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Schor LI, Pearson SM, de Castro Sousa B, Ettore U, Rohrer U, Gu Y, Wu H, El-Dahdah F, Shapiro RE, Kaas JH, Burish MJ. The location of pain in cluster headache: Data from the International Cluster Headache Questionnaire. Headache 2024; 64:783-795. [PMID: 38922887 DOI: 10.1111/head.14766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE To identify the most common locations of cluster headache pain from an international, non-clinic-based survey of participants with cluster headache, and to compare these locations to other cluster headache features as well as to somatotopic maps of peripheral, brainstem, thalamic, and cortical areas. BACKGROUND Official criteria for cluster headache state pain in the orbital, supraorbital, and/or temporal areas, yet studies have noted pain extending beyond these locations, and the occipital nerve appears relevant, given the effectiveness of suboccipital corticosteroid injections and occipital nerve stimulation. Furthermore, cranial autonomic features vary between patients, and it is not clear if the trigeminovascular reflex is dermatome specific (e.g., do patients with maxillary or V2 division pain have more rhinorrhea?). Finally, functional imaging studies show early activation of the posterior hypothalamus in a cluster headache attack. However, the first somatosensory area to be sensitized is unclear; the first area can be hypothesized based on the complete map of pain locations. METHODS The International Cluster Headache Questionnaire was an internet-based cross-sectional survey that included a clickable pain map of the face. These data were compared to several other datasets: (1) a meta-analysis of 22 previous publications of pain location in cluster headache (consisting of 6074 patients); (2) four cephalic dermatome maps; (3) participants' survey responses for demographics, autonomic features, and effective medications; and (4) previously published somatotopic maps of the brainstem, thalamus, primary somatosensory cortex, and higher order somatosensory cortex. RESULTS One thousand five hundred eighty-nine participants completed the pain map portion of the survey, and the primary locations of pain across all respondents was the orbital, periorbital, and temporal areas with a secondary location in the lower occiput; these primary and secondary locations were consistent with our meta-analysis of 22 previous publications. Of the four cephalic dermatomes (V1, V2, V3, and a combination of C2-3), our study found that most respondents had pain in two or more dermatomes (range 85.7% to 88.7%, or 1361-1410 of 1589 respondents, across the four dermatome maps). Dermatomes did not correlate with their respective autonomic features or with medication effectiveness. The first area to be sensitized in the canonical somatosensory pathway is either a subcortical (brainstem or thalamus) or higher order somatosensory area (parietal ventral or secondary somatosensory cortices) because the primary somatosensory cortex (area 3b) and somatosensory area 1 have discontinuous face and occipital regions. CONCLUSIONS The primary pain locations in cluster headache are the orbital, supraorbital, and temporal areas, consistent with the official International Classification of Headache Disorders criteria. However, activation of the occiput in many participants suggests a role for the occipital nerve, and the pain locations suggest that somatosensory sensitization does not start in the primary somatosensory cortex.
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Affiliation(s)
- Larry I Schor
- Department of Psychology, University of West Georgia, Carrollton, Georgia, USA
| | - Stuart M Pearson
- Department of Psychology, University of West Georgia, Carrollton, Georgia, USA
| | | | - Uilvim Ettore
- Department of Art History, Rice University, Houston, Texas, USA
| | - Ualas Rohrer
- Department of Art History, Rice University, Houston, Texas, USA
| | - Yuxuan Gu
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, Texas, USA
| | - Hulin Wu
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, Texas, USA
| | - Fares El-Dahdah
- Department of Art History, Rice University, Houston, Texas, USA
| | - Robert E Shapiro
- Department of Neurological Sciences, University of Vermont, Burlington, Vermont, USA
| | - Jon H Kaas
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
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Liaw YC, Chen SP, Wang SJ. The Prevalence and Clinical Phenotypes of Cluster Headache in Relation with Latitude. Curr Pain Headache Rep 2024; 28:427-438. [PMID: 38441794 PMCID: PMC11126473 DOI: 10.1007/s11916-024-01229-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE OF REVIEW Previous studies have indicated a possible link between the prevalence of cluster headache (CH) and sunlight exposure. However, this theory has yet to be tested systemically. In this article, we aim to examine how latitude affects the prevalence and phenotypes of CH. RECENT FINDINGS To our knowledge, there is by far no article describing the effect of latitude on disease phenotype; thus, we performed a literature review. We noted positive effects of latitude on 1-year prevalence, the proportion of chronic CH, and the proportion of miosis and/or ptosis. Latitude may affect the phenotypic presentations of cluster headache, probably partially mediated via temperature and sunlight variations. Still, other factors, such as environmental exposure to smoking and the genetic difference between the Eastern and Western populations, may participate in the pathogenesis and clinical manifestations of CH.
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Affiliation(s)
- Yi-Chia Liaw
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Pin Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Membrilla JA, Cuadrado ML, González-García N, Porta-Etessam J, Sánchez-Soblechero A, Lozano Ros A, Gonzalez-Martinez A, Gago-Veiga AB, Quintas S, Rodríguez Vico JS, Jaimes A, Llorente Ayuso L, Roa J, Estebas C, Díaz-de-Terán J. Clinical predictors of therapeutic failure of occipital nerve stimulation in refractory chronic cluster headache. Cephalalgia 2024; 44:3331024241254078. [PMID: 38825586 DOI: 10.1177/03331024241254078] [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: 06/04/2024]
Abstract
BACKGROUND Occipital nerve stimulation (ONS) is a treatment with evidence in refractory chronic cluster headache (CCH). However, the variable response rate and cost make it necessary to investigate predictors of response. METHODS This is a cross-sectional study conducted through the review of medical records of CCH patients from six hospitals in Madrid. Epidemiological and clinical variables were compared between patients with ONS failure and the rest. ONS failure was defined as the need for device withdrawal or switch off because of lack of response or adverse events. RESULTS From a series of 88 CCH, 26 (29.6%) underwent ONS surgery, of whom 13/26 (50.0%) failed because lack of response. ONS failure group had an earlier headache onset (mean ± SD) of 27.7 ± 6.9 vs. 36.7 ± 11.8 years, p = 0.026) and a higher smoking rate (100% vs. 42.9%, p = 0.006). Stational fluctuations (58.3% vs. 7.7%, p = 0.007) and nocturnal exacerbations (91.7% vs. 53.9%, p = 0.035) were more frequent in the ONS failure group as well. There was no difference between groups in diagnostic delay, years of evolution prior to surgery, mental illness, comorbidity with other headache disorders or chronic pain conditions or prior response to occipital nerves anesthetic blocks. CONCLUSIONS Some clinical features such as an early debut, smoking and seasonal or circadian fluctuations could be related to failure of ONS in refractory CCH.
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Affiliation(s)
- Javier A Membrilla
- Neurology Department, Hospital Universitari Francesc de Borja, Gandia, València, Spain
| | - María-Luz Cuadrado
- Neurology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
- Medicine Department, Universidad Complutense, Madrid, Spain
| | | | - Jesús Porta-Etessam
- Neurology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
- Medicine Department, Universidad Complutense, Madrid, Spain
| | | | - Alberto Lozano Ros
- Neurology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Sonia Quintas
- Neurology Department, Hospital Universitario La Princesa, Madrid, Spain
| | | | - Alex Jaimes
- Neurology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - Javier Roa
- Neurology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Carlos Estebas
- Neurology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Javier Díaz-de-Terán
- Neurology Department, Hospital Universitario La Paz, Madrid, Spain
- La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
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Zhang S, Xu S, Chen C, Xue Z, Yao Y, Zhao H, Zhao H, Ji Y, Wang D, Hu D, Liu K, Chen J, Chen S, Gao X, Gui W, Fan Z, Wan D, Yuan X, Qu W, Xiao Z, Dong M, Wang H, Ju C, Xu H, Zhang L, Wang X, Zhang M, Han X, Ran Y, Jia Z, Su H, Li Y, Liu H, Zhao W, Gong Z, Lin X, Liu Y, Sun Y, Xie S, Zhai D, Liu R, Wang S, Dong Z, Yu S. Profile of Chinese Cluster Headache Register Individual Study (CHRIS): Clinical characteristics, diagnosis and treatment status data of 816 patients in China. Cephalalgia 2024; 44:3331024241235193. [PMID: 38501875 DOI: 10.1177/03331024241235193] [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: 03/20/2024]
Abstract
BACKGROUND The clinical profile of cluster headache may differ among different regions of the world, warranting interest in the data obtained from the initial Chinese Cluster Headache Register Individual Study (CHRIS) for better understanding. METHODS We conducted a multicenter, prospective, longitudinal cohort study on cluster headache across all 31 provinces of China, aiming to gather clinical characteristics, treatment approaches, imaging, electrophysiological and biological samples. RESULTS In total 816 patients were enrolled with a male-to-female ratio of 4.33:1. The mean age at consultation was 34.98 ± 9.91 years, and 24.89 ± 9.77 years at onset. Only 2.33% were diagnosed with chronic cluster headache, and 6.99% had a family history of the condition. The most common bout was one to two times per year (45.96%), lasting two weeks to one month (44.00%), and occurring frequently in spring (76.23%) and winter (73.04%). Of these, 68.50% experienced one to two attacks per day, with the majority lasting one to two hours (45.59%). The most common time for attacks was between 9 am and 12 pm (75.86%), followed by 1 am and 3 am (43.48%). Lacrimation (78.80%) was the most predominant autonomic symptom reported. Furthermore, 39.22% of patients experienced a delay of 10 years or more in receiving a correct diagnosis. Only 35.67% and 24.26% of patients received common acute and preventive treatments, respectively. CONCLUSION Due to differences in ethnicity, genetics and lifestyle conditions, CHRIS has provided valuable baseline data from China. By establishing a dynamic cohort with comprehensive multidimensional data, it aims to advance the management system for cluster headache in China.
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Affiliation(s)
- Shuhua Zhang
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Suiyi Xu
- Department of Neurology, Headache Center, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Chunfu Chen
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Zhanyou Xue
- Department of Neurology, Shanghai Donglei Brain Hospital, Shanghai, China
| | - Yuanrong Yao
- Department of Neurology, Guizhou Province People's Hospital, Guiyang, Guizhou, China
| | - Hongru Zhao
- Department of Neurology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Hongling Zhao
- Department of Neurology, Dalian Municipal Central Hospital, Dalian, Liaoning, China
| | - Yabin Ji
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Dan Wang
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, Liaoning, China
| | - Dongmei Hu
- Department of Neurology, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
| | - Kaiming Liu
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jianjun Chen
- Department of Neurology, LiShui Municipal Central Hospital, Lishui, ZheJiang, China
| | - Sufen Chen
- Department of Neurology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan, China
| | - Xiaoyu Gao
- Department of Neurology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Wei Gui
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Zhiliang Fan
- Department of Neurology, Xingtai People's Hospital, Xingtai, Hebei, China
| | - Dongjun Wan
- Department of Neurology, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, Gansu, China
| | - Xueqian Yuan
- Department of Neurology, Zhengzhou People Hospital, Zhengzhou, Henan, China
| | - Wensheng Qu
- Department of Neurology, Tongji Hospital, Tongji Medical Collage Huazhong University of Science & Technology, Wuhan, Hubei, China
| | - Zheman Xiao
- Department of Neurology, Renmin hospital of Wuhan University, Wuhan, Hubei, China
| | - Ming Dong
- Department of Neurology, Neuroscience Center, the First Hospital, Jilin University, Changchun, Jilin, China
| | - Hebo Wang
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Chunyang Ju
- Department of Neurology, Xuchang Central Hospital Affiliated to Henan University of Science and Technology, Xuchang, Henan, China
| | - Huifang Xu
- Department of Neurology, Wuhan No.1 Hospital, Wuhan, Hubei, China
| | - Liang Zhang
- Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xiaolin Wang
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Mingjie Zhang
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Xun Han
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Ye Ran
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Zhihua Jia
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Hui Su
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Yingji Li
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Huanxian Liu
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Wei Zhao
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Zihua Gong
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Xiaoxue Lin
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Yingyuan Liu
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Yin Sun
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Siyuan Xie
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Deqi Zhai
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Ruozhuo Liu
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Shengshu Wang
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhao Dong
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Shengyuan Yu
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
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Leonardi M, Martelletti P, Burstein R, Fornari A, Grazzi L, Guekht A, Lipton RB, Mitsikostas DD, Olesen J, Owolabi MO, Ruiz De la Torre E, Sacco S, Steiner TJ, Surya N, Takeshima T, Tassorelli C, Wang SJ, Wijeratne T, Yu S, Raggi A. The World Health Organization Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders and the headache revolution: from headache burden to a global action plan for headache disorders. J Headache Pain 2024; 25:4. [PMID: 38178049 PMCID: PMC10768290 DOI: 10.1186/s10194-023-01700-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/01/2023] [Indexed: 01/06/2024] Open
Abstract
The World Health Organization (WHO) Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders was developed by WHO to address the worldwide challenges and gaps in provision of care and services for people with epilepsy and other neurological disorders and to ensure a comprehensive, coordinated response across sectors to the burden of neurologic diseases and to promote brain health across life-course. Headache disorders constitute the second most burdensome of all neurological diseases after stroke, but the first if young and midlife adults are taken into account. Despite the availability of a range of treatments, disability associated with headache disorders, and with migraine, remains very high. In addition, there are inequalities between high-income and low and middle income countries in access to medical care. In line with several brain health initiatives following the WHOiGAP resolution, herein we tailor the main pillars of the action plan to headache disorders: (1) raising policy prioritization and strengthen governance; (2) providing effective, timely and responsive diagnosis, treatment and care; (3) implementing strategies for promotion and prevention; (4) fostering research and innovation and strengthen information systems. Specific targets for future policy actions are proposed. The Global Action Plan triggered a revolution in neurology, not only by increasing public awareness of brain disorders and brain health but also by boosting the number of neurologists in training, raising research funding and making neurology a public health priority for policy makers. Reducing the burden of headache disorders will not only improve the quality of life and wellbeing of people with headache but also reduce the burden of neurological disorders increasing global brain health and, thus, global population health.
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Affiliation(s)
- Matilde Leonardi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
| | | | - Rami Burstein
- John Hedley-Whyte Professor of Anesthesia and Neuroscience at the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Arianna Fornari
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Licia Grazzi
- Neuroalgology Unit and Headache Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Richard B Lipton
- Montefiore Headache Center and the Albert Einstein College of Medicine, New York, Bronx, USA
| | - Dimos Dimitrios Mitsikostas
- 1st Neurology Department, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jes Olesen
- Department of Neurology, Danish Headache Center, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mayowa Ojo Owolabi
- Faculty of Clinical Sciences, Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Timothy J Steiner
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Edvard Griegs gate, Trondheim, Norway
- Department of Neurology, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
- Division of Brain Sciences, Imperial College London, London, UK
| | | | - Takao Takeshima
- Department of Neurology, Headache Center, Tominaga Hospital, Osaka, Japan
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Shuu-Jiun Wang
- College of Medicine and Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tissa Wijeratne
- Department of Neurology, Sunshine Hospital, St Albans, VIC, Australia
- Australian Institute of Migraine, Pascoe Vale South, Victoria, Australia
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
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Kim SA, Choi SY, Youn MS, Pozo-Rosich P, Lee MJ. Epidemiology, burden and clinical spectrum of cluster headache: a global update. Cephalalgia 2023; 43:3331024231201577. [PMID: 37728577 DOI: 10.1177/03331024231201577] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND This narrative review aims to broaden our understanding of the epidemiology, burden and clinical spectrum of cluster headache based on updated findings with a global perspective. METHODS We conducted a literature search on the following topics: (a) epidemiology; (b) burden: quality of life, disability, economic burden, job-related burden and suicidality; and (c) clinical spectrum: male predominance and its changes, age, pre-cluster and pre-attack symptoms, aura, post-drome, attack characteristics (location, severity, duration and associated symptoms), bout characteristics (attack frequency, bout duration and bout frequency), circadian and seasonal rhythmicity and disease course. RESULTS New large-scale population-based reports have suggested a lower prevalence than previous estimations. The impact of cluster headache creates a significant burden in terms of the quality of life, disability, economic and job-related burdens and suicidality. Several studies have reported decreasing male-to-female ratios and a wide age range at disease onset. The non-headache phases of cluster headache, including pre-cluster, pre-attack and postictal symptoms, have recently been revisited. The latest data regarding attack characteristics, bout characteristics, and circadian and seasonal rhythmicity from different countries have shown variability among bouts, attacks, individuals and ethnicities. Studies on the disease course of cluster headache have shown typical characteristics of attacks or bouts that decrease with time. CONCLUSIONS Cluster headache may be more than a "trigeminal autonomic headache" because it involves complex central nervous system phenomena. The spectrum of attacks and bouts is wider than previously recognised. Cluster headache is a dynamic disorder that evolves or regresses over time.
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Affiliation(s)
- Seung Ae Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - So Youn Choi
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | | | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Institute of Research, Departament Medicina, Universtitat Autonoma de Barcelona, Spain
| | - Mi Ji Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
- Seoul National University College of Medicine, Seoul, South Korea
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7
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Fourier C, Ran C, Steinberg A, Sjöstrand C, Waldenlind E, Belin AC. Sex Differences in Clinical Features, Treatment, and Lifestyle Factors in Patients With Cluster Headache. Neurology 2023; 100:e1207-e1220. [PMID: 36543572 PMCID: PMC10033163 DOI: 10.1212/wnl.0000000000201688] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 10/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Cluster headache is considered a male-dominated disorder, but we have previously suggested that female patients may display a more severe phenotype. Studies on sex differences in cluster headache have been conflicting; therefore, this study, with the largest validated cluster headache material at present, gives more insights into sex-specific characteristics of the disease. The objective of this study was to describe sex differences in patient demographics, clinical phenotype, chronobiology, triggers, treatment, and lifestyle in a Swedish cluster headache population. METHODS Study participants were identified by screening medical records from 2014 to 2020, requested from hospitals and neurology clinics in Sweden for the ICD-10 code G44.0 for cluster headache. Each study participant answered a detailed questionnaire on clinical information and lifestyle, and all variables were compared with regard to sex. RESULTS A total of 874 study participants with a verified cluster headache diagnosis were included. Of the participants, 575 (66%) were male and 299 (34%) were female, and biological sex matched self-reported sex for all. Female participants were to a greater extent diagnosed with the chronic cluster headache subtype compared with male participants (18% vs 9%, p = 0.0002). In line with this observation, female participants report longer bouts than male participants (p = 0.003) and used prophylactic treatment more often (60% vs 48%, p = 0.0005). Regarding associated symptoms, female participants experienced ptosis (61% vs 47%, p = 0.0002) and restlessness (54% vs 46%, p = 0.02) more frequently compared with male participants. More female than male study participants had a positive family history of cluster headache (15% vs 7%, p = 0.0002). In addition, female participants reported diurnal rhythmicity of their attacks more often than male participants (74% vs 63%, p = 0.002). Alcohol as a trigger occurred more frequently in male participants (54% vs 48%, p = 0.01), whereas lack of sleep triggering an attack was more common in female participants (31% vs 20%, p = 0.001). DISCUSSION With this in-depth analysis of a well-characterized cluster headache population, we could demonstrate that there are significant differences between male and female participants with cluster headache, which should be regarded at the time of diagnosis and when choosing treatment options. The data suggest that female patients generally may be more gravely affected by cluster headache than male patients.
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Affiliation(s)
- Carmen Fourier
- From the Departments of Neuroscience (C.F., C.R., A.C.B.), and Clinical Neuroscience (A.S., C.S., E.W.), Karolinska Institutet; Department of Neurology (A.S., E.W.), Karolinska University Hospital; and Department of Neurology (C.S.), Danderyd Hospital, Stockholm, Sweden
| | - Caroline Ran
- From the Departments of Neuroscience (C.F., C.R., A.C.B.), and Clinical Neuroscience (A.S., C.S., E.W.), Karolinska Institutet; Department of Neurology (A.S., E.W.), Karolinska University Hospital; and Department of Neurology (C.S.), Danderyd Hospital, Stockholm, Sweden
| | - Anna Steinberg
- From the Departments of Neuroscience (C.F., C.R., A.C.B.), and Clinical Neuroscience (A.S., C.S., E.W.), Karolinska Institutet; Department of Neurology (A.S., E.W.), Karolinska University Hospital; and Department of Neurology (C.S.), Danderyd Hospital, Stockholm, Sweden
| | - Christina Sjöstrand
- From the Departments of Neuroscience (C.F., C.R., A.C.B.), and Clinical Neuroscience (A.S., C.S., E.W.), Karolinska Institutet; Department of Neurology (A.S., E.W.), Karolinska University Hospital; and Department of Neurology (C.S.), Danderyd Hospital, Stockholm, Sweden
| | - Elisabet Waldenlind
- From the Departments of Neuroscience (C.F., C.R., A.C.B.), and Clinical Neuroscience (A.S., C.S., E.W.), Karolinska Institutet; Department of Neurology (A.S., E.W.), Karolinska University Hospital; and Department of Neurology (C.S.), Danderyd Hospital, Stockholm, Sweden
| | - Andrea Carmine Belin
- From the Departments of Neuroscience (C.F., C.R., A.C.B.), and Clinical Neuroscience (A.S., C.S., E.W.), Karolinska Institutet; Department of Neurology (A.S., E.W.), Karolinska University Hospital; and Department of Neurology (C.S.), Danderyd Hospital, Stockholm, Sweden.
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8
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Artificial Intelligence-Enabled Evaluation of Pain Sketches to Predict Outcomes in Headache Surgery. Plast Reconstr Surg 2023; 151:405-411. [PMID: 36696328 DOI: 10.1097/prs.0000000000009855] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Recent evidence has shown that patient drawings of pain can predict poor outcomes in headache surgery. Given that interpretation of pain drawings requires some clinical experience, the authors developed a machine learning framework capable of automatically interpreting pain drawings to predict surgical outcomes. This platform will allow surgeons with less clinical experience, neurologists, primary care practitioners, and even patients to better understand candidacy for headache surgery. METHODS A random forest machine learning algorithm was trained on 131 pain drawings provided prospectively by headache surgery patients before undergoing trigger-site deactivation surgery. Twenty-four features were used to describe the anatomical distribution of pain on each drawing for interpretation by the machine learning algorithm. Surgical outcome was measured by calculating percentage improvement in Migraine Headache Index at least 3 months after surgery. Artificial intelligence predictions were compared with clinician predictions of surgical outcome to determine artificial intelligence performance. RESULTS Evaluation of the data test set demonstrated that the algorithm was consistently more accurate (94%) than trained clinical evaluators. Artificial intelligence weighted diffuse pain, facial pain, and pain at the vertex as strong predictors of poor surgical outcome. CONCLUSIONS This study indicates that structured algorithmic analysis is able to correlate pain patterns drawn by patients to Migraine Headache Index percentage improvement with good accuracy (94%). Further studies on larger data sets and inclusion of other significant clinical screening variables are required to improve outcome predictions in headache surgery and apply this tool to clinical practice.
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9
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Liaw YC, Wang YF, Chen WT, Chen SP, Wu JW, Chen ST, Lai KL, Fuh JL, Wang SJ. Sex-related differences in cluster headache: A hospital-based study in Taiwan. Cephalalgia 2022; 42:1532-1542. [PMID: 36003003 DOI: 10.1177/03331024221120054] [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: 11/17/2022]
Abstract
OBJECTIVES To compare the clinical profiles between male and female cluster headache patients from a large cohort. METHODS This hospital-based study enrolled patients diagnosed with cluster headache between 1997 to 2021. Participants completed structured questionnaires collecting information on demographics, clinical profiles, and quality of life. Treatment regimens and effectiveness were determined through medical chart review. All variables were compared between the sexes. RESULTS In total, 798 patients (M/F:659/139) were enrolled. The male-to-female ratio was 4.7:1 for the full study period, but it declined from 5.2:1 to 4.3:1 for patients enrolled before and after 2010, respectively. The frequencies of chronic cluster headache (M:1.2%, F:1.4%) and aura (M:0.3%, F:0.7%) were low but similar between the sexes. Most headache features showed no difference between men and women. Female patients had significantly longer attack duration, shorter inter-bout duration, higher frequencies for eyelid edema, nausea and vomiting and lower frequencies for conjunctival injection and pacing. Sex difference did not influence headache-associated disability, anxiety, or depression, but poor sleep quality was significantly more common in women. Among menstruating women, 22/122 (18.0%) reported worsening headaches during menses. The effectiveness of treatment was similar between the sexes. CONCLUSIONS Despite a decline of male-to-female ratio in the past two decades, most clinical profiles were similar between the sexes.
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Affiliation(s)
- Yi-Chia Liaw
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yen-Feng Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Ta Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Neurology, Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan
| | - Shih-Pin Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jr-Wei Wu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shu-Ting Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kuan-Lin Lai
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jong-Ling Fuh
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
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10
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Cho S, Cho SJ, Lee MJ, Park JW, Chu MK, Moon HS, Chung PW, Sohn JH, Kim BS, Kim D, Kim JM, Chung JM, Oh K, Ahn JY, Gil YE, Chung CS, Kim BK. Characteristics of pre-cluster symptoms in cluster headache: A cross-sectional multicentre study. Cephalalgia 2022; 42:570-578. [PMID: 35112933 DOI: 10.1177/03331024211067784] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Contrary to pre-attack symptoms before an individual cluster headache attack, little is known about the pre-cluster symptoms before the onset of cluster bouts. We previously described pre-attack symptoms before cluster headache attacks. The aim of this study was to investigate characteristics of pre-cluster symptoms in patients with episodic cluster headache. METHODS In this multicentre study, 184 patients with episodic cluster headache were recruited between October 2018 and December 2020. They were interviewed by investigators and completed a structured questionnaire. To investigate pre-cluster and pre-attack symptoms, we assessed 20 symptoms and signs using the questionnaire. RESULTS The upcoming cluster bout was predictable in 35.3% (n = 65/184) of the patients. When present, pre-cluster symptoms occurred at a median duration of 7 days (interquartile range, 2.3-14 days) before the onset of the cluster bout. Patients with pre-cluster symptoms showed a higher proportion of women, prevalence of pre-attack symptoms and seasonal rhythmicity, frequency of cluster headache attacks per day, and total number of cluster bouts compared to patients without pre-cluster symptoms. In univariable and multivariable logistic regression analyses, female sex was associated with the predictability of pre-cluster symptoms (odds ratio = 2.297, p = 0.016). CONCLUSIONS The upcoming cluster bout was predicted in approximately 35% of patients with episodic cluster headache, which may allow for an earlier preventive treatment and help understand the pathophysiology.
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Affiliation(s)
- Soohyun Cho
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Korea
| | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Mi Ji Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Wook Park
- Department of Neurology, Uijeongbu St. Mary's Hospital, Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Heui-Soo Moon
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pil-Wook Chung
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Byung-Su Kim
- Department of Neurology, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea
| | - Daeyoung Kim
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jae-Moon Kim
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jae Myun Chung
- Department of Neurology, Inje University College of Medicine, Seoul, South Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Jin-Young Ahn
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Young Eun Gil
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Chin-Sang Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Kun Kim
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
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11
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Abstract
PURPOSE OF REVIEW The treatment of cluster headache has evolved to include a handheld neuromodulation device and a monoclonal antibody in addition to more traditional agents. RECENT FINDINGS Galcanezumab is an approved treatment for episodic cluster headache. The non-invasive vagal nerve stimulator has been shown to be effective as a treatment for episodic cluster headache. Dedicated pituitary imaging may not be necessary with a normal MRI of the brain. Cluster headache is the most common trigeminal-autonomic cephalalgia, characterized by unilateral, frequent, debilitating attacks associated with ipsilateral autonomic symptoms. Attacks have a circadian and, often, seasonal pattern with periods of remission that can last months to years in episodic patients. Though a rare disease, an increasing number of studies have revealed novel targets for treatment. Treatment in cluster headache should focus on early intervention to reduce frequency of attacks and the length of the cycle, which improves outcomes and disability. Acute therapy is used to treat attacks, while bridging and preventive therapies are combined to reduce cycle length. Case 1: A 43-year-old man presents with the chief complaint of severe headaches. Upon general examination, he seems uncomfortable, agitated, and exhausted. He states that he hasn't "slept in over a week because of debilitating headaches." His headaches start around the same time every night: when he lays down to go to sleep. The pain is described as sharp, like a "hot poker" to his left eye. His partner has noticed that his eye droops and turns red when the pain starts. The attacks come on abruptly and prevent him from sleeping. The severe pain lasts 30 to 45 min, but he has mild-to-moderate pain that lingers for the rest of the night. He has seen his primary care physician, an allergist, and an ear, nose, and throat (ENT) specialist before coming to see a neurologist. Similar headaches occurred last year during the month of October as well. On further questioning, he reports that these headache attacks have been occurring almost yearly for the past 7 years. Each year, these headaches come on as the weather is changing and occur on a nightly basis for about 3 to 4 weeks.
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12
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Chung PW, Kim BS, Park JW, Sohn JH, Lee MJ, Kim BK, Chu MK, Ahn JY, Choi YJ, Song TJ, Bae DW, Kim D, Kim JM, Kim SK, Park KY, Chung JM, Moon HS, Oh K, Chung CS, Cho SJ. Smoking History and Clinical Features of Cluster Headache: Results from the Korean Cluster Headache Registry. J Clin Neurol 2021; 17:229-235. [PMID: 33835743 PMCID: PMC8053542 DOI: 10.3988/jcn.2021.17.2.229] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/13/2020] [Accepted: 11/13/2020] [Indexed: 12/25/2022] Open
Abstract
Background and Purpose Epidemiologic data suggest that cluster headache (CH) is significantly associated with cigarette smoking. The aim of this study was to determine differences in features between patients with a smoking history and those who are never-smokers, using data from a prospective multicenter registry. Methods Data used in this study were obtained from the Korean Cluster Headache Registry that collected data from consecutive patients diagnosed with CH. We compared clinical and demographic features between ever-smokers (current or former smokers) and never-smokers. Results This study enrolled 250 patients who were diagnosed with CH, of which 152 (60.8%) were ever-smokers and 98 (39.2%) were never-smokers. The age at CH onset was significantly lower in the never-smoker group than in the ever-smoker group [27.1±12.9 years vs. 30.6±10.9 years (mean±standard deviation), p=0.024]. Seasonal rhythmicity (58.1% vs. 44.7%, p=0.038) and triptan responsiveness (100% vs. 85.1%, p=0.001) were higher in never-smokers, while other clinical features such as pain severity, duration, attack frequency, and associated autonomic symptoms did not differ significantly between the groups. The male-to-female ratio was markedly higher in ever-smokers (29.4:1) than in never-smokers (1.7:1). Conclusions Most of the clinical features did not differ significantly between patients with a smoking history and never-smokers. However, the age at CH onset, sex ratio, and seasonal rhythmicity were significantly associated with smoking history.
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Affiliation(s)
- Pil Wook Chung
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung Su Kim
- Department of Neurology, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea
| | - Jeong Wook Park
- Department of Neurology, Uijeongbu St. Mary's Hospital, Uijeongbu, Korea
| | - Jong Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Mi Ji Lee
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung Kun Kim
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Seoul, Korea
| | - Jin Young Ahn
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Yun Ju Choi
- Department of Neurology, Dr. Choi's Neurology Clinic, Jeonju, Korea
| | - Tae Jin Song
- Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Dae Woong Bae
- Department of Neurology, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Daeyoung Kim
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jae Moon Kim
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Soo Kyoung Kim
- Department of Neurology, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Kwang Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae Myun Chung
- Department of Neurology, Inje University College of Medicine, Seoul, Korea
| | - Heui Soo Moon
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Chin Sang Chung
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.
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13
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Abstract
PURPOSE OF REVIEW Gender differences exist in headache disorders. A greater understanding of the role of hormones in headache can help the clinician better approach and manage common primary headache disorders. RECENT FINDINGS Recent studies highlight differences in how migraine and cluster headache present in women and men. Updates to the ongoing debate of how to manage the use of hormones in women with migraine, especially with aura, have been well reviewed in the last 18 months. A new meta-analysis evaluates gender differences in response to triptans. SUMMARY This review will focus on recent updates on the role of gender and hormones on migraine and cluster headache and how this may influence treatment.
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14
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Yang J, Yu SY, Yang J, Kong J, Liang FR, Lv ZT. No Association Between G1246A Polymorphism in HCRTR2 Gene and Risk of Cluster Headache: Evidence From an Updated Meta-Analysis of Observational Studies. Front Genet 2020; 11:560517. [PMID: 33343621 PMCID: PMC7744679 DOI: 10.3389/fgene.2020.560517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 10/21/2020] [Indexed: 12/23/2022] Open
Abstract
Background: The hypocretin receptor 2 (HCRTR2) gene may play a pathological role in cluster headache (CH). However, the conclusions of published reports on the relationship between the G1246A polymorphism (rs2653349) in the HCRTR2 gene and risk of CH remain controversial. This purpose of this article is to comprehensively study the current evidence and assess the association between G1246A polymorphism (rs2653349) in the HCRTR2 gene and risk of CH. Materials and Methods: Four electronic databases—ISI Web of Science, CNKI, PubMed, and EMBASE—were comprehensively searched on August 2020 to find and pinpoint all observational articles related to this study. The association between G1246A polymorphism in the HCRTR2 gene and risk of CH under five different genetic models was evaluated based on the summary odds ratio and corresponding 95 confidence interval (95% CI). Methodological quality was assessed based on the Newcastle–Ottawa Scale (NOS). To assist the analysis, RevMan 5.3 software was used to perform subgroup and sensitivity analyses. Egger's and Begg's tests were then conducted to evaluate and assess publication bias. Finally, a meta-regression was carried out by residual (restricted) maximum likelihood (REML). Results: Eight observation studies containing 3,161 healthy controls and 1,964 patients with CH were identified and to be used for the meta-analysis. With methodological quality NOS assessment, the incorporated studies showed an average score of 6.4 stars. The pooled data didn't support the association between G1246A polymorphism in the HCRTR2 gene and CH vulnerability in the overall population (OR: 0.85, 95% CI 0.69, 1.03; p = 0.10). Subgroup analysis by ethnicity showed no significant association between G1246A and CH in either Caucasians (OR: 0.89, 95% CI 0.77, 1.01; p = 0.08) or Asians (OR: 1.65, 95% CI 0.80, 3.41; p = 0.18). The robustness of the conclusion was tested and confirmed with the leave-one-out sensitivity analysis. Meta-regression analysis showed that chronological order of publication appeared to be significantly associated with the heterogeneity (t = 2.47, p = 0.039; residual I2 = 0%, adjusted R2 = 100%). Conclusion: Our present study showed that the G1246A polymorphism in the HCRTR2 gene did not appear to be an accomplice and associated with CH predisposition among either the Asian or Caucasian population.
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Affiliation(s)
- Jiao Yang
- The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Si-Yi Yu
- The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jie Yang
- The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jing Kong
- The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fan-Rong Liang
- The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zheng-Tao Lv
- Department of Orthopedics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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15
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Liampas I, Siokas V, Brotis A, Aloizou A, Mentis AA, Vikelis M, Dardiotis E. Meta-analysis of melatonin levels in cluster headache-Review of clinical implications. Acta Neurol Scand 2020; 142:356-367. [PMID: 32677039 DOI: 10.1111/ane.13317] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/07/2020] [Accepted: 07/12/2020] [Indexed: 12/18/2022]
Abstract
Cluster headache (CH) has been associated with circadian disturbances. The present systematic review examined available evidence for the utilization of melatonin (MT) in CH prophylaxis. First, case-control studies assessing nocturnal MT or its urine-expelled metabolite 6-sulfatoxymelatonin (aMT6s) in CH individuals and healthy controls (HC) were reviewed and meta-analyzed. Secondly, the results from randomized controlled trials (RCTs) and non-randomized studies evaluating MT's use in the prevention of CH were discussed. Literature search included MEDLINE, EMBASE, CENTRAL, PsycINFO, trial registries, Google Scholar, and OpenGrey. Bouts and remissions were assessed separately. Ten case-control studies (adult participants) were retrieved. Seven evaluated serum MT; meta-analysis involved only three of them (due to deficient reporting, n: bout = 31, remission = 38, HC = 31). Results were compatible with lower nocturnal serum MT levels during bouts [bout-HC; FE-MD = -29.89 pg/mL, 95% CI = (-46.00, -13.78), remission-HC; FE-MD = -2.40 pg/mL, 95% CI = (-16.57, 21.38), bout-remission; RE-MD = -32.10 pg/mL, 95% CI = (-56.78, -7.42)]. Nocturnal urinary melatonin was appraised in two studies, but reporting issues impeded the capitalization of the results. Nocturnal urine aMT6s was evaluated by two studies (n: bout = 29, remission = 22, HC = 20), and pooled results were indicative of lower aMT6s concentration in CH individuals during both active and inactive periods [bout-HC; FE-MD = -9.63 μg/nocturnal urine collection, 95% CI = (-14.40, -4.85), remission-HC; FE-MD = -9.12 μg/nocturnal urine collection, 95% CI = (-14.63,-3.62), bout-remission; FE-MD = -0.58 μg/nocturnal urine collection, 95% CI = (-4.58, 3.42)]. Regarding CH prophylaxis, one RCT and two non-randomized trials were retrieved, involving a total of 41 adult CH individuals (11-episodic, 31-chronic) and rendering the deduction of any conclusions precarious. Overall, available data for the role use of MT in CH are insufficient and inconclusive. Complementary studies evaluating endogenous MT concentrations and MT administration to patients with CH are warranted.
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Affiliation(s)
- Ioannis Liampas
- Department of Neurology University Hospital of LarissaSchool of MedicineUniversity of Thessaly Larissa Greece
| | - Vasileios Siokas
- Department of Neurology University Hospital of LarissaSchool of MedicineUniversity of Thessaly Larissa Greece
| | - Alexandros Brotis
- Department of Neurosurgery University Hospital of LarissaSchool of MedicineUniversity of Thessaly Larissa Greece
| | - Athina‐Maria Aloizou
- Department of Neurology University Hospital of LarissaSchool of MedicineUniversity of Thessaly Larissa Greece
| | - Alexios‐Fotios A. Mentis
- Department of Microbiology University Hospital of LarissaSchool of MedicineUniversity of Thessaly Larissa Greece
- Public Health Laboratories Hellenic Pasteur Institute Athens Greece
| | - Michail Vikelis
- Headache Clinic Mediterraneo Hospital Glyfada Greece
- Glyfada Headache Clinic Glyfada Greece
| | - Efthimios Dardiotis
- Department of Neurology University Hospital of LarissaSchool of MedicineUniversity of Thessaly Larissa Greece
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16
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Kim BS, Chung PW, Kim BK, Lee MJ, Park JW, Chu MK, Ahn JY, Bae DW, Song TJ, Sohn JH, Oh K, Kim D, Kim JM, Kim SK, Choi YJ, Chung JM, Moon HS, Chung CS, Park KY, Cho SJ. The impact of remission and coexisting migraine on anxiety and depression in cluster headache. J Headache Pain 2020; 21:58. [PMID: 32471362 PMCID: PMC7257141 DOI: 10.1186/s10194-020-01120-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 04/28/2020] [Indexed: 02/07/2023] Open
Abstract
Background Our aim was to investigate the relationship between coexisting cluster headache (CH) and migraine with anxiety and depression during active cluster bouts, and how symptoms change during remission. Methods We analyzed data from 222 consecutive CH patients and 99 age- and sex-matched controls using a prospective multicenter registry. Anxiety or depression was evaluated using the Generalized Anxiety Disorder-7 (GAD-7) or Patient Health Questionnaire-9 (PHQ-9), respectively. Moderate-to-severe anxiety or depression was defined as a score of ≥10 at baseline (during a cluster bout). We assessed for changes in anxiety and depression during CH remission periods. Results Among the CH patients, the prevalence of moderate-to-severe anxiety and depression was seen in 38.2% and 34.6%, respectively. Compared with controls, CH patients were associated with moderate-to-severe anxiety and depression (multivariable-adjusted odds ratio [aOR] = 7.32, 95% confidence intervals [CI] = 3.35–15.99 and aOR = 4.95, 95% CI = 2.32–10.57, respectively). CH patients with migraine were significantly more likely to have moderate-to-severe anxiety and depression (aOR = 32.53, 95% CI = 6.63–159.64 and aOR = 16.88, 95% CI = 4.16–68.38, respectively), compared to controls without migraine. The GAD-7 and PHQ-9 scores were significantly reduced between cluster bout and remission periods (from 6.8 ± 5.6 to 1.6 ± 2.8; P < 0.001, and from 6.1 ± 5.0 to 1.8 ± 2.4; P < 0.001, respectively). Conclusions Our results indicate that CH patients are at increased risk of anxiety and depression, especially in the presence of coexisting migraine. However, the anxiety and depression can improve during remission periods.
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Affiliation(s)
- Byung-Su Kim
- Department of Neurology, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, South Korea
| | - Pil-Wook Chung
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byung-Kun Kim
- Department of Neurology, Eulji Hospital, Eulji University, Seoul, South Korea
| | - Mi Ji Lee
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jeong Wook Park
- Department of Neurology, Uijeongbu St.Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, South Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin-Young Ahn
- Department of Neurology, Seoul Medical Center, Seoul, South Korea
| | - Dae Woong Bae
- Department of Neurology, College of Medicine, The Catholic University of Korea, Suwon, South Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University Seoul Hospital, College of Medicine, Seoul, South Korea
| | - Jong-Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University College of Medicine, Seoul, South Korea
| | - Daeyoung Kim
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Jae-Moon Kim
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Soo-Kyoung Kim
- Department of Neurology, Gyeongsang National University College of Medicine, Jinju, South Korea
| | - Yun-Ju Choi
- Dr. Choi's Neurology Clinic, Jeonju, South Korea
| | - Jae Myun Chung
- Department of Neurology, Inje University College of Medicine, Seoul, South Korea
| | - Heui-Soo Moon
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chin-Sang Chung
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea.
| | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Keun Jae Bong-gil 7, Hwaseong, Gyeonggi-do, 18450, South Korea.
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17
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Peng KP, Takizawa T, Lee MJ. Cluster headache in Asian populations: Similarities, disparities, and a narrative review of the mechanisms of the chronic subtype. Cephalalgia 2020; 40:1104-1112. [PMID: 32397739 PMCID: PMC7457455 DOI: 10.1177/0333102420923646] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Headache disorders like migraine show geographic and ethnic differences between Asian and European/North American countries. In cluster headache, these differences are rarely mentioned and discussed. This article aimed to review the characteristics of cluster headache in Asian countries and compare the clinical features to those in European and North American populations. METHODS We conducted a narrative literature review on the demographics, clinical presentations, and treatments of cluster headache in Asian countries. RESULTS Patients with cluster headache in Asian populations showed a stronger male predominance compared to European and North American populations. Chronic cluster headache was rare in Asian countries. The clinical presentation of restlessness was not as common in Asian as it was in European and North American countries, and Asian patients with aura were extremely rare. Patients in Asian countries may have a lower circadian rhythmicity of cluster headache and a lower headache load, as demonstrated by lower attack frequencies per day, bout frequencies, and bout durations. CONCLUSIONS Regional differences in the presentation of cluster headache exist. Greater awareness for cluster headache should be raised in Asian regions, and further studies are warranted to elucidate the mechanisms behind observed differences.
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Affiliation(s)
- Kuan-Po Peng
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Tsubasa Takizawa
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Mi Ji Lee
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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18
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Allena M, De Icco R, Sances G, Ahmad L, Putortì A, Pucci E, Greco R, Tassorelli C. Gender Differences in the Clinical Presentation of Cluster Headache: A Role for Sexual Hormones? Front Neurol 2019; 10:1220. [PMID: 31824403 PMCID: PMC6882735 DOI: 10.3389/fneur.2019.01220] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/01/2019] [Indexed: 12/26/2022] Open
Abstract
Introduction: Cluster Headache (CH) is a well-characterized primary headache that mostly affects men, although a progressive decrease in the male-to-female ratio has occurred over time. Available, but partly discordant, data on gender-related differences in CH suggest a more marked overlapping with migraine features in female subjects. The aim of this study is to carefully evaluate the female/male distribution of the typical migraine-associated symptoms and of other features of the disease in a large and well-characterized clinical population of CH subjects. Materials and Methods: We enrolled consecutive CH patients regularly followed at the tertiary Headache Science Center of the IRCCS Mondino Foundation of Pavia (Italy) who attended the Center for a CH bout between September 2016 and October 2018. The subjects were requested to fill in a semi-structured questionnaire focused on the presence of migraine-associated symptoms, familiarity for migraine and, for women, the relationship of CH onset with the reproductive events of their life. These data were compared and integrated with those recorded over time in our clinical database, including demographics and clinical characteristics. The primary outcome was the gender distribution of subjects who satisfied ICHD-III criterion D for migraine-associated symptoms. The secondary outcomes were represented by the gender distribution of individual migraine-associated symptoms and of other disease features included in the questionnaire and/or in the clinical database. Results: Data from 163 males (mean age 41.46 ± 10.37) and 87 females suffering of CH (mean age 42.24 ± 11.95) were analyzed. We did not find a different distribution between sexes as regards the primary outcome measure (F 73.6%, M 65.6%, p = 0.200). However, when we analyzed the occurrence of individual symptoms, nausea and osmophobia were reported more frequently by women (p = 0.048, p = 0.037, respectively). Ptosis and nasal congestion were predominant in females (p = 0.017 and p = 0.01, respectively), while enlarged temporal artery was more frequently reported by men (p = 0.001). Distribution of pain across the head tended to be larger in women, extending more frequently to the zygomatic (p = 0.050), parietal (p = 0.049), and frontal (p = 0.037) regions. Women had a longer mean attack duration (p = 0.004) than men. In CH women the onset of disease often corresponded with moments of important changes in the levels of sexual hormones (menarche, post-partum, menopause). Concomitant thyroid diseases and psychiatric disorders were observed more frequently in women than in men, while snoring and smoking habit was reported by a higher percentage of men than women. Conclusion: We confirmed the presence of distinct gender-related differences in CH and added some novel information that lends credibility to the hypothesis of a closer phenotypical similarity between CH and migraine in the female sex. These observations are relevant for advancing our knowledge on CH pathophysiology, as well as for a more refined diagnostic framing and improved management of the disease.
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Affiliation(s)
- Marta Allena
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Roberto De Icco
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Grazia Sances
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Lara Ahmad
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Alessia Putortì
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Ennio Pucci
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Rosaria Greco
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Cristina Tassorelli
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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