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Lagman-Bartolome AM, Im J, Gladstone J. Headaches Attributed to Disorders of Homeostasis. Neurol Clin 2024; 42:521-542. [PMID: 38575264 DOI: 10.1016/j.ncl.2023.12.007] [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: 04/06/2024]
Abstract
Headaches attributed to disorders of homeostasis include those different headache types associated with metabolic and systemic diseases. These are headache disorders occurring in temporal relation to a disorder of homeostasis including hypoxia, high altitude, airplane travel, diving, sleep apnea, dialysis, autonomic dysreflexia, hypothyroidism, fasting, cardiac cephalalgia, hypertension and other hypertensive disorders like pheochromocytoma, hypertensive crisis, and encephalopathy, as well as preeclampsia or eclampsia. The proposed mechanism behind the causation of these headache subtypes including diagnostic criteria, evaluation, treatment, and overall management will be discussed.
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Affiliation(s)
- Ana Marissa Lagman-Bartolome
- Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, University of Toronto; Department of Pediatrics, Division of Neurology, Children's Hospital, London Health Sciences Center, Schulich School of Medicine & Dentistry, University of Western Ontario, 800 Commissioner's Road East, London, Ontario N6A5W9, Canada.
| | - James Im
- Department of Medicine, Division of Adult Neurology, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario M5B1W8, Canada
| | - Jonathan Gladstone
- Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, University of Toronto; Gladstone Headache Clinic, 1333 Sheppard Avenue E, Suite 122, North York, Ontario M2J1V1, Canada
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Unnikrishnan A, Shekhar A, Kumar D, Jaipurkar R, Sikri G, Singh K, Manral R. Does Lake Louise questionnaire interpret high-altitude headache as acute mountain sickness? Experience in the western Himalayas. Indian J Med Res 2024; 159:241-245. [PMID: 38517219 PMCID: PMC11050752 DOI: 10.4103/ijmr.ijmr_2127_21] [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: 07/07/2021] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND OBJECTIVES High-altitude headache (HAH) and headache in acute mountain sickness (AMS) are common among lowlanders ascending to the high altitude and are often confused with one another. A pilot study was undertaken to analyze HAH and AMS cases in Indian lowlanders ascending to Leh city (3500 m) in western Himalayas. METHODS A total number of 1228 Indian lowlanders, who ascended (fresh and re-inductees) by air and acclimatized, participated in this pilot study. The intensity of headache was assessed by the Visual Analogue Score. The parameters of HAH as per the International Classification of Headache Disorders-3 and 2018 Revised Lake Louise Questionnaire (LLQ) were used to differentiate HAH and AMS. RESULTS Out of 1228 cases, 78 (6.4%) cases had headache, of which 24 (1.95%) cases were HAH only, 40 (3.25%) cases AMS only and 14 (1.14%) cases were defined as both HAH and AMS. There was a significant difference in heart rate [F (2,51) = (4.756), P =0.01] between these groups. It also showed a difference in the correlation between the parameters within the groups. The Odd's Ratio of AMS in fresh and re-inductees was found to be 4.5 and for HAH it was 4.33. INTERPRETATION CONCLUSIONS The findings of this study suggest that LLQ has a tendency of overestimating AMS by including HAH cases. Furthermore differential parameters exhibit differences when AMS and HAH are considered separately. Re-inductees showed a lower incidence of HAH and AMS.
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Affiliation(s)
- Abhilash Unnikrishnan
- Department of Physiology, Armed Forces Medical College, Pune, Maharashtra, India
- High Altitude Medical Research Centre, Leh, Ladakh, India
| | - Atul Shekhar
- Department of Physiology, Armed Forces Medical College, Pune, Maharashtra, India
- High Altitude Medical Research Centre, Leh, Ladakh, India
| | - Dharmendra Kumar
- Department of Physiology, Armed Forces Medical College, Pune, Maharashtra, India
- High Altitude Medical Research Centre, Leh, Ladakh, India
| | - Raksha Jaipurkar
- Department of Physiology, Armed Forces Medical College, Pune, Maharashtra, India
- High Altitude Medical Research Centre, Leh, Ladakh, India
| | - Gaurav Sikri
- Department of Physiology, Armed Forces Medical College, Pune, Maharashtra, India
- High Altitude Medical Research Centre, Leh, Ladakh, India
| | - Krishan Singh
- Department of Physiology, Armed Forces Medical College, Pune, Maharashtra, India
- High Altitude Medical Research Centre, Leh, Ladakh, India
| | - Rahul Manral
- Department of Physiology, Armed Forces Medical College, Pune, Maharashtra, India
- High Altitude Medical Research Centre, Leh, Ladakh, India
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Zubieta-Calleja GR, Zubieta-DeUrioste N. High Altitude Pulmonary Edema, High Altitude Cerebral Edema, and Acute Mountain Sickness: an enhanced opinion from the High Andes - La Paz, Bolivia 3,500 m. REVIEWS ON ENVIRONMENTAL HEALTH 2023; 38:327-338. [PMID: 35487499 DOI: 10.1515/reveh-2021-0172] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/21/2022] [Indexed: 06/02/2023]
Abstract
Traveling to high altitudes for entertainment or work is sometimes associated with acute high altitude pathologies. In the past, scientific literature from the lowlander point of view was primarily based on mountain climbing. Sea level scientists developed all guidelines, but they need modifications for medical care in high altitude cities. Acute Mountain Sickness, High Altitude Pulmonary Edema, and High Altitude Cerebral Edema are medical conditions that some travelers can face. We present how to diagnose and treat acute high altitude pathologies, based on 51 years of high altitude physiology research and medical practice in hypobaric hypoxic diseases in La Paz, Bolivia (3,600 m; 11,811 ft), at the High Altitude Pulmonary and Pathology Institute (HAPPI - IPPA). These can occasionally present after flights to high altitude cities, both in lowlanders or high-altitude residents during re-entry. Acute high altitude ascent diseases can be adequately diagnosed and treated in high altitude cities following the presented guidelines. Treating these high-altitude illnesses, we had no loss of life. Traveling to a high altitude with sound medical advice should not be feared as it has many benefits. Nowadays, altitude descent and evacuation are not mandatory in populated highland cities, with adequate medical resources.
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Affiliation(s)
- Gustavo R Zubieta-Calleja
- High Altitude Pulmonary and Pathology Institute (HAPPI-IPPA), La Paz, Bolivia
- Department of Physiology, Shri B.M. Patil Medical College, Hospital and Research Centre, BLDE (Deemed to be University), Vijayapur 586103, Karnataka, India
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Sherpas, Coca Leaves, and Planes: High Altitude and Airplane Headache Review with a Case of Post-LASIK Myopic Shift. Curr Neurol Neurosci Rep 2019; 19:104. [PMID: 31781974 DOI: 10.1007/s11910-019-1013-0] [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: 10/25/2022]
Abstract
PURPOSE OF REVIEW High altitude headache is a common neurological symptom that is associated with ascent to high altitude. It is classified by the International Classification of Headache Disorders, 3rd Edition (ICHD-3) as a disorder of homeostasis. In this article, we review recent clinical and insights into the pathophysiological mechanisms of high altitude and airplane headache. We also report a second case of post-LASIK myopic shift at high altitude exposure secondary hypoxia. Headache attributed to airplane travel is a severe typically unilateral orbital headache that usually improves after landing. This was a relative recent introduction to the ICHD-3 diagnostic criteria. Headache pain with flight travel has long been known and may have been previously considered as a part of barotrauma. Recent studies have helped identify this as a distinct headache disorder. RECENT FINDINGS Physiologic, hematological, and biochemical biomarkers have been identified in recent high altitude studies. There have been recent advance in identification of molecular mechanisms underlying neurophysiologic changes secondary to hypoxia. Calcitonin gene-related peptide, a potent vasodilator, has been implicated in migraine pathophysiology. Recent epidemiological studies indicate that the prevalence of airplane headache may be more common than we think in the adult as well at the pediatric population. Simulated flight studies have identified potential biomarkers. Although research is limited, there have been advances in both clinical and pathophysiological mechanisms associated with high altitude and airplane headache.
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Zhang J, Zhang J, Wang R, Jia Z. Effects of Gut Microbiota on Drug Metabolism and Guidance for Rational Drug Use Under Hypoxic Conditions at High Altitudes. Curr Drug Metab 2019; 20:155-165. [PMID: 30338735 DOI: 10.2174/1389200219666181019145159] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/11/2018] [Accepted: 09/14/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Modern features of drug development such as low permeability, low solubility, and improved release affect the interplay of the gut microbiota and drug metabolism. In recent years, studies have established the impact of plateau hypoxia on gut microbiota, where drug use by plateau populations is affected by hypoxia- induced changes in intestinal microflora-mediated drug metabolism. METHODS In this review, we summarized the effects of gut microbiota on drug metabolism, and of plateau hypoxia on the intestinal flora, with the aim of providing guidance for the rational use of drugs in high-altitude populations. RESULTS The evidence clearly shows that alterations in gut microbiota can affect pro-drug activation, drug inactivation, and the biotransformation of xenobiotics. Additionally, plateau hypoxia alters drug metabolism by affecting intestinal flora. CONCLUSION This review provides an overview of the effects of gut microbiota on drug metabolism and provides guidance for rational drug use under hypoxic conditions at high altitudes.
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Affiliation(s)
- Juanhong Zhang
- School of Pharmacy, Lanzhou University, Lanzhou, 730000, Gansu, China.,Key Laboratory for Prevention and Remediation of Plateau Environmental Damage, Lanzhou, General Hospital, Lanzhou, 730000, Gansu, China
| | - Junmin Zhang
- School of Pharmacy, Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Rong Wang
- School of Pharmacy, Lanzhou University, Lanzhou, 730000, Gansu, China.,Key Laboratory for Prevention and Remediation of Plateau Environmental Damage, Lanzhou, General Hospital, Lanzhou, 730000, Gansu, China
| | - Zhengping Jia
- School of Pharmacy, Lanzhou University, Lanzhou, 730000, Gansu, China.,Key Laboratory for Prevention and Remediation of Plateau Environmental Damage, Lanzhou, General Hospital, Lanzhou, 730000, Gansu, China
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Liu C, Liu B, Liu L, Zhang EL, Sun BD, Xu G, Chen J, Gao YQ. Arachidonic Acid Metabolism Pathway Is Not Only Dominant in Metabolic Modulation but Associated With Phenotypic Variation After Acute Hypoxia Exposure. Front Physiol 2018; 9:236. [PMID: 29615930 PMCID: PMC5864929 DOI: 10.3389/fphys.2018.00236] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 03/02/2018] [Indexed: 12/22/2022] Open
Abstract
Background: The modulation of arachidonic acid (AA) metabolism pathway is identified in metabolic alterations after hypoxia exposure, but its biological function is controversial. We aimed at integrating plasma metabolomic and transcriptomic approaches to systematically explore the roles of the AA metabolism pathway in response to acute hypoxia using an acute mountain sickness (AMS) model. Methods: Blood samples were obtained from 53 enrolled subjects before and after exposure to high altitude. Ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry and RNA sequencing were separately performed for metabolomic and transcriptomic profiling, respectively. Influential modules comprising essential metabolites and genes were identified by weighted gene co-expression network analysis (WGCNA) after integrating metabolic information with phenotypic and transcriptomic datasets, respectively. Results: Enrolled subjects exhibited diverse response manners to hypoxia. Combined with obviously altered heart rate, oxygen saturation, hemoglobin, and Lake Louise Score (LLS), metabolomic profiling detected that 36 metabolites were highly related to clinical features in hypoxia responses, out of which 27 were upregulated and nine were downregulated, and could be mapped to AA metabolism pathway significantly. Integrated analysis of metabolomic and transcriptomic data revealed that these dominant molecules showed remarkable association with genes in gas transport incapacitation and disorders of hemoglobin metabolism pathways, such as ALAS2, HEMGN. After detailed description of AA metabolism pathway, we found that the molecules of 15-d-PGJ2, PGA2, PGE2, 12-O-3-OH-LTB4, LTD4, LTE4 were significantly up-regulated after hypoxia stimuli, and increased in those with poor response manner to hypoxia particularly. Further analysis in another cohort showed that genes in AA metabolism pathway such as PTGES, PTGS1, GGT1, TBAS1 et al. were excessively elevated in subjects in maladaptation to hypoxia. Conclusion: This is the first study to construct the map of AA metabolism pathway in response to hypoxia and reveal the crosstalk between phenotypic variation under hypoxia and the AA metabolism pathway. These findings may improve our understanding of the advanced pathophysiological mechanisms in acute hypoxic diseases and provide new insights into critical roles of the AA metabolism pathway in the development and prevention of these diseases.
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Affiliation(s)
- Chang Liu
- Institute of Medicine and Hygienic Equipment for High Altitude Region, College of High Altitude Military Medicine, Army Medical University, Third Military Medical University, Chongqing, China.,Key Laboratory of High Altitude Environmental Medicine, Army Medical University, Third Military Medical University, Ministry of Education, Chongqing, China.,Key Laboratory of High Altitude Medicine, People's Liberation Army, Chongqing, China
| | - Bao Liu
- Institute of Medicine and Hygienic Equipment for High Altitude Region, College of High Altitude Military Medicine, Army Medical University, Third Military Medical University, Chongqing, China.,Key Laboratory of High Altitude Environmental Medicine, Army Medical University, Third Military Medical University, Ministry of Education, Chongqing, China.,Key Laboratory of High Altitude Medicine, People's Liberation Army, Chongqing, China.,The 12th Hospital of Chinese People's Liberation Army, Kashi, China
| | - Lu Liu
- Institute of Medicine and Hygienic Equipment for High Altitude Region, College of High Altitude Military Medicine, Army Medical University, Third Military Medical University, Chongqing, China.,Key Laboratory of High Altitude Environmental Medicine, Army Medical University, Third Military Medical University, Ministry of Education, Chongqing, China.,Key Laboratory of High Altitude Medicine, People's Liberation Army, Chongqing, China
| | - Er-Long Zhang
- Institute of Medicine and Hygienic Equipment for High Altitude Region, College of High Altitude Military Medicine, Army Medical University, Third Military Medical University, Chongqing, China.,Key Laboratory of High Altitude Environmental Medicine, Army Medical University, Third Military Medical University, Ministry of Education, Chongqing, China.,Key Laboratory of High Altitude Medicine, People's Liberation Army, Chongqing, China
| | - Bind-da Sun
- Institute of Medicine and Hygienic Equipment for High Altitude Region, College of High Altitude Military Medicine, Army Medical University, Third Military Medical University, Chongqing, China.,Key Laboratory of High Altitude Environmental Medicine, Army Medical University, Third Military Medical University, Ministry of Education, Chongqing, China.,Key Laboratory of High Altitude Medicine, People's Liberation Army, Chongqing, China
| | - Gang Xu
- Institute of Medicine and Hygienic Equipment for High Altitude Region, College of High Altitude Military Medicine, Army Medical University, Third Military Medical University, Chongqing, China.,Key Laboratory of High Altitude Environmental Medicine, Army Medical University, Third Military Medical University, Ministry of Education, Chongqing, China.,Key Laboratory of High Altitude Medicine, People's Liberation Army, Chongqing, China
| | - Jian Chen
- Institute of Medicine and Hygienic Equipment for High Altitude Region, College of High Altitude Military Medicine, Army Medical University, Third Military Medical University, Chongqing, China.,Key Laboratory of High Altitude Environmental Medicine, Army Medical University, Third Military Medical University, Ministry of Education, Chongqing, China.,Key Laboratory of High Altitude Medicine, People's Liberation Army, Chongqing, China
| | - Yu-Qi Gao
- Institute of Medicine and Hygienic Equipment for High Altitude Region, College of High Altitude Military Medicine, Army Medical University, Third Military Medical University, Chongqing, China.,Key Laboratory of High Altitude Environmental Medicine, Army Medical University, Third Military Medical University, Ministry of Education, Chongqing, China.,Key Laboratory of High Altitude Medicine, People's Liberation Army, Chongqing, China
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Sridharan K, Sivaramakrishnan G. Pharmacological interventions for preventing acute mountain sickness: a network meta-analysis and trial sequential analysis of randomized clinical trials. Ann Med 2018; 50:147-155. [PMID: 29166795 DOI: 10.1080/07853890.2017.1407034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Individuals ascending to high altitude are at a risk of getting acute mountain sickness (AMS). The present study is a network meta-analysis comparing all the interventions available to prevent AMS. METHODS Electronic databases were searched for randomized clinical trials evaluating the use of drugs to prevent AMS. Incidence of AMS was the primary outcome and incidence of severe AMS, paraesthesia (as side effect of acetazolamide use), headache and severe headache, and oxygen saturation were the secondary outcomes. Odds ratio [95% confidence interval] was the effect estimate for categorical outcomes and weighted mean difference for oxygen saturation. Random effects model was used to derive the direct and mixed treatment comparison pooled estimates. Trial sequential analysis and grading of the evidence for key comparisons were carried out. RESULTS A total of 24 studies were included. Acetazolamide at 125, 250 and 375 mg twice daily, dexamethasone and ibuprofen had statistically significant lower incidence of AMS compared to placebo. All the above agents except ibuprofen were also observed to significantly reduce the incidence of severe AMS. Acetazolamide alone or in combination with Ginkgo biloba were associated with lower incidence of headache, but higher risk of paraesthesia. Acetazolamide at 125 mg and 375 mg twice daily significantly reduce the incidence of severe headache as like ibuprofen. Trial sequential analysis indicates that the current evidence is adequate for the incidence of AMS only for acetazolamide 125 and 250 mg twice daily. Similarly, the strength of evidence for acetazolamide 125 and 250 mg twice daily was moderate while it was either low or very low for all other comparisons. CONCLUSIONS Acetazolamide at 125, 250 and 375 mg twice daily, ibuprofen and dexamethasone significantly reduce the incidence of AMS of which adequate evidence exists only for acetazolamide 125 and 250 mg twice daily therapy. Acetazolamide 125 mg twice daily could be the best in the pool considering the presence of enough evidence for preventing AMS and associated with lower incidence of paraesthesia. Key messages Acetazolamide 125, 250 and 375 mg twice daily, dexamethasone and ibuprofen reduce the incidence of AMS in high altitudes. Adequate evidence exists supporting the use of acetazolamide 125 mg and 250 mg twice daily for preventing AMS of which acetazolamide 125 mg twice daily could be the best.
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Affiliation(s)
- Kannan Sridharan
- a Department of Pharmacology and Therapeutics, College of Medicine and Medical Sciences , Arabian Gulf University , Manama , Bahrain
| | - Gowri Sivaramakrishnan
- b School of Oral Health, College of Medicine, Nursing and Health Sciences , Fiji National University , Suva , Fiji
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