1
|
Coppola G, Abagnale C, Sebastianelli G, Goadsby PJ. Pathophysiology of cluster headache: From the trigeminovascular system to the cerebral networks. Cephalalgia 2024; 44:3331024231209317. [PMID: 38415635 DOI: 10.1177/03331024231209317] [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: 02/29/2024]
Abstract
BACKGROUND Despite advances in neuroimaging and electrophysiology, cluster headache's pathogenesis remains unclear. This review will examine clinical neurophysiology studies, including electrophysiological and functional neuroimaging, to determine if they might help us construct a neurophysiological model of cluster headache. RESULTS Clinical, biochemical, and electrophysiological research have implicated the trigeminal-parasympathetic system in cluster headache pain generation, although the order in which these two systems are activated, which may be somewhat independent, is unknown. Electrophysiology and neuroimaging have found one or more central factors that may cause seasonal and circadian attacks. The well-known posterior hypothalamus, with its primary circadian pacemaker suprachiasmatic nucleus, the brainstem monoaminergic systems, the midbrain, with an emphasis on the dopaminergic system, especially when cluster headache is chronic, and the descending pain control systems appear to be involved. Functional connection investigations have verified electrophysiological evidence of functional changes in distant brain regions connecting to wide cerebral networks other than pain. CONCLUSION We propose that under the impact of external time, an inherited misalignment between the primary circadian pacemaker suprachiasmatic nucleus and other secondary extra- suprachiasmatic nucleus clocks may promote disturbance of the body's internal physiological clock, lowering the threshold for bout recurrence.
Collapse
Affiliation(s)
- Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino ICOT, Latina, Italy
| | - Chiara Abagnale
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino ICOT, Latina, Italy
| | - Gabriele Sebastianelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino ICOT, Latina, Italy
| | - Peter J Goadsby
- NIHR King's Clinical Research Facility, and Wolfson Sensory, Pain and Regeneration Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London UK
- Department of Neurology, University of California, Los Angeles, Los Angeles, California, USA
| |
Collapse
|
2
|
Casillo F, Sebastianelli G, Renzo AD, Cioffi E, Parisi V, Lorenzo CD, Serrao M, Coppola G. The monoclonal CGRP-receptor blocking antibody erenumab has different effects on brainstem and cortical sensory-evoked responses. Cephalalgia 2022; 42:1236-1245. [DOI: 10.1177/03331024221103811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives It is unclear whether the electrophysiological effects of erenumab, a monoclonal antibody against the calcitonin gene-related peptide receptor, occur only at the periphery of the trigeminal system or centrally and at the cortical level. Methods We prospectively enrolled 20 patients with migraine who had failed at least two preventative treatments. We measured the nociceptive blink reflex and non-noxious somatosensory evoked potentials in all participants. The area under the curve and habituation of the second polysynaptic nociceptive blink reflex component (R2) as well as the amplitude and habituation of somatosensory evoked potentials N20-P25 were measured. Electrophysiological data were collected at baseline (T0), 28 days (T1), and 56 days (T2) before each injection of erenumab (70 mg). Results Erenumab reduced the patients’ mean monthly headache days, headache intensity, and acute medication intake considerably at T1 and T2 (all p < 0.05). The nociceptive blink reflex area under the curve was considerably lower at T1 and T2 than at baseline without changing the habituation slope. At T2, there was a significant increase in the delayed somatosensory evoked potentials amplitude reduction (habituation) but not in the initial cortical activation. Conclusion Our findings showed that erenumab, in addition to its well-known peripheral effects, can induce central effects earlier in the brainstem and later in the cortex. We cannot rule out whether these results are due to a direct effect of erenumab on the central nervous system or an indirect effect secondary to peripheral drug modulation.
Collapse
Affiliation(s)
- Francesco Casillo
- Sapienza University of Rome Polo Pontino, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy
| | - Gabriele Sebastianelli
- Sapienza University of Rome Polo Pontino, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy
| | | | - Ettore Cioffi
- Sapienza University of Rome Polo Pontino, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy
| | | | - Cherubino Di Lorenzo
- Sapienza University of Rome Polo Pontino, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy
| | - Mariano Serrao
- Sapienza University of Rome Polo Pontino, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy
| | - Gianluca Coppola
- Sapienza University of Rome Polo Pontino, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy
| |
Collapse
|
3
|
Cluster Headache Pathophysiology—A Disorder of Network Excitability? CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2021. [DOI: 10.3390/ctn5020016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Patients’ accounts of cluster headache attacks, ictal restlessness, and electrophysiological studies suggest that the pathophysiology involves Aδ-fibre nociceptors and the network processing their input. Continuous activity of the trigeminal autonomic reflex throughout the in-bout period results in central sensitization of these networks in many patients. It is likely that several factors force circadian rhythmicity upon the disease. In addition to sensitization, circadian changes in pain perception and autonomic innervation might influence the excitability of the trigeminal cervical complex. Summation of several factors influencing pain perception might render neurons vulnerable to spontaneous depolarization, particularly at the beginning of rapid drops of the pain threshold (“summation headache”). In light of studies suggesting an impairment of short-term synaptic plasticity in CH patients, we suggest that the physiologic basis of CH attacks might be network overactivity—similarly to epileptic seizures. Case reports documenting cluster-like attacks support the idea of distinct factors being transiently able to induce attacks and being relevant in the pathophysiology of the disorder. A sustained and recurring proneness to attacks likely requires changes in the activity of other structures among which the hypothalamus is the most probable candidate.
Collapse
|
4
|
Malo-Urriés M, Estébanez-de-Miguel E, Bueno-Gracia E, Tricás-Moreno JM, Santos-Lasaosa S, Hidalgo-García C. Sensory function in headache: a comparative study among patients with cluster headache, migraine, tension-type headache, and asymptomatic subjects. Neurol Sci 2020; 41:2801-2810. [DOI: 10.1007/s10072-020-04384-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 03/28/2020] [Indexed: 10/24/2022]
|
5
|
Schulte LH, Haji AA, May A. Phase dependent hypothalamic activation following trigeminal input in cluster headache. J Headache Pain 2020; 21:30. [PMID: 32228453 PMCID: PMC7106813 DOI: 10.1186/s10194-020-01098-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 03/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Task-free imaging approaches using PET have shown the posterior hypothalamus to be specifically activated during but not outside cluster headache attacks. Evidence from task related functional imaging approaches however is scarce. METHODS Twenty-one inactive cluster headache patients (episodic cluster headache out of bout), 16 active cluster headache patients (10 episodic cluster headache in bout, 6 chronic cluster headache) and 18 control participants underwent high resolution brainstem functional magnetic resonance imaging of trigeminal nociception using gaseous ammonia as a painful stimulus. RESULTS Following trigeminonociceptive stimulation with ammonia there was a significantly stronger activation within the posterior hypothalamus in episodic cluster headache patients out of bout when compared to controls. When contrasting estimates of the pain contrast, active cluster headache patients where in between the two other groups but did not differ significantly from either. CONCLUSION The posterior hypothalamus might thus be hyperexcitable in cluster headache patients outside the bout while excitability to external nociceptive stimuli decreases during in bout periods, probably due to frequent hypothalamic activation and possible neurotransmitter exhaustion during cluster attacks.
Collapse
Affiliation(s)
- Laura H Schulte
- Department of Systems Neuroscience, University Medical Center Eppendorf, University of Hamburg, Hamburg, Germany.,Clinic for Psychiatry, University Medical Center Eppendorf, University of Hamburg, Hamburg, Germany
| | - Ame Abdu Haji
- Department of Systems Neuroscience, University Medical Center Eppendorf, University of Hamburg, Hamburg, Germany
| | - Arne May
- Department of Systems Neuroscience, University Medical Center Eppendorf, University of Hamburg, Hamburg, Germany.
| |
Collapse
|
6
|
Di Lorenzo C, Coppola G, Bracaglia M, Di Lenola D, Sirianni G, Rossi P, Di Lorenzo G, Parisi V, Serrao M, Cervenka MC, Pierelli F. A ketogenic diet normalizes interictal cortical but not subcortical responsivity in migraineurs. BMC Neurol 2019; 19:136. [PMID: 31228957 PMCID: PMC6588932 DOI: 10.1186/s12883-019-1351-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 05/31/2019] [Indexed: 11/26/2022] Open
Abstract
Background A short ketogenic diet (KD) treatment can prevent migraine attacks and correct excessive cortical response. Here, we aim to prove if the KD-related changes of cortical excitability are primarily due to cerebral cortex activity or are modulated by the brainstem. Methods Through the stimulation of the right supraorbital division of the trigeminal nerve, we concurrently interictally recorded the nociceptive blink reflex (nBR) and the pain-related evoked potentials (PREP) in 18 migraineurs patients without aura before and after 1-month on KD, while in metabolic ketosis. nBR and PREP reflect distinct brain structures activation: the brainstem and the cerebral cortex respectively. We estimated nBR R2 component area-under-the-curve as well as PREP amplitude habituation as the slope pof the linear regression between the 1st and the 2nd block of 5 averaged responses. Results Following 1-month on KD, the mean number of attacks and headache duration reduced significantly. Moreover, KD significantly normalized the interictal PREP habituation (pre: + 1.8, post: − 9.1, p = 0.012), while nBR deficit of habituation did not change. Conclusions The positive clinical effects we observed in a population of migraineurs by a 1-month KD treatment coexists with a normalization at the cortical level, not in the brainstem, of the typical interictal deficit of habituation. These findings suggest that the cerebral cortex may be the primary site of KD-related modulation. Trial registration ClinicalTrials.gov NCT03775252 (retrospectively registered, December 09, 2018).
Collapse
Affiliation(s)
| | - Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University Rof Rome Polo Pontino, Latina, Italy
| | - Martina Bracaglia
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University Rof Rome Polo Pontino, Latina, Italy
| | - Davide Di Lenola
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University Rof Rome Polo Pontino, Latina, Italy
| | | | - Paolo Rossi
- INI, Headache Clinic, Grottaferrata (RM), Italy
| | - Giorgio Di Lorenzo
- Laboratory of Psychophysiology, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Vincenzo Parisi
- Research Unit of Neurophysiology of Vision and Neurophthalmology, IRCCS - Fondazione Bietti, Rome, Italy
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University Rof Rome Polo Pontino, Latina, Italy
| | - Mackenzie C Cervenka
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University Rof Rome Polo Pontino, Latina, Italy.,IRCCS - Neuromed, Pozzilli, IS, Italy
| |
Collapse
|
7
|
Tsao YC, Lai KL, Chen JT, Liao KK, Wang SJ. Paired nociceptive blink stimuli can facilitate trigeminofacial circuit at a long inter-stimulus interval. J Chin Med Assoc 2019; 82:30-34. [PMID: 30839400 DOI: 10.1097/jcma.0000000000000003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUNDS Conditioned responses of paired nociceptive blink reflex (nBR) can reflect the excitability of trigeminofacial circuit. In the present study, we studied paired homotopic nBR with different inter-stimulus intervals (ISI). By monitoring different ISIs and consequential conditioned R2 of nBR, we aimed to investigate the impact of ISIs on the recovery cycle of nBR in normal individuals. METHODS Twelve healthy volunteers (mean age: 29.9 ± 7.0 years; M/F: 7/5) were enrolled in this study. After individuals' reflex threshold was determined, triple pulses were given in pairs with ISIs 125 to 10000 milliseconds randomly. We calculated the ratio of conditioned and unconditioned nBR area-under-curve (AUC) (defined as recovery index), and amplitude of each ISI. RESULTS The average latency of unconditioned nR2 is 42.6 ± 5.5 ms, with amplitude of 53.4 ± 43.9 μV and the AUC of 563.5 ± 480.6 ms·μV. The conditioned nBR/unconditioned nBR response ratio was less than 100% while the ISI is shorter than 1667 ms, suggesting an inhibited conditioned response. The recovery index and the amplitude of conditioned nBR gradually increased with increasing ISI. The recovery index was greater than 100% at ISI of 10 s (p = 0.005), implying full recovery and facilitation of conditioned nBR. CONCLUSION Our study established the time-dependent dynamic recovery curve of paired nBR. The facilitated nBR at ISI longer than 10 s might be associated with temporal summation to the facial motor neurons after repeated stimuli. Our study results provided potential applications for patients with pain disorders involving trigeminofacial region.
Collapse
Affiliation(s)
- Yu-Chien Tsao
- Department of Internal Medicine, Yonghe Cardinal Tien Hospital, Taipei, Taiwan, ROC
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine
| | - Kuan-Lin Lai
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine
| | - Jen-Tse Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine
- Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan, ROC
| | - Kwong-Kum Liao
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine
- Brain Research Center National Yang-Ming University, Taipei, Taiwan, ROC
| |
Collapse
|
8
|
Perrotta A, Coppola G, Anastasio MG, De Icco R, Ambrosini A, Serrao M, Parisi V, Evangelista M, Sandrini G, Pierelli F. Trait- and Frequency-Dependent Dysfunctional Habituation to Trigeminal Nociceptive Stimulation in Trigeminal Autonomic Cephalalgias. THE JOURNAL OF PAIN 2018; 19:1040-1048. [PMID: 29655843 DOI: 10.1016/j.jpain.2018.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/31/2018] [Accepted: 03/02/2018] [Indexed: 01/03/2023]
Abstract
We investigated whether the stimulation frequency (SF), the pain phases, and different diagnoses of trigeminal autonomic cephalalgias (TACs) may influence the habituation to pain. We studied the habituation of the nociceptive blink reflex R2 responses at different SFs (.05, .1, .2, .3, .5, and 1 Hz), in 28 episodic cluster headache (ECH) patients, 16 during and 12 outside the bout; they were compared with 16 episodic paroxysmal hemicrania (EPH) during the bout and 21 healthy subjects. We delivered 26 electrical stimuli and subdivided stimuli 2 to 26 in 5 blocks of 5 responses for each SF. Habituation values for each SF were expressed as the percentages of the mean area value of second through fifth blocks with respect to the first one. A significant lower mean percentage decrease of the R2 area across all blocks was found at .2 to 1 Hz SF during ECH, outside of the ECH, and EPH compared with healthy subjects. We showed a common frequency-dependent deficit of habituation of trigeminal nociceptive responses at higher SFs in ECH and EPH patients, independently from the disease phase. This abnormal temporal pattern of pain processing may suggest a trait-dependent dysfunction of some underlying pain-related subcortical structures, rather than a state-dependent functional abnormality due to the recurrence of the headache attacks during the active period. PERSPECTIVE TACs showed a frequency-related defective habituation of nociceptive trigeminal responses at the higher SFs, irrespectively of the diagnosis and/or the disease phase. We showed that the clinical similarities in the different subtypes of TACs are in parallel with a trait-dependent dysfunction in pain processing.
Collapse
Affiliation(s)
| | - Gianluca Coppola
- G.B. Bietti Foundation IRCCS, Research Unit of Neurophysiology of Vision and Neurophthalmology, Rome, Italy
| | - Maria Grazia Anastasio
- IRCCS Neuromed, Pozzilli, IS, Italy; Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Roberto De Icco
- C. Mondino National Neurological Institute, Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | | | - Mariano Serrao
- Unit of Neurorehabilitation, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, ICOT, Latina, Italy
| | - Vincenzo Parisi
- G.B. Bietti Foundation IRCCS, Research Unit of Neurophysiology of Vision and Neurophthalmology, Rome, Italy
| | - Maurizio Evangelista
- Istituto di Anestesiologia, Rianimazione e Terapia del Dolore, Università Cattolica del Sacro Cuore/CIC, Rome, Italy
| | - Giorgio Sandrini
- C. Mondino National Neurological Institute, Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Francesco Pierelli
- IRCCS Neuromed, Pozzilli, IS, Italy; Unit of Neurorehabilitation, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, ICOT, Latina, Italy
| |
Collapse
|
9
|
Di Lorenzo C, Coppola G, Di Lenola D, Evangelista M, Sirianni G, Rossi P, Di Lorenzo G, Serrao M, Pierelli F. Efficacy of Modified Atkins Ketogenic Diet in Chronic Cluster Headache: An Open-Label, Single-Arm, Clinical Trial. Front Neurol 2018; 9:64. [PMID: 29483892 PMCID: PMC5816269 DOI: 10.3389/fneur.2018.00064] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 01/24/2018] [Indexed: 01/03/2023] Open
Abstract
Introduction Drug-resistant cluster headache (CH) is still an open clinical challenge. Recently, our group observed the clinical efficacy of a ketogenic diet (KD), usually adopted to treat drug-resistant epilepsies, on migraine. Aim Here, we aim to detect the effect of KD in a group of drug-resistant chronic CH (CCH) patients. Materials and methods Eighteen drug-resistant CCH patients underwent a 12-week KD (Modified Atkins Diet, MAD), and the clinical response was evaluated in terms of response (≥50% attack reduction). Results Of the 18 CCH patients, 15 were considered responders to the diet (11 experienced a full resolution of headache, and 4 had a headache reduction of at least 50% in terms of mean monthly number of attacks during the diet). The mean monthly number of attacks for each patient at the baseline was 108.71 (SD = 81.71); at the end of the third month of diet, it was reduced to 31.44 (SD = 84.61). Conclusion We observed for the first time that a 3-month ketogenesis ameliorates clinical features of CCH. Clinical Trial Registration www.ClinicalTrials.gov, identifier NCT03244735.
Collapse
Affiliation(s)
| | - Gianluca Coppola
- G. B. Bietti Foundation-IRCCS, Research Unit of Neurophysiology of Vision and Neurophthalmology, Rome, Italy
| | - Davide Di Lenola
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome Polo Pontino, Latina, Italy
| | - Maurizio Evangelista
- Istituto di Anestesiologia, Rianimazione e Terapia del Dolore, Università Cattolica del Sacro Cuore/CIC, Rome, Italy
| | - Giulio Sirianni
- Delle Medical Center, Wellness and Dietary Medicine, Rome, Italy
| | - Paolo Rossi
- INI, Headache Clinic, Grottaferrata, Rome, Italy
| | - Giorgio Di Lorenzo
- Laboratory of Psychophysiology, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome Polo Pontino, Latina, Italy
| | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome Polo Pontino, Latina, Italy.,INM Neuromed IRCCS, Isernia, Italy
| |
Collapse
|
10
|
Malo-Urriés M, Hidalgo-García C, Estébanez-de-Miguel E, Tricás-Moreno JM, Santos-Lasaosa S, Jahanshahi M. Sensory function in cluster headache: an observational study comparing the symptomatic and asymptomatic sides. Neuropsychiatr Dis Treat 2018; 14:3363-3371. [PMID: 30573960 PMCID: PMC6292232 DOI: 10.2147/ndt.s186051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Based on inconsistent sensory alterations demonstrated in cluster headache (CH), the aim of this study was to determine whether patients with CH develop sensory changes in the symptomatic side compared to the asymptomatic side. METHODS Quantitative sensory testing (QST), including pressure pain threshold (PPT), tactile detection threshold (TDT), prick detection threshold (PDT), and two-point detection threshold (2PDT), was evaluated in 16 patients (seven women; age 41.9±6.8 years) with CH. Test sites included the first, second, and third divisions of the trigeminal nerve, cervical spine, and thenar eminence in the symptomatic and asymptomatic sides. RESULTS The symptomatic side, compared to the asymptomatic side, presented significantly decreased PPT in the first (P=0.011; 423.81±174.05 kPa vs 480.13±214.99 kPa) and second (P=0.023; 288.88±140.80 kPa vs 326.38±137.33 kPa) divisions of the trigeminal nerve, significantly increased TDT in the first (P=0.002; 2.44±0.40 vs 1.74±0.24) and second (P=0.016; 1.92±0.34 vs 1.67±0.09) divisions, and increased 2PDT in the first division (P=0.004; 18.13±4.70 mm vs 15.0±4.92 mm) and neck (P=0.007; 45.31±20.65 mm vs 38.44±16.10 mm). CONCLUSION These results support the prior evidence suggesting a specific pattern of alteration of sensory function with alterations in the symptomatic side compared to the asymptomatic side.
Collapse
Affiliation(s)
- Miguel Malo-Urriés
- Physiotherapy Research Unit, Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain,
| | - César Hidalgo-García
- Physiotherapy Research Unit, Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain,
| | - Elena Estébanez-de-Miguel
- Physiotherapy Research Unit, Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain,
| | - José Miguel Tricás-Moreno
- Physiotherapy Research Unit, Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain,
| | | | - Marjan Jahanshahi
- Cognitive Motor Neuroscience Group, Department of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
| |
Collapse
|
11
|
Di Lorenzo C, Pellesi L, Coppola G, Parisi V, Evangelista M, Guerzoni S, Rossi P, Serrao M, Pini LA, Pierelli F. Efficacy of transdermal rotigotine in chronic cluster headache: A case series. CEPHALALGIA REPORTS 2018. [DOI: 10.1177/2515816318809697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cluster headache (CH) is one of the most severe forms of headache, but the number of effective treatments is still limited. Recently, we reported the case of a drug-resistant CH patient responsive to the rotigotine transdermal patch, which is used in the treatment of Parkinson’s disease. This report formed the basis for a case series where other drug-resistant CH patients were treated with rotigotine. Here are the results of this study. Twenty-two CH patients underwent the treatment. Eight were episodic cluster headache (ECH) patients and 14 were chronic cluster headache (CCH) patients. Of the eight ECH patients, four reported that their CH had been stopped by the treatment. Of the 14 CCH patients, 11 were considered responders to the treatment (5 experienced a full resolution of headache, and 6 had a headache reduction of at least 50% in terms of mean monthly number of attacks). Our case series confirms the previous observation that rotigotine could be helpful in the treatment of CH. It may even influence the monoaminergic system that has a key role in the pathogenesis of CH.
Collapse
Affiliation(s)
| | - Lanfranco Pellesi
- Medical Toxicology and Headache Center, Policlinic Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Gianluca Coppola
- Department of Neurophysiology of Vision and Neurophthalmology, IRCCS – Fondazione Bietti, Rome, Italy
| | - Vincenzo Parisi
- Department of Neurophysiology of Vision and Neurophthalmology, IRCCS – Fondazione Bietti, Rome, Italy
| | - Maurizio Evangelista
- Istituto di Anestesiologia, Rianimazione e Terapia del Dolore, Università Cattolica del Sacro Cuore/CIC, Rome, Italy
| | - Simona Guerzoni
- Medical Toxicology and Headache Center, Policlinic Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Rossi
- INI, Headache Clinic, Grottaferrata (RM), Italy
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, ‘Sapienza’ University of Rome Polo Pontino, Latina, Italy
| | - Luigi Alberto Pini
- Medical Toxicology and Headache Center, Policlinic Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, ‘Sapienza’ University of Rome Polo Pontino, Latina, Italy
- IRCCS – Neuromed, Pozzilli (IS), Italy
| |
Collapse
|
12
|
Abstract
Context The classification of headache disorders has improved over the years, but further work is needed to develop and improve headache diagnosis within headache subtypes. The present review is a call for action to implement laboratory tests in the classification and management of primary and some secondary headaches. Background In this narrative review we present and discuss published tests that might be useful in phenotyping and/or diagnosis of long-lasting headache disorders such as migraine, tension-type headache, trigeminal autonomic cephalalgias, trigeminal neuralgia and persisting secondary headaches. Aim The palpometer test, quantitative sensory testing, nociceptive blink reflex and autonomic tests may be valuable to phenotype and/or diagnose subforms of migraine, tension-type headache, cluster headache, trigeminal neuralgia and medication-overuse headache. Provocation tests with glyceryl trinitrate (GTN) and calcitonin gene-related peptide (CGRP) may be valuable in subclassification of migraine and cluster headache. Lumbar pressure monitoring and optical coherence tomography may valuable tools to diagnose and follow patients with chronic headache and raised intracranial pressure. Finding A number of laboratory tests in headache research are presently available, but have primarily been performed in single research studies or a few studies that differ in methods and patient groups. At present, there is no evidence-based strategy for implementing diagnostic tests, but this could be achieved if well-reputed tertiary headache centers commence developing and implementing laboratory tests in order to improve the classification and treatment of headache patients.
Collapse
Affiliation(s)
- Henrik Winther Schytz
- University of Copenhagen, Danish Headache Centre, Department of Neurology at Glostrup Hospital, Denmark
| | - Jes Olesen
- University of Copenhagen, Danish Headache Centre, Department of Neurology at Glostrup Hospital, Denmark
| |
Collapse
|
13
|
Neural Plasticity in Common Forms of Chronic Headaches. Neural Plast 2015; 2015:205985. [PMID: 26366304 PMCID: PMC4558449 DOI: 10.1155/2015/205985] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 08/02/2015] [Indexed: 01/03/2023] Open
Abstract
Headaches are universal experiences and among the most common disorders. While headache may be physiological in the acute setting, it can become a pathological and persistent condition. The mechanisms underlying the transition from episodic to chronic pain have been the subject of intense study. Using physiological and imaging methods, researchers have identified a number of different forms of neural plasticity associated with migraine and other headaches, including peripheral and central sensitization, and alterations in the endogenous mechanisms of pain modulation. While these changes have been proposed to contribute to headache and pain chronification, some findings are likely the results of repetitive noxious stimulation, such as atrophy of brain areas involved in pain perception and modulation. In this review, we provide a narrative overview of recent advances on the neuroimaging, electrophysiological and genetic aspects of neural plasticity associated with the most common forms of chronic headaches, including migraine, cluster headache, tension-type headache, and medication overuse headache.
Collapse
|