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Peng KP, Burish MJ. Management of cluster headache: Treatments and their mechanisms. Cephalalgia 2023; 43:3331024231196808. [PMID: 37652457 DOI: 10.1177/03331024231196808] [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: 09/02/2023]
Abstract
BACKGROUND The management of cluster headache is similar to that of other primary headache disorders and can be broadly divided into acute and preventive treatments. Acute treatments for cluster headache are primarily delivered via rapid, non-oral routes (such as inhalation, nasal, or subcutaneous) while preventives include a variety of unrelated treatments such as corticosteroids, verapamil, and galcanezumab. Neuromodulation is becoming an increasingly popular option, both non-invasively such as vagus nerve stimulation when medical treatment is contraindicated or side effects are intolerable, and invasively such as occipital nerve stimulation when medical treatment is ineffective. Clinically, this collection of treatment types provides a range of options for the informed clinician. Scientifically, this collection provides important insights into disease mechanisms. METHODS Two authors performed independent narrative reviews of the literature on guideline recommendations, clinical trials, real-world data, and mechanistic studies. RESULTS Cluster headache is treated with acute treatments, bridge treatments, and preventive treatments. Common first-line treatments include subcutaneous sumatriptan and high-flow oxygen as acute treatments, corticosteroids (oral or suboccipital injections) as bridge treatments, and verapamil as a preventive treatment. Some newer acute (non-invasive vagus nerve stimulation) and preventive (galcanezumab) treatments have excellent clinical trial data for episodic cluster headache, while other newer treatments (occipital nerve stimulation) have been specifically tested in treatment-refractory chronic cluster headache. Most treatments are suspected to act on the trigeminovascular system, the autonomic system, or the hypothalamus. CONCLUSIONS The first-line treatments have not changed in recent years, but new treatments have provided additional options for patients.
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Affiliation(s)
- Kuan-Po Peng
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mark J Burish
- Department of Neurosurgery, UTHealth Houston, Houston, Texas, USA
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2
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Abstract
Cluster headache, a primary headache disorder, consists of short (15-180 minutes), frequent (up to eight a day), unilateral attacks of facial pain with associated ipsilateral autonomic features and restlessness. The attacks are suspected to be one of the most painful human experiences, and the disorder is associated with a high rate of suicidal ideation. Proper diagnosis is key, as some of the most effective treatments, such as high flow oxygen gas, are rarely used in other headache disorders. Yet diagnostic delay is typically years for this disorder, as it is often confused with migraine and trigeminal neuralgia, and secondary causes may be overlooked. This review covers the clinical, pathophysiologic, and therapeutic features of cluster headache. Recent updates in diagnosis include the redefinition of chronic cluster headache (remission periods lasting less than three months instead of the previous one month), and recent advances in management include new treatments for episodic cluster headache (galcanezumab and non-invasive vagus nerve stimulation).
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Affiliation(s)
- Emmanuelle A D Schindler
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
- Veterans Health Administration Headache Center of Excellence, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - Mark J Burish
- Department of Neurosurgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
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3
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Papasavva M, Vikelis M, Siokas V, Katsarou MS, Dermitzakis E, Raptis A, Dardiotis E, Drakoulis N. VDR Gene Polymorphisms and Cluster Headache Susceptibility: Case-Control Study in a Southeastern European Caucasian Population. J Mol Neurosci 2021; 72:382-392. [PMID: 34519950 DOI: 10.1007/s12031-021-01892-w] [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: 04/23/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
Cluster headache (CH) is a severe primary headache disorder with a genetic component, as indicated by family and twin studies. Diurnal and seasonal rhythmicity are key features of the disease and might be related to vitamin D, as low vitamin D levels have been observed in patients with cluster headache. In addition, the vitamin D receptor (VDR) occurs in brain areas and particularly in the hypothalamus. The aim of the present case-control study was to investigate the association of cluster headache susceptibility and clinical phenotypes with the VDR gene polymorphisms FokI, BsmI and TaqI in a Southeastern European Caucasian population. DNA was extracted from 131 unrelated CH patients and 282 non-headache controls and genotyped using real-time PCR (melting curve analysis). Linkage disequilibrium (LD) analysis confirmed that BsmI and TaqI, both located in the 3'UTR of the VDR gene, are in strong LD. Genotype and allele frequency distribution analysis of the VDR FokI, BsmI, and TaqI polymorphisms showed no statistically significant difference between cases and controls, whereas haplotype analysis indicated that the TAC haplotype might be associated with decreased cluster headache susceptibility. Intra-patient analysis according to diverse clinical phenotypes showed an association of the BsmI GG and TaqI TT genotypes with more frequent occurrence of CH attacks in this cohort. Therefore, a possible association was observed between VDR gene polymorphisms BsmI and TaqI or a linked locus and susceptibility for cluster headache development and altered clinical phenotypes in the Southeastern European Caucasian study population. Further large-scale replication studies are needed to validate these findings.
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Affiliation(s)
- Maria Papasavva
- Research Group of Clinical Pharmacology and Pharmacogenomics, Faculty of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Panepistimiopolis Zografou, 15771, Athens, Greece
| | | | - Vasileios Siokas
- Department of Neurology, Laboratory of Neurogenetics, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Martha-Spyridoula Katsarou
- Research Group of Clinical Pharmacology and Pharmacogenomics, Faculty of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Panepistimiopolis Zografou, 15771, Athens, Greece
| | | | - Athanasios Raptis
- Research Group of Clinical Pharmacology and Pharmacogenomics, Faculty of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Panepistimiopolis Zografou, 15771, Athens, Greece
| | - Efthimios Dardiotis
- Department of Neurology, Laboratory of Neurogenetics, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Nikolaos Drakoulis
- Research Group of Clinical Pharmacology and Pharmacogenomics, Faculty of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Panepistimiopolis Zografou, 15771, Athens, Greece.
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Day M, Abd-Elsayed A, Ashworth B. Algorithms for Management Recommendations. TRIGEMINAL NERVE PAIN 2021:229-242. [DOI: 10.1007/978-3-030-60687-9_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Abstract
Abstract
Purpose of review
Among the spectrum of pain conditions, cluster headache represents one of the most severe. Targeted therapies for cluster headache are evolving thus improving the available therapeutic armamentarium. A better understanding of the currently available therapies, as well as new and emerging options, may aide physicians to manage affected sufferers better by evolving treatment guidance.
Recent findings
While classic first-line medications are useful in some patients with cluster headache, they are often accompanied by significant side effects that limit their use. Recently, novel treatments with better tolerability and decreased medication interactions have proven to be effective. A remarkable example of this is the blockage of the calcitonin gene-related peptide pathway with monoclonal antibodies, which may be a key element in the future treatment of cluster headache. The sphenopalatine ganglion and vagus nerve perform a critical role in the regulation of pain and the trigeminal autonomic reflex. Neuromodulation therapies targeting these structures have shown excellent tolerability and few significant adverse events, constituting a promising form of treatment. Finally, several potential therapeutic targets are examined in this review, such as small molecule CGRP receptor antagonists, known as gepants, and serotonin receptor 5-HT1F receptor agonists: ditans.
Summary
In summary, a deepening of the understanding of cluster headache mechanisms in recent years has driven the evolution of sophisticated therapeutic approaches that could allow a new era in the treatment of this difficult condition.
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6
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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.
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Gurumukhani JK, Patel DM, Patel MV, Patel MM, Patel AV, Patel SY. Short-Lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection and Tearing (SUNCT) Status Like Condition: A Rare Case Report and Review of the Literature. Open Neurol J 2020. [DOI: 10.2174/1874205x02014010074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) is rare trigeminal autonomic cephalgia characterized by recurrent, brief, excruciating unilateral, intermittent headache paroxysms over orbital, frontal or temporal region occurring multiple times per day and it can rarely present as “SUNCTstatus like condition” (SSLC).
Case Report:
A 28-year old male with a history of SUNCT headache for 6 months presented with left forehead stabs lasting for 30 seconds with a frequency of 40-45 episodes per hour for three days followed by infective gastroenteritis. His neurological examination was normal, except left-sided ptosis, tearing, and conjunctival injection. His MRI brain with contrast, MR angiography, and laboratory investigations were unremarkable except mild hypokalemia. He was treated with intravenous fluids, potassium replacement, and high dose methylprednisolone along with an escalated dose of carbamazepine.
Review and Conclusion:
We have reviewed the previously reported seven cases and our case of SSLC. Female: Male ratio was 3:1and the mean age was 40.87 years. Three patients responded to high dose steroids and three to lignocaine along with rapid escalation or change of anticonvulsant drugs. One case responded to the high dose of lamotrigine, and in a pregnant lady, the pain subsided only after the termination of the pregnancy. One case was secondary to multiple sclerosis, while the rest of seven were primary episodic SSLC. The condition is highly disabling, and the treatment with steroids or lignocaine, along with the rapid escalation of preventive drugs, can provide long-lasting relief
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Gurumukhani JK, Patel DM, Patel MV, Patel MM, Patel AV, Patel SY. Short-Lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection and Tearing (SUNCT) Status Like Condition: A Rare Case Report and Review of the Literature. Open Neurol J 2020. [DOI: 10.2174/1874205x02014010075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) is rare trigeminal autonomic cephalgia characterized by recurrent, brief, excruciating unilateral, intermittent headache paroxysms over orbital, frontal or temporal region occurring multiple times per day and it can rarely present as “SUNCTstatus like condition” (SSLC).
Case Report:
A 28-year old male with a history of SUNCT headache for 6 months presented with left forehead stabs lasting for 30 seconds with a frequency of 40-45 episodes per hour for three days followed by infective gastroenteritis. His neurological examination was normal, except left-sided ptosis, tearing, and conjunctival injection. His MRI brain with contrast, MR angiography, and laboratory investigations were unremarkable except mild hypokalemia. He was treated with intravenous fluids, potassium replacement, and high dose methylprednisolone along with an escalated dose of carbamazepine.
Review and Conclusion:
We have reviewed the previously reported seven cases and our case of SSLC. Female: Male ratio was 3:1and the mean age was 40.87 years. Three patients responded to high dose steroids and three to lignocaine along with rapid escalation or change of anticonvulsant drugs. One case responded to the high dose of lamotrigine, and in a pregnant lady, the pain subsided only after the termination of the pregnancy. One case was secondary to multiple sclerosis, while the rest of seven were primary episodic SSLC. The condition is highly disabling, and the treatment with steroids or lignocaine, along with the rapid escalation of preventive drugs, can provide long-lasting relief
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Silvestro M, Tessitore A, Scotto di Clemente F, Tedeschi G, Russo A. Erenumab Efficacy on Comorbid Cluster Headache in Patients With Migraine: A Real‐World Case Series. Headache 2020; 60:1187-1195. [DOI: 10.1111/head.13832] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 03/26/2020] [Accepted: 04/11/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Marcello Silvestro
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences University of Campania “Luigi Vanvitelli” Naples Italy
| | - Alessandro Tessitore
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences University of Campania “Luigi Vanvitelli” Naples Italy
| | - Fabrizio Scotto di Clemente
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences University of Campania “Luigi Vanvitelli” Naples Italy
| | - Gioacchino Tedeschi
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences University of Campania “Luigi Vanvitelli” Naples Italy
- Institute for Diagnosis and Care “Hermitage‐Capodimonte” Naples Italy
| | - Antonio Russo
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences University of Campania “Luigi Vanvitelli” Naples Italy
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Empiric use of oxygen for acute atraumatic, unilateral, retro-orbital headaches. JAAPA 2020; 33:25-27. [DOI: 10.1097/01.jaa.0000651724.17784.e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Analysis of HCRTR2, GNB3, and ADH4 Gene Polymorphisms in a Southeastern European Caucasian Cluster Headache Population. J Mol Neurosci 2019; 70:467-474. [PMID: 31768945 DOI: 10.1007/s12031-019-01439-0] [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: 09/05/2019] [Accepted: 11/06/2019] [Indexed: 12/31/2022]
Abstract
Studies point to an increased hereditary risk of cluster headache. HCRTR2 gene rs2653349 and ADH4 gene rs1800759 polymorphisms have been associated with cluster headache susceptibility. Also, GNB3 rs5443 polymorphism, associated with increased signal transduction via GPCRs, seems to influence triptan treatment response. DNA from 114 cluster headache patients and 570 non-related controls, representing a general Southeastern European Caucasian (SEC) population, was extracted from buccal swabs and genotyped using real-time PCR. Gene distribution for the rs2653349 was GG = 79.8%, GA = 18.4%, and AA = 1.8% for patients and GG = 79.1%, GA = 19.1%, and AA = 1.8% for controls. The frequency of the mutated A allele was 11.0% for patients and 11.3% for controls. The frequencies for rs5443 were CC = 44.7%, CT = 44.7%, and TT = 10.5% for patients and CC = 43.9%, CT = 42.6%, and TT = 13.5% for controls. The frequency of the mutated T allele was 32.9% for patients and 34.8% for controls. A 2.7-fold more frequent appearance of the mutated T allele was observed in patients with better triptan treatment response, although not statistically significant. For rs1800759, the frequencies were CC = 36.0%, CA = 43.0%, and AA = 21.0% for patients and CC = 34.0%, CA = 50.2%, and AA = 15.8% for controls. The frequency of the mutated A allele was 42.5% and 40.9% for patients and controls, respectively. The mutated T allele of GNB3 rs5443 polymorphism was more prevalent in patients with better triptan treatment response, indicating a possible trend of association between this polymorphism and triptan treatment response in SEC population. According to our observation, no association of HCRTR2 rs2653349 and ADH4 rs1800759 polymorphisms and cluster headache in SEC population could be documented.
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Pisano S, Pozzi M, Catone G, Scrinzi G, Clementi E, Coppola G, Milone A, Bravaccio C, Santosh P, Masi G. Putative Mechanisms of Action and Clinical Use of Lithium in Children and Adolescents: A Critical Review. Curr Neuropharmacol 2019; 17:318-341. [PMID: 29256353 PMCID: PMC6482478 DOI: 10.2174/1570159x16666171219142120] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/09/2017] [Accepted: 11/28/2017] [Indexed: 01/17/2023] Open
Abstract
Background: Lithium is a first-line treatment for bipolar disorder in adults, but its mechanism of action is still far from clear. Furthermore, evidences of its use in pediatric populations are sparse, not only for bipolar disorders, but also for other possible indications. Objectives: To provide a synthesis of published data on the possible mechanisms of action of lithium, as well as on its use in pediatric samples, including pharmacokinetics, efficacy, and safety data. Methods: Clinical trials in pediatric samples with at least one standardized measure of efficacy/effectiveness were included in this review. We considered: i) randomized and open label trials, ii) combination studies iii) augmentation studies iv) case series including at least 5 patients. Results: Different and non-alternative mechanisms of action can explain the clinical efficacy of lithium. Clinical studies in pediatric samples suggest that lithium is effective in managing manic symptoms/episodes of bipolar disorder, both in the acute phase and as maintenance strategy. Efficacy on depressive symptoms/phases of bipolar disorder is much less clear, while studies do not support its use in unipolar depression and severe mood dysregulation. Conversely, it may be effective on aggression in the context of conduct disorder. Other possible indications, with limited published evidence, are the acute attacks in Kleine-Levin syndrome, behavioral symptoms of X-fragile syndrome, and the management of clozapine- or chemotherapy- induced neutropenia. Generally, lithium resulted relatively safe. Conclusions: Lithium seems an effective and well-tolerated medication in pediatric bipolar disorder and aggression, while further evidences are needed for other clinical indications.
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Affiliation(s)
- Simone Pisano
- Clinic of Child and Adolescent Neuropsychiatry, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Marco Pozzi
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy
| | - Gennaro Catone
- Dept. of Mental and Physical Health and Preventive Medicine, Child and Adolescent Psychiatry Division, Campania University- Luigi Vanvitelli, Italy
| | - Giulia Scrinzi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Child Neuropsychiatry Unit, University of Verona, Verona 37126, Italy
| | - Emilio Clementi
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy.,Unit of Clinical Pharmacology, CNR Institute of Neuroscience, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, University of Milan, 20157 Milan, Italy
| | - Giangennaro Coppola
- Clinic of Child and Adolescent Neuropsychiatry, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Annarita Milone
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Carmela Bravaccio
- Department of Translational Medical Sciences, University Federico II of Naples, Italy
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.,Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), National and Specialist Child and Adolescent Mental Health Services, Maudsley Hospital, London, United States.,HealthTracker Ltd, Gillingham, United States
| | - Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
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Chen Z, Chen X, Liu M, Ma L, Yu S. Volume of Hypothalamus as a Diagnostic Biomarker of Chronic Migraine. Front Neurol 2019; 10:606. [PMID: 31244765 PMCID: PMC6563769 DOI: 10.3389/fneur.2019.00606] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/22/2019] [Indexed: 12/04/2022] Open
Abstract
It is believed than hypothalamus (HTH) might be involved in generation of migraine, and evidence from high resolution fMRI reported that the more anterior part of HTH seemed to play an important role in migraine chronification. The current study was aimed to identify the alteration of morphology and resting-state functional connectivity (FC) of the hypothalamus (HTH) in interictal episodic migraine (EM) and chronic migraine (CM). High-resolution structural and resting-state functional magnetic resonance images were acquired in 18 EM patients, 16 CM patients, and 21 normal controls (NC). The volume of HTH was calculated and voxel-based morphometry (VBM) was performed over the whole HTH. Receiver operating characteristics (ROC) curve analysis was applied to evaluate the diagnostic efficacy of HTH volume. Correlation analyses with clinical variables were performed and FC maps were generated for positive HTH regions according to VBM comparison. The volume of the HTH significantly decreased in both EM and CM patients compared with NC. The cut-off volume of HTH as 1.429 ml had a good diagnostic accuracy for CM with sensitivity of 81.25% and specificity of 100%. VBM analyses identified volume reduction of posterior HTH in EM vs. NC which was negatively correlated with headache frequency. The posterior HTH presented decreased FC with the left inferior temporal gyrus (Brodmann area 20) in EM. Decreased volume of anterior HTH was identified in CM vs. NC and CM vs. EM which was positively correlated with headache frequency in CM. The anterior HTH presented increased FC with the right anterior orbital gyrus (AOrG) (Brodmann area 11) in CM compared with NC and increased FC with the right medial orbital gyrus (MOrG) (Brodmann area 11) in CM compared with EM. Our study provided evidence of structural plasticity and FC changes of HTH in the pathogensis of migraine generation and chronification, supporting potential therapeutic target toward the HTH and its peptide.
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Affiliation(s)
- Zhiye Chen
- Department of Radiology, Chinese PLA General Hospital, Beijing, China.,Department of Neurology, Chinese PLA General Hospital, Beijing, China.,Department of Radiology, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Xiaoyan Chen
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Mengqi Liu
- Department of Radiology, Chinese PLA General Hospital, Beijing, China.,Department of Radiology, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Lin Ma
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
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Membrane Stabilizer Medications in the Treatment of Chronic Neuropathic Pain: a Comprehensive Review. Curr Pain Headache Rep 2019; 23:37. [DOI: 10.1007/s11916-019-0774-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Ponté C, Giron A, Crequy M, Lapeyre-Mestre M, Fabre N, Salles J. Cluster Headache in Subjects With Substance Use Disorder: A Case Series and a Review of the Literature. Headache 2019; 59:576-589. [PMID: 30957220 DOI: 10.1111/head.13516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To describe a case series of 7 patients presenting cluster headache (CH) criteria and a substance use disorder, reported to a French Addictovigilance center. Then, to assess clinical, pharmacological, and neurobiological linkages between substance use and CH onset. BACKGROUND CH patients are presenting a higher prevalence of comorbidities, among which the use of psychoactive substances, licit or illicit, have been explored by a few authors. Recently, 3 cases of CH in patients seen in the hospital-based addiction care center have been reported to the Toulouse addictovigilance center. METHODS Other cases have been identified in the same tertiary hospital after a collaborative investigation done with the departments of neurology and psychiatry and included in the case series. A narrative review was performed to assess the potential of psychoactive substance consumption to induce or facilitate CH. RESULTS From 2016 to 2018, 6 males and 1 female aged between 26 and 54 years old, presenting CH criteria and a substance use disorder, were included in our case series. Among substances used, there are: (1) daily use of tobacco and alcohol in 5/7 subjects; (2) daily or almost daily use of cocaine in 5/7 subjects; (3) regular use of cannabis before attacks beginning in 4/7 subjects; and (4) opioids, as a substitutive medication or abused, in 5/7 subjects. The intranasal route administration is reported by all the subjects and precedes the beginning of attacks for 5/7 subjects. CONCLUSIONS We have found a CH prevalence of 0.9% in our studied population, while it is estimated at 0.1% in the general population. The coexistence of cluster headache and addiction behaviors reflects possible common neurobiological pathways, which would include the hypothalamus. Research could be conducted on the potential of hypothalamic therapeutic targets.
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Affiliation(s)
- Camille Ponté
- Service de Pharmacologie Médicale et Clinique, Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, Faculté de Médecine, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Aurélie Giron
- Service de Psychiatrie et Psychologie, Université de Toulouse III, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Marie Crequy
- Service Universitaire de Psychiatrie et Psychologie Médicale, Centre de Soins d'Accompagnement et de Prévention en Addictologie, Hopital La Grave, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Maryse Lapeyre-Mestre
- Service de Pharmacologie Médicale et Clinique, Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, INSERM UMR 1027, CIC INSERM 1436, Faculté de Médecine, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Nelly Fabre
- Departement de Neurologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Juliette Salles
- Service de Psychiatrie et Psychologie, INSERM UMR 1043, Université de Toulouse III, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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Navarro-Fernández G, de-la-Puente-Ranea L, Gandía-González M, Gil-Martínez A. Endogenous Neurostimulation and Physiotherapy in Cluster Headache: A Clinical Case. Brain Sci 2019; 9:brainsci9030060. [PMID: 30870974 PMCID: PMC6468612 DOI: 10.3390/brainsci9030060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE The aim of this paper is to describe the progressive changes of chronic cluster headaches (CHs) in a patient who is being treated by a multimodal approach, using pharmacology, neurostimulation and physiotherapy. SUBJECT A male patient, 42 years of age was diagnosed with left-sided refractory chronic CH by a neurologist in November 2009. In June 2014, the patient underwent a surgical intervention in which a bilateral occipital nerve neurostimulator was implanted as a treatment for headache. METHODS Case report. RESULTS Primary findings included a decreased frequency of CH which lasted up to 2 months and sometimes even without pain. Besides this, there were decreased levels of anxiety, helplessness (PCS subscale) and a decreased impact of headache (HIT-6 scale). Bilateral pressure pain thresholds (PPTs) were improved along with an increase in strength and motor control of the neck muscles. These improvements were present at the conclusion of the treatment and maintained up to 4 months after the treatment. CONCLUSIONS A multimodal approach, including pharmacology, neurostimulation and physiotherapy may be beneficial for patients with chronic CHs. Further studies such as case series and clinical trials are needed to confirm these results.
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Affiliation(s)
- Gonzalo Navarro-Fernández
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid 28023, Spain.
- Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid 28023, Spain.
| | - Lucía de-la-Puente-Ranea
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid 28023, Spain.
| | | | - Alfonso Gil-Martínez
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid 28023, Spain.
- Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid 28023, Spain.
- Hospital La Paz Institute for Health Research, Madrid 28046, Spain.
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Jose A, Prasad RS, Pai A. Trigeminal autonomic cephalalgias: The impersonators. INDIAN JOURNAL OF PAIN 2019. [DOI: 10.4103/ijpn.ijpn_2_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Vyas DB, Ho AL, Dadey DY, Pendharkar AV, Sussman ES, Cowan R, Halpern CH. Deep Brain Stimulation for Chronic Cluster Headache: A Review. Neuromodulation 2018; 22:388-397. [DOI: 10.1111/ner.12869] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/21/2018] [Accepted: 08/30/2018] [Indexed: 01/24/2023]
Affiliation(s)
- Daivik B. Vyas
- Department of Neurosurgery Stanford University Stanford CA USA
| | - Allen L. Ho
- Department of Neurosurgery Stanford University Stanford CA USA
| | - David Y. Dadey
- Department of Neurosurgery Stanford University Stanford CA USA
| | | | - Eric S. Sussman
- Department of Neurosurgery Stanford University Stanford CA USA
| | - Robert Cowan
- Department of Neurology Stanford University Stanford CA USA
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Vollesen AL, Benemei S, Cortese F, Labastida-Ramírez A, Marchese F, Pellesi L, Romoli M, Ashina M, Lampl C. Migraine and cluster headache - the common link. J Headache Pain 2018; 19:89. [PMID: 30242519 PMCID: PMC6755613 DOI: 10.1186/s10194-018-0909-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 08/20/2018] [Indexed: 01/07/2023] Open
Abstract
Although clinically distinguishable, migraine and cluster headache share prominent features such as unilateral pain, common pharmacological triggers such glyceryl trinitrate, histamine, calcitonin gene-related peptide (CGRP) and response to triptans and neuromodulation. Recent data also suggest efficacy of anti CGRP monoclonal antibodies in both migraine and cluster headache. While exact mechanisms behind both disorders remain to be fully understood, the trigeminovascular system represents one possible common pathophysiological pathway and network of both disorders. Here, we review past and current literature shedding light on similarities and differences in phenotype, heritability, pathophysiology, imaging findings and treatment options of migraine and cluster headache. A continued focus on their shared pathophysiological pathways may be important in paving future treatment avenues that could benefit both migraine and cluster headache patients.
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Affiliation(s)
- Anne Luise Vollesen
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Silvia Benemei
- Health Sciences Department, University of Florence and Headache Centre, Careggi University Hospital, Florence, Italy
| | - Francesca Cortese
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza, University of Rome, Polo Pontino, Latina, Italy
| | - Alejandro Labastida-Ramírez
- Dep Internal Medicine, Division of Vascular Pharmacology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Lanfranco Pellesi
- Medical Toxicology, Headache and Drug Abuse Center, University of Modena and Reggio Emilia, Modena, Italy
| | - Michele Romoli
- Neurology Clinic, University of Perugia - S.M. Misericordiae Hospital, Perugia, Italy
| | - Messoud Ashina
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christian Lampl
- Department of Neurogeriatric Medicine, Headache Medical Center Linz, Ordensklinikum Linz Barmherzige Schwestern, Seilerstaette 4, 4010, Linz, Austria.
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20
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Sokolov AY, Murzina AA, Osipchuk AV, Lyubashina OA, Amelin AV. Cholinergic mechanisms of headaches. NEUROCHEM J+ 2017. [DOI: 10.1134/s1819712417020131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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21
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Baraldi C, Pellesi L, Guerzoni S, Cainazzo MM, Pini LA. Therapeutical approaches to paroxysmal hemicrania, hemicrania continua and short lasting unilateral neuralgiform headache attacks: a critical appraisal. J Headache Pain 2017; 18:71. [PMID: 28730562 PMCID: PMC5519518 DOI: 10.1186/s10194-017-0777-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/04/2017] [Indexed: 12/30/2022] Open
Abstract
Background Hemicrania continua (HC), paroxysmal hemicrania (PH) and short lasting neuralgiform headache attacks (SUNCT and SUNA) are rare syndromes with a difficult therapeutic approach. The aim of this review is to summarize all articles dealing with treatments for HC, PH, SUNCT and SUNA, comparing them in terms of effectiveness and safety. Methods A survey was performed using the pubmed database for documents published from the 1st January 1989 onwards. All types of articles were considered, those ones dealing with symptomatic cases and non-English written ones were excluded. Results Indomethacin is the best treatment both for HC and PH. For the acute treatment of HC, piroxicam and celecoxib have shown good results, whilst for the prolonged treatment celecoxib, topiramate and gabapentin are good options besides indomethacin. For PH the best drug besides indomethacin is piroxicam, both for acute and prolonged treatment. For SUNCT and SUNA the most effective treatments are intravenous or subcutaneous lidocaine for the acute treatment of active phases and lamotrigine for the their prevention. Other effective therapeutic options are intravenous steroids for acute treatment and topiramate for prolonged treatment. Non-pharmacological techniques have shown good results in SUNCT and SUNA but, since they have been tried on a small number of patients, the reliability of their efficacy is poor and their safety profile mostly unknown. Conclusions Besides a great number of treatments tried, HC, PH, SUNCT and SUNA management remains difficult, according with their unknown pathogenesis and their rarity, which strongly limits the studies upon these conditions. Further studies are needed to better define the treatment of choice for these conditions. Electronic supplementary material The online version of this article (doi:10.1186/s10194-017-0777-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carlo Baraldi
- Medical Toxicology - Headache and Drug Abuse Centre, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy.
| | - Lanfranco Pellesi
- Medical Toxicology - Headache and Drug Abuse Centre, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Simona Guerzoni
- Medical Toxicology - Headache and Drug Abuse Centre, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Maria Michela Cainazzo
- Medical Toxicology - Headache and Drug Abuse Centre, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Luigi Alberto Pini
- Medical Toxicology - Headache and Drug Abuse Centre, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
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Santos-Morales O, Díaz-Machado A, Jiménez-Rodríguez D, Pomares-Iturralde Y, Festary-Casanovas T, González-Delgado CA, Pérez-Rodríguez S, Alfonso-Muñoz E, Viada-González C, Piedra-Sierra P, García-García I, Amaro-González D, García-Rodríguez JC, Sosa-Testé I, Lagarto-Parra A, Barrero-Viera L, David-Baldo M, Tamayo-Rodríguez M, Rivero-Vázquez I, González-Gamiz G, Martín-Trujillo A, Rodríguez-Fernández Y, Ledo-de la Luz AA, Álvarez-Delgado M, Howland-Álvarez I, Cruz-Gómez Y. Nasal administration of the neuroprotective candidate NeuroEPO to healthy volunteers: a randomized, parallel, open-label safety study. BMC Neurol 2017; 17:129. [PMID: 28676085 PMCID: PMC5496637 DOI: 10.1186/s12883-017-0908-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Delivery of therapeutic agents as erythropoietin (EPO) into Central Nervous System through intranasal route could benefit patients with neurological disorders. A new nasal formulation containing a non-hematopoietic recombinant EPO (NeuroEPO) has shown neuroprotective actions in preclinical models. In the current study, the safety of NeuroEPO was evaluated for the first time in humans. METHODS A phase I, randomized, parallel, open-label study was carried out in healthy volunteers. They received, intranasally, 1 mg of NeuroEPO every 8 h during 4 days (Group A) or 0.5 mg of NeuroEPO (Group B) with the same schedule. The working hypothesis was that intranasal NeuroEPO produce <10% of severe adverse reactions in the evaluated groups. Therefore, a rigorous assessment of possible adverse events was carried out, which included tolerance of the nasal mucosa and the effect on hematopoietic activity. Clinical safety evaluation was daily during treatment and laboratory tests were done before and on days 5 and 14 after starting treatment. RESULTS Twenty-five volunteers, 56% women, with a mean age of 27 yrs. were included. Twelve of them received the highest NeuroEPO dose. Twenty types of adverse events occurred, with headache (20%) and increase of hepatic enzymes (20%) as the most reported ones. Nasopharyngeal itching was the most common local event but only observed in four patients (16%), all of them from the lowest dose group. About half of the events were very probably or probably caused by the studied product. Most of the events were mild (95.5%), did not require treatment (88.6%) and were completely resolved (81.8%). No severe adverse events were reported. During the study the hematopoietic variables were kept within reference values. CONCLUSIONS NeuroEPO was a safe product, well tolerated at the nasal mucosa level and did not stimulate erythropoiesis in healthy volunteers. TRIAL REGISTRATION Cuban Public Registry of Clinical Trials RPCEC00000157 , June 10, 2013.
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Affiliation(s)
| | - Alina Díaz-Machado
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
| | - Daise Jiménez-Rodríguez
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | | | - Tatiana Festary-Casanovas
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | | | - Sonia Pérez-Rodríguez
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
| | - Eulalia Alfonso-Muñoz
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
| | - Carmen Viada-González
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
| | | | - Idrian García-García
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Daniel Amaro-González
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
| | - for the NeuroEPO Study Group
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Julio César García-Rodríguez
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Iliana Sosa-Testé
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Alicia Lagarto-Parra
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Laura Barrero-Viera
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Marlene David-Baldo
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Maura Tamayo-Rodríguez
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Ivonne Rivero-Vázquez
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Gricel González-Gamiz
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Alis Martín-Trujillo
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Yasmila Rodríguez-Fernández
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Ana Alfa Ledo-de la Luz
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Maylén Álvarez-Delgado
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Ivón Howland-Álvarez
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Yolanda Cruz-Gómez
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
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Vikelis M, Rapoport AM. Cluster headache in Greece: an observational clinical and demographic study of 302 patients. J Headache Pain 2016; 17:88. [PMID: 27670427 PMCID: PMC5037095 DOI: 10.1186/s10194-016-0683-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 09/22/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Cluster headache (CH) is considered the most excruciating primary headache syndrome; although much less prevalent than migraine, it is not rare as it affects more than 1/1000 people. While its clinical presentation is considered stereotypic, atypical features are often encountered. Internationally, cluster headache is often misdiagnosed, undertreated and mistreated. METHODS We prospectively studied 302 CH patients, all examined by the same headache specialist. The aim of our study was to describe the demographic and clinical characteristics of CH patients in Greece and draw attention to under-management, under-treatment and mis-treatment often encountered in clinical practice; our purpose is to improve recognition and successful treatment of cluster patients by Greek neurologists and other physicians. RESULTS In the present cohort, clinical characteristics of CH are similar to those described in other populations. Beyond the standard clinical characteristics, features like side shifts (12.6 %), location of maximal pain intensity outside the first trigeminal branch division (10.2 %), lack of autonomic features (7 %), presence of associated features of migraine and aggravation by physical activity (10 %) were encountered. Four out of five patients had consulted a physician prior to diagnosis. The median number of physicians seen prior to diagnosis was 3 and the median time to diagnosis was 5 years, though it improved for patients with recent onset. Chronic cluster headache, side shifts, pain location in the face or the back of the head and aggravation by physical activity were found, among others, to be statistically significantly related to delayed diagnosis or more physicians seen prior to diagnosis. Even properly diagnosed patients were often undertreated or mistreated. CONCLUSIONS Cluster headache, in a large cohort of Greek patients, has the same phenotypic characteristics as described internationally. Uncommon clinical features do exist and physicians should be aware of those, since they may eventuate in diagnostic problems. Most CH patients in Greece remain misdiagnosed or undiagnosed for rather lengthy periods of time, but time to diagnosis has improved recently. Even after diagnosis, treatment received was suboptimal.
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Affiliation(s)
- Michail Vikelis
- Headache Clinic, Mediterraneo Hospital, Glyfada, Greece
- Glyfada Headache Clinic, 8 Lazaraki Str, Glyfada, 16675 Greece
| | - Alan M. Rapoport
- The David Geffen School of Medicine at UCLA, Los Angeles, California USA
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D'Andrea G, Leone M, Bussone G, Fiore PD, Bolner A, Aguggia M, Saracco MG, Perini F, Giordano G, Gucciardi A, Leon A. Abnormal tyrosine metabolism in chronic cluster headache. Cephalalgia 2016; 37:148-153. [PMID: 27009563 DOI: 10.1177/0333102416640502] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective Episodic cluster headache is characterized by abnormalities in tyrosine metabolism (i.e. elevated levels of dopamine, tyramine, octopamine and synephrine and low levels of noradrenalin in plasma and platelets.) It is unknown, however, if such biochemical anomalies are present and/or constitute a predisposing factor in chronic cluster headache. To test this hypothesis, we measured the levels of dopamine and noradrenaline together with those of elusive amines, such as tyramine, octopamine and synephrine, in plasma of chronic cluster patients and control individuals. Methods Plasma levels of dopamine, noradrenaline and trace amines, including tyramine, octopamine and synephrine, were measured in a group of 23 chronic cluster headache patients (10 chronic cluster ab initio and 13 transformed from episodic cluster), and 16 control participants. Results The plasma levels of dopamine, noradrenaline and tyramine were several times higher in chronic cluster headache patients compared with controls. The levels of octopamine and synephrine were significantly lower in plasma of these patients with respect to control individuals. Conclusions These results suggest that anomalies in tyrosine metabolism play a role in the pathogenesis of chronic cluster headache and constitute a predisposing factor for the transformation of the episodic into a chronic form of this primary headache.
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Affiliation(s)
| | - Massimo Leone
- 2 Headache Center, Neurology Department, Clinical Neuroscience Department, C. Besta Neurological Institute IRCCS Foundation, Italy
| | - Gennaro Bussone
- 2 Headache Center, Neurology Department, Clinical Neuroscience Department, C. Besta Neurological Institute IRCCS Foundation, Italy
| | - Paola Di Fiore
- 2 Headache Center, Neurology Department, Clinical Neuroscience Department, C. Besta Neurological Institute IRCCS Foundation, Italy
| | | | - Marco Aguggia
- 3 Headache Center, Neurology Department, Asti Hospital, Italy
| | | | - Francesco Perini
- 4 Headache Center, Neurology Department, Vicenza Hospital, Italy
| | - Giuseppe Giordano
- 5 Mass Spectrometry and Metabolomic Laboratory, Institute of Pediatric Research IRP Città della Speranza, Italy.,6 Women's and Children's Health Department, University of Padova, Italy
| | - Antonina Gucciardi
- 5 Mass Spectrometry and Metabolomic Laboratory, Institute of Pediatric Research IRP Città della Speranza, Italy
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Muñoz I, Hernández MS, Santos S, Jurado C, Ruiz L, Toribio E, Sotelo EM, Guerrero AL, Molina V, Uribe F, Cuadrado ML. Personality traits in patients with cluster headache: a comparison with migraine patients. J Headache Pain 2016; 17:25. [PMID: 26975362 PMCID: PMC4791411 DOI: 10.1186/s10194-016-0618-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/09/2016] [Indexed: 12/21/2022] Open
Abstract
Background Cluster headache (CH) has been associated with certain personality traits and lifestyle features, but there are few studies assessing personality profiles in CH. We aimed to analyze personality traits in patients with CH, and to compare them with those found in migraine. Methods We included all consecutive patients with CH attending 5 outpatient offices between January and December 2013. Personality traits were evaluated using the Salamanca screening test, a validated inventory assessing 11 personality traits grouped in 3 clusters. We analyzed the test results in this population, and compared them with those of a migraine population previously assessed with the same test. Results Eighty patients with CH (75 men, 5 women; mean age, 43.2 ± 9.9 years) were recruited. The reference population consisted of 164 migraine patients (30 men, 134 women; mean age 36.4 ± 12.7 years). In CH patients, the most frequent personality traits were anancastic (52.5 %), anxious (47.5 %), histrionic (45 %), schizoid (42.5 %), impulsive (32.5 %) and paranoid (30 %). When compared to migraine patients, paranoid (p < 0.001; χ2 test), and schizoid traits (p = 0.007; χ2 test) were significantly more prevalent in CH patients. In logistic regression analysis the paranoid trait was significantly associated with CH (p = 0.001; OR: 3.27, 95 % CI [1.66–6.43]). Conclusion According to the Salamanca screening test, personality traits included in cluster A (odd or eccentric disorders) are more prevalent in CH patients than in a population of migraineurs. Larger studies are needed to determine whether certain personality traits are related to CH.
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Affiliation(s)
- I Muñoz
- Psychiatry Department Hospital Clínico Universitario, Valladolid, Spain
| | - M S Hernández
- Psychiatry Department Hospital Clínico Universitario, Valladolid, Spain
| | - S Santos
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - C Jurado
- Neurology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - L Ruiz
- Neurology Department, Hospital Universitario del Henares, Coslada, Madrid, Spain
| | - E Toribio
- Neurology Department, Hospital Universitario del Henares, Coslada, Madrid, Spain
| | - E M Sotelo
- Psychiatry Department Hospital Clínico Universitario, Valladolid, Spain
| | - A L Guerrero
- Neurology Department, Hospital Clínico Universitario, Avda. Ramón y Cajal 3, 47005, Valladolid, Spain.
| | - V Molina
- Psychiatry Department Hospital Clínico Universitario, Valladolid, Spain
| | - F Uribe
- Psychiatry Department Hospital Clínico Universitario, Valladolid, Spain
| | - M L Cuadrado
- Neurology Department. Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
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Chronic Cluster Headache with an Atypical Presentation and Treatment Response. Case Rep Neurol Med 2016; 2016:5230127. [PMID: 28127484 PMCID: PMC5227136 DOI: 10.1155/2016/5230127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/10/2016] [Accepted: 12/12/2016] [Indexed: 01/03/2023] Open
Abstract
The management of cluster headache (CH) may be challenging. We report a 50-year-old male with recurrent attacks of dull and severe unilateral periorbital pain, lasting 30–45 minutes, twice a day, exclusively during sleep, and accompanied by ipsilateral rhinorrhea and lacrimation. The pain switched sides within every attack. CH treatment was initiated but the patient maintained recurrence rates compatible with chronic CH, even after increasing verapamil to 460 mg/day. Afterwards we decided to add lithium (800 mg/day). With this treatment the severity and recurrence of CH substantially decreased, despite the patient's autonomous decision to take lithium only during the acute phase of the cluster. The exclusively alternating location and the excellent response to short cycles of lithium represent two unique features of CH.
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