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May A, Evers S, Goadsby PJ, Leone M, Manzoni GC, Pascual J, Carvalho V, Romoli M, Aleksovska K, Pozo-Rosich P, Jensen RH. European Academy of Neurology guidelines on the treatment of cluster headache. Eur J Neurol 2023; 30:2955-2979. [PMID: 37515405 DOI: 10.1111/ene.15956] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND AND PURPOSE Cluster headache is a relatively rare, disabling primary headache disorder with a major impact on patients' quality of life. This work presents evidence-based recommendations for the treatment of cluster headache derived from a systematic review of the literature and consensus among a panel of experts. METHODS The databases PubMed (Medline), Science Citation Index, and Cochrane Library were screened for studies on the efficacy of interventions (last access July 2022). The findings in these studies were evaluated according to the recommendations of the European Academy of Neurology, and the level of evidence was established using GRADE (Grading of Recommendations Assessment, Development, and Evaluation). RECOMMENDATIONS For the acute treatment of cluster headache attacks, there is a strong recommendation for oxygen (100%) with a flow of at least 12 L/min over 15 min and 6 mg subcutaneous sumatriptan. Prophylaxis of cluster headache attacks with verapamil at a daily dose of at least 240 mg (maximum dose depends on efficacy and tolerability) is recommended. Corticosteroids are efficacious in cluster headache. To reach an effect, the use of at least 100 mg prednisone (or equivalent corticosteroid) given orally or at up to 500 mg iv per day over 5 days is recommended. Lithium, topiramate, and galcanezumab (only for episodic cluster headache) are recommended as alternative treatments. Noninvasive vagus nerve stimulation is efficacious in episodic but not chronic cluster headache. Greater occipital nerve block is recommended, but electrical stimulation of the greater occipital nerve is not recommended due to the side effect profile.
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Affiliation(s)
- Arne May
- Department of Systems Neuroscience, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
| | - Stefan Evers
- Department of Neurology, Lindenbrunn Hospital, Coppenbrügge, Germany
- Faculty of Medicine, University of Münster, Münster, Germany
| | - Peter J Goadsby
- NIHR King's CRF, SLaM Biomedical Research Centre, King's College London, London, UK
| | - Massimo Leone
- Neuroalgology Department, Foundation of the Carlo Besta Neurological Institute, IRCCS, Milan, Italy
| | | | - Julio Pascual
- Service of Neurology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Santander, Spain
| | - Vanessa Carvalho
- Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Michele Romoli
- Neurology and Stroke Unit, Bufalini Hospital, Cesena, Italy
| | | | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Headache Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rigmor H Jensen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
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Becker M, Axelrod DJ, Oyesanmi O, Markov DD, Kunkel EJS. Hematologic problems in psychosomatic medicine. Psychiatr Clin North Am 2007; 30:739-59. [PMID: 17938043 DOI: 10.1016/j.psc.2007.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Vitamin B12 deficiency is associated with problems in cognition, mood, psychosis, and less commonly, anxiety. Folate deficiency primarily is associated with problems in mood. Patients who have sickle cell disease, a disease of chronic pain, experience difficulties with depression, anxiety, stigma, and are at risk for substance abuse and dependence. Patients with hemophilia have benefited from advances in treatment; however, their morbidity and mortality were compounded in those who received blood products contaminated with HIV, or hepatitis B and C. Psychiatrists who practice psychosomatic medicine should expect to encounter patients with the above problems, as they are frequently seen in medical settings. Finally, most of the commonly used psychotropic medications have uncommon but potentially important hematologic side effects or may interact with the anticoagulants used in medically ill patients.
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Affiliation(s)
- Madeleine Becker
- Department of Psychiatry, Thomas Jefferson University, Philadelphia, PA, USA
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Abstract
The trigeminal autonomic cephalgias (TACs) are a group of primary headache disorders characterised by unilateral trigeminal distribution pain that occurs in association with ipsilateral cranial autonomic features. This group of headache disorders includes cluster headache, paroxysmal hemicrania and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT syndrome). Although hemicrania continua has previously been classified amongst the TACs, its nosological status remains unclear. Despite their similarities, these disorders differ in their clinical manifestations and response to therapy, thus underpinning the importance of recognising them. We have outlined the clinical manifestations, differential diagnoses, diagnostic workup and the treatment options for each of these syndromes.
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Affiliation(s)
- Manjit S Matharu
- Headache Group, Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
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Oyesanmi O, Kunkel EJ, Monti DA, Field HL. Hematologic side effects of psychotropics. PSYCHOSOMATICS 1999; 40:414-21. [PMID: 10479946 DOI: 10.1016/s0033-3182(99)71206-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Psychiatrists are often unaware of the potential hematologic complications of the psychotropics they prescribe. Although this review is not a hematologic text reference, relevant hematologic syndromes are described so that the consultation-liaison psychiatrist will be familiar with the usual signs, symptoms, and treatments of these syndromes. This article reviews the hematologic side effects of the commonly prescribed psychotropics, including antipsychotics, antidepressants, benzodiazepines, lithium, mood stabilizers (including some of the anticonvulsants), and the acetylcholinesterase inhibitors. Clinical signs and symptoms that should alert the physician to obtain a complete blood count are described.
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Affiliation(s)
- O Oyesanmi
- Department of Psychiatry and Human Behavior, Jefferson Medical College, Philadelphia, Pennsylvania 19107-5004, USA
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Ekblom J, Zhu QS, Chen K, Shih JC. Monoamine oxidase gene transcription in human cell lines: treatment with psychoactive drugs and ethanol. J Neural Transm (Vienna) 1996; 103:681-92. [PMID: 8836930 DOI: 10.1007/bf01271228] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In the present study transcriptional activities has been measured with different fragments of the 5'-flanking sequence of the human monoamine oxidase (MAO) genes linked to human growth hormone which was used as a reporter gene. SH-SY5Y neuroblastoma cells and 1242 MG glioma cells were compared under basal conditions as well as after treatments with different drugs. Under basal conditions, the relative reporter activities of the different promoter fragments were similar for both cell lines. No changes in promoter activities, were observed when cells were treated with L-deprenyl, lithium chloride or raclopride. In contrast, increases (2-3-fold) in both reporter gene expression and enzyme activity were observed after ethanol treatment of cells transfected with MAO-B fragments. Gel retardation analysis showed that ethanol caused changes in transcription factor binding to the MAO-B core promoter in both the SH-SY5Y and 1242 MG cell lines in a cell-type specific fashion.
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Affiliation(s)
- J Ekblom
- Department of Molecular Pharmacology and Toxicology, School of Pharmacy, University of Southern California, Los Angeles, USA
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Abstract
The effect of lithium on platelet count was studied by examining 12 patients treated with lithium carbonate without any additional medication, 13 patients treated with lithium carbonate with additional psychotropic medication, 25 patients with major affective disorder prior to any treatment, 25 patients with panic disorder prior to any treatment and 25 healthy controls. The platelet counts were increased in the group of subjects treated with lithium carbonate without any additional psychotropic medication. The increase was not clinically significant.
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Titus F, Picó M, Dávalos A. Study of Platelet Activation in Cluster Headache. Cephalalgia 1985. [DOI: 10.1177/03331024850050s3160] [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)
- Feliu Titus
- Service of Neurology, Hospital Volle Hebron, Barcelona, Spain
| | - Marta Picó
- Service of Neurology, Hospital Volle Hebron, Barcelona, Spain
| | - Antoni Dávalos
- Service of Neurology, Hospital Volle Hebron, Barcelona, Spain
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Abstract
Most of the effort directed at understanding the problems of allergy has focused on the interacting components of the immune system. The possibility that histamine may be released as a learned response has now been tested. In a classical conditioning procedure in which an immunologic challenge was paired with the presentation of an odor, guinea pigs showed a plasma histamine increase when presented with the odor alone. This suggests that the immune response can be enhanced through activity of the central nervous system.
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Abstract
Lithium has been put to clinical trials in no less than fifteen neurological disorders. They are Huntington's chorea, tardive dyskinesia, spasmodic torticollis, Tourette's syndrome, L-dopa induced hyperkinesia and the "on-off" phenomenon in parkinsonism, organic brain disorders secondary to brain-injury, drug induced delusional disorders, migraine and cluster headache, periodic hypersomnolence, epilepsy, meniere's disease and periodic hypokalemic paralysis. This paper gives a brief summary of the clinical trials with lithium salts reported in the literature. There are encouraging results on the use of lithium in cluster headaches, cyclic form of migraine and hypomanic mood disorders due to organic brain disorders. The trials with lithium and amitriptyline in tardive dyskinesia needs independent confirmation. The effect of lithium on seizure disorders needs to be addressed too.
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Boiardi A, Bussone G, Merati B, Tansini E, Boeri R. Course of chronic cluster headache. ITALIAN JOURNAL OF NEUROLOGICAL SCIENCES 1983; 4:75-7. [PMID: 6408022 DOI: 10.1007/bf02043441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A follow-up study (3.2 years) of 56 patients with chronic cluster headache who had had no remissions for at least a year. They were treated with lithium carbonate, methysergide and prednisone singly and in combination. An assessment of the therapeutic benefits is followed by a discussion on the course of chronic cluster headache.
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Meltzer HY, Tueting P, Jackman H. The effect of lithium on platelet monoamine oxidase activity in bipolar and schizoaffective disorders. Br J Psychiatry 1982; 140:192-8. [PMID: 7074305 DOI: 10.1192/bjp.140.2.192] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Platelet monoamine oxidase (MAO) activity was studied in 33 in-patients with bipolar and schizoaffective disorder who were treated with lithium. Platelet MAO activity was found to increase following 10-41 dys of lithium treatment compared to a prior drug free period, and the increase was positively correlated with the duration of lithium treatment. The increase in platelet MAO activity was not correlated wtih clinical improvement as measured by the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment Scale (GAS). The number of platelets per unit of blood was also significantly correlated with the number of days of lithium treatment. However, the increase in the number of platelets in lithium-treated patients was not correlated with the increase in MAO activity and thus appears not to account for it. These results indicate that studies relating platelet MAO activity to psychiatric diagnosis should be interpreted cautiously if patients are receiving lithium carbonate.
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