1
|
Jeon-Chapman J, Estrela T, Heidary G, Gise R. Efficacy and Side Effects of Topiramate in Treatment of Children With Pseudotumor Cerebri Syndrome. Pediatr Neurol 2024; 160:32-37. [PMID: 39178652 DOI: 10.1016/j.pediatrneurol.2024.06.015] [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] [Received: 02/04/2024] [Revised: 06/17/2024] [Accepted: 06/28/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND Topiramate is often considered as a second-line medication for the treatment of pseudotumor cerebri syndrome (PTCS), but limited studies exist that evaluate its efficacy in children. METHODS Retrospective study of patients aged <21 years with PTCS who were treated with topiramate alone or in combination with acetazolamide was performed. Data regarding clinical courses and visual outcomes were recorded. RESULTS A total of 46 patients were identified. Three (6.5%) patients were treated with topiramate alone, 31 (67.4%) transitioned to topiramate from acetazolamide, and 12 (26.1%) took both topiramate and acetazolamide concurrently. The median time to resolution of papilledema on topiramate was 0.57 years (interquartile range 0.32 to 0.84). Among eyes with papilledema graded on the Frisen scale at topiramate initiation, 40 of 57 (70.2%) were grade 1, nine of 57 (15.8%) were grade 2, and eight of 57 (14.0%) were grade 3. Twenty-seven of 46 (58.7%) reported headache improvement after starting topiramate. The mean dose of topiramate was 1.3 ± 0.8 mg/kg/day. The most common side effect was patient report of cognitive slowing (10 of 46 [21.7%]). All patients on topiramate monotherapy who were compliant with treatment and follow-up had resolution of papilledema with no evidence of visual function loss. CONCLUSIONS Topiramate can effectively treat PTCS in children with mild to moderate papilledema or in those unable to tolerate acetazolamide. More research is needed to assess the efficacy of topiramate for higher grade papilledema.
Collapse
Affiliation(s)
- Jacqueline Jeon-Chapman
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts; Frank H. Netter Medical School, North Haven, Connecticut
| | - Tais Estrela
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Gena Heidary
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Ryan Gise
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
2
|
Panda AK, Hazra S, Grover D. Excellent Response to Repeated Greater Occipital Nerve Blocks in a Patient with Short-Lasting Unilateral Neuralgiform Headache with Conjunctival Tearing. Ann Indian Acad Neurol 2024; 27:334-336. [PMID: 38819412 PMCID: PMC11232818 DOI: 10.4103/aian.aian_1104_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/06/2024] [Accepted: 02/22/2024] [Indexed: 06/01/2024] Open
Affiliation(s)
- Ashwin K Panda
- Department of Neurology, Institute of Human Behavior and Allied Sciences, Dilshad Garden, Delhi, India
| | | | | |
Collapse
|
3
|
Hagen K. One-year prevalence of cluster headache, hemicrania continua, paroxysmal hemicrania and SUNCT in Norway: a population-based nationwide registry study. J Headache Pain 2024; 25:30. [PMID: 38443787 PMCID: PMC10916002 DOI: 10.1186/s10194-024-01738-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/27/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND There is lack of population-based studies evaluating the prevalence of paroxysmal hemicrania, hemicrania continua and short-lasting unilateral neuralgiform headache attacks. OBJECTIVES The aim of this study was to investigate the gender-specific 1-year prevalence of cluster headache, paroxysmal hemicrania, hemicrania continua, and short-lasting unilateral neuralgiform headache attacks. METHODS A nationwide study was conducted from January 1 2022 and December 31 2022 by linking diagnostic codes from Norwegian Patient Registry and prescription of relevant drugs from Norwegian Prescription Database on an individual basis. The 1-year prevalence with 95% confidence intervals (CI) of cluster headache, paroxysmal hemicrania, hemicrania continua and short-lasting unilateral neuralgiform headache attacks are estimated based on the combination of diagnostic codes, prescription of drugs and corresponding reimbursement codes. RESULTS Among 4,316,747 individuals aged ≥ 18 years, the 1-year prevalence per 100,000 was 14.6 (95% CI 13.5-15.8) for cluster headache, 2.2 (95% CI 1.8-2.7) for hemicrania continua, 1.4 (95% CI 1.0-1.8) for paroxysmal hemicrania, and 1.2 (95% CI 0.8-1.4) for short-lasting unilateral neuralgiform headache attacks. For all the trigeminal autonomic cephalalgies, cluster headache included, the prevalence was higher for women than men. CONCLUSIONS In this nationwide register-based study, we found a 1-year prevalence per 100,100 of 14.6 for cluster headache, 2.2 for hemicranias continua, 1.4 for paroxysmal hemicranias, and 1.2 for short-lasting unilateral neuralgiform headache attacks. This is the first study reporting higher prevalence of cluster headache for women than men.
Collapse
Affiliation(s)
- Knut Hagen
- Department of Medical Quality Registries and Clinical Research Unit, St. Olav's University Hospital, Trondheim, 7006, Norway.
- Department of Neuromedicine and Movement Science, NorHEAD-Norwegian Centre for Headache Research, Norwegian University of Science and Technology, Trondheim, Norway.
| |
Collapse
|
4
|
Verma R, Chakraborty R. SUNHA: A Mystifying Cephalgia. Ann Indian Acad Neurol 2024; 27:111-112. [PMID: 38751917 PMCID: PMC11093153 DOI: 10.4103/aian.aian_776_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 05/18/2024] Open
Affiliation(s)
- Rajesh Verma
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rajarshi Chakraborty
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Svoboda R, Pakosta M, Doležel P. How the Presence of Crystalline Phase Affects Structural Relaxation in Molecular Liquids: The Case of Amorphous Indomethacin. Int J Mol Sci 2023; 24:16275. [PMID: 38003465 PMCID: PMC10671508 DOI: 10.3390/ijms242216275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/10/2023] [Accepted: 11/12/2023] [Indexed: 11/26/2023] Open
Abstract
The influence of partial crystallinity on the structural relaxation behavior of low-molecular organic glasses is, contrary to, e.g., polymeric materials, a largely unexplored territory. In the present study, differential scanning calorimetry was used to prepare a series of amorphous indomethacin powders crystallized to various extents. The preparations stemmed from the two distinct particle size fractions: 50-125 µm and 300-500 µm. The structural relaxation data from the cyclic calorimetric measurements were described in terms of the phenomenological Tool-Narayanaswamy-Moynihan model. For the 300-500 µm powder, the crystalline phase forming dominantly on the surface led to a monotonous decrease in the glass transition by ~6 °C in the 0-70% crystallinity range. The activation energy of the relaxation motions and the degree of heterogeneity within the relaxing matrix were not influenced by the increasing crystallinity, while the interconnectivity slightly increased. This behavior was attributed to the release of the quenched-in stresses and to the consequent slight increase in the structural interconnectivity. For the 50-125 µm powder, distinctly different relaxation dynamics were observed. This leads to a conclusion that the crystalline phase grows throughout the bulk glassy matrix along the internal micro-cracks. At higher crystallinity, a sharp increase in Tg, an increase in interconnectivity, and an increase in the variability of structural units engaged in the relaxation motions were observed.
Collapse
Affiliation(s)
- Roman Svoboda
- Department of Physical Chemistry, Faculty of Chemical Technology, University of Pardubice, Studentská 573, 532 10 Pardubice, Czech Republic
| | - Marek Pakosta
- Faculty of Electrical Engineering and Informatics, University of Pardubice, nam. Cs. legii 565, 530 02 Pardubice, Czech Republic; (M.P.); (P.D.)
| | - Petr Doležel
- Faculty of Electrical Engineering and Informatics, University of Pardubice, nam. Cs. legii 565, 530 02 Pardubice, Czech Republic; (M.P.); (P.D.)
| |
Collapse
|
7
|
Bahra A. Paroxysmal hemicrania and hemicrania continua: Review on pathophysiology, clinical features and treatment. Cephalalgia 2023; 43:3331024231214239. [PMID: 37950675 DOI: 10.1177/03331024231214239] [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: 11/13/2023]
Abstract
BACKGROUND Paroxysmal hemicrania and hemicrania continua are indometacin-sensitive trigeminal autonomic cephalalgias, a terminology which reflects the predominant distribution of the pain, observable cranial autonomic features and shared pathophysiology. Understanding the latter is limited, both by low prevalence and the intricacies of studying brain function, requiring multimodal techniques to glean insights into such disorders. Similarly obscure is the curious response to indometacin. This review will address what is currently known about pathophysiology, the rationale for the current classification and, features which may confound the diagnosis, such as lack of cranial autonomic symptoms and those which are typically associated with migraine such as nausea, photophobia, phonophobia and aura. Despite these characteristics, a dramatic response to indometacin, which is not seen in migraine nor the other trigeminal autonomic cephalalgias , provides the hallmark of the diagnosis. The main clinical differential for paroxysmal hemicrania is based on temporal pattern and lies between cluster headache and short-lasting-neuralgiform headache attacks with tearing or additional cranial autonomic symptoms. For hemicrania continua it is more challenging as the main differential for which the disorder is often treated is migraine. A prior episodic pattern, often days at a time, and the tendency to exacerbation with analgesics will further deflect from the diagnosis. The relevance of this is that there is little overlap in therapeutics between paroxysmal hemicrania and hemicrania continua and other headache disorders and there are limited effective alternatives to indometacin. The most effective are other non-steroidal anti-inflammatory drugs including the newer COX-II inhibitors. Even though early reports suggest that a higher indometacin dose-requirement may herald a secondary precipitating pathology, this does not seem to be the case, with syndrome and response to treatment being similar with the primary disorder. In this context imaging of new onset paroxysmal hemicrania or hemicrania continua and implication of the results will be discussed as will alternative treatment options.
Collapse
Affiliation(s)
- Anish Bahra
- Department of Neurology, Barts Health NHS Trust, Whipps Cross Hospital, London, UK
- The Neurosciences Department, John Radcliffe Hospital, Oxford, UK
- Pain Management Centre at National Hospital for Neurology & Neurosurgery, London, UK
| |
Collapse
|
8
|
Kashyap PV, Chabri S. Steroids in Headache: A Comprehensive Review of Recent Research. Ann Neurosci 2023; 30:256-261. [PMID: 38020407 PMCID: PMC10662276 DOI: 10.1177/09727531231173286] [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: 08/18/2022] [Accepted: 12/28/2022] [Indexed: 12/01/2023] Open
Abstract
Background Headache is an extremely common symptom of the general outpatient department and also the headache clinic, with prevalence of 48.9% in the general population. None has ever experienced headache in life time. Headache is seen in 1 patient out of 10 general practitioner (GP) consultations, 1 referral out of 3 is headache in neurology OPD, and 1 in 5 of all emergency medical admissions. Of all headaches, around 98% constitute primary headache: migraine without aura, tension headache, and cluster headache. With advancement in various drug modalities, certain headache forms respond less well to the regular approved medications, and some headaches are complicated by the analgesic itself. Steroids have been tried in many subtypes of headache, especially in primary forms of headache with dysautonomia, headache with trigeminal pathway activation and disinhibition, and in certain medication-culprit headaches. This subgroup of headaches is almost a challenge in an emergency for the headache expert as well. So, we need to assess the role of steroids in less well-responsive headaches. Summary Current reviewed evidence on the role of steroids in primary headache suggests that steroids have a role in status migrainosus and medication overuse headache when used in the mentioned and monitored manner. Consideration and further exploration of its role in other primary headaches may reveal insight into steroid efficacy as a treatment modality in various subtypes of headache. Key message Steroids, when used cautiously in specifically selected primary headaches under supervision, proved miraculous where other modalities failed.
Collapse
Affiliation(s)
- Priyanka V. Kashyap
- Department of Neurology, All India Institute of Medical Science (AIIMS), Saket Nagar, Bhopal, Madhya Pradesh, India
| | - Sounak Chabri
- Department of Neurology, All India Institute of Medical Science (AIIMS), Saket Nagar, Bhopal, Madhya Pradesh, India
| |
Collapse
|
9
|
Al-Khazali HM, Christensen RH, Lambru G, Dodick DW, Ashina H. Hemicrania Continua: An Update. Curr Pain Headache Rep 2023; 27:543-550. [PMID: 37566220 DOI: 10.1007/s11916-023-01156-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE OF REVIEW Hemicrania Continua (HC) is a rare and disabling primary headache disorder that is characterized by persistent, unilateral headache with ipsilateral, cranial autonomic symptoms and restlessness or agitation. The diagnosis requires patients to experience an absolute response to therapeutic doses of indomethacin. RECENT FINDINGS HC is diagnosed in in about 1.8% of adult patients who were evaluated for headache in tertiary care services, albeit this estimate should be interpreted with caution. The most prevalent accompanying symptoms appear to be lacrimation, conjunctival injection and restlessness or agitation. However, the available literature is limited by methodologic issues, and the current diagnostic criteria lack clarity on what defines absolute response to indomethacin. More rigorous studies are thus needed to improve our understanding of HC which, in turn, will facilitate better disease management in clinical practice. Here, we provide a comprehensive overview of HC, including its epidemiology, clinical presentation, diagnostic evaluation, and management.
Collapse
Affiliation(s)
- Haidar M Al-Khazali
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rune Häckert Christensen
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Giorgio Lambru
- The Headache and Facial Pain Service, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - David W Dodick
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
| | - Håkan Ashina
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Department of Brain and Spinal Cord Injury, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| |
Collapse
|
10
|
Diener HC, Tassorelli C, Dodick DW. Management of Trigeminal Autonomic Cephalalgias Including Chronic Cluster: A Review. JAMA Neurol 2023; 80:308-319. [PMID: 36648786 DOI: 10.1001/jamaneurol.2022.4804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Importance Trigeminal autonomic cephalalgias (TACs) comprise a unique collection of primary headache disorders characterized by moderate or severe unilateral pain, localized in in the area of distribution of the first branch of the trigeminal nerve, accompanied by cranial autonomic symptoms and signs. Most TACs are rare diseases, which hampers the possibility of performing randomized clinical trials and large studies. Therefore, knowledge of treatment efficacy must be based only on observational studies, rare disease registries, and case reports, where real-world data and evidence play an important role in health care decisions. Observations Chronic cluster headache is the most common of these disorders, and the literature offers some evidence from randomized clinical trials to support the use of pharmacologic and neurostimulation treatments. Galcanezumab, a monoclonal antibody targeting the calcitonin gene-related peptide, was not effective at 3 months in a randomized clinical trial but showed efficacy at 12 months in a large case series. For the other TACs (ie, paroxysmal hemicrania, hemicrania continua, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing, and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms), only case reports and case series are available to guide physicians in everyday management. Conclusions and Relevance The accumulation of epidemiologic, pathophysiologic, natural history knowledge, and data from case series and small controlled trials, especially over the past 20 years from investigators around the world, has added to the previously limited evidence and has helped advance and inform the treatment approach to rare TACs, which can be extremely challenging for clinicians.
Collapse
Affiliation(s)
- Hans Christoph Diener
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), Department of Neuroepidemiology, University Duisburg-Essen, Essen, Germany
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science & Neurorehabilitation Centre, IRCCS C., Mondino Foundation, Pavia, Italy
| | - David W Dodick
- Department of Neurology, Mayo Clinic, Phoenix, Arizona
- Atria Institute, New York, New York
| |
Collapse
|
11
|
Bemanalizadeh M, Baghaei Oskouei H, Hadizadeh A, Dakkali MS, Qahremani R, Mansouri V. Paroxysmal hemicrania in children and adolescents: A systematic review. Headache 2022; 62:952-966. [DOI: 10.1111/head.14354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/28/2022] [Accepted: 05/02/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Maryam Bemanalizadeh
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non‐Communicable Disease Isfahan University of Medical Sciences Isfahan Iran
- Department of Pediatrics Neurology, School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | | | - Alireza Hadizadeh
- School of Medicine Tehran University of Medical Sciences Tehran Iran
| | | | - Reihane Qahremani
- School of Medicine Tehran University of Medical Sciences Tehran Iran
| | - Vahid Mansouri
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non‐Communicable Disease Isfahan University of Medical Sciences Isfahan Iran
- Department of Pediatrics Neurology, School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| |
Collapse
|
12
|
Dora B, Demir-Dora D. Indomethacin Resistant Hemicrania Continua Responsive to Venlafaxine. Neurol India 2022; 70:1670. [PMID: 36076682 DOI: 10.4103/0028-3886.355083] [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]
Affiliation(s)
- Babur Dora
- Department of Neurology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Devrim Demir-Dora
- Department of Pharmacology, Akdeniz University Medical Faculty, Antalya, Turkey
| |
Collapse
|
13
|
Teixeira D, Borelli WV, Mantovani GP, Castilhos RM, Londero R. Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) responsive to intranasal lidocaine and nerve blockage: a case report. HEADACHE MEDICINE 2022. [DOI: 10.48208/headachemed.2022.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Abstract
Background: Trigeminal autonomic cephalalgias comprehend a myriad of headaches with different symptoms, with comprehend short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) or with conjunctival injection and tearing (SUNCT). Current treatment options are limited, and they are based mostly on case reports and small studies. Case Report: We report here the case of a 75 years old man suffering from acutetrigeminal autonomic headache with a satisfying response to intranasal lidocaine and nerve blockage. Conclusion: Intranasal lidocaine and nerve blockage may represent a useful and costeffective treatment for patients with SUNCT/SUNA.
Collapse
|
14
|
Abstract
Background Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache with autonomic symptoms (SUNA) are rare and disabling primary headache disorders that are subtypes of Short-lasting unilateral neuralgiform headache attacks (SUNHA). Aim The aim of this narrative review was to provide a comprehensive update on headache phenotype, pathophysiology, and various treatment options available for SUNCT and SUNA. Methods References for this review were identified by searches of articles published in the English language in PubMed between 1978 and October 2020 using "short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)", "short-lasting unilateral neuralgiform headache with autonomic symptoms (SUNA)", "short-lasting unilateral neuralgiform headache attacks (SUNHA)", "trigeminal autonomic cephalalgias" as keywords in various combinations. Results Of a potential 1103 articles, seven case series describing clinical characteristics of SUNCT/SUNA patients were identified for this review. For symptomatic/secondary SUNCT/SUNA, 53 individual case reports, and one case series were reviewed. One placebo-controlled trial and 11 open-label case series that evaluated various medical and surgical treatments in SUNCT/SUNA were also reviewed. Available literature suggests that SUNCT and SUNA are subtypes of the same disorder characterized by severe side locked short duration headache with ipsilateral prominent cranial autonomic symptoms and signs. Pathophysiology may involve both peripheral and central mechanisms. Lamotrigine is the most effective preventive therapy while intravenous lidocaine is the most efficacious drug as transitional therapy for severe disabling attacks. Surgical options including microvascular decompression in those having neurovascular conflict, occipital nerve stimulation, and hypothalamic deep brain stimulation can be alternative treatment options for medically refractory patients.
Collapse
Affiliation(s)
- Ashish K Duggal
- Department of Neurology, G B Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Debashish Chowdhury
- Department of Neurology, G B Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| |
Collapse
|
15
|
Togha M, Totonchi A, Molaei H, Ansari H. The Promising Effect of Nerve Decompression in Trigeminal Autonomic Cephalalgias: Report of Case Series. Front Neurol 2021; 12:678749. [PMID: 34163429 PMCID: PMC8216486 DOI: 10.3389/fneur.2021.678749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/06/2021] [Indexed: 01/24/2023] Open
Abstract
Trigeminal Autonomic Cephalalgias (TAC) are excruciating headaches with limited treatment options. The chronic forms of TACs, including chronic cluster, chronic paroxysmal hemicrania, and hemicrania continua, are disabling conditions. In addition to drug therapy, there are some studies regarding nerve blocking and nerve stimulation with acceptable results. Here we report four cases of decompression nerve surgery with promising results on pain control in these difficult to treat headaches.
Collapse
Affiliation(s)
- Mansoureh Togha
- Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Totonchi
- Department of Neurological Surgery, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Hojjat Molaei
- Sina Hospital, Imam Khomeini Hospital Complex, Medicine School, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Ansari
- Department of Neuroscience, University of California, San Diego, San Diego, CA, United States
| |
Collapse
|
16
|
Criscuolo A, Strumia S, Di Concetto G, Corso RM. Acupuncture and lamotrigine for acute short unilateral neuralgiform headache attacks with conjunctival injection and tearing syndrome: a case report. Acupunct Med 2021; 39:724-725. [PMID: 34044624 DOI: 10.1177/09645284211009908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Armando Criscuolo
- Department of Surgery-Anaesthesia and Intensive Care Section, "G.B. Morgagni-L. Pierantoni" Hospital, Forlì, Italy
| | - Silvia Strumia
- Neurology Unit, "G.B. Morgagni-L. Pierantoni" Hospital, Forlì, Italy
| | | | - Ruggero M Corso
- Department of Surgery-Anaesthesia and Intensive Care Section, "G.B. Morgagni-L. Pierantoni" Hospital, Forlì, Italy
| |
Collapse
|
17
|
Bjørk MH, Kristoffersen ES, Tronvik E, Egeland Nordeng HM. Management of cluster headache and other trigeminal autonomic cephalalgias in pregnancy and breastfeeding. Eur J Neurol 2021; 28:2443-2455. [PMID: 33852763 DOI: 10.1111/ene.14864] [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: 03/15/2021] [Accepted: 04/07/2021] [Indexed: 11/26/2022]
Abstract
Many clinicians lack experience in managing trigeminal autonomic cephalalgias (TACs) in pregnancy and lactation. In addition to cluster headache, TACs include hemicrania continua, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache with conjunctival injection and tearing/autonomic symptoms (SUNCT/SUNA). Treating these rare, severe headache conditions often requires off-label drugs that have uncertain teratogenic potential. In the last few years, several new treatment options and safety documentation have emerged, but clinical guidelines are lacking. This narrative review aimed to provide an updated clinical guide and good clinical practice recommendations for the management of these debilitating headache disorders in pregnancy and lactation.
Collapse
Affiliation(s)
- Marte-Helene Bjørk
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Espen Saxhaug Kristoffersen
- Department of General Practice, HELSAM, University of Oslo, Oslo, Norway.,Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Erling Tronvik
- Department of Neurology, St. Olav's University Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hedvig Marie Egeland Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway.,Department of Child Health and Development, National Institute of Public Health, Oslo, Norway
| |
Collapse
|
18
|
Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) secondary to an acute cranial nerve meningoradiculitis. Rev Neurol (Paris) 2021; 177:1031-1032. [PMID: 33781563 DOI: 10.1016/j.neurol.2020.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/22/2020] [Accepted: 11/26/2020] [Indexed: 11/24/2022]
|
19
|
Mauritz MD, Enninger A, Wamsler C, Wager J, Zernikow B. Long-Term Outcome of Indomethacin Treatment in Pediatric Patients with Paroxysmal Hemicrania-A Case Series. CHILDREN-BASEL 2021; 8:children8020101. [PMID: 33546261 PMCID: PMC7913346 DOI: 10.3390/children8020101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 11/23/2022]
Abstract
Paroxysmal Hemicrania is a rare form of primary headache in children and adolescents, belonging to the group of trigeminal autonomic cephalalgias. Patients suffer from severe, short-lasting unilateral headaches accompanied by symptoms of the autonomic system on the same side of the head. The short duration of attacks distinguishes Paroxysmal Hemicrania from other trigeminal autonomic cephalalgias. Indomethacin is the treatment of choice, and its effectiveness provides a unique diagnostic criterion. However, the long-term outcomes in children are highly underreported. In this case-series, n = 8 patients diagnosed with Paroxysmal Hemicrania were contacted via telephone 3.1 to 10.7 years after initial presentation. A standardized interview was conducted. n = 6 patients were headache-free and no longer took indomethacin for 5.4 ± 3.4 years. The mean treatment period in these patients was 2.2 ± 1.9 years. Weaning attempts were undertaken after 1.7 ± 1.3 months; in n = 3 patients, more than one weaning attempt was necessary. n = 2 patients were still taking indomethacin (4.5 and 4.9 years, respectively). Both unsuccessfully tried to reduce the indomethacin treatment (two and six times, respectively). Adverse effects appeared in n = 6 (75%) patients and led to a discontinuation of therapy in n = 2 patients. Our long-term follow-up suggests that in a substantial proportion of pediatric patients, discontinuing indomethacin therapy is possible without the recurrence of Paroxysmal Hemicrania.
Collapse
Affiliation(s)
- Maximilian David Mauritz
- German Paediatric Pain Centre, Children′s and Adolescents′ Hospital, Witten/Herdecke University, 45711 Datteln, Germany; (C.W.); (J.W.); (B.Z.)
- Department of Children′s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany;
- Correspondence: ; Tel.: +49-2363-9750
| | - Anna Enninger
- Department of Children′s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany;
| | - Christine Wamsler
- German Paediatric Pain Centre, Children′s and Adolescents′ Hospital, Witten/Herdecke University, 45711 Datteln, Germany; (C.W.); (J.W.); (B.Z.)
- Centre for Rare Pain Disorders in Young People, Centre for Rare Diseases Ruhr (CeSER), 45711 Datteln, Germany
| | - Julia Wager
- German Paediatric Pain Centre, Children′s and Adolescents′ Hospital, Witten/Herdecke University, 45711 Datteln, Germany; (C.W.); (J.W.); (B.Z.)
- Department of Children′s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany;
| | - Boris Zernikow
- German Paediatric Pain Centre, Children′s and Adolescents′ Hospital, Witten/Herdecke University, 45711 Datteln, Germany; (C.W.); (J.W.); (B.Z.)
- Department of Children′s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany;
- Centre for Rare Pain Disorders in Young People, Centre for Rare Diseases Ruhr (CeSER), 45711 Datteln, Germany
| |
Collapse
|
20
|
Groenke BR, Daline IH, Nixdorf DR. SUNCT/SUNA: Case series presenting in an orofacial pain clinic. Cephalalgia 2020; 41:665-676. [PMID: 33269943 DOI: 10.1177/0333102420977292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM Little is known about short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA). We present our experience with SUNCT/SUNA patients to aid identification and management of these disorders. METHODS A retrospective review of patient records of one orofacial pain clinic was performed. Inclusion criteria was a diagnosis of SUNCT/SUNA confirmed with at least one follow-up visit. RESULTS Six of the 2464 new patients seen between 2015-2018 met the selection criteria (SUNCT n = 2, SUNA n = 4). Gender distribution was one male to one female and average age of diagnosis was 52 years (range 26-62). Attacks were located in the V1/V2 trigeminal distributions, and five patients reported associated intraoral pain. Pain quality was sharp, shooting, and burning with two patients reporting "numbness". Pain was moderate-severe in intensity, with daily episodes that typically lasted for seconds. Common autonomic features were lacrimation, conjunctival injection, rhinorrhea, and flushing. Frequent triggers were touching the nose or a specific intraoral area. Lamotrigine and gabapentin were commonly used as initial therapy. CONCLUSIONS Differentiating between SUNCT/SUNA does not appear to be clinically relevant. Presenting symptoms were consistent with those published, except 5/6 patients describing intraoral pain and two patients describing paresthesia.
Collapse
Affiliation(s)
- Beth R Groenke
- Division of TMD & Orofacial Pain, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - Iryna Hryvenko Daline
- Division of TMD & Orofacial Pain, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.,Division of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - Donald R Nixdorf
- Division of TMD & Orofacial Pain, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.,Department of Neurology, Medical School, University of Minnesota, Minneapolis, MN, USA.,Department of Radiology, Medical School, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
21
|
Stubberud A, Tronvik E, Matharu M. Treatment of SUNCT/SUNA, Paroxysmal Hemicrania, and Hemicrania Continua: An Update Including Single-Arm Meta-analyses. Curr Treat Options Neurol 2020. [DOI: 10.1007/s11940-020-00649-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abstract
Purpose of Review
This review presents a critical appraisal of the treatment strategies for short-lasting unilateral neuralgiform headache attacks (SUNHA), paroxysmal hemicrania (PH), and hemicrania continua (HC). We assess the available, though sparse, evidence on both medical and surgical treatments. In addition, we present estimated pooled analyses of the most common treatments and emphasize recent promising findings.
Recent Findings
The majority of literature available on the treatment of these rare trigeminal autonomic cephalalgias are small open-label observational studies and case reports. Pooled analyses reveal that lamotrigine for SUNHA and indomethacin for PH and HC are the preventative treatments of choice. Second-line choices include topiramate, gabapentin, and carbamazepine for SUNHA; verapamil for PH; and cyclooxygenase-2 inhibitors and gabapentin for HC. Parenteral lidocaine is highly effective as a transitional treatment for SUNHA. Novel therapeutic strategies such as non-invasive neurostimulation, targeted nerve and ganglion blockades, and invasive neurostimulation, including implanted occipital nerve stimulators and deep brain stimulation, appears to be promising options.
Summary
At present, lamotrigine as a prophylactic and parenteral lidocaine as transitional treatment remain the therapies of choice for SUNHA. While, by definition, both PH and CH respond exquisitely to indomethacin, evidence for other prophylactics is less convincing. Evidence for the novel emerging therapies is limited, though promising.
Collapse
|
22
|
Primaries non-migraine headaches treatment: a review. Neurol Sci 2020; 41:385-394. [PMID: 33021705 DOI: 10.1007/s10072-020-04762-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In the "headache world," great attention has always been paid to migraine patients, especially for the research and development of new therapies. For the other forms of primary headaches, especially those of Chapters 2 and 3 of the classification, there are however therapies that, even if not specific, can give significant results. Tension-type headache recognizes in NSAIDs the most effective drugs to treat acute attack, while prevention is based on the use of tricyclic antidepressants and muscle relaxants. For TACs, the discussion is more complex: first of all, there are two forms of primary headache that respond absolutely to indomethacin. For these, the main problem is how to manage the possible side effects arising from prolonged treatments and possibly what to use as an alternative. For cluster headaches and short-lasting unilateral neuralgiform headache attacks, we have drugs with good efficacy as regards medical therapy, such as verapamil or lamotrigine, but in recent years, neuromodulation techniques, both surgical and non-invasive, have also been affirming themselves, which represent a more possibility for forms of headache that are often very disabling and resistant to common analgesics.
Collapse
|
23
|
Edvinsson JCA, Viganò A, Alekseeva A, Alieva E, Arruda R, De Luca C, D'Ettore N, Frattale I, Kurnukhina M, Macerola N, Malenkova E, Maiorova M, Novikova A, Řehulka P, Rapaccini V, Roshchina O, Vanderschueren G, Zvaune L, Andreou AP, Haanes KA. The fifth cranial nerve in headaches. J Headache Pain 2020; 21:65. [PMID: 32503421 PMCID: PMC7275328 DOI: 10.1186/s10194-020-01134-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/25/2020] [Indexed: 12/27/2022] Open
Abstract
The fifth cranial nerve is the common denominator for many headaches and facial pain pathologies currently known. Projecting from the trigeminal ganglion, in a bipolar manner, it connects to the brainstem and supplies various parts of the head and face with sensory innervation. In this review, we describe the neuroanatomical structures and pathways implicated in the sensation of the trigeminal system. Furthermore, we present the current understanding of several primary headaches, painful neuropathies and their pharmacological treatments. We hope that this overview can elucidate the complex field of headache pathologies, and their link to the trigeminal nerve, to a broader field of young scientists.
Collapse
Affiliation(s)
- J C A Edvinsson
- Department of Clinical Experimental Research, Glostrup Research Institute, Rigshospitalet Glostrup, 2600, Glostrup, Denmark. .,Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - A Viganò
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - A Alekseeva
- Department of Neurology, First Pavlov State Medical University of St.Petersburg, St.Petersburg, Russia
| | - E Alieva
- GBUZ Regional Clinical Hospital № 2, Krasnodar, Russia
| | - R Arruda
- Department of Neuroscience, University of Sao Paulo, Ribeirao Preto, Brazil
| | - C De Luca
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, 56126, Pisa, Italy.,Department of Public Medicine, Laboratory of Morphology of Neuronal Network, University of Campania-Luigi Vanvitelli, Naples, Italy
| | - N D'Ettore
- Department of Neurology, University of Rome, Tor Vergata, Rome, Italy
| | - I Frattale
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100, L'Aquila, Italy
| | - M Kurnukhina
- Department of Neurosurgery, First Pavlov State Medical University of St.Petersburg, Lev Tolstoy Street 6-8, St.Petersburg, Russia.,The Leningrad Regional State Budgetary Institution of health care "Children's clinical hospital", St.Petersburg, Russia
| | - N Macerola
- Department of Internal Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Malenkova
- Pain Department, Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - M Maiorova
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - A Novikova
- F.F. Erisman Federal Research Center for Hygiene, Mytishchy, Russia
| | - P Řehulka
- Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - V Rapaccini
- Child Neurology and Psychiatry Unit, Systems Medicine Department, University Hospital Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.,Unità Sanitaria Locale (USL) Umbria 2, Viale VIII Marzo, 05100, Terni, Italy.,Department of Neurology, Headache Center, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - O Roshchina
- Department of Neurology, First Pavlov State Medical University of St.Petersburg, St.Petersburg, Russia
| | - G Vanderschueren
- Department of Neurology, ZNA Middelheim, Lindendreef 1, 2020, Antwerp, Belgium
| | - L Zvaune
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Riga Stradins University, Riga, Latvia.,Department of Pain Medicine, Hospital Jurmala, Jurmala, Latvia.,Headache Centre Vivendi, Riga, Latvia
| | - A P Andreou
- Headache Research, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,The Headache Centre, Guy's and St Thomas, NHS Foundation Trust, London, UK
| | - K A Haanes
- Department of Clinical Experimental Research, Glostrup Research Institute, Rigshospitalet Glostrup, 2600, Glostrup, Denmark
| | | |
Collapse
|
24
|
Van Deun L, de Witte M, Goessens T, Halewyck S, Ketelaer MC, Matic M, Moens M, Vaes P, Van Lint M, Versijpt J. Facial Pain: A Comprehensive Review and Proposal for a Pragmatic Diagnostic Approach. Eur Neurol 2020; 83:5-16. [PMID: 32222701 DOI: 10.1159/000505727] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 01/01/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Facial pain, alone or combined with other symptoms, is a frequent complaint. Moreover, it is a symptom situated at, more than any other pain condition, a crosspoint where several disciplines meet, for example, dentists; manual therapists; ophthalmologists; psychologists; and ear-nose-throat, pain, and internal medicine physicians besides neurologists and neurosurgeons. Recently, a new version of the most widely used classification system among neurologists for headache and facial pain, the International Classification of Headache Disorders, has been published. OBJECTIVE The aims of this study were to provide an overview of the most prevalent etiologies of facial pain and to provide a generic framework for the neurologist on how to manage patients presenting with facial pain. METHODS An overview of the different etiologies of facial pain is provided from the viewpoint of the respective clinical specialties that are confronted with facial pain. Key message: Caregivers should "think outside their own box" and refer to other disciplines when indicated. If not, a correct diagnosis can be delayed and unnecessary treatments might be given. The presented framework is aimed at excluding life- or organ-threatening diseases, providing several clinical clues and indications for technical investigations, and ultimately leading to the correct diagnosis and/or referral to other disciplines.
Collapse
Affiliation(s)
- Laura Van Deun
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Neurology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Muriel de Witte
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Clinical Psychology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Thaïs Goessens
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Clinical Psychology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Stijn Halewyck
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Otorhinolaryngology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Marie-Christine Ketelaer
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium
| | - Milica Matic
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Anesthesiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Maarten Moens
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Neurosurgery, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Peter Vaes
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Manual Therapy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Michel Van Lint
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Ophthalmology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Jan Versijpt
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium, .,Department of Neurology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium,
| |
Collapse
|
25
|
|
26
|
Tajti J, Szok D, Nyári A, Vécsei L. Therapeutic strategies that act on the peripheral nervous system in primary headache disorders. Expert Rev Neurother 2019; 19:509-533. [DOI: 10.1080/14737175.2019.1615447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- János Tajti
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
| | - Délia Szok
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
| | - Aliz Nyári
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
| | - László Vécsei
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
- MTA-SZTE Neuroscience Research Group of the Hungarian Academy of Sciences, Szeged, Hungary
| |
Collapse
|
27
|
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
|
28
|
|
29
|
Demarquay G, Giraud P. Cefalee primarie non emicraniche. Neurologia 2018. [DOI: 10.1016/s1634-7072(18)41287-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
30
|
Hryvenko I, Cervantes-Chavarría AR, Law AS, Nixdorf DR. Hemicrania continua: Case series presenting in an orofacial pain clinic. Cephalalgia 2018; 38:1950-1959. [PMID: 29562746 DOI: 10.1177/0333102418764895] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AIM OF INVESTIGATION Hemicrania continua (HC) is an uncommon primary headache and little is known of the characteristics of such patients managed in an orofacial pain setting. This study provides clinical features of HC, its association with other disorders, and treatment outcomes of patients managed in the TMD and Orofacial Pain Clinic at the University of Minnesota. METHODS A retrospective review of patient records was undertaken. Inclusion criteria were a diagnosis of HC and confirmation at follow-up. RESULTS Six of the 1617 new patients seen between 2015 and 2017 met the selection criteria. Four patients presented with "facial pain", one with "toothache" and one with "jaw pain". All were female with mean age 55 ± 10.5 years (range = 41-69). Headache characteristics included unilateral (R:L = 1:1) pain of moderate intensity with severe exacerbations in the distribution of V1 (1/6), V1 + V2 (3/6) and V1 + V2 + V3 (2/6). Lacrimation and photophobia were the most common associated symptoms. Patient presentations were complicated by multiple medical and comorbid diagnoses. All were diagnosed with temporomandibular disorder (TMD). Indomethacin alone was sufficient for adequate headache control in 2/6 patients with several add-on medications providing sustained pain relief. CONCLUSIONS Comorbid pain conditions can be expected in patients with HC presenting to orofacial pain clinics. Symptom presentation varies, and multimodal treatment approach is necessary for success.
Collapse
Affiliation(s)
- Iryna Hryvenko
- 1 Division of TMD & Orofacial Pain, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - Andrés R Cervantes-Chavarría
- 1 Division of TMD & Orofacial Pain, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - Alan S Law
- 2 Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.,3 Private Practice, Lake Elmo, MN, USA
| | - Donald R Nixdorf
- 1 Division of TMD & Orofacial Pain, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.,4 Department of Neurology, Medical School, University of Minnesota, Minneapolis, MN, USA.,5 HealthPartners Institute for Education and Research, Bloomington, MN, USA
| |
Collapse
|