLUSIONS We have found a CH prevalence of 0.9% in our studied population, while it is estimated at 0.1% in the general population. The coexistence of cluster headache and addiction behaviors reflects possible common neurobiological pathways, which would include the hypothalamus. Research could be conducted on the potential of hypothalamic therapeutic targets.
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Affiliation(s)
- Camille Ponté
- Service de Pharmacologie Médicale et Clinique, Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, Faculté de Médecine, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Aurélie Giron
- Service de Psychiatrie et Psychologie, Université de Toulouse III, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Marie Crequy
- Service Universitaire de Psychiatrie et Psychologie Médicale, Centre de Soins d'Accompagnement et de Prévention en Addictologie, Hopital La Grave, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Maryse Lapeyre-Mestre
- Service de Pharmacologie Médicale et Clinique, Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, INSERM UMR 1027, CIC INSERM 1436, Faculté de Médecine, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Nelly Fabre
- Departement de Neurologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Juliette Salles
- Service de Psychiatrie et Psychologie, INSERM UMR 1043, Université de Toulouse III, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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10
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Demarquay G, Giraud P. Cefalee primarie non emicraniche. Neurologia 2018. [DOI: 10.1016/s1634-7072(18)41287-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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11
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Fontaine D, Santucci S, Lanteri-Minet M. Managing cluster headache with sphenopalatine ganglion stimulation: a review. J Pain Res 2018; 11:375-381. [PMID: 29497328 PMCID: PMC5819579 DOI: 10.2147/jpr.s129641] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Cluster headache (CH) is a primary headache and considered as one of the worst pains known to man. The sphenopalatine ganglion (SPG) plays a pivotal role in cranial autonomic symptoms associated with pain. Lesioning procedures involving the SPG and experimental acute SPG stimulation have shown some degree of efficacy with regard to CH. A neuromodulation device, chronically implanted in the pterygopalatine fossa, has been specifically designed for acute on-demand SPG stimulation. In a pilot placebo-controlled study in 28 patients suffering from refractory chronic CH, alleviation of pain was achieved in 67.1% of full stimulation-treated attacks compared to 7% of sham stimulation-treated attacks (p<0.0001). Long-term results (24 months; 33 patients) confirmed the efficacy of SPG stimulation as an abortive treatment for CH attacks. Moreover, 35% of the patients observed a >50% reduction in attack frequency, suggesting that repeated use of SPG stimulation might act as a CH-preventive treatment. Globally, 61% of the patients were acute responders, frequency responders, or both, and 39% did not respond to SPG stimulation. The safety of SPG microstimulator implantation procedure was evaluated in a cohort of 99 patients; facial sensory disturbances were observed in 67% of the patients (46% of them being transient), transient allodynia in 3%, and infection in 5%. SPG stimulation appears as a promising innovative, efficient, and safe therapeutic solution for patients suffering from severe CH. It has shown its efficacy in aborting CH attacks compared to placebo stimulation, suggesting that it is particularly adapted for CH patients who are not sufficiently improved by abortive treatments such as sumatriptan and oxygen. However, further studies comparing SPG stimulation with standard abortive and/or preventive CH treatments will be necessary to define more precisely its place within the management of severe chronic and/or episodic CH.
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Affiliation(s)
- Denys Fontaine
- Department of Neurosurgery, CHU de Nice, Université Cote d'Azur, Nice, France.,Université Cote d'Azur, FHU INOVPAIN, CHU de Nice, Nice, France
| | - Serena Santucci
- Department of Neurosurgery, CHU de Nice, Université Cote d'Azur, Nice, France.,Université Cote d'Azur, FHU INOVPAIN, CHU de Nice, Nice, France
| | - Michel Lanteri-Minet
- Université Cote d'Azur, FHU INOVPAIN, CHU de Nice, Nice, France.,INSERM/UdA, Auvergne University, Clermont-Ferrand, France.,Pain Department, CHU de Nice, Université Cote d'Azur, Nice, France
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12
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Robbins MS, Starling AJ, Pringsheim TM, Becker WJ, Schwedt TJ. Treatment of Cluster Headache: The American Headache Society Evidence-Based Guidelines. Headache 2017; 56:1093-106. [PMID: 27432623 DOI: 10.1111/head.12866] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 05/10/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Cluster headache (CH), the most common trigeminal autonomic cephalalgia, is an extremely debilitating primary headache disorder that is often not optimally treated. New evidence-based treatment guidelines for CH will assist clinicians with identifying and choosing among current treatment options. OBJECTIVES In this systematic review we appraise the available evidence for the acute and prophylactic treatment of CH, and provide an update of the 2010 American Academy of Neurology (AAN) endorsed systematic review. METHODS Medline, PubMed, and EMBASE databases were searched for double-blind, randomized controlled trials that investigated treatments of CH in adults. Exclusion and inclusion criteria were identical to those utilized in the 2010 AAN systematic review. RESULTS AND RECOMMENDATIONS For acute treatment, sumatriptan subcutaneous, zolmitriptan nasal spray, and high flow oxygen remain the treatments with a Level A recommendation. Since the 2010 review, a study of sphenopalatine ganglion stimulation was added to the current guideline and has been administered a Level B recommendation for acute treatment. For prophylactic therapy, previously there were no treatments that were administered a Level A recommendation. For the current guidelines, suboccipital steroid injections have emerged as the only treatment to receive a Level A recommendation with the addition of a second Class I study. Other newly evaluated treatments since the 2010 guidelines have been given a Level B recommendation (negative study: deep brain stimulation), a Level C recommendation (positive study: warfarin; negative studies: cimetidine/chlorpheniramine, candesartan), or a Level U recommendation (frovatriptan). CONCLUSIONS This AHS guideline can be utilized for understanding which therapies have superiority to placebo or sham treatment in the management of CH. In clinical practice, these recommendations should be considered in concert with other variables including safety, side effects, patient preferences, clinician experience, cost, and the invasiveness of the intervention. Given the lack of Class I evidence and Level A recommendations, particularly for a number of commonly used preventive therapies, further studies are warranted to demonstrate safety and efficacy for established and emerging therapies.
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Affiliation(s)
- Matthew S Robbins
- Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, NY, USA
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13
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Fontaine D, Blond S, Lucas C, Regis J, Donnet A, Derrey S, Guegan-Massardier E, Jarraya B, Dang-Vu B, Bourdain F, Valade D, Roos C, Creach C, Chabardes S, Giraud P, Voirin J, Bloch J, Rocca A, Colnat-Coulbois S, Caire F, Roger C, Romettino S, Lanteri-Minet M. Occipital nerve stimulation improves the quality of life in medically-intractable chronic cluster headache: Results of an observational prospective study. Cephalalgia 2016; 37:1173-1179. [PMID: 27697849 DOI: 10.1177/0333102416673206] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Occipital nerve stimulation (ONS) has been proposed to treat chronic medically-intractable cluster headache (iCCH) in small series of cases without evaluation of its functional and emotional impacts. Methods We report the multidimensional outcome of a large observational study of iCCH patients, treated by ONS within a nationwide multidisciplinary network ( https://clinicaltrials.gov NCT01842763), with a one-year follow-up. Prospective evaluation was performed before surgery, then three and 12 months after. Results One year after ONS, the attack frequency per week was decreased >30% in 64% and >50% in 59% of the 44 patients. Mean (Standard Deviation) weekly attack frequency decreased from 21.5 (16.3) to 10.7 (13.8) ( p = 0.0002). About 70% of the patients responded to ONS, 47.8% being excellent responders. Prophylactic treatments could be decreased in 40% of patients. Functional (HIT-6 and MIDAS scales) and emotional (HAD scale) impacts were significantly improved, as well as the health-related quality of life (EQ-5D). The mean (SD) EQ-5D visual analogic scale score increased from 35.2 (23.6) to 51.9 (25.7) ( p = 0.0037). Surgical minor complications were observed in 33% of the patients. Conclusion ONS significantly reduced the attack frequency per week, as well as the functional and emotional headache impacts in iCCH patients, and dramatically improved the health-related quality of life of responders.
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Affiliation(s)
- Denys Fontaine
- 1 Dept. of Neurosurgery, CHU de Nice, Nice, France.,2 Fédération Hospitalo-Universitaire INOVPAIN, Université Nice Côte d'Azur, Nice, France
| | - Serge Blond
- 3 Dept. of Neurosurgery, CHU de Lille, Lille, France
| | | | - Jean Regis
- 5 Dept. of Functional Neurosurgery, Aix-Marseille University, La Timone Hospital, Marseille, France
| | - Anne Donnet
- 2 Fédération Hospitalo-Universitaire INOVPAIN, Université Nice Côte d'Azur, Nice, France.,6 Pain Clinic, La Timone Hospital, Marseille, France
| | | | | | - Bechir Jarraya
- 9 Dept. of Neurosurgery, Foch Hospital, Suresnes, France
| | - Bich Dang-Vu
- 10 Dept. of Neurology, Foch Hospital, Suresnes, France
| | | | - Dominique Valade
- 11 Emergency Headache Centre, Lariboisière Hospital, Paris, France
| | - Caroline Roos
- 11 Emergency Headache Centre, Lariboisière Hospital, Paris, France
| | - Christèle Creach
- 12 Dept. of Neurology, CHU de Saint Etienne, Saint Etienne, France
| | | | - Pierric Giraud
- 14 Dept. of Neurology, d'Annecy Hospital, Annecy, France
| | - Jimmy Voirin
- 15 Dept. of Neurosurgery, CHG de Colmar, Colmar, France
| | | | - Alda Rocca
- 16 Dept. of Neurosurgery, CHUV, Lausanne, Switzerland
| | | | - Francois Caire
- 18 Dept. of Neurosurgery, CHU de Limoges, Limoges, France
| | - Coralie Roger
- 19 Dept. of Clinical Research and Innovation, CHU de Nice, Nice, France
| | | | - Michel Lanteri-Minet
- 2 Fédération Hospitalo-Universitaire INOVPAIN, Université Nice Côte d'Azur, Nice, France.,20 Pain Clinic, CHU de Nice, Nice, France.,21 INSERM/UdA, U1107, Neuro-Dol, Trigeminal Pain and Migraine, Clermont-Ferrand, France
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14
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Moisset X, Mawet J, Guegan-Massardier E, Bozzolo E, Gilard V, Tollard E, Feraud T, Noëlle B, Rondet C, Donnet A. French Guidelines For the Emergency Management of Headaches. Rev Neurol (Paris) 2016; 172:350-60. [PMID: 27377828 DOI: 10.1016/j.neurol.2016.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 06/08/2016] [Indexed: 01/03/2023]
Affiliation(s)
- X Moisset
- Inserm U-1107, NeuroDol, Clermont Université, Université d'Auvergne, 49, boulevard François-Mitterrand, 63000 Clermont-Ferrand, France; CHU Gabriel Montpied, Service de Neurologie, Clermont Université, Université d'Auvergne, Clermont-Ferrand, France.
| | - J Mawet
- Centre d'urgences céphalées, département de Neurologie, GH Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris AP-HP, Université Paris Denis Diderot et DHU NeuroVasc Sorbonne Paris-Cité, Paris, France
| | - E Guegan-Massardier
- Service de neurologie, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - E Bozzolo
- Service de neurologie, Pôle des Neurosciences Cliniques, CHU de Nice, Nice, France
| | - V Gilard
- Service de neurochirurgie, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - E Tollard
- Service de neuroradiologie, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - T Feraud
- Service d'accueil des urgences, hôpital Timone, boulevard Jean-Moulin, 264, rue Saint-Pierre, 13385 Marseille, France
| | - B Noëlle
- Cabinet privé, 35, allée de Champrond, 38330 Saint-Ismier, France
| | - C Rondet
- Faculté de médecine, Service de médecine générale, Université Pierre-et-Marie-Curie Paris 06, Paris, France
| | - A Donnet
- Inserm U-1107, NeuroDol, Clermont Université, Université d'Auvergne, 49, boulevard François-Mitterrand, 63000 Clermont-Ferrand, France; Centre d'évaluation et de traitement de la douleur, hôpital Timone, boulevard Jean-Moulin, 264, rue Saint-Pierre, 13385 Marseille, France
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15
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Giraud P, Demarquay G. [Cluster headache and brain imagery]. Presse Med 2015; 44:1185-7. [PMID: 26585270 DOI: 10.1016/j.lpm.2015.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 05/21/2015] [Indexed: 11/30/2022] Open
Abstract
Cluster headache is defined on clinical international criteria developed by International Headache Society (IHS, 2013). The realization of a brain MRI with arterial angio-MRI is required according to the French recommendations (Donnet et al., 2014) based on recent the literature. Numerous causes or diseases can mimic typical or atypical AVF (Edvardsson, 2014). Identification of these causes allows an appropriate treatment in addition with symptomatic treatment.
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Affiliation(s)
- Pierric Giraud
- Hôpital d'Annecy, CETD, consultation douleurs et céphalées, 1, avenue de l'Hôpital, BP 90074, 74374 Pringy, France.
| | - Geneviève Demarquay
- Hospices civils de Lyon, hôpital de la Croix-Rousse, consultation céphalées-migraine, service de neurologie, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France; Lyon Neuroscience Research Center (CRNL), Brain Dynamics and Cognition Team (Dycog), Inserm U1028, CNRS UMR5292, 69000 Lyon, France
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16
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Abstract
UNLABELLED Acute treatment: sumatriptan, oxygen inhalation. Prophylactic treatment: verapamil, lithium carbonate. Transitional treatment. SURGICAL TREATMENT deep brain stimulation, occipital nerve stimulation, stimulation of the sphenopalatin ganglion.
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Affiliation(s)
- Anne Donnet
- Centre d'évaluation et de traitement de la douleur, Timone, 13000 Marseille, France.
| | - Dominique Valade
- Hôpital Lariboisière, centre urgences céphalées, 75000 Paris, France
| | - Denys Fontaine
- Centre hospitalier universitaire de Nice, service de neurochirurgie, 06000 Nice, France; IGCN-EA 7282 (Image-Guided Clinical Neuroscience and Connectomics), UMR 6284 ISIT, UdA, 63000 Clermont-Ferrand, France
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17
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Guégan-Massardier E, Laubier C. Diagnostic différentiel de l’AVF. Presse Med 2015; 44:1180-4. [DOI: 10.1016/j.lpm.2015.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 06/29/2015] [Indexed: 11/26/2022] Open
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18
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Lanteri-Minet M. [Epidemiology, clinical presentation, diagnosis, natural history and screening of cluster headache]. Presse Med 2015; 44:1176-9. [PMID: 26476753 DOI: 10.1016/j.lpm.2015.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 06/22/2015] [Indexed: 12/28/2022] Open
Abstract
This review is focused on the essential data about epidemiology, clinical presentation, diagnosis, natural history and screening for cluster headache.
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Affiliation(s)
- Michel Lanteri-Minet
- CHU de Nice, hôpital Cimiez, pôle neurosciences cliniques, département évaluation et traitement douleur, 4, avenue Reine-Victoria, 06003 Nice, France.
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19
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Lademann V, Jansen JP, Evers S, Frese A. Evaluation of guideline-adherent treatment in cluster headache. Cephalalgia 2015; 36:760-4. [PMID: 26481303 DOI: 10.1177/0333102415612774] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 08/30/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Several treatment guidelines exist for cluster headache. However, it is not yet known how many cluster headache patients are treated according to these guidelines. METHODS We enrolled 434 cluster headache patients with confirmed diagnosis referred to two tertiary pain centers. The history of treatment was registered and analyzed according to the treatment guidelines of the European Federation of Neurological Societies. RESULTS Regarding acute attack treatment, 62.1% of the episodic and 71.0% of the chronic cluster headache patients were treated according to the guidelines. The efficacy rate was above 92% in both groups. Regarding prophylactic treatment, 31.3% of the episodic and 50.9% of the chronic cluster headache patients were treated according to the guidelines. The efficacy rate was 92.8% for episodic and 70.9% for chronic cluster headache. CONCLUSION The rate of guideline-adherent treatment in cluster headache is about 70% for acute treatment and about 35% for prophylactic treatment. The efficacy of this treatment is significantly higher than the efficacy of non-guideline-adherent treatment.
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Affiliation(s)
| | | | - Stefan Evers
- Department of Neurology, University of Münster, Germany Berlin Pain Centre, Germany
| | - Achim Frese
- Department of Neurology, University of Münster, Germany Academy for Manual Medicine, Germany
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20
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Alexandre J, Humbert X, Sassier M, Milliez P, Coquerel A, Fedrizzi S. High-Dose Verapamil in Episodic and Chronic Cluster Headaches and Cardiac Adverse Events: Is It as Safe as We Think? DRUG SAFETY - CASE REPORTS 2015; 2:13. [PMID: 27747725 PMCID: PMC5005783 DOI: 10.1007/s40800-015-0015-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Cluster headache (CH) is a primary headache disorder with relatively effective treatments. Although few sufficiently
controlled trials are available, verapamil is recommended as the first-line prophylactic drug for CH by the French Headache Society (with a low level of evidence, level B) and by the EFNS (European Federation of Neurological Societies, level A). Daily doses of more than 480 mg (and up to 1200 mg daily) are frequently used off-label, while 360 mg daily is the only dosage to have demonstrated its effectiveness in a double-blind trial against placebo, and the usual label posology used by cardiologists is 240 mg daily in hypertension. We report the case of a 19-year-old man who was self-reported to our cardiology consultation for dyspnea and asthenia for 18 months. His medical history consisted of CH crisis for 4 years treated by verapamil 720 mg/day for 18 months with relatively good efficiency. His electrocardiogram (ECG) showed a sinus bradycardia at 40 bpm with a first-degree atrio-ventricular block. Evolution was favorable after progressive verapamil discontinuation. Analysis performed on the French Pharmacovigilance Database between July 1, 2000 and December 1, 2014 found four other cases of cardiac adverse events related to high-dose verapamil used in CH prevention (two cases of syncope with complete atrio-ventricular block with verapamil 1200 and 240 mg daily, respectively, one syncope related to sick sinus syndrome with verapamil 360 mg daily, and one case of sinus bradycardia with verapamil 720 mg daily). Although available studies seem to demonstrate an apparent good tolerance, this off-label practice should not be considered as standard of care and requires strict cardiac monitoring, as suggested by the Agence Nationale de Sécurité du Médicament (ANSM) in a recent re-evaluation of the benefit/risk ratio of high-dose verapamil used in CH prevention.
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Affiliation(s)
- Joachim Alexandre
- Department of Pharmacology, CHU de Caen, Avenue de la côte de nacre, 14000, Caen, France. .,Department of Cardiology, CHU de Caen, 14032, Caen, France. .,Université de Caen Basse-Normandie, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, 14032, Caen, France. .,Université de Caen Basse-Normandie, Medical School, 14032, Caen, France.
| | - Xavier Humbert
- Department of General Medicine, CHU de Caen, 14032, Caen, France
| | - Marion Sassier
- Department of Pharmacology, CHU de Caen, Avenue de la côte de nacre, 14000, Caen, France
| | - Paul Milliez
- Department of Cardiology, CHU de Caen, 14032, Caen, France.,Université de Caen Basse-Normandie, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, 14032, Caen, France.,Université de Caen Basse-Normandie, Medical School, 14032, Caen, France
| | - Antoine Coquerel
- Department of Pharmacology, CHU de Caen, Avenue de la côte de nacre, 14000, Caen, France.,Université de Caen Basse-Normandie, Medical School, 14032, Caen, France.,Université de Caen Basse-Normandie, Inserm U 1075 COMETE, 14032, Caen, France
| | - Sophie Fedrizzi
- Department of Pharmacology, CHU de Caen, Avenue de la côte de nacre, 14000, Caen, France
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