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Risch N, Dubois J, Etain B, Aouizerate B, Bellivier F, Belzeaux R, Dubertret C, Haffen E, Januel D, Leboyer M, Lefrere A, Samalin L, Polosan M, Rey R, Roux P, Schwan R, Walter M, Courtet P, Olié E. Subjects suffering from bipolar disorder taking lithium are less likely to report physical pain: a FACE-BD study. Eur Psychiatry 2023; 67:e8. [PMID: 38086540 DOI: 10.1192/j.eurpsy.2023.2476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Physical pain is a common issue in people with bipolar disorder (BD). It worsens mental health and quality of life, negatively impacts treatment response, and increases the risk of suicide. Lithium, which is prescribed in BD as a mood stabilizer, has shown promising effects on pain. METHODS This naturalistic study included 760 subjects with BD ( FACE-BD cohort) divided in two groups: with and without self-reported pain (evaluated with the EQ-5D-5L questionnaire). In this sample, 176 subjects were treated with lithium salts. The objectives of the study were to determine whether patients receiving lithium reported less pain, and whether this effect was associated with the recommended mood-stabilizing blood concentration of lithium. RESULTS Subjects with lithium intake were less likely to report pain (odds ratio [OR] = 0.59, 95% confidence interval [CI], 0.35-0.95; p = 0.036) after controlling for sociodemographic variables, BD type, lifetime history of psychiatric disorders, suicide attempt, personality traits, current depression and anxiety levels, sleep quality, and psychomotor activity. Subjects taking lithium were even less likely to report pain when lithium concentration in blood was ≥0.5 mmol/l (OR = 0.45, 95% CI, 0.24-0.79; p = 0.008). CONCLUSIONS This is the first naturalistic study to show lithium's promising effect on pain in subjects suffering from BD after controlling for many confounding variables. This analgesic effect seems independent of BD severity and comorbid conditions. Randomized controlled trials are needed to confirm the analgesic effect of lithium salts and to determine whether lithium decreases pain in other vulnerable populations.
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Affiliation(s)
- Nathan Risch
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, Montpellier, France
- Clinique de la Lironde, Clinea Psychiatrie, Saint-Clément-de-Rivière, France
| | - Jonathan Dubois
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, Montpellier, France
| | - Bruno Etain
- Fondation FondaMental, Créteil, France
- Département de Psychiatrie et de Médecine Addictologique, AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU Neurosciences, Hôpital Fernand Widal, Paris, France
- Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Université Paris Cité, INSERM UMR-S 1144, Paris, France
| | - Bruno Aouizerate
- Fondation FondaMental, Créteil, France
- Centre Hospitalier Charles Perrens, Bordeaux, France
- Laboratoire NutriNeuro (UMR INRA 1286), Université de Bordeaux, Bordeaux, France
| | - Frank Bellivier
- Fondation FondaMental, Créteil, France
- Département de Psychiatrie et de Médecine Addictologique, AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU Neurosciences, Hôpital Fernand Widal, Paris, France
- Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Université Paris Cité, INSERM UMR-S 1144, Paris, France
| | - Raoul Belzeaux
- Fondation FondaMental, Créteil, France
- Pôle Universitaire de Psychiatrie, CHU de Montpellier, Montpellier, France /INT-UMR7289, CNRS Aix-Marseille Université, France
| | - Caroline Dubertret
- Fondation FondaMental, Créteil, France
- AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU ESPRIT, Service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France
- Université de Paris, Inserm UMR1266, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Emmanuel Haffen
- Fondation FondaMental, Créteil, France
- Service de Psychiatrie de l'Adulte, CIC-1431 INSERM, CHU de Besançon, Laboratoire de Neurosciences, UFC, UBFC, Besançon, France
| | - Dominique Januel
- Fondation FondaMental, Créteil, France
- Pôle universitaire 93G03 EPS ville Evrard, Neuilly-sur- Marne, France
- Université Sorbonne Paris Nord, Bobigny, France
| | - Marion Leboyer
- Fondation FondaMental, Créteil, France
- Translational NeuroPsychiatry Laboratory, Univ Paris Est Créteil, INSERM U955, IMRB, Créteil, France
- AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d'Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France
| | - Antoine Lefrere
- Fondation FondaMental, Créteil, France
- Assistance Publique Hôpitaux de Marseille, Pôle de Psychiatrie, Marseille, France
- Institut de neurosciences de la Timone UMR 7289, Aix-Marseille Université & CNRS, Marseille, France
| | - Ludovic Samalin
- Fondation FondaMental, Créteil, France
- University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, CHU Clermont-Ferrand, Department of Psychiatry, Clermont-Ferrand, France
| | - Mircea Polosan
- Fondation FondaMental, Créteil, France
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - Romain Rey
- Fondation FondaMental, Créteil, France
- Centre Hospitalier Le Vinatier, INSERM U1028, CNRS UMR5292, Université Claude Bernard Lyon 1, Centre de Recherche en Neurosciences de Lyon, Equipe PSYR2, Pole Est, 95 bd Pinel, BP 30039, Bron Cedex, France
| | - Paul Roux
- Fondation FondaMental, Créteil, France
- Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie d'Adultes et d'Addictologie, Le Chesnay, Université Paris-Saclay; Université de Versailles Saint-Quentin-En-Yvelines; DisAP-DevPsy-CESP, INSERM UMR1018, Villejuif, France
| | - Raymund Schwan
- Fondation FondaMental, Créteil, France
- Centre Psychothérapique de Nancy, Inserm, Université de Lorraine, Nancy, France
| | - Michel Walter
- Fondation FondaMental, Créteil, France
- Service Hospitalo-Universitaire de Psychiatrie Générale et de Réhabilitation Psycho Sociale 29G01 et 29G02, CHRU de Brest, Hôpital de Bohars, Brest, France
| | - Philippe Courtet
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, Montpellier, France
- Fondation FondaMental, Créteil, France
| | - Emilie Olié
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, Montpellier, France
- Fondation FondaMental, Créteil, France
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Sgro M, Ray J, Foster E, Mychasiuk R. Making migraine easier to stomach: the role of the gut-brain-immune axis in headache disorders. Eur J Neurol 2023; 30:3605-3621. [PMID: 37329292 DOI: 10.1111/ene.15934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/30/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND AND PURPOSE Headache disorders place a significant burden on the healthcare system, being the leading cause of disability in those under 50 years. Novel studies have interrogated the relationship between headache disorders and gastrointestinal dysfunction, suggesting a link between the gut-brain-immune (GBI) axis and headache pathogenesis. Although the exact mechanisms driving the complex relationship between the GBI axis and headache disorders remain unclear, there is a growing appreciation that a healthy and diverse microbiome is necessary for optimal brain health. METHODS A literature search was performed through multiple reputable databases in search of Q1 journals within the field of headache disorders and gut microbiome research and were critically and appropriately evaluated to investigate and explore the following; the role of the GBI axis in dietary triggers of headache disorders and the evidence indicating that diet can be used to alleviate headache severity and frequency. The relationship between the GBI axis and post-traumatic headache is then synthesized. Finally, the scarcity of literature regarding paediatric headache disorders and the role that the GBI axis plays in mediating the relationship between sex hormones and headache disorders are highlighted. CONCLUSIONS There is potential for novel therapeutic targets for headache disorders if understanding of the GBI axis in their aetiology, pathogenesis and recovery is increased.
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Affiliation(s)
- Marissa Sgro
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jason Ray
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Neurology, Austin Health, Melbourne, Victoria, Australia
| | - Emma Foster
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Dominguez Garcia MM, Abejon Gonzalez D, de Diego Gamarra JM, Cánovas Martinez ML, Balboa Díaz M, Hadjigeorgiou I. Symptoms and pathophysiology of cluster headache. Approach to combined occipital and supraorbital neurostimulation. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:83-96. [PMID: 36822404 DOI: 10.1016/j.redare.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 10/05/2021] [Indexed: 02/25/2023]
Abstract
Cluster headache (CH) is included under section 3 - Trigeminal autonomic cephalalgias (TAC) of the International Headache Society (IHS) classification. It is one of the most frequent, painful and disabling primary headaches. Acute and preventive pharmacological treatments are often poorly tolerated and of limited effectiveness. Due to improved understanding of the pathophysiology of CH, neuromodulation devices are now considered safe and effective options for preventive and acute treatment of CH. In this paper, we review the information available to date, and present the case of a patient with disabling cluster headache highly resistant to medical treatment who underwent implantation of a peripheral nerve neurostimulation system to stimulate the supraorbital nerves (SON) and greater occipital nerve (GON) in our Pain Unit. We also review the diagnostic criteria for CH, the state of the knowledge on the pathophysiology of CH, and the role played by neuromodulation in treating this condition.
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Affiliation(s)
- M M Dominguez Garcia
- Hospital Doctor José Molina Orosa de Lanzarote: Hospital Doctor José Molina Orosa Arrecife, Las Palmas, Spain.
| | - D Abejon Gonzalez
- Hospital Doctor José Molina Orosa de Lanzarote: Hospital Doctor José Molina Orosa Arrecife, Las Palmas, Spain
| | - J M de Diego Gamarra
- Hospital Doctor José Molina Orosa de Lanzarote: Hospital Doctor José Molina Orosa Arrecife, Las Palmas, Spain
| | - M L Cánovas Martinez
- Hospital Doctor José Molina Orosa de Lanzarote: Hospital Doctor José Molina Orosa Arrecife, Las Palmas, Spain
| | - M Balboa Díaz
- Hospital Doctor José Molina Orosa de Lanzarote: Hospital Doctor José Molina Orosa Arrecife, Las Palmas, Spain
| | - I Hadjigeorgiou
- Hospital Doctor José Molina Orosa de Lanzarote: Hospital Doctor José Molina Orosa Arrecife, Las Palmas, Spain
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McBrien S, Fallon J. Methylphenidate as a potential treatment for cluster headache. PROGRESS IN NEUROLOGY AND PSYCHIATRY 2022. [DOI: 10.1002/pnp.765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Sophie McBrien
- Dr McBrien is Higher Specialty Trainee, Sussex Partnership Trust
| | - James Fallon
- Dr Fallon is Clinical Senior Lecturer, Brighton and Sussex Medical School and Honorary Consultant Psychiatrist, Sussex Partnership Foundation Trust
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Mo H, Chung SJ, Rozen TD, Cho SJ. Oxygen Therapy in Cluster Headache, Migraine, and Other Headache Disorders. J Clin Neurol 2022; 18:271-279. [PMID: 35589316 PMCID: PMC9163947 DOI: 10.3988/jcn.2022.18.3.271] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 11/17/2022] Open
Abstract
Oxygen therapy (OT) can relieve head pain in certain primary headache disorders, including cluster headache (CH). The exact underlying mechanism is currently uncertain, but suggested mechanisms include inhibition of the trigeminoautonomic reflex, modulation of neurotransmitters, and cerebral vasoconstriction. OT is the standard for acute treatment of CH, but patients with CH often experience considerable difficulties accessing home OT due to problems with insurance coverage. Inhalation of 100% oxygen at 6–12 L/min for 15–30 min using a non-rebreather face mask is one of the most effective acute therapies for CH, but several trials have indicated the superiority of higher oxygen flow rates of up to 15 L/min and/or using a demand-valve oxygen mask that can produce very high flow rates. Two randomized controlled trials have demonstrated the efficacy of OT in migraine, but obtaining reliable evidence is considered difficult because of different inhalation protocols, varying outcome measures, and small samples. There are some reports on the efficacy of OT as an adjuvant therapy in hypnic headache, primary headache in the emergency department, and even postdural puncture headache. The goal of this review article is to expand the knowledge regarding the use of oxygen in the treatment of headache disorders.
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Affiliation(s)
- Heejung Mo
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Soo Jie Chung
- Department of Pulmonology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Todd D Rozen
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.
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Amighi D, Majedi H, Tafakhori A, Orandi A. The Efficacy of Sphenopalatine Ganglion Block and Radiofrequency Denervation in the Treatment of Cluster Headache: A Case Series. Anesth Pain Med 2020; 10:e104466. [PMID: 34150572 PMCID: PMC8207843 DOI: 10.5812/aapm.104466] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 09/01/2020] [Accepted: 10/06/2020] [Indexed: 12/23/2022] Open
Abstract
Background Cluster headache is a variant of primary neurovascular headaches. some patients with cluster headache are not responsive to medical treatment and may benefit from interventional modalities, including sphenopalatine ganglion block and denervation. Objectives Our purpose was to evaluate the efficacy of sphenopalatine ganglion block/denervation in the treatment of cluster headache. Methods In this study, we performed the sphenopalatine ganglion block for patients with cluster headaches, intractable to medical therapy, who were referred to our pain clinic between 2014 and 2018. We registered the following information for all patients: demographic data, pain relief, and pain intensity. First, we conducted a prognostic C-arm-guided sphenopalatine ganglion block. If there was at least 50% pain relief within the first 5 h, then we denervated the ganglion by radiofrequency ablation. The main outcome of the study (dependent variable) was pain relief. We followed the patients for 6 months. Results Among 23 enrolled patients, 19 consented to interventional treatment. Fifteen out of 19 patients (79%) had an acceptable response to the prognostic block. Ultimately, 11 patients underwent ganglion denervation, and 4 patients did not consent for ganglion ablation. Pain relief at intervals of 48 h, and 1, 3, and 6 months after ganglion denervation was 77, 59, 50, and 31 percent, respectively. Conclusions Sphenopalatine ganglion conventional radiofrequency denervation can effectively decrease the pain intensity of the patients with cluster headache for at least several months.
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Affiliation(s)
- Dorsa Amighi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Majedi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Anesthesiology, Critical Care and Pain Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Department of Anesthesiology, Critical Care and Pain Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Abbas Tafakhori
- Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Orandi
- Department of Anesthesiology, Critical Care and Pain Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Akram H, Zrinzo L. Cluster Headache: Deep Brain Stimulation. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Headache is the most common neurologic symptom and affects nearly half the world's population at any given time. Although the prevalence declines with age, headache remains a common neurologic complaint among elderly populations. Headaches can be divided into primary and secondary causes. Primary headaches comprise about two-thirds of headaches among the elderly. They are defined by clinical criteria and are diagnosed based on symptom pattern and exclusion of secondary causes. Primary headaches include migraine, tension-type, trigeminal autonomic cephalalgias, and hypnic headache. Secondary headaches are defined by their suspected etiology. A higher index of suspicion for a secondary headache disorder is warranted in older patients with new-onset headache. They are roughly 12 times more likely to have serious underlying causes and, frequently, have different symptomatic presentations compared to younger adults. Various imaging and laboratory evaluations are indicated in the presence of any "red flag" signs or symptoms. Head CT is the procedure of choice for acute headache presentations, and brain MRI for those with chronic headache complaints. Management of headache in elderly populations can be challenging due to the presence of multiple medical comorbidities, polypharmacy, and differences in drug metabolism and clearance.
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Affiliation(s)
- Robert G Kaniecki
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
| | - Andrew D Levin
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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9
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Jose A, Prasad RS, Pai A. Trigeminal autonomic cephalalgias: The impersonators. INDIAN JOURNAL OF PAIN 2019. [DOI: 10.4103/ijpn.ijpn_2_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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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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11
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Oral High-Dose Thiamine Improves the Symptoms of Chronic Cluster Headache. Case Rep Neurol Med 2018; 2018:3901619. [PMID: 29850313 PMCID: PMC5932500 DOI: 10.1155/2018/3901619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/03/2018] [Accepted: 02/25/2018] [Indexed: 12/31/2022] Open
Abstract
Cluster headache is a rare painful primary disorder occurring in either episodic or chronic patterns. Several authors found that the hypothalamus, the brain region regulating endocrine function and autonomic system, is involved in the pathophysiology of cluster headache. Some authors have found in patients affected by this disease abnormality in glucose metabolism. Considering the role of thiamine in brain function, in energetic metabolism, and in pain modulation, we treated a patient affected by cluster headache with oral high-dose thiamine. We report a 41-year-old man suffering from primary chronic cluster headache since the age of 15 years. The patient began oral therapy with high-dose thiamine in December 2016. Oral thiamine supplementation led to a dramatic improvement of the symptoms. The therapy was effective in reversing all the symptoms of the disease. Our observation suggests that a thiamine deficiency due to enzymatic abnormalities or to dysfunction of the circulation of thiamine in the intracellular space could cause a neuronal selective impairment in the centers that are involved in this disease and could have an important role in the pathogenesis of the symptoms of cluster headache.
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12
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Lupi C, Evangelista L, Favoni V, Granato A, Negro A, Pellesi L, Ornello R, Russo A, Cevoli S, Guerzoni S, Benemei S. Rare primary headaches in Italian tertiary Headache Centres: Three year nationwide retrospective data from the RegistRare Network. Cephalalgia 2018; 38:1429-1441. [PMID: 29754500 DOI: 10.1177/0333102418768824] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Rare primary headaches are mainly included in Chapters 3, Trigeminal autonomic cephalalgias, and 4, Other primary headache disorders, Part One of the International Classification of Headache Disorders 3rd edition. Epidemiological data are scarce, mostly emerging from case series or small studies, with the exception of cluster headache. In order to overcome the knowledge gap about rare primary headaches, the RegistRare Network was launched in 2017 to promote research in the field. Methods A retrospective cohort study including patients who, from April 30, 2014 to May 1, 2017, visited seven Italian tertiary Headache Centres, was undertaken to estimate in that clinical setting prevalence and incidence of headaches included in Chapters 3 and 4, Part One of the International Classification of Headache Disorders 3rd edition. Prevalent headache is defined as a headache recorded within the study timeframe, regardless of when the diagnosis was made. Incident headache is defined as a headache diagnosed for the first time in the patient during the study period. Results Twenty thousand and eighty-three patients visited the participating centres, and 822 (4.1%) prevalent cases, of which 461 (2.3%) were incident cases, were registered. Headaches listed in Chapter 3 affected 668 patients, representing 81.3% of the total number of prevalent cases. Headaches listed in Chapter 4 affected 154 patients and represent 18.7% of the total number of prevalent cases. Cluster headaches represent the most frequently diagnosed rare headaches (70.4%). For 13 entities out of 20, no cases were registered in more than 50% (n ≥ 4) of the centres, and for 14 entities more than 50% of diagnoses were incident. Conclusions This large, multicentre study gives the first wide-ranging snapshot of the burden in clinical practice of rare headaches and confirms that cooperative networks are necessary to study rare headaches, as their prevalence is often very low. The launch of a disease registry by the RegistRare Network will favour research in this neglected population of headache patients. Trial registration NCT03416114.
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Affiliation(s)
- Chiara Lupi
- 1 Headache Centre, Careggi University Hospital, Department of Health Sciences, University of Florence, Florence, Italy
| | - Luana Evangelista
- 2 Regional Headache Referral Center, Department of Neurology, University of L'Aquila, L'Aquila, Italy
| | - Valentina Favoni
- 3 IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Antonio Granato
- 4 Department of Medical, Technological and Translational Sciences, Headache Centre, University of Trieste, Trieste, Italy
| | - Andrea Negro
- 5 Regional Referral Headache Centre, Sant'Andrea Hospital, Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Lanfranco Pellesi
- 6 Headache and Drug Abuse Research Centre, Policlinico Hospital, Department of Diagnostic Medicine, Clinical and Public Health, University of Modena e Reggio Emilia, Modena, Italy
| | - Raffaele Ornello
- 2 Regional Headache Referral Center, Department of Neurology, University of L'Aquila, L'Aquila, Italy
| | - Antonio Russo
- 7 Headache Centre, Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Sabina Cevoli
- 3 IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Simona Guerzoni
- 6 Headache and Drug Abuse Research Centre, Policlinico Hospital, Department of Diagnostic Medicine, Clinical and Public Health, University of Modena e Reggio Emilia, Modena, Italy
| | - Silvia Benemei
- 1 Headache Centre, Careggi University Hospital, Department of Health Sciences, University of Florence, Florence, Italy
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Sokolov AY, Murzina AA, Osipchuk AV, Lyubashina OA, Amelin AV. Cholinergic mechanisms of headaches. NEUROCHEM J+ 2017. [DOI: 10.1134/s1819712417020131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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de Andrés F, Lionetto L, Curto M, Capi M, Cipolla F, Negro A, Martelletti P. Acute, transitional and long-term cluster headache treatment: pharmacokinetic issues. Expert Opin Drug Metab Toxicol 2016; 12:1011-20. [DOI: 10.1080/17425255.2016.1201067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Fernando de Andrés
- CICAB Clinical Research Centre, Extremadura University Hospital and Medical School, Badajoz, Spain
| | - Luana Lionetto
- Advanced Molecular Diagnostics Unit, IDI-IRCCS, Rome, Italy
| | - Martina Curto
- Department of Molecular Medicine, Sant’Andrea Medical Center, Sapienza University of Rome, Rome, Italy
- Regional Referral Headache Center, Sant’Andrea Hospital, Rome, Italy
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Matilde Capi
- NESMOS Department, Sapienza University of Rome, Rome, Italy
| | | | - Andrea Negro
- Department of Molecular Medicine, Sant’Andrea Medical Center, Sapienza University of Rome, Rome, Italy
- Regional Referral Headache Center, Sant’Andrea Hospital, Rome, Italy
| | - Paolo Martelletti
- Department of Molecular Medicine, Sant’Andrea Medical Center, Sapienza University of Rome, Rome, Italy
- Regional Referral Headache Center, Sant’Andrea Hospital, Rome, Italy
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15
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Fourier C, Ran C, Steinberg A, Sjöstrand C, Waldenlind E, Carmine Belin A. Screening of Two ADH4 Variations in a Swedish Cluster Headache Case-Control Material. Headache 2016; 56:835-840. [PMID: 27041676 PMCID: PMC5071723 DOI: 10.1111/head.12807] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Cluster headache (CH) is a severe neurovascular disorder and an increasing amount of evidence points to a genetic contribution to this disease. When CH was first described, it was observed that alcohol may precipitate an attack during the active phase of the disease. The alcohol dehydrogenase 4 (ADH4) gene encodes an enzyme which contributes to the metabolization of alcohol and is, therefore, an interesting candidate gene for CH. Two Italian groups have reported association of the single nucleotide polymorphism (SNP) rs1126671 located in the ADH4 gene with an increased risk of CH in Italy. In addition, one of the groups found an association between the ADH4 SNP rs1800759 and CH. Objective To perform a replication study on the ADH4 SNPs rs1126671 and rs1800759 in a large homogeneous Swedish case–control cohort in order to further investigate the possible contribution of ADH4 to CH. Methods A total of 390 unrelated patients diagnosed with CH and 389 controls representing a general Swedish population were recruited to the study. DNA samples from patients and controls were genotyped for the two ADH4 SNPs rs1126671 and rs1800759 using quantitative real‐time polymerase chain reaction. Statistical analyses of genotype, allele and haplotype frequencies for the two SNPs were performed and compared between patients and controls. Results For rs1126671, the minor allele frequency (A allele) was 32.8% (n = 254) in controls compared with 31.9% (n = 249) in CH patients. The minor allele frequency (A allele) of rs1800759 was 42.3% (n = 324) in controls and 41.9% (n = 327) in CH patients. Statistical analysis showed no significant differences in allele as well as in genotype or haplotype frequencies between the patient and control group for either SNP. This was also seen after stratifying the patient group for experiencing alcohol as a trigger factor. Conclusions The data did not support an association of the ADH4 SNPs rs1126671 and rs1800759 with CH. A comparison with previous studies revealed variance in genotype, allele, and haplotype frequencies among the different populations which might contribute to the contradictory results. Although a significant association with CH in Swedish case–control group was not found, ADH4 as a candidate gene for CH could not be excluded.
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Affiliation(s)
- Carmen Fourier
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Caroline Ran
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna Steinberg
- Department of Clinical Neuroscience, Karolinska University Hospital, Stockholm, Sweden
| | - Christina Sjöstrand
- Department of Clinical Neuroscience, Karolinska University Hospital, Stockholm, Sweden
| | - Elisabet Waldenlind
- Department of Clinical Neuroscience, Karolinska University Hospital, Stockholm, Sweden
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Akram H, Miller S, Lagrata S, Hyam J, Jahanshahi M, Hariz M, Matharu M, Zrinzo L. Ventral tegmental area deep brain stimulation for refractory chronic cluster headache. Neurology 2016; 86:1676-82. [PMID: 27029635 DOI: 10.1212/wnl.0000000000002632] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 01/20/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To present outcomes in a cohort of medically intractable chronic cluster headache (CCH) patients treated with ventral tegmental area (VTA) deep brain stimulation (DBS). METHODS In an uncontrolled open-label prospective study, 21 patients (17 male; mean age 52 years) with medically refractory CCH were selected for ipsilateral VTA-DBS by a specialist multidisciplinary team including a headache neurologist and functional neurosurgeon. Patients had also failed or were denied access to occipital nerve stimulation within the UK National Health Service. The primary endpoint was improvement in the headache frequency. Secondary outcomes included other headache scores (severity, duration, headache load), medication use, disability and affective scores, quality of life (QoL) measures, and adverse events. RESULTS Median follow-up was 18 months (range 4-60 months). At the final follow-up point, there was 60% improvement in headache frequency (p = 0.007) and 30% improvement in headache severity (p = 0.001). The headache load (a composite score encompassing frequency, severity, and duration of attacks) improved by 68% (p = 0.002). Total monthly triptan intake of the group dropped by 57% posttreatment. Significant improvement was observed in a number of QoL, disability, and mood scales. Side effects included diplopia, which resolved in 2 patients following stimulation adjustment, and persisted in 1 patient with a history of ipsilateral trochlear nerve palsy. There were no other serious adverse events. CONCLUSIONS This study supports that VTA-DBS may be a safe and effective therapy for refractory CCH patients who failed conventional treatments. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that VTA-DBS decreases headache frequency, severity, and headache load in patients with medically intractable chronic cluster headaches.
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Affiliation(s)
- Harith Akram
- From the Unit of Functional Neurosurgery (H.A., J.H., M.J., M.H., L.Z.), Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London; Victor Horsley Department of Neurosurgery (H.A., J.H., L.Z.), National Hospital for Neurology and Neurosurgery, London; Headache Group (S.M., S.L., M.M.), Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK; and Department of Neurosurgery (M.H.), University Hospital, Umeå, Sweden.
| | - Sarah Miller
- From the Unit of Functional Neurosurgery (H.A., J.H., M.J., M.H., L.Z.), Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London; Victor Horsley Department of Neurosurgery (H.A., J.H., L.Z.), National Hospital for Neurology and Neurosurgery, London; Headache Group (S.M., S.L., M.M.), Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK; and Department of Neurosurgery (M.H.), University Hospital, Umeå, Sweden
| | - Susie Lagrata
- From the Unit of Functional Neurosurgery (H.A., J.H., M.J., M.H., L.Z.), Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London; Victor Horsley Department of Neurosurgery (H.A., J.H., L.Z.), National Hospital for Neurology and Neurosurgery, London; Headache Group (S.M., S.L., M.M.), Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK; and Department of Neurosurgery (M.H.), University Hospital, Umeå, Sweden
| | - Jonathan Hyam
- From the Unit of Functional Neurosurgery (H.A., J.H., M.J., M.H., L.Z.), Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London; Victor Horsley Department of Neurosurgery (H.A., J.H., L.Z.), National Hospital for Neurology and Neurosurgery, London; Headache Group (S.M., S.L., M.M.), Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK; and Department of Neurosurgery (M.H.), University Hospital, Umeå, Sweden
| | - Marjan Jahanshahi
- From the Unit of Functional Neurosurgery (H.A., J.H., M.J., M.H., L.Z.), Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London; Victor Horsley Department of Neurosurgery (H.A., J.H., L.Z.), National Hospital for Neurology and Neurosurgery, London; Headache Group (S.M., S.L., M.M.), Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK; and Department of Neurosurgery (M.H.), University Hospital, Umeå, Sweden
| | - Marwan Hariz
- From the Unit of Functional Neurosurgery (H.A., J.H., M.J., M.H., L.Z.), Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London; Victor Horsley Department of Neurosurgery (H.A., J.H., L.Z.), National Hospital for Neurology and Neurosurgery, London; Headache Group (S.M., S.L., M.M.), Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK; and Department of Neurosurgery (M.H.), University Hospital, Umeå, Sweden
| | - Manjit Matharu
- From the Unit of Functional Neurosurgery (H.A., J.H., M.J., M.H., L.Z.), Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London; Victor Horsley Department of Neurosurgery (H.A., J.H., L.Z.), National Hospital for Neurology and Neurosurgery, London; Headache Group (S.M., S.L., M.M.), Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK; and Department of Neurosurgery (M.H.), University Hospital, Umeå, Sweden
| | - Ludvic Zrinzo
- From the Unit of Functional Neurosurgery (H.A., J.H., M.J., M.H., L.Z.), Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London; Victor Horsley Department of Neurosurgery (H.A., J.H., L.Z.), National Hospital for Neurology and Neurosurgery, London; Headache Group (S.M., S.L., M.M.), Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK; and Department of Neurosurgery (M.H.), University Hospital, Umeå, Sweden
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Curto M, Lionetto L, Negro A, Capi M, Perugino F, Fazio F, Giamberardino MA, Simmaco M, Nicoletti F, Martelletti P. Altered serum levels of kynurenine metabolites in patients affected by cluster headache. J Headache Pain 2016; 17:27. [PMID: 27000870 PMCID: PMC4801826 DOI: 10.1186/s10194-016-0620-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 03/17/2016] [Indexed: 01/03/2023] Open
Abstract
Background The reported efficacy of memantine in the treatment of patients with cluster headache (CH) suggests that NMDA receptors are involved in mechanisms of nociceptive sensitization within the trigeminal system associated with CH. NMDA receptors are activated or inhibited by neuroactive compounds generated by tryptophan metabolism through the kynurenine pathway. In the accompanying manuscript, we have found that serum levels of all kynurenine metabolites are altered in patients with chronic migraine. Here, we have extended the study to patients affected by episodic or chronic CH as compared to healthy controls. Method We assessed serum levels of kynurenine (KYN), kynurenic Acid (KYNA), anthranilic acid (ANA), 3-hydroxy-anthranilic acid (3-HANA), 3-hydroxykynurenine (3-HK), xanthurenic acid (XA), quinolinic acid (QUINA), tryptophan (Trp) and 5-hydroxyindolacetic acid (5-HIAA) by means of a liquid chromatography/tandem mass spectrometry (LC/MS-MS) method in 21 patients affected by CH (15 with episodic and 6 with chronic CH), and 35 age-matched healthy subjects. Patients with psychiatric co-morbidities, systemic inflammatory, endocrine or neurological disorders, and mental retardation were excluded. Results LC/MS-MS analysis of kynurenine metabolites showed significant reductions in the levels of KYN (-36 %), KYNA (-34 %), 3-HK (-51 %), 3-HANA (-54 %), XA (-25 %), 5-HIAA (-39 %) and QUINA (-43 %) in the serum of the overall population of patients affected by CH, as compared to healthy controls. Serum levels of Trp and ANA were instead significantly increased in CH patients (+18 % and +54 %, respectively). There was no difference in levels of any metabolite between patients affected by episodic and chronic CH, with the exception of KYN levels, which were higher in patients with chronic CH. Conclusion The reduced levels of KYNA (an NMDA receptor antagonist) support the hypothesis that NMDA receptors are overactive in CH. A similar reduction in KYNA levels was shown in the accompanying manuscript in patients affected by chronic migraine. The reduced levels of XA, a putative analgesic compound, may contribute to explain the severity of pain attacks in CH. These data, associated with the data reported in the accompanying manuscript, supports a role for the kynurenine pathway in the pathophysiology of chronic headache disorders.
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Affiliation(s)
- Martina Curto
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA. .,Department of Molecular Medicine, Sant'Andrea Medical Center, Sapienza University of Rome, Via di Grottarossa 1035-1039, Rome, 00189, Italy. .,Regional referral headache center, Sant'Andrea Hospital, Rome, Italy.
| | | | - Andrea Negro
- Department of Molecular Medicine, Sant'Andrea Medical Center, Sapienza University of Rome, Via di Grottarossa 1035-1039, Rome, 00189, Italy.,Advanced Molecular Diagnostics, IDI-IRCCS, Rome, Italy
| | - Matilde Capi
- Advanced Molecular Diagnostics, IDI-IRCCS, Rome, Italy
| | - Francesca Perugino
- Department of Molecular Medicine, Sant'Andrea Medical Center, Sapienza University of Rome, Via di Grottarossa 1035-1039, Rome, 00189, Italy
| | | | - Maria Adele Giamberardino
- Headache Center and Geriatrics Clinic, Department of Medicine and Science of Aging, "G. D'Annunzio" University, Chieti, Italy
| | | | - Ferdinando Nicoletti
- IRCCS Neuromed, Pozzilli, Italy.,Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy
| | - Paolo Martelletti
- Department of Molecular Medicine, Sant'Andrea Medical Center, Sapienza University of Rome, Via di Grottarossa 1035-1039, Rome, 00189, Italy.,Regional referral headache center, Sant'Andrea Hospital, Rome, Italy
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El-Sherbiny NA, Masoud M, Shalaby NM, Shehata HS. Prevalence of primary headache disorders in Fayoum Governorate, Egypt. J Headache Pain 2015; 16:85. [PMID: 26438329 PMCID: PMC4593989 DOI: 10.1186/s10194-015-0569-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 09/27/2015] [Indexed: 01/03/2023] Open
Abstract
Background There is abundance of epidemiological studies of headache in developed and western countries; however, data in developing countries and in Egypt are still lacking. This study aims to detect the prevalence of primary headache disorders in both urban and rural sectors in Fayoum governorate, Egypt. Methods A total of 2600 subjects were included using multi-stage stratified systematic random sampling, with respondent rate of 91.3 %. A pre-designed Arabic version, interviewer-administered, pilot tested structured questionnaire was developed according to The International Classification of Headache Disorders, 3rd edition (beta version), and this questionnaire was validated and the strength of agreement in headache diagnosis was good. Results The 1-year headache prevalence was 51.4 %, which was more prevalent in urban dwellers. The most common primary headache type was episodic tension type headache (prevalence; 24.5 %), followed by episodic migraine (prevalence; 17.3 %), both types peaked in midlife. Headache disorders were more common in females with exception of cluster headache that showed the expected male dominance. The risk of chronic headache increased more than one fold and half when the participants were females, married, and in those with high education. More than 60 % of our participants did not seek medical advice for their headaches problem; this percentage was higher in rural areas. Conclusions Primary headache disorders are common in Egypt; prevalence rate was comparable with western countries with exception of episodic tension headache. Still headache is under-estimated and under-recognized in Egypt and this problem should be targeted by health care providers.
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Luvisetto S, Gazerani P, Cianchetti C, Pavone F. Botulinum Toxin Type a as a Therapeutic Agent against Headache and Related Disorders. Toxins (Basel) 2015; 7:3818-44. [PMID: 26404377 PMCID: PMC4591645 DOI: 10.3390/toxins7093818] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/15/2015] [Indexed: 12/24/2022] Open
Abstract
Botulinum neurotoxin A (BoNT/A) is a toxin produced by the naturally-occurring Clostridium botulinum that causes botulism. The potential of BoNT/A as a useful medical intervention was discovered by scientists developing a vaccine to protect against botulism. They found that, when injected into a muscle, BoNT/A causes a flaccid paralysis. Following this discovery, BoNT/A has been used for many years in the treatment of conditions of pathological muscle hyperactivity, like dystonias and spasticities. In parallel, the toxin has become a “glamour” drug due to its power to ward off facial wrinkles, particularly frontal, due to the activity of the mimic muscles. After the discovery that the drug also appeared to have a preventive effect on headache, scientists spent many efforts to study the potentially-therapeutic action of BoNT/A against pain. BoNT/A is effective at reducing pain in a number of disease states, including cervical dystonia, neuropathic pain, lower back pain, spasticity, myofascial pain and bladder pain. In 2010, regulatory approval for the treatment of chronic migraine with BoNT/A was given, notwithstanding the fact that the mechanism of action is still not completely elucidated. In the present review, we summarize experimental evidence that may help to clarify the mechanisms of action of BoNT/A in relation to the alleviation of headache pain, with particular emphasis on preclinical studies, both in animals and humans. Moreover, we summarize the latest clinical trials that show evidence on headache conditions that may obtain benefits from therapy with BoNT/A.
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Affiliation(s)
- Siro Luvisetto
- National Research Council (CNR) of Italy, Institute of Cell Biology and Neurobiology, Roma 00185, Italy.
| | - Parisa Gazerani
- Center for Sensory-Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg East 9220, Denmark.
| | - Carlo Cianchetti
- Former Professor of Child & Adolescent Neuropsychiatry, University of Cagliari, Cagliari 09124, Italy.
| | - Flaminia Pavone
- National Research Council (CNR) of Italy, Institute of Cell Biology and Neurobiology, Roma 00185, Italy.
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20
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Uca AU, Kozak HH. The Alice in Wonderland Syndrome: A Case of Aura Accompanying Cluster Headache. Balkan Med J 2015; 32:320-2. [PMID: 26185724 DOI: 10.5152/balkanmedj.2015.15650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 01/10/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cluster headache (CH) is a primary headache which has highly specific and sensitive criteria, and notpresence of an aura. It has been recently reported that CH may not presence with aura more than ever and this condition will be identified by headache specialists as a new form of CH. CASE REPORT As there is no report to our knowledge on Alice in Wonderland syndrome (AIWS) manifested as CH aura in the literature, we present a case of a 35-year-old man having AIWS as CH aura. CONCLUSION Clinically, AIWS is not uncommon and is likely to be underestimated as a diagnostic entity. Valproate may be preferred for treatment in CH patients with AIWS aura.
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Affiliation(s)
- Ali Ulvi Uca
- Department of Neurology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Hasan Hüseyin Kozak
- Department of Neurology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
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21
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Altiokka O, Mutluay B, Koksal A, Ciftci-Kavaklioglu B, Ozturk M, Altunkaynak Y, Baybas S, Soysal A. Evaluation of interictal autonomic function during attack and remission periods in cluster headaches. Cephalalgia 2015; 36:37-43. [DOI: 10.1177/0333102415580112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 03/03/2015] [Indexed: 12/29/2022]
Abstract
Objective To investigate which part of the autonomic system is mainly involved and assess the sensitivity of face sympathetic skin response in cluster headache. Material and methods The study sample consisted of 19 drug-free cluster headache patients (16 males, three females) and 19 healthy volunteers. Demographic features and pain characteristics were thoroughly identified. Dysautonomic symptoms were evaluated during attack and remission periods of cluster headache patients. Orthostatic hypotension, R-R interval variation and sympathetic skin responses obtained from the face and four extremities were evaluated and the sensitivity of face sympathetic skin responses was assessed in contrast to extremity sympathetic skin responses. Results All sympathetic skin responses of face and extremities could be obtained during attack and remission periods. On the symptomatic side, mean latency of face sympathetic skin responses was longer compared to the asymptomatic side and controls (p = 0.02, p = 0.004). There were no differences in latency or amplitude of extremity sympathetic skin responses between symptomatic and asymptomatic sides and controls. No significant relationship was determined between sympathetic skin responses, R-R interval variation, orthostatic hypotension and cluster headache clinical features. Conclusion Sympathetic hypoactivity of the face seems to predominate the pathophysiology of cluster headache. Face sympathetic skin responses might be more sensitive compared to extremity sympathetic skin response in demonstrating dysautonomic symptoms in cluster headache patients.
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Affiliation(s)
- Ozlem Altiokka
- Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Turkey
| | - Belgin Mutluay
- Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Turkey
| | - Ayhan Koksal
- Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Turkey
| | - Beyza Ciftci-Kavaklioglu
- Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Turkey
| | - Musa Ozturk
- Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Turkey
| | - Yavuz Altunkaynak
- Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Turkey
| | - Sevim Baybas
- Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Turkey
| | - Aysun Soysal
- Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Turkey
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Diot C, Eiden C, Leglise Y, Donnadieu-Rigole H, Peyrière H. Role of Methadone in Induction and/or Exacerbation of Cluster Headache in Patients Treated for Opioid Addiction. Therapie 2014; 70:305-7. [PMID: 25487851 DOI: 10.2515/therapie/2014211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 10/02/2014] [Indexed: 11/20/2022]
Abstract
Methadone is a potent opioid agonist widely used in opioid maintenance therapy. In some countries, methadone is available for pain treatment. We report the cases of two patients with history of substance abuse (mainly heroin), who presented with cluster headache possibly related to high-dose methadone. One possible explanation for the severe pain described in these cases is hyperalgesia induced by high doses of methadone.
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Affiliation(s)
- Caroline Diot
- Département de pharmacologie médicale et toxicologie, Centre d'addictovigilance, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France
| | - Céline Eiden
- Département de pharmacologie médicale et toxicologie, Centre d'addictovigilance, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France
| | - Yves Leglise
- Unité de traitement des toxicodépendances, Médecine interne E - addictologie, Hôpital Saint Eloi, CHU Montpellier, Montpellier, France
| | - Hélène Donnadieu-Rigole
- Département de médecine interne et addictologie, Hôpital Saint-Eloi, CHU Montpellier, Montpellier, France
| | - Hélène Peyrière
- Département de pharmacologie médicale et toxicologie, Centre d'addictovigilance, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France
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Lee AG, Al-Zubidi N, Beaver HA, Brazis PW. An Update on Eye Pain for the Neurologist. Neurol Clin 2014; 32:489-505. [DOI: 10.1016/j.ncl.2013.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Wu EC, Rothholtz VS, Zardouz S, Lee AD, Djalilian HR. Facial nerve hemangioma: a case report. EAR, NOSE & THROAT JOURNAL 2014; 92:262-3. [PMID: 23780592 DOI: 10.1177/014556131309200607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Although hemangiomas are relatively common in the head and neck, those that originate in the facial nerve are extremely rare. These benign tumors have the potential to compress or invade the adjacent facial nerve and thereby produce facial paralysis and other associated symptoms. We present a case of facial nerve hemangioma in a 15-year-old girl that initially manifested as unilateral facial weakness. We also discuss the diagnostic imaging and management options.
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Affiliation(s)
- Edward C Wu
- Department of Head and Neck Surgery, University of California Los Angeles Medical Center, Los Angeles, CA, USA
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Lovati C, D’Amico D, Raimondi E, Mariani C, Bertora P. Sleep and headache: a bidirectional relationship. Expert Rev Neurother 2014; 10:105-17. [DOI: 10.1586/ern.09.135] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Sokolov AY, Lyubashina OA, Amelin AV, Panteleev SS. The role of noradrenalin in the pathogenesis of primary headaches. NEUROCHEM J+ 2013. [DOI: 10.1134/s1819712413040090] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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A single-fibre electromyography study of neuromuscular transmission in patients with cluster headache. Neurol Neurochir Pol 2012; 46:140-4. [PMID: 22581595 DOI: 10.5114/ninp.2012.28256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Mutations of CACNA1A, which encodes a neuronal P/Q Ca2+ channel, are present in patients with familial hemiplegic migraine, and possibly in other types of migraine as well. This calcium channel is also involved in neuromuscular transmission. In our previous study we confirmed that the single-fibre electromyography (SFEMG) method can demonstrate a neuromuscular transmission deficit in migraine with aura. The aim of our present study was to estimate the neurotransmitter dysfunction in cluster headache and to compare the results between patients with cluster headache and those with migraine with aura. MATERIAL AND METHODS We selected 6 patients with cluster headache and 6 patients with migraine with typical aura. SFEMG of the voluntarily activated extensor digitorum communis muscle was performed. RESULTS The SFEMG results were in the normal range in the cluster headache group and in the healthy controls. Slight neuromuscular transmission disturbances were present in patients with migraine with aura. CONCLUSIONS The abnormal neuromuscular transmission detectable by SFEMG may reflect a genetically determined dysfunction of the P/Q Ca2+ channels in a group of migraineurs with aura. Conversely, absence of neuromuscular abnormalities in cluster headache patients could be explained by different aetiology not resulting in channelopathy. Single-fibre electromyography could be a helpful tool in clinically questionable cases in differentiating between cluster headache and migraine with aura.
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Peñarrocha-Diago M, Boronat A, Peñarrocha-Oltra D, Ata-Ali J, Bagan JV, Peñarrocha-Diago M. Clinical course of patients with episodic cluster headache treated with corticosteroids inproximity to the sphenopalatine ganglion: a preliminary study of 23 patients. Med Oral Patol Oral Cir Bucal 2012; 17:e477-82. [PMID: 22143727 PMCID: PMC3476098 DOI: 10.4317/medoral.17578] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 09/03/2011] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE A study is made of the clinical course of patients with episodic cluster headache following the injection of corticosteroids in the proximity of the sphenopalatine ganglion of the affected side. STUDY DESIGN A retrospective observation study was made corresponding to the period between 2006 and 2010. Patients with episodic cluster headache received corticosteroid infiltrations in the vicinity of the sphenopalatine ganglion. Data were collected to assess the clinical course, quantifying pain intensity and quality of life. A total of 23 patients (11 women and 12 men) with a mean age of 50.4 years (range 25-65) were included. Forty percent of the patients had undergone dental extractions in the quadrant affected by the pain, before the development of episodic cluster headache, and 37.8% underwent extractions in the same quadrant after appearance of the headache. RESULTS Most of the patients suffered 1-3 attacks a day, with a duration of pain of between 31-90 minutes. The mean pain intensity score during the attacks at the time of the first visit was 8.8 (range 6-10), versus 5.4 (range 3-9) one week after the first corticosteroid injection. On the first visit, 86.9% of the patients reported unbearable pain, versus 21.7% after one week, and a single patient after one month. CONCLUSIONS The evolution of episodic cluster headache is unpredictable and variable, though corticosteroid administration clearly reduces the attacks and their duration.
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Efficacy and safety of lithium carbonate treatment of chronic spinal cord injuries: a double-blind, randomized, placebo-controlled clinical trial. Spinal Cord 2011; 50:141-6. [DOI: 10.1038/sc.2011.126] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ivanusic JJ, Kwok MMK, Ahn AH, Jennings EA. 5-HT(1D) receptor immunoreactivity in the sphenopalatine ganglion: implications for the efficacy of triptans in the treatment of autonomic signs associated with cluster headache. Headache 2011; 51:392-402. [PMID: 21352213 DOI: 10.1111/j.1526-4610.2011.01843.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine if 5-HT(1D) receptors are located in the sphenopalatine ganglion. BACKGROUND While the 5-HT(1D) receptor has been described in sensory and sympathetic ganglia in the head, it was not known whether they were also located in parasympathetic ganglia. METHODS We used retrograde labeling combined with immunohistochemistry to examine 5-HT(1D) receptor immunoreactivity in rat sphenopalatine ganglion neurons that project to the lacrimal gland, nasal mucosa, cerebral vasculature, and trigeminal ganglion. RESULTS We found 5-HT(1D) receptor immunoreactivity in nerve terminals around postganglionic cell bodies within the sphenopalatine ganglion. All 5-HT(1D) -immunoreactive terminals were also immunoreactive for calcitonin gene-related peptide but not vesicular acetylcholine transporter, suggesting that they were sensory and not preganglionic parasympathetic fibers. Our retrograde labeling studies showed that approximately 30% of sphenopalatine ganglion neurons innervating the lacrimal gland, 23% innervating the nasal mucosa, and 39% innervating the trigeminal ganglion were in apparent contact with 5-HT(1D) receptor containing nerve terminals. CONCLUSION These data suggest that 5-HT(1D) receptors within primary afferent neurons that innervate the sphenopalatine ganglion are in a position to modulate the excitability of postganglionic parasympathetic neurons that innervate the lacrimal gland and nasal mucosa, as well as the trigeminal ganglion. This has implications for triptan (5-HT(1D) receptor agonist) actions on parasympathetic symptoms in cluster headache.
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Affiliation(s)
- Jason J Ivanusic
- From the Department of Anatomy and Cell Biology, University of Melbourne, Parkville, Australia (J.J. Ivanusic, M.M.K. Kwok, E.A. Jennings); School of Dentistry James Cook University, Cairns, Queensland, Australia (E.A. Jennings); Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA (A.H. Ahn)
| | - Matthew M K Kwok
- From the Department of Anatomy and Cell Biology, University of Melbourne, Parkville, Australia (J.J. Ivanusic, M.M.K. Kwok, E.A. Jennings); School of Dentistry James Cook University, Cairns, Queensland, Australia (E.A. Jennings); Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA (A.H. Ahn)
| | - Andrew H Ahn
- From the Department of Anatomy and Cell Biology, University of Melbourne, Parkville, Australia (J.J. Ivanusic, M.M.K. Kwok, E.A. Jennings); School of Dentistry James Cook University, Cairns, Queensland, Australia (E.A. Jennings); Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA (A.H. Ahn)
| | - Ernest A Jennings
- From the Department of Anatomy and Cell Biology, University of Melbourne, Parkville, Australia (J.J. Ivanusic, M.M.K. Kwok, E.A. Jennings); School of Dentistry James Cook University, Cairns, Queensland, Australia (E.A. Jennings); Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA (A.H. Ahn)
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Effendi K, Jarjoura S, Mathieu D. SUNCT syndrome successfully treated by gamma knife radiosurgery: case report. Cephalalgia 2011; 31:870-3. [PMID: 21478230 DOI: 10.1177/0333102411404716] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The SUNCT syndrome (short-unilateral neuralgiform headache with conjunctival injection and tearing) can be very disabling for affected patients and is often refractory to medical management. We report the first case of SUNCT with a successful response to stereotactic radiosurgery without any adverse effect. CASE After failing optimal medical treatment, a 82-year old male patient suffering from SUNCT syndrome was treated with Gamma knife radiosurgery. The trigeminal nerve and sphenopalatine ganglion were targeted with a maximum dose of 80 Gy each. The patient had complete pain cessation 2 weeks after the treatment, and remains pain-free with no medication at the latest follow-up 39 months after radiosurgery. He did not have any side effect from the procedure. CONCLUSION Gamma knife radiosurgery is an option for medically refractory SUNCT patients.
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Affiliation(s)
- Khaled Effendi
- Service de neurochirurgie, Centre Hospitalier Universitaire de Sherbrooke, 3001 12th avenue Nord, Sherbrooke, QC, Canada
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Ivanusic JJ, Kwok MMK, Jennings EA. Peripheral targets of 5-HT(1D) receptor immunoreactive trigeminal ganglion neurons. Headache 2011; 51:744-51. [PMID: 21453326 DOI: 10.1111/j.1526-4610.2011.01862.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of the current study was to determine the proportion of trigeminal primary afferent neurons that innervate the intracranial vasculature, and other craniofacial tissues, that are also 5 hydroxy triptamine (5-HT)(1D) receptor immunoreactive. METHODS Retrograde tracing and immunohistochemistry was used to identify 5-HT(1D) receptor labeled trigeminal primary afferent neurons that innervate the lacrimal gland (n = 3 animals), nasal mucosa (n = 3 animals), and the intracranial vasculature (middle meningeal artery in the dura [n = 3 animals] and middle cerebral artery [n = 3 animals]). RESULTS The percentage of neurons that were 5-HT(1D) receptor immunoreactive was greater for primary afferent neurons innervating the middle meningeal artery (41.8 ± 1%) than those innervating the middle cerebral artery (28.4 ± 0.8%), nasal mucosa (25.6 ± 1%), or lacrimal gland (23.5 ± 3%). For each retrograde labeled population, the 5-HT(1D) receptor immunoreactive cells were among the smallest of the retrograde labeled cells. CONCLUSIONS These findings provide a basis for understanding the role of 5-HT(1D) receptor agonists (eg, triptans) in the treatment of primary vascular headaches and suggest that the selectivity of triptans in the treatment of these headaches does not appear to result from specific localization of the 5-HT(1D) receptor to trigeminovascular neurons alone.
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Affiliation(s)
- Jason J Ivanusic
- Department of Anatomy & Cell Biology, University of Melbourne, Parkville, Vic., Australia
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Kano H, Kondziolka D, Niranjan A, Flickinger JC, Lunsford LD. Gamma Knife Stereotactic Radiosurgery in the Management of Cluster Headache. Curr Pain Headache Rep 2010; 15:118-23. [DOI: 10.1007/s11916-010-0169-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Providencia RA. Headache and cardiovascular disease: old symptoms, new proposals. Future Cardiol 2010; 6:703-23. [DOI: 10.2217/fca.10.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Evidence of a link between headache symptoms and cardiovascular disease has rapidly grown in recent years and it is of utmost importance for the cardiologist and neurologist to be aware of this intimate connection. A brief overview of different cardiovascular diseases (namely hypertension, stroke, coronary heart disease, patent foramen ovale, atrial septal defects, atrial septal aneurisms, mitral valve prolapse, and aortic and carotid disease) that may be related to headache is presented in this article. Proposed pathophysiological mechanisms for this association and landmark studies are reviewed and discussed.
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Cosentino G, Fierro B, Puma AR, Talamanca S, Brighina F. Different forms of trigeminal autonomic cephalalgias in the same patient: description of a case. J Headache Pain 2010; 11:281-4. [PMID: 20376519 PMCID: PMC3451915 DOI: 10.1007/s10194-010-0210-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 03/23/2010] [Indexed: 12/19/2022] Open
Abstract
The trigeminal autonomic cephalalgias (TACs), including cluster headache, paroxysmal hemicrania and SUNCT, are characterized by the cardinal combination of short-lasting unilateral pain and autonomic phenomena affecting the head. Hemicrania continua (HC) shares many clinical characteristics with TACs, including unilateral pain and ipsilateral autonomic features. Nevertheless, HC is separately classified in the revised International Classification of Headache Disorders (ICHD-II). Here, we describe the case of a 45-year-old man presenting an unusual concurrence of different forms of primary headaches associated with autonomic signs, including subsequently ipsilateral cluster headache, SUNCT and HC. This report supports the theory that common mechanisms could be involved in pathophysiology of different primary headache syndromes.
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Affiliation(s)
- Giuseppe Cosentino
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BioNeC), University of Palermo, Via G. La Loggia 1, 90129 Palermo, Italy
| | - Brigida Fierro
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BioNeC), University of Palermo, Via G. La Loggia 1, 90129 Palermo, Italy
| | - Angela Rita Puma
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BioNeC), University of Palermo, Via G. La Loggia 1, 90129 Palermo, Italy
| | - Simona Talamanca
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BioNeC), University of Palermo, Via G. La Loggia 1, 90129 Palermo, Italy
| | - Filippo Brighina
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BioNeC), University of Palermo, Via G. La Loggia 1, 90129 Palermo, Italy
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van Kleef M, Lataster A, Narouze S, Mekhail N, Geurts JW, van Zundert J. Evidence-based interventional pain medicine according to clinical diagnoses. 2. Cluster headache. Pain Pract 2010; 9:435-42. [PMID: 19874534 DOI: 10.1111/j.1533-2500.2009.00331.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cluster headache is a strictly unilateral headache that is associated with ipsilateral cranial autonomic symptoms and usually has a circadian and circannual pattern. Prevalence is estimated at 0.5 to 1.0/1,000. The diagnosis of cluster headache is made based on the patient's case history. There are two main clinical patterns of cluster headache: the episodic and the chronic. Episodic is the most common pattern of cluster headache. It occurs in periods lasting 7 days to 1 year and is separated by at least a 1-month pain-free interval. The attacks in the chronic form occur for more than 1 year without remission periods or with remission periods lasting less than 1 month. Conservative therapy consists of abortive and preventative remedies. Ergotamines and sumatriptan injections, sublingual ergotamine tartrate administration, and oxygen inhalation are effective abortive therapies. Verapamil is an effective and the safest prophylactic remedy. When pharmacological and oxygen therapies fail, interventional pain treatment may be considered. The effectiveness of radiofrequency treatment of the ganglion pterygopalatinum and of occipital nerve stimulation is only evaluated in observational studies, resulting in a 2 C+ recommendation. In conclusion, the primary treatment is medication. Radiofrequency treatment of the ganglion pterygopalatinum should be considered in patients who are resistant to conservative pain therapy. In patients with cluster headache refractory to all other treatments, occipital nerve stimulation may be considered, preferably within the context of a clinical study.
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Affiliation(s)
- Maarten van Kleef
- Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands.
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