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Badea RȘ, Grecu N, Ribigan AC, Antochi F, Tiu C, Popescu BO. Headache patterns in patent foramen ovale patients: beyond migraine with aura. J Neural Transm (Vienna) 2024; 131:755-761. [PMID: 38416197 DOI: 10.1007/s00702-024-02760-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 02/23/2024] [Indexed: 02/29/2024]
Abstract
Patent foramen ovale (PFO) is a common cardiac anomaly linked with cryptogenic strokes and migraine, particularly migraine with aura. This study aims to explore the spectrum of headache disorders in PFO patients, focusing on identifying patterns beyond the well-established migraine-PFO connection. A retrospective observational study was conducted on patients diagnosed with PFO. Headache types were classified using the International Classification of Headache Disorders, 3rd edition. The study analyzed headache prevalence and patterns in PFO patients, comparing those with and without a history of stroke. Of 177 participants, 63 (35.59%) reported headaches. Tension-type headache was the most common (15.25%), followed by migraine without aura (11.30%) and migraine with aura (8.47%). Notably, migraine without aura was more prevalent than migraine with aura, contrasting previous assumptions. No significant differences were found in headache types based on stroke history. The study reveals a diverse spectrum of headache types in PFO patients, with migraine without aura being more common than migraine with aura. These findings suggest a need for broader diagnostic perspective and individualized treatment approaches in PFO patients with headaches.
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Affiliation(s)
- Raluca Ștefania Badea
- Department of Neurology, University and Emergency Hospital, 169 Splaiul Independenței, Bucharest, 050098, Romania.
- University of Medicine and Pharmacy Carol Davila, 37 Dionisie Lupu, Bucharest, 020021, Romania.
| | - N Grecu
- Department of Neurology, University and Emergency Hospital, 169 Splaiul Independenței, Bucharest, 050098, Romania
- University of Medicine and Pharmacy Carol Davila, 37 Dionisie Lupu, Bucharest, 020021, Romania
| | - A C Ribigan
- Department of Neurology, University and Emergency Hospital, 169 Splaiul Independenței, Bucharest, 050098, Romania
- University of Medicine and Pharmacy Carol Davila, 37 Dionisie Lupu, Bucharest, 020021, Romania
| | - F Antochi
- Department of Neurology, University and Emergency Hospital, 169 Splaiul Independenței, Bucharest, 050098, Romania
| | - C Tiu
- Department of Neurology, University and Emergency Hospital, 169 Splaiul Independenței, Bucharest, 050098, Romania
- University of Medicine and Pharmacy Carol Davila, 37 Dionisie Lupu, Bucharest, 020021, Romania
| | - B O Popescu
- University of Medicine and Pharmacy Carol Davila, 37 Dionisie Lupu, Bucharest, 020021, Romania
- Department of Neurology, Colentina Clinical Hospital, 19-21 Șoseaua Ștefan cel Mare, Bucharest, 020123, Romania
- Laboratory of Cell Biology, Neurosciences and Experimental Myology, 'Victor Babes' National Institute of Pathology, Bucharest, 050096, Romania
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2
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Kuruvilla DE, Natbony L, Chandwani B, Jann A, Bradley BA, Zhang N. Complementary and Integrative Medicine for the Treatment of Trigeminal Neuralgia and Trigeminal Autonomic Cephalalgia. Curr Pain Headache Rep 2024; 28:195-203. [PMID: 38285128 DOI: 10.1007/s11916-024-01212-y] [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] [Accepted: 01/09/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE OF REVIEW Trigeminal neuralgia (TN) and trigeminal autonomic cephalalgias (TACs) are both painful diseases which directly impact the branches of the trigeminal nerve, which supply the face. Patients who have experienced adverse effects, have not responded to mainstream treatments, or have a personal preference for nonmedication options, often turn to complementary and integrative medicine (CIM). The aim of this review is to discuss the efficacy and safety of CIM therapies available for the treatment of TN and TACs. RECENT FINDINGS Not only are there limited therapeutic options for TN and TAC patients, but also is there a proportion of patients who are intolerant to standard medical treatments. Recent findings have illustrated that 86% of patients with headache disorders utilize CIM modalities in combination with mainstream medical therapy. CIM modalities can be helpful for these diseases and have primarily been studied in combination with standard medical therapy. There is limited evidence for CIM and behavioral therapies in managing these conditions, and more research is needed to confirm which therapies are safe and effective.
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Affiliation(s)
- Deena E Kuruvilla
- Westport Headache Institute, 1 Turkey Hill Road South, Suite 201, Westport, CT, USA, 06880.
| | - Lauren Natbony
- Integrative Headache Medicine of New York, New York, NY, 10016, USA
| | | | | | | | - Niushen Zhang
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
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3
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Mulcahy T, Ma N, Mitchell K. Endovascular treatment of trigeminal neuralgia with cranial autonomic symptoms due to a right-sided petrous ridge dAVF. Br J Neurosurg 2023; 37:1339-1345. [PMID: 33467937 DOI: 10.1080/02688697.2021.1874295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
Dural arteriovenous fistula represents a rare cause of secondary Trigeminal Neuralgia. To date, there have been 18 reported cases of successful treatment of trigeminal neuralgia with endovascular embolization. Here we describe a unique case of a 51-year-old man with right-sided petrous ridge dural arteriovenous fistula causing ipsilateral V1 pain and cranial autonomic dysfunction. Cerebral angiography confirmed a Cognard type 3 right-sided tentorial dAVF supplied by an enlarged meningo-hypophpyseal vessel from the extradural ICA and by the middle meningeal artery. The fistula drains towards the midline via deep cerebral veins, the internal cerebral vein and the straight sinus with likely variceal compression of the right trigeminal nerve root entry zone. Transarterial Onyx embolization resulted in complete obliteration of the dural arteriovenous fistula with immediate resolution of facial pain and autonomic symptoms. After 24 months, the patient remains symptom-free and has no radiographic or clinical evidence of fistula recurrence. To date, there have been no other cases reported of trigeminal neuralgia with cranial autonomic symptoms or SUNCT syndrome due to a dural arteriovenous fistula. The presence of cranial autonomic symptoms with trigeminal neuralgia or a diagnosis of SUNCT should not deter endovascular treatments of dural arteriovenous fistulas or treatment of other compressive vascular lesions.
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Affiliation(s)
- Thomas Mulcahy
- Department of Neurosurgery, Royal Brisbane and Women's Hospital, Herston, Australia
- School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | - Norman Ma
- Department of Neurosurgery, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Kenneth Mitchell
- Department of Interventional Radiology, Royal Brisbane and Women's Hospital, Herston, Australia
- School of Medicine, The University of Queensland, Brisbane, Australia
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Schiller K, Rauchenzauner M, Avidgor T, Hannan S, Lorenzen C, Kaml M, Walser G, Unterberger I, Filippi V, Broessner G, Luef G. Primary headache types in adult epilepsy patients. Eur J Med Res 2023; 28:49. [PMID: 36707895 PMCID: PMC9881350 DOI: 10.1186/s40001-023-01023-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/29/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Headache is among the most common comorbidities in epilepsy. This study examined the distribution of different primary headache disorders in a large cohort of patients with diagnosed epilepsy. Headache types were analysed with regard to gender, type of epilepsy and antiepileptic drugs (AEDs). METHODS In this prospective single-centre study, 500 patients with epilepsy (250 female, mean age: 45.52 ± 17.26 years) were evaluated with regards to primary headache types using a validated German headache questionnaire categorizing for migraine (MIG), tension-type headache (TTH) or trigeminal autonomic cephalalgias (TAC), their combinations and unclassifiable headache. Data regarding type of epilepsy, seizure-associated headache, AED treatment and seizure freedom were collected. RESULTS Of 500 patients with epilepsy, 163 (32.6%) patients (108 female and 55 male) reported suffering from headaches at least 1 day per month. MIG (without aura, with aura) and TTH were the most frequent headache type (MIG 33.1%, TTH 33.1%). Female epilepsy patients reported headaches significantly more often than male patients (x2 = 8.20, p = 0.0042). In contrast, the type of epilepsy did not significantly affect headache distribution. Of 163 patients with headache, 66 (40.5%) patients reported seizure-associated headache and AEDs were used by 157 patients. Of importance, patients with AED monotherapy suffered from MIG less often when compared to patients on polytherapy (x2 = 4.79, p = 0.028). CONCLUSION MIG and TTH are the most common headache types in epilepsy patients and headache is more frequent among female epilepsy patients. Monotherapy in AEDs might have a beneficial effect on the frequency of headache compared to polytherapy.
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Affiliation(s)
- Katharina Schiller
- Department of Pediatrics and Neonatology, Hospital Ostallgaeu, Kaufbeuren, Germany ,grid.14709.3b0000 0004 1936 8649Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada ,grid.5361.10000 0000 8853 2677Department of Pediatrics, Medical University Innsbruck, Innsbruck, Austria
| | - Markus Rauchenzauner
- Department of Pediatrics and Neonatology, Hospital Ostallgaeu, Kaufbeuren, Germany ,grid.5361.10000 0000 8853 2677Department of Pediatrics, Medical University Innsbruck, Innsbruck, Austria
| | - Tamir Avidgor
- grid.14709.3b0000 0004 1936 8649Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Sana Hannan
- grid.14709.3b0000 0004 1936 8649Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Carlo Lorenzen
- grid.5361.10000 0000 8853 2677Department of Neurology, Epilepsy Unit, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020 Austria
| | - Manuela Kaml
- grid.5361.10000 0000 8853 2677Department of Neurology, Epilepsy Unit, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020 Austria
| | - Gerald Walser
- grid.5361.10000 0000 8853 2677Department of Neurology, Epilepsy Unit, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020 Austria
| | - Iris Unterberger
- grid.5361.10000 0000 8853 2677Department of Neurology, Epilepsy Unit, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020 Austria
| | - Vera Filippi
- grid.5361.10000 0000 8853 2677Department of Neurology, Headache Outpatient Clinic, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020 Austria
| | - Gregor Broessner
- grid.5361.10000 0000 8853 2677Department of Neurology, Headache Outpatient Clinic, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020 Austria
| | - Gerhard Luef
- grid.5361.10000 0000 8853 2677Department of Neurology, Epilepsy Unit, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020 Austria
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McCullagh K, Castillo M, Zamora C. Headache Attributed to Non-vascular Intracranial Disorder: Neoplasms, Infections, and Substance Abuse. Neurol Clin 2022; 40:531-546. [PMID: 35871783 DOI: 10.1016/j.ncl.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Evaluation of headaches warrants a careful history and neurologic assessment to determine the need for further workup and imaging. Identifying patients who are at risk for underlying pathology is important and this includes individuals with known or suspected malignancy and those who are immunocompromised and at increased risk for intracranial infection. While CT is helpful in the acute setting and to screen for intracranial hypertension, MRI is the modality of choice for the evaluation of underlying pathologies. Imaging in substance abuse may show injury related to direct toxicity or secondary to vascular complications.
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Affiliation(s)
- Kassie McCullagh
- Division of Neuroradiology, Department of Radiology, The University of North Carolina at Chapel Hill, CB 7510 2000 Old Clinic, 101 Manning Drive, Chapel Hill, NC 27599, USA.
| | - Mauricio Castillo
- Division of Neuroradiology, Department of Radiology, The University of North Carolina at Chapel Hill, CB 7510 2000 Old Clinic, 101 Manning Drive, Chapel Hill, NC 27599, USA
| | - Carlos Zamora
- Division of Neuroradiology, Department of Radiology, The University of North Carolina at Chapel Hill, CB 7510 2000 Old Clinic, 101 Manning Drive, Chapel Hill, NC 27599, USA
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Heir GM, DiPede L, Kuchukulla M, Kalladka M, Aziz S. Diagnosis and Management of Traumatically Induced Hemicrania Continua and Neuropathic Pain Secondary to Facial Gun Shot Wound. J Oral Rehabil 2022; 49:831-837. [PMID: 35347753 PMCID: PMC9544847 DOI: 10.1111/joor.13324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/12/2022] [Accepted: 03/21/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Gary M. Heir
- Clinic and Program Director Center for Temporomandibular Disorders and Orofacial Pain Rutgers school of dental medicine Newark New Jersey USA
| | - Louis DiPede
- Restorative Dentistry Kornberg School of Dentistry Temple University Philadelphia USA
| | - Manvitha Kuchukulla
- Private practice, former Chief Resident Post‐Graduate Program in Orofacial Pain, Center for Temporomandibular Disorders and Orofacial Pain, Rutgers School of Dental Medicine Newark New Jersey USA
| | - Mythili Kalladka
- Orofacial Pain and TMD Eastman Institute of Oral Health Rochester New York USA
| | - Shahad Aziz
- Department of Oral and Maxillofacial Surgery Rutgers School of Dental Medicine Newark New Jersey USA
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Kalladka M, Al-Azzawi O, Heir GM, Kodapala S, Nainan MT, Khan J. Hemicrania continua secondary to neurogenic paravertebral tumor- a case report. Scand J Pain 2022; 22:204-209. [PMID: 34432971 DOI: 10.1515/sjpain-2021-0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/09/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Hemicrania continua (HC) is one of the trigeminal autonomic cephalalgias (TAC), where sympathetic dysfunction and autonomic dysfunction resulting in parasympathetic over activation with some evidence of sympathetic inhibition have been suggested as probable causes. However, cases of hemicrania continua secondary to sympathetic dysfunction due to neurogenic paravertebral tumor impinging on the sympathetic chain has not been previously reported. In this case, the probability of the sympathetic dysfunction was more likely based on the clinical features and management. CASE PRESENTATION A 23-year-old female presented with a chief complaint of right unilateral pain in the retro-bulbar, head and facial region for the past three years. An initial MRI of the brain was negative, whereas an MRI of the spine was advised to rule out a cervicogenic origin of the pain. The MRI revealed a well-defined mass lesion within right paravertebral region at T3 indicative of a neurogenic tumor. The patient was diagnosed with probable hemicrania continua secondary to neurogenic tumor impinging on adjacent sympathetic chain. A trial of indomethacin 75 mg/day was advised, which provided complete relief of the headache. The patient was referred to a neurologist for management of the neurogenic tumor. CONCLUSIONS Headache disorders may be secondary to pathologies and comprehensive evaluation and accurate diagnosis are essential. Knowledge of neuroanatomy is paramount to understand and explain underlying pathophysiological mechanisms. Multidisciplinary management is essential in complex orofacial cases.
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Affiliation(s)
- Mythili Kalladka
- Eastman Institute for Oral Health, Orofacial Pain and Temporomandibular Joint Disorders, Rochester, NY, USA
| | - Osamah Al-Azzawi
- Eastman Institute for Oral Health, Orofacial Pain and Temporomandibular Joint Disorders, Rochester, NY, USA
| | - Gary M Heir
- Program and Clinical Director Center for Temporomandibular, Disorders and Orofacial Pain Rutgers, School of Dental Medicine, Newark, NJ, USA
| | - Suresha Kodapala
- Department of Neurology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | | | - Junad Khan
- Eastman Institute for Oral Health, Orofacial Pain and Temporomandibular Joint Disorders, Rochester, NY, USA
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8
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Jay GW, Barkin RL. Trigeminal neuralgia and persistent idiopathic facial pain (atypical facial pain). Dis Mon 2022; 68:101302. [PMID: 35027171 DOI: 10.1016/j.disamonth.2021.101302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Gary W Jay
- Department of Neurology, Division: Headache/Pain, University of North Carolina, Chapel Hill, USA.
| | - Robert L Barkin
- Departmentts of Anesthesilogy, Family Medicine, Pharrmacology, Rush University Medical College, Chicago Illinois, USA
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9
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Krishna Kumar V, Nair PP, Sree Deepthi GN, Pradeep Kumar PP. A case report on probable short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing following vairechanika nasya in Ménière's disease. J Ayurveda Integr Med 2021; 13:100532. [PMID: 34969589 PMCID: PMC8728096 DOI: 10.1016/j.jaim.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 11/26/2022] Open
Abstract
A 62 year old woman diagnosed with Ménière's disease, who underwent vairechanika nasya (VN) with shadbindu taila presented with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) like phenomena immediately after the procedure. Rescue measures of abhyanga (local oil massage) and nadi sweda (local fomentation) were administered. Within half an hour the symptoms considerably declined and after 1 hour got completely relieved. The exact symptom disclosure by the patient who herself was a doctor helped in detecting the classic pattern of ‘saw tooth phenomena’ giving leads into a rare manifestation of probable SUNCT. Naranjo scale yielded zero score and thus the probable causality of VN with shadbindu taila could not be established so as to cause probable SUNCT as an adverse drug reaction (ADR). This case study is not put up for reporting an ADR of VN with shadbindu taila; rather this illustrates an uncommon, yet imperative adverse event of probable SUNCT while undergoing nasya procedure probably due to judgment error while fixing the VN dose in a patient with Ménière's disease. Transparent reporting of such unusual events during panchakarma procedures is necessary so that clinicians can understand, evaluate and take appropriate initiatives to manage them.
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Affiliation(s)
- V Krishna Kumar
- Research Officers at National Ayurveda Research Institute for Panchakarma, Central Council for Research in Ayurvedic Sciences, Ministry of AYUSH, Govt. of India, Cheruthuruthy, India.
| | - Pratibha P Nair
- Research Officers at National Ayurveda Research Institute for Panchakarma, Central Council for Research in Ayurvedic Sciences, Ministry of AYUSH, Govt. of India, Cheruthuruthy, India
| | - G N Sree Deepthi
- Research Officers at National Ayurveda Research Institute for Panchakarma, Central Council for Research in Ayurvedic Sciences, Ministry of AYUSH, Govt. of India, Cheruthuruthy, India
| | - P P Pradeep Kumar
- Research Officers at National Ayurveda Research Institute for Panchakarma, Central Council for Research in Ayurvedic Sciences, Ministry of AYUSH, Govt. of India, Cheruthuruthy, India
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Xu R, Xie ME, Jackson CM. Trigeminal Neuralgia: Current Approaches and Emerging Interventions. J Pain Res 2021; 14:3437-3463. [PMID: 34764686 PMCID: PMC8572857 DOI: 10.2147/jpr.s331036] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/13/2021] [Indexed: 12/22/2022] Open
Abstract
Trigeminal neuralgia (TN) has been described in the literature as one of the most debilitating presentations of orofacial pain. This review summarizes over 150 years of collective clinical experience in the medical and surgical treatment of TN. Fundamentally, TN remains a clinical diagnosis that must be distinguished from other types of trigeminal neuropathic pain and/or facial pain associated with other neuralgias or headache syndromes. What is increasingly clear is that there is no catch-all medical or surgical intervention that is effective for all patients with trigeminal neuralgia, likely reflective of the fact that TN is likely a heterogenous group of disorders that jointly manifests in facial pain. The first-line treatment for TN remains anticonvulsant medical therapy. Patients who fail this have a range of surgical options available to them. In general, microvascular decompression is a safe and effective procedure with immediate and durable outcomes. Patients who are unable to tolerate general anesthesia or whose medical comorbidities preclude a suboccipital craniectomy may benefit from percutaneous methodologies including glycerol or radiofrequency ablation, or both. For patients with bleeding diathesis due to blood thinning medications who are ineligible for invasive procedures, or for those who are unwilling to undergo open surgical procedures, radiosurgery may be an excellent option-provided the patient understands that maximum pain relief will take on the order of months to achieve. Finally, peripheral neurectomies continue to provide an inexpensive and resource-sparing alternative to pain relief for patients in locations with limited economic and medical resources. Ultimately, elucidation of the molecular mechanisms underlying trigeminal neuralgia will pave the way for novel, more effective and less invasive therapies.
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Affiliation(s)
- Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael E Xie
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher M Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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11
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Boeddinghaus R, Whyte A. Imaging of Trigeminal Neuralgia and Other Facial Pain. Neuroimaging Clin N Am 2021; 31:485-508. [PMID: 34689929 DOI: 10.1016/j.nic.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We review and illustrate the radiology of facial pain, emphasizing trigeminal neuralgia, relevant anatomy, current classification, concepts about etiology, and the role of imaging and its influence on the choice of treatment. We discuss glossopharyngeal neuralgia, other neuropathic causes of facial pain, postinflammatory and neoplastic causes, and nociceptive (end-organ) causes of facial pain, as well as referred otalgia. Other conditions that may present with facial pain, including trigeminal autonomic cephalgias and giant cell arteritis, are reviewed briefly. We discuss the elements of a comprehensive MR imaging protocol to enable detection of these diverse causes of facial pain.
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Affiliation(s)
- Rudolf Boeddinghaus
- Perth Radiological Clinic, 127 Hamersley Road, Subiaco, Western Australia 6008, Australia; Department of Surgery, University of Western Australia, 35 Stirling Highway, Perth, Western Australia 6009, Australia.
| | - Andy Whyte
- Department of Medicine and Radiology, University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Department of Dentistry, University of Western Australia, 35 Stirling Highway, Perth, Western Australia 6009, Australia
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12
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Day M, Abd-Elsayed A, Ashworth B. Algorithms for Management Recommendations. TRIGEMINAL NERVE PAIN 2021:229-242. [DOI: 10.1007/978-3-030-60687-9_22] [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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13
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Gurumukhani JK, Patel DM, Patel MV, Patel MM, Patel AV, Patel SY. Short-Lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection and Tearing (SUNCT) Status Like Condition: A Rare Case Report and Review of the Literature. Open Neurol J 2020. [DOI: 10.2174/1874205x02014010074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) is rare trigeminal autonomic cephalgia characterized by recurrent, brief, excruciating unilateral, intermittent headache paroxysms over orbital, frontal or temporal region occurring multiple times per day and it can rarely present as “SUNCTstatus like condition” (SSLC).
Case Report:
A 28-year old male with a history of SUNCT headache for 6 months presented with left forehead stabs lasting for 30 seconds with a frequency of 40-45 episodes per hour for three days followed by infective gastroenteritis. His neurological examination was normal, except left-sided ptosis, tearing, and conjunctival injection. His MRI brain with contrast, MR angiography, and laboratory investigations were unremarkable except mild hypokalemia. He was treated with intravenous fluids, potassium replacement, and high dose methylprednisolone along with an escalated dose of carbamazepine.
Review and Conclusion:
We have reviewed the previously reported seven cases and our case of SSLC. Female: Male ratio was 3:1and the mean age was 40.87 years. Three patients responded to high dose steroids and three to lignocaine along with rapid escalation or change of anticonvulsant drugs. One case responded to the high dose of lamotrigine, and in a pregnant lady, the pain subsided only after the termination of the pregnancy. One case was secondary to multiple sclerosis, while the rest of seven were primary episodic SSLC. The condition is highly disabling, and the treatment with steroids or lignocaine, along with the rapid escalation of preventive drugs, can provide long-lasting relief
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Gurumukhani JK, Patel DM, Patel MV, Patel MM, Patel AV, Patel SY. Short-Lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection and Tearing (SUNCT) Status Like Condition: A Rare Case Report and Review of the Literature. Open Neurol J 2020. [DOI: 10.2174/1874205x02014010075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) is rare trigeminal autonomic cephalgia characterized by recurrent, brief, excruciating unilateral, intermittent headache paroxysms over orbital, frontal or temporal region occurring multiple times per day and it can rarely present as “SUNCTstatus like condition” (SSLC).
Case Report:
A 28-year old male with a history of SUNCT headache for 6 months presented with left forehead stabs lasting for 30 seconds with a frequency of 40-45 episodes per hour for three days followed by infective gastroenteritis. His neurological examination was normal, except left-sided ptosis, tearing, and conjunctival injection. His MRI brain with contrast, MR angiography, and laboratory investigations were unremarkable except mild hypokalemia. He was treated with intravenous fluids, potassium replacement, and high dose methylprednisolone along with an escalated dose of carbamazepine.
Review and Conclusion:
We have reviewed the previously reported seven cases and our case of SSLC. Female: Male ratio was 3:1and the mean age was 40.87 years. Three patients responded to high dose steroids and three to lignocaine along with rapid escalation or change of anticonvulsant drugs. One case responded to the high dose of lamotrigine, and in a pregnant lady, the pain subsided only after the termination of the pregnancy. One case was secondary to multiple sclerosis, while the rest of seven were primary episodic SSLC. The condition is highly disabling, and the treatment with steroids or lignocaine, along with the rapid escalation of preventive drugs, can provide long-lasting relief
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15
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Karamat A, Smith J, Lambru G, Renton T. Changing face of orofacial pain: The diagnostic impact of working with Neurology on an orofacial pain clinic. Int J Oral Maxillofac Surg 2019; 48:924-929. [DOI: 10.1016/j.ijom.2018.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 09/21/2018] [Accepted: 11/06/2018] [Indexed: 01/07/2023]
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Copp SR, LeBlanc C. A Case of Ophthalmic Branch Trigeminal Neuralgia in the Emergency Department. Cureus 2019; 11:e3831. [PMID: 30891372 PMCID: PMC6407718 DOI: 10.7759/cureus.3831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 01/02/2019] [Indexed: 12/03/2022] Open
Abstract
This case report describes a middle-aged patient with a past history of migraine headaches, who presented to the emergency department with a new onset of headaches around his left eye that were different from the pattern and character of his usual migraine headaches. The pain was severe, brief, and stabbing in nature, lasting only seconds, and occurring over intervals of a few minutes. His vital signs, including glucose, were normal. He had no constitutional symptoms, a normal neurological examination, and a normal head, eyes, ears, nose, and throat examination. The painful paroxysms could not be elicited on palpation of his face, head, or oral mucosa. His blood investigations were reported as within normal limits. He was not using alcohol or any illicit drugs and was not taking any medication. A diagnosis, with supportive imaging, of ophthalmic branch trigeminal neuralgia (TN) was made. His pain responded well to treatment with carbamazepine. TN is characterized by brief and intermittent lancinating pain with or without a constant background level of pain in the sensory distribution of one or more branches of the trigeminal nerve. There are three main causes for TN: idiopathic, the classical type resulting from neurovascular compression, and the secondary type typically due to multiple sclerosis, a space-occupying lesion, or a skull base abnormality. The mandibular and maxillary branches are most affected and can often be affected simultaneously. Ophthalmic branch TN is relatively rare. Virtually all of TN cases are unilateral and most are the classical type. Distinguishing TN from other cephalalgias, ocular pain, dental pain, or other pathology is critical to a proper diagnosis and initiation of effective therapy. Identifying trigger zones is important and carries a high diagnostic yield; however, they may be anatomically difficult to access, or in a refractory period during a physical examination. Physicians should be aware of several red flags associated with a suspected case of TN. Carbamazepine is the first-line treatment for TN, capable of reducing pain in 90% of patients. Failure to respond to medication requires further investigation and/or specialist referral. Untreated or unrecognized TN can have significant impacts on a patient's quality of life.
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Buture A, Boland JW, Dikomitis L, Ahmed F. Update on the pathophysiology of cluster headache: imaging and neuropeptide studies. J Pain Res 2019; 12:269-281. [PMID: 30655693 PMCID: PMC6324919 DOI: 10.2147/jpr.s175312] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Cluster headache (CH) is the most severe primary headache condition. Its pathophysiology is multifaceted and incompletely understood. This review brings together the latest neuroimaging and neuropeptide evidence on the pathophysiology of CH. METHODS A review of the literature was conducted by searching PubMed and Web of Science. The search was conducted using the following keywords: imaging studies, voxel-based morphometry, diffusion-tensor imaging, diffusion magnetic resonance imaging, tractography, connectivity, cerebral networks, neuromodulation, central modulation, deep brain stimulation, orexin-A, orexin-B, tract-based spatial statistics, single-photon emission computer tomography studies, positron-emission tomography, functional magnetic resonance imaging, magnetic resonance spectroscopy, trigeminovascular system, neuropeptides, calcitonin gene-related peptide, neurokinin A, substance P, nitric oxide synthase, pituitary adenylate cyclase-activating peptide, vasoactive intestinal peptide, neuropeptide Y, acetylcholine, noradrenaline, and ATP. "Cluster headache" was combined with each keyword for more relevant results. All irrelevant and duplicated records were excluded. Search dates were from October 1976 to May 2018. RESULTS Neuroimaging studies support the role of the hypothalamus in CH, as well as other brain areas involved in the pain matrix. Activation of the trigeminovascular system and the release of neuropeptides play an important role in CH pathophysiology. Among neuropeptides, calcitonin gene-related peptide, vasoactive intestinal peptide, and pituitary adenylate cyclase-activating peptide have been reported to be reliable biomarkers for CH attacks, though not specific for CH. Several other neuropeptides are involved in trigeminovascular activation, but the current evidence does not qualify them as reliable biomarkers in CH. CONCLUSION CH has a complex pathophysiology and the pain mechanism is not completely understood. Recent neuroimaging studies have provided insight into the functional and structural network bases of CH pathophysiology. Although there has been important progress in neuropeptide studies, a specific biomarker for CH is yet to be found.
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Affiliation(s)
- Alina Buture
- Department of Neurology, Hull Royal Infirmary, Hull, UK,
- Hull York Medical School, University of Hull, Hull, UK,
| | | | - Lisa Dikomitis
- School of Medicine and Institute of Primary Care and Health Sciences, Keele University, Newcastle, UK
| | - Fayyaz Ahmed
- Department of Neurology, Hull Royal Infirmary, Hull, UK,
- Hull York Medical School, University of Hull, Hull, UK,
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Jose A, Prasad RS, Pai A. Trigeminal autonomic cephalalgias: The impersonators. INDIAN JOURNAL OF PAIN 2019. [DOI: 10.4103/ijpn.ijpn_2_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Abstract
Following evidence that acupuncture is clinically feasible and cost-effective in the treatment of headache, the UK National Institute for Health and Care Excellence recommends acupuncture as prophylactic treatment for migraine and tension headache. There has thus been expectation that other forms of headache should benefit also. Unfortunately, acupuncture has not generally been successful for cluster headache. This may be due to acupuncturists approaching the problem as one of severe migraine. In fact, cluster headache is classed as a trigeminal autonomic cephalgia. In this case report, episodic cluster headache is treated in the same way as has been shown effective for trigeminal neuralgia. Acupuncture is applied to the contralateral side at points appropriate for stimulating branches of the trigeminal nerve. Thus, ST2 is used for the infraorbital nerve, BL2 and Yuyao for the supratrochlear and supraorbital nerves, and Taiyang for the temporal branch of the zygomatic nerve.
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Affiliation(s)
- Simon Hayhoe
- Department of Pain Management, Colchester University Hospital, Colchester, UK
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20
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Jurno ME, Pereira BSR, Fonseca FAS, Teixeira GA, Maffia LQ, Barros MRA, Camilo VF, Bordini CA. Epidemiologic study of cluster headache prevalence in a medium-size city in Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:467-472. [DOI: 10.1590/0004-282x20180065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 04/21/2018] [Indexed: 11/22/2022]
Abstract
ABSTRACT To determine the prevalence of cluster headache (CH) in Barbacena, a medium-size city in the State of Minas Gerais, Brazil. Methods The total population of Barbacena is 126,284 inhabitants and the Family Health Strategy Program covers 84,610 of them. In order to identify patients with cluster headache, 36,145 of these inhabitants were screened, following which, a questionnaire was completed by 181 health agents distributed throughout the 28 health posts belonging to the Family Health Strategy network. The completed questionnaires were selected based on the clinical criteria established by the International Headache Society, and those patients (18 years of age or older) with a possible CH diagnosis were later assessed by a headache specialist. This was an observational, cross-sectional study. Results In all, 15 patients were diagnosed as having CH, comprising a prevalence of 0.0414%; or 41.4/100,000 inhabitants. Conclusion The prevalence of cluster headache in Barbacena was lower than that observed in many locations worldwide.
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Affiliation(s)
| | | | | | | | | | | | | | - Carlos A. Bordini
- Faculdade de Medicina de Barbacena, Brasil; Universidade de São Paulo, Brasil
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21
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Capella GL. Flushes, neurodermatology, and surroundings. J Am Acad Dermatol 2018; 78:e123. [DOI: 10.1016/j.jaad.2017.10.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 10/17/2022]
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22
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Abstract
Background Persistent idiopathic facial pain (PIFP) is a chronic disorder recurring daily for more than two hours per day over more than three months, in the absence of clinical neurological deficit. PIFP is the current terminology for Atypical Facial Pain and is characterized by daily or near daily pain that is initially confined but may subsequently spread. Pain cannot be attributed to any pathological process, although traumatic neuropathic mechanisms are suspected. When present intraorally, PIFP has been termed ‘Atypical Odontalgia’, and this entity is discussed in a separate article in this special issue. PIFP is often a difficult but important differential diagnosis among chronic facial pain syndromes. Aim To summarize current knowledge on diagnostic criteria, differential diagnosis, pathophysiology and management of PIFP. Methods We present a narrative review reporting current literature and personal experience. Additionally, we discuss and differentiate the common differential diagnoses associated with PIFP including traumatic trigeminal neuropathies, regional myofascial pain, atypical neurovascular pains and atypical trigeminal neuropathic pains. Results and conclusion The underlying pathophysiology in PIFP is still enigmatic, however neuropathic mechanisms may be relevant. PIFP needs interdisciplinary collaboration to rule out and manage secondary causes, psychiatric comorbidities and other facial pain syndromes, particularly trigeminal neuralgia. Burden of disease and psychiatric comorbidity screening is recommended at an early stage of disease, and should be addressed in the management plan. Future research is needed to establish clear diagnostic criteria and treatment strategies based on clinical findings and individual pathophysiology.
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Affiliation(s)
| | - Charly Gaul
- Migraine and Headache Clinic Königstein, Königstein im Taunus, Germany
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23
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Friedman DI, Evans RW. Are Blurred Vision and Short-Duration Visual Phenomena Migraine Aura Symptoms? Headache 2017; 57:643-647. [DOI: 10.1111/head.13042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2017] [Indexed: 01/03/2023]
Affiliation(s)
- Deborah I. Friedman
- Department of Neurology & Neurotherapeutics and Ophthalmology; University of Texas Southwestern Medical Center; Dallas TX USA
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Hayhoe S. Acupuncture for episodic cluster headache: a trigeminal approach. BMJ Case Rep 2015; 2015:bcr-2015-211984. [PMID: 26359462 DOI: 10.1136/bcr-2015-211984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Following evidence that acupuncture is clinically feasible and cost-effective in the treatment of headache, the UK National Institute for Health and Care Excellence recommends acupuncture as prophylactic treatment for migraine and tension headache. There has thus been expectation that other forms of headache should benefit also. Unfortunately, acupuncture has not generally been successful for cluster headache. This may be due to acupuncturists approaching the problem as one of severe migraine. In fact, cluster headache is classed as a trigeminal autonomic cephalgia. In this case report, episodic cluster headache is treated in the same way as has been shown effective for trigeminal neuralgia. Acupuncture is applied to the contralateral side at points appropriate for stimulating branches of the trigeminal nerve. Thus, ST2 is used for the infraorbital nerve, BL2 and Yuyao for the supratrochlear and supraorbital nerves, and Taiyang for the temporal branch of the zygomatic nerve.
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Affiliation(s)
- Simon Hayhoe
- Department of Pain Management, Colchester University Hospital, Colchester, UK
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25
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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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26
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Lin GY, Lee JT, Peng GS, Yang FC. Sildenafil can induce the onset of a cluster headache bout. Can Urol Assoc J 2014; 8:E378-80. [PMID: 24940471 DOI: 10.5489/cuaj.1736] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
About 25% of patients who are prescribed sildenafil, the phosphodiesterase type 5 (PDE-5) inhibitor, for erectile dysfunction (ED) experience headaches. These migraine effects are well-described, including cluster headaches. We report the case of a man who experienced a cluster headache attack following each of 2 sildenafil doses. His symptoms were resolved by adding naproxen to his treatment regimen and changing his ED treatment from 50 mg of sildenafil to 5 mg of vardenafil. To our knowledge, no study has reported cluster headaches triggered by the less commonly used PDE-5 inhibitors, namely vardenafil and tadalafil. Urologists should be cautious in prescribing sildenafil to patients with ED and with a history of cluster headaches. In these patients, they should consider prescribing low-dose vardenafil or tadalafil instead. Failure to recognize sildenafil risks could result in unnecessary headache bouts in patients with a history of cluster headaches.
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Affiliation(s)
- Guan-Yu Lin
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Jiunn-Tay Lee
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Giia-Sheun Peng
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Fu-Chi Yang
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
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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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28
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Chong MS. Guest Editorial. Br J Pain 2012; 6:102. [DOI: 10.1177/2049463712460947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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