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Leonardi M, Martelletti P, Burstein R, Fornari A, Grazzi L, Guekht A, Lipton RB, Mitsikostas DD, Olesen J, Owolabi MO, Ruiz De la Torre E, Sacco S, Steiner TJ, Surya N, Takeshima T, Tassorelli C, Wang SJ, Wijeratne T, Yu S, Raggi A. The World Health Organization Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders and the headache revolution: from headache burden to a global action plan for headache disorders. J Headache Pain 2024; 25:4. [PMID: 38178049 PMCID: PMC10768290 DOI: 10.1186/s10194-023-01700-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/01/2023] [Indexed: 01/06/2024] Open
Abstract
The World Health Organization (WHO) Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders was developed by WHO to address the worldwide challenges and gaps in provision of care and services for people with epilepsy and other neurological disorders and to ensure a comprehensive, coordinated response across sectors to the burden of neurologic diseases and to promote brain health across life-course. Headache disorders constitute the second most burdensome of all neurological diseases after stroke, but the first if young and midlife adults are taken into account. Despite the availability of a range of treatments, disability associated with headache disorders, and with migraine, remains very high. In addition, there are inequalities between high-income and low and middle income countries in access to medical care. In line with several brain health initiatives following the WHOiGAP resolution, herein we tailor the main pillars of the action plan to headache disorders: (1) raising policy prioritization and strengthen governance; (2) providing effective, timely and responsive diagnosis, treatment and care; (3) implementing strategies for promotion and prevention; (4) fostering research and innovation and strengthen information systems. Specific targets for future policy actions are proposed. The Global Action Plan triggered a revolution in neurology, not only by increasing public awareness of brain disorders and brain health but also by boosting the number of neurologists in training, raising research funding and making neurology a public health priority for policy makers. Reducing the burden of headache disorders will not only improve the quality of life and wellbeing of people with headache but also reduce the burden of neurological disorders increasing global brain health and, thus, global population health.
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Affiliation(s)
- Matilde Leonardi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
| | | | - Rami Burstein
- John Hedley-Whyte Professor of Anesthesia and Neuroscience at the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Arianna Fornari
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Licia Grazzi
- Neuroalgology Unit and Headache Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Richard B Lipton
- Montefiore Headache Center and the Albert Einstein College of Medicine, New York, Bronx, USA
| | - Dimos Dimitrios Mitsikostas
- 1st Neurology Department, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jes Olesen
- Department of Neurology, Danish Headache Center, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mayowa Ojo Owolabi
- Faculty of Clinical Sciences, Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Timothy J Steiner
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Edvard Griegs gate, Trondheim, Norway
- Department of Neurology, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
- Division of Brain Sciences, Imperial College London, London, UK
| | | | - Takao Takeshima
- Department of Neurology, Headache Center, Tominaga Hospital, Osaka, Japan
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Shuu-Jiun Wang
- College of Medicine and Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tissa Wijeratne
- Department of Neurology, Sunshine Hospital, St Albans, VIC, Australia
- Australian Institute of Migraine, Pascoe Vale South, Victoria, Australia
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
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Teshima THN, Zakrzewska JM, Potter R. A systematic review of screening diagnostic tools for trigeminal neuralgia. Br J Pain 2023; 17:255-266. [PMID: 37342400 PMCID: PMC10278451 DOI: 10.1177/20494637221146854] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Background and objective Trigeminal neuralgia (TN) is a rare chronic neuropathic pain condition of sudden and severe pain, often described as an electric shock. Diagnosis is challenging for non-expert clinicians, particularly in primary care settings. We wanted to identify and assess the diagnostic accuracy of existing screening tools for TN and orofacial pain that could be used to support the diagnosis of TN in primary care. Databases and data treatment We searched key databases (MEDLINE, ASSIA, Embase, and Web of Knowledge and PsycINFO) supplemented by citation tracking from January 1988 to 2021. We used an adapted version of the Quality of Diagnostic Accuracy Studies (QUADAS-2) to assess the methodological quality of each study. Results Searches identified five studies, from the UK, USA and Canada; three validated self-report questionnaires; and two artificial neural networks. All screened for multiple orofacial pain diagnoses, including dentoalveolar pain, musculoskeletal pain (temporomandibular disorders) and neurological pain (trigeminal neuralgia, headache, atypical facial pain and postherpetic neuralgia). The overall quality assessment was low for one study. Conclusions Diagnosis of TN can be challenging for non-expert clinicians. Our review found few existing screening tools to diagnose TN, and none is currently suitable to be used in primary care settings. This evidence supports the need to adapt an existing tools or to create a new tool for this purpose. The development of an appropriate screening questionnaire could assist non-expert dental and medical clinicians to identify TN more effectively and empower them to manage or refer patients for treatment more effectively.
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Affiliation(s)
- THN Teshima
- Department of Oral Medicine, UCL Eastman Dental Institute, London, UK
- Department of Oral Medicine and Pain Education Research Centre at ULCH NHS Foundation Trust, Royal National ENT & Eastman Dental Hospitals, ULCH NHS Foundation Trust, London, UK
| | - JM Zakrzewska
- Department of Oral Medicine, UCL Eastman Dental Institute, London, UK
- Department of Oral Medicine and Pain Education Research Centre at ULCH NHS Foundation Trust, Royal National ENT & Eastman Dental Hospitals, ULCH NHS Foundation Trust, London, UK
| | - R Potter
- Warwick Clinical Trials Unit, Coventry, UK
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Vicente BN, Oliveira R, Martins IP, Gil-Gouveia R. Cranial Autonomic Symptoms and Neck Pain in Differential Diagnosis of Migraine. Diagnostics (Basel) 2023; 13:diagnostics13040590. [PMID: 36832077 PMCID: PMC9955923 DOI: 10.3390/diagnostics13040590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/07/2023] Open
Abstract
Cranial autonomic symptoms and neck pain have been reported to be highly prevalent in migraine, although they are rarely considered in clinical evaluation. The aim of this review is to focus on the prevalence, pathophysiology, and clinical characteristics of these two symptoms, and their importance in the differential diagnosis between migraines and other headaches. The most common cranial autonomic symptoms are aural fullness, lacrimation, facial/forehead sweating, and conjunctival injection. Migraineurs experiencing cranial autonomic symptoms are more likely to have more severe, frequent, and longer attacks, as well as higher rates of photophobia, phonophobia, osmophobia, and allodynia. Cranial autonomic symptoms occur due to the activation of the trigeminal autonomic reflex, and the differential diagnosis with cluster headaches can be challenging. Neck pain can be part of the migraine prodromal symptoms or act as a trigger for a migraine attack. The prevalence of neck pain correlates with headache frequency and is associated with treatment resistance and greater disability. The convergence between upper cervical and trigeminal nociception via the trigeminal nucleus caudalis is the likely mechanism for neck pain in migraine. The recognition of cranial autonomic symptoms and neck pain as potential migraine features is important because they often contribute to the misdiagnosis of cervicogenic problems, tension-type headache, cluster headache, and rhinosinusitis in migraine patients, delaying appropriate attack and disease management.
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Affiliation(s)
- Beatriz Nunes Vicente
- Neurology Department, Headache Outaptient Clinic, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, 1649-028 Lisbon, Portugal
- Correspondence:
| | - Renato Oliveira
- Hospital da Luz Headache Center, Neurology Department, Hospital da Luz, 1500-650 Lisbon, Portugal
| | - Isabel Pavão Martins
- Neurology Department, Headache Outaptient Clinic, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, 1649-028 Lisbon, Portugal
- Centro de Estudos Egas Moniz, Universidade de Lisboa, 1649-028 Lisbon, Portugal
| | - Raquel Gil-Gouveia
- Hospital da Luz Headache Center, Neurology Department, Hospital da Luz, 1500-650 Lisbon, Portugal
- Center for Interdisciplinary Research in Health, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal
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Bemanalizadeh M, Baghaei Oskouei H, Hadizadeh A, Dakkali MS, Qahremani R, Mansouri V. Paroxysmal hemicrania in children and adolescents: A systematic review. Headache 2022; 62:952-966. [DOI: 10.1111/head.14354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/28/2022] [Accepted: 05/02/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Maryam Bemanalizadeh
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non‐Communicable Disease Isfahan University of Medical Sciences Isfahan Iran
- Department of Pediatrics Neurology, School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | | | - Alireza Hadizadeh
- School of Medicine Tehran University of Medical Sciences Tehran Iran
| | | | - Reihane Qahremani
- School of Medicine Tehran University of Medical Sciences Tehran Iran
| | - Vahid Mansouri
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non‐Communicable Disease Isfahan University of Medical Sciences Isfahan Iran
- Department of Pediatrics Neurology, School of Medicine Isfahan University of Medical Sciences Isfahan Iran
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Bryson A. Temporary resolution of hemicrania continua following ipsilateral ear piercing. BMJ Neurol Open 2021; 3:e000193. [PMID: 34632387 PMCID: PMC8477251 DOI: 10.1136/bmjno-2021-000193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 11/16/2022] Open
Abstract
Background Hemicrania continua is an uncommon subtype of trigeminal autonomic cephalgia that exhibits dramatic therapeutic response to indomethacin. Unfortunately, indomethacin is associated with a range of adverse effects, including neuropsychiatric complications, which limits its use in many patients. Although no other effective pharmacologic agents exist, there is emerging evidence for interventional treatments such as occipital nerve and vagus nerve stimulation, which may act by modulating neural activity within the trigeminovascular system. Case We present a 30-year-old woman with long-standing refractory hemicrania continua who suffered adverse effects to indomethacin. She experienced temporary, but near-complete, symptom resolution following piercing of the crus of the ear helix ipsilateral to her headache, whereas contralateral piercing produced no benefit. Conclusions To our knowledge, this case is the first to describe a therapeutic benefit following ear piercing in a patient with trigeminal autonomic cephalgia. We argue that symptom relief was obtained through a similar mechanism to occipital or vagus nerve stimulation.
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Affiliation(s)
- Alexander Bryson
- Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
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6
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Chen G, You H, Juha H, Lou B, Zhong Y, Lian X, Peng Z, Xu T, Yuan L, Woralux P, Hugo AB, Jianliang C. Trigger areas nerve decompression for refractory chronic migraine. Clin Neurol Neurosurg 2021; 206:106699. [PMID: 34053808 DOI: 10.1016/j.clineuro.2021.106699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/19/2021] [Accepted: 05/11/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Chronic migraine refractory to medical treatment represents a common debilitating primary neurovascular disorder associated with great disability, high financial costs, reduced rates of productivity and impaired health-related quality of life. OBJECTIVE To demonstrate the feasibility of scalp (trigger areas) nerve decompression as a treatment alternative in the management of refractory CM patients METHODS: From January 2005 to January 2020, we retrospectively collected data of 154 patients diagnosed with chronic migraine that underwent trigger site nerve decompression. These trigger areas were divided according the nerve compromise as frontal (supraorbital nerve), temporal (auriculotemporal nerve), occipital (greater occipital nerve). Following extensive clinical evaluation, the surgical treatment was performed after under local anesthesia and required the release of the affected nerve from surrounding connective tissue adhesions, and vascular conflicts. RESULTS Of the total amount of patients, 91 (59.09%) patients underwent auriculotemporal nerve decompression, 27 (13.63%) cases supraorbital nerve decompression, 15 (9.74%) patients greater occipital nerve decompression, and the remaining 21 (13.63%) patients had more than one procedure of nerve decompression. At 1-year follow or latest follow-up, 96 (62.2%) patients were considered as cured, 29 cases (18.83%) reported improvement of their symptoms, 21 (13.64%) patients considered only a partial symptomatic remission and 5 (3.25%) patients reported no change or failed surgical treatment. CONCLUSION Nerve decompression of trigger site areas (frontal, temporal, occipital) by removal of tissue, muscles and vessels in patients with medically refractory CM is a feasible alternative treatment modality with a high success of up to 80.5.
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Affiliation(s)
- Guiwen Chen
- Department of neurosurgery, the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 518033, Guangdong Province, China
| | - Hengxing You
- Department of neurosurgery, the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 518033, Guangdong Province, China
| | - Hernesniemi Juha
- Department of Neurosurgery, Zhengzhou University People's Hospital, Zhengzhou, Henan, China; Henan Provincial People's, Hospital, Zhengzhou, Henan, China; Cerebrovascular Disease Hospital, Zhengzhou, Henan, China; Henan University People's, Hospital, Zhengzhou, Henan, China
| | - Bin Lou
- Department of neurosurgery, the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 518033, Guangdong Province, China
| | - Yuanqiang Zhong
- Department of neurosurgery, the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 518033, Guangdong Province, China
| | - Xiaowen Lian
- Department of neurosurgery, the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 518033, Guangdong Province, China
| | - Zhitao Peng
- Department of neurosurgery, the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 518033, Guangdong Province, China
| | - Ting Xu
- Department of neurosurgery, the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 518033, Guangdong Province, China
| | - Li Yuan
- Department of neurosurgery, the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 518033, Guangdong Province, China
| | | | - Andrade-Barazarte Hugo
- Department of Neurosurgery, Zhengzhou University People's Hospital, Zhengzhou, Henan, China; Henan Provincial People's, Hospital, Zhengzhou, Henan, China; Cerebrovascular Disease Hospital, Zhengzhou, Henan, China; Henan University People's, Hospital, Zhengzhou, Henan, China.
| | - Chen Jianliang
- Department of neurosurgery, the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 518033, Guangdong Province, China.
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Tripathi M, Sadashiva N, Gupta A, Jani P, Pulickal SJ, Deora H, Kaur R, Kaur P, Batish A, Mohindra S, Kumar N. Please spare my teeth! Dental procedures and trigeminal neuralgia. Surg Neurol Int 2020; 11:455. [PMID: 33408940 PMCID: PMC7771490 DOI: 10.25259/sni_729_2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/17/2020] [Indexed: 02/02/2023] Open
Abstract
Background: The correct diagnosis of trigeminal neuralgia (TN) is still a far cry and the patients suffer from unnecessary dental procedures before getting the definite treatment. In this study, we evaluated, if the patients have undergone dental procedures for their misdiagnosed TN before receiving definite treatment for the same. Methods: A total of 187 patients received GKRS for their TN (excluding secondary TN) in two institutes from 2010 to 2019. We did a retrospective analysis of these patients’ primary complaints on a standard questionnaire. Results: One hundred and seventeen of the 187 patients responded. About 55.5% of patients had a toothache and 65.8% did visit a dentist for the pain. About 41.8% of patients underwent one dental procedure; 18.8% suffered from worsening of the pain while 8.5% received some partial improvement. About 19.6% also underwent root canal treatment while 6.8% had a nerve block. Mean of 1.6 teeth was extracted per person. About 71% of patients were satisfied with their Gamma Knife radiosurgery for TN at a median follow-up of 49 months. Conclusion: There is a need for a better understanding of the disease among the dentists and the patients for the timely and correct treatment, without losing their teeth. The onus lies on neurosurgeons/neurologists disseminate knowledge regarding proper diagnosis and treatment modalities.
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Affiliation(s)
- Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Anand Gupta
- Department of Dentistry, Government Medical College, Chandigarh, India
| | - Parth Jani
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sachin Jose Pulickal
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Rupinder Kaur
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parwinder Kaur
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Batish
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Mohindra
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Narendra Kumar
- Department of Radiotherapy, Postgraduate Institute of Medical Education and Reserach, Chandigarh, India
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8
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Antonaci F, Arceri S, Rakusa M, Mitsikostas DD, Milanov I, Todorov V, Ramusino MC, Costa A. Pitfals in recognition and management of trigeminal neuralgia. J Headache Pain 2020; 21:82. [PMID: 32605593 PMCID: PMC7325374 DOI: 10.1186/s10194-020-01149-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/17/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Trigeminal neuralgia (TN) is a severe, disabling form of painful cranial neuropathy. Even though TN has a typical clinical picture, diagnosis it is often missed or delayed in clinical practice. In order to investigate the occurrence of diagnostic and therapeutic errors in TN, we studied 102 patients suffering from TN recruited through a multicentric survey. METHODS We performed a Pubmed database search on errors and pittfalls in TN diagnosis and management. Then, patients with TN were consecutively enrolled in the period from February 2017 to October 2019, by several European Headache Centers participating in the study, following a call of the Headache and Pain Scientific Panels of the European Academy of Neurology (EAN). Diagnosis of Classical Trigeminal Neuralgia (CTN) was made according to the International Headache Society (IHS) criteria (Tölle et al., Pain Pract 6:153-160, 2006). All the patients were evaluated using telephone/frontal interviews conducted by headache/pain specialists using an ad hoc questionnaire. RESULTS A number of 102 patients were recruited, mostly females (F:M ratio 2.64:1). Eighty-six percent of the patients consulted a physician at the time they experienced the first pain attacks. Specialists consulted before TN diagnosis were: primary care physicians (PCP) (43.1%), dentists (in 30.4%), otorhinolaryngologists (3.9%), neurosurgeons (3.9%), neurologists or headache specialists (14.7%), others (8%). The final diagnosis was made mainly by a neurologist or headache specialist (85.3%), and the mean interval between the disease onset and the diagnosis made by a specialist was 10.8 ± 21.2 months. The "diagnostic delay" was 7.2 ± 12.5 months, and misdiagnoses at first consultation were found in 42.1% of cases. Instrumental and laboratory investigations were carried out in 93.1% of the patients before the final diagnosis of TN. CONCLUSION While TN has typical features and it is well defined by the available international diagnostic criteria, it is still frequently misdiagnosed and mistreated. There is a need to improve the neurological knowledge in order to promptly recognize the clinical picture of TN and properly adhere to the specific guidelines. This may result in a favorable outcome for patients, whose quality of life is usually severely impaired.
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Affiliation(s)
- F Antonaci
- IRCCS Mondino Foundation, Pavia, Italy. .,Department of Brain and Behavior, University of Pavia, via Mondino 2, 27100, Pavia, Italy.
| | - S Arceri
- IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavior, University of Pavia, via Mondino 2, 27100, Pavia, Italy
| | - M Rakusa
- Department of Neurology, University Medical Centre, Maribor, Slovenia
| | - D D Mitsikostas
- First Neurology Department, National and Kapodistrian University of Athens, Athens, Greece
| | - I Milanov
- St. Naum Hospital of Neurology and Psychiatry, Medical University, Sofia, Bulgaria
| | - V Todorov
- St. Naum Hospital of Neurology and Psychiatry, Medical University, Sofia, Bulgaria
| | - M Cotta Ramusino
- IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavior, University of Pavia, via Mondino 2, 27100, Pavia, Italy
| | - A Costa
- IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavior, University of Pavia, via Mondino 2, 27100, Pavia, Italy
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9
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Chronic orofacial pain. J Neural Transm (Vienna) 2020; 127:575-588. [DOI: 10.1007/s00702-020-02157-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/03/2020] [Indexed: 02/06/2023]
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10
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Viana M, Khaliq F, Zecca C, Figuerola MDL, Sances G, Di Piero V, Petolicchio B, Alessiani M, Geppetti P, Lupi C, Benemei S, Iannacchero R, Maggioni F, Jurno ME, Odobescu S, Chiriac E, Marfil A, Brighina F, Barrientos Uribe N, Pérez Lago C, Bordini C, Lucchese F, Maffey V, Nappi G, Sandrini G, Tassorelli C. Poor patient awareness and frequent misdiagnosis of migraine: findings from a large transcontinental cohort. Eur J Neurol 2019; 27:536-541. [PMID: 31574197 DOI: 10.1111/ene.14098] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/27/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Although migraine is the second most disabling condition worldwide, there is poor awareness of it. The objective was to assess the awareness of migraine and previous diagnostic and therapeutic consultations and treatments in a large international population of migraineurs. METHODS This was a multicentre study conducted in 12 headache centres in seven countries. Each centre recruited up to 100 patients referred for a first visit and diagnosed with migraine. Subjects were given a structured clinical questionnaire-based interview about the perceptions of the type of headache they suffered from, its cause, previous diagnoses, investigations and treatments. RESULTS In all, 1161 patients completed the study. Twenty-eight per cent of participants were aware that they suffered from migraine. Sixty-four per cent called their migraine 'headache'; less commonly they used terms such as 'cervical pain' (4%), tension headache (3%) and sinusitis (1%). Eight per cent of general practitioners and 35% of specialists (of whom 51% were neurologists and/or headache specialists) consulted for migraine formulated the correct diagnosis. Before participating in the study, 50% of patients had undergone X-ray, computed tomography and/or magnetic resonance imaging of the cervical spine and 76% underwent brain and/or cervical spine imaging for migraine. Twenty-eight per cent of patients had received symptomatic migraine-specific medications and 29% at least one migraine preventive medication. CONCLUSIONS Although migraine is a very common disease, poor awareness of it amongst patients and physicians is still an issue in several countries. This highlights the importance of the promotion of migraine awareness to reduce its burden and limit direct and indirect costs and the risk of exposure to useless investigations.
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Affiliation(s)
- M Viana
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy.,Headache Center, Neurocenter of Southern Switzerland, Regional Hospital Lugano, Lugano, Switzerland.,Headache Group, Department of Basic and Clinical Neurosciences, King's College London, London, UK
| | - F Khaliq
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy.,Scunthorpe General Hospital, North Lincolnshire, UK
| | - C Zecca
- Headache Center, Neurocenter of Southern Switzerland, Regional Hospital Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - M D L Figuerola
- Hospital de Clínicas José San Martín, Buenos Aires, Argentina.,Hospital Alemán, Buenos Aires, Argentina
| | - G Sances
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - V Di Piero
- Sapienza University of Rome, Rome, Italy
| | | | | | - P Geppetti
- Headache Center, Careggi University Hospital, University of Florence, Florence, Italy
| | - C Lupi
- Headache Center, Careggi University Hospital, University of Florence, Florence, Italy
| | - S Benemei
- Headache Center, Careggi University Hospital, University of Florence, Florence, Italy
| | | | | | - M E Jurno
- FAME/FUNJOB and FHEMIG, Barbacena, Brazil
| | - S Odobescu
- National Headache Center, Institute of Neurology and Neurosurgery of Chisinau City, Chisinau, Moldova
| | - E Chiriac
- National Headache Center, Institute of Neurology and Neurosurgery of Chisinau City, Chisinau, Moldova
| | - A Marfil
- Hospital Universitario, Monterrey, Mexico
| | - F Brighina
- Headache Center, Department BIONEC, University of Palermo, Palermo, Italy
| | | | | | - C Bordini
- Clínica Neurológica Batatais, Batatais, Brazil
| | - F Lucchese
- Sapienza University of Rome, Rome, Italy
| | - V Maffey
- Sapienza University of Rome, Rome, Italy
| | - G Nappi
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - G Sandrini
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - C Tassorelli
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Ziegeler C, May A. Facial presentations of migraine, TACs, and other paroxysmal facial pain syndromes. Neurology 2019; 93:e1138-e1147. [DOI: 10.1212/wnl.0000000000008124] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/24/2019] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo assess the prevalence of facial pain (V2 and/or V3) presentations among nearly 3,000 patients with headache treated in a university tertiary care center.MethodsBetween 2010 and 2018, we routinely assessed the prevalence of facial pain presentations of all patients with primary headaches.ResultsOf 2,912 patient datasets, 291 patients reported facial pain either as an independent or as an additional symptom. Among patients with migraine, 2.3% (44 of 1,935) reported a facial involvement, most commonly in V2. Of these, 18 patients (40.9%) experienced the pain predominantly in the face. In patients with cluster headache, 14.8% (42 of 283) reported a facial involvement, of which 31.0% perceived the pain predominantly in the face. A facial involvement was seen in 45.0% of patients with paroxysmal hemicrania (9 of 20), 21.4% of patients with hemicrania continua (9 of 42), and 20.0% of patients with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing/short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (3 of 15). In addition, we present 6 patients who reported a constant side-locked facial pain with superseded well-defined facial pain attacks of 10- to 30-minute duration that appeared several times per day.ConclusionOur data suggest that a facial involvement in primary headaches is infrequent but not uncommon. A sole facial presentation of primary headache symptomatology seems to be exceptionally rare. We describe 3 different types of facial pain involvement and, in this context, distinguish patients with paroxysmal orofacial pain syndromes that have not been previously described. These patients may represent a new entity that could tentatively be called constant unilateral facial pain with added attacks.
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12
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Wei DY, Moreno-Ajona D, Renton T, Goadsby PJ. Trigeminal autonomic cephalalgias presenting in a multidisciplinary tertiary orofacial pain clinic. J Headache Pain 2019; 20:69. [PMID: 31185885 PMCID: PMC6734481 DOI: 10.1186/s10194-019-1019-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/30/2019] [Indexed: 01/03/2023] Open
Abstract
Abstract Orofacial pain may have a variety of causes and offers a significant clinical challenge for its diagnosis and management. Objective To assess the headache disorders presenting in a tertiary multidisciplinary orofacial pain clinic, after dental causes have been excluded. Methods Clinic letters from the initial consultation and subsequent follow up reviews of the 142 patients, who were seen in the tertiary Multidisciplinary Orofacial Pain clinic between January 2015 until January 2018 were reviewed as a clinical audit. Results The most common diagnoses were possible trigeminal autonomic cephalalgia (n = 62, 44%), migraine (n = 38, 27%) and painful post-traumatic trigeminal neuropathy (n = 17, 12%). The most common trigeminal autonomic cephalalgia diagnosis was hemicrania continua (n = 13, 9%), which is higher than the reported prevalence in neurology and headache clinics. Conclusion This study demonstrates the importance of a multidisciplinary approach to diagnosing complex orofacial pain patients and the importance of awareness of primary headache disorders, in particular trigeminal autonomic cephalalgias, thereby reducing unnecessary diagnostic delays or procedures.
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Affiliation(s)
- D Y Wei
- Headache Group, Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | - D Moreno-Ajona
- Headache Group, Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | - T Renton
- Oral Surgery, Institute of Dentistry, Kings College London, London, UK
| | - P J Goadsby
- Headache Group, Department of Basic and Clinical Neuroscience, King's College London, London, UK. .,NIHR Wellcome Trust King's Clinical Research Facility, SLaM Biomedical Research Centre, Wellcome Foundation Building, King's College Hospital, London, SE5 9PJ, UK.
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13
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Chung PW, Cho SJ, Kim BK, Kim SK, Lee MJ, Choi YJ, Park JW, Kim BS, Oh K, Moon HS, Song TJ, Kang D, Cho J, Chung CS. Development and Validation of the Cluster Headache Screening Questionnaire. J Clin Neurol 2019; 15:90-96. [PMID: 30618222 PMCID: PMC6325359 DOI: 10.3988/jcn.2019.15.1.90] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/17/2018] [Accepted: 09/19/2018] [Indexed: 01/03/2023] Open
Abstract
Background and Purpose Cluster headache (CH) is frequently either not diagnosed or the diagnosis is delayed. We addressed this issue by developing the self-administered Cluster Headache Screening Questionnaire (CHSQ). Methods Experts selected items from the diagnostic criteria of CH and the characteristics of migraine. The questionnaire was administered to first-visit headache patients at nine headache clinics. The finally developed CHSQ included items based on the differences in responses between CH and non-CH patients, and the accuracy and reliability of the scoring model were assessed. Results Forty-two patients with CH, 207 migraineurs, 73 with tension-type headache, and 18 with primary stabbing headache were enrolled. The CHSQ item were scored as follows: 3 points for ipsilateral eye symptoms, agitation, and duration; 2 points for clustering patterns; and 1 point for the male sex, unilateral pain, disability, ipsilateral nasal symptoms, and frequency. The total score of the CHSQ ranged from 0 to 16. The mean score was higher in patients with CH than in non-CH patients (12.9 vs. 3.4, p<0.001). At a cutoff score of >8 points, the CHSQ had a sensitivity, specificity, positive predictive value, and negative predictive value of 95.2%, 96%, 76.9%, and 99.3%, respectively. Conclusions The CHSQ is a reliable screening tool for the rapid identification of CH.
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Affiliation(s)
- Pil Wook Chung
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.
| | - Byung Kun Kim
- Department of Neurology, Eulji Hospital, Eulji University, Seoul, Korea
| | - Soo Kyoung Kim
- Department of Neurology, Gyeonsang National University College of Medicine, Jinju, Korea
| | - Mi Ji Lee
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun Ju Choi
- Department of Neurology, Presbyterian Medical Center, Jeonju, Korea
| | - Jeong Wook Park
- Department of Neurology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea
| | - Byung Su Kim
- Department of Neurology, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Heui Soo Moon
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Jin Song
- Department of Neurology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Danbee Kang
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea.,Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea.,Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chin Sang Chung
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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14
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DE CORSO E, KAR M, CANTONE E, LUCIDI D, SETTIMI S, MELE D, SALVATI A, MULUK NBAYAR, PALUDETTI G, CINGI C. Facial pain: sinus or not? ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2018; 38:485-496. [PMID: 30623894 PMCID: PMC6325651 DOI: 10.14639/0392-100x-1721] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 05/29/2018] [Indexed: 01/13/2023]
Abstract
Facial pain remains a diagnostic and therapeutic challenge for both clinicians and patients. In clinical practice, patients suffering from facial pain generally undergo multiple repeated consultations with different specialists and receive various treatments, including surgery. Many patients, as well as their primary care physicians, mistakenly attribute their pain as being due to rhinosinusitis when this is not the case. It is important to exclude non-sinus-related causes of facial pain before considering sinus surgery to avoid inappropriate treatment. Unfortunately, a significant proportion of patients have persistent facial pain after endoscopic sinus surgery (ESS) due to erroneous considerations on aetiology of facial pain by physicians. It should be taken into account that neurological and sinus diseases may share overlapping symptoms, but they frequently co-exist as comorbidities. The aim of this review was to clarify the diagnostic criteria of facial pain in order to improve discrimination between sinogenic and non-sinogenic facial pain and provide some clinical and diagnostic criteria that may help clinicians in addressing differential diagnosis.
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Affiliation(s)
- E. DE CORSO
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M. KAR
- ENT Specialist Kumluca State Hospital, ENT Clinic, Antalya, Turkey
| | - E. CANTONE
- Department of Neuroscience, ENT section, “Federico II” University, Naples, Italy
| | - D. LUCIDI
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S. SETTIMI
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - D. MELE
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A. SALVATI
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - N. BAYAR MULUK
- Kirikkale University, Medical Faculty, Department of Otorhinolaryngology, Kirikkale, Turkey
| | - G. PALUDETTI
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C. CINGI
- Eskisehir Osmangazi University, Medical Faculty, Department of Otorhinolaryngology, Eskisehir, Turkey
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Abstract
The primary headaches are composed of multiple entities that cause episodic and chronic head pain in the absence of an underlying pathologic process, disease, or traumatic injury. The most common of these are migraine, tension-type headache, and the trigeminal autonomic cephalalgias. This article reviews the clinical presentation, pathophysiology, and treatment of each to help in differential diagnosis. These headache types share many common signs and symptoms, thus a clear understanding of each helps prevent a delay in diagnosis and inappropriate or ineffective treatment. Many of these patients seek dental care because orofacial pain is a common presenting symptom.
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Affiliation(s)
- Robert W Mier
- Tufts University School of Dental Medicine, 1 Kneeland Street, Suite 601, Boston, MA 02111, USA.
| | - Shuchi Dhadwal
- Tufts University School of Dental Medicine, 1 Kneeland Street, Suite 601, Boston, MA 02111, USA
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16
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Benoliel R. Classifying head, face and oral pain. Cephalalgia 2017; 37:1315-1316. [PMID: 29034786 DOI: 10.1177/0333102417739311] [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]
Affiliation(s)
- Rafael Benoliel
- Department of Diagnostic Sciences, Director, Center for Orofacial Pain and Temporomandibular Disorders, Associate Dean for Research, Rutgers School of Dental Medicine, Newark, NJ, USA
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17
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Baraldi C, Pellesi L, Guerzoni S, Cainazzo MM, Pini LA. Therapeutical approaches to paroxysmal hemicrania, hemicrania continua and short lasting unilateral neuralgiform headache attacks: a critical appraisal. J Headache Pain 2017; 18:71. [PMID: 28730562 PMCID: PMC5519518 DOI: 10.1186/s10194-017-0777-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/04/2017] [Indexed: 12/30/2022] Open
Abstract
Background Hemicrania continua (HC), paroxysmal hemicrania (PH) and short lasting neuralgiform headache attacks (SUNCT and SUNA) are rare syndromes with a difficult therapeutic approach. The aim of this review is to summarize all articles dealing with treatments for HC, PH, SUNCT and SUNA, comparing them in terms of effectiveness and safety. Methods A survey was performed using the pubmed database for documents published from the 1st January 1989 onwards. All types of articles were considered, those ones dealing with symptomatic cases and non-English written ones were excluded. Results Indomethacin is the best treatment both for HC and PH. For the acute treatment of HC, piroxicam and celecoxib have shown good results, whilst for the prolonged treatment celecoxib, topiramate and gabapentin are good options besides indomethacin. For PH the best drug besides indomethacin is piroxicam, both for acute and prolonged treatment. For SUNCT and SUNA the most effective treatments are intravenous or subcutaneous lidocaine for the acute treatment of active phases and lamotrigine for the their prevention. Other effective therapeutic options are intravenous steroids for acute treatment and topiramate for prolonged treatment. Non-pharmacological techniques have shown good results in SUNCT and SUNA but, since they have been tried on a small number of patients, the reliability of their efficacy is poor and their safety profile mostly unknown. Conclusions Besides a great number of treatments tried, HC, PH, SUNCT and SUNA management remains difficult, according with their unknown pathogenesis and their rarity, which strongly limits the studies upon these conditions. Further studies are needed to better define the treatment of choice for these conditions. Electronic supplementary material The online version of this article (doi:10.1186/s10194-017-0777-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carlo Baraldi
- Medical Toxicology - Headache and Drug Abuse Centre, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy.
| | - Lanfranco Pellesi
- Medical Toxicology - Headache and Drug Abuse Centre, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Simona Guerzoni
- Medical Toxicology - Headache and Drug Abuse Centre, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Maria Michela Cainazzo
- Medical Toxicology - Headache and Drug Abuse Centre, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Luigi Alberto Pini
- Medical Toxicology - Headache and Drug Abuse Centre, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
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18
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Cowan R, Barad M. Effect of Educating the Primary Care Physician About Headache to Help Reduce "Trivial" Referrals and Improve the Number and Quality of "Substantial" Referrals that Truly Need Subspecialty Headache Medicine Care. Curr Treat Options Neurol 2017; 19:25. [PMID: 28536899 DOI: 10.1007/s11940-017-0462-5] [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: 11/29/2022]
Abstract
OPINION STATEMENT Technology is likely to play an increasingly important role in the delivery of healthcare as the disparity between provider availability/expertise and patient numbers/needs increases. This article is intended to lend insight into the ways in which technology can facilitate the evaluation of patients with headache disorders and improve the ongoing monitoring of disease progression and response to therapy, following proper diagnosis. While it is not possible to prognosticate the impact of technologies not yet available, the article addresses potential novel usage of currently existing technology to standardize intake, expedite evaluations, ensure adequate history and documentation, and monitoring of patient care.
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Affiliation(s)
- Robert Cowan
- Stanford School of Medicine, 213 Quarry Rd, Stanford, CA, 94305, USA.
| | - Meredith Barad
- Neurology & Neurological Sciences, 450 Broadway, Pavilion A, 1st Floor, Redwood City, CA, 94063, USA
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19
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Gao J, Fu Y, Guo SK, Li B, Xu ZX. Efficacy and Prognostic Value of Partial Sensory Rhizotomy and Microvascular Decompression for Primary Trigeminal Neuralgia: A Comparative Study. Med Sci Monit 2017; 23:2284-2291. [PMID: 28502974 PMCID: PMC5441416 DOI: 10.12659/msm.901510] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background This study aimed to compare the efficacy and prognostic value of partial sensory rhizotomy (PSR) and microvascular decompression (MVD) for primary trigeminal neuralgia (PTN). Material/Methods From June 2010 to June 2012, 117 patients with PTN were recruited for the study, of which 52 cases were treated with MVD (the MVD group) and 65 cases were treated with PSR (the PSR group). Visual Analog Scoring (VAS) was performed at 1 and 2 weeks, and at 1, 3, and 6 month after surgery. The overall response rate (ORR) was determined 1 month after surgery. Barrow Neurological Institute score was adopted to value the reoccurrence at 6, 12, 24, and 36 months after surgery. A 3-year follow-up was conducted and the complications were recorded. Results The ORR 2 weeks after surgery in the MVD and PSR groups was 98.08% and 84.62%, respectively. One and 2 weeks after surgery, the VAS was lower in the MVD group than in the PSR group, but there was no significant difference in VAS between the 2 groups at 1, 3, and 6 months after surgery. Three years after surgery, the recurrence rate was significantly lower in the MVD group than in the PSR group. The recurrence-free survival time was longer in the MVD group than in the PSR group. The occurrence rates of herpes and total postoperative complications were significantly higher in the PSR group than in the MVD group. Conclusions Compared with PSR, MVD is more suitable for PTN treatment, with less disturbance, lower recurrence rate, and better efficacy.
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Affiliation(s)
- Jian Gao
- Department of Neurosurgery, The China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Yao Fu
- Department of Neurosurgery, The First People's Hospital of Shangqiu, Shangqiu, Henan, China (mainland)
| | - Shi-Kun Guo
- Department of Neurosurgery, The First People's Hospital of Shangqiu, Shangqiu, Henan, China (mainland)
| | - Bing Li
- Department of Neurosurgery, The First People's Hospital of Shangqiu, Shangqiu, Henan, China (mainland)
| | - Zhong-Xin Xu
- Department of Neurology, The China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
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20
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Russo A, Silvestro M, Cirillo M, Tessitore A, Tedeschi G. Idiopathic hypertrophic pachymeningitis mimicking hemicrania continua: An unusual clinical case. Cephalalgia 2017; 38:804-807. [PMID: 28474987 DOI: 10.1177/0333102417708773] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Hemicrania continua (HC) is a primary headache syndrome characterized by a unilateral, moderate, continuous headache with exacerbations marked by migrainous and cranial autonomic symptoms. However, clinical phenotypes similar to primary HC may be subtended by several disorders. Case report We report the case of a 62-year-old man experiencing, over the previous year, a headache completely consistent with HC and its absolute responsiveness to indomethacin therapy. Later, the patient developed diplopia caused by sixth cranial nerve palsy ipsilateral to headache. In this frame, clinical, laboratory and neuroimaging characteristics supported the diagnosis of idiopathic hypertrophic pachymeningitis (IHP). Conclusions IHP is a rare fibrosing inflammatory disorder leading to a localized or diffuse dura mater thickening. IHP clinical manifestations are a progressively worsening headache and signs related to cranial nerves involvement and venous sinus thrombosis. Here, we report, for the first time, a HC phenotype subtended by IHP.
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Affiliation(s)
- Antonio Russo
- 1 Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy.,2 MRI Research Center SUN-FISM, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Marcello Silvestro
- 1 Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy.,2 MRI Research Center SUN-FISM, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Mario Cirillo
- 2 MRI Research Center SUN-FISM, University of Campania 'Luigi Vanvitelli', Naples, Italy.,3 Neuroradiology Service, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Alessandro Tessitore
- 1 Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy.,2 MRI Research Center SUN-FISM, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Gioacchino Tedeschi
- 1 Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy.,2 MRI Research Center SUN-FISM, University of Campania 'Luigi Vanvitelli', Naples, Italy
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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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22
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Benoliel R, Sharav Y, Haviv Y, Almoznino G. Tic, Triggering, and Tearing: From CTN to SUNHA. Headache 2017; 57:997-1009. [DOI: 10.1111/head.13040] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 01/03/2017] [Indexed: 01/03/2023]
Affiliation(s)
- R. Benoliel
- Rutgers School of Dental Medicine; Rutgers State University of New Jersey; Newark NJ USA
| | - Y. Sharav
- Department of Oral Medicine, The Faculty of Dentistry; Hebrew University-Hadassah; Jerusalem Israel
| | - Y. Haviv
- Department of Oral Medicine, The Faculty of Dentistry; Hebrew University-Hadassah; Jerusalem Israel
| | - G. Almoznino
- Department of Oral Medicine, The Faculty of Dentistry; Hebrew University-Hadassah; Jerusalem Israel
- Department of Oral Medicine; Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces; Tel-Hashomer Israel
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23
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Vikelis M, Rapoport AM. Cluster headache in Greece: an observational clinical and demographic study of 302 patients. J Headache Pain 2016; 17:88. [PMID: 27670427 PMCID: PMC5037095 DOI: 10.1186/s10194-016-0683-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 09/22/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Cluster headache (CH) is considered the most excruciating primary headache syndrome; although much less prevalent than migraine, it is not rare as it affects more than 1/1000 people. While its clinical presentation is considered stereotypic, atypical features are often encountered. Internationally, cluster headache is often misdiagnosed, undertreated and mistreated. METHODS We prospectively studied 302 CH patients, all examined by the same headache specialist. The aim of our study was to describe the demographic and clinical characteristics of CH patients in Greece and draw attention to under-management, under-treatment and mis-treatment often encountered in clinical practice; our purpose is to improve recognition and successful treatment of cluster patients by Greek neurologists and other physicians. RESULTS In the present cohort, clinical characteristics of CH are similar to those described in other populations. Beyond the standard clinical characteristics, features like side shifts (12.6 %), location of maximal pain intensity outside the first trigeminal branch division (10.2 %), lack of autonomic features (7 %), presence of associated features of migraine and aggravation by physical activity (10 %) were encountered. Four out of five patients had consulted a physician prior to diagnosis. The median number of physicians seen prior to diagnosis was 3 and the median time to diagnosis was 5 years, though it improved for patients with recent onset. Chronic cluster headache, side shifts, pain location in the face or the back of the head and aggravation by physical activity were found, among others, to be statistically significantly related to delayed diagnosis or more physicians seen prior to diagnosis. Even properly diagnosed patients were often undertreated or mistreated. CONCLUSIONS Cluster headache, in a large cohort of Greek patients, has the same phenotypic characteristics as described internationally. Uncommon clinical features do exist and physicians should be aware of those, since they may eventuate in diagnostic problems. Most CH patients in Greece remain misdiagnosed or undiagnosed for rather lengthy periods of time, but time to diagnosis has improved recently. Even after diagnosis, treatment received was suboptimal.
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Affiliation(s)
- Michail Vikelis
- Headache Clinic, Mediterraneo Hospital, Glyfada, Greece
- Glyfada Headache Clinic, 8 Lazaraki Str, Glyfada, 16675 Greece
| | - Alan M. Rapoport
- The David Geffen School of Medicine at UCLA, Los Angeles, California USA
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25
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Maxfield AZ, Korkmaz H, Gregorio LL, Busaba NY, Gray ST, Holbrook EH, Guo R, Bleier BS. General antibiotic exposure is associated with increased risk of developing chronic rhinosinusitis. Laryngoscope 2016; 127:296-302. [DOI: 10.1002/lary.26232] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/04/2016] [Accepted: 07/18/2016] [Indexed: 12/29/2022]
Affiliation(s)
- Alice Z. Maxfield
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary, Harvard Medical School; Boston Massachusetts U.S.A
| | - Hakan Korkmaz
- Department of Otorhinolaryngology; Ordu University Faculty of Medicine; Ordu Turkey
| | - Luciano L. Gregorio
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary, Harvard Medical School; Boston Massachusetts U.S.A
| | - Nicolas Y. Busaba
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary, Harvard Medical School; Boston Massachusetts U.S.A
| | - Stacey T. Gray
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary, Harvard Medical School; Boston Massachusetts U.S.A
| | - Eric H. Holbrook
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary, Harvard Medical School; Boston Massachusetts U.S.A
| | - Rong Guo
- Department of Biostatistics; Massachusetts Eye and Ear Infirmary, Harvard Medical School; Boston Massachusetts U.S.A
| | - Benjamin S. Bleier
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary, Harvard Medical School; Boston Massachusetts U.S.A
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26
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Case Studies of Uncommon and Rare Headache Disorders. Neurol Clin 2016; 34:631-50. [PMID: 27445245 DOI: 10.1016/j.ncl.2016.04.006] [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: 11/24/2022]
Abstract
The following 6 case studies are presented: a 12-day migraine with recurring aura?; a migraineur with a new constant headache for 1 month; an orthostatic headache; a unilateral headache; migraine with aura and limb pain without headache; and nocturnal headaches. These cases illustrate the fascinating diversity and challenges of primary and secondary headaches that neurologists commonly encounter.
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Gay-Escoda C, Mayor-Subirana G, Camps-Font O, Berini-Aytés L. Sunct syndrome. Report of a case and treatment update. J Clin Exp Dent 2015; 7:e342-7. [PMID: 26155359 PMCID: PMC4483350 DOI: 10.4317/jced.51854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 11/13/2014] [Indexed: 12/03/2022] Open
Abstract
Short-lasting unilateral neuralgiform headache attacks with conjuntival injection and tearing (SUNCT) is considered a rare trigeminal autonomic cephalgias, a group of primary headache disorders characterized by brief episodes of severe unilateral headache in the distribution territory of the trigeminal nerve, accompanied by prominent ipsilateral and cranial parasympathetic autonomic features. The present report describes a SUNCT syndrome in a 64-year-old male who had been diagnosed with trigeminal neuralgia several years ago. The patient reported stabbing pain in the orbital zone and in the left upper maxillary region, of great intensity, brief duration, and a frequency of 20-100 attacks a day. Pain episodes were accompanied by conjunctival injection and tearing. Based on the anamnesis, clinical examination and a magnetic resonance imaging scan, episodic SUNCT syndrome was diagnosed and pharmacological treatment with topiramate was started. This reduced the intensity and number of attacks to 3-6 a day.
Key words:Trigeminal autonomic cephalgias, SUNCT, Cluster headache, topiramate.
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Affiliation(s)
- Cosme Gay-Escoda
- MD, DDS, MS, PhD. Chairman and Professor of Oral and Maxillofacial Surgery. Faculty of Dentistry - University of Barcelona. Director of the Master of Oral Surgery and Implantology (EFHRE International University/UCAM/FUCSO). Coordinating investigator of the IDIBELL institute. Head of the Department of Oral and Maxillofacial Surgery and Implantology, and Director of the TMJ Disease and Orofacial Pain Unit. Teknon Medical Center. Barcelona, Spain
| | - Gemma Mayor-Subirana
- DDS, MS. Master degree program in Oral Surgery and Implantology. Faculty of Dentistry - University of Barcelona
| | - Octavi Camps-Font
- DDS. Fellow of the Master degree program in Oral Surgery and Implantology. Faculty of Dentistry - University of Barcelona
| | - Leonardo Berini-Aytés
- DDS, MD, PhD. Emeritus Professor of Oral and Maxillofacial Surgery, Professor of the Master's Degree Program in Oral Surgery and Implantology, School of Dentistry, University of Barcelona, Barcelona, Spain. Researcher of the IDIBELL Institute
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Jerić M, Vuica A, Borić M, Puljak L, Jeličić Kadić A, Grković I, Filipović N. Diabetes mellitus affects activity of calcium/calmodulin-dependent protein kinase II alpha in rat trigeminal ganglia. J Chem Neuroanat 2015; 64-65:12-9. [DOI: 10.1016/j.jchemneu.2015.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 02/07/2015] [Accepted: 02/10/2015] [Indexed: 12/31/2022]
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Abstract
The symptoms of migraine are non-specific and can be present in many other primary and secondary headache disorders, which are reviewed. Even experienced headache specialists may be challenged at times when diagnosing what appears to be first or worst, new type, migraine status, and chronic migraine.
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Affiliation(s)
- Randolph W Evans
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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Wöber C. Headache Resembling Hemicrania Continua Caused by Pituitary Adenoma. CASE-BASED DIAGNOSIS AND MANAGEMENT OF HEADACHE DISORDERS 2015. [DOI: 10.1007/978-3-319-06886-2_24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Paroxysmal hemicrania (PH) is an underreported and underdiagnosed primary headache disorder. It usually begins in the third or fourth decade of life. The recent observations indicate that it is equally prevalent in both males and females. PH is characterized by severe, strictly unilateral head pain attacks that occur in association with ipsilateral autonomic features. The attacks in PH are shorter and more frequent compared with cluster headache (CH) but otherwise PH and CH have similar clinical features. The hallmark of PH is the absolute cessation of the headache with indomethacin. However, a range of drugs may show partial to complete relief in certain groups of patients. Neuromodulatory procedures, such as greater occipital nerve blockade, blockade of sphenopalatine ganglion and neurostimulation of the posterior hypothalamus, are reserved for refractory PH.
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Affiliation(s)
- Sanjay Prakash
- Department of Neurology, Smt. B.K Shah Medical Institute & Research Centre, Piperia, Vadodara, Gujarat, India, 390001,
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Sánchez Del Rio M, Leira R, Pozo-Rosich P, Laínez JM, Alvarez R, Pascual J. Errors in recognition and management are still frequent in patients with cluster headache. Eur Neurol 2014; 72:209-12. [PMID: 25227490 DOI: 10.1159/000362517] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 03/28/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To analyze the trajectory to diagnosis and information provided in a series of cluster headache (CH) patients from five headache clinics. METHODS CH patients were asked to fill in an ad hoc questionnaire. RESULTS Seventy-five patients (mean age 41.5 years, 67 males) completed the questionnaire. Patients had visited during an average of 4.9 years a mean of 4.6 physicians who had obtained 2.5 neuroimaging procedures per patient before getting a diagnosis of CH. Sixty-three (84%) had received no diagnosis (21 cases; 28%), while 43 (57%) had been given an average of 2.1 alternative diagnoses. Migraine, trigeminal neuralgia and sinusitis were the most frequent mistakes. After diagnosis, 55% had subjectively received poor/very poor information on CH. Ninety-five percent had poor or incorrect information about the nature of the disease, or acute (70%) and preventive (61%) treatments. Etiology (90%), management options (36%) and potential adverse events of medications (29%) were their main information demands. CONCLUSIONS Although CH is an invalidating and clinically clear-cut disorder suffered by around 1/1,000 people, it is still frequently unrecognized and/or mistaken for other disorders, which calls for a better knowledge and education in the diagnosis of the main primary headaches.
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Voiticovschi-Iosob C, Allena M, De Cillis I, Nappi G, Sjaastad O, Antonaci F. Diagnostic and therapeutic errors in cluster headache: a hospital-based study. J Headache Pain 2014; 15:56. [PMID: 25178541 PMCID: PMC4166399 DOI: 10.1186/1129-2377-15-56] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/13/2014] [Indexed: 01/03/2023] Open
Abstract
Background Cluster headache (CH) is a severe, disabling form of headache. Even though CH has a typical clinical picture it seems that its diagnosis is often missed or delayed in clinical practice. CH patients may thus face: misdiagnosis, unnecessary investigations and delays in accessing adequate treatment. This study was conducted to investigate the occurrence of diagnostic and therapeutic errors with a view to improving the clinical and instrumental work-up in affected patients. Methods Our study comprised 144 episodic CH patients: 116 from Italy and 28 from Eastern European countries (Moldova, Ukraine, Bulgaria). One hundred six patients (73.6%) were examined personally and 38 (26.4%) were evaluated through telephone interviews conducted by headache specialists using an ad hoc questionnaire developed by the authors. Results The sample was predominantly male (M:F ratio 2.79:1) and had a mean age of 42.4 ± 9.8 years; approximately 76% of the patients had already consulted a physician about their CH at the onset of the disease. The mean interval between onset of the disease and first consultation at a headache center was 4.1 ± 5.6 years. The patients had consulted different specialists prior to receiving their CH diagnosis: neurologists (49%), primary care physicians (35%), ENT specialists (10%), dentists (3%), etc. Misdiagnoses at first consultation were recorded in 77% of the cases: trigeminal neuralgia (22%), migraine without aura (19%), sinusitis (15%), etc. The average “diagnostic delay” was 5.3 ± 6.4 years and the condition was diagnosed approximately (“doctor delay”: one year). Instrumental and laboratory investigations were carried out in 93% of the patients prior to diagnosis of CH. Some of the patients had never received abortive or preventive medications, either before or after diagnosis. Medical prescription compliance: 88% of the cases. Conclusions Our results emphasize the need to improve specialist education in this field in order to improve recognition of the clinical picture of CH and increase knowledge of the proper medical treatments for de novo CH. Continuous medical education on CH should target general neurologists, primary care physicians, ENT specialists and dentists. A study on a larger population of CH patients may further improve error-avoidance strategies.
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Affiliation(s)
| | | | | | | | | | - Fabio Antonaci
- Pavia Headache Center, C, Mondino National Neurological Institute, University of Pavia, Pavia, Italy.
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Stuhr SH, Earnshaw DH, Duncombe AM. Use of orthopedic manual physical therapy to manage chronic orofacial pain and tension-type headache in an adolescent. J Man Manip Ther 2014; 22:51-8. [PMID: 24976748 DOI: 10.1179/2042618613y.0000000054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Temporomandibular dysfunction (TMD) is frequently associated with multiple headache types. While the efficacy of orthopedic manual physical therapy (OMPT) intervention for TMD with/without headache symptoms has been investigated, it has received less attention than other musculoskeletal conditions. This case describes the OMPT treatment and outcome of a 14 year-old female with a 2-year history of facial pain surrounding the right temporomandibular joint (TMJ), and bilateral occipital and temporal tension-type headaches (TTHs). Intervention included manual mobilization of the TMJ and surrounding cervical/facial soft tissue structures, postural re-education, and patient/family education on prevention, self-treatment, and postural adaptations. Outcomes included pain free and maximal mouth opening (MMO), pressure pain threshold (PPT) over the masseter muscle belly, fear avoidance beliefs questionnaire-physical activity subscale (FABQ-PA), jaw pain and function questionnaire (JPFQ), visual analog pain scale (VAS) for facial pain, and headache frequency, duration, and intensity on a VAS. Results included increased pain free and MMO by 22 mm, improved PPT bilaterally by 403.05 kPa on the affected, and 360.88 kPa on the unaffected side, and decreased reported headache frequency, duration, and intensity. Score decreases of 5 points on VAS with MMO, 8 points on FABQ-PA, and 5 points on JPFQ were also noted. Further research is warranted to investigate the effects of OMPT on pain processing and functional outcomes in patients with TMD and headache.
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Affiliation(s)
- Sarah H Stuhr
- University of Illinois Hospital and Health System, Chicago, IL, USA
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Patel ZM, Setzen M, Poetker DM, DelGaudio JM. Evaluation and Management of “Sinus Headache” in the Otolaryngology Practice. Otolaryngol Clin North Am 2014; 47:269-87. [DOI: 10.1016/j.otc.2013.10.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Goadsby PJ, Goasdby PJ. Hemicrania continua--building on experience and clinical science. J Headache Pain 2014; 15:9. [PMID: 24524422 PMCID: PMC3974119 DOI: 10.1186/1129-2377-15-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 01/17/2014] [Indexed: 11/10/2022] Open
Affiliation(s)
- Peter J Goadsby
- Headache Group, Department of Neurology, University of California, San Francisco, USA.
| | - Peter J Goasdby
- Headache Group, Department of Neurology, University of California, San Francisco, USA.
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Zidverc-Trajkovic J, Markovic K, Radojicic A, Podgorac A, Sternic N. Cluster headache: Is age of onset important for clinical presentation? Cephalalgia 2014; 34:664-670. [PMID: 24445197 DOI: 10.1177/0333102413520085] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The age of onset of cluster headache (CH) attacks most commonly is between 20 and 40 years old, although CH has been reported in all age groups. There is increasing evidence of CH with early or late onset and a different course of the disorder. The aim of the study was to analyze the influence of the age of onset on clinical features, disorder course, and therapy effectiveness in CH patients. METHODS A retrospective and cross-sectional analysis was performed on 182 CH patients divided into three groups according to the age of onset. The first group consisted of patients with the first CH attack before 20 years of age, the second group was patients with age of onset between 20 and 40 years of age, and the third group was patients with age of onset after 40 years of age. Demographic data, features of CH periods and attacks, and the response to standardized treatment were compared among the groups. RESULTS Patients with CH onset after 40 years of age reported a lower number of autonomic features and less frequently had conjunctival injection and nasal congestion/rhinorrhea phenomena during their attacks. Diagnostic delay was the longest in the patients with CH onset before 20 years of age. CONCLUSION The influence of the age of onset of CH is intriguing for further studies and could possibly extend the knowledge about CH pathophysiology. From a clinical point of view, the differences in CH presentation are insufficient to preclude a correct diagnosis and treatment because the same criteria could be applied regardless of patient age.
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Affiliation(s)
- Jasna Zidverc-Trajkovic
- Neurology Clinic, Clinical Center of Serbia, Serbia Faculty of Medicine, University of Belgrade, Serbia
| | | | | | - Ana Podgorac
- Faculty of Medicine, University of Belgrade, Serbia
| | - Nadezda Sternic
- Neurology Clinic, Clinical Center of Serbia, Serbia Faculty of Medicine, University of Belgrade, Serbia
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