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Cui H, Zhang L, Zhu T, Liu R, Yuan X. Headache as the sole clinical manifestation of acute myocardial infarction: one case with cardiac cephalalgia and literature review. Coron Artery Dis 2024:00019501-990000000-00245. [PMID: 38870021 DOI: 10.1097/mca.0000000000001394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
OBJECTIVE Cardiac cephalalgia, once seen as a rare symptom of coronary artery disease, is now more recognized. It often comes with chest discomfort and autonomic dysfunction, worsened by physical activity. However, not all cases have chest symptoms or are activity induced. This report presents a case of cardiac cephalalgia and reviews 46 previous cases. METHOD We discuss a unique case where a patient had headache attacks without chest symptoms, autonomic dysfunction, or triggers. We reviewed English case reports of cardiac cephalalgia from 1982 to 2022 using PubMed (http://www.ncbi.nlm.nih.gov/pubmed). RESULTS A 69-year-old man presented with a sudden headache without triggers or typical symptoms. Coronary computed tomography angiography (CTA) showed diffuse stenosis in the left anterior descending and the first diagonal branch arteries. His headache improved after percutaneous coronary intervention. Cardiac cephalalgia is usually marked by severe headaches, autonomic signs, and often affects the occipital region. Electrocardiogram (ECG) might not always show abnormalities, and chest pain is not always present. In such cases, elevated cardiac enzymes can be crucial for diagnosis. CONCLUSION When a headache is the sole symptom of an acute coronary event, consider moderate to severe intensity, older age at onset, occipital localization, and autonomic signs. ECG, cardiac enzymes, and coronary CTA are valuable for accurate diagnosis and treatment.
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Affiliation(s)
- Huili Cui
- Department of Neurology, Zhengzhou People's Hospital Affiliated Henan University of Traditional Chinese Medicine, Zhengzhou, China
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2
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Bednarczyk V, Proulx F, Paez A. The effectiveness of cervical rehabilitation interventions for pain in adults with myogenic temporomandibular disorders: A systematic review and meta-analysis. J Oral Rehabil 2024; 51:1091-1107. [PMID: 38454576 DOI: 10.1111/joor.13671] [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: 03/01/2023] [Revised: 12/14/2023] [Accepted: 02/22/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE Little evidence exists for the most effective conservative treatment approach for adults with myogenic temporomandibular disorders (MTMD). We aim to assess the effectiveness of cervical rehabilitation interventions on pain intensity and sensitivity in adults with MTMD compared to comparison intervention such as placebo, sham treatment, education or no intervention. METHODS For this systematic review and meta-analysis, we searched PubMed, EMBASE, Medline, PEDro databases, forward and backward citations and grey literature studies through PROSPERO, clinical trials and data registries without language or date restrictions between inception and 1 December 2021. We selected randomised controlled trials (RCTs) based on adult populations with MTMD who had a cervical rehabilitation intervention which was defined as any conservative intervention targeting the anatomical structures of the cervical spine. The primary outcome measures for pain were self-reported pain intensity and pain sensitivity through the pressure pain threshold (PPT) of the masseter and temporalis muscles. Secondary outcome measures of maximal mouth opening (on MMO) were included. Included studies were assessed for bias with the Cochrane risk of bias tool for randomised trials. Evidence from RCTs was synthesised to determine treatment effect size as differences between standardised mean difference (SMD) for changes in pain intensity, PPT and MMO comparing adults with MTMD who were treated with cervical rehabilitation interventions compared to a control group. This study is registered on Prospero, number CRD 42021289299. RESULTS Our general search yielded 2647 studies where seven RCTs met eligibility criteria with low to some concerns in their risk of bias. Pain intensity (five studies, n = 223, SMD -0.98, 95% CI -1.67 to -0.28, I2 = 79%), PPT of the masseter muscle (six studies, n = 395, SMD 0.64, 95% CI 0.43 to 0.86, I2 = 90%) and the temporalis muscles (five studies, n = 295, SMD 0.76, 95% CI 0.07 to 1.45, I2 = 84%) showed large treatment effect estimates favouring cervical rehabilitation interventions compared to no treatment, sham cervical treatment, patient education or non-cervical neuromuscular techniques. Compared to control interventions, one type of cervical rehabilitation intervention, cervical manual therapy alone or in combination with a neck exercise program was associated with statistically significant, large treatment effect estimates on pain intensity (four studies, n = 203, SMD -1.52, 95% CI -2.50 to -0.55). CONCLUSIONS This review found that in the short-term, cervical rehabilitation interventions especially upper cervical MT alone or in combination with a neck exercise program are effective in improving multiple pain outcomes in adults with MTMD. However, further research is needed to measure the long-term effects of this type of intervention.
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Affiliation(s)
- Victoria Bednarczyk
- College of Professional Studies, Northeastern University, Boston, Massachusetts, USA
| | - François Proulx
- Oral and Maxillofacial Surgery Division, University of Minnesota School of Dentistry, Minneapolis, Minnesota, USA
| | - Arsenio Paez
- Bouvé College of Health Professions, Northeastern University, Boston, Massachusetts, USA
- Nuffield Department for Primary Care Health Sciences, University of Oxford, Oxford, UK
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3
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Nakaya A, Kaneko K, Miyazawa K, Matsumoto A, Hisanaga K, Matsumori Y, Nagano I. Neuralgia in the occipital region associated with ipsilateral trigeminal herpes zoster: Three case reports. Headache 2024; 64:464-468. [PMID: 38525807 DOI: 10.1111/head.14698] [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: 11/17/2023] [Revised: 02/06/2024] [Accepted: 02/28/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Nerve fibers related to pain and temperature sensation in the trigeminal nerve territory converge with the upper cervical spinal nerves from the level of the lower medulla oblongata to the upper cervical cord. This structure is called the trigemino-cervical complex and may cause referred pain in the territory of the trigeminal or upper cervical spinal nerves. CASE SERIES Here, we report three cases of paroxysmal neuralgia in the occipital region with mild conjunctivitis or a few reddish spots in the ipsilateral trigeminal nerve territory. The patients exhibited gradual progression of these reddish spots evolving into vesicles over the course of several days, despite the absence of a rash in the occipital region. The patients were diagnosed with trigeminal herpes zoster and subsequently received antiherpetic therapy. Remarkably, the neuralgia in the occipital region showed gradual amelioration or complete resolution before the treatment, with no sequelae reported in the occipital region. DISCUSSION The trigemino-cervical complex has the potential to cause neuralgia in the occipital region, as referred pain, caused by trigeminal herpes zoster. These cases suggest that, even if conjunctivitis or reddish spots appear to be trivial in the trigeminal nerve territory, trigeminal herpes zoster should be considered when neuralgia occurs in the ipsilateral occipital region.
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Affiliation(s)
- Akihiko Nakaya
- Department of Neurology, National Hospital Organization Miyagi National Hospital, Yamamoto-cho, Miyagi, Japan
| | - Kimihiko Kaneko
- Department of Neurology, National Hospital Organization Miyagi National Hospital, Yamamoto-cho, Miyagi, Japan
| | - Koichi Miyazawa
- Department of Neurology, National Hospital Organization Miyagi National Hospital, Yamamoto-cho, Miyagi, Japan
- Department of Neurology, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Miyagi, Japan
| | - Arifumi Matsumoto
- Department of Neurology, National Hospital Organization Miyagi National Hospital, Yamamoto-cho, Miyagi, Japan
| | - Kinya Hisanaga
- Department of Neurology, National Hospital Organization Miyagi National Hospital, Yamamoto-cho, Miyagi, Japan
| | | | - Isao Nagano
- Department of Neurology, National Hospital Organization Miyagi National Hospital, Yamamoto-cho, Miyagi, Japan
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Ercan M, Ertekin A. The effect of simultaneous administration of occipital nerve block and cervical myofascial trigger point injection (MTrPI) on headache parameters in chronic migraine patients. Ir J Med Sci 2024:10.1007/s11845-024-03628-2. [PMID: 38451438 DOI: 10.1007/s11845-024-03628-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/06/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND AND AIM Peripheral myofascial mechanisms have been identified as contributors to migraine pathophysiology. The specific comorbid relationship between migraine and cervical trigger points may exacerbate the occurrence and severity of migraine attacks. Trigger point injections (TPIs) are frequently employed to address headaches and alleviate migraine symptoms. The current study explores the impact of concurrent myofascial trigger point injection (MTrPI) and occipital nerve block (greater occipital nerve block [GONB] + lesser occipital nerve block [LONB]) on the severity of headaches and the number of migraine attacks in individuals with chronic migraine (CM) and cervical myofascial trigger points (MTrPs), with a comparison of occipital nerve block alone (GONB + LONB). During trigger point examination and injection, trapezius, levator scapulae, splenius capitis, temporalis, and sternocleidomastoid muscles were targeted. We planned the treatment based on whether they were in the muscle groups we determined, rather than the number of trigger points. MATERIALS AND METHOD This study enrolled 62 individuals experiencing CM with bilateral headache and cervical MTrP who sought care at the Algology Unit within the Departments of Neurology and Physical Therapy and Rehabilitation at Siirt Training and Research Hospital between 2020 and 2022. The CM cohort was stratified into two groups: group 1 received trigger point injections (TrPI), while group 2 underwent concurrent bilateral occipital nerve block (GONB + LONB) and TrPI. Both groups underwent three treatment sessions with bupivacaine 0.5% (1 ml = 5 mg) in weeks 1, 2, and 4. Visual analog scale (VAS) was used to measure the patients' pain intensity. The evaluation included the assessment of the monthly migraine frequency and visual analog scale (VAS) p score for pain before treatment (BT) and after treatment (AT), conducted at baseline and during follow-up visits. Analysis of the data was conducted utilizing IBM SPSS Statistics for Windows version 28.0 software. RESULTS Among patients diagnosed with CM and MTrPs, 32 individuals (51.6%) underwent GONB and LONB, while 30 patients (48.4%) received simultaneous GONB, LONB, and cervical MTrPI. Within the entire sample, 51 participants (82.3%) were female, and 11 (17.7%) were male, with a mean age of 32.81 ± 10.75 years. With an average age of 32.81 ± 10.75 years, there was no statistically significant variance between the two groups (p = 0.516). Of the total cohort, 45 individuals (72.6%) reported experiencing headaches persisting for 12 months or longer. Among CM patients, 80% had active trigger points, while 20% had latent trigger points. No statistically significant difference was observed between the groups concerning TrPs (p = 0.158), and the distribution of TrPs was homogenous across the two groups. In group 1, the median (min-max) monthly frequency of migraines reduced from 18.5 days (range: 15.0 to 25.0 days) before treatment to 12.0 days (range: 7.0 to 17.0 days) after treatment (p = 0.000). In group 2, the median monthly frequency of migraines reduced from 16.5 days (range: 15.0 to 22.0 days) before treatment to 4.0 days (range: 2.0 to 8.0 days) after treatment (p = 0.000). The median (min-max) VAS score in group 1 was 8.0 (range: 5.0 to 9.0) before treatment, 4.0 (range: 2.0 to 6.0) at week 1, and 5.0 (range: 4.0 to 8.0) at week 4 (p = 0.000). In group 2, the median VAS score was 7.0 (range: 5.0 to 9.0) before treatment, 0.0 (range: 0.0 to 0.3) at week 1, and 2.0 (range: 0.0 to 0.3) at week 4 (p = 0.000). There were significant distinctions between the groups in terms of both the monthly count of migraine days and the severity of headaches (p = 0.000). CONCLUSION The combination of repeated MTrPIs and ONB proves more effective than ONB alone in managing patients with CM and cervical MTrP. In patients with CM, performing TrPs examination and adding treatments for this may contribute to the treatment. In cases where patients endure prolonged episodes of headache associated with chronic migraine, the inclusion of trigger point injections alongside peripheral nerve blocks may offer enhanced therapeutic benefits.
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Affiliation(s)
- Mehmet Ercan
- Department of Physical Therapy and Rehabilitation, Siirt Education and Research Hospital, Siirt, Turkey.
| | - Ayfer Ertekin
- Department of Neurology, Siirt Education and Research Hospital, Siirt, Turkey
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5
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McPherson JI, Nazir MSZ, Willer BS, Leddy JJ, Haider MN. Does Physiologic Post-Concussion Disorder Cause Persistent Post-Traumatic Headache? Curr Pain Headache Rep 2023; 27:793-799. [PMID: 37831366 DOI: 10.1007/s11916-023-01176-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE OF REVIEW One system classifies patients with symptoms after concussion into physiologic, vestibulo-ocular, cervicogenic, and mood/cognition post-concussion disorders (PCD) based upon the preponderance of specific symptoms and physical impairments. This review discusses physiologic PCD and its potential relationship to the development of persistent post-traumatic headaches (PPTH). RECENT FINDINGS Headache is the most reported symptom after a concussion. Headaches in physiologic PCD are suspected to be due to abnormal cellular metabolism, subclinical neuroinflammation, and dysfunction of the autonomic nervous system (ANS). These abnormalities have been linked to the development of migraine-like and neuralgia-related PPTH. Physiologic PCD is a potential cause of PPTH after a concussion. Future research should focus on how to prevent PPTH in patients with physiologic PCD.
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Affiliation(s)
- Jacob I McPherson
- Department of Rehabilitation Science, School of Public Health and Health Professions, State University of New York at Buffalo, 534 Kimball Tower, Buffalo, NY, 14214, USA.
| | - Muhammad S Z Nazir
- Concussion Management Clinic and Research Center, UBMD Orthopedics and Sports Medicine, State University of New York at Buffalo, Buffalo, NY, 14214, USA
| | - Barry S Willer
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, 14215, USA
| | - John J Leddy
- Department of Orthopedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, 14215, USA
| | - Mohammad N Haider
- Department of Orthopedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, 14215, USA
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O'Toole R, Watson D. Manual cervical therapy and vestibular migraine: A case series. HEALTH OPEN RESEARCH 2023; 5:12. [PMID: 38708034 PMCID: PMC11065132 DOI: 10.12688/healthopenres.13319.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 05/07/2024]
Abstract
Background Vestibular migraine (VM) is a relatively new diagnostic entity with incomplete knowledge regarding pathophysiological mechanisms and therapeutic guidelines. By reporting the effect of manual cervical therapy (MCT) on people with VM, we suggest a possible role for upper cervical afferents in VM treatment and/or pathogenesis. The objective was to describe the change in clinical presentation and self-reported symptoms of VM corresponding to MCT and followed up to six months. Methods A nonrandomised *ABA design was utilised to consecutively and prospectively evaluate selected patients with diagnosed VM. Symptom characteristics (frequency and intensity) were recorded along with standardised patient-reported outcomes (PROs) to document the response to MCT. Results Three patients were recruited who met the diagnostic criteria for VM. All three patients demonstrated improvement in both migraine attack and interictal symptom frequency. These improvements mirrored changes in PROs and were sustained over a six-month follow-up period. Conclusions The improvement that coincided with the intervention including MCT was rapid, observable and sustained. This suggests that the upper cervical spine could be a therapeutic target in VM and may have implications for future research into the pathogenesis of VM.
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Affiliation(s)
- Roger O'Toole
- Melbourne Headache Centre, Melbourne, Victoria, 3000, Australia
| | - Dean Watson
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
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7
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Jin GY, Jin LL, Jin BX, Zheng J, He BJ, Li SJ. Neural control of cerebral blood flow: scientific basis of scalp acupuncture in treating brain diseases. Front Neurosci 2023; 17:1210537. [PMID: 37650106 PMCID: PMC10464620 DOI: 10.3389/fnins.2023.1210537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/03/2023] [Indexed: 09/01/2023] Open
Abstract
Scalp acupuncture (SA), as a modern acupuncture therapy in the treatment of brain diseases, especially for acute ischemic strokes, has accumulated a wealth of experience and tons of success cases, but the current hypothesized mechanisms of SA therapy still seem to lack significant scientific validity, which may not be conducive to its ultimate integration into mainstream medicine. This review explores a novel perspective about the mechanisms of SA in treating brain diseases based on its effects on cerebral blood flow (CBF). To date, abundant evidence has shown that CBF is significantly increased by stimulating specific SA points, areas or nerves innervating the scalp, which parallels the instant or long-term improvement of symptoms of brain diseases. Over time, the neural pathways that improve CBF by stimulating the trigeminal, the facial, and the cervical nerves have also been gradually revealed. In addition, the presence of the core SA points or areas frequently used for brain diseases can be rationally explained by the characteristics of nerve distribution, including nerve overlap or convergence in certain parts of the scalp. But such characteristics also suggest that the role of these SA points or areas is relatively specific and not due to a direct correspondence between the current hypothesized SA points, areas and the functional zones of the cerebral cortex. The above evidence chain indicates that the efficacy of SA in treating brain diseases, especially ischemic strokes, is mostly achieved by stimulating the scalp nerves, especially the trigeminal nerve to improve CBF. Of course, the mechanisms of SA in treating various brain diseases might be multifaceted. However, the authors believe that understanding the neural regulation of SA on CBF not only captures the main aspects of the mechanisms of SA therapy, but also facilitates the elucidation of other mechanisms, which may be of greater significance to further its clinical applications.
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Affiliation(s)
- Guan-Yuan Jin
- International Institute of Systems Medicine, Inc., Milwaukee, WI, United States
- Ace Acupuncture Clinic of Milwaukee, LLC, Milwaukee, WI, United States
| | - Louis Lei Jin
- The Woodlands Acupuncture and Herbal Clinic, The Woodlands, TX, United States
| | - Bonnie Xia Jin
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jin Zheng
- HCA Houston Healthcare Conroe, Conroe, TX, United States
| | - Belinda Jie He
- The Woodlands Acupuncture and Herbal Clinic, The Woodlands, TX, United States
| | - Shi-Jiang Li
- Medical College of Wisconsin, Milwaukee, WI, United States
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Caballero Ruiz de la Hermosa C, Mesa-Jiménez JA, Justribó Manion C, Armijo-Olivo S. Are Morphometric Alterations of the Deep Neck Muscles Related to Primary Headache Disorders? A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:2334. [PMID: 36850939 PMCID: PMC9961645 DOI: 10.3390/s23042334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/10/2023] [Accepted: 02/12/2023] [Indexed: 06/18/2023]
Abstract
This systematic review aims to summarise the evidence from studies that examined morphometric alterations of the deep neck muscles using diagnostic imaging (ultrasound imaging, magnetic resonance imaging, and computed tomography) in patients diagnosed with primary headache disorders (PHD). No previous reviews have focused on documenting morphometric changes in this population. We searched five databases (up to 12 November 2022) to identify the studies. The risk of bias (RoB) was assessed using the Quality in Prognostic Studies (QUIPS) tool and the overall quality of the evidence was assessed using The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. A total of 1246 studies were screened and five were finally included; most were at high RoB, and the overall level of confidence in results was very low. Only two studies showed a significant association between morphometric alterations of the deep neck muscles and PHD (p < 0.001); nevertheless, their RoB was high. Contradictory and mixed results were obtained. The overall evidence did not show a clear association between morphometric alterations of the deep neck muscles in patients diagnosed with PHD. However, due to the limited number of studies and low confidence in the evidence, it is necessary to carry out more studies, with higher methodological quality to better answer our question.
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Affiliation(s)
| | - Juan Andrés Mesa-Jiménez
- Department Physical Therapy, Faculty of Medicine, University of San-Pablo CEU, Campus Montepríncipe, Urb. Montepríncipe, 28925 Alcorcón, Spain
| | - Cristian Justribó Manion
- Department Physical Therapy, Faculty of Medicine, University of San-Pablo CEU, Campus Montepríncipe, Urb. Montepríncipe, 28925 Alcorcón, Spain
- Department of Transational Medicine, University of Abat Oliba CEU, CEU Universities, 08022 Barcelona, Spain
- National Centre, Foundation COME Collaboration, Via Venezia 7, 65121 Pescara, Italy
| | - Susan Armijo-Olivo
- Faculty of Business and Social Sciences, University of Applied Sciences Osnabrück, 30A, 49076 Osnabruck, Germany
- Faculties of Rehabilitation Medicine and Medicine and Dentistry, 3-48 Corbett Hall, Edmonton, AB T6G 2G4, Canada
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Rupert MP, Budwany R, Abd-Elsayed A. Craniofacial Stimulation and Headache. PERIPHERAL NERVE STIMULATION 2023:215-224. [DOI: 10.1016/b978-0-323-83007-2.00032-1] [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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10
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Robertson CE, Benarroch EE. The anatomy of head pain. HANDBOOK OF CLINICAL NEUROLOGY 2023; 198:41-60. [PMID: 38043970 DOI: 10.1016/b978-0-12-823356-6.00001-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Pain-sensitive structures in the head and neck, including the scalp, periosteum, meninges, and blood vessels, are innervated predominantly by the trigeminal and upper cervical nerves. The trigeminal nerve supplies most of the sensation to the head and face, with the ophthalmic division (V1) providing innervation to much of the supratentorial dura mater and vessels. This creates referral patterns for pain that may be misleading to clinicians and patients, as described by studies involving awake craniotomies and stimulation with electrical and mechanical stimuli. Most brain parenchyma and supratentorial vessels refer pain to the ipsilateral V1 territory, and less commonly the V2 or V3 region. The upper cervical nerves provide innervation to the posterior scalp, while the periauricular region and posterior fossa are territories with shared innervation. Afferent fibers that innervate the head and neck send nociceptive input to the trigeminocervical complex, which then projects to additional pain processing areas in the brainstem, thalamus, hypothalamus, and cortex. This chapter discusses the pain-sensitive structures in the head and neck, including pain referral patterns for many of these structures. It also provides an overview of peripheral and central nervous system structures responsible for transmitting and interpreting these nociceptive signals.
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Affiliation(s)
- Carrie E Robertson
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, United States.
| | - Eduardo E Benarroch
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
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11
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Navarro-Pérez MP, Bellosta-Diago E, Olesen J, Santos-Lasaosa S. Cardiac cephalalgia: a narrative review and ICHD-3 criteria evaluation. J Headache Pain 2022; 23:136. [PMID: 36266636 PMCID: PMC9583508 DOI: 10.1186/s10194-022-01508-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Cardiac cephalalgia is an unusual condition that occurs during an episode of myocardial ischemia. Information about cardiac cephalalgia is scarce and its characteristics and physiopathology remain unclear. Our aim is to provide a narrative review of clinical characteristics and physiopathology of cardiac cephalalgia and to evaluate the current diagnostic criteria. Methods A search through PubMed was undertaken for studies on cardiac cephalalgia published until 20th September 2022. We summarized the literature and provide a comprehensive review of the headache characteristics and possible mechanisms. We also evaluated current International Classification of Headache Disorders third edition diagnostic criteria based on prior reported cases. Results In total, 88 cases were found. Headache characteristics were variable. Occipital location and throbbing pain were the most frequently reported. Headache was accompanied in most cases by cardiac symptoms. Criterion B was fulfilled by 98% of cases, criterion C1 by 72%, and criteria C2a and C2b by 37 and 93.2%, respectively. Regarding headache features described in diagnostic criterion C3, ‘moderate to severe intensity’, ‘accompanied by nausea’, ‘not accompanied by photophobia or phonophobia’ and ‘aggravated by exertion’, were reported in 75, 31, 55 and 55% of cases, respectively. Conclusion Cardiac cephalalgia characteristics are variable and the headache features described in the diagnostic criterion C3 might not be adequate. Given that cardiac cephalalgia can be the manifestation of a life-threatening condition it is important to increase the knowledge about this entity. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01508-7.
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Affiliation(s)
- María Pilar Navarro-Pérez
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, San Juan Bosco 15, 50009, Saragossa, Spain. .,Aragon Institute for Health Research (IIS Aragón), Saragossa, Spain.
| | - Elena Bellosta-Diago
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, San Juan Bosco 15, 50009, Saragossa, Spain.,Aragon Institute for Health Research (IIS Aragón), Saragossa, Spain
| | - Jes Olesen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Sonia Santos-Lasaosa
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, San Juan Bosco 15, 50009, Saragossa, Spain.,Aragon Institute for Health Research (IIS Aragón), Saragossa, Spain
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12
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Siu WS, Shih YF, Lee SY, Hsu CY, Wei MJ, Wang TJ, Lin HC, Lin YL. Alterations in kinematics of temporomandibular joint associated with chronic neck pain. J Oral Rehabil 2022; 49:860-871. [PMID: 35699317 DOI: 10.1111/joor.13347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 05/26/2022] [Accepted: 06/02/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Temporomandibular disorder (TMD) is an umbrella term for pain and dysfunction of the temporomandibular joint (TMJ) and its associated structures. Patients with TMD show changes in TMJ kinematics and masticatory muscle activation. TMD is commonly comorbid with non-specific chronic neck pain (NCNP), which may be one of the risk factors for TMD. OBJECTIVES This study aimed to investigate whether patients with NCNP have altered TMJ kinematics and masticatory muscle activity. METHODS This was a cross-sectional exploratory study including 19 healthy participants and 20 patients with NCNP but without TMD symptoms. TMJ kinematics was measured during mouth opening and closing, jaw protrusion and jaw lateral deviation. Surface electromyography was used to record the muscle activity of the anterior temporalis, masseter, sternocleidomastoid and upper trapezius while clenching. Furthermore, cervical posture, cervical range of motion (ROM) and pressure-pain threshold of the neck and masticatory muscles were measured. RESULTS Compared with the healthy group, the NCNP group showed significantly reduced upper cervical rotation ROM (p = .041) and increased condylar path length (p = .02), condylar translation (opening p = .034, closing p = .011) and mechanical pain sensitivity of the upper trapezius (p = .018). Increased condylar translation was significantly correlated with reduced upper cervical mobility and poor cervical posture (r = -0.322 to -0.397; p = .012-.046). CONCLUSION Increased condylar translation and path length in patients with NCNP may indicate poor control of TMJ articular movement, which may result from neck pain or may be a compensation for limited neck mobility. Evaluation of excessive TMJ translation may be considered in patients with NCNP.
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Affiliation(s)
- Weng-Sam Siu
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Fen Shih
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shyh-Yuan Lee
- Department of Dentistry, National Yang Ming Chiao Tung University, Taiwan.,Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Dentistry, Taipei City Hospital, Taipei, Taiwan
| | - Chih-Yu Hsu
- Department of Dentistry, National Yang Ming Chiao Tung University, Taiwan.,Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Min-Ju Wei
- Department of Physical Medicine and Rehabilitation, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Tzyy-Jiuan Wang
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsiu-Chen Lin
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan
| | - Yin-Liang Lin
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
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13
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How Do You Treat Trigeminal Neuralgia in Your Practice? Med Acupunct 2022; 34:201-209. [DOI: 10.1089/acu.2022.29207.cpl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Botros J, Gornitsky M, Samim F, der Khatchadourian Z, Velly AM. Back and neck pain: A comparison between acute and chronic pain-related Temporomandibular Disorders. Can J Pain 2022; 6:112-120. [PMID: 35799959 PMCID: PMC9255212 DOI: 10.1080/24740527.2022.2067032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Temporomandibular disorders (TMDs) are common and cause persistent pain. Comorbidities are associated with TMDs and can affect the effectiveness of their treatments. The literature is lacking enough evidence on the difference between acute and chronic pain, particularly in TMDs. Investigating this difference could highlight potential risk factors for the transition from acute to chronic pain–related TMDs. Aim To compare the likelihood of back and neck pain (BP, NP) between acute and chronic pain–related TMDs (AP-TMD, CP-TMD) as defined by pain duration and pain-related disability. Methods Participants with AP-TMDs (≤3 months) and CP-TMDs (>3 months) were recruited according to the diagnostic criteria and research diagnostic criteria of TMD. BP and NP were assessed using a self-reported checklist. CP-TMDs defined by disability (chronic disability) and depression and anxiety symptoms were assessed using validated instruments. Logistic regression analyses were employed. Results This study enrolled 487 adults with AP-TMD (n = 118) and CP-TMD (n = 369). Relative to AP-TMD, participants with CP-TMD had twice the odds of reporting NP (odds ratio [OR] = 2.17, 95% CI 1.27–3.71) but not BP (OR = 0.96, 95% CI 0.57–1.64). Participants with chronic disability were twice as likely to report NP (OR = 1.95, 95% CI 1.20–3.17) but not BP (OR = 1.13, 95% CI 0.69–1.82) compared to those without. All analyses were adjusted for age, sex, and anxiety and depression symptoms. Conclusions Within the limitations of this study, results suggest that central dysregulation or trigeminocervical convergence mechanisms are implicated in the process of pain-related TMD chronification and highlight the relevance of considering disability when defining CP-TMDs.
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Affiliation(s)
- Jack Botros
- Department of Dentistry, Jewish General Hospital, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Montreal, QC, Canada
| | - Mervyn Gornitsky
- Department of Dentistry, Jewish General Hospital, Montreal, QC, Canada
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Montreal, QC, Canada
| | - Firoozeh Samim
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
- Department of Dentistry, Montreal General Hospital, Montreal, QC, Canada
| | - Zovinar der Khatchadourian
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
- Alan Edwards Pain Management Unit, Montreal General Hospital, Montreal Quebec
| | - Ana Miriam Velly
- Department of Dentistry, Jewish General Hospital, Montreal, QC, Canada
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Montreal, QC, Canada
- Alan Edwards Pain Management Unit, Montreal General Hospital, Montreal Quebec
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15
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Piovesan EJ, Kowacs PA. Bening paraxysmal torticollis is a sensoriomotos trigeminocervical convergence merchanisms? Experimental evidence. HEADACHE MEDICINE 2022. [DOI: 10.48208/headachemed.2021.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Introduction
Benign paroxysmal torticollis (BPT) is likely an age-sensitive, childhood periodic syndromes that are commonly precursors of migraine, with atypical postural behavior (torticollis) to start early and self-limited, which of unknown etiology.
Objective
To prove the existence of forms of sensorimotor convergence between the trigeminal nerve and upper cervical roots respectively.
Methods
Ninety-five rats Norvegicus were submitted to infraorbital nerve blockade using botulinum neurotoxin type A (BoNT/A) (n=48) controlled by isotonic saline solution animals (ISS) (n=47). After 84 days the animals were evaluated on their motor functions using open field test and postural behavior.
Results
Of the 48 animals in the BoNT/A group one animal showed the torticollis ipsilateral to BoNT/A injection. The macroscopic analysis showed fasciculations on clavotrapezius muscle. The biopsy with optical and electronic microscopy of this muscle showed changes suggestive of denervation secondary to BoNT/A.
Conclusion
We suggested the existence of a pathway sensoriomotor probably in the brainstem involves the trigeminal system and cervical motoneurons.
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16
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Utiumi MAT, Küster JGB, Godk KS, Santos MLD, Tan BC, Mioto E, Kotsifas NJE, Canalli Filho LC, Colombani GEF, Kowacs PA, Piovesan EJ. Prevalence of trigeminocervical convergence mechanisms in episodic and chronic migraine. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:482-489. [PMID: 35239801 DOI: 10.1590/0004-282x-anp-2021-0095] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/31/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Migraine pain location and trigeminocervical convergence have limited diagnostic value and have usually been assessed using non-standard verbal descriptors in a small number of centers. OBJECTIVE To use non-verbal descriptors of migraine pain location to determine the prevalence of trigeminocervical convergence mechanisms in patients with episodic and chronic migraine. In addition, we explored the factors associated with the presence of convergence. METHODS A multicenter study was carried out. The explicit pain location was explored by asking subjects to indicate, on an electronic form, three points on the anterolateral side and three points on the posterolateral side of the head and neck that represented the common locations of their migraine pain. We evaluated associations of the pain pattern with demographic and psychological features, comorbidities, lifestyle and other headache characteristics. RESULTS 97 episodic and 113 chronic migraine patients were included. Convergence was present in 116 migraineurs (55%) who indicated dominance of pain in the posterior cervical region. This site was more often involved in the chronic migraine group (21 vs. 33%; p=0.034). The number of migrainous/altered sensitivity symptoms (OR=1.39; 95%CI 1.14-1.71) was associated with convergence independently of the chronification status. In this symptom group, there were statistical associations between convergence and vomiting (p=0.045), tactile allodynia (p<0.001), nuchal rigidity (p<0.001) and movement allodynia (p=0.031). CONCLUSIONS Trigeminocervical convergence is common in migraineurs and, in practice, it might be found frequently in chronic migraineurs. Some features commonly found in this group, such as altered sensitivity symptoms, are associated with this phenomenon.
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Affiliation(s)
- Marco Antonio Takashi Utiumi
- Universidade Federal do Paraná, Hospital de Clínicas, Programa de Pós-Graduação em Medicina Interna, Departamento de Clínica Médica, Curitiba PR, Brazil.,Clínica de Neurologia São José, São José dos Pinhais PR, Brazil.,Hospital Marcelino Champagnat, Serviço de Neurologia, Curitiba PR, Brazil
| | | | - Keryn Sporh Godk
- Universidade Federal do Paraná, Curso de Medicina, Setor de Ciências da Saúde, Curitiba PR, Brazil
| | - Maria Luiza Dos Santos
- Universidade Federal do Paraná, Curso de Medicina, Setor de Ciências da Saúde, Curitiba PR, Brazil
| | - Bin Cheng Tan
- Universidade Federal do Paraná, Curso de Medicina, Setor de Ciências da Saúde, Curitiba PR, Brazil
| | - Eldislei Mioto
- Universidade Federal do Paraná, Curso de Medicina, Setor de Ciências da Saúde, Curitiba PR, Brazil
| | | | | | | | - Pedro André Kowacs
- Universidade Federal do Paraná, Hospital de Clínicas, Programa de Pós-Graduação em Medicina Interna, Departamento de Clínica Médica, Curitiba PR, Brazil
| | - Elcio Juliato Piovesan
- Universidade Federal do Paraná, Hospital de Clínicas, Programa de Pós-Graduação em Medicina Interna, Departamento de Clínica Médica, Curitiba PR, Brazil.,Clínica de Neurologia São José, São José dos Pinhais PR, Brazil
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17
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Seemungal BM, Agrawal Y, Bisdorff A, Bronstein A, Cullen KE, Goadsby PJ, Lempert T, Kothari S, Lim PB, Magnusson M, Marcus HJ, Strupp M, Whitney SL. The Bárány Society position on 'Cervical Dizziness'. J Vestib Res 2022; 32:487-499. [PMID: 36404562 PMCID: PMC9837683 DOI: 10.3233/ves-220202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper describes the Bárány Society Classification OverSight Committee (COSC) position on Cervical Dizziness, sometimes referred to as Cervical Vertigo. This involved an initial review by a group of experts across a broad range of fields, and then subsequent review by the Bárány Society COSC. Based upon the so far published literature, the Bárány Society COSC takes the view that the evidence supporting a mechanistic link between an illusory sensation of self-motion (i.e. vertigo - spinning or otherwise) and neck pathology and/or symptoms of neck pain - either by affecting the cervical vertebrae, soft tissue structures or cervical nerve roots - is lacking. When a combined head and neck movement triggers an illusory sensation of spinning, there is either an underlying common vestibular condition such as migraine or BPPV or less commonly a central vestibular condition including, when acute in onset, dangerous conditions (e.g. a dissection of the vertebral artery with posterior circulation stroke and, exceedingly rarely, a vertebral artery compression syndrome). The Committee notes, that migraine, including vestibular migraine, is by far, the commonest cause for the combination of neck pain and vestibular symptoms. The committee also notes that since head movement aggravates symptoms in almost any vestibular condition, the common finding of increased neck muscle tension in vestibular patients, may be linked as both cause and effect, to reduced head movements. Additionally, there are theoretical mechanisms, which have not been explored, whereby cervical pain may promote vaso-vagal, cardio-inhibitory reflexes and hence by presyncopal mechanisms, elicit transient disorientation and/or imbalance. The committee accepts that further research is required to answer the question as to whether those rare cases in which neck muscle spasm is associated with a vague sense of spatial disorientation and/or imbalance, is indeed linked to impaired neck proprioception. Future studies should ideally be placebo controlled and double-blinded where possible, with strict inclusion and exclusion criteria that aim for high specificity at the cost of sensitivity. To facilitate further studies in "cervical dizziness/vertigo", we provide a narrative view of the important confounds investigators should consider when designing controlled mechanistic and therapeutic studies. Hence, currently, the Bárány COSC refrains from proposing any preliminary diagnostic criteria for clinical use outside a research study. This position may change as new research evidence is provided.
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Affiliation(s)
- Barry M. Seemungal
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, UK
| | - Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Alexander Bisdorff
- Department of Neurology, Centre Hospitalier Emile Mayrisch, Esch-sur-Alzette, Luxembourg
| | - Adolfo Bronstein
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, UK
| | - Kathleen E. Cullen
- Departments of Biomedical Engineering, Neuroscience, and Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, USA
| | - Peter J. Goadsby
- King’s College London, UK & University of California, Los Angeles, USA
| | - Thomas Lempert
- Department of Neurology, Schlosspark-Klinik, Berlin, Germany
| | - Sudhir Kothari
- Department of Neurology, Poona Hospital and Research Centre, Pune, India
| | - Phang Boon Lim
- Cardiology Department, Hammersmith Hospital, Imperial College London, UK
| | - Måns Magnusson
- Department of Otorhinolaryngology and Clinical Sciences, Lund University & Skane University Hospital, Sweden
| | - Hani J. Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany
| | - Susan L. Whitney
- School of Health and Rehabilitation Sciences, Department of Physical Therapy, University of Pittsburgh, USA
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18
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Rocabado M, Gutierrez R, Gutierrez MF, Gutierrez MJ. Case report: Anterior open bite correction treatment by dental treatment and physical therapy through craniocervical mandibular and occlusal stabilization. Cranio 2021:1-6. [PMID: 34890299 DOI: 10.1080/08869634.2021.2014168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The opinion on whether a patient with an anterior open bite should be treated surgically or not is controversial. These patients generally suffer from associated discomfort due to their occlusal instability and musculoskeletal pain. CLINICAL PRESENTATION A 60-year-old woman visited the clinic with dental mobility of her upper central incisors as her chief complaint. She had a severe anterior open bite, with a history of continuous grinding and multiple dental restorations in poor condition. Additionally, she suffered neck pain with movement restrictions. CONCLUSION Dentists can evaluate and treat patients with an anterior open bite using this integrative model (physical therapy/dentistry) as a possible alternative as part of the treatment for anterior open bite patients.
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Affiliation(s)
- Mariano Rocabado
- Facultad de Ciencias de la Rehabilitación, Universidad Andrés Bello, Santiago, Chile
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19
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Velly AM, Botros J, Bolla MM, Khan K, Teixeira Junior OA, Guimarães AS, Gornitsky M. Painful and non-painful comorbidities associated with short- and long-term painful temporomandibular disorders: A cross-sectional study among adolescents from Brazil, Canada, and France. J Oral Rehabil 2021; 49:273-282. [PMID: 34731502 DOI: 10.1111/joor.13280] [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: 03/21/2021] [Revised: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Temporomandibular disorder (TMD) pain is common among adolescents. The association between painful TMD and other comorbidities has been demonstrated. However, the difference between short-term (<6 months) and long-term (≥ 6 months) painful TMD is not yet clear. OBJECTIVE The aim of this study was to assess the association between comorbidities and short- and long-term painful TMD among adolescents. METHODS In this cross-sectional study, adolescents were recruited from Montreal (Canada), Nice (France), and Arceburgo (Brazil). Self-reported painful TMD, comorbidities, school absence, and analgesic intake were assessed using reliable instruments. Multivariable logistic regression analyses were conducted to assess the study aims. RESULTS The prevalence of short- and long-term painful TMD was estimated at 22.29% and 9.93%, respectively. The number of comorbidities was associated with short- (OR = 1.71, 95%CI = 1.53-1.90) and long-term painful TMD (OR = 1.79, 95%CI = 1.55-2.08) compared to controls. Frequent headaches (ORshort-term = 4.39, 95%CI = 3.23-5.98, ORlong-term = 3.69, 95%CI = 2.45-5.57) and back pain (ORshort-term = 1.46, 95%CI=1.06-2.03, ORlong-term = 1.69, 95%CI = 1.11-2.59) were associated with both painful TMD groups. Frequent neck pain (OR = 2.23, 95%CI = 1.53-3.26) and allergies were only associated with short-term painful TMD (OR = 1.54, 95%CI = 1.13-2.10). Frequent stomach pain was related to long-term (OR = 2.01, 95%CI = 1.35-3.26), and it was the only comorbidity significantly more frequent among the long than short-term TMD (OR = 1.82, 95%CI: 1.14-2.90). These analyses were adjusted by sex, age, and city. CONCLUSION In this multi-center study, both short- and long-term painful TMD are associated with frequent headaches and back pain, whereas frequent neck pain and allergies are related to only short-term, and frequent stomach pain with long-term painful TMD.
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Affiliation(s)
- Ana Miriam Velly
- Dental Department, SMBD - Jewish General Hospital, Montreal, QC, Canada.,Faculty of Dentistry, McGill University, Montreal, QC, Canada.,Lady Davis Institute for Medical Research, Montreal, QC, Canada
| | - Jack Botros
- Dental Department, SMBD - Jewish General Hospital, Montreal, QC, Canada.,Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - Michèle Muller Bolla
- Centre Hospitalier Universitaire de Nice, Nice, France.,Department of Pediatric Dentistry, Faculty of Dentistry, Côte d'Azur University, France.,Laboratory URB2i, University Paris Descartes, Paris, France
| | - Khurram Khan
- Dental Department, SMBD - Jewish General Hospital, Montreal, QC, Canada.,Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | | | | | - Mervyn Gornitsky
- Dental Department, SMBD - Jewish General Hospital, Montreal, QC, Canada.,Faculty of Dentistry, McGill University, Montreal, QC, Canada.,Lady Davis Institute for Medical Research, Montreal, QC, Canada
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20
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Leahu P, Bange M, Ciolac D, Scheiter S, Matei A, Gonzalez-Escamilla G, Chirumamilla VC, Groppa SA, Muthuraman M, Groppa S. Increased migraine-free intervals with multifocal repetitive transcranial magnetic stimulation. Brain Stimul 2021; 14:1544-1552. [PMID: 34673259 DOI: 10.1016/j.brs.2021.10.383] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/13/2021] [Accepted: 10/16/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Episodic migraine is a debilitating condition associated with vast impairments of health, daily living, and life quality. Several prophylactic treatments exist, having a moderate ratio of action related to side effects and therapy costs. Repetitive transcranial magnetic stimulation (rTMS) is an evidence based therapy in several neuropsychiatric conditions, showing robust efficacy in alleviating specific symptoms. However, its efficacy in migraine disorders is unequivocal and might be tightly linked to the applied rTMS protocol. We hypothesized that multifocal rTMS paradigm could improve clinical outcomes in patients with episodic migraine by reducing the number of migraine days, frequency and intensity of migraine attacks, and improve the quality of life. METHODS We conducted an experimental, double-blind, randomized controlled study by applying a multifocal rTMS paradigm. Patients with episodic migraine with or without aura were enrolled in two centers from August 2018, to December 2019, and randomized to receive either real (n = 37) or sham (sham coil stimulation, n = 28) multifocal rTMS for six sessions over two weeks. Patients, physicians, and raters were blinded to the applied protocol. The experimental multifocal rTMS protocol included two components; first, swipe stimulation of 13 trains of 140 pulses/train, 67 Hz, 60% of RMT, and 2s intertrain interval and second, spot burst stimulation of 33 trains of 15 pulses/train, 67 Hz, 85% of RMT, and 8s intertrain interval. Reduction >50% from the baseline in migraine days (as primary outcome) and frequency and intensity of migraine attacks (as key secondary outcomes) over a 12-week period were assessed. To balance the baseline variables between the treatment arms, we applied the propensity score matching through the logistic regression. RESULTS Among 65 randomized patients, sixty (age 39.7 ± 11.6; 52 females; real rTMS n = 33 and sham rTMS n = 27) completed the trial and five patients dropped out. Over 12 weeks, the responder's rate in the number of migraine days was significantly higher in the real rTMS compared to the sham group (42% vs. 26%, p < 0.05). The mean migraine days per month decreased from 7.6 to 4.3 days in the real rTMS group and from 6.2 to 4.3 days in the sham rTMS group, resulting in a difference with real vs. sham rTMS of -3.2 days (p < 0.05). Similarly, over the 12-week period, the responder's rate in the reduction of migraine attacks frequency was higher in the real rTMS compared to the sham group (42% vs 33%, p < 0.05). No serious adverse events were observed. CONCLUSION Our pilot study shows compelling evidence in a double placebo-controlled trial that multifocal rTMS is an effective and well-tolerated preventive treatment in patients with episodic migraine.
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Affiliation(s)
- Pavel Leahu
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova; Laboratory of Neurobiology and Medical Genetics, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - Manuel Bange
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Dumitru Ciolac
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova; Laboratory of Neurobiology and Medical Genetics, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - Stefanie Scheiter
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Alexandru Matei
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | - Gabriel Gonzalez-Escamilla
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Venkata C Chirumamilla
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stanislav A Groppa
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova; Laboratory of Neurobiology and Medical Genetics, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - Muthuraman Muthuraman
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sergiu Groppa
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
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The Enduring Controversy of Cervicogenic Vertigo, and Its Place among Positional Vertigo Syndromes. Audiol Res 2021; 11:491-507. [PMID: 34698085 PMCID: PMC8544230 DOI: 10.3390/audiolres11040045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 11/22/2022] Open
Abstract
The idea of cervicogenic vertigo (CV) was proposed nearly a century ago, yet despite considerable scrutiny and research, little progress has been made in clarifying the underlying mechanism of the disease, developing a confirmatory diagnostic test, or devising an appropriately targeted treatment. Given the history of this idea, we offer a review geared towards understanding why so many attempts at clarifying it have failed, with specific comments regarding how CV fits into the broader landscape of positional vertigo syndromes, what a successful diagnostic test might require, and some practical advice on how to approach this in the absence of a diagnostic test.
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22
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Thomas DC, Patil AG, Sood R, Katzmann G. Occipital Neuralgia and Its Management: An Overview. Neurol India 2021; 69:S213-S218. [PMID: 34003168 DOI: 10.4103/0028-3886.315978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Greater and lesser occipital neuralgias are primary neuralgias that are relatively uncommon, where the pain is felt in the distribution of these nerves. Objective This review paper was intended to describe the features and management of occipital neuralgia in the context of a challenging case. Material and Methods We looked at succinct literature from the past 30 years. We compared the features of our challenging case given in the current literature. In addition, an overview of the current literature is provided. Results The case, although proved to be a diagnostic challenge, we were able to reach a conclusion and render the patient almost complete pain relief by conservative management modalities. It proved to be a rare presentation of occipital neuralgia with unusual pain distribution, and we are able to describe a literature-based explanation for this entity to be a diagnostic and management challenge. Conclusion Primary headaches, i'n general, are a group of headache disorders that require exquisite diagnostic skills. The clinical history is a key factor when making an accurate diagnosis, and to establish an appropriate management plan.
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Affiliation(s)
| | - Amey G Patil
- Department of Restorative Dentistry and Department of Diagnostic Sciences, Center for TMD and Orofacial Pain, Rutgers School of Dental Medicine, Newark, NJ, USA
| | - Ruchika Sood
- Department of Diagnostic Sciences, Center for TMD and Orofacial Pain, Rutgers School of Dental Medicine, Newark, NJ, USA
| | - Giannina Katzmann
- Department of Diagnostic Sciences Rutgers School of Dental Medicine, Newark, NJ, USA
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23
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Clinical Evaluation and Treatment of Patients with Postconcussion Syndrome. Neurol Res Int 2021; 2021:5567695. [PMID: 34194843 PMCID: PMC8181109 DOI: 10.1155/2021/5567695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/13/2021] [Indexed: 12/30/2022] Open
Abstract
Postconcussion syndrome (PCS) is a complex set of symptoms occurring in a small percentage of patients following concussion. The condition is characterized by headaches, dizziness, cognitive difficulties, somatosensory issues, and a variety of other symptoms with varying durations. There is a lack of objective markers and standard treatment protocols. With the complexity created by premorbid conditions, psychosomatic issues, secondary gains, and litigations, providers often find themselves in a tough situation in the care of these patients. This article combines literature review and clinical insights with a focus on the underlying pathophysiology of PCS to provide a roadmap for evaluating and treating this condition.
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Review of Literatures: Physiology of Orofacial Pain in Dentistry. eNeuro 2021; 8:ENEURO.0535-20.2021. [PMID: 33820801 PMCID: PMC8086974 DOI: 10.1523/eneuro.0535-20.2021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/14/2021] [Accepted: 03/23/2021] [Indexed: 01/01/2023] Open
Abstract
The objective of this review of the literature is to summarize the physiology of orofacial pain in dentistry, particularly physiology of the pain pathway and molecular mechanisms on pathophysiology of pain, on account of new insights into classification of orofacial pain related diseases. This article will also focus on possible mechanisms of neuropathic orofacial pain which is distinguished from other types of pain.
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25
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Argyriou AA, Mitsikostas DD, Mantovani E, Litsardopoulos P, Panagiotopoulos V, Tamburin S. An updated brief overview on post-traumatic headache and a systematic review of the non-pharmacological interventions for its management. Expert Rev Neurother 2021; 21:475-490. [PMID: 33682560 DOI: 10.1080/14737175.2021.1900734] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Post-traumatic headache (PTH), a common type of headache secondary to traumatic brain injury (TBI) or whiplash, carries a relevant burden on patients. PTH is still an undertreated condition because of limited pharmacological treatment options. Therefore, multimodal non-pharmacologic approaches, which account for comorbidities and biopsychosocial factors, are often used in PTH patients. AREAS COVERED After providing a brief overview of PTH, a systematic review was conducted, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations on recently published (2015-2020) papers on non-pharmacological interventions for PTH. We also collected data on ongoing trials on this topic. Studies and results are reviewed and discussed. EXPERT OPINION PTH is one of the most common complications of TBI and accounts for almost 4% of symptomatic headache disorders. The most common clinical presentations of PTH are migraine-like or tension type (TTH)-like headache, neck pain, cognitive complaints, and psychological/psychiatric symptoms. Growing evidence suggests that combined pharmacological and non-pharmacological interventions, encompassing noninvasive neuromodulation, physical therapy, cognitive-behavioral treatment, and education, may be the best approaches for PTH and related comorbidities. Acute/preemptive pharmacological treatments for PTH include drugs used for migraine and TTH. When PTH management is multidisciplinary, the patient benefits most.
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Affiliation(s)
- Andreas A Argyriou
- Headache Outpatient Clinic, Department of Neurology, Saint Andrew's State General Hospital of Patras, Greece
| | - Dimos-Dimitrios Mitsikostas
- 1st Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Pantelis Litsardopoulos
- Headache Outpatient Clinic, Department of Neurology, Saint Andrew's State General Hospital of Patras, Greece
| | | | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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26
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Roberts B, Makar AE, Canaan R, Pazdernik V, Kondrashova T. Effect of occipitoatlantal decompression on cerebral blood flow dynamics as evaluated by Doppler ultrasonography. J Osteopath Med 2021; 121:171-179. [PMID: 33567080 DOI: 10.1515/jom-2020-0100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Context Osteopathic manipulative treatment reduces symptoms in patients with headache disorders, but the underlying mechanisms are unclear. Objective To evaluate blood flow in the intracranial and extracranial vasculature before and after occipitoatlantal decompression (OAD) using Doppler ultrasonography. Methods Healthy, first-year osteopathic medical students from A.T. Still University's Kirksville College of Osteopathic Medicine participated in a randomized, single-blinded, two-period, two-treatment crossover study. The participants were randomly assigned to 1 of 2 treatment interventions: OAD or sham touch. After one week, participants returned to have the other intervention performed. Blood flow parameters-peak systolic velocity (PSV) and end-diastolic velocity (EDV)-in the middle cerebral artery (MCA), internal carotid artery (ICA), and vertebral artery (VA) were evaluated before, immediately after, 5 minutes after, and 10 minutes after treatment. Differences in PSV, EDV, heart rate (HR), and blood pressure (BP) for both interventions were analyzed for the four time points using mixed-effects models. Results Thirty healthy medical students (11 men, 19 women; mean age, 24 years) participated in this study. EDV increased after OAD in the MCA, ICA, and VA (all p<0.001); no change occurred after sham touch (all p>0.05). EDV was greater for all post-treatment timepoints after OAD in the MCA, ICA, and VA than after sham touch (all p<0.001). Although baseline PSV in the MCA measured before treatment was different between treatment interventions (p=0.01), no difference was found between interventions at any post-treatment time point (all p>0.59). Changes in PSV in the ICA and VA and for HR and BP did not depend on treatment intervention (p>0.06). Conclusion Increases in EDV occurred in major cranial arteries after OAD but not after sham touch, indicating that OAD improves blood flow to the brain. The exact mechanism of this increase is unknown; however, it can be explained by either parasympathetic stimulation through the secretion of vasodilating neurotransmitters or by a decrease in external tissue pressure on ICA and VA, with the resulting flow causing further dilation in the MCA.
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Affiliation(s)
- Bryan Roberts
- Kirksville College of Osteopathic Medicine , A.T. Still University , Kirksville , MO , USA
| | - Andrew E Makar
- Kirksville College of Osteopathic Medicine , A.T. Still University , Kirksville , MO , USA
| | - Ryan Canaan
- Kirksville College of Osteopathic Medicine , A.T. Still University , Kirksville , MO , USA
| | - Vanessa Pazdernik
- Department of Research Support , A.T. Still University , Kirksville , MO , USA
| | - Tatyana Kondrashova
- Department of Family Medicine, Preventive Medicine, and Community Health , A.T. Still University , Kirksville , MO , USA
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27
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Edvinsson JCA, Viganò A, Alekseeva A, Alieva E, Arruda R, De Luca C, D'Ettore N, Frattale I, Kurnukhina M, Macerola N, Malenkova E, Maiorova M, Novikova A, Řehulka P, Rapaccini V, Roshchina O, Vanderschueren G, Zvaune L, Andreou AP, Haanes KA. The fifth cranial nerve in headaches. J Headache Pain 2020; 21:65. [PMID: 32503421 PMCID: PMC7275328 DOI: 10.1186/s10194-020-01134-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/25/2020] [Indexed: 12/27/2022] Open
Abstract
The fifth cranial nerve is the common denominator for many headaches and facial pain pathologies currently known. Projecting from the trigeminal ganglion, in a bipolar manner, it connects to the brainstem and supplies various parts of the head and face with sensory innervation. In this review, we describe the neuroanatomical structures and pathways implicated in the sensation of the trigeminal system. Furthermore, we present the current understanding of several primary headaches, painful neuropathies and their pharmacological treatments. We hope that this overview can elucidate the complex field of headache pathologies, and their link to the trigeminal nerve, to a broader field of young scientists.
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Affiliation(s)
- J C A Edvinsson
- Department of Clinical Experimental Research, Glostrup Research Institute, Rigshospitalet Glostrup, 2600, Glostrup, Denmark. .,Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - A Viganò
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - A Alekseeva
- Department of Neurology, First Pavlov State Medical University of St.Petersburg, St.Petersburg, Russia
| | - E Alieva
- GBUZ Regional Clinical Hospital № 2, Krasnodar, Russia
| | - R Arruda
- Department of Neuroscience, University of Sao Paulo, Ribeirao Preto, Brazil
| | - C De Luca
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, 56126, Pisa, Italy.,Department of Public Medicine, Laboratory of Morphology of Neuronal Network, University of Campania-Luigi Vanvitelli, Naples, Italy
| | - N D'Ettore
- Department of Neurology, University of Rome, Tor Vergata, Rome, Italy
| | - I Frattale
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100, L'Aquila, Italy
| | - M Kurnukhina
- Department of Neurosurgery, First Pavlov State Medical University of St.Petersburg, Lev Tolstoy Street 6-8, St.Petersburg, Russia.,The Leningrad Regional State Budgetary Institution of health care "Children's clinical hospital", St.Petersburg, Russia
| | - N Macerola
- Department of Internal Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Malenkova
- Pain Department, Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - M Maiorova
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - A Novikova
- F.F. Erisman Federal Research Center for Hygiene, Mytishchy, Russia
| | - P Řehulka
- Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - V Rapaccini
- Child Neurology and Psychiatry Unit, Systems Medicine Department, University Hospital Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.,Unità Sanitaria Locale (USL) Umbria 2, Viale VIII Marzo, 05100, Terni, Italy.,Department of Neurology, Headache Center, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - O Roshchina
- Department of Neurology, First Pavlov State Medical University of St.Petersburg, St.Petersburg, Russia
| | - G Vanderschueren
- Department of Neurology, ZNA Middelheim, Lindendreef 1, 2020, Antwerp, Belgium
| | - L Zvaune
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Riga Stradins University, Riga, Latvia.,Department of Pain Medicine, Hospital Jurmala, Jurmala, Latvia.,Headache Centre Vivendi, Riga, Latvia
| | - A P Andreou
- Headache Research, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,The Headache Centre, Guy's and St Thomas, NHS Foundation Trust, London, UK
| | - K A Haanes
- Department of Clinical Experimental Research, Glostrup Research Institute, Rigshospitalet Glostrup, 2600, Glostrup, Denmark
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Terry DP, Wojtowicz M, Cook NE, Maxwell BA, Zafonte R, Seifert T, Silverberg ND, Berkner PD, Iverson GL. Factors Associated With Self-Reported Concussion History in Middle School Athletes. Clin J Sport Med 2020; 30 Suppl 1:S69-S74. [PMID: 32132480 DOI: 10.1097/jsm.0000000000000594] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Identifying personal characteristics associated with sustaining a concussion is of great interest, yet only a few have examined this in children. The purpose of this study was to examine the association between sex, neurodevelopmental disorders, health history, and lifetime history of self-reported concussion in 12- and 13-year-old athletes. DESIGN Cross-sectional study. SETTING Middle schools. PARTICIPANTS Participants were 1744 twelve- and thirteen-year-old student athletes who completed preseason Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) testing, including a self-report questionnaire about previous concussions, developmental diagnoses, and previous medical treatment. INDEPENDENT VARIABLES Age, sex, attention-deficit/hyperactivity disorder (ADHD), learning disabilities (LDs), and previous treatment for migraine. MAIN OUTCOME MEASURES Self-reported history of concussion. RESULTS A minority of athletes (13.7%) reported previous concussions (1 concussion, n = 181; 2 concussions, n = 41; and 3+ concussions, n = 17). A small proportion reported a history of ADHD (4.4%), LD (2.8%) or migraine treatment (4.0%). Higher rates of self-reported previous concussions were associated with male sex [16.9% vs 9.1%; χ(1) = 21.47, P < 0.001] and previous migraine treatment [31.9% vs 13.0%; χ(1) = 20.08, P < 0.001]. There were no differences in self-reported concussion history between 12- and 13-year olds (P = 0.18) and those with/without ADHD (P = 0.41) or LDs (P = 0.06). The overall logistic regression model was statistically significant [χ(5) = 42.01, P < 0.001] but explained only 4.3% of the variance. Previous treatment for migraine [P < 0.001, Exp(B) = 3.30] and male sex [P < 0.001, Exp(B) = 2.06] were independently associated with a self-reported concussion history, whereas age, LD, and ADHD were not (P's > 0.05). CONCLUSIONS Male sex and previous migraine treatment were associated with higher rates of self-reported previous concussions in both independent and multivariate models in middle school athletes, whereas age, ADHD, and LDs were not.
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Affiliation(s)
- Douglas P Terry
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Massachusetts
- MassGeneral Hospital for Children Sport Concussion Program, Boston, Massachusetts
| | | | - Nathan E Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
- MassGeneral Hospital for Children Sport Concussion Program, Boston, Massachusetts
| | - Bruce A Maxwell
- Department of Computer Science, Colby College, Waterville, Maine
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Massachusetts
- MassGeneral Hospital for Children Sport Concussion Program, Boston, Massachusetts
| | - Tad Seifert
- Departments of Neurology and Sports Health, Norton Healthcare, Louisville, Kentucky
- Kentucky Boxing and Wrestling Commission, Frankfort, Kentucky
| | - Noah D Silverberg
- Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health Research Institute Rehabilitation Research Program, Vancouver, BC, Canada; and
| | - Paul D Berkner
- Department of Biology and Health Services, Colby College, Waterville, Maine
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Massachusetts
- MassGeneral Hospital for Children Sport Concussion Program, Boston, Massachusetts
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Bortolato A, Simonato D, Garrì F, Gabrieli JD, Cester G, Causin F, Feltracco P. Greater Occipital Nerve Block as a Tool to Diagnose Spontaneous Intracranial Hypotension Before Epidural Blood Patch: A Case Report. A A Pract 2020; 14:6-8. [PMID: 31703006 DOI: 10.1213/xaa.0000000000001126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Spontaneous intracranial hypotension (SIH) has been increasingly characterized in recent years. A definitive diagnostic algorithm remains controversial because several symptoms are often found to be nonspecific. When neuroimaging fails to identify a cerebrospinal fluid leak and symptoms are atypical, an epidural blood patch (EBP) may be performed but not without risks. Our case shows how greater occipital nerve block (GONB) can expedite SIH diagnosis in a man with atypical presentation by reducing the sensory input from the posterior cranial fossa. The relief provided by GONB allowed to diagnose SIH promptly and the patient underwent a curative EBP.
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Affiliation(s)
- Andrea Bortolato
- From the Neuroanesthesia and Intensive Care, University Hospital of Padova, Padova, Italy.,Institute of Radiology, University of Padova, Padova, Italy
| | | | | | | | - Giacomo Cester
- Neuroradiology Unit, University Hospital of Padova, Padova, Italy
| | - Francesco Causin
- Neuroradiology Unit, University Hospital of Padova, Padova, Italy
| | - Paolo Feltracco
- Institute of Anesthesia and Intensive Care, University of Padova, Padova, Italy
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30
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Ghodrati M, Mosallanezhad Z, Shati M, Noroozi M, Moghadam AN, Rostami M, Nourbakhsh MR. Adding Temporomandibular joint treatments to routine physiotherapy for patients with non-specific chronic neck pain: A randomized clinical study. J Bodyw Mov Ther 2019; 24:202-212. [PMID: 32507146 DOI: 10.1016/j.jbmt.2019.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 11/12/2019] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Neck Pain can be related to the disorders of other adjacent areas such as the Temporomandibular Joint (TMJ). This study aimed to investigate whether there is value in adding TMJ treatments to routine physiotherapy in patients with non-specific chronic neck pain compared with a control group. METHODS A randomized, single-blind, clinical study desined including two groups of patients. Group A (20 people) received routine physiotherapy for neck pain and group B (20 people) received TMJ manual therapy plus exercise therapy in addition to routine physiotherapy for neck pain. The Treatment program included six sessions for two days a week over a period of 21 days. Assessments were performed during the first session, in the last session and one month after treatment as a follow-up. Outcome measures included neck range of motion (ROM), neck disability index (NDI) and visual analogue scale (VAS). Before starting the study, the reliability of methods for measuring neck ROM was evaluated. RESULTS Participants were 21 women and 19 men. Initially, a pilot study was carried out on the 40 volunteers to assess the reliability of the measurement methods, and the results were acceptable. With both the control group and the intervention group, the indexes showed significant improvement (p < 0.001), although the intervention group showed more improvement (p < 0.001). CONCLUSION This result means adding treatments of TMJ to routine neck physiotherapy can magnify the effect of the intervention, a significant change still in evidence at follow up. Moreover, given the clinically important differences, our results for VAS and NDI were acceptable.
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Affiliation(s)
- Maryam Ghodrati
- Health and Rehabilitation Sciences Program, University of Western Ontario, London, Canada
| | - Zahra Mosallanezhad
- Department of Physical Therapy and Research Center of Aging, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran.
| | - Mohsen Shati
- Mental Health Research Center, School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mehdi Noroozi
- Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
| | - Afsun Nodehi Moghadam
- Department of Physical Therapy and Research Center of Aging, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
| | - Mohamad Rostami
- Department of Physical Therapy and Research Center of Aging, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
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31
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Greater Occipital Nerve Block for the Treatment of Chronic Migraine Headaches: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2019; 144:943-952. [PMID: 31568309 DOI: 10.1097/prs.0000000000006059] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Few treatment options exist for chronic migraine headaches, with peripheral nerve blocks having long been used to reduce the frequency and severity of migraines. Although the therapeutic effects have been observed in clinical practice, the efficacy has never been fully studied. In the past decade, however, several randomized controlled clinical trials have been conducted to assess the efficacy of greater occipital nerve block in the treatment of chronic migraine headaches. METHODS A systematic review of the literature was performed in the citation databases PubMed, Embase, MEDLINE, and the Cochrane Library. The initial search of databases yielded 259 citations, of which 33 were selected as candidates for full-text review. Of these, nine studies were selected for inclusion in this meta-analysis. RESULTS Studies were analyzed that reported mean number of headache days per month in both intervention and control groups. A total of 417 patients were studied, with a pooled mean difference of -3.6 headache days (95 percent CI, -1.39 to -5.81 days). This demonstrates that greater occipital nerve block intervention significantly reduced the frequency of migraine headaches compared with controls (p < 0.00001). Pooled mean difference in pain scores of -2.2 (95 percent CI, -1.56 to -2.84) also demonstrated a significant decrease in headache severity compared with controls (p < 0.0121). CONCLUSIONS Greater occipital nerve blocking should be recommended for use in migraine patients, particularly those that may require future surgical intervention. The block may act as an important stepping stone for patients experiencing migraine headache because of its usefulness for potentially assessing surgical candidates for nerve decompression. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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32
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Noreña AJ, Fournier P, Londero A, Ponsot D, Charpentier N. An Integrative Model Accounting for the Symptom Cluster Triggered After an Acoustic Shock. Trends Hear 2019; 22:2331216518801725. [PMID: 30249168 PMCID: PMC6156190 DOI: 10.1177/2331216518801725] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Acoustic shocks and traumas sometimes result in a cluster of debilitating symptoms, including tinnitus, hyperacusis, ear fullness and tension, dizziness, and pain in and outside the ear. The mechanisms underlying this large variety of symptoms remain elusive. In this article, we elaborate on the hypothesis that the tensor tympani muscle (TTM), the trigeminal nerve (TGN), and the trigeminal cervical complex (TCC) play a central role in generating these symptoms. We argue that TTM overuse (due to the acoustic shock), TTM overload (due to muscle tension), and ultimately, TTM injury (due to hypoxia and "energy crisis") lead to inflammation, thereby activating the TGN, TCC, and cortex. The TCC is a crossroad structure integrating sensory inputs coming from the head-neck complex (including the middle ear) and projecting back to it. The multimodal integration of the TCC may then account for referred pain outside the ear when the middle ear is inflamed and activates the TGN. We believe that our model proposes a synthetic and explanatory framework to explain the phenomena occurring postacoustic shock and potentially also after other nonauditory causes. Indeed, due to the bidirectional properties of the TCC, musculoskeletal disorders in the region of the head-neck complex, including neck injury due to whiplash or temporomandibular disorders, may impact the middle ear, thereby leading to otic symptoms. This previously unavailable model type is experimentally testable and must be taken as a starting point for identifying the mechanisms responsible for this particular subtype of tinnitus and its associated symptoms.
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Affiliation(s)
- Arnaud J Noreña
- 1 Aix-Marseille Université, UMR CNRS 7260, Laboratoire Neurosciences Intégratives et Adaptatives-Centre Saint-Charles, Marseille, France
| | - Philippe Fournier
- 1 Aix-Marseille Université, UMR CNRS 7260, Laboratoire Neurosciences Intégratives et Adaptatives-Centre Saint-Charles, Marseille, France
| | - Alain Londero
- 2 Service ORL et CCF, Hôpital Européen G. Pompidou, Paris, France
| | - Damien Ponsot
- 3 Académie de Lyon-Lycée Germaine Tillion, Sain-Bel, France
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Grant GJ, Echevarria GC, Lax J, Pass HI, Oshinsky ML. Sphenopalatine Ganglion Block to Treat Shoulder Tip Pain After Thoracic Surgery: Report of 2 Cases. A A Pract 2018; 11:90-92. [PMID: 29634542 DOI: 10.1213/xaa.0000000000000746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Shoulder tip pain may occur after thoracic surgical procedures. The pain is caused by diaphragmatic irritation and is referred to the shoulder. Shoulder tip pain is often resistant to treatment with conventional analgesics. The sphenopalatine ganglion block has been described to manage many painful conditions. We report here the first use of this block to treat shoulder tip pain in 2 thoracic surgical patients. In both patients, the block produced rapid and sustained relief of the shoulder tip pain. We suggest that sphenopalatine ganglion block be considered to treat postoperative shoulder tip pain after thoracic surgical procedures.
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Affiliation(s)
- Gilbert J Grant
- From the Departments of Anesthesiology, Perioperative Care and Pain Management
| | | | - Jerome Lax
- From the Departments of Anesthesiology, Perioperative Care and Pain Management
| | - Harvey I Pass
- Cardiothoracic Surgery, New York University School of Medicine, New York, New York
| | - Michael L Oshinsky
- Cardiothoracic Surgery, New York University School of Medicine, New York, New York.,National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
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Terry DP, Huebschmann NA, Maxwell BA, Cook NE, Mannix R, Zafonte R, Seifert T, Berkner PD, Iverson GL. Preinjury Migraine History as a Risk Factor for Prolonged Return to School and Sports following Concussion. J Neurotrauma 2018; 36:142-151. [PMID: 29732944 DOI: 10.1089/neu.2017.5443] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Having a preexisting migraine disorder might be a risk factor for a prolonged recovery following a sport-related concussion. We examined whether having a migraine history was associated with a prolonged return to academics and athletics following a concussion. High school and collegiate athletes (n = 1265; 42% female) who sustained a sport-related concussion were monitored by athletic trainers using a web-based surveillance system that collects information about concussion recovery. Nonparametric Kolmogorov-Smirnov tests (KS) were used to compare days to return to academics/athletics across groups due to non-normally distributed outcome variables and unequal distributions of scores between groups. Chi-squared tests were used to examine the proportion of players who had not returned to academics/athletics at 7, 14, and 21 days post-injury stratified by self-reported migraine history. There were 117 athletes (9.2%) who reported a preinjury migraine history. Athletes with a history of migraine took a median of 6 days to return to academics (mean [M] = 10.6, standard deviation [SD] = 14.2) and 15.5 days to return to athletics (M = 23.8, SD = 30.8), while those with no migraine history took a median of 5 days to return to academics (M = 7.5, SD = 10.9) and 14 days to return to athletics (M = 19.4, SD = 19.4). There were no statistically significant differences in days to return to school or athletics between the groups (KS p > 0.05). However, a lower percentage of athletes with a history of migraine had returned to school after 7 days (57% vs. 68%, χ2 = 5.53, p = 0.02), 14 days (75% vs. 88%, χ2 = 14.21, p < 0.001), and 21 days post-injury (89% vs. 94%, χ2 = 4.90, p = 0.03). Stratifying the analyses by sex showed that this effect was significant in girls and women with preexisting migraines, but not boys and men with preexisting migraines. There were no group differences in recovery rates when examining return to athletics. Athletes with a preinjury migraine history may be at an elevated risk for a protracted return to school after concussion, especially girls and women.
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Affiliation(s)
- Douglas P Terry
- 1 Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Brigham and Women's Hospital , Harvard Medical School, Boston Massachusetts
- 2 Home Base, A Red Sox Foundation and Massachusetts General Hospital Program , Boston, Massachusetts
- 3 MassGeneral Hospital for Children™ Sport Concussion Program , Charlestown, Massachusetts
| | | | - Bruce A Maxwell
- 5 Department of Computer Science, Colby College , Waterville, Maine
| | - Nathan E Cook
- 1 Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Brigham and Women's Hospital , Harvard Medical School, Boston Massachusetts
- 3 MassGeneral Hospital for Children™ Sport Concussion Program , Charlestown, Massachusetts
| | - Rebekah Mannix
- 6 Division of Emergency Medicine, Boston Children's Hospital, Brigham and Women's Hospital , Harvard Medical School, Boston Massachusetts
- 10 Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Ross Zafonte
- 1 Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Brigham and Women's Hospital , Harvard Medical School, Boston Massachusetts
- 2 Home Base, A Red Sox Foundation and Massachusetts General Hospital Program , Boston, Massachusetts
- 7 Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital , Harvard Medical School, Boston Massachusetts
| | - Tad Seifert
- 8 Sports Neurology Program, Norton Healthcare, Kentucky Boxing and Wrestling Commission , Louisville, Kentucky
| | - Paul D Berkner
- 9 Health Services and the Department of Biology, Colby College , Waterville, Maine
| | - Grant L Iverson
- 1 Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Brigham and Women's Hospital , Harvard Medical School, Boston Massachusetts
- 2 Home Base, A Red Sox Foundation and Massachusetts General Hospital Program , Boston, Massachusetts
- 3 MassGeneral Hospital for Children™ Sport Concussion Program , Charlestown, Massachusetts
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35
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Spinal high-velocity low-amplitude manipulation with exercise in women with chronic temporomandibular disorders. MANUELLE MEDIZIN 2018. [DOI: 10.1007/s00337-018-0406-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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37
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Abstract
PURPOSE OF REVIEW The study focuses on neural blocks with local anesthetics in postoperative and chronic pain. It is prompted by the recent publication of several systematic reviews and guidelines. RECENT FINDINGS For postoperative pain, the current evidence supports infusions of local anesthetics at the surgical site, continuous peripheral nerve blocks, and neuraxial analgesia for major thoracic and abdominal procedures. Ultrasound guidance can improve the performance of the blocks and different patient outcomes, although the incidence of peripheral nerve damage is not decreased. For chronic pain, the best available evidence is on nerve blocks for the diagnosis of facet joint pain. Further research is needed to validate diagnostic nerve blocks for other indications. Therapeutic blocks with only local anesthetics (greater occipital nerve and sphenopalatine ganglion) are effective in headache. A possible mechanism is modulation of central nociceptive pathways. Therapeutic nerve blocks for other indications are mostly supported by retrospective studies and case series. SUMMARY Recent literature strongly supports the use of regional anesthesia for postoperative pain, whereby infusions at peripheral nerves and surgical site are gaining increasing importance. Local anesthetic blocks are valid for the diagnosis of facet joint pain and effective in treating headache. There is a need for further research in diagnostic and therapeutic blocks for chronic pain.
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Seifert T. The relationship of migraine and other headache disorders to concussion. HANDBOOK OF CLINICAL NEUROLOGY 2018; 158:119-126. [DOI: 10.1016/b978-0-444-63954-7.00012-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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COACH CV: The Seven Clinical Phenotypes of Concussion. Brain Sci 2017; 7:brainsci7090119. [PMID: 28926944 PMCID: PMC5615260 DOI: 10.3390/brainsci7090119] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 09/07/2017] [Accepted: 09/12/2017] [Indexed: 11/17/2022] Open
Abstract
Our understanding of the diverse physiological manifestations of concussion is changing rapidly. This has an influence on the clinical assessment of patients who have sustained a concussion. The 2017 Consensus Statement on Concussion in Sport states that numerous post-injury clinical findings, such as cognitive deficits, post-traumatic headaches, dizziness, difficulties with oculomotor function, and depression have all been associated with a poorer prognosis in concussed patients. This demonstrates that there are several potential clinical manifestations after head injury warranting clinical evaluation. We have developed an acronym to guide the office-based assessment of concussed patients to consider each of the potential clinical phenotypes. "COACH CV" prompts the clinician to evaluate for cognitive problems, oculomotor dysfunction, affective disturbances, cervical spine disorders, headaches, and cardiovascular and vestibular anomalies.
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Londero A, Charpentier N, Ponsot D, Fournier P, Pezard L, Noreña AJ. A Case of Acoustic Shock with Post-trauma Trigeminal-Autonomic Activation. Front Neurol 2017; 8:420. [PMID: 28861040 PMCID: PMC5562182 DOI: 10.3389/fneur.2017.00420] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 08/03/2017] [Indexed: 11/25/2022] Open
Abstract
This study reports the case of an acoustic shock injury (ASI), which did not result in a significant hearing loss, but was followed by manifold chronic symptoms both within (tinnitus, otalgia, tingling in the ear, tension in the ear, and red tympanum) and outside the ears (blocked nose, pain in the neck/temporal region). We suggest that these symptoms may result from a loop involving injury to middle ear muscles, peripheral inflammatory processes, activation and sensitization of the trigeminal nerve, the autonomic nervous system, and central feedbacks. The pathophysiology of this ASI is reminiscent of that observed in post-traumatic trigeminal-autonomic cephalalgia. This framework opens new and promising perspectives on the understanding and medical management of ASI.
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Affiliation(s)
- Alain Londero
- Service ORL et CCF, Hôpital Européen G. Pompidou, Paris, France
| | | | - Damien Ponsot
- Lycée Germaine Tillion, Académie de Lyon, Sain-Bel, France
| | - Philippe Fournier
- Laboratoire Neurosciences Intégratives et Adaptatives, UMR CNRS 7260, Fédération 3C, Aix-Marseille Université, Marseille, France
| | - Laurent Pezard
- Laboratoire Neurosciences Intégratives et Adaptatives, UMR CNRS 7260, Fédération 3C, Aix-Marseille Université, Marseille, France
| | - Arnaud J Noreña
- Laboratoire Neurosciences Intégratives et Adaptatives, UMR CNRS 7260, Fédération 3C, Aix-Marseille Université, Marseille, France
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Bir SC, Nanda A, Patra DP, Maiti TK, Liendo C, Minagar A, Chernyshev OY. Atypical presentation and outcome of cervicogenic headache in patients with cervical degenerative disease: A single-center experience. Clin Neurol Neurosurg 2017; 159:62-69. [DOI: 10.1016/j.clineuro.2017.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/05/2017] [Accepted: 05/09/2017] [Indexed: 11/16/2022]
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Temporomandibular disorders and whiplash injury: a narrative review. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:e37-e46. [DOI: 10.1016/j.oooo.2017.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 02/24/2017] [Accepted: 03/01/2017] [Indexed: 11/17/2022]
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Tseng SC, Cheng AM, Fu Y. Retrospective study to identify trigeminal-cervical ocular referred pain as a new causative entity of ocular pain. J Pain Res 2017; 10:1747-1754. [PMID: 28794654 PMCID: PMC5536137 DOI: 10.2147/jpr.s140895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Purpose To determine the prevalence and clinical characteristics of trigeminal–cervical (TC) ocular referred pain. Methods A retrospective study of 1,680 patients seen during 2002–2010 was performed in an ocular surface specialty center to identify patients with or without TC pain defined as ocular pain with ipsilateral trigger points located at the occipital region. Patients with refractory TC pain despite topical anesthetics and conventional treatments received interventional injection to each trigger point. Results A total of 81 (4.8%) patients (study group) with TC pain and 241 patients (control group) without TC pain were identified out of the 1,680 patients over an 8 year period. There was no difference in age, gender, prior surgeries, medications, non-pain symptoms, pain laterality, and concomitant ocular diseases between the 2 groups. Multivariate regression analysis showed that patients with TC pain had a significant correlation with persistent deep ocular pain, ipsilateral trigger points (f2=99, p<0.001) but not headaches (f2=0.09, p=0.5). Injection at the trigger points achieved complete or partial pain resolution with a low recurrence rate in 43 of 45 (96%) patients with TC pain. Conclusion TC pain defined herein may be a different entity of ocular pain and can indeed be differentiated from other ocular pain by the referral character so that one may avoid mislabeling it as undetermined or as a reason to unnecessarily overtreat concomitant ocular diseases.
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Affiliation(s)
| | - Anny Ms Cheng
- Ocular Surface Center.,Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Yao Fu
- Department of Ophthalmology, Ninth People's Hospital, Medical School of Shanghai Jiaotong University, Shanghai, People's Republic of China
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Hong CK, Shim YS, Sim SY, Joo JY, Kwon MA, Kim YB, Chung J. Post-traumatic headache in patients with minimal traumatic intracranial hemorrhage after traumatic brain injury: a retrospective matched case-control study. J Headache Pain 2017; 18:64. [PMID: 28653247 PMCID: PMC5484651 DOI: 10.1186/s10194-017-0774-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 06/14/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND No evidence is available on the risks of neurologically asymptomatic minimal traumatic intracranial hemorrhage (mTIH) in patients with traumatic brain injury (TBI) for post-traumatic headache (PTH). The purpose of this study was to investigate whether mTIH in patients with TBI was associated with PTH and to evaluate its risk factors. METHODS Between September 2009 and December 2014, 1484 patients with TBI were treated at our institution, 57 of whom had mTIH after TBI and were include in this study. We performed propensity score matching to establish a control group among the 823 patients with TBI treated during the same period. Patients with TBI rated their headaches prospectively using a numeric rating scale (NRS). We compared NRS scores between mTIH group (n = 57) and non-mTIH group (n = 57) and evaluated risk factors of moderate-to-severe PTH (NRS ≥ 4) at the 12-month follow-up. RESULTS Moderate-to-severe PTH was reported by 21.9% of patients (29.8% in mTIH group and 14.0% in non-mTIH group B, p = 0.012) at the 12-month follow-up. The mean NRS was higher in mTIH group than in non-mTIH group throughout the follow-up period (95% confidence interval [CI], 0.11 to 1.14; p < 0.05, ANCOVA). Logistic regression analysis showed that post-traumatic seizure (odds ratio, 1.520; 95% CI, 1.128-6.785; p = 0.047) and mTIH (odds ratio, 2.194; 95% CI, 1.285-8.475; p = 0.039) were independently associated with moderate-to-severe PTH at the 12-month follow-up. CONCLUSIONS Moderate-to-severe PTH can be expected after TBI in patients with mTIH and post-traumatic seizure. PTH occurs more frequently in patients with mTIH than in those without mTIH.
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Affiliation(s)
- Chang-Ki Hong
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 06273, Republic of Korea.,Severance Institute for Vascular and Metabolic Research, Yonsei University, Seoul, Republic of Korea
| | - Yu Shik Shim
- Department of Neurosurgery, Inha University School of Medicine and Hospital, Incheon, Republic of Korea
| | - Sook Young Sim
- Department of Neurosurgery, Inje University Seoul Paik Hospital, Seoul, Republic of Korea
| | - Jin-Yang Joo
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Min A Kwon
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Yong Bae Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Joonho Chung
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 06273, Republic of Korea. .,Severance Institute for Vascular and Metabolic Research, Yonsei University, Seoul, Republic of Korea. .,Department of Neurological Surgery, Rush University Medical Center, 1725 W. Harrison St., Professional Building Suite 855, Chicago, IL, 60612, USA.
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Lee YH, Lee KM, Kim HG, Kang SK, Auh QS, Hong JP, Chun YH. Orofacial complex regional pain syndrome: pathophysiologic mechanisms and functional MRI. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:e164-e170. [PMID: 28522185 DOI: 10.1016/j.oooo.2017.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 02/27/2017] [Accepted: 03/03/2017] [Indexed: 01/29/2023]
Abstract
Complex regional pain syndrome (CRPS) is one of the most challenging chronic pain conditions and is characterized by burning pain, allodynia, hyperalgesia, autonomic changes, trophic changes, edema, and functional loss involving mainly the extremities. Until recently, very few reports have been published concerning CRPS involving the orofacial area. We report on a 50-year-old female patient who presented with unbearable pain in all of her teeth and hypersensitivity of the facial skin. She also reported intractable pain in both extremities accompanied by temperature changes and orofacial pain that increased when the other pains were aggravated. In the case of CRPS with trigeminal neuropathic pain, protocols for proper diagnosis and prompt treatment have yet to be established in academia or in the clinical field. We performed functional magnetic resonance imaging for a thorough analysis of the cortical representation of the affected orofacial area immediately before and immediately after isolated light stimulus of the affected hand and foot and concluded that CRPS can be correlated with trigeminal neuropathy in the orofacial area. Furthermore, the patient was treated with carbamazepine administration and stellate ganglion block, which can result in a rapid improvement of pain in the trigeminal region.
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Affiliation(s)
- Yeon-Hee Lee
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, Seoul, Korea
| | - Kyung Mi Lee
- Department of Radiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Korea.
| | - Hyug-Gi Kim
- Department of Radiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Soo-Kyung Kang
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, Seoul, Korea
| | - Q-Schick Auh
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, Seoul, Korea
| | - Jyung-Pyo Hong
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, Seoul, Korea
| | - Yang-Hyun Chun
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, Seoul, Korea
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Seifert T, Sufrinko A, Cowan R, Scott Black W, Watson D, Edwards B, Livingston S, Webster K, Akers D, Lively M, Kontos AP. Comprehensive Headache Experience in Collegiate Student-Athletes: An Initial Report From the NCAA Headache Task Force. Headache 2017; 57:877-886. [DOI: 10.1111/head.13104] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2017] [Indexed: 12/25/2022]
Affiliation(s)
| | | | | | - W. Scott Black
- Department of Family and Community Medicine; University of Kentucky
| | - Dave Watson
- Department of Neurology; West Virginia University
| | - Bill Edwards
- Department of Athletics; Western Kentucky University
| | | | | | - David Akers
- Department of Statistics; University of Kentucky
| | - Mathew Lively
- Department of Medicine and Pediatrics; West Virginia University
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Abstract
OBJECTIVE The purpose of this study was to investigate the association between migraine headache and concussion in athletes. DESIGN Case-control observational study. SETTING A university-associated combined sports neurology and orthopedic sports medicine clinic. PARTICIPANTS A total of 221 male (n = 140) and female (n = 81) athletes aged 12 to 24 years, including 115 concussion cases (52%) and 106 orthopedic controls (48%), were included in this study. INTERVENTIONS Participants completed a one-page questionnaire that recorded their age, sex, reason for visit (concussion vs any other injury), concussion history, and self/immediate family member migraine headache history. MAIN OUTCOME MEASURES The odds of having a previous history of migraine headache were compared in the concussion group versus orthopedic controls. RESULTS Controlling for between-group differences in age and sex, there was a significant positive association between concussion group status and history of migraine headache [adjusted odds ratio (OR), 1.90; 95% confidence interval (CI), 1.03-3.50. P = 0.039]. However, when including a previous concussion history in the statistical model, this relationship failed to reach significance [adjusted OR, 1.68; 95% CI, 0.89-3.16. P = 0.107]. CONCLUSIONS These results suggest that there is an association between migraine headache and concussion in athletes, but the cause-effect nature of this relationship cannot be determined. Migraine headache should be considered a modifying factor when caring for concussed athletes.
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D'Ostilio K, Magis D. Invasive and Non-invasive Electrical Pericranial Nerve Stimulation for the Treatment of Chronic Primary Headaches. Curr Pain Headache Rep 2017; 20:61. [PMID: 27678260 DOI: 10.1007/s11916-016-0589-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Chronic primary headaches are widespread disorders which cause significant quality of life and socioprofessional impairment. Available pharmacological treatments have often a limited efficacy and/or can generate unbearable side effects. Electrical nerve stimulation is a well-known non-destructive method of pain modulation which has been recently applied to headache management. In this review, we summarise recent advances in invasive and non-invasive neurostimulation techniques targeting pericranial structures for the treatment of chronic primary headaches, chiefly migraine and cluster headache: occipital nerve, supraorbital nerve, vagus nerve, and sphenopalatine ganglion stimulations. Invasive neurostimulation therapies have offered a new hope to drug-refractory headache sufferers but are not riskless and should be proposed only to chronic patients who failed to respond to most existing preventives. Non-invasive neurostimulation devices are user-friendly, safe and well tolerated and are thus taking an increasing place in the multidisciplinary therapeutical armamentarium of primary headaches.
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Affiliation(s)
- Kevin D'Ostilio
- Headache Research Unit, University Department of Neurology, CHR Citadelle, Boulevard du 12ème de Ligne 1, 4000, Liège, Belgium
| | - Delphine Magis
- Headache Research Unit, University Department of Neurology, CHR Citadelle, Boulevard du 12ème de Ligne 1, 4000, Liège, Belgium.
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Ahuja V, Thapa D, Dhiman D. Role of superficial cervical plexus block in somatic referred cervical spine pain. Indian J Anaesth 2017; 61:1012-1014. [PMID: 29307909 PMCID: PMC5752771 DOI: 10.4103/ija.ija_196_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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50
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Lyubashina OA, Panteleev SS, Sokolov AY. Inhibitory effect of high-frequency greater occipital nerve electrical stimulation on trigeminovascular nociceptive processing in rats. J Neural Transm (Vienna) 2016; 124:171-183. [PMID: 27677650 DOI: 10.1007/s00702-016-1626-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 09/20/2016] [Indexed: 12/19/2022]
Abstract
Electrical stimulation of the greater occipital nerve (GON) has recently shown promise as an effective non-pharmacological prophylactic therapy for drug-resistant chronic primary headaches, but the neurobiological mechanisms underlying its anticephalgic action are not elucidated. Considering that the spinal trigeminal nucleus (STN) is a key segmental structure playing a prominent role in pathophysiology of headaches, in the present study we evaluated the effects of GON electrical stimulation on ongoing and evoked firing of the dura-sensitive STN neurons. The experiments were carried out on urethane/chloralose-anesthetized, paralyzed and artificially ventilated male Wistar rats. Extracellular recordings were made from 11 neurons within the caudal part of the STN that received convergent input from the ipsilateral facial cutaneous receptive fields, dura mater and GON. In each experiment, five various combinations of the GON stimulation frequency (50, 75, 100 Hz) and intensity (1, 3, 6 V) were tested successively in 10 min interval. At all parameter sets, preconditioning GON stimulation (250 ms train of pulses applied before each recording) produced suppression of both the ongoing activity of the STN neurons and their responses to electrical stimulation of the dura mater. The inhibitory effect depended mostly on the GON stimulation intensity, being maximally pronounced when a stimulus of 6 V was applied. Thus, the GON stimulation-induced inhibition of trigeminovascular nociceptive processing at the level of STN has been demonstrated for the first time. The data obtained can contribute to a deeper understanding of neurophysiological mechanisms underlying the therapeutic efficacy of GON stimulation in primary headaches.
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Affiliation(s)
- Olga A Lyubashina
- Laboratory of Cortico-Visceral Physiology, Pavlov Institute of Physiology of the Russian Academy of Sciences, 6 Nab. Makarova, Saint Petersburg, 199034, Russia. .,Department of Neuropharmacology, Valdman Institute of Pharmacology, First Saint-Petersburg Pavlov State Medical University, 6/8 Lev Tolstoy Street, Saint Petersburg, 197022, Russia.
| | - Sergey S Panteleev
- Laboratory of Cortico-Visceral Physiology, Pavlov Institute of Physiology of the Russian Academy of Sciences, 6 Nab. Makarova, Saint Petersburg, 199034, Russia.,Department of Neuropharmacology, Valdman Institute of Pharmacology, First Saint-Petersburg Pavlov State Medical University, 6/8 Lev Tolstoy Street, Saint Petersburg, 197022, Russia
| | - Alexey Y Sokolov
- Laboratory of Cortico-Visceral Physiology, Pavlov Institute of Physiology of the Russian Academy of Sciences, 6 Nab. Makarova, Saint Petersburg, 199034, Russia.,Department of Neuropharmacology, Valdman Institute of Pharmacology, First Saint-Petersburg Pavlov State Medical University, 6/8 Lev Tolstoy Street, Saint Petersburg, 197022, Russia
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