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Martens JM, Fiala KJ, Kalia H, Abd-Elsayed A. Radiofrequency ablation and pulsed radiofrequency ablation for the sympathetic nervous system. RADIOFREQUENCY ABLATION TECHNIQUES 2024:186-201. [DOI: 10.1016/b978-0-323-87063-4.00025-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Shakeel F, Alam P, Alqarni MH, Haq N, Bar FMA, Iqbal M. A Rapid and Sensitive Stability-Indicating Eco-Friendly HPTLC Assay for Fluorescence Detection of Ergotamine. Molecules 2023; 28:5101. [PMID: 37446763 DOI: 10.3390/molecules28135101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Eco-friendly liquid chromatographic methods for measuring ergotamine (EGT) are scant in the published database. Accordingly, the goal of the current study was to develop a high-performance thin-layer chromatography (HPTLC) method for fluorescence detection of EGT in commercially available tablets. This approach was based on the application of ethyl alcohol-water (80:20 v/v) as the eco-friendly eluent mixture. The fluorescence detection of EGT was carried out at 322 nm. The greenness score of the present approach was evaluated by "Analytical GREENness (AGREE)" technology. The present approach for measuring EGT in the 25-1000 ng band-1 range was linear. The present assay for fluorescence detection of EGT was validated successfully by ICH guidelines for various parameters. The method was found to be rapid, sensitive, eco-friendly, and stability-indicating. The computed AGREE index for the current strategy was 0.84, displaying outstanding greenness features. The present methodology successfully separated the EGT degradation products under forced-degradation circumstances, exhibiting its stability-indicating qualities and selectivity. An amount of 99.33% of EGT was found in commercial formulations, indicating the validity of the current method for pharmaceutical analysis of EGT in commercial products. The results showed that EGT in commercial products might be regularly measured by the existing method.
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Affiliation(s)
- Faiyaz Shakeel
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Prawez Alam
- Department of Pharmacognosy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Mohammed H Alqarni
- Department of Pharmacognosy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Nazrul Haq
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Fatma M Abdel Bar
- Department of Pharmacognosy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Muzaffar Iqbal
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
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Interventional Radiofrequency Treatment for the Sympathetic Nervous System: A Review Article. Pain Ther 2021; 10:115-141. [PMID: 33433856 PMCID: PMC8119558 DOI: 10.1007/s40122-020-00227-8] [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] [Received: 10/23/2020] [Accepted: 11/24/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction Interventional techniques such as radiofrequency (RF) treatment can be used to interrupt pain signals transmitted through the sympathetic nervous system (SNS). RF treatments including the pulsed (PRF) and continuous (CRF) modalities show enhanced control over lesion size and enhanced ability to confirm accurate positioning compared to other interventional methods. PRF also acts to reduce the area of the lesion. In this article, we characterize the currently available evidence supporting the use and efficacy of RF treatments in sympathetically mediated pain (SMP) conditions. Study Design A comprehensive literature review. Methods A PubMed and Cochrane Library database search was performed for human studies applying RF treatment at sympathetic sites (sphenopalatine ganglion, stellate ganglion, cervical, thoracic, or lumbar sympathetic ganglia, celiac plexus, splanchnic nerves, superior hypogastric plexus, and ganglion impar) between January 1970 to May 2020. Data were extracted, summarized into tables, and qualitatively analyzed. Results PRF and CRF both show promise in relieving SMP conditions, such as complex regional pain syndrome (CRPS), pain in the perineal region, headache and facial pain, and oncologic and non-oncologic abdominal pain, in addition to other types of pain, with minimal complications. Furthermore, in most comparative studies, outcomes using RF treatments exceeded other interventional techniques, such as anesthetic block and chemical neurolysis. Conclusions RF treatments can be effective in carefully selected patients who are refractory to conservative management. However, further randomized controlled studies are needed prior to implementing it into common practice.
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Abstract
Cluster headache (CH) is a primary headache (PH) disorder characterized by recurrent attacks of severe/extremely severe unilateral pain and associated symptoms. While less prevalent than other PHs such as migraine, CH impact is substantial given the agonizing pain, negative effect on daily productivity, impaired mental health, and increased costs. Cluster headache is not optimally treated and few clinical trials are available to model therapy, especially dosing and administration. Pharmacists are well positioned to help prescribers and CH individuals with several key opportunities. Subcutaneous sumatriptan (SC SM) lower than the FDA-approved 6 mg per attack, specifically 2 mg and 3 mg, can be considered; literature describes these doses' benefits. Moreover, lower doses may improve patient access to this treatment-of-choice. Despite the SC SM's FDA-approved dose limit of 12 mg per 24 hours, the maximum CH dose has not been examined; this limit merits reevaluation since literature and clinical experience illustrate treatment exceeding this limit. Oxygen therapy for CH remains unfamiliar to, and under-utilized by, clinicians and CH individuals. Pharmacists can facilitate prescribing, distribution, and administration of oxygen via education. Patient education for the various CH medication devices, including oxygen, is paramount. Narcotics remain widely prescribed for CH, without supporting evidence, but with considerable abuse and diversion risks. Pharmacists are positioned to help guard against narcotic usage and to direct care toward medications endorsed by CH guidelines. Since the optimal method to initiate and discontinue drugs which may decrease CH attacks' remains unknown, pharmacists can educate clinicians and individuals with CH to make fully informed decisions.
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Affiliation(s)
- Richard Wenzel
- Global Medical Affairs, 1539Eli Lilly & Company, Lilly Corporate Center, Indianapolis, IN, USA
| | | | - Alexis S Clark
- Global Medical Affairs, 1539Eli Lilly & Company, Lilly Corporate Center, Indianapolis, IN, USA
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Chronic Cluster Headache Update and East-West Comparisons: Focusing on Clinical Features, Pathophysiology, and Management. Curr Pain Headache Rep 2020; 24:68. [PMID: 32990832 DOI: 10.1007/s11916-020-00902-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW This review provides an update on chronic cluster headache (CH) focusing on clinical features, pathophysiology, and management as well as comparisons between Eastern and Western populations. RECENT FINDINGS Chronic CH in Eastern populations was relatively rare, compared to that in Western populations. Lacrimation and/or conjunctival injection is the most frequently reported cranial autonomic symptom, and visual aura is predominant in chronic CH patients. Neuroimaging evidence in both ethnic groups suggests that CH pathophysiology involves the hypothalamus and pain-modulatory areas, with dynamic alternations between CH episodes. Recent evidence indicates that midbrain dopaminergic systems may participate in CH chronicity. Noteworthy advances have emerged in neuromodulatory therapies for chronic CH, but treatment with calcitonin gene-related peptide (CGRP) monoclonal antibodies has been unsuccessful. Recent evidence shows divergence of chronic CH between Eastern and Western populations. Neuromodulatory therapies but not CGRP inhibition is effective in this intractable patient group.
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6
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Mecklenburg J, Sanchez Del Rio M, Reuter U. Cluster headache therapies: pharmacology and mode of action. Expert Rev Clin Pharmacol 2020; 13:641-654. [DOI: 10.1080/17512433.2020.1774361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Jasper Mecklenburg
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Molsberger A, McCaig CD. Percutaneous Bioelectric Current Stimulation for Chronic Cluster Headache - A Possible Transformative Approach to Cluster Headache. J Pain Res 2020; 13:817-828. [PMID: 32425586 PMCID: PMC7186886 DOI: 10.2147/jpr.s242093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/11/2020] [Indexed: 12/17/2022] Open
Abstract
Background Cluster headache (CH) is considered to be a catastrophic disease presenting the most severe human pain condition. Available pharmacological treatments are hampered by unwanted side effects, and there is an urgent need for non-pharmacological treatment alternatives. We present a novel therapeutic approach for chronic CH, having evolved from an episodic CH, using a non-invasive percutaneous bioelectric current stimulation (PBCS), which generates static electric fields in the range of the naturally occurring electric potentials. Patients and Methods This study employed a retrospective data analysis of 20 cases of chronic cluster headache (CCH) patients, four of those having had cluster-related surgery (SPG, ONS). All patients were treated with PBCS between 2014 and 2018. Data of these patients were analyzed with respect to frequency of CH attacks and triptan application and followed up for one (20 cases) or two (12 cases) years. Results Four weeks after the first PBCS treatment, cluster headache attacks were reduced from 2.8 to 1.7 per day and triptan application decreased from 2.5 to 1.5 times/day. Six non-responders, 4 of which had pre-CH surgery, did not show any reaction to PBCS, while 14 responders improved within 4 weeks from 2.2 to 0.7 attacks/day and 2.0 to 0.4 triptan applications/day. A 50% or greater reduction of attack frequency was observed in 10 patients after 4 weeks and in 11 patients after 12 weeks. One year after the first treatment, 13/20 patients experienced a reduction of attack frequency of 50% or more, while remarkably 10 patients were completely free of attack. After 2 years, 8 of 12 patients experienced a reduction of attack frequency of 50% or more and 7 of those were completely symptom-free. No serious adverse effects were observed. Conclusion PBCS is a promising transformative treatment approach for CCH patients. Drug consumption was reduced significantly, and the CCH may revert back to an episodic cluster headache with increasingly long times of remission. Responders can be clearly differentiated from non-responders. The data support the need for randomized controlled trials.
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Affiliation(s)
- Albrecht Molsberger
- Department of Orthopedics, Ruhr-University Bochum, Germany, Clinic for Headache, Pain and Locomotive Disorders, Duesseldorf, Germany
| | - Colin D McCaig
- Institute of Medical Sciences, University of Aberdeen, Aberdeen AB25 2ZD, Scotland
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Abstract
Headache is the most common neurologic symptom and affects nearly half the world's population at any given time. Although the prevalence declines with age, headache remains a common neurologic complaint among elderly populations. Headaches can be divided into primary and secondary causes. Primary headaches comprise about two-thirds of headaches among the elderly. They are defined by clinical criteria and are diagnosed based on symptom pattern and exclusion of secondary causes. Primary headaches include migraine, tension-type, trigeminal autonomic cephalalgias, and hypnic headache. Secondary headaches are defined by their suspected etiology. A higher index of suspicion for a secondary headache disorder is warranted in older patients with new-onset headache. They are roughly 12 times more likely to have serious underlying causes and, frequently, have different symptomatic presentations compared to younger adults. Various imaging and laboratory evaluations are indicated in the presence of any "red flag" signs or symptoms. Head CT is the procedure of choice for acute headache presentations, and brain MRI for those with chronic headache complaints. Management of headache in elderly populations can be challenging due to the presence of multiple medical comorbidities, polypharmacy, and differences in drug metabolism and clearance.
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Affiliation(s)
- Robert G Kaniecki
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
| | - Andrew D Levin
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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Kumar S, Kalita J, Misra UK. Repetitive transcranial magnetic stimulation in cluster headache. Brain Stimul 2018; 12:383-384. [PMID: 30573324 DOI: 10.1016/j.brs.2018.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 01/03/2023] Open
Affiliation(s)
- Sumit Kumar
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Jayantee Kalita
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226014, India.
| | - Usha K Misra
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226014, India
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Marin J, Giffin N, Consiglio E, McClure C, Liebler E, Davies B. Non-invasive vagus nerve stimulation for treatment of cluster headache: early UK clinical experience. J Headache Pain 2018; 19:114. [PMID: 30470171 PMCID: PMC6755582 DOI: 10.1186/s10194-018-0936-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/18/2018] [Indexed: 01/03/2023] Open
Abstract
Background Evidence supports the use of non-invasive vagus nerve stimulation (nVNS; gammaCore®) as a promising therapeutic option for patients with cluster headache (CH). We conducted this audit of real-world data from patients with CH, the majority of whom were treatment refractory, to explore early UK clinical experience with nVNS used acutely, preventively, or both. Methods We retrospectively analysed data from 30 patients with CH (29 chronic, 1 episodic) who submitted individual funding requests for nVNS to the National Health Service. All patients had responded to adjunctive nVNS therapy during an evaluation period (typical duration, 3–6 months). Data collected from patient interviews, treatment diaries, and physician notes were summarised with descriptive statistics. Paired t tests were used to examine statistical significance. Results The mean (SD) CH attack frequency decreased from 26.6 (17.1) attacks/wk. before initiation of nVNS therapy to 9.5 (11.0) attacks/wk. (P < 0.01) afterward. Mean (SD) attack duration decreased from 51.9 (36.7) minutes to 29.4 (28.5) minutes (P < 0.01), and mean (SD) attack severity (rated on a 10-point scale) decreased from 7.8 (2.3) to 6.0 (2.6) (P < 0.01). Use of abortive treatments also decreased. Favourable changes in the use of preventive medication were also observed. No serious device-related adverse events were reported. Conclusions Significant decreases in attack frequency, severity, and duration were observed in these patients with CH who did not respond to or were intolerant of multiple preventive and/or acute treatments. These real-world findings complement evidence from clinical trials demonstrating the efficacy and safety of nVNS in CH. Electronic supplementary material The online version of this article (10.1186/s10194-018-0936-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Juana Marin
- Wellcome Foundation Building, King's College Hospital, London, SE5 9PJ, UK.
| | - Nicola Giffin
- Royal United Hospital, Coombe Park, Bath, BA1 3NG, UK
| | | | - Candace McClure
- North American Science Associates, Inc., 400 US-169, Minneapolis, MN, 55441, USA
| | - Eric Liebler
- electroCore, Inc., 150 Allen Road, Suite 201, Basking Ridge, NJ, 07920, USA
| | - Brendan Davies
- University Hospitals of North Midlands, Newcastle Road, Stoke-on-Trent, ST4 6QG, UK
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Population-Based Analysis of Cluster Headache-Associated Genetic Polymorphisms. J Mol Neurosci 2018; 65:367-376. [PMID: 29959630 DOI: 10.1007/s12031-018-1103-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
Abstract
Cluster headache is a disorder with increased hereditary risk. Associations between cluster headache and polymorphism rs2653349 of the HCRTR2 gene have been demonstrated. The less common allele (A) seems to reduce disease susceptibility. The polymorphism rs5443 of the GNB3 gene positively influences triptan treatment response. Carriers of the mutated T allele are more likely to respond positively compared to C:C homozygotes, when treated with triptans. DNA was extracted from buccal swabs obtained from 636 non-related Southeastern European Caucasian individuals and was analyzed by real-time PCR. Gene distribution for the rs2653349 was G:G = 79.1%, G:A = 19.2%, and A:A = 1.7%. The frequency of the wild-type G allele was 88.7%. The frequencies for rs5443 were C:C = 44.0%, C:T = 42.6%, and T:T = 13.4%. The frequency of the wild-type C allele was 65.3%. The frequency distribution of rs2653349 in the Southeastern European Caucasian population differs significantly when compared with other European and East Asian populations, and the frequency distribution of rs5443 showed a statistically significant difference between Southeastern European Caucasian and African, South Asian, and East Asian populations. For rs2653349, a marginal statistically significant difference between genders was found (p = 0.080) for A:A versus G:G and G:A genotypes (OR = 2.78), indicating a higher representation of male homozygotes for the protective mutant A:A allele than female. No statistically significant difference was observed between genders for rs5443. Cluster headache pathophysiology and pharmacotherapy response may be affected by genetic factors, indicating the significant role of genotyping in the overall treatment effectiveness of cluster headaches.
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Dodick D, Edvinsson L, Makino T, Grisold W, Sakai F, Jensen R, Balch A, Ruiz de la Torre E, Henscheid-Lorenz D, Craven A, Ashina M. Vancouver Declaration on Global Headache Patient Advocacy 2018. Cephalalgia 2018; 38:1899-1909. [PMID: 29882695 DOI: 10.1177/0333102418781644] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Headache disorders comprise the three most prevalent medical disorders globally and contribute almost 20% to the total burden of neurologic illness. Although the experience of a recurrent headache disorder tends to be highly individualized, patient preferences tend to be a low priority in guidelines for the management of patients with headache. METHODS In September 2017, the first Global Patient Advocacy Summit was convened, bringing together patients, patient advocates, patient advocacy organizations, healthcare professionals, pharmaceutical manufacturers, scientists, and regulatory agencies to advance issues of importance to patients affected by headache worldwide. RESULTS Presentations and discussion covered multiple issues, such as improving access to appropriate medical care; incorporating the insights of independent patient advocates and advocacy organizations; leveraging the insights, experience and influence of leading health and neurological organizations; and raising awareness of the role of regulatory agencies in disease advocacy. Attendees agreed that it is important to understand and promote the global, regional, and local interests of people with headache disorders, as well as challenge the pervasive stigma associated with headache. They also agreed that those with severe, recurrent, or disabling headache disorders should have reliable access to competent medical care; healthcare professionals should have access to adequate training in Headache Medicine; global benchmarks should be established for accurate diagnosis and the use of evidence-based treatments in patients with headache; and that information is needed about consultation, diagnosis, and treatment of headache, particularly in regard to patient preferences. CONCLUSION Based on the group's consensus around these issues, a series of statements was developed, and they are collectively presented herein as the Vancouver Declaration on Global Headache Patient Advocacy 2018.
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Affiliation(s)
| | | | - Tomohiko Makino
- 3 World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | | | | | - Rigmor Jensen
- 6 Danish Headache Center, University of Copenhagen, Rigshopitalet, Glostrup, Denmark
| | - Alan Balch
- 7 Patient Advocate Foundation, Hampton, VA, USA
| | | | | | | | - Messoud Ashina
- 6 Danish Headache Center, University of Copenhagen, Rigshopitalet, Glostrup, Denmark
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Wei J, Robbins MS. Greater Occipital Nerve Injection versus Oral Steroids for Short Term Prophylaxis of Cluster Headache: A Retrospective Comparative Study. Headache 2018; 58:852-858. [DOI: 10.1111/head.13334] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 01/03/2023]
Affiliation(s)
- Jerry Wei
- Department of Neurology; Montefiore Headache Center; Bronx NY USA
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O'Brien M, Ford JH, Aurora SK, Govindan S, Tepper DE, Tepper SJ. Economics of Inhaled Oxygen Use as an Acute Therapy for Cluster Headache in the United States of America. Headache 2017; 57:1416-1427. [DOI: 10.1111/head.13167] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/25/2017] [Accepted: 05/25/2017] [Indexed: 01/03/2023]
Affiliation(s)
| | | | | | | | | | - Stewart J. Tepper
- Geisel School of Medicine at Dartmouth; Hanover NH, USA (S.J. Tepper)
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Gul HL, Ozon AO, Karadas O, Koc G, Inan LE. The efficacy of greater occipital nerve blockade in chronic migraine: A placebo-controlled study. Acta Neurol Scand 2017; 136:138-144. [PMID: 27910088 DOI: 10.1111/ane.12716] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE GON blockade with local anesthetics is an effective treatment for a group of headaches, such as cervicogenic headache, cluster headache, occipital neuralgia, migraine. Our aim was to evaluate the efficacy of greater occipital nerve (GON) blockade in patients with chronic migraine (CM) by using a control group. MATERIALS AND METHODS We included 44 CM patients and randomly divide the patients into two groups, as group A (bupivacaine) and group B (placebo) to our study. GON blockade was administered four times (once per week) with bupivacaine or saline. After 4 weeks of treatment, patients were followed up for 3 months, and findings were recorded once every month for comparing each month's values with the pretreatment values. The primary endpoint was the difference in the frequency of headache (headache days/month). VAS pain scores were also recorded. RESULTS A total of 44 patients had completed the study; no severe adverse effects had occurred. Group A showed a significant decrease in the frequency of headache and VAS scores at the first, second, and third months of follow-up. Similarly, group B showed a significant decrease in the frequency of headache and VAS scores at the first month of follow-up, but second and third months of follow-up showed no significant difference. CONCLUSION Our results suggest that GON blockade with bupivacaine was superior to placebo, has long-lasting effect than placebo, and was found to be effective for the treatment of CM. More studies are needed to better define the safety and cost-effectiveness of GON blockade in CM.
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Affiliation(s)
- H. L. Gul
- Department of Neurology; Dr. Lutfi Kirdar Kartal Training and Research Hospital; Istanbul Turkey
| | - A. O. Ozon
- Department of Neurology; Liv Hospital; Ankara Turkey
| | - O. Karadas
- Department of Neurology; Gulhane Education and Research Hospital; Ankara Turkey
| | - G. Koc
- Gaziler Physical Medicine and Rehabilitation Education and Research Hospital; Ankara Turkey
| | - L. E. Inan
- Department of Neurology; Ankara Education and Research Hospital; Ankara Turkey
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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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Bagheri A, Mohammadi M, Harooni G, Khosravifard K, Feizi M, Yazdani S. Cluster Headache Associated with Secondary Unilateral Blepharospasm: A Case Report and Review of the Literature. J Ophthalmic Vis Res 2017; 12:225-227. [PMID: 28540017 PMCID: PMC5423379 DOI: 10.4103/jovr.jovr_158_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: Cluster headache is one of the most serious types of headache that is accompanied by autonomic parasympathetic symptoms. Its association with hemifacial spasm in the same side had been rarely reported. The aim of this report is describing a case with this association and treatment strategies. Case Report: Here we report a 37-year-old female with cluster headache associated with secondary unilateral blepharospasm that was successfully treated with combination therapy including botulinum toxin injection. Conclusion: Hemifacial spasm associated with cluster headache needs special attention and can be treated successfully.
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Affiliation(s)
- Abbas Bagheri
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Minoo Mohammadi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghader Harooni
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Keyvan Khosravifard
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohadeseh Feizi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahin Yazdani
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Silberstein SD, Mechtler LL, Kudrow DB, Calhoun AH, McClure C, Saper JR, Liebler EJ, Rubenstein Engel E, Tepper SJ. Non-Invasive Vagus Nerve Stimulation for the ACute Treatment of Cluster Headache: Findings From the Randomized, Double-Blind, Sham-Controlled ACT1 Study. Headache 2017; 56:1317-32. [PMID: 27593728 PMCID: PMC5113831 DOI: 10.1111/head.12896] [Citation(s) in RCA: 164] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/11/2016] [Accepted: 06/10/2016] [Indexed: 01/03/2023]
Abstract
Objective To evaluate non‐invasive vagus nerve stimulation (nVNS) as an acute cluster headache (CH) treatment. Background Many patients with CH experience excruciating attacks at a frequency that is not sufficiently addressed by current symptomatic treatments. Methods One hundred fifty subjects were enrolled and randomized (1:1) to receive nVNS or sham treatment for ≤1 month during a double‐blind phase; completers could enter a 3‐month nVNS open‐label phase. The primary end point was response rate, defined as the proportion of subjects who achieved pain relief (pain intensity of 0 or 1) at 15 minutes after treatment initiation for the first CH attack without rescue medication use through 60 minutes. Secondary end points included the sustained response rate (15‐60 minutes). Subanalyses of episodic cluster headache (eCH) and chronic cluster headache (cCH) cohorts were prespecified. Results The intent‐to‐treat population comprised 133 subjects: 60 nVNS‐treated (eCH, n = 38; cCH, n = 22) and 73 sham‐treated (eCH, n = 47; cCH, n = 26). A response was achieved in 26.7% of nVNS‐treated subjects and 15.1% of sham‐treated subjects (P = .1). Response rates were significantly higher with nVNS than with sham for the eCH cohort (nVNS, 34.2%; sham, 10.6%; P = .008) but not the cCH cohort (nVNS, 13.6%; sham, 23.1%; P = .48). Sustained response rates were significantly higher with nVNS for the eCH cohort (P = .008) and total population (P = .04). Adverse device effects (ADEs) were reported by 35/150 (nVNS, 11; sham, 24) subjects in the double‐blind phase and 18/128 subjects in the open‐label phase. No serious ADEs occurred. Conclusions In one of the largest randomized sham‐controlled studies for acute CH treatment, the response rate was not significantly different (vs sham) for the total population; nVNS provided significant, clinically meaningful, rapid, and sustained benefits for eCH but not for cCH, which affected results in the total population. This safe and well‐tolerated treatment represents a novel and promising option for eCH. ClinicalTrials.gov identifier: NCT01792817.
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Affiliation(s)
| | - Laszlo L Mechtler
- Department of Neurology and Neuro-Oncology, Dent Neurologic Headache Center, Amherst, NY, USA
| | - David B Kudrow
- California Medical Clinic for Headache, Santa Monica, CA, USA
| | | | | | - Joel R Saper
- Michigan Head Pain and Neurological Institute, Ann Arbor, MI, USA
| | - Eric J Liebler
- Department of Scientific, Medical and Governmental Affairs, electroCore, LLC, Basking Ridge, NJ, USA
| | | | - Stewart J Tepper
- Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Dr. Tepper was at Cleveland Clinic Headache Center, Cleveland, OH, at the time of study completion
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Gaul C, Magis D, Liebler E, Straube A. Effects of non-invasive vagus nerve stimulation on attack frequency over time and expanded response rates in patients with chronic cluster headache: a post hoc analysis of the randomised, controlled PREVA study. J Headache Pain 2017; 18:22. [PMID: 28197844 PMCID: PMC5309191 DOI: 10.1186/s10194-017-0731-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 02/07/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND In the PREVention and Acute treatment of chronic cluster headache (PREVA) study, attack frequency reductions from baseline were significantly more pronounced with non-invasive vagus nerve stimulation plus standard of care (nVNS + SoC) than with SoC alone. Given the intensely painful and frequent nature of chronic cluster headache attacks, additional patient-centric outcomes, including the time to and level of therapeutic response, were evaluated in a post hoc analysis of the PREVA study. FINDINGS After a 2-week baseline phase, 97 patients with chronic cluster headache entered a 4-week randomised phase to receive nVNS + SoC (n = 48) or SoC alone (n = 49). All 92 patients who continued into a 4-week extension phase received nVNS + SoC. Compared with SoC alone, nVNS + SoC led to a significantly lower mean weekly attack frequency by week 2 of the randomised phase; the attack frequency remained significantly lower in the nVNS + SoC group through week 3 of the extension phase (P < 0.02). Attack frequencies in the nVNS + SoC group were significantly lower at all study time points than they were at baseline (P < 0.05). Response rates were significantly greater with nVNS + SoC than with SoC alone when response was defined as attack frequency reductions of ≥25%, ≥50%, and ≥75% from baseline (≥25% and ≥50%, P < 0.001; ≥75%, P = 0.009). The 100% response rate was 8% with nVNS + SoC and 0% with SoC alone. CONCLUSIONS Prophylactic nVNS led to rapid, significant, and sustained reductions in chronic cluster headache attack frequency within 2 weeks after its addition to SoC and was associated with significantly higher ≥25%, ≥50%, and ≥75% response rates than SoC alone. The rapid decrease in weekly attack frequency justifies a 4-week trial period to identify responders to nVNS, with a high degree of confidence, among patients with chronic cluster headache.
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Affiliation(s)
- Charly Gaul
- Department of Headache and Facial Pain, Migraine and Headache Clinic, Ölmühlweg 31, Königstein im Taunus, 61462, Germany.
| | - Delphine Magis
- Headache Research Unit, University Department of Neurology, Centre Hospitalier Régional de la Citadelle, Boulevard du 12ème de Ligne 1, 4000, Liège, Belgium
| | - Eric Liebler
- electroCore, LLC, 150 Allen Road, Suite 201, Basking Ridge, 07920, NJ, USA
| | - Andreas Straube
- Department of Neurology, Ludwig-Maximilian University, Marchioninistr 15, Munich, D81377, Germany
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20
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Ocak T, Tekin E, Basturk M, Duran A, Serinken M, Emet M. Treatment in carbon monoxide poisoning patients with headache: a prospective, multicenter, double-blind, controlled clinical trial. Am J Emerg Med 2016; 34:2140-2145. [PMID: 27553827 DOI: 10.1016/j.ajem.2016.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There is a lack of specificity of the analgesic agents used to treat headache and underlying acute carbon monoxide poisoning. OBJECTIVE To compare effectiveness of "oxygen alone" vs "metoclopramide plus oxygen" vs "metamizole plus oxygen" therapy in treating carbon monoxide-induced headache. DESIGN A prospective, multicenter, double-blind, controlled trial. SETTING Three emergency departments in Turkey. POPULATION Adult carbon monoxide poisoning patients with headache. METHODS A total of 117 carbon monoxide-intoxicated patients with headache were randomized into 3 groups and assessed at baseline, 30 minutes, 90 minutes, and 4 hours. MAIN OUTCOME MEASURE The primary outcome was patient-reported improvement rates for headache. Secondary end points included nausea, need for rescue medication during treatment, and reduction in carboxyhemoglobin levels. RESULTS During observation, there was no statistical difference between drug type and visual analog scale score change at 30 minutes, 90 minutes, or 4 hours, for either headache or nausea. No rescue medication was needed during the study period. The reduction in carboxyhemoglobin levels did not differ among the 3 groups. CONCLUSION The use of "oxygen alone" is as efficacious as "oxygen plus metoclopramide" or "oxygen plus metamizole sodium" in the treatment of carbon monoxide-induced headache.
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Affiliation(s)
- Tarik Ocak
- Department of Emergency Medicine, Kanuni Sultan Suleyman Education and Research Hospital, Istanbul, Turkey.
| | - Erdal Tekin
- Department of Emergency, Ataturk University Medical Faculty, Erzurum, Turkey.
| | - Mustafa Basturk
- Department of Emergency, Bagcilar Research and Teaching Hospital, Istanbul, Turkey.
| | - Arif Duran
- Department of Emergency, Abant Izzet Baysal University Medical Faculty, Bolu, Turkey.
| | - Mustafa Serinken
- Department of Emergency, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
| | - Mucahit Emet
- Department of Emergency, Ataturk University Medical Faculty, Erzurum, Turkey.
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Oude Nijhuis JC, Haane DYP, Koehler PJ. A review of the current and potential oxygen delivery systems and techniques utilized in cluster headache attacks. Cephalalgia 2016; 36:970-9. [DOI: 10.1177/0333102415616878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 10/04/2015] [Indexed: 12/11/2022]
Abstract
Background Despite oxygen therapy being one of the foremost acute treatments for cluster headache (CH) attacks, little is known about the different techniques and systems. Objectives In this review we will examine the efficacy of the standard non-rebreather mask (NRM) with room temperature oxygen in relieving pain in CH, and try to compare it with the diversity of other oxygen gas conditions and interfaces like partial rebreathers, simple masks, nasal cannulas, tusk masks, demand valve oxygen, hyperbaric and cooled oxygen. Method We searched non-structured Pubmed, Medline, the Cochrane online database and instruction protocols from various oxygen delivery devices. Conclusions and implications Interfaces like demand valves and tusk masks are already proving to be superior or at least similar to the standard NRM in terms of fraction of inspired oxygen (FiO2), though the demand valve only showed better results than the NRM in a single study in only four participants. Furthermore, new research shows how lower temperatures of the gas may be an essential part of effective pain relief and hyperbaric treatments show potential in preventing night time attacks.
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Affiliation(s)
- Jerome C Oude Nijhuis
- Department of Neurology, Atrium Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands
| | - Danielle YP Haane
- Department of Neurology, Atrium Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands
| | - Peter J Koehler
- Department of Neurology, Atrium Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands
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Koppen H, Stolwijk J, Wilms EB, van Driel V, Ferrari MD, Haan J. Cardiac monitoring of high-dose verapamil in cluster headache: An international Delphi study. Cephalalgia 2016; 36:1385-1388. [DOI: 10.1177/0333102416631968] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/04/2016] [Accepted: 01/07/2016] [Indexed: 11/16/2022]
Abstract
Background In many patients, high-dose verapamil (HDV) is the only effective prophylactic treatment for cluster headache. Although cardiac adverse events and EKG abnormalities are relatively common, evidence-based guidelines for screening and monitoring patients on HDV are lacking. Goal and methods Using the Delphi approach, we interviewed 22 international clinical experts in cardiac rhythm disorders to formulate EKG guidelines for the pretreatment screening and monitoring of cluster headache patients using HDV. Results The panel agreed only on performing pretreatment EKG to screen for pre-existing cardiac arrhythmia. Pretreatment EKG was deemed not necessary by most panel members for patients who did not have cardiac adverse events during a previous period of cluster headache attacks treated with HDV. Half the panel advised Holter EKG for patients on verapamil ≥ 480 mg/day. The highest recommended daily doses varied between 240 and 960 mg. Contraindications for use of verapamil largely followed FDA guidelines. Discussion Experts in cardiac rhythm disorders agreed on pretreatment EKG monitoring, but no consensus was reached on EKG monitoring during HDV treatment and around dose adjustments.
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Affiliation(s)
- H Koppen
- Department of Neurology, Haga Hospital, The Netherlands
| | - J Stolwijk
- Department of Neurology, Haga Hospital, The Netherlands
| | - EB Wilms
- Department of Clinical Pharmacy, Haga Hospital, The Netherlands
| | - V van Driel
- Department of Cardiology Haga Hospital, The Netherlands
| | - MD Ferrari
- Department of Neurology, Leiden University Medical Center, The Netherlands
| | - J Haan
- Department of Neurology, Rijnland Hospital Leiderdorp and Leiden University Medical Center, The Netherlands
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23
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de Andrés F, Lionetto L, Curto M, Capi M, Cipolla F, Negro A, Martelletti P. Acute, transitional and long-term cluster headache treatment: pharmacokinetic issues. Expert Opin Drug Metab Toxicol 2016; 12:1011-20. [DOI: 10.1080/17425255.2016.1201067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Fernando de Andrés
- CICAB Clinical Research Centre, Extremadura University Hospital and Medical School, Badajoz, Spain
| | - Luana Lionetto
- Advanced Molecular Diagnostics Unit, IDI-IRCCS, Rome, Italy
| | - Martina Curto
- Department of Molecular Medicine, Sant’Andrea Medical Center, Sapienza University of Rome, Rome, Italy
- Regional Referral Headache Center, Sant’Andrea Hospital, Rome, Italy
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Matilde Capi
- NESMOS Department, Sapienza University of Rome, Rome, Italy
| | | | - Andrea Negro
- Department of Molecular Medicine, Sant’Andrea Medical Center, Sapienza University of Rome, Rome, Italy
- Regional Referral Headache Center, Sant’Andrea Hospital, Rome, Italy
| | - Paolo Martelletti
- Department of Molecular Medicine, Sant’Andrea Medical Center, Sapienza University of Rome, Rome, Italy
- Regional Referral Headache Center, Sant’Andrea Hospital, Rome, Italy
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24
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Gaul C, Roguski J, Dresler T, Abbas H, Totzeck A, Görlinger K, Diener HC, Weber R. Efficacy and safety of a single occipital nerve blockade in episodic and chronic cluster headache: A prospective observational study. Cephalalgia 2016; 37:873-880. [PMID: 27313215 DOI: 10.1177/0333102416654886] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Treatment options for cluster headache (CH) include acute, transitional and prophylactic strategies. We assessed the efficacy and safety of a single occipital nerve block (ONB) in patients with episodic (eCH) and chronic CH (cCH). Methods In this prospective, observational study 101 CH were treated with a single ONB using triamcinolone 10 mg and bupivacaine. Attack frequency, pain intensity and side effects were assessed at days 1 and 7 after ONB and thereafter weekly for 60 days until recurrence of attacks. Results Baseline mean daily attack frequency was 2.9 ± 2.5 (eCH) and 3.3 ± 2.9 (cCH), which was reduced to 0.7 ± 1.2 (eCH) and 1.1 ± 1.4 (cCH) after one day ( p = 0.08 for group difference) and to 1.1 ± 1.6 (eCH) and 1.9 ± 2.3 (cCH) after seven days ( p = 0.01 for group difference). In patients with eCH the pain-free period lasted longer compared to cCH ( p = 0.004). There was no association between the presence of local anesthesia and treatment response ( p = 0.88). No serious adverse events occurred. Conclusion ONB is an easy, safe and effective transitional treatment option in case of insufficient response of CH to treatment both in patients with eCH and cCH. Patients with eCH have a better and more sustainable treatment response.
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Affiliation(s)
- Charly Gaul
- 1 Department of Neurology, University Hospital Essen, Germany.,2 Migraine and Headache Clinic Königstein, Germany
| | - Jana Roguski
- 1 Department of Neurology, University Hospital Essen, Germany
| | - Thomas Dresler
- 3 Department of Psychiatry and Psychotherapy, University of Tübingen, Germany.,4 LEAD Graduate School & Research Network, University of Tübingen, Germany
| | - Hind Abbas
- 1 Department of Neurology, University Hospital Essen, Germany
| | - Andreas Totzeck
- 1 Department of Neurology, University Hospital Essen, Germany
| | - Klaus Görlinger
- 5 Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, Germany
| | | | - Ralph Weber
- 1 Department of Neurology, University Hospital Essen, Germany.,6 Department of Neurology, Alfried Krupp Krankenhaus Essen, Germany
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25
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Curto M, Lionetto L, Negro A, Capi M, Perugino F, Fazio F, Giamberardino MA, Simmaco M, Nicoletti F, Martelletti P. Altered serum levels of kynurenine metabolites in patients affected by cluster headache. J Headache Pain 2016; 17:27. [PMID: 27000870 PMCID: PMC4801826 DOI: 10.1186/s10194-016-0620-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 03/17/2016] [Indexed: 01/03/2023] Open
Abstract
Background The reported efficacy of memantine in the treatment of patients with cluster headache (CH) suggests that NMDA receptors are involved in mechanisms of nociceptive sensitization within the trigeminal system associated with CH. NMDA receptors are activated or inhibited by neuroactive compounds generated by tryptophan metabolism through the kynurenine pathway. In the accompanying manuscript, we have found that serum levels of all kynurenine metabolites are altered in patients with chronic migraine. Here, we have extended the study to patients affected by episodic or chronic CH as compared to healthy controls. Method We assessed serum levels of kynurenine (KYN), kynurenic Acid (KYNA), anthranilic acid (ANA), 3-hydroxy-anthranilic acid (3-HANA), 3-hydroxykynurenine (3-HK), xanthurenic acid (XA), quinolinic acid (QUINA), tryptophan (Trp) and 5-hydroxyindolacetic acid (5-HIAA) by means of a liquid chromatography/tandem mass spectrometry (LC/MS-MS) method in 21 patients affected by CH (15 with episodic and 6 with chronic CH), and 35 age-matched healthy subjects. Patients with psychiatric co-morbidities, systemic inflammatory, endocrine or neurological disorders, and mental retardation were excluded. Results LC/MS-MS analysis of kynurenine metabolites showed significant reductions in the levels of KYN (-36 %), KYNA (-34 %), 3-HK (-51 %), 3-HANA (-54 %), XA (-25 %), 5-HIAA (-39 %) and QUINA (-43 %) in the serum of the overall population of patients affected by CH, as compared to healthy controls. Serum levels of Trp and ANA were instead significantly increased in CH patients (+18 % and +54 %, respectively). There was no difference in levels of any metabolite between patients affected by episodic and chronic CH, with the exception of KYN levels, which were higher in patients with chronic CH. Conclusion The reduced levels of KYNA (an NMDA receptor antagonist) support the hypothesis that NMDA receptors are overactive in CH. A similar reduction in KYNA levels was shown in the accompanying manuscript in patients affected by chronic migraine. The reduced levels of XA, a putative analgesic compound, may contribute to explain the severity of pain attacks in CH. These data, associated with the data reported in the accompanying manuscript, supports a role for the kynurenine pathway in the pathophysiology of chronic headache disorders.
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Affiliation(s)
- Martina Curto
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA. .,Department of Molecular Medicine, Sant'Andrea Medical Center, Sapienza University of Rome, Via di Grottarossa 1035-1039, Rome, 00189, Italy. .,Regional referral headache center, Sant'Andrea Hospital, Rome, Italy.
| | | | - Andrea Negro
- Department of Molecular Medicine, Sant'Andrea Medical Center, Sapienza University of Rome, Via di Grottarossa 1035-1039, Rome, 00189, Italy.,Advanced Molecular Diagnostics, IDI-IRCCS, Rome, Italy
| | - Matilde Capi
- Advanced Molecular Diagnostics, IDI-IRCCS, Rome, Italy
| | - Francesca Perugino
- Department of Molecular Medicine, Sant'Andrea Medical Center, Sapienza University of Rome, Via di Grottarossa 1035-1039, Rome, 00189, Italy
| | | | - Maria Adele Giamberardino
- Headache Center and Geriatrics Clinic, Department of Medicine and Science of Aging, "G. D'Annunzio" University, Chieti, Italy
| | | | - Ferdinando Nicoletti
- IRCCS Neuromed, Pozzilli, Italy.,Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy
| | - Paolo Martelletti
- Department of Molecular Medicine, Sant'Andrea Medical Center, Sapienza University of Rome, Via di Grottarossa 1035-1039, Rome, 00189, Italy.,Regional referral headache center, Sant'Andrea Hospital, Rome, Italy
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26
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Chen FS, Jiang ZR. Prediction of drug’s Anatomical Therapeutic Chemical (ATC) code by integrating drug–domain network. J Biomed Inform 2015; 58:80-88. [DOI: 10.1016/j.jbi.2015.09.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 09/14/2015] [Accepted: 09/22/2015] [Indexed: 10/22/2022]
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Perloff MD, Berlin RK, Gillette M, Petersile MJ, Kurowski D. Gabapentin in Headache Disorders: What Is the Evidence? PAIN MEDICINE 2015; 17:162-71. [PMID: 26398728 DOI: 10.1111/pme.12931] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/23/2015] [Accepted: 08/28/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Gabapentin (GBP), originally an antiepileptic drug, is more commonly used in the treatment of pain, including headache disorders. Off-label GBP is used in headache disorders with some success, some failure, and much debate. Due to this ambiguity, a clinical evidence literature review was performed investigating GBP's efficacy in headache disorders. METHODS Bibliographic reference searches for GBP use in headache disorders were performed in PUBMED and OVID Medline search engines from January 1, 1983 to August 31, 2014. Based on abstracts read by two reviewers, references were excluded if: GBP was not a study compound or headache symptoms were not studied. The resulting references were then read, reviewed, and analyzed. RESULTS Fifty-six articles pertinent to GBP use in headache disorders were retained. Eight headache clinical trials were quality of evidence Class 2 or higher based on American Academy of Neurology criteria. Seven of the eight clinical trials showed statistically significant clinical benefit from GBP in various headache syndromes (though modest affects at times). One study, Mathew et al., had concerns about intention-treat analysis breaches and primary outcomes. CONCLUSION Despite the conflicting evidence surrounding select studies, a significant amount of evidence shows that GBP has benefit for a majority of primary headache syndromes, including chronic daily headaches. GBP has some efficacy in migraine headache, but not sufficient evidence to suggest primary therapy. When primary headache treatments fail, a GBP trial may be considered in the individual patient.
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28
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Gaul C, Diener HC, Silver N, Magis D, Reuter U, Andersson A, Liebler EJ, Straube A. Non-invasive vagus nerve stimulation for PREVention and Acute treatment of chronic cluster headache (PREVA): A randomised controlled study. Cephalalgia 2015; 36:534-46. [PMID: 26391457 PMCID: PMC4853813 DOI: 10.1177/0333102415607070] [Citation(s) in RCA: 163] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 08/27/2015] [Indexed: 12/21/2022]
Abstract
Background Chronic cluster headache (CH) is a debilitating disorder for which few well-controlled studies demonstrate effectiveness of available therapies. Non-invasive vagus nerve stimulation (nVNS) was examined as adjunctive prophylactic treatment of chronic CH. Methods PREVA was a prospective, open-label, randomised study that compared adjunctive prophylactic nVNS (n = 48) with standard of care (SoC) alone (control (n = 49)). A two-week baseline phase was followed by a four-week randomised phase (SoC plus nVNS vs control) and a four-week extension phase (SoC plus nVNS). The primary end point was the reduction in the mean number of CH attacks per week. Response rate, abortive medication use and safety/tolerability were also assessed. Results During the randomised phase, individuals in the intent-to-treat population treated with SoC plus nVNS (n = 45) had a significantly greater reduction in the number of attacks per week vs controls (n = 48) (−5.9 vs −2.1, respectively) for a mean therapeutic gain of 3.9 fewer attacks per week (95% CI: 0.5, 7.2; p = 0.02). Higher ≥50% response rates were also observed with SoC plus nVNS (40% (18/45)) vs controls (8.3% (4/48); p < 0.001). No serious treatment-related adverse events occurred. Conclusion Adjunctive prophylactic nVNS is a well-tolerated novel treatment for chronic CH, offering clinical benefits beyond those with SoC.
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Affiliation(s)
- Charly Gaul
- Migraine and Headache Clinic, Königstein, Germany
| | | | | | | | - Uwe Reuter
- Department of Neurology, Charité University Hospital, Berlin, Germany
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29
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Schwedt TJ, Vargas B. Neurostimulation for Treatment of Migraine and Cluster Headache. PAIN MEDICINE (MALDEN, MASS.) 2015; 16:1827-34. [PMID: 26177612 PMCID: PMC4572909 DOI: 10.1111/pme.12792] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this narrative review is to summarize the current state of neurostimulation therapies for the treatment of migraine and/or cluster. METHODS For this narrative review, publications were identified by searching PubMed using the search terms "migraine" or "cluster" combined with "vagal nerve stimulation," "transcranial magnetic stimulation," "supraorbital nerve stimulation," "sphenopalatine ganglion stimulation," "occipital nerve stimulation," "deep brain stimulation," "neurostimulation," or "neuromodulation." Publications were chosen based on the quality of data that were provided and their relevance to the chosen topics of interest for this review. Reference lists of chosen articles and the authors' own files were used to identify additional publications. Current clinical trials were identified by searching clinicaltrials.org. RESULTS AND CONCLUSIONS Neurostimulation of the vagal nerve, supraorbital nerve, occipital nerve and sphenopalatine ganglion, transcranial magnetic stimulation (TMS), and deep brain stimulation have been investigated for the treatment of migraine and/or cluster. Whereas invasive methods of neurostimulation would be reserved for patients with very severe and treatment refractory migraine or cluster, noninvasive methods of stimulation might serve as useful adjuncts to more conventional therapies. Currently, transcutaneous supraorbital nerve stimulation is FDA approved and commercially available for migraine prevention and TMS is FDA approved for the treatment of migraine with aura. The potential utility of each type of neurostimulation has yet to be completely defined.
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Affiliation(s)
- Todd J. Schwedt
- Royalties: Up To Date, Cambridge University Press, Consulting/Advisory Boards: Allergan, Zogenix, Supernus, Pfizer, Clinical Trial Investigator: eNeura, Boston Scientific, Alder, Biopharmaceuticals, Autonomic Technologies, Labrys Biologics, Arteaus, Therapeutics, OptiNose US
| | - Bert Vargas
- Consulting/Advisory Boards: Allergan, Zogenix, Avanir, Clinical Trial Investigator: Boston Scientific, Autonomic Technologies, eNeura, Alder Biopharmaceuticals, OptiNose US, Alder, Biopharmaceuticals, Labrys Biologics, Arteaus
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30
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Costa M, Squassina A, Piras IS, Pisanu C, Congiu D, Niola P, Angius A, Chillotti C, Ardau R, Severino G, Stochino E, Deidda A, Persico AM, Alda M, Del Zompo M. Preliminary Transcriptome Analysis in Lymphoblasts from Cluster Headache and Bipolar Disorder Patients Implicates Dysregulation of Circadian and Serotonergic Genes. J Mol Neurosci 2015; 56:688-95. [DOI: 10.1007/s12031-015-0567-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/14/2015] [Indexed: 12/22/2022]
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31
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Obermann M, Holle D, Naegel S, Burmeister J, Diener HC. Pharmacotherapy options for cluster headache. Expert Opin Pharmacother 2015; 16:1177-84. [PMID: 25911317 DOI: 10.1517/14656566.2015.1040392] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Cluster headache (CH) is a primary headache disorder and the most common trigeminal autonomic cephalalgia. Patients suffer from very severe unilateral headache attacks accompanied by ipsilateral trigeminal autonomic symptoms. Previous studies described a high burden of disease due to its impact on social life as well as an increased suicide ideation rate. The mean time to diagnosis in western industrialized countries is estimated at 4 years. AREAS COVERED Many treatment options for CH exist, but due to the rarity of the disease, controlled randomized clinical studies remain difficult to perform. This review summarizes the current knowledge about the treatment of CH including internationally accepted treatment guidelines, and an additional MEDLINE search (1 February 2015). EXPERT OPINION International treatment recommendations and official guidelines give reassurance about specific pharmacotherapy options for CH, but only few of these are backed by sufficient scientific evidence. The limited therapeutic efficacy in some patients leads to the use of alternative, complementary, but also illicit drugs to better cope with the disease. Many single cases, case series and uncontrolled studies were performed with different substances in an attempt to find a better way to treat or prevent the excruciatingly painful attacks associated with CH. Large-scale, randomized controlled clinical trials are desperately needed in order to further increase the quality of patient care for this outstanding but terrifying disease.
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Affiliation(s)
- Mark Obermann
- University of Duisburg-Essen, Department of Neurology , Hufelandstr. 55, 45122 Essen , Germany +49 201 723 84385 ; +49 201 723 5542 ;
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Maximova MY, Piradov MA, Suanova ET, Sineva NA. Trigeminal autonomic cephalgias. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:137-145. [DOI: 10.17116/jnevro2015115111137-145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Ibrahim F, Wahba MEK. Liquid Chromatographic Determination of Ergotamine Tartrate in its Combined Tablets using Fluorimetric and UV Detection: Application to Content Uniformity Testing. SEP SCI TECHNOL 2014. [DOI: 10.1080/01496395.2014.914953] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
PURPOSE Our aim was to review the existing literature to document oxygen's therapeutic effect on cluster headache. METHOD A PubMed search resulted in 28 hits, and from these and their references we found in total 11 relevant studies. We included six studies that investigated the efficacy of oxygen treatment. One study is observational and the remaining five are RCTs. Another five studies were on hyperbaric oxygen treatment hereof two case studies. CONCLUSION Oxygen therapy can be administered at different flow rates. Three studies investigate the effect of low-flow oxygen, 6-7 l/min, and found a positive response in 56%, 75% and 82%, respectively, of the patients. One study investigates high-flow oxygen, 12 l/min, and found efficacy in 78% of attacks. The effect of hyperbaric oxygen therapy has been investigated in a few small studies and there is evidence only for an acute, but not a prophylactic effect. Despite the fact that only a few high-quality RCT studies are available, oxygen treatment is close to an ideal treatment because it is effective and safe. However, sufferers of cluster headache do not always have access to oxygen because of logistic and financial concerns.
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Affiliation(s)
- Anja S Petersen
- Danish Headache Center, Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark
| | - Mads C J Barloese
- Danish Headache Center, Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark
| | - Rigmor H Jensen
- Danish Headache Center, Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark
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Abstract
Primary headache disorders include migraine, tension-type headaches, and the trigeminal autonomic cephalgias (TACs). "Primary" refers to a lack of clear underlying causative pathology, trauma, or systemic disease. The TACs include cluster headache, paroxysmal hemicrania, and short-lasting neuralgiform headache attacks with conjunctival injection and tearing; hemicrania continua, although classified separately by the International Headache Society, shares many features of both migraine and the TACs. This article describes the features and treatment of these disorders.
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Affiliation(s)
- Rafael Benoliel
- Department of Oral Medicine, The Faculty of Dentistry, Hebrew University-Hadassah, POB 12272, Jerusalem, Israel.
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Becker WJ. Cluster headache: conventional pharmacological management. Headache 2013; 53:1191-6. [PMID: 23773141 DOI: 10.1111/head.12145] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2013] [Indexed: 11/28/2022]
Abstract
Cluster headache pain is very intense, usually increases in intensity very rapidly from onset, and attacks are often frequent. These clinical features result in significant therapeutic challenges. The most effective pharmacological treatment options for acute cluster attack include subcutaneous sumatriptan, 100% oxygen, and intranasal zolmitriptan. Subcutaneous or intramuscular dihydroergotamine and intranasal sumatriptan are additional options. Transitional therapy is applicable mainly for patients with high-frequency (>2 attacks per day) episodic cluster headache, and options include short courses of high-dose oral corticosteroids, dihydroergotamine, and occipital nerve blocks with local anesthetic and steroids. Prophylactic therapy is important both for episodic and chronic cluster headache, and the main options are verapamil and lithium. Verapamil is drug of first choice but may cause cardiac arrhythmias, and periodic electrocardiograms (EKGs) during dose escalation are important. Many other drugs are also in current use, but there is an insufficient evidence base to recommend them.
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Affiliation(s)
- Werner J Becker
- Department of Clinical Neurosciences, University of Calgary and Alberta Health Services, Calgary, AB, Canada
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Kawada S, Kashihara K, Imamura T, Ohno M. High-dose intravenous methylprednisolone for the prophylactic treatment of cluster headache. SPRINGERPLUS 2013; 2:156. [PMID: 23667809 PMCID: PMC3647094 DOI: 10.1186/2193-1801-2-156] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 03/10/2013] [Indexed: 11/13/2022]
Abstract
Background Triptans are effective for immediate relief of episodic cluster headache (CH) but do not reduce the frequency of attacks. Intravenous bolus injection of corticosteroids like methylprednisolone (MP) has been reported to decrease the frequency of CH attacks. We validated the prophylactic efficacy of MP pulse therapy by monitoring CH recurrence over several years following treatment of six consecutive male patients (mean age: 38.8 years, range: 26–54 years) afflicted by frequent (often daily) CH attacks. Findings Total MP dose per infusion was 250–500 mg for five patients and 125 mg for the sixth (a diabetic). High-dose MP was administered for 2 or 3 consecutive days in hospital for the first two patients treated. The next four patients received a single bolus injection at presentation, and in some cases a second injection days later at an outpatient clinic. The first two cases treated were also prescribed daily oral prednisolone for at most 6 months while the latter four cases were not. The frequency of CH attacks was markedly reduced in all patients, with intervals between attacks ranging from 4 to 23 months. We noted no apparent adverse events following MP administration. Conclusions High-dose MP therapy reduced CH attack frequency and improved patient quality of life.
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Affiliation(s)
- Sanami Kawada
- Department of Neurology, Okayama Kyokuto Hospital, 567-1 Kurata, Naka-ku, Okayama, 703-8265 Japan
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Wang CC, Fernández LP, Gómez MR. Sensitive ergotamine determination in pharmaceuticals and biological samples using cloud point preconcentration and spectrofluorimetric detection. Anal Chim Acta 2013; 768:90-5. [DOI: 10.1016/j.aca.2013.01.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 01/08/2013] [Accepted: 01/13/2013] [Indexed: 11/29/2022]
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Leroux E, Ducros A. Occipital Injections for Trigemino-Autonomic Cephalalgias: Evidence and Uncertainties. Curr Pain Headache Rep 2013; 17:325. [DOI: 10.1007/s11916-013-0325-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Tfelt-Hansen P, Hougaard A. Sumatriptan: a review of its pharmacokinetics, pharmacodynamics and efficacy in the acute treatment of migraine. Expert Opin Drug Metab Toxicol 2012; 9:91-103. [PMID: 23228070 DOI: 10.1517/17425255.2013.744394] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Sumatriptan was developed more than 20 years ago as a 5-HT1B/1D receptor agonist, the first drug in a new class of specific anti-migraine drugs, the triptans. A large amount of information and experience has been gained from the clinical trials undertaken as well the various formulations of sumatriptan used over this period of time. AREAS COVERED This evaluation specifically reviews the pharmacokinetics, pharmacodynamics, clinical efficacy, and safety of different formulations and dosages of sumatriptan used for the acute treatment of migraines. Special clinical trials of the timing of dosage and sumatriptan in combination with other triptans as well as non-triptan drugs are also included. EXPERT OPINION Oral sumatriptan is effective, but not in a convincing majority (60%) of patients in clinical trials. Sumatriptan has failed to show superiority over more standard and cheaper treatment such as aspirin or aspirin plus metoclopramide. In addition, migraine patients want to quickly become pain free, and to remain pain free, but oral sumatriptan at 100 mg managed to keep patients pain free for 24 h is only 20% of cases. Even though sumatriptan has been a major step forward in providing a new specific therapy for the treatment of migraines, there are still are limitations in its use. There is still an unmet need to develop new non-triptan, anti-migraine drugs which act as effective treatment for those who suffer with migraines.
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Affiliation(s)
- Peer Tfelt-Hansen
- University of Copenhagen, Glostrup Hospital, Danish Headache Center, Department of Neurology, Glostrup, Denmark.
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&NA;. Once correctly diagnosed, cluster headache can usually be adequately managed with pharmacological options. DRUGS & THERAPY PERSPECTIVES 2012. [DOI: 10.2165/11470120-000000000-00000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Once correctly diagnosed, cluster headache can usually be adequately managed with pharmacological options. DRUGS & THERAPY PERSPECTIVES 2012. [DOI: 10.1007/bf03262134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
1. Trigeminal autonomic cephalgias (TACs) are headaches/facial pains classified together based on:a suspected common pathophysiology involving the trigeminovascular system, the trigeminoparasympathetic reflex and centres controlling circadian rhythms;a similar clinical presentation of trigeminal pain, and autonomic activation. 2. There is much overlap in the diagnostic features of individual TACs. 3. In contrast, treatment response is relatively specific and aids in establishing a definitive diagnosis. 4. TACs are often presentations of underlying pathology; all patients should be imaged. 5. The aim of the article is to provide the reader with a broad introduction to, and an overview of, TACs. The reading list is extensive for the interested reader.
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Affiliation(s)
- Rafael Benoliel
- Department of Oral Medicine, The Hebrew University-Hadassah Faculty of Dental Medicine Founded by the Alpha Omega Fraternity, Jerusalem, Israel
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Abstract
The prevalence of cluster headache is 0.1% and cluster headache is often not diagnosed or misdiagnosed as migraine or sinusitis. In cluster headache there is often a considerable diagnostic delay - an average of 7 years in a population-based survey. Cluster headache is characterized by very severe or severe orbital or periorbital pain with a duration of 15-180 minutes. The cluster headache attacks are accompanied by characteristic associated unilateral symptoms such as tearing, nasal congestion and/or rhinorrhoea, eyelid oedema, miosis and/or ptosis. In addition, there is a sense of restlessness and agitation. Patients may have up to eight attacks per day. Episodic cluster headache (ECH) occurs in clusters of weeks to months duration, whereas chronic cluster headache (CCH) attacks occur for more than 1 year without remissions. Management of cluster headache is divided into acute attack treatment and prophylactic treatment. In ECH and CCH the attacks can be treated with oxygen (12 L/min) or subcutaneous sumatriptan 6 mg. For both oxygen and sumatriptan there are two randomized, placebo-controlled trials demonstrating efficacy. In both ECH and CCH, verapamil is the prophylactic drug of choice. Verapamil 360 mg/day was found to be superior to placebo in one clinical trial. In clinical practice, daily doses of 480-720 mg are mostly used. Thus, the dose of verapamil used in cluster headache treatment may be double the dose used in cardiology, and with the higher doses the PR interval should be checked with an ECG. At the start of a cluster, transitional preventive treatment such as corticosteroids or greater occipital nerve blockade can be given. In CCH and in long-standing clusters of ECH, lithium, methysergide, topiramate, valproic acid and ergotamine tartrate can be used as add-on prophylactic treatment. In drug-resistant CCH, neuromodulation with either occipital nerve stimulation or deep brain stimulation of the hypothalamus is an alternative treatment strategy. For most cluster headache patients there are fairly good treatment options both for acute attacks and for prophylaxis. The big problem is the diagnosis of cluster headache as demonstrated by the diagnostic delay of 7 years. However, the relatively short-lasting attack of pain in one eye with typical associated symptoms should lead the family doctor to suspect cluster headache resulting in a referral to a neurologist or a headache centre with experience in the treatment of cluster headache.
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Affiliation(s)
- Peer C Tfelt-Hansen
- Danish Headache Center, Department of Neurology, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark.
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Stochino ME, Deidda A, Asuni C, Cherchi A, Manchia M, Del Zompo M. Evaluation of Lithium Response in Episodic Cluster Headache: A Retrospective Case Series. Headache 2012; 52:1171-5. [DOI: 10.1111/j.1526-4610.2012.02183.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cologno D, Mazzeo A, Lecce B, Mundi C, Petretta V, Casucci G, d’Onofrio F. Triptans: over the migraine. Neurol Sci 2012; 33 Suppl 1:S193-8. [DOI: 10.1007/s10072-012-1066-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Cluster headache is a rare primary neurovascular headache and a severe pain condition with unilateral headache over 15-180 minutes and concomitant unilateral autonomic symptoms. The detailed pathophysiology of the condition is still unclear. Only a few evidence-based therapeutic options for acute therapy and the preventive management of the disease are available. Triptans, in particular sumatriptan 6 mg subcutaneously, are highly effective for acute treatment. This review focuses on the potential use of oral triptans in the prophylaxis of cluster headache.
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Leroux E, Valade D, Taifas I, Vicaut E, Chagnon M, Roos C, Ducros A. Suboccipital steroid injections for transitional treatment of patients with more than two cluster headache attacks per day: a randomised, double-blind, placebo-controlled trial. Lancet Neurol 2011; 10:891-7. [DOI: 10.1016/s1474-4422(11)70186-7] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Biagi C, Poluzzi E, Roberto G, Puccini A, Vaccheri A, D’Alessandro R, Motola D, Montanaro N. Pattern of triptan use and cardiovascular coprescription: a pharmacoepidemiological study in Italy. Eur J Clin Pharmacol 2011; 67:1283-9. [DOI: 10.1007/s00228-011-1076-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 05/27/2011] [Indexed: 10/18/2022]
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