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Zhang S, Xu S, Chen C, Xue Z, Yao Y, Zhao H, Zhao H, Ji Y, Wang D, Hu D, Liu K, Chen J, Chen S, Gao X, Gui W, Fan Z, Wan D, Yuan X, Qu W, Xiao Z, Dong M, Wang H, Ju C, Xu H, Zhang L, Wang X, Zhang M, Han X, Ran Y, Jia Z, Su H, Li Y, Liu H, Zhao W, Gong Z, Lin X, Liu Y, Sun Y, Xie S, Zhai D, Liu R, Wang S, Dong Z, Yu S. Profile of Chinese Cluster Headache Register Individual Study (CHRIS): Clinical characteristics, diagnosis and treatment status data of 816 patients in China. Cephalalgia 2024; 44:3331024241235193. [PMID: 38501875 DOI: 10.1177/03331024241235193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND The clinical profile of cluster headache may differ among different regions of the world, warranting interest in the data obtained from the initial Chinese Cluster Headache Register Individual Study (CHRIS) for better understanding. METHODS We conducted a multicenter, prospective, longitudinal cohort study on cluster headache across all 31 provinces of China, aiming to gather clinical characteristics, treatment approaches, imaging, electrophysiological and biological samples. RESULTS In total 816 patients were enrolled with a male-to-female ratio of 4.33:1. The mean age at consultation was 34.98 ± 9.91 years, and 24.89 ± 9.77 years at onset. Only 2.33% were diagnosed with chronic cluster headache, and 6.99% had a family history of the condition. The most common bout was one to two times per year (45.96%), lasting two weeks to one month (44.00%), and occurring frequently in spring (76.23%) and winter (73.04%). Of these, 68.50% experienced one to two attacks per day, with the majority lasting one to two hours (45.59%). The most common time for attacks was between 9 am and 12 pm (75.86%), followed by 1 am and 3 am (43.48%). Lacrimation (78.80%) was the most predominant autonomic symptom reported. Furthermore, 39.22% of patients experienced a delay of 10 years or more in receiving a correct diagnosis. Only 35.67% and 24.26% of patients received common acute and preventive treatments, respectively. CONCLUSION Due to differences in ethnicity, genetics and lifestyle conditions, CHRIS has provided valuable baseline data from China. By establishing a dynamic cohort with comprehensive multidimensional data, it aims to advance the management system for cluster headache in China.
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Affiliation(s)
- Shuhua Zhang
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Suiyi Xu
- Department of Neurology, Headache Center, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Chunfu Chen
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Zhanyou Xue
- Department of Neurology, Shanghai Donglei Brain Hospital, Shanghai, China
| | - Yuanrong Yao
- Department of Neurology, Guizhou Province People's Hospital, Guiyang, Guizhou, China
| | - Hongru Zhao
- Department of Neurology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Hongling Zhao
- Department of Neurology, Dalian Municipal Central Hospital, Dalian, Liaoning, China
| | - Yabin Ji
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Dan Wang
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, Liaoning, China
| | - Dongmei Hu
- Department of Neurology, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
| | - Kaiming Liu
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jianjun Chen
- Department of Neurology, LiShui Municipal Central Hospital, Lishui, ZheJiang, China
| | - Sufen Chen
- Department of Neurology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan, China
| | - Xiaoyu Gao
- Department of Neurology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Wei Gui
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Zhiliang Fan
- Department of Neurology, Xingtai People's Hospital, Xingtai, Hebei, China
| | - Dongjun Wan
- Department of Neurology, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, Gansu, China
| | - Xueqian Yuan
- Department of Neurology, Zhengzhou People Hospital, Zhengzhou, Henan, China
| | - Wensheng Qu
- Department of Neurology, Tongji Hospital, Tongji Medical Collage Huazhong University of Science & Technology, Wuhan, Hubei, China
| | - Zheman Xiao
- Department of Neurology, Renmin hospital of Wuhan University, Wuhan, Hubei, China
| | - Ming Dong
- Department of Neurology, Neuroscience Center, the First Hospital, Jilin University, Changchun, Jilin, China
| | - Hebo Wang
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Chunyang Ju
- Department of Neurology, Xuchang Central Hospital Affiliated to Henan University of Science and Technology, Xuchang, Henan, China
| | - Huifang Xu
- Department of Neurology, Wuhan No.1 Hospital, Wuhan, Hubei, China
| | - Liang Zhang
- Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xiaolin Wang
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Mingjie Zhang
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Xun Han
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Ye Ran
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Zhihua Jia
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Hui Su
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Yingji Li
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Huanxian Liu
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Wei Zhao
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Zihua Gong
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Xiaoxue Lin
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Yingyuan Liu
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Yin Sun
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Siyuan Xie
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Deqi Zhai
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Ruozhuo Liu
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Shengshu Wang
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhao Dong
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
| | - Shengyuan Yu
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- International Headache Centre, Chinese PLA General Hospital, Beijing, China
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Lee MJ, Park JW, Chu MK, Moon HS, Chung PW, Chung JM, Sohn JH, Kim BK, Kim BS, Kim SK, Song TJ, Choi YJ, Park KY, Oh K, Ahn JY, Lee KS, Bae DW, Cho SJ. Treatment pattern and response for cluster headache in Korea: A prospective multicenter observation study. Cephalalgia 2023; 43:3331024231159627. [PMID: 36855967 DOI: 10.1177/03331024231159627] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Only limited data are available regarding the treatment status and response to cluster headache in an Asian population. Therefore, this study aimed to provide a real-world treatment pattern of cluster headache and the response rate of each treatment in an Asian population. METHODS Patients with cluster headache were recruited between September 2016 and January 2019 from 16 hospitals in Korea. At the baseline visit, we surveyed the patients about their previous experience of cluster headache treatment, and acute and/or preventive treatments were prescribed at the physician's discretion. Treatment response was prospectively evaluated using a structured case-report form at 2 ± 2 weeks after baseline visit and reassessed after three months. RESULTS Among 295 recruited patients, 262 experiencing active bouts were included. Only one-third of patients reported a previous experience of evidence-based treatment. At the baseline visit, oral triptans (73.4%), verapamil (68.3%), and systemic steroids (55.6%) were the three most common treatments prescribed by the investigators. Most treatments were given as combination. For acute treatment, oral triptans and oxygen were effective in 90.1% and 86.8% of the patients, respectively; for preventive treatment, evidence-based treatments, i.e. monotherapy or different combinations of verapamil, lithium, systemic steroids, and suboccipital steroid injection, helped 75.0% to 91.8% of patients. CONCLUSION Our data provide the first prospective analysis of treatment responses in an Asian population with cluster headache. The patients responded well to treatment despite the limited availability of treatment options, and this might be attributed at least in part by combination of medications. Most patients were previously undertreated, suggesting a need to raise awareness of cluster headache among primary physicians.
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Affiliation(s)
- Mi Ji Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Wook Park
- Department of Neurology, Uijeongbu St. Mary's Hospital, Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Heui-Soo Moon
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pil-Wook Chung
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Myun Chung
- Department of Neurology, Inje University College of Medicine, Seoul, Korea
| | - Jong-Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Byung-Kun Kim
- Department of Neurology, Eulji University School of Medicine, Seoul, Korea
| | - Byung-Su Kim
- Department of Neurology, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea
| | - Soo-Kyoung Kim
- Department of Neurology and Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | | | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University Hospital, Seoul, Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Jin-Young Ahn
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Kwang-Soo Lee
- Department of Neurology, Seoul St. Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, Korea
| | - Dae Woong Bae
- Department of Neurology, The Catholic University of Korea, St Vincent's Hospital, Suwon, Republic of Korea
| | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
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Ran C, Alexanderson K, Belin AC, Almondo G, Steinberg A, Sjöstrand C. Multimorbidity and Sickness Absence/Disability Pension in Patients With Cluster Headache and Matched References: A Swedish Register-Based Study. Neurology 2023; 100:e1083-e1094. [PMID: 36517237 PMCID: PMC9990846 DOI: 10.1212/wnl.0000000000201685] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/27/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Multimorbidity among patients with cluster headache (CH) is considered to be high, but large studies are lacking. The aims were to explore the occurrence of diagnosis-specific multimorbidity among patients with CH and matched references and possible associations of this with their sickness absence and disability pension. METHODS We performed a register-based study of patients with CH and matched references, regarding their multimorbidity, sickness absence, and disability pension. Data were obtained from 2 nationwide registers: Statistics Sweden's Longitudinal Integration Database for Health Insurance and Labor Market Studies (LISA) (for sociodemographics in 2009, sickness absence, and disability pension in 2010) and The National Board of Health and Welfare's specialized outpatient and inpatient registers for diagnosis-specific health care in 2001-2010 (for identifying patients with CH and multimorbidity, defined by ICD-10 codes). The prevalence and number of net days of sickness absence and/or disability pension in 2010 were calculated, in general and by multimorbidity. Odds ratios (OR) with 95% confidence intervals (CIs) were calculated for comparison of each diagnostic group with references without the chosen morbidity. RESULTS We analyzed 3,240 patients with CH, aged 16-64 years, and living in Sweden in 2010 and 16,200 matched references. A higher proportion of patients with CH had multimorbidity (91.9%) than of references (77.6%), OR 3.263 (95% CI 2.861-3.721), both in general and regarding all analyzed diagnostic groups. Differences were particularly high for diagnoses relating to the nervous (CH 51.8% vs references 15.4%), OR 5.922 (95% CI 5.461-6.422), and musculoskeletal (CH 39.0% vs references 23.7%), OR 2.057 (95% CI 1.900-2.227), systems. Multimorbidity rates were overall higher among women in patients with CH (96.4% vs men 89.6%). Patients with CH had a higher mean number of days of sickness absence and disability pension compared with references, 63.15 vs 34.08 days. Moreover, multimorbidity was associated with a higher mean number of such days in patients with CH, 67.25, as compared with references, 40.69 days. DISCUSSION The proportions of multimorbidity were high in both patients with CH and references, however, higher in the patients with CH, who also had higher sickness absence and disability pension levels. In particular, CH patients with multimorbidity and of female sex had high sickness absence and disability pension levels.
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Affiliation(s)
- Caroline Ran
- From the Department of Neuroscience (C.R., A.C.B.), Karolinska Institutet, SE-171 77; Department of Clinical Neuroscience (K.A., G.A., A.S., C.S.), Karolinska Institutet, SE-171; Department of Neurology (A.S.), Karolinska University Hospital, SE-171 76; and Department of Neurology (C.S.), Danderyd Hospital, SE-182 88 Stockholm, Sweden.
| | - Kristina Alexanderson
- From the Department of Neuroscience (C.R., A.C.B.), Karolinska Institutet, SE-171 77; Department of Clinical Neuroscience (K.A., G.A., A.S., C.S.), Karolinska Institutet, SE-171; Department of Neurology (A.S.), Karolinska University Hospital, SE-171 76; and Department of Neurology (C.S.), Danderyd Hospital, SE-182 88 Stockholm, Sweden
| | - Andrea C Belin
- From the Department of Neuroscience (C.R., A.C.B.), Karolinska Institutet, SE-171 77; Department of Clinical Neuroscience (K.A., G.A., A.S., C.S.), Karolinska Institutet, SE-171; Department of Neurology (A.S.), Karolinska University Hospital, SE-171 76; and Department of Neurology (C.S.), Danderyd Hospital, SE-182 88 Stockholm, Sweden
| | - Gino Almondo
- From the Department of Neuroscience (C.R., A.C.B.), Karolinska Institutet, SE-171 77; Department of Clinical Neuroscience (K.A., G.A., A.S., C.S.), Karolinska Institutet, SE-171; Department of Neurology (A.S.), Karolinska University Hospital, SE-171 76; and Department of Neurology (C.S.), Danderyd Hospital, SE-182 88 Stockholm, Sweden
| | - Anna Steinberg
- From the Department of Neuroscience (C.R., A.C.B.), Karolinska Institutet, SE-171 77; Department of Clinical Neuroscience (K.A., G.A., A.S., C.S.), Karolinska Institutet, SE-171; Department of Neurology (A.S.), Karolinska University Hospital, SE-171 76; and Department of Neurology (C.S.), Danderyd Hospital, SE-182 88 Stockholm, Sweden
| | - Christina Sjöstrand
- From the Department of Neuroscience (C.R., A.C.B.), Karolinska Institutet, SE-171 77; Department of Clinical Neuroscience (K.A., G.A., A.S., C.S.), Karolinska Institutet, SE-171; Department of Neurology (A.S.), Karolinska University Hospital, SE-171 76; and Department of Neurology (C.S.), Danderyd Hospital, SE-182 88 Stockholm, Sweden
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O'Connor E, Nikram E, Grangeon L, Danno D, Houlden H, Matharu M. The clinical characteristics of familial cluster headache. Cephalalgia 2022; 42:715-721. [PMID: 35166160 PMCID: PMC9218408 DOI: 10.1177/03331024221076478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background A positive family history predisposes to the development of cluster headache. The distinct characteristics of familial cluster headache have yet to be confirmed, however, evidence suggests a younger age of onset and higher proportion of females in this subgroup. Objectives To assess the rate and mode of inheritance of familial cluster headache in a tertiary referral centre for headache. To describe the clinical features of familial cluster headache. Methods A retrospective study conducted between 2007 and 2017. Cluster headache was confirmed in probands and affected relatives. Differences in demographics, clinical characteristics, and response-to-treatment in familial cluster headache were delineated through multivariate analysis using a control cohort of 597 patients with sporadic cluster headache. Results Familial cluster headache was confirmed in 48 (7.44%) patients and predominantly reflected an autosomal dominant mode of inheritance with reduced penetrance. Familial cases were more likely to report nasal blockage (OR 4.06, 95% CI; 2.600–6.494, p < 0.001) during an attack and a higher rate of concurrent short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (OR 3.76, 95% CI; 1.572–9.953, p = 0.004). Conclusion These findings add to evidence suggesting a genetic component to cluster headache. Here, we demonstrated prominent nasal blockage, and a higher occurrence of concomitant short-lasting unilateral neuralgiform headache with conjunctival injection and tearing in this subgroup, further delineating the phenotype.
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Affiliation(s)
- Emer O'Connor
- Headache and Facial Pain Group, University College London (UCL), Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK.,Department of Neuromuscular Diseases, Institute of Neurology, University College London, UK
| | - Elham Nikram
- Peninsula Technology Assessment Group (PenTAG), 3286University of Exeter, University of Exeter, UK
| | - Lou Grangeon
- Headache and Facial Pain Group, University College London (UCL), Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK.,Department of Neurology, Rouen University Hospital, Rouen, France
| | - Daisuke Danno
- Headache and Facial Pain Group, University College London (UCL), Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Henry Houlden
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, UK
| | - Manjit Matharu
- Headache and Facial Pain Group, University College London (UCL), Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
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Andre L, Cavers D. 'A cry in the dark': a qualitative exploration of living with cluster headache. Br J Pain 2021; 15:420-428. [PMID: 34840790 DOI: 10.1177/2049463720976695] [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] Open
Abstract
Context Cluster headache is a rare primary headache disorder said to be one of the most painful conditions in existence. Limited evidence demonstrates cluster headache patients have difficulties securing a diagnosis and poor access to services. There is a gap in research around psychosocial needs, meaning there are no evidence-based guidelines to inform optimal management of this patient group in primary care. Objectives The aim of this study is to explore the perspectives of cluster headache patients in the United Kingdom in order to suggest ways their care can be improved. Methods It is an in-depth qualitative study involving telephone interviews with 15 participants with either chronic or episodic cluster headache. Semi-structured interviews (43-58 minutes) were conducted, recorded and transcribed verbatim. Two researchers conducted thematic analysis to identify themes. Results Participants described the impact cluster headache has on their quality of life. They also felt the legitimacy of their disorder was questioned. This situation was often exacerbated by a reported lack of awareness among General Practitioners (GPs), which negatively impacted their care in terms of diagnosis and access to treatments and specialists. They attempted to control the pain through treatments and avoiding triggers, often with detrimental consequences for their social contact and mental health. Conclusion Findings indicate the need to improve the lived experience of cluster headache patients in two key areas: (1) raising awareness of the disorder and its impact among GPs, and (2) extending care beyond clinical treatment provision, supporting patients in self-management and addressing its psychosocial impact, with implications for the management of this group in primary care.
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Affiliation(s)
| | - Debbie Cavers
- Medical School, The University of Edinburgh, Edinburgh, UK
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Hervás C, Somovilla A, Gago-Veiga AB, Alonso J, Del Arco C, Vivancos J, Quintas S. Headache History-Taking in an Emergency Department: Impact Evaluation of a Training Session. PAIN MEDICINE 2021; 22:1864-1869. [PMID: 33769531 DOI: 10.1093/pm/pnaa483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Headache represents about 25% of the total neurological consultations at the emergency department (ED). Up to 80% of these consultations are represented by primary headaches, in which an accurate and directed history-taking may help reach the specific diagnosis avoiding unnecessary complementary tests and reducing diagnostic latencies. METHODS We carried out a training session on headache management at the ED, focusing on history-taking and primary headaches' diagnoses and management. We retrospectively compared the number of variables included in the medical reports and the percentage of patients who were diagnosed and/or treated for a primary headache between two months before and two months after the training session. RESULTS A total of 369 medical histories were analyzed for this study (196 before and 173 after the training session). The number of essential variables regarding pain characteristics included in the medical reports showed a post-intervention increment from 4.34 ± 1.224 to 4.67 ± 1.079 (P = .007) and the number of total items registered also increased from 6.87 ± 1.982 to 7.53 ± 1.686 (P = 0.001). The percentage of patients that were given a specific diagnosis for primary headache showed an increment of 11.8% (P = .002) in the post-intervention group. CONCLUSION Educational interventions can improve history-taking in headache patients in the ED. This fact grants them as potential efficient measures to optimize patient management at Emergency Room.
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Affiliation(s)
- Carlos Hervás
- Department of Neurology, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria, Madrid, Spain
| | - Alba Somovilla
- Neurology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ana Beatriz Gago-Veiga
- Headache Unit, Department of Neurology, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, Spain
| | - Jaime Alonso
- Department of Neurology, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria, Madrid, Spain
| | - Carmen Del Arco
- Emergency Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Jose Vivancos
- Department of Neurology, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria, Madrid, Spain
| | - Sonia Quintas
- Headache Unit, Department of Neurology, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, Spain
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Schröder P, Gaul C, Drabik A, Molsberger A. Pain localization in cluster headache patients: Onset, peak, and radiation. Acta Neurol Scand 2021; 143:441-449. [PMID: 33523462 DOI: 10.1111/ane.13396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/23/2020] [Accepted: 01/14/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE AND AIM To describe differences in pain locations for onset, peak, and radiation aspects of cluster headache (CH) attacks. METHODS AND MATERIALS Data were collected for 23 months using a cross-sectional online survey composed of 117 questions on pain location, demographics, and clinical features. 5260 datapoints on 44 pain locations from 631 respondents were analyzed. RESULTS During the onset and peak of attacks, pain is concentrated periorbitally. Pain locations outside the periorbital region were reported more frequently for radiation than for onset and peak of attacks. Dorsal (occipital, neck, shoulder) pain was reported more frequently in connection with onset and radiation than during peak: onset (13%) versus peak (6%), p < 0.001, and radiation (22%) versus peak (6%), p < 0.001. There was no significant difference in dorsal pain frequencies for onset (13%) vs. radiation (22%), p = 0.552. Furthermore, the frequency with which individual pain locations were reported differed significantly for onset, peak, and radiation in CH. CONCLUSIONS Analysis of the pain location data shows specific frequencies and distributions of pain location for three aspects of CH attacks. The frequency with which individual pain points were reported differed significantly for onset, peak, and radiation. In general, dorsal pain points were reported more frequently for onset and radiation than for peak pain. Pain locations beyond the eye (extraorbital points) were more frequently reported in connection with radiating pain. Our findings could serve as a basis for future research, correlating CH pain patterns with the outcome of treatment approaches.
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Affiliation(s)
| | - Charly Gaul
- Migraine and Headache Clinic Königstein Königstein Germany
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Etiology of 'Sinus Headache'-Moving the Focus from Rhinology to Neurology. A Systematic Review. Brain Sci 2021; 11:brainsci11010079. [PMID: 33435283 PMCID: PMC7827425 DOI: 10.3390/brainsci11010079] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/31/2020] [Accepted: 01/07/2021] [Indexed: 12/28/2022] Open
Abstract
'Sinus headache and/or facial pain' (SH) is a common complaint encountered by otorhinolaryngologists, neurologists and general practitioners. However, several studies suggested that the majority of those cases may be attributed to primary headaches (i.e., migraine and tension-type headache (TTH). The purpose of this review is to evaluate the etiology of SH. The first part includes cross-sectional studies analyzing the prevalence of respective diagnoses in subjects with SH. The majority of these publications indicate that migraine and TTH are the most prevalent causes of SH, although most of these studies were conducted in a clinical setting. The second part of this review included treatment trials in subjects with SH. The findings from this part of the review show that SH without rhinosinusitis responds well to pharmacotherapy targeted at primary headaches. This observation further supports a neurologic etiology of the majority of SH cases.
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Giani L, Proietti Cecchini A, Leone M. Galcanezumab for the prevention of cluster headache. Expert Opin Biol Ther 2020; 20:1133-1142. [PMID: 32702245 DOI: 10.1080/14712598.2020.1800635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Cluster headache (CH) is among the worst painful conditions. The available therapies are scarce and not specific, leaving many patients unsatisfied because of poor efficacy and/or tolerability. Patients not responding to common treatments are offered semi-invasive and invasive procedures with uncertain results. Based on the current understanding of CH pathophysiology, new possible therapeutic approaches come from drugs interfering with Calcitonin Gene Related Peptide (CGRP). AREAS COVERED After summarizing the evidence for CGRP involvement in CH pathophysiology, we review the published literature (PubMed) and information (clinicaltrials.gov, EudraCT, EMA and FDA websites) regarding a novel anti-CGRP monoclonal antibody, Galcanezumab, its pharmacological properties, development, and evidence for the treatment of CH. Publications regarding other indications (migraine) are considered for completeness and safety/tolerability profile. EXPERT OPINION In one randomized clinical trial, Galcanezumab has proven to be effective and safe as a preventive treatment in episodic CH, with a favorable tolerability profile offering a potential new option in the therapeutic arsenal. Inefficacy of galcanezumab in chronic CH as well as the inefficacy of another monoclonal antibody against CGRP (fremanezumab) in both episodic and chronic CH question the scalability of the drug in CH management. Further, studies comparing galcanezumab to the current standard treatments are highly desirable.
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Affiliation(s)
- Luca Giani
- Neuroalgology Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta" , 20133, Milano (MI), Italy
| | | | - Massimo Leone
- Neuroalgology Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta" , 20133, Milano (MI), Italy
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11
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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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O'Connor E, Simpson BS, Houlden H, Vandrovcova J, Matharu M. Prevalence of familial cluster headache: a systematic review and meta-analysis. J Headache Pain 2020; 21:37. [PMID: 32334514 PMCID: PMC7183702 DOI: 10.1186/s10194-020-01101-w] [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: 02/07/2020] [Accepted: 03/27/2020] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION The population rate of familial cluster headache (CH) has been reported to be as high as 20% however this varies considerably across studies. To obtain a true estimate of family history in CH, we conducted a systematic review and meta-analysis of previously published data. METHODS Our systematic review involved a search of electronic databases (Medline, EMBASE, PubMed, CINAHL) to identify and appraise studies of interest utilising the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. To further ameliorate the accuracy of our analysis we included an additional unpublished cohort of CH patients recruited at a tertiary referral centre for headache, who underwent detailed family history with diagnostic verification in relatives. Data was extracted and meta-analysis conducted to provide a true estimation of family history. RESULTS In total, we identified 7 studies which fulfilled our inclusion criteria. The estimated true prevalence of CH patients with a positive family history was 6.27% (95% CI:4.65-8.40%) with an overall I2 of 73%. Fitted models for gender subgroups showed higher estimates 9.26% (95% CI: 6.29-13.43%) in females. However the I2 for the female model was 58.42% and significant (p = 0.047). CONCLUSION Our findings estimate a rate of family history in CH to be approximately 6.27% (95% CI: 4.65-8.40%). While estimates were larger for female probands, we demonstrated high heterogeneity in this subgroup. These findings further support a genetic role in the aetiology of CH.
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Affiliation(s)
- Emer O'Connor
- Department of Neuromuscular Disorders, UCL Institute of Neurology, DMN, Institute of Neurology, Queen Square, London, WC1N 3BG, UK. .,Headache and Facial Pain Group, UCL Institute of Neurology, Queen Square and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
| | - Benjamin S Simpson
- UCL Division of Surgery and Interventional Science, University College London, London, UK
| | - Henry Houlden
- Department of Neuromuscular Disorders, UCL Institute of Neurology, DMN, Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Jana Vandrovcova
- Department of Neuromuscular Disorders, UCL Institute of Neurology, DMN, Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Manjit Matharu
- Headache and Facial Pain Group, UCL Institute of Neurology, Queen Square and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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Development and Evaluation of a Screening Tool to Aid the Diagnosis of a Cluster Headache. Brain Sci 2020; 10:brainsci10020077. [PMID: 32024213 PMCID: PMC7071485 DOI: 10.3390/brainsci10020077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/25/2020] [Accepted: 01/30/2020] [Indexed: 01/03/2023] Open
Abstract
Cluster headache (CH), a severe primary headache, is often misdiagnosed and mismanaged. The aim of this study was to develop and evaluate a screening tool to aid the diagnosis of CH. We developed a novel 12-item screening tool. This was comprised of four components: (1) images depicting headache pain; (2) pain descriptors; (3) key questions that could differentiate between CH and migraine; and (4) a visual analogue pain scale. The total possible questionnaire score ranged from 3-32. Patients with CH and migraines (control group) were recruited prospectively from a headache centre in the North of England, UK. Two-hundred and ninety-six patients were included in the study: 81 CH patients, 36 of which suffer with episodic CH and 45 with chronic CH; 215 migraine patients, 92 of which suffer with episodic migraine and 123 with chronic migraine. The mean questionnaire score was higher in CH patients versus migraine patients (28.4 versus 19.5). At a cut-off score of >25 out of 32, the screening tool had a sensitivity of 86.4% and a specificity of 92.0% in differentiating between CH and migraine. The screening tool could be a useful instrument to aid the diagnosis of a CH. The images depicting headache pain do not clearly discriminate between CH and migraine.
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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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Frederiksen HH, Lund NLT, Barloese MCJ, Petersen AS, Jensen RH. Diagnostic delay of cluster headache: A cohort study from the Danish Cluster Headache Survey. Cephalalgia 2019; 40:49-56. [DOI: 10.1177/0333102419863030] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Aim To investigate the influence of clinical and demographic features on diagnostic delay in cluster headache patients, in order to discuss diagnostic pitfalls and raise disease awareness. Methods A large, well-characterized cohort of 400 validated cluster headache patients from the Danish Cluster Headache Survey, diagnosed according to ICHD-II, were investigated. ANOVA was applied to investigate differences in diagnostic delay between groups. Selected independent variables were assessed in relation to diagnostic delay using a gamma regression model. Results Diagnostic delay was significantly reduced for each decade of cluster headache onset from 1950–2010 ( p < 0.001). Onset after 1990 was associated with shorter diagnostic delay (OR = 0.28, p < 0.001), whereas attack duration > 180 minutes (OR = 1.62, p < 0.034), migraine-like features (OR = 1.30, p < 0.043) and nocturnal attacks (OR = 1.39, p < 0.021) were associated with prolonged diagnostic delay. Further, diagnostic delay decreased with age of onset (age < 20: 13.8 years, age 20–40: 5.4 years and age > 40: 2.1 years, p < 0.001). Conclusion Diagnostic delay was reduced for every decade investigated, whereas some atypical cluster headache features were associated with prolonged diagnostic delay. Better medical education and more disease awareness are needed to prevent misdiagnosis and prolonged diagnostic delay.
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Affiliation(s)
- Hans-Henrik Frederiksen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Nunu LT Lund
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Mads CJ Barloese
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
- Department of Clinical Physiology and Nuclear Medicine, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Anja S Petersen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Rigmor H Jensen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
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Al-Hashel J, Ibrahim I, Youssry D, Ahmed SF, Goadsby P. Cluster Headache in Kuwait: A Hospital-Based Study. Front Neurol 2019; 10:573. [PMID: 31214109 PMCID: PMC6558162 DOI: 10.3389/fneur.2019.00573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 05/15/2019] [Indexed: 01/03/2023] Open
Abstract
Background: Cluster headache (CH) is a relatively uncommon primary headache disorder. Few studies in our region described CH. We aimed to study demographics, clinical characteristics and treatment modalities of CH patients referred to Headache Clinic in Kuwait. Materials and Methods: This cross-sectional study included all CH patients who are referred to headache clinic. The diagnosis of CH based on the CH diagnostic criteria of the Headache Classification Committee of the IHS, 3rd edition (beta version) (ICHD-3-beta). The demographics, clinical characteristics and treatment modalities of CH patients were recorded. Results: Forty six patients were diagnosed with CH which constituted 1.7% of all headache patients and 0.1% of all visits to Neurology clinic. Male:Female ratio was 15.3:1. Mean age was 40.1 ± 10.7 years and mean age at onset was 29 years (20-49). Family history was positive in 6.5%. Smoking was seen in 63.0% of patients while 6.5 % reported alcohol intake. CH was episodic in 84.4% and chronic in 15.2%. Seasonal predilection was seen in all patients; the most frequent season was Autumn 47.8%. The mean duration of the cluster bouts was 6 weeks (2-12 weeks). The mean duration of the attack was 60 min (15-180 min). Number of attacks per day ranged from 2 to 10 attacks with a mean of 5 attacks/day. The median of attack severity by Visual Analog Scale (VAS) was 8.5 (7-10). The time taken to diagnose the patients ranged from <1 year to 12 years with a mean of 4 years. Chronic CH have a statically significant relation with smoking (P = 0.036), older age (P = 0.027), and longer time taken to diagnosis (P = 0.026) compared to episodic CH. Conclusion: Our results reported that there is higher proportion of males compared to females and less positive family history. Smoking was a significant risk factor for chronicity in addition to advanced age, higher age at disease onset and a longer time taken till diagnosis.
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Affiliation(s)
- Jasem Al-Hashel
- Department of Neurology, Ibn Sina Hospital, Kuwait City, Kuwait
- Department of Medicine, Faculty of Medicine, Health Sciences Centre, Kuwait University, Kuwait City, Kuwait
| | - Ismail Ibrahim
- Department of Neurology, Ibn Sina Hospital, Kuwait City, Kuwait
| | - Doaa Youssry
- Department of Neurology, Ibn Sina Hospital, Kuwait City, Kuwait
- Department of Neurology, Cairo University, Cairo, Egypt
| | - Samar Farouk Ahmed
- Department of Neurology, Ibn Sina Hospital, Kuwait City, Kuwait
- Department of Neuropsychiatry, Minia University, Minia, Egypt
| | - Peter Goadsby
- Department of Basic and Clinical Neuroscience, Headache Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London, United Kingdom
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Snoer AH, Lund N, Jensen RH, Kristoffersen ES, Barloese M, Hansen JM. More precise phenotyping of cluster headache using prospective attack reports. Eur J Neurol 2019; 26:1303-e85. [PMID: 31059165 DOI: 10.1111/ene.13980] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/30/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE The clinical characteristics of cluster headache (CH) are based mainly on retrospective attack descriptions of 'usual' attacks, but whether these reports are reliable is uncertain. The aim was to compare retrospective and prospective attack descriptions and describe the within- and between-patient variability of attacks. METHOD Fifty-seven CH patients underwent a semi-structured interview obtaining a retrospective account of usual CH attacks. Patients thereafter prospectively recorded the clinical characteristics of up to 10 attacks per patient in a headache diary. Four different attack characteristics were investigated: (i) severity, (ii) duration, (iii) number of autonomic symptoms and (iv) number of migrainous symptoms. Retrospective and prospective data were compared. Within- and between-patient variability of attacks was assessed. RESULTS Retrospective attack descriptions (n = 57) were significantly longer (P = 0.046) and more severe (P < 0.0001) for untreated attacks compared with prospective reports (n = 500). The number of autonomic symptoms was significantly higher in the retrospective reports compared to the prospective reports (P < 0.0001). Within-patient variability for attack duration, pain severity and number of autonomic and migrainous symptoms was low. Compared to men, more women reported longer (P = 0.026) and more severe (P = 0.028) attacks with more migrainous symptoms (P = 0.033). CONCLUSIONS Important differences were found between prospectively and retrospectively reported attacks with duration and severity of untreated attacks overestimated in retrospective attack descriptions. CH attacks display low within-patient variability, but the presentation of CH attacks varies between patients. The high prevalence of symptoms typically associated with migraine should raise more diagnostic awareness for CH, especially in women who are more often misdiagnosed as having migraine.
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Affiliation(s)
- A H Snoer
- Department of Neurology, Danish Headache Center, Rigshospitalet Glostrup, University of Copenhagen, Glostrup, Copenhagen, Denmark
| | - N Lund
- Department of Neurology, Danish Headache Center, Rigshospitalet Glostrup, University of Copenhagen, Glostrup, Copenhagen, Denmark
| | - R H Jensen
- Department of Neurology, Danish Headache Center, Rigshospitalet Glostrup, University of Copenhagen, Glostrup, Copenhagen, Denmark
| | - E S Kristoffersen
- Department of Neurology, Akershus University Hospital, Oslo, Norway.,Department of General Practice, University of Oslo, Oslo, Norway
| | - M Barloese
- Department of Neurology, Danish Headache Center, Rigshospitalet Glostrup, University of Copenhagen, Glostrup, Copenhagen, Denmark.,Center of Functional and Diagnostic Imaging and Research, Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - J M Hansen
- Department of Neurology, Danish Headache Center, Rigshospitalet Glostrup, University of Copenhagen, Glostrup, Copenhagen, Denmark.,National Headache Knowledge Centre, Rigshospitalet Glostrup, Copenhagen, Denmark
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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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Vandewiele G, De Backere F, Lannoye K, Vanden Berghe M, Janssens O, Van Hoecke S, Keereman V, Paemeleire K, Ongenae F, De Turck F. A decision support system to follow up and diagnose primary headache patients using semantically enriched data. BMC Med Inform Decis Mak 2018; 18:98. [PMID: 30424769 PMCID: PMC6234630 DOI: 10.1186/s12911-018-0679-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 10/18/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Headache disorders are an important health burden, having a large health-economic impact worldwide. Current treatment & follow-up processes are often archaic, creating opportunities for computer-aided and decision support systems to increase their efficiency. Existing systems are mostly completely data-driven, and the underlying models are a black-box, deteriorating interpretability and transparency, which are key factors in order to be deployed in a clinical setting. METHODS In this paper, a decision support system is proposed, composed of three components: (i) a cross-platform mobile application to capture the required data from patients to formulate a diagnosis, (ii) an automated diagnosis support module that generates an interpretable decision tree, based on data semantically annotated with expert knowledge, in order to support physicians in formulating the correct diagnosis and (iii) a web application such that the physician can efficiently interpret captured data and learned insights by means of visualizations. RESULTS We show that decision tree induction techniques achieve competitive accuracy rates, compared to other black- and white-box techniques, on a publicly available dataset, referred to as migbase. Migbase contains aggregated information of headache attacks from 849 patients. Each sample is labeled with one of three possible primary headache disorders. We demonstrate that we are able to reduce the classification error, statistically significant (ρ≤0.05), with more than 10% by balancing the dataset using prior expert knowledge. Furthermore, we achieve high accuracy rates by using features extracted using the Weisfeiler-Lehman kernel, which is completely unsupervised. This makes it an ideal approach to solve a potential cold start problem. CONCLUSION Decision trees are the perfect candidate for the automated diagnosis support module. They achieve predictive performances competitive to other techniques on the migbase dataset and are, foremost, completely interpretable. Moreover, the incorporation of prior knowledge increases both predictive performance as well as transparency of the resulting predictive model on the studied dataset.
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Affiliation(s)
- Gilles Vandewiele
- IDLab, Ghent University - imec, Technologiepark 15, Ghent, 9052 Belgium
| | - Femke De Backere
- IDLab, Ghent University - imec, Technologiepark 15, Ghent, 9052 Belgium
| | - Kiani Lannoye
- IDLab, Ghent University - imec, Technologiepark 15, Ghent, 9052 Belgium
| | | | - Olivier Janssens
- IDLab, Ghent University - imec, Technologiepark 15, Ghent, 9052 Belgium
| | - Sofie Van Hoecke
- IDLab, Ghent University - imec, Technologiepark 15, Ghent, 9052 Belgium
| | - Vincent Keereman
- Department of Neurology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, 9000 Belgium
| | - Koen Paemeleire
- Department of Neurology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, 9000 Belgium
| | - Femke Ongenae
- IDLab, Ghent University - imec, Technologiepark 15, Ghent, 9052 Belgium
| | - Filip De Turck
- IDLab, Ghent University - imec, Technologiepark 15, Ghent, 9052 Belgium
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Buture A, Ahmed F, Dikomitis L, Boland JW. Systematic literature review on the delays in the diagnosis and misdiagnosis of cluster headache. Neurol Sci 2018; 40:25-39. [PMID: 30306398 PMCID: PMC6329709 DOI: 10.1007/s10072-018-3598-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/01/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Patients with cluster headache (CH), the most common trigeminal autonomic cephalalgia, often face delayed diagnosis, misdiagnosis and mismanagement. OBJECTIVES To identify, appraise and synthesise clinical studies on the delays in diagnosis and misdiagnosis of CH in order to determine its causes and help the management of this condition. METHODS The systematic review was prepared, conducted and reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis. It was registered with International Prospective Register of Systematic Reviews. A systematic search of different electronic databases (Medline, EMBASE, PsycINFO, PubMed, CINAHL, BNI, HMIC, AMED, HBE and Cochrane Library) was carried out in May 2017. Reference lists of relevant articles were hand searched. RESULTS The search identified 201 unique studies. Fifteen studies met the inclusion criteria of which 13 case series studies and two survey studies. Nine studies assessed the delays in diagnosis and misdiagnosis of CH, five studies the delays in diagnosis and one study the misdiagnosis of CH. The studies included 4661 patients. Delays in diagnosis, misdiagnosis and mismanagement have been reported in many European countries, Japan and in the USA with well-developed health services. The patients with CH often visited many different clinicians, surgeons and dentists and received multiple diagnosis prior to being correctly diagnosed. CONCLUSION This systematic review shows that the delays in the diagnosis of CH are a widespread problem, the time to diagnosis still vary from country to country and both patients and physicians are responsible for the delays in diagnosis.
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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.
| | - Fayyaz Ahmed
- Department of Neurology, Hull Royal Infirmary, Hull, UK.,Hull York Medical School, University of Hull, Hull, UK
| | - Lisa Dikomitis
- School of Medicine and Research Institute Primary Care and Health Sciences, Keele University, Keele, UK
| | - Jason W Boland
- Hull York Medical School, University of Hull, Hull, UK.,Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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Cluster headache: pathophysiology, diagnosis and treatment. J Neurol 2018; 266:1059-1066. [DOI: 10.1007/s00415-018-9007-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/04/2018] [Accepted: 08/07/2018] [Indexed: 12/16/2022]
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Korostyshevskiy V. Acupuncture for Headache: Possible Clinical Improvements-Analysis of Two Typical Case Reports. Med Acupunct 2018; 30:204-208. [PMID: 30147822 DOI: 10.1089/acu.2018.1269] [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: 11/13/2022] Open
Abstract
Background: Various types of headache comprise a widespread health problem. Among the possible treatment options, acupuncture is one of the most effective, with the least number of adverse effects. While the locations of acupuncture points have long been established, slight and specific modifications in point locations, as well as needling angles and depths in each individual case, can increase the effectiveness of acupuncture treatment for some types of headaches. Cases: Two typical "cases," which are composites of several similar cases, are discussed. One case is a 31-year-old Caucasian woman with persistent headaches for 8 months and the other case is a 52-year-old Caucasian woman with frequent headaches for years. In both cases, usual care provided only temporary relief; acupuncture treatment was more effective. Results: The patients' headaches went away-as they usually do for months or even years after only several treatments, provided that the acupuncture practitioner finds the points to stimulate that can reproduce each individual patient's exact symptoms of his or her headache. Conclusions: In treatment of headaches, the effectiveness of acupuncture can be increased if the acupuncture practitioner identifies, or modifies, the point selection and/or location to identify active points. As the acupuncture practitioner examines the active points, he or she can monitor the treatment's progress by palpating the points while observing and communicating with the patient about whether or not the headache is being reproduced.
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Antonaci F, Rossi E, Voiticovschi-Iosob C, Dalla Volta G, Marceglia S. Frontal infrared thermography in healthy individuals and chronic migraine patients: Reliability of the method. Cephalalgia 2018; 39:489-496. [PMID: 29989426 DOI: 10.1177/0333102418788341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The use of frontal infrared thermography in the diagnosis of primary headaches provided scattering results due to measurement fluctuations and different types of headaches or research protocols. OBJECTIVE This study aims to assess the reliability of frontal infrared thermography in healthy individuals and provide a preliminary evaluation in chronic migraine patients using a commercial infrared thermal camera. METHODS Thermographic images were acquired in 20 controls and 15 patients at three consecutive time-points in two daily sessions. The Side Difference and Asymmetry Index parameters were defined. The reproducibility of the measurements, the correlation of Asymmetry Index and Side Difference with clinical evaluations and patient perceptions, and the ability of the parameters to discriminate between patients and controls were investigated. RESULTS We reported a good reproducibility of the measurements (Inter-class Correlation Coefficient > 0.75 and Coefficient of Variation < 13.4%), independent from external factors. The Side Difference was significantly different between patients and controls ( p < 0.001). The Asymmetry Index showed good correlation with the side of unilateral pain ( p = 0.0056). CONCLUSIONS Frontal infrared thermography can be used to quantify the difference between the right and the left side of frontal vascular changes in chronic migraine patients, provided that standardized conditions are satisfied.
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Affiliation(s)
- Fabio Antonaci
- 1 Headache Centre, C. Mondino National Institute of Neurology Foundation, IRCCS, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Elena Rossi
- 2 Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy.,3 Newronika srl, Milan, Italy
| | | | - Giorgio Dalla Volta
- 5 Unità Operativa Neurologia, Istituto Clinico Città di Brescia, Brescia, Italy
| | - Sara Marceglia
- 6 Dipartimento di Ingegneria e Architettura, Università degli Studi di Trieste, Trieste, Italy
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Dodick D, Edvinsson L, Makino T, Grisold W, Sakai F, Jensen R, Balch A, Ruiz de la Torre E, Henscheid-Lorenz D, Craven A, Ashina M. Vancouver Declaration on Global Headache Patient Advocacy 2018. Cephalalgia 2018; 38:1899-1909. [PMID: 29882695 DOI: 10.1177/0333102418781644] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Headache disorders comprise the three most prevalent medical disorders globally and contribute almost 20% to the total burden of neurologic illness. Although the experience of a recurrent headache disorder tends to be highly individualized, patient preferences tend to be a low priority in guidelines for the management of patients with headache. METHODS In September 2017, the first Global Patient Advocacy Summit was convened, bringing together patients, patient advocates, patient advocacy organizations, healthcare professionals, pharmaceutical manufacturers, scientists, and regulatory agencies to advance issues of importance to patients affected by headache worldwide. RESULTS Presentations and discussion covered multiple issues, such as improving access to appropriate medical care; incorporating the insights of independent patient advocates and advocacy organizations; leveraging the insights, experience and influence of leading health and neurological organizations; and raising awareness of the role of regulatory agencies in disease advocacy. Attendees agreed that it is important to understand and promote the global, regional, and local interests of people with headache disorders, as well as challenge the pervasive stigma associated with headache. They also agreed that those with severe, recurrent, or disabling headache disorders should have reliable access to competent medical care; healthcare professionals should have access to adequate training in Headache Medicine; global benchmarks should be established for accurate diagnosis and the use of evidence-based treatments in patients with headache; and that information is needed about consultation, diagnosis, and treatment of headache, particularly in regard to patient preferences. CONCLUSION Based on the group's consensus around these issues, a series of statements was developed, and they are collectively presented herein as the Vancouver Declaration on Global Headache Patient Advocacy 2018.
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Affiliation(s)
| | | | - Tomohiko Makino
- 3 World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | | | | | - Rigmor Jensen
- 6 Danish Headache Center, University of Copenhagen, Rigshopitalet, Glostrup, Denmark
| | - Alan Balch
- 7 Patient Advocate Foundation, Hampton, VA, USA
| | | | | | | | - Messoud Ashina
- 6 Danish Headache Center, University of Copenhagen, Rigshopitalet, Glostrup, Denmark
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Rossi P, Craven A, De La Torra ER. In the face of pain there are no heroes. An open letter to the members of the European Parliament about ensuring in the whole Europe high quality care, research, equitable employment opportunities, and socio-economic support for Cluster Headache (CH) pati. FUNCTIONAL NEUROLOGY 2018; 32:54-55. [PMID: 28380325 PMCID: PMC5505532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Rossi P, Little P, De La Torre ER, Palmaro A. If you want to understand what it really means to live with cluster headache, imagine... fostering empathy through European patients' own stories of their experiences. FUNCTIONAL NEUROLOGY 2018; 33:57-59. [PMID: 29633698 DOI: 10.11138/fneur/2018.33.1.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cluster headache (CH) is arguably the most severe pain condition that afflicts humans. The severity of the pain has earned it the nickname "suicide headache". Understanding how CH impacts on those who suffer from it is essential, because this understanding creates empathy, which is so valuable to these patients. On the occasion of Cluster Headache Day 2017, we asked CH patients from different European countries to share their experiences, in order to help people to imagine what it means to live with the condition. Here, we look at some extracts from their stories. These CH patients' direct accounts provide an important illustration of the clinical features and consequences of the disease, helping to contextualise it and its psychological and social consequences. Reports of CH patients' first-person accounts might help to underline the physicians' role and responsibility with regard to the psychological and social consequences of this disease.
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Abstract
Cluster headache is an excruciating, strictly one-sided pain syndrome with attacks that last between 15 minutes and 180 minutes and that are accompanied by marked ipsilateral cranial autonomic symptoms, such as lacrimation and conjunctival injection. The pain is so severe that female patients describe each attack as worse than childbirth. The past decade has seen remarkable progress in the understanding of the pathophysiological background of cluster headache and has implicated the brain, particularly the hypothalamus, as the generator of both the pain and the autonomic symptoms. Anatomical connections between the hypothalamus and the trigeminovascular system, as well as the parasympathetic nervous system, have also been implicated in cluster headache pathophysiology. The diagnosis of cluster headache involves excluding other primary headaches and secondary headaches and is based primarily on the patient's symptoms. Remarkable progress has been achieved in developing effective treatment options for single cluster attacks and in developing preventive measures, which include pharmacological therapies and neuromodulation.
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Affiliation(s)
- Arne May
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany
| | | | - Delphine Magis
- University Department of Neurology CHR, CHU de Liege, Belgium
| | - Patricia Pozo-Rosich
- Headache and Craniofacial Pain Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Headache Research Group, VHIR, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Stefan Evers
- Department of Neurology, Krankenhaus Lindenbrunn, Coppenbrügge, Germany
| | - Shuu-Jiun Wang
- Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan
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Joshi S, Rizzoli P, Loder E. The comorbidity burden of patients with cluster headache: a population-based study. J Headache Pain 2017; 18:76. [PMID: 28741257 PMCID: PMC5524654 DOI: 10.1186/s10194-017-0785-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 07/13/2017] [Indexed: 01/03/2023] Open
Abstract
Background Evidence is limited regarding the comorbidity burden of patients with cluster headache (CH). We aimed to characterize comorbid conditions in a cohort of CH patients diagnosed by headache experts, using electronic health record information from the Partners Research Patient Data Registry (RPDR). Methods We identified and reviewed the charts of unique patients diagnosed by headache specialists over an 11-year period, and a set of matched controls. Patients were categorized as having Definite, Unconfirmed or no CH. We calculated the prevalence of and tested for statistically significant differences of selected comorbid conditions in these populations. Results An RPDR query identified 170 patients with a free text or ICD diagnosis of cluster headache. 15 records belonging to Partners employees were excluded. 75 patients met diagnostic criteria for CH (Definite CH). 22 had headaches with some features of CH but the diagnosis was uncertain (Unconfirmed CH). In 58 the diagnosis was determined to be inaccurate due to data entry errors. Patients with Definite CH had an average age of 43.4 years; 80% were male. The average time from CH onset to diagnosis was 12.7 years (range 1–51). The average number of yearly emergency department and outpatient visits for the group of Definite CH patients was 4.5 and 25.4, respectively, compared with 1.1 and 6.9 in controls. Of the 55 examined conditions, four were statistically significantly less common in patients with definite CH compared with controls (diabetes, musculoskeletal/orthopaedic problems, “other gastrointestinal diagnoses” and skin conditions) and four were statistically significantly more common (smoking, depression, dental disorders and deviated septum). Conclusions In this large population-based study, we identified a surprisingly small number of patients who met strict diagnostic criteria for CH. In these patients, however, we identified a distinct pattern of selected comorbidities. The pattern is somewhat but not entirely consistent with that of the “classic” CH patient depicted in the medical literature. CH patients are frequently diagnosed with sinus or dental problems. Many experience substantial delay in receiving a diagnosis. These things may in part explain the high frequency of medical visits in this population. It is difficult to distinguish conditions that are genuinely comorbid with CH from those that reflect misdiagnoses or medical scrutiny of patients in frequent contact with the healthcare system.
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Affiliation(s)
- Shivang Joshi
- Clinical Pharmacy Practice, MCPHS University College of Pharmacy, Worcester, USA.,Community Neuroscience Services, Westborough, MA, 01581, USA
| | - Paul Rizzoli
- Harvard Medical School, Boston, USA.,Graham Headache Center, Brigham and Women's Faulkner Hospitals, Boston, MA, 02130, USA
| | - Elizabeth Loder
- Harvard Medical School, Boston, USA. .,Division of Headache, Department of Neurology, Brigham and Women's Faulkner Hospitals, Boston, MA, 02130, USA.
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Robbins MS, Starling AJ, Pringsheim TM, Becker WJ, Schwedt TJ. Treatment of Cluster Headache: The American Headache Society Evidence-Based Guidelines. Headache 2017; 56:1093-106. [PMID: 27432623 DOI: 10.1111/head.12866] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 05/10/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Cluster headache (CH), the most common trigeminal autonomic cephalalgia, is an extremely debilitating primary headache disorder that is often not optimally treated. New evidence-based treatment guidelines for CH will assist clinicians with identifying and choosing among current treatment options. OBJECTIVES In this systematic review we appraise the available evidence for the acute and prophylactic treatment of CH, and provide an update of the 2010 American Academy of Neurology (AAN) endorsed systematic review. METHODS Medline, PubMed, and EMBASE databases were searched for double-blind, randomized controlled trials that investigated treatments of CH in adults. Exclusion and inclusion criteria were identical to those utilized in the 2010 AAN systematic review. RESULTS AND RECOMMENDATIONS For acute treatment, sumatriptan subcutaneous, zolmitriptan nasal spray, and high flow oxygen remain the treatments with a Level A recommendation. Since the 2010 review, a study of sphenopalatine ganglion stimulation was added to the current guideline and has been administered a Level B recommendation for acute treatment. For prophylactic therapy, previously there were no treatments that were administered a Level A recommendation. For the current guidelines, suboccipital steroid injections have emerged as the only treatment to receive a Level A recommendation with the addition of a second Class I study. Other newly evaluated treatments since the 2010 guidelines have been given a Level B recommendation (negative study: deep brain stimulation), a Level C recommendation (positive study: warfarin; negative studies: cimetidine/chlorpheniramine, candesartan), or a Level U recommendation (frovatriptan). CONCLUSIONS This AHS guideline can be utilized for understanding which therapies have superiority to placebo or sham treatment in the management of CH. In clinical practice, these recommendations should be considered in concert with other variables including safety, side effects, patient preferences, clinician experience, cost, and the invasiveness of the intervention. Given the lack of Class I evidence and Level A recommendations, particularly for a number of commonly used preventive therapies, further studies are warranted to demonstrate safety and efficacy for established and emerging therapies.
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Affiliation(s)
- Matthew S Robbins
- Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Wöber C. Tics in TACs: A Step into an Avalanche? Systematic Literature Review and Conclusions. Headache 2017; 57:1635-1647. [PMID: 28542727 DOI: 10.1111/head.13099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/04/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Trigeminal autonomic cephalalgias (TACs) comprise cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks, and hemicrania continua. In some cases, trigeminal neuralgia (TN, "tic douloureux") or TN-like pain may co-occur with TACs. AIM This article will review the co-occurrence and overlap of TACs and tics in order to contribute to a better understanding of the issue and an improved management of the patients. METHODS For performing a systematic literature review Pubmed was searched using a total of ten terms. The articles identified were screened for further articles of relevance. SUMMARY TACs are related to tics in various ways. TN or TN-like paroxysms may co-occur with CH, PH, and HC, labeled as cluster-tic syndrome, PH-tic syndrome, and HC-tic syndrome. Such co-occurrence was not only found in the primary TACs but also in secondary headaches resembling TACs. The initial onset of TAC and tic may be simultaneous or separated by months or years. In acute attacks, tic and TAC may occur concurrently or much more often independently of each other. The term "cluster-tic syndrome" was also used in patients with a single type of pain in a twilight zone between TACs and TN fulfilling none of the relevant diagnostic criteria. Short-lasting neuralgiform headache attacks overlap with TN in terms of clinical features, imaging findings, and therapy.
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Affiliation(s)
- Christian Wöber
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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Lambru G, Andreou AP, de la Torre ER, Martelletti P. Tackling the perils of unawareness: the cluster headache case. J Headache Pain 2017; 18:49. [PMID: 28451865 PMCID: PMC5407400 DOI: 10.1186/s10194-017-0757-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 04/21/2017] [Indexed: 01/03/2023] Open
Affiliation(s)
- Giorgio Lambru
- Headache Centre, Guy's and St Thomas' NHS Trust, London, UK
| | - Anna P Andreou
- Headache Centre, Guy's and St Thomas' NHS Trust, London, UK.,Headache Research - Wolfson CARD, King's College London, London, UK
| | | | - Paolo Martelletti
- Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy. .,Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy. .,European Headache Federation, London, UK.
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Moon HS, Park JW, Lee KS, Chung CS, Kim BK, Kim JM, Sohn JH, Chu MK, Oh K, Cho SJ. Clinical Features of Cluster Headache Patients in Korea. J Korean Med Sci 2017; 32:502-506. [PMID: 28145655 PMCID: PMC5290111 DOI: 10.3346/jkms.2017.32.3.502] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 12/03/2016] [Indexed: 01/03/2023] Open
Abstract
Cluster headache (CH) is a rare underdiagnosed primary headache disorder with very severe unilateral pain and autonomic symptoms. Clinical characteristics of Korean patients with CH have not yet been reported. We analyzed the clinical features of CH patients from 11 university hospitals in Korea. Among a total of 200 patients with CH, only 1 patient had chronic CH. The average age of CH patients was 38.1 ± 8.9 years (range 19-60 years) and the average age of onset was 30.7 ± 10.3 years (range 10-57 years). The male-to-female ratio was 7:1 (2.9:1 among teen-onset and 11.7:1 among twenties-onset). Pain was very severe at 9.3 ± 1.0 on the visual analogue scale. The average duration of each attack was 100.6 ± 55.6 minutes and a bout of CH lasted 6.5 ± 4.5 weeks. Autonomic symptoms were present in 93.5% and restlessness or agitation was present in 43.5% of patients. Patients suffered 3.0 ± 3.5 (range 1-25) bouts over 7.3 ± 6.7 (range 1-30) years. Diurnal periodicity and season propensity were present in 68.5% and 44.0% of patients, respectively. There were no sex differences in associated symptoms or diurnal and seasonal periodicity. Korean CH patients had a high male-to-female ratio, relatively short bout duration, and low proportion of chronic CH, unlike CH patients in Western countries.
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Affiliation(s)
- Heui Soo Moon
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Wook Park
- Department of Neurology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Kwang Soo Lee
- Department of Neurology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Chin Sang Chung
- Department of Neurology, Seoul Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung Kun Kim
- Department of Neurology, Eulji University School of Medicine, Seoul, Korea
| | - Jae Moon Kim
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jong Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Min Kyung Chu
- Department of Neurology, Gangnam Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Soo Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.
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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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Prakash S, Rathore C. Side-locked headaches: an algorithm-based approach. J Headache Pain 2016; 17:95. [PMID: 27770404 PMCID: PMC5074931 DOI: 10.1186/s10194-016-0687-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 10/04/2016] [Indexed: 01/03/2023] Open
Abstract
The differential diagnosis of strictly unilateral hemicranial pain includes a large number of primary and secondary headaches and cranial neuropathies. It may arise from both intracranial and extracranial structures such as cranium, neck, vessels, eyes, ears, nose, sinuses, teeth, mouth, and the other facial or cervical structure. Available data suggest that about two-third patients with side-locked headache visiting neurology or headache clinics have primary headaches. Other one-third will have either secondary headaches or neuralgias. Many of these hemicranial pain syndromes have overlapping presentations. Primary headache disorders may spread to involve the face and / or neck. Even various intracranial and extracranial pathologies may have similar overlapping presentations. Patients may present to a variety of clinicians, including headache experts, dentists, otolaryngologists, ophthalmologist, psychiatrists, and physiotherapists. Unfortunately, there is not uniform approach for such patients and diagnostic ambiguity is frequently encountered in clinical practice. Herein, we review the differential diagnoses of side-locked headaches and provide an algorithm based approach for patients presenting with side-locked headaches. Side-locked headache is itself a red flag. So, the first priority should be to rule out secondary headaches. A comprehensive history and thorough examinations will help one to formulate an algorithm to rule out or confirm secondary side-locked headaches. The diagnoses of most secondary side-locked headaches are largely investigations dependent. Therefore, each suspected secondary headache should be subjected for appropriate investigations or referral. The diagnostic approach of primary side-locked headache starts once one rule out all the possible secondary headaches. We have discussed an algorithmic approach for both secondary and primary side-locked headaches.
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Affiliation(s)
- Sanjay Prakash
- Department of Neurology, Smt. B. K. Shah Medical institute and research Centre, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara, 391760, Gujarat, India. .,Department of Neurology, Smt B. K. Shah Medical institute and research Centre, Piperia, Waghodia, Vadodara, 391760, Gujarat, India.
| | - Chaturbhuj Rathore
- Department of Neurology, Smt. B. K. Shah Medical institute and research Centre, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara, 391760, Gujarat, India
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Palacios-Ceña D, Talavera B, López-Ruiz P, Gutiérrez-Viedma Á, Palacios-Ceña M, Arias JA, Fernández-de-las-Peñas C, Cuadrado ML. Living With Cluster Headache: A Qualitative Study of Patients’ Perspectives. Headache 2016; 56:1171-82. [DOI: 10.1111/head.12886] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 03/17/2016] [Accepted: 04/06/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, “Grupo de Investigación Traslacional en el Proceso de Salud - Enfermedad (ITPSE),”; Universidad Rey Juan Carlos, Alcorcón; Madrid Spain
| | - Blanca Talavera
- Department of Medicine, School of Medicine; Universidad Complutense; Madrid Spain
| | - Pedro López-Ruiz
- Headache Unit, Department of Neurology; Hospital Clínico San Carlos; Madrid Spain
| | | | - María Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, “Grupo de Investigación Traslacional en el Proceso de Salud - Enfermedad (ITPSE),”; Universidad Rey Juan Carlos, Alcorcón; Madrid Spain
| | - José A. Arias
- School of Medicine; Universidad Alfonso X el Sabio; Villanueva de la Cañada Madrid Spain
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, “Grupo de Investigación Traslacional en el Proceso de Salud - Enfermedad (ITPSE),”; Universidad Rey Juan Carlos, Alcorcón; Madrid Spain
| | - María L. Cuadrado
- Department of Medicine, School of Medicine; Universidad Complutense; Madrid Spain
- Headache Unit, Department of Neurology; Hospital Clínico San Carlos; Madrid Spain
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Cluster Headache: Special Considerations for Treatment of Female Patients of Reproductive Age and Pediatric Patients. Curr Neurol Neurosci Rep 2016; 16:5. [PMID: 26711274 DOI: 10.1007/s11910-015-0610-9] [Citation(s) in RCA: 9] [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
Cluster headache is a rare disorder that is more common in adult male patients. It has a unique phenotype of unilateral, severe, to very severe headaches lasting 15 to 180 min with ipsilateral autonomic symptoms. Time to correct diagnosis can be protracted. A number of treatment options exist for the standard cluster headache patient, but special considerations must be made for female patients of reproductive age and pediatric patients. The objective of this article is to explore the current literature pertaining to special considerations in cluster headache management, including treatment of pregnant or breastfeeding patients and pediatric patients.
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Du S, Ma X, Li X, Yuan H. Ophthalmic branch radiofrequency thermocoagulation for atypical trigeminal neuralgia:a case report. SPRINGERPLUS 2015; 4:813. [PMID: 26722633 PMCID: PMC4690819 DOI: 10.1186/s40064-015-1624-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 12/15/2015] [Indexed: 01/03/2023]
Abstract
Background Trigeminal neuralgia is an intense neuralgia involving facial areas supplied by trigeminal nerve. The pain is characterized by sudden onset, short persistence, sharp or lancinating. Trigeminal neuralgia commonly affects frontal areas, infraorbital or paranasal areas, mandibular areas and teeth. While Trigeminal neuralgia affecting merely the upper eyelid is rare. Here we report a case of atypical Trigeminal neuralgia confined to the upper eyelid. The patient was pain free during the follow-up period of 6 months after unusual ophthalmic branch radiofrequency thermocoagulation. Case presentation A 55-year-old female patient was diagnosed as primary trigeminal neuralgia involving the right upper eyelid. As the pain could not be controlled by drug therapy, peripheral nerve branch radiofrequency thermocoagulation was recommended. A combination of infratrochlear, supratrochlear and lacrimal radiofrequency thermocoagulation was implemented in this case. The point where the bridge of the nose abuts the supraorbital ridge and the point slightly above the lateral canthus along outer border of the orbit were selected respectively as the puncture sites. After positive diagnostic test, radiofrequency thermocoagulation of the above-mentioned nerve branches was performed respectively. The patient was pain free immediately after the treatment and during the follow-up period of 6 months. Discussion Trigeminal neuralgia is a common severe and chronic facial neuralgia which requires accurate diagnosis and effective therapy. With typical clinical symptoms, normal neurological signs, normal CT and MRI findings, the patient was diagnosed as classic trigeminal neuralgia. As the patient was drug resistant, some invasive treatments were considered. Peripheral branch neurolysis was chosen for its minimal invasiveness, convenience, low risk and not affecting further invasive treatments. According to the anatomic data and the diagnostic test results, infratrochlear, supratrochlear and lacrimal nerve were responsible, therefore, an unusual combination of infratrochlear, supratrochlear, and lacrimal radiofrequency thermocoagulation was implemented for this patient. Conclusions Radiofrequency thermocoagulation is an effective treatment option for trigeminal neuralgia. Peripheral branch radiofrequency thermocoagulation for trigeminal neuralgia should be considered preferentially due to its minimal invasiveness and convenience. Furthermore, as the sensory innervation of the upper eyelid is complex, the knowledge of peripheral distribution of trigeminal nerve is essential.
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Affiliation(s)
- Shibin Du
- Department of Anesthesiology and Pain Management, Xijing Hospital, Fourth Military Medical University, 710032 Xian, China
| | - Xiaoliang Ma
- Department of Anesthesiology and Pain Management, Xijing Hospital, Fourth Military Medical University, 710032 Xian, China
| | - Xiaoqin Li
- Department of Anesthesiology and Pain Management, Xijing Hospital, Fourth Military Medical University, 710032 Xian, China
| | - Hongjie Yuan
- Department of Anesthesiology and Pain Management, Xijing Hospital, Fourth Military Medical University, 710032 Xian, China
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Guégan-Massardier E, Laubier C. Diagnostic différentiel de l’AVF. Presse Med 2015; 44:1180-4. [DOI: 10.1016/j.lpm.2015.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 06/29/2015] [Indexed: 11/26/2022] Open
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Lademann V, Jansen JP, Evers S, Frese A. Evaluation of guideline-adherent treatment in cluster headache. Cephalalgia 2015; 36:760-4. [PMID: 26481303 DOI: 10.1177/0333102415612774] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 08/30/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Several treatment guidelines exist for cluster headache. However, it is not yet known how many cluster headache patients are treated according to these guidelines. METHODS We enrolled 434 cluster headache patients with confirmed diagnosis referred to two tertiary pain centers. The history of treatment was registered and analyzed according to the treatment guidelines of the European Federation of Neurological Societies. RESULTS Regarding acute attack treatment, 62.1% of the episodic and 71.0% of the chronic cluster headache patients were treated according to the guidelines. The efficacy rate was above 92% in both groups. Regarding prophylactic treatment, 31.3% of the episodic and 50.9% of the chronic cluster headache patients were treated according to the guidelines. The efficacy rate was 92.8% for episodic and 70.9% for chronic cluster headache. CONCLUSION The rate of guideline-adherent treatment in cluster headache is about 70% for acute treatment and about 35% for prophylactic treatment. The efficacy of this treatment is significantly higher than the efficacy of non-guideline-adherent treatment.
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Affiliation(s)
| | | | - Stefan Evers
- Department of Neurology, University of Münster, Germany Berlin Pain Centre, Germany
| | - Achim Frese
- Department of Neurology, University of Münster, Germany Academy for Manual Medicine, Germany
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Martelletti P, Mitsikostas DD. Cluster headache: a quasi-rare disorder needing a reappraisal. J Headache Pain 2015; 16:59. [PMID: 26113477 PMCID: PMC4480266 DOI: 10.1186/s10194-015-0545-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 06/16/2015] [Indexed: 11/17/2022] Open
Affiliation(s)
- Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
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Shaw M, Singh S. Complex clinical reasoning in the critical care unit - difficulties, pitfalls and adaptive strategies. Int J Clin Pract 2015; 69:396-400. [PMID: 25816909 DOI: 10.1111/ijcp.12614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 12/17/2014] [Indexed: 11/26/2022] Open
Abstract
Diagnostic error has implications for both clinical outcome and resource utilisation, and may often be traced to impaired data gathering, processing or synthesis because of the influence of cognitive bias. Factors inherent to the intensive/acute care environment afford multiple additional opportunities for such errors to occur. This article illustrates many of these with reference to a case encountered on our intensive care unit. Strategies to improve completeness of data gathering, processing and synthesis in the acute care environment are critically appraised in the context of early detection and amelioration of cognitive bias. These include reflection, targeted simulation training and the integration of social media and IT based aids in complex diagnostic processes. A framework which can be quickly and easily employed in a variety of clinical environments is then presented.
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Affiliation(s)
- M Shaw
- Intensive Care Unit, Magill Department of Anaesthesia, Intensive Care and Pain Management, Chelsea and Westminster Hospital NHS Trust, Imperial College, London, UK
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Mitsikostas DD, Edvinsson L, Jensen RH, Katsarava Z, Lampl C, Negro A, Osipova V, Paemeleire K, Siva A, Valade D, Martelletti P. Refractory chronic cluster headache: a consensus statement on clinical definition from the European Headache Federation. J Headache Pain 2014; 15:79. [PMID: 25430992 PMCID: PMC4256964 DOI: 10.1186/1129-2377-15-79] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 11/12/2014] [Indexed: 12/31/2022] Open
Abstract
Chronic cluster headache (CCH) often resists to prophylactic pharmaceutical treatments resulting in patients’ life damage. In this rare but pragmatic situation escalation to invasive management is needed but framing criteria are lacking. We aimed to reach a consensus for refractory CCH definition for clinical and research use. The preparation of the final consensus followed three stages. Internal between authors, a larger between all European Headache Federation members and finally an international one among all investigators that have published clinical studies on cluster headache the last five years. Eighty-five investigators reached by email. Proposed criteria were in the format of the International Classification of Headache Disorders III-beta (description, criteria, notes, comments and references). Following this evaluation eight drafts were prepared before the final. Twenty-four (28.2%) international investigators commented during two rounds. Refractory CCH is described in the present consensus as a situation that fulfills the criteria of ICHD-3 beta for CCH with at least three severe attacks per week despite at least three consecutive trials of adequate preventive treatments. The condition is rare, but difficult to manage and invasive treatments may be needed. The consensus addresses five specific clinical and paraclinical diagnostic criteria followed by three notes and specific comments. Although refractory CCH may be not a separate identity these specific diagnostic criteria should help clinicians and investigators to improve patient’s quality of life.
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Affiliation(s)
- Dimos D Mitsikostas
- Athens Naval Hospital, Neurology Department, 77A Vas, Sofias Avenue, 11521 Athens, Greece.
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