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Kang MK, Cho SJ. SUNCT, SUNA and short-lasting unilateral neuralgiform headache attacks: Debates and an update. Cephalalgia 2024; 44:3331024241232256. [PMID: 38415675 DOI: 10.1177/03331024241232256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Short-lasting unilateral neuralgiform headache attacks (SUNHA) have the features of both short-lasting unilateral neuralgiform pain, such as trigeminal neuralgia or stabbing headache, and associated trigeminal autonomic symptoms, such as paroxysmal hemicrania or cluster headache. Recognizing and adequately treating SUNHA is essential but current treatment methods are ineffective in treating SUNHA. METHODS We reviewed the changes in the concept of short-lasting unilateral neuralgiform headache attacks and provide a narrative review of the current medical and surgical treatment options, from the first choice of treatment for patients to treatments for selective intractable cases. RESULTS Unlike the initial impression of an intractable primary headache disorder affecting older men, SUNHA affects both sexes throughout their lifespan. One striking feature of SUNHA is that the attacks are triggered by cutaneous or intraoral stimulation. The efficacy of conventional treatments is disappointing and challenging, and preventive therapy is the mainstay of treatment because of highly frequent attacks of a very brief duration. Amongst them, lamotrigine is effective in approximately two-third of the patients with SUNHA, and intravenous lidocaine is essential for the management of acute exacerbation of intractable pain. Topiramate, oxcarbazepine and gabapentin are considered good secondary options for SUNHA, and botulinum toxin can be used in selective cases. Neurovascular compression is commonly observed in SUNHA, and surgical approaches, such as neurovascular compression, have been reported to be effective for intractable cases. CONCLUSIONS Recent advances in the understanding of SUNHA have improved the recognition and treatment approaches for this unique condition.
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Affiliation(s)
- Mi-Kyoung Kang
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
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2
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Cuneo A, Murinova N. Headache Management in Individuals with Brain Tumor. Semin Neurol 2024; 44:74-89. [PMID: 38183973 DOI: 10.1055/s-0043-1777423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2024]
Abstract
Headache occurs commonly in individuals diagnosed with cerebral neoplasm. Though the features of a brain tumor-associated headache may vary, a progressive nature of headache and a change in headache phenotype from a prior primary headache disorder often are identified. Pathophysiologic mechanisms proposed for headache associated with brain tumor include headache related to traction on pain-sensitive structures, activation of central and peripheral pain processes, and complications from surgical, chemotherapeutic and/or radiotherapy treatment(s). Optimization of headache management is important for an individual's quality of life. Treatments are based upon patient-specific goals of care and may include tumor-targeted medical and surgical interventions, as well as a multimodal headache treatment approach incorporating acute and preventive medications, nutraceuticals, neuromodulation devices, behavioral interventions, anesthetic nerve blocks, and lifestyles changes.
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Affiliation(s)
- Ami Cuneo
- Department of Neurology, University of Washington, Seattle, Washington
| | - Natalia Murinova
- Department of Neurology, University of Washington, Seattle, Washington
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Eberhard SW, Jackman CT. Pediatric Cluster Headache Case Series: Symptomatic Cases and the Migraine Relationship. J Child Neurol 2024; 39:22-32. [PMID: 38146171 DOI: 10.1177/08830738231220415] [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: 12/27/2023]
Abstract
BACKGROUND Current criteria help differentiate cluster headache from migraine. However, children may have overlapping features making it difficult to distinguish the 2 conditions, which may delay diagnosis. Differentiating cluster headache from migraine is important regarding treatment as well as diagnostic workup of secondary headache etiologies. METHODS Cases at a single pediatric children's hospital from 2015 to 2023 diagnosed with cluster headache before the age of 18 years were reviewed. RESULTS Twenty-five cases were identified of which 22 cases met criteria for either chronic, episodic, or probable cluster headache. Three cases were diagnosed with cluster headache by their provider, but documentation was insufficient to meet criteria for cluster headache. There were 16 females and 9 males between ages 6 and 17 years. Five cases were identified as symptomatic, 2 cases as chronic, 7 cases as episodic, and 13 cases as probable cluster headache. Symptomatic etiologies include Graves disease, optic neuritis, prolactinoma, hypothalamic pilocytic astrocytoma with carotid stenosis, and congenital right eye blindness. Migrainous features were common, including 76% with nausea, 36% with vomiting, 68% with photophobia, and 56% with phonophobia. Patients with cluster headache also had an independent diagnosis of migraine in 64%. CONCLUSION Children with cluster headache have a high frequency of migrainous symptoms and co-occurrent diagnosis of migraine. A careful history may differentiate cluster headache from migraine and treated accordingly. Children with cluster headache features should undergo screening for secondary causes with appropriate imaging and other studies. Except for prolactinoma, the symptomatic associations noted in this case series have not been reported before.
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Affiliation(s)
| | - Christopher T Jackman
- Department of Neurology, Indiana University School of Medicine Neurology Department, Indianapolis, IN, USA
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May A, Evers S, Goadsby PJ, Leone M, Manzoni GC, Pascual J, Carvalho V, Romoli M, Aleksovska K, Pozo-Rosich P, Jensen RH. European Academy of Neurology guidelines on the treatment of cluster headache. Eur J Neurol 2023; 30:2955-2979. [PMID: 37515405 DOI: 10.1111/ene.15956] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND AND PURPOSE Cluster headache is a relatively rare, disabling primary headache disorder with a major impact on patients' quality of life. This work presents evidence-based recommendations for the treatment of cluster headache derived from a systematic review of the literature and consensus among a panel of experts. METHODS The databases PubMed (Medline), Science Citation Index, and Cochrane Library were screened for studies on the efficacy of interventions (last access July 2022). The findings in these studies were evaluated according to the recommendations of the European Academy of Neurology, and the level of evidence was established using GRADE (Grading of Recommendations Assessment, Development, and Evaluation). RECOMMENDATIONS For the acute treatment of cluster headache attacks, there is a strong recommendation for oxygen (100%) with a flow of at least 12 L/min over 15 min and 6 mg subcutaneous sumatriptan. Prophylaxis of cluster headache attacks with verapamil at a daily dose of at least 240 mg (maximum dose depends on efficacy and tolerability) is recommended. Corticosteroids are efficacious in cluster headache. To reach an effect, the use of at least 100 mg prednisone (or equivalent corticosteroid) given orally or at up to 500 mg iv per day over 5 days is recommended. Lithium, topiramate, and galcanezumab (only for episodic cluster headache) are recommended as alternative treatments. Noninvasive vagus nerve stimulation is efficacious in episodic but not chronic cluster headache. Greater occipital nerve block is recommended, but electrical stimulation of the greater occipital nerve is not recommended due to the side effect profile.
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Affiliation(s)
- Arne May
- Department of Systems Neuroscience, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
| | - Stefan Evers
- Department of Neurology, Lindenbrunn Hospital, Coppenbrügge, Germany
- Faculty of Medicine, University of Münster, Münster, Germany
| | - Peter J Goadsby
- NIHR King's CRF, SLaM Biomedical Research Centre, King's College London, London, UK
| | - Massimo Leone
- Neuroalgology Department, Foundation of the Carlo Besta Neurological Institute, IRCCS, Milan, Italy
| | | | - Julio Pascual
- Service of Neurology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Santander, Spain
| | - Vanessa Carvalho
- Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Michele Romoli
- Neurology and Stroke Unit, Bufalini Hospital, Cesena, Italy
| | | | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Headache Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rigmor H Jensen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
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Nägel S, Kraya T. [Trigeminal Autonomic Cephalgias]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2022; 90:121-134. [PMID: 35294984 DOI: 10.1055/a-1706-5952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Compared with migraine and tension-type headache, trigeminal autonomic cephalgias (TAC) are rare, but the resulting significant impairment and the not irrelevant prevalence (e. g., cluster headache 0.1%) make TACs important diagnoses. Unfortunately, the correct diagnosis is often delayed. This article provides an overview of the diagnostic approach and therapeutic options in TACs.
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Pérez-Pereda S, Madera J, González-Quintanilla V, Drake-Pérez M, Marzal Espí CN, Serrano Munuera C, García SC, Aguilella Linares C, Fernández Recio M, Velamazán Delgado G, Pascual J. Is conventional brain MRI useful for the diagnosis of cluster headache in patients who meet ICHD-3 criteria? Experience in three hospitals in Spain. J Neurol Sci 2021; 434:120122. [PMID: 34979370 DOI: 10.1016/j.jns.2021.120122] [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: 08/09/2021] [Revised: 11/24/2021] [Accepted: 12/21/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the frequency of symptomatic structural lesions and the diagnostic yield of conventional brain MRI in cluster headache (CH). BACKGROUND In contrast to migraine, brain MRI is recommended in patients with CH to exclude potential mimics. The prevalence of symptomatic CH is not known. METHODS We retrospectively analysed in detail the brain MRIs of patients diagnosed as CH in 3 Neurology Services in Spain and reviewed their clinical history. Clinical diagnoses were reassessed based on the ICHD-3 criteria. RESULTS We included 130 patients: 113 (86.9%) were male; mean age at diagnosis being 41.4 years (range 7-82). Forty-nine (37.7%) showed some abnormal MRI finding. Only in two cases potential symptomatic lesions were found: one trigeminal schwannoma and one craneopharyngioma, but both presented atypical features (facial hypoesthesia on examination and episodes of prolonged duration that had progressed to continuous refractory pain without specific pattern, respectively) and therefore did not fulfil the ICHD-3 CH criteria. The remaining abnormal MRI findings were: white matter lesions (24 patients; 18.4%), sinus inflammatory changes (13; 10.0%), small arachnoid cysts (5; 3.8%), empty sella turca (3; 2.3%), and other unspecific findings (8; 6.2%). All of them were not symptomatic based on neuroimaging characteristics, clinical course and response to treatment. CONCLUSIONS Brain MRI in patients who meet ICHD-3 CH criteria, with no atypical clinical features, does not show any clinically-relevant findings, suggesting that these criteria are highly predictive of its primary origin and that systematic MRI is not useful for the diagnosis of typical CH.
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Affiliation(s)
- Sara Pérez-Pereda
- Service of Neurology, University Hospital Marqués de Valdecilla, University of Cantabria and IDIVAL, Santander, Spain
| | - Jorge Madera
- Service of Neurology, University Hospital Marqués de Valdecilla, University of Cantabria and IDIVAL, Santander, Spain
| | - Vicente González-Quintanilla
- Service of Neurology, University Hospital Marqués de Valdecilla, University of Cantabria and IDIVAL, Santander, Spain
| | - Marta Drake-Pérez
- Service of Radiology, University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain
| | | | | | - Silvia Cusó García
- Service of Neurology, Fundació Hospital Sant Joan de Déu, Martorell, Barcelona, Spain
| | | | | | | | - Julio Pascual
- Service of Neurology, University Hospital Marqués de Valdecilla, University of Cantabria and IDIVAL, Santander, Spain.
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7
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Fiore A, Tsantes E, Curti E, Bazzurri V, Granella F. Secondary cluster headache due to a contralateral demyelinating periaqueductal gray matter lesion. Headache 2021; 61:1136-1139. [PMID: 34363407 DOI: 10.1111/head.14180] [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: 01/03/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES/BACKGROUND Tension-type headache and migraine without aura are the most common primary headaches occurring in people with demyelinating diseases, whereas cluster headache (CH) can be considered exceptional. The location of demyelinating lesions could be strategic in these cases, involving areas interacting with the trigeminovascular system. METHODS AND RESULTS We report a case of a 54-year-old woman with right-sided CH as the initial manifestation of multiple sclerosis and showing a left dorsal brainstem lesion on magnetic resonance imaging, in the region of the dorsal longitudinal fasciculus (DLF). CONCLUSION Our case seems to suggest a possible role of the DLF in the process that leads to CH attacks. Because neuroimaging clearly showed a lesion contralateral to CH pain, we hypothesize that some fibers from periaqueductal gray matter project to the contralateral side, besides the known ipsilateral connections.
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Affiliation(s)
- Alessia Fiore
- Neurosciences Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Elena Tsantes
- Neurosciences Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Erica Curti
- Neurosciences Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Veronica Bazzurri
- Neurosciences Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Franco Granella
- Neurosciences Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.,Multiple Sclerosis Centre, Department of General Medicine, Parma University Hospital, Parma, Italy
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Agha M, El Halabi T, Nofal O, Awwad S, Makki A. Trigeminal Autonomic Cephalalgia following Corneal Transplantation: A Case Report and Review of the Literature. PAIN MEDICINE 2021; 22:1707-1709. [PMID: 33760015 DOI: 10.1093/pm/pnaa478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mohamad Agha
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Tarek El Halabi
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Omar Nofal
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Shady Awwad
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Achraf Makki
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
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9
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Yu K, Chadehumbe M. A rare pediatric case of cluster headaches after cardiac catheterization in a patient with an isolated innominate artery. SAGE Open Med Case Rep 2021; 9:2050313X211023679. [PMID: 34178346 PMCID: PMC8202302 DOI: 10.1177/2050313x211023679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 05/17/2021] [Indexed: 11/30/2022] Open
Abstract
While cluster headaches are classified and considered a primary headache disorder, secondary causes of cluster headaches have been reported and may provide insight into cluster headaches’ potential pathophysiology. The mechanisms underlying this headache phenotype are poorly understood, and several theories have been proposed that range from the activation within the posterior hypothalamus to autonomic tone dysfunction. We provide a review of reported cases in the literature describing secondary causes after cardiac procedures. We will present a novel pediatric case report of a 16-year-old boy with an isolated innominate artery who presented with acute new-onset headaches 8 h following cardiac catheterization of the aortic arch with arteriography and left pulmonary artery stent placement. The headaches were characterized by attacks of excruciating pain behind the left eye and jaw associated with ipsilateral photophobia, conjunctival injection, rhinorrhea, with severe agitation and restlessness. These met the International Classification of Headache Disorders-3 criteria for episodic cluster headaches. The headaches failed to respond to non-steroidal anti-inflammatory medications, dopamine antagonists, and steroids. He showed an immediate response to treatment with oxygen. This unique case of cluster headaches following cardiac catheterization in a pediatric patient with an isolated innominate artery may provide new insight into cluster headaches’ pathogenesis. We hypothesize that the cardiac catheterization induced cardiac autonomic changes that contributed to the development of his cluster headaches. The role of aortic arch anomalies and procedures in potential disruption of the autonomic tone and the causation of cluster headaches is an area requiring further study.
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Affiliation(s)
- Kimberley Yu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Madeline Chadehumbe
- Department of Neurology, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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10
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Grangeon L, O'Connor E, Danno D, Ngoc TMP, Cheema S, Tronvik E, Davagnanam I, Matharu M. Is pituitary MRI screening necessary in cluster headache? Cephalalgia 2021; 41:779-788. [PMID: 33406848 PMCID: PMC8166405 DOI: 10.1177/0333102420983303] [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] [Indexed: 01/03/2023]
Abstract
Objective To determine the prevalence and clinical predictors of pituitary adenomas in cluster headache patients, in order to determine the necessity of performing dedicated pituitary magnetic resonance imaging in patients with cluster headache. Methods A retrospective study was conducted of all consecutive patients diagnosed with cluster headache and with available brain magnetic resonance imaging between 2007 and 2017 in a tertiary headache center. Data including demographics, attack characteristics, response to treatments, results of neuroimaging, and routine pituitary function tests were recorded. Results Seven hundred and eighteen cluster headache patients attended the headache clinic; 643 underwent a standard magnetic resonance imaging scan, of whom 376 also underwent dedicated pituitary magnetic resonance imaging. Pituitary adenomas occurred in 17 of 376 patients (4.52%). Non-functioning microadenomas (n = 14) were the most common abnormality reported. Two patients, one of whom lacked the symptoms of pituitary disease, required treatment for their pituitary lesion. No clinical predictors of those adenomas were identified after multivariate analysis using random forests. Systematic pituitary magnetic resonance imaging scanning did not benefit even a single patient in the entire cohort. Conclusion The prevalence of pituitary adenomas in cluster headache is similar to that reported in the general population, thereby precluding an over-representation of pituitary lesions in cluster headache. We conclude that the diagnostic assessment of cluster headache patients should not include specific pituitary screening. Only patients with standard brain magnetic resonance imaging findings or symptoms suggestive of a pituitary disorder require brain magnetic resonance imaging with dedicated pituitary views.
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Affiliation(s)
- Lou Grangeon
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, Queen Square, London, UK.,Headache and Facial Pain Group, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Emer O'Connor
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Daisuke Danno
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | | | - Sanjay Cheema
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Erling Tronvik
- Mathematics Institute of Orsay, Paris Sud University, Orsay, France.,Department of Neurology, St Olav's University Hospital, Trondheim, Norway.,NTNU (University of Science and Technology), Department of Neuromedicine and Movement Science, Trondheim, Norway
| | | | - Manjit Matharu
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, Queen Square, London, UK
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Argyriou AA, Vikelis M, Mantovani E, Litsardopoulos P, Tamburin S. Recently available and emerging therapeutic strategies for the acute and prophylactic management of cluster headache: a systematic review and expert opinion. Expert Rev Neurother 2020; 21:235-248. [PMID: 33243037 DOI: 10.1080/14737175.2021.1857240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Introduction: Although it causes a huge burden to sufferers, cluster headache (CH), remains an undertreated condition, partly due to the absence of established acute and prophylactic treatment options. New therapeutic approaches providing fast and safe relief from CH are needed. Areas covered: A systematic review was conducted, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendation on recently published (last 5 years) papers on CH treatment. The authors also collected preliminary results from ongoing trials on emerging therapeutic/preventive pharmacological and interventional approaches for CH. Studies and results are reviewed and discussed. Expert opinion: The complexity of CH pathophysiology prevents the definition of reliable acute and preventive treatments. In the real-world clinical setting, several treatments are combined to provide relief to patients and increase their quality of life. Drugs targeting neuropeptides or their receptors within the trigeminovascular network are of particular interest to prevent CH attacks. Calcitonin gene-related peptide (CGRP) blockade seems attractive and promising, but studies on anti-CGRP monoclonal antibodies indicated rather modest or even absence of a prophylactic effect. A deeper insight into CH pathophysiology, and combined approaches may lead the path to new, more effective, and personalized CH therapies.
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Affiliation(s)
- Andreas A Argyriou
- Headache Outpatient Clinic, Department of Neurology, Saint Andrew's State General Hospital of Patras , Patras, Greece
| | - Michail Vikelis
- Headache Clinic, Mediterraneo Hospital , Glyfada, Greece.,Glyfada Headache Clinic , Glyfada, Greece
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona , Verona, Italy
| | - Pantelis Litsardopoulos
- Headache Outpatient Clinic, Department of Neurology, Saint Andrew's State General Hospital of Patras , Patras, Greece
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona , Verona, Italy
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12
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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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13
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Förderreuther S. [Headache emergencies are easily overlooked]. Schmerz 2020; 34:517-524. [PMID: 33118076 DOI: 10.1007/s00482-020-00513-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 11/26/2022]
Abstract
This article presents secondary headache syndromes caused by life-threatening disease as well as symptomatic headaches requiring immediate treatment to prevent irreversible deficits. Clinical signs and symptoms indicating a secondary headache syndrome are summarized in the so-called SNOOP list (SNOOP: systemic symptoms, neurological symptoms, acute onset, older patients and previous history). The main topic of this publication is the diagnostic procedure, with a discussion of the pitfalls of computed tomography and magnetic resonance imaging investigations and the specificities of other methods such as lumbar puncture and duplex sonography.
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Affiliation(s)
- Stefanie Förderreuther
- Neurologische Klinik, Neurologischer Konsiliardienst am Standort Innenstadt, Ludwig-Maximilians-Universität München, Ziemssenstraße 1, 80336, München, Deutschland.
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14
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15
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Kawazoe Y, Kumon M, Tateyama S, Moriya S. Efficacy of cabergoline and triptans for cluster-like headache caused by prolactin-secreting pituitary adenoma: A literature review and case report. Clin Neurol Neurosurg 2020; 196:106005. [PMID: 32599424 DOI: 10.1016/j.clineuro.2020.106005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/05/2020] [Accepted: 06/07/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Cluster-like headache (CLH) associated with pituitary adenoma (PA) is rare. Although numerous cases have been reported, no summary of the literature has been published. Furthermore, the mechanism and efficacy of medication in CLH associated with PA remains unknown. METHODS We reviewed 14 cases of CLHs associated with PA published in the English and Japanese literature. We have also included and presented our experience with such a case. RESULTS The median age of patients with CLHs associated with PA was 46 years (range, 17-58 years). The ratio of men to women was 14:1. Headache duration ranged from 15-480 min, with left fronto-orbital pain being common. The most common autonomic nervous symptoms were eye-related in 13 patients (86.6 %), followed by nasal symptoms in 12 (80.0 %). Thirteen patients (86.6 %) had functional adenomas; the remaining two were nonfunctional. Twelve of the functional adenomas were lactotroph adenomas (80.0 %), and one was a somatotroph adenoma (6.6 %). CLHs significantly improved after cabergoline administration in 7/9 patients with a lactotroph adenoma (77.7 % response rate). In 5/11 patients with either a functional or nonfunctional PA who received a triptan, CLHs improved (45.4 % response rate). CONCLUSION Based on the efficacies of cabergoline and triptans, two different mechanisms may coexist in the pathogenesis of CLHs associated with PA: endocrinological and physical effects of the tumor itself. Cabergoline is the first-line treatment for headaches caused by lactotroph adenomas. Triptans can be effective as an acute drug for headaches associated with nonfunctional PAs and persistent headaches that remain after cabergoline administration.
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Affiliation(s)
- Yushi Kawazoe
- Department of Neurosurgery, Nishichita General Hospital, 3-1-1 Nakanoike, Tokai, Aichi, 477-8522, Japan.
| | - Masanobu Kumon
- Department of Neurosurgery, Nishichita General Hospital, 3-1-1 Nakanoike, Tokai, Aichi, 477-8522, Japan.
| | - Shinichiro Tateyama
- Department of Neurosurgery, Nishichita General Hospital, 3-1-1 Nakanoike, Tokai, Aichi, 477-8522, Japan.
| | - Shigeta Moriya
- Department of Neurosurgery, Nishichita General Hospital, 3-1-1 Nakanoike, Tokai, Aichi, 477-8522, Japan.
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Mecklenburg J, Sanchez Del Rio M, Reuter U. Cluster headache therapies: pharmacology and mode of action. Expert Rev Clin Pharmacol 2020; 13:641-654. [DOI: 10.1080/17512433.2020.1774361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Jasper Mecklenburg
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Abstract
Cluster headache is characterised by attacks of excruciating unilateral headache or facial pain lasting 15 min to 3 h and is seen as one of the most intense forms of pain. Cluster headache attacks are accompanied by ipsilateral autonomic symptoms such as ptosis, miosis, redness or flushing of the face, nasal congestion, rhinorrhoea, peri-orbital swelling and/or restlessness or agitation. Cluster headache treatment entails fast-acting abortive treatment, transitional treatment and preventive treatment. The primary goal of prophylactic and transitional treatment is to achieve attack freedom, although this is not always possible. Subcutaneous sumatriptan and high-flow oxygen are the most proven abortive treatments for cluster headache attacks, but other treatment options such as intranasal triptans may be effective. Verapamil and lithium are the preventive drugs of first choice and the most widely used in first-line preventive treatment. Given its possible cardiac side effects, electrocardiogram (ECG) is recommended before treating with verapamil. Liver and kidney functioning should be evaluated before and during treatment with lithium. If verapamil and lithium are ineffective, contraindicated or discontinued because of side effects, the second choice is topiramate. If all these drugs fail, other options with lower levels of evidence are available (e.g. melatonin, clomiphene, dihydroergotamine, pizotifen). However, since the evidence level is low, we also recommend considering one of several neuromodulatory options in patients with refractory chronic cluster headache. A new addition to the preventive treatment options in episodic cluster headache is galcanezumab, although the long-term effects remain unknown. Since effective preventive treatment can take several weeks to titrate, transitional treatment can be of great importance in the treatment of cluster headache. At present, greater occipital nerve injection is the most proven transitional treatment. Other options are high-dose prednisone or frovatriptan.
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He W, Zhang Y, Long T, Pan Q, Zhang S, Zhou J. Sphenopalatine Neuralgia: An Independent Neuralgia Entity. Pooled Analysis of a Case Series and Literature Review. Headache 2019; 59:358-370. [PMID: 30635915 DOI: 10.1111/head.13469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Structural damage or demyelization of the sphenopalatine ganglion may cause sphenopalatine neuralgia (SN). The current International Classification of Headache Disorders, third edition (ICHD-3) regards SN as a phenotype of cluster headache. Whether SN is an independent neuralgia entity has been debated for years. METHODS This article presents a case series of SN, a review of all published cases, and a pooled data analysis of the identified cases. RESULTS Seven patients were identified, with a median age at symptom onset of 59 years. Six cases were secondary to structural lesions surrounding the ipsilateral sphenopalatine ganglion, and all of them experienced significant clinical improvements after removing the primary causes. In the seventh patient, no evidence of underlying disease was found. The literature review showed that SN affected patients spanning a wide range of ages and both sexes. The clinical characteristics of SN might mimic cluster headache with the exception of cluster pattern and treatment response to oxygen. The typical duration of pain episodes in SN was several hours to several days; and in some cases, pain was persistent. Sixty-seven percent (59/88) of patients with SN had structural lesions around the sphenopalatine ganglion. CONCLUSION SN could possibly be regarded as a different clinical entity from cluster headache. Based on our patients and literature review, SN can be categorized as idiopathic SN and secondary SN. Craniofacial structural lesions should be highly rating and taken into account when SN is suspected.
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Affiliation(s)
- Wei He
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yixin Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ting Long
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Pan
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shanshan Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiying Zhou
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Cluster-Like Headache Secondary to Sphenoid Sinus Mucocele. Case Rep Neurol Med 2018; 2018:5850286. [PMID: 30631616 PMCID: PMC6304483 DOI: 10.1155/2018/5850286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 11/25/2018] [Indexed: 01/03/2023] Open
Abstract
Background The great majority of cases of cluster headache (CH) are primary, but there are several reported cases of CH secondary to underlying structural lesions. The identification of these lesions is crucial for the achievement of an effective treatment and favorable outcome, although the determination of a cause-effect relationship between the two entities may be challenging. Case Report We present the first case of CH secondary to sphenoid sinus mucocele. Discussion This case reinforces the need to perform neuroimaging studies in CH patients in order to identify lesions that can constitute its cause, especially if atypical features are present. Activation of the trigeminovascular system due to direct contact between the lesion and the trigeminal nerve or by local edema and inflammation possibly plays a role in the pathophysiology of this CH secondary to sphenoid sinus mucocele.
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Abstract
Primary trigeminal autonomic cephalalgias (TACs) are uncommon group of headache disorders. These are defined and diagnosed by the criteria given by the International Classification of Headache Disorders 3β version. Over the past few decades, a number of secondary (symptomatic) cases have been described in the literature with headache features indistinguishable from primary TACs. Many structural and other pathologies have been found in these patients that can be causally related to the headaches. This review attempts to critically analyze the existing literature including the new cases published during 2015–2017.
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Affiliation(s)
- Debashish Chowdhury
- Department of Neurology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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Chang YH, Luo CB, Wang SJ, Chen SP. Cluster headache and middle meningeal artery dural arteriovenous fistulas: A case report. Cephalalgia 2017; 38:1792-1796. [PMID: 29199428 DOI: 10.1177/0333102417747229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Of the multiple etiologies identified for symptomatic cluster headache, vascular origin is common; however, there are no known reports of arteriovenous (AV) fistulas. Here we report a case with typical presentation of cluster headache, which might be associated with middle meningeal AV fistulas. Case report The subject is a 49-year-old man with a 7-year history of episodic left-side cluster headache, consistent with the criteria in the International Classification of Headache Disorders, 3rd edition, beta version (ICHD-3β). Magnetic resonance angiography (MRA) demonstrated dural arteriovenous fistulas at the left posterior fossa, which is supplied mainly by the left middle meningeal artery. After endovascular balloon-assisted embolization, his symptoms have disappeared without relapse for 1.5 years. Discussion We suggest that middle meningeal arteriovenous fistulas should be considered as a potential differential diagnosis of secondary cluster headache, even when the initial clinical manifestations and treatment response are typical for primary cluster headache.
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Affiliation(s)
- Yu-Han Chang
- 1 Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,2 Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chao-Bao Luo
- 2 Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,3 Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shuu-Jiun Wang
- 1 Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,2 Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,4 Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Pin Chen
- 1 Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,2 Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,4 Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,5 Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,6 Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
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Hu X, Zhang X, Gan H, Yu D, Sun W, Shi Z. Horner syndrome as a postoperative complication after minimally invasive video-assisted thyroidectomy: A case report. Medicine (Baltimore) 2017; 96:e8888. [PMID: 29310374 PMCID: PMC5728775 DOI: 10.1097/md.0000000000008888] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Horner syndrome is an unusual complication after thyroidectomy. PATIENT CONCERNS We report a case of Horner syndrome in a 34-year-old female patient with Graves disease associated with papillary thyroid carcinoma who underwent left-side minimally invasive video-assisted thyroidectomy and neck dissection. DIAGNOSIS Horner syndrome was diagnosed based on left myosis, eyelid ptosis, and mild enophthalmos, which developed in the patient on postoperative day 2. INTERVENTIONS The patient was administered glucocorticoids and neurotrophic drugs on postoperative day 3. OUTCOME The symptoms of Horner syndrome were significantly relieved 1 year later. LESSONS Surgeons must be aware that Horner syndrome may be a source of iatrogenic complications, and patients also should be informed of these complications before surgery.
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Affiliation(s)
| | | | | | - Dajun Yu
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui, China
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Elhfnawy AM, Solymosi L, Sommer C. Carotid dissection presenting as a prolonged cluster-like headache in a patient with episodic cluster headache. BMJ Case Rep 2017; 2017:bcr-2017-220845. [PMID: 28765481 PMCID: PMC5623249 DOI: 10.1136/bcr-2017-220845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
We present a patient with known episodic cluster headache, who presented with cluster-like headache in the course of internal carotid artery dissection (ICAD) and discuss possible pathophysiological links between the two diseases. It is well known that cluster-like headache could be the presenting symptom of ICAD. However, ICAD occurring in a patient with a known episodic cluster headache was only once previously described. In the end of the manuscript, we propose red flags to help clinicians differentiate between primary cluster headache and cluster-like attacks masking underlying ICAD. Finally, we raise the question whether at least some proportion of those patients with cluster headache and Horner syndrome previously classified as a primary headache disorder might have been secondary cases to ICAD.
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Affiliation(s)
| | - László Solymosi
- Department of Neuroradiology, University Hospital of Würzburg, Würzburg, Bavaria, Germany
| | - Claudia Sommer
- Department of Neurology, University Hospital of Würzburg, Würzburg, Bayern, Germany
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Evans RW. Incidental Findings and Normal Anatomical Variants on MRI of the Brain in Adults for Primary Headaches. Headache 2017; 57:780-791. [PMID: 28294311 DOI: 10.1111/head.13057] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 01/25/2017] [Indexed: 01/18/2023]
Abstract
When MRI scans of the brain are obtained for evaluation of primary headaches in adults, incidental findings are commonly present. After a review of the prevalence of incidental findings and normal anatomical variants, 21 types are presented.
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Affiliation(s)
- Randolph W Evans
- Department of Neurology, Baylor College of Medicine, 1200 Binz #1370, Houston, TX, 77004, USA
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Dirkx THT, Koehler PJ. Post-Operative Cluster Headache Following Carotid Endarterectomy. Eur Neurol 2017; 77:175-179. [PMID: 28152528 DOI: 10.1159/000456004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/11/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Secondary cluster headache following carotid endarterectomy (CEA) is a rare condition and may help us understand the pathophysiology of primary cluster headache. SUMMARY We describe 2 patients diagnosed with cluster headache, fulfilling the ICHD-IIIB criteria, following CEA. Neither of the patients had headache prior to surgery. They both responded to treatment with oxygen and verapamil. Recent medical literature does not describe any definite cases of cluster headache following CEA. Cluster-like headache has been reported in several studies in the 1990s. Recent studies in primary cluster headache patients show evidence for a central origin of cluster headache in which no peripheral drive seems necessary. Key Messages: Our findings may provide more insight into the pathophysiology and show how a peripheral cause may lead to cluster headache. We hypothesize a role of the trigemino-autonomic reflex. Damage to the carotid artery may activate this reflex and trigger cluster headache. Injury to the internal carotid artery may unleash attacks in patients who are predisposed to develop cluster headache. Further study on the subject is needed to resolve this issue.
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Affiliation(s)
- Thijs H T Dirkx
- Department of Neurology, Zuyderland Medical Centre, Heerlen, The Netherlands
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Mastronikolis NS, Spiliopoulou SP, Zolota V, Papadas TA. Horner's Syndrome Incidental to Medullary Thyroid Carcinoma Excision: Case Report and Brief Literature Review. Case Rep Otolaryngol 2016; 2016:7348175. [PMID: 27200201 PMCID: PMC4856912 DOI: 10.1155/2016/7348175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 04/10/2016] [Indexed: 11/25/2022] Open
Abstract
Horner's syndrome is characterized by a combination of ipsilateral miosis, blepharoptosis, enophthalmos, facial anhidrosis, and iris heterochromia in existence of congenital lesions. The syndrome results from a disruption of the ipsilateral sympathetic innervation of the eye and ocular adnexa at different levels. Though rare, thyroid and neck surgery could be considered as possible causes of this clinical entity. We present a case of Horner's syndrome in a patient after total thyroidectomy and neck dissection for medullary thyroid cancer with neck nodal disease and attempt a brief review of the relevant literature.
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Affiliation(s)
- Nicholas S. Mastronikolis
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Patras Medical School, 26504 Rio, Patras, Greece
| | - Sofia P. Spiliopoulou
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Patras Medical School, 26504 Rio, Patras, Greece
| | - Vassiliki Zolota
- Department of Pathology, University Hospital of Patras Medical School, 26504 Rio, Patras, Greece
| | - Theodoros A. Papadas
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Patras Medical School, 26504 Rio, Patras, Greece
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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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De Pue A, Lutin B, Paemeleire K. Chronic cluster headache and the pituitary gland. J Headache Pain 2016; 17:23. [PMID: 26969187 PMCID: PMC4788665 DOI: 10.1186/s10194-016-0614-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/07/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Cluster headache is classified as a primary headache by definition not caused by an underlying pathology. However, symptomatic cases of otherwise typical cluster headache have been reported. CASE PRESENTATION A 47-year-old male suffered from primary chronic cluster headache (CCH, ICHD-3 beta criteria fulfilled) since the age of 35 years. A magnetic resonance imaging (MRI) study of the brain in 2006 came back normal. He tried several prophylactic treatments but was never longer than 1 month without attacks. He was under chronic treatment with verapamil with only a limited effect on the attack frequency. Subcutaneous sumatriptan 6 mg injections were very effective in aborting attacks. By February 2014 the patient developed a continuous interictal pain ipsilateral to the right-sided cluster headache attacks. An indomethacin test (up to 225 mg/day orally) was negative. Because of the change in headache pattern we performed a new brain MRI, which showed a cystic structure in the pituitary gland. The differential diagnosis was between a Rathke cleft cyst and a cystic adenoma. Pituitary function tests showed an elevated serum prolactin level. A dopamine agonist (cabergoline) was started and the headache subsided completely. Potential pathophysiological mechanisms of pituitary tumor-associated headache are discussed. CONCLUSION Neuroimaging should be considered in all patients with CCH, especially those with an atypical presentation or evolution. Response to acute treatment does not exclude a secondary form of cluster headache. There may be shared pathophysiological mechanisms of primary and secondary cluster headache.
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Affiliation(s)
- Annelien De Pue
- />Department of Neurology, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium
| | - Bart Lutin
- />Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Koen Paemeleire
- />Department of Neurology, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium
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Pelikan JB, McCombe JA, Kotylak T, Becker WJ. Cluster Headache as the Index Event in MS: A Case Report. Headache 2016; 56:392-6. [DOI: 10.1111/head.12768] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2015] [Indexed: 12/18/2022]
Affiliation(s)
| | - Jennifer A. McCombe
- Division of Neurology, Department of Medicine; University of Alberta; Edmonton Alberta Canada
| | - Trevor Kotylak
- Division of Neuroradiology; University of Alberta; Edmonton Alberta Canada
| | - Werner J. Becker
- Department of Clinical Neurosciences; University of Calgary; Calgary Alberta Canada
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Giraud P, Demarquay G. [Cluster headache and brain imagery]. Presse Med 2015; 44:1185-7. [PMID: 26585270 DOI: 10.1016/j.lpm.2015.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 05/21/2015] [Indexed: 11/30/2022] Open
Abstract
Cluster headache is defined on clinical international criteria developed by International Headache Society (IHS, 2013). The realization of a brain MRI with arterial angio-MRI is required according to the French recommendations (Donnet et al., 2014) based on recent the literature. Numerous causes or diseases can mimic typical or atypical AVF (Edvardsson, 2014). Identification of these causes allows an appropriate treatment in addition with symptomatic treatment.
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Affiliation(s)
- Pierric Giraud
- Hôpital d'Annecy, CETD, consultation douleurs et céphalées, 1, avenue de l'Hôpital, BP 90074, 74374 Pringy, France.
| | - Geneviève Demarquay
- Hospices civils de Lyon, hôpital de la Croix-Rousse, consultation céphalées-migraine, service de neurologie, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France; Lyon Neuroscience Research Center (CRNL), Brain Dynamics and Cognition Team (Dycog), Inserm U1028, CNRS UMR5292, 69000 Lyon, France
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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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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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Mijajlović MD, Aleksić VM, Covičković Šternić NM. Cluster headache as a first manifestation of multiple sclerosis: case report and literature review. Neuropsychiatr Dis Treat 2014; 10:2269-74. [PMID: 25473291 PMCID: PMC4251745 DOI: 10.2147/ndt.s73491] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Cluster headache (CH) is estimated to be the most common primary trigeminal autonomic headache, although it is a rare disabling medical condition. Dominant symptoms of CH include severe unilateral orbital, supraorbital, and/or temporal pain, lasting from 15 to 180 minutes if untreated, associated with at least one of various autonomic symptoms during the headache, such as conjunctival injection, lacrimation, nasal congestion and rhinorrhea, facial sweating, miosis, ptosis, and eyelid edema. Headache is not frequently a symptom of multiple sclerosis (MS). The most commonly reported primary headaches are migraine without aura and a tension-type headache. Several described cases involved complicated migraine, ophthalmoplegic migraine-like headache, and finally cluster-like headache. We present a case of a 45-year-old male patient who had typical CH attacks as the initial and only clinical manifestation of MS, which was diagnosed after cerebrospinal fluid (CSF) isoelectric focusing and brain magnetic resonance imaging (MRI) investigation. He presented as a typical cluster-like headache patient since in the background of the CH symptoms and signs, were MS demyelinating lesions. In a patient with CH symptoms one should always think about the possibility of cluster-like-headache, which presents the CH patient with different underlying diseases, so we proposed a protocol to evaluate such patients and exclude diseases that could be in the background of CH symptoms.
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Affiliation(s)
- Milija D Mijajlović
- Department for Cerebrovascular Disorders and Headaches, Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vuk M Aleksić
- Department for Cerebrovascular Disorders and Headaches, Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nadežda M Covičković Šternić
- Department for Cerebrovascular Disorders and Headaches, Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
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