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Proserpio P, Terzaghi M, Manni R, Nobili L. Drugs Used in Parasomnia. Sleep Med Clin 2022; 17:367-378. [PMID: 36150800 DOI: 10.1016/j.jsmc.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Parasomnias, especially disorders of arousal during childhood, are often relatively benign and transitory and do not usually require a pharmacologic therapy. A relevant aspect in both nonrapid eye movement and rapid eye movement parasomnia treatment is to prevent sleep-related injuries by maintaining a safe environment. Physicians should always evaluate the possible presence of favoring and precipitating factors (sleep disorders and drugs). A pharmacologic treatment may be indicated in case of frequent, troublesome, or particularly dangerous events. The aim of this article is to review current available evidence on pharmacologic treatment of different forms of parasomnia.
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Affiliation(s)
- Paola Proserpio
- Sleep Medicine Center, Department of Neuroscience, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milano, Italy.
| | - Michele Terzaghi
- Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
| | - Raffaele Manni
- Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
| | - Lino Nobili
- Sleep Medicine Center, Department of Neuroscience, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milano, Italy; Department of Neuroscience (DINOGMI), University of Genoa, Child Neuropsychiatry Unit, IRCCS Istituto G. Gaslini, Genoa 5-16147, Italy
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Cabral G, Saraiva M, Serôdio M, Serrazina F, Salavisa M, Fernandes M, Meira B, Ventura R, Pinho A, Magriço M, Caetano A, Baptista MV. Clinical pattern and response to treatment of primary stabbing headache: Retrospective case series study from a Portuguese tertiary hospital. Headache 2022; 62:1053-1058. [DOI: 10.1111/head.14377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Gonçalo Cabral
- Departamento de Neurologia, Hospital Egas Moniz Centro Hospitalar Lisboa Ocidental Lisbon Portugal
| | - Marlene Saraiva
- Departamento de Neurologia, Hospital Egas Moniz Centro Hospitalar Lisboa Ocidental Lisbon Portugal
| | - Miguel Serôdio
- Departamento de Neurologia, Hospital Egas Moniz Centro Hospitalar Lisboa Ocidental Lisbon Portugal
| | - Filipa Serrazina
- Departamento de Neurologia, Hospital Egas Moniz Centro Hospitalar Lisboa Ocidental Lisbon Portugal
| | - Manuel Salavisa
- Departamento de Neurologia, Hospital Egas Moniz Centro Hospitalar Lisboa Ocidental Lisbon Portugal
| | - Marco Fernandes
- Departamento de Neurologia, Hospital Egas Moniz Centro Hospitalar Lisboa Ocidental Lisbon Portugal
| | - Bruna Meira
- Departamento de Neurologia, Hospital Egas Moniz Centro Hospitalar Lisboa Ocidental Lisbon Portugal
| | - Rita Ventura
- Departamento de Neurologia, Hospital Egas Moniz Centro Hospitalar Lisboa Ocidental Lisbon Portugal
| | - André Pinho
- Departamento de Neurologia, Hospital Egas Moniz Centro Hospitalar Lisboa Ocidental Lisbon Portugal
| | - Marta Magriço
- Departamento de Neurologia, Hospital Egas Moniz Centro Hospitalar Lisboa Ocidental Lisbon Portugal
| | - André Caetano
- Departamento de Neurologia, Hospital Egas Moniz Centro Hospitalar Lisboa Ocidental Lisbon Portugal
- CEDOC ‐ Nova Medical School Universidade Nova de Lisboa Lisbon Portugal
| | - Miguel Viana Baptista
- Departamento de Neurologia, Hospital Egas Moniz Centro Hospitalar Lisboa Ocidental Lisbon Portugal
- CEDOC ‐ Nova Medical School Universidade Nova de Lisboa Lisbon Portugal
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Narbut AM, Tsenteradze SL, Poluektov MG. [Exploding head syndrome]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:111-115. [PMID: 34693698 DOI: 10.17116/jnevro2021121091111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Exploding head syndrome (EHS) is a paroxysmal sensory parasomnia characterized by the sensation of a loud noise or «explosion in the head» during the wake-sleep/sleep-wake cycle. The most popular explanation for this condition is the decrease of reticular formation activity during the transition between wakefulness and sleep. The authors present a review of literature on the diagnosis and treatment of EHS and clinical observations of patients with classical signs.
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Affiliation(s)
- A M Narbut
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - S L Tsenteradze
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - M G Poluektov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Abstract
Patient education and behavioral management represent the first treatment approaches to the patient with parasomnia, especially in case of disorders of arousal (DOA). A pharmacologic treatment of DOA may be useful when episodes are frequent and persist despite resolution of predisposing factors, are associated with a high risk of injury, or cause significant impairment, such as excessive sleepiness. Approved drugs for DOA are still lacking. The most commonly used medications are benzodiazepines and antidepressants. The pharmacologic treatment of rapid eye movement sleep behavior disorder is symptomatic, and the most commonly used drugs are clonazepam and melatonin.
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Affiliation(s)
- Paola Proserpio
- Department of Neuroscience, Centre of Sleep Medicine, Centre for Epilepsy Surgery, Niguarda Hospital, Piazza Ospedale Maggiore, Milan 3-20162, Italy
| | - Michele Terzaghi
- Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Via Mondino, Pavia 2-27100, Italy
| | - Raffaele Manni
- Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Via Mondino, Pavia 2-27100, Italy
| | - Lino Nobili
- Department of Neuroscience, Centre of Sleep Medicine, Centre for Epilepsy Surgery, Niguarda Hospital, Piazza Ospedale Maggiore, Milan 3-20162, Italy; Department of Neuroscience (DINOGMI), University of Genoa, Child neuropsychiatry, Gaslini Institute, Via Gerolamo Gaslini, Genoa 5-16147, Italy.
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Gillis K, Ng MC. Exploding Head Syndrome in the Epilepsy Monitoring Unit: Case Report and Literature Review. Neurodiagn J 2019. [PMID: 28622122 DOI: 10.1080/21646821.2017.1302264] [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] [Indexed: 10/19/2022]
Abstract
Diagnosis of paroxysmal events in epilepsy patients is often made through video-telemetry electroencephalography in the epilepsy monitoring unit. This case report describes the first-ever diagnosis of exploding head syndrome in a patient with longstanding epilepsy and novel nocturnal events. In this report, we describe the presentation of exploding head syndrome and its prevalence and risk factors. In addition, the prevalence of newly diagnosed sleep disorders through video-telemetry electroencephalography in the epilepsy monitoring unit is briefly reviewed. This report also illustrates the novel use of clobazam for the treatment of exploding head syndrome.
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Affiliation(s)
- Kara Gillis
- a Adult Neurodiagnostics, Health Sciences Centre , Winnipeg , Canada
| | - Marcus C Ng
- b Section of Neurology, Department of Internal Medicine , University of Manitoba , Winnipeg , Canada
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Abstract
PURPOSE OF REVIEW Unusual headache disorders are less commonly discussed and may be misdiagnosed. These headache disorders frequently have a benign natural history; however, without reassurance, therapeutic education, and treatment, they can negatively affect the health and function of patients. RECENT FINDINGS This article reviews the clinical features, diagnosis, workup, and proposed treatments for several unusual headache disorders including primary cough headache, primary headache associated with sexual activity, primary exercise headache, cold-stimulus headache, primary stabbing headache, nummular headache, hypnic headache, and headache attributed to travel in space. Exploding head syndrome is also discussed, which is a sleep disorder commonly confused with a headache disorder. SUMMARY Unusual headache disorders are usually benign, yet without the correct diagnosis can be very worrisome for many patients. Through greater awareness of these headache disorders, neurologists can evaluate and effectively manage unusual headache disorders, which offers significant benefits to patients and practice satisfaction to neurologists.
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Manni R, Toscano G, Terzaghi M. Therapeutic Symptomatic Strategies in the Parasomnias. Curr Treat Options Neurol 2018; 20:26. [DOI: 10.1007/s11940-018-0508-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
Primary stabbing headache (PSH) is a short-lasting but troublesome headache disorder which has been known for several decades. We surveyed and registered consecutive patients with PSH in a headache clinic in Taiwan. A total of 80 patients (24 M/56 F, 53.2 ± 16.2 years) were enrolled in our study. Migraine was reported in 20 (25%) patients and was less common in those with PSH onset at >50 years than those with onset at <50 years (14% vs. 38%, P = 0.02). The headache was unilateral in 59% of the patients and always in a fixed area in 36%. The head pain frequently involved extratrigeminal regions (70%) and in 30 patients (38%) was accompanied by jolts, i.e. head or body movements. Indomethacin was effective (74%) in patients who received it. Our study showed primary stabbing headache was a common and easily treated headache disorder in headache clinic. However, 70% of our patients could not fulfil criterion A ‘exclusively or predominantly in the distribution of the first division of the trigeminal nerve’ and 15% could not fulfil criterion C ‘no accompanying symptoms’ of the International Classification of Headache Disorders-II criteria proposed for PSH.
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Affiliation(s)
- J-L Fuh
- Neurological Institute, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan
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Abstract
Indomethacin-responsive headaches are a heterogeneous group of primary headache disorders distinguished by their swift and often absolute response to indomethacin. The epidemiology of these conditions is incompletely defined. Traditionally, indomethacin-responsive headaches include a subset of trigeminal autonomic cephalalgias (paroxysmal hemicrania and hemicrania continua), Valsalva-induced headaches (cough headache, exercise headache, and sex headache), primary stabbing headache, and hypnic headache. These headache syndromes differ in extent of response to indomethacin, clinical features, and differential diagnoses. Neuroimaging is recommended to investigate for various organic causes that may mimic these headaches. Case reports of other primary headache disorders that also respond to indomethacin, such as cluster headache, nummular headache, and ophthalmoplegic migraine, have been described. These "novel" indomethacin-responsive headaches beg the question of what headache characteristics are required to qualify a headache as an indomethacin-responsive headache. Furthermore, they challenge the concept of using a therapeutic intervention as a diagnostic criterion.
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Exploding head syndrome. Sleep Med Rev 2014; 18:489-93. [DOI: 10.1016/j.smrv.2014.03.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 02/17/2014] [Accepted: 03/04/2014] [Indexed: 11/22/2022]
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Frese A, Summ O, Evers S. Exploding head syndrome: Six new cases and review of the literature. Cephalalgia 2014; 34:823-7. [DOI: 10.1177/0333102414536059] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Exploding head syndrome (EHS) is characterized by attacks of a sudden noise or explosive feeling experienced in the head occurring during the transition from wake to sleep or from sleep to wake. Methods We present six new cases extending the clinical experience with the syndrome. We also reviewed all available cases from the scientific literature and evaluated the typical features of EHS. Results The female to male ratio is 1.5 to 1. The median age at onset is 54. In average, one attack per day to one attack per week occurs. Some patients suffer from several attacks per night. In about half of all patients, a chronic time course can be observed but episodic or sporadic occurrence is also common. The most frequent accompanying symptoms beside the noise are fear and flashes of light. Polysomnographic studies do not reveal any specific sleep pattern associated with EHS. Tricyclic antidepressants are helpful in some patients. However, most patients do not need treatment because of the benign nature of the syndrome. Conclusion EHS is a well‐defined disease entity with a benign nature.
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Affiliation(s)
- Achim Frese
- Akademie für Manuelle Medizin, University of Münster, Germany
| | - Oliver Summ
- Department of Neurology, University of Münster, Germany
| | - Stefan Evers
- Department of Neurology, Krankenhaus Lindenbrunn, Germany
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Feketeova E, Buskova J, Skorvanek M, Mudra J, Gdovinova Z. Exploding head syndrome – a rare parasomnia or a dissociative episode? Sleep Med 2014; 15:728-30. [PMID: 24831250 DOI: 10.1016/j.sleep.2014.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 01/14/2014] [Accepted: 02/17/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Eva Feketeova
- Faculty of Medicine, P. J. Safarik University and L. Pasteur University Hospital, Kosice, Slovak Republic.
| | - Jitka Buskova
- 1st Faculty of Medicine and General Teaching Hospital, Charles University, Praha, Czech Republic
| | - Matej Skorvanek
- Faculty of Medicine, P. J. Safarik University and L. Pasteur University Hospital, Kosice, Slovak Republic
| | - Jana Mudra
- L. Pasteur University Hospital, Kosice, Slovak Republic
| | - Zuzana Gdovinova
- Faculty of Medicine, P. J. Safarik University and L. Pasteur University Hospital, Kosice, Slovak Republic
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Abstract
INTRODUCTION Exploding head syndrome (EHS) is a rare parasomnia in which affected individuals awaken from sleep with the sensation of a loud bang. The etiology is unknown, but other conditions including primary and secondary headache disorders and nocturnal seizures need to be excluded. CASE PRESENTATION A 57-year-old Indian male presented with four separate episodes of awakening from sleep at night after hearing a flashing sound on the right side of his head over the last 2 years. These events were described 'as if there are explosions in my head'. A neurologic examination, imaging studies, and a polysomnogram ensued, and the results led to the diagnosis of EHS. CONCLUSION EHS is a benign, uncommon, predominately nocturnal disorder that is self-limited. No treatment is generally required. Reassurance to the patient is often all that is needed.
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Affiliation(s)
- Gautam Ganguly
- Neurological Consultants Medical Group, Los Angeles County Medical Center, University of Southern California - Keck School of Medicine, Los Angeles, Calif., USA
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Affiliation(s)
- Luiz P. Queiroz
- Department of Neurology; Universidade Federal de Santa Catarina; Florianópolis Brazil
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Abstract
Primary stabbing "ice-pick" headache is rarely reported in children. It is characterized by transient, sharp stabbing pain that occurs within a localized area of the scalp for seconds. Five children were diagnosed according to the International Classification of Headache Disorders Diagnostic Criteria, Second Edition. Ages at diagnosis ranged from 6-16 years (mean age, 9.8 years), with signs lasting for 3-12 months (mean, 6.5 months) before assessment. All children presented with recurrent daily to monthly headaches that were very brief, lasting for seconds. The headache was orbital in one child, temporal in one child, and occipital in three children. Three children manifested other associated migraine headache types, and two had a positive family history of migraine. Amitriptyline was prescribed to two patients because of headache frequency and severity. The signs gradually subsided in all patients during follow-up of 3 months to 5 years (mean, 27 months). Primary stabbing headache may occasionally occur in children with features different from those encountered in adults. The headache is less frequent and often occipital in location. Its signs respond well to amitriptyline. However, larger prospective pediatric studies are needed to describe this syndrome further.
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Genetics of Parasomnias. Sleep Med Clin 2011. [DOI: 10.1016/j.jsmc.2011.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Evers S, Goadsby P, Jensen R, May A, Pascual J, Sixt G. Treatment of miscellaneous idiopathic headache disorders (Group 4 of the IHS classification)--report of an EFNS task force. Eur J Neurol 2011; 18:803-12. [PMID: 21435110 DOI: 10.1111/j.1468-1331.2011.03389.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Certain miscellaneous idiopathic headache disorders, which are regarded as entities, are grouped in Chapter 4 of the International Classification of Headache Disorders. Recent epidemiological research suggests that these headache disorders are underdiagnosed. OBJECTIVES To give expert recommendations for the different drug and non-drug treatment procedures of these different headache disorders based on a literature search and on consensus of an expert panel. METHODS All available medical reference systems were screened for all kinds of clinical studies on these headache disorders. The findings in these studies were evaluated according to the recommendations of the EFNS resulting in level A, B or C recommendations and good practice points. RECOMMENDATIONS For all headache disorders, acute and prophylactic drug treatment is recommended based on case series and on expert consensus. Furthermore, recommendations for the differential diagnoses are given because these headache disorders can also present with a symptomatic form. The most effective drug for the majority of these headache disorders is indomethacin, mostly applied as long-term or short-term prophylaxis.
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Affiliation(s)
- S Evers
- Department of Neurology, University of Münster, Münster, Germany.
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Abstract
Parasomnias are undesirable physical or experiential events that occur in and around sleep. Treatments include reassurance in some cases, various forms of cognitive-behavioral therapy (CBT), and pharmacologic agents. Cognitive restructuring, imagery rehearsal, relaxation, hypnosis, desensitization, and anticipatory awakenings are some of the common CBT and nonpharmacologic interventions. Medications that are used belong to a wide variety of pharmacologic classes, such as alpha-blockers (prazosin), tricyclic antidepressants (imipramine and clomipramine), selective serotonin reuptake inhibitors, benzodiazepines (diazepam and clonazepam), anticonvulsants (topiramate and gabapentin), desmopressin acetate, and anticholinergic agents (oxybutynin and tolterodine). Data on efficacy are only available from randomized trials on CBT and prazosin for nightmares and on pharmacologic and alarm therapy for enuresis. No large-scale randomized trials are available to assess the efficacy of the other treatments, and most data come from anecdotal case reports, case series, or small open-label trials.
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Affiliation(s)
- Hrayr Attarian
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, Maguire Building, Room 2700, 2160 South First Avenue, Maywood, IL 60153, USA.
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Piovesan EJ, Teive HG, Kowacs PA, Silva LLD, Werneck LC. Botulinum neurotoxin type-A for primary stabbing headache: an open study. ARQUIVOS DE NEURO-PSIQUIATRIA 2010; 68:212-5. [DOI: 10.1590/s0004-282x2010000200011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Accepted: 12/03/2009] [Indexed: 11/22/2022]
Abstract
Primary stabbing headache is an ultra-short headache, associated with primary headaches, more prevalent in women and with a poor response to therapy. The effect of botulinum neurotoxin type-A (BoNTA) on primary stabbing headache was investigated in 24 patients. Three patients showed complete remission. Nineteen patients showed a decrease in their primary stabbing headaches that started in the second week, and that was sustained during approximately 63 days. In two patients BoNTA showed no therapeutic effect. The BoNTA seems to be an excellent therapeutic option for primary stabbing headache.
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Ferrante E, Rossi P, Tassorelli C, Lisotto C, Nappi G. Focus on therapy of primary stabbing headache. J Headache Pain 2010; 11:157-60. [PMID: 20119679 PMCID: PMC3452291 DOI: 10.1007/s10194-010-0189-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 01/07/2010] [Indexed: 11/28/2022] Open
Abstract
Primary stabbing headache (PSH) is a short-lasting but troublesome headache disorder, which has been known for several decades. The head pain occurs as a single stab or as a series of stabs generally involving the area supplied by the first division of trigeminal nerve. Stabs last for approximately a few seconds, occurring and recurring from once to multiple times per day in an irregular pattern. For the diagnosis of PSH, it is mandatory that any other underlying disorder is ruled out. Indomethacin represents the principal option in the treatment of PSH, despite therapeutic failure in up to 35% of the cases. Recent reports showed that cyclooxygenase-2 (COX-2) inhibitors, gabapentin, nifedipine, paracetamol and melatonin may also be effective. In this report, we focus on the therapy of PSH summarizing the information collected from a systematic analysis of the international literature over the period 1980–2009.
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Affiliation(s)
- Enrico Ferrante
- Department of Neuroscience, Niguarda Ca' Granda Hospital, Milan, Italy
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27
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The “Other” Headaches: Primary Cough, Exertion, Sex, and Primary Stabbing Headaches. Curr Pain Headache Rep 2010; 14:41-6. [DOI: 10.1007/s11916-009-0083-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Jacome DE. Jactatio extra-capitis and migraine suppression. J Headache Pain 2009; 10:129-31. [PMID: 19153650 PMCID: PMC3451644 DOI: 10.1007/s10194-008-0092-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2008] [Accepted: 12/14/2008] [Indexed: 11/30/2022] Open
Abstract
Sleep often terminates migraine headaches, and sleep disorders occur with greater prevalence in individuals with chronic or recurrent headaches. Rhythmic head, limb or body movements are common in children before falling asleep, but they very rarely persist into adolescence and adulthood, or appear de novo later in life as sleep-related rhythmic movement disorders. A 22-year-old female with migraine without aura and history of early childhood pre-dormital body rocking (jactatio) discovered that unilateral slow rhythmic movements of her right foot greatly facilitated falling sound asleep while reclining. Sleep served every time to terminate her migraine attack. Rhythmic movements may serve on occasion as a therapeutic hypnotic maneuver in migraine sufferers.
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Affiliation(s)
- Daniel E Jacome
- Dartmouth Hitchcock Medical Center, Medicine (Neurology), Lebanon, NH, USA.
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30
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Affiliation(s)
- A Chakravarty
- Department of Neurology, Vivekananda Institute of Medical Sciences, Calcutta, India
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31
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O'Connor MB, Murphy E, Phelan MJ, Regan MJ. Primary stabbing headache can be responsive to etoricoxib, a selective COX-2 inhibitor. Eur J Neurol 2008; 15:e1. [PMID: 18171381 DOI: 10.1111/j.1468-1331.2007.01962.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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O'Connor MB, Murphy E, Phelan MJ, Regan MJ. The use of etoricoxib to treat an idiopathic stabbing headache: a case report. J Med Case Rep 2007; 1:100. [PMID: 17883876 PMCID: PMC2075504 DOI: 10.1186/1752-1947-1-100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Accepted: 09/21/2007] [Indexed: 11/18/2022] Open
Abstract
According to the International Headache Society, idiopathic stabbing headache (ISH), an indomethacin-responsive headache syndrome, is a paroxysmal disorder of short duration manifested as head pain occurring as a single stab or a series of stabs involving the area supplied in the distribution of the first division of the trigeminal nerve. Stabs last for approximately a few seconds, occurring and recurring from once to multiple times per day in an irregular frequency, with no underlying attributable disorder.Previously indomethacin was the principle treatment option for ISH, despite therapeutic failure in up to 35% of cases, until reports showed gabapentin, melatonin and selective cyclo-oxygenase-2 (COX-2) inhibitors were also possibly effective. In this report we present the full case report of an 88 year old lady with a history of untreated ISH where etoricoxib, a selective COX-2 inhibitor, was used to effectively treat her ISH.
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Affiliation(s)
- Mortimer B O'Connor
- Department of Medicine, South Infirmary – Victoria University Hospital, Old Blackrock Road, Cork, Ireland
| | - Elizabeth Murphy
- Department of Medicine, South Infirmary – Victoria University Hospital, Old Blackrock Road, Cork, Ireland
| | - Mark J Phelan
- Arthritis and Osteoporosis Centre, Department of Rheumatology, South Infirmary, Victoria University Hospital, Old Blackrock Road, Cork, Ireland
| | - Michael J Regan
- Arthritis and Osteoporosis Centre, Department of Rheumatology, South Infirmary, Victoria University Hospital, Old Blackrock Road, Cork, Ireland
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Abstract
Parasomnias are unpleasant or undesirable behavioral or experiential phenomena that occur during sleep. Once believed unitary phenomena related to psychiatric disorders, it is now clear that parasomnias result from several different phenomena and usually are not related to psychiatric conditions. Parasomnias are categorized as primary (disorders of the sleep states) and secondary (disorders of other organ systems that manifest themselves during sleep). Primary sleep parasomnias can be classified according to the sleep state of origin: rapid eye movement sleep, non-rapid eye movement sleep, and miscellaneous (those not respecting sleep state). Secondary sleep parasomnias are classified by the organ system involved.
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Affiliation(s)
- Mark W Mahowald
- Minnesota Regional Sleep Disorders Center, Minneapolis, MN 55415, USA.
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Abstract
Idiopathic stabbing headache (ISH) is defined as the occurrence of short-lasting, painful jabs, restricted to the ophthalmic division of the trigeminal nerve. It is closely related to other forms of headache (such as migraine and tension-type headache) and has been reported among all age groups, including children and adolescents. As pathogenic mechanisms of the disease remain unclear, management decisions are empirical and limited to few options. Classically, indomethacin has been considered the first option, but therapeutic failure occurs in up to 35% of cases. In this setting, we report four patients with young-onset indomethacin-resistant ISH which had good responses to gabapentin and discuss the use of this drug in the presenting situation.
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Affiliation(s)
- M C França
- Headache Clinic, Department of Neurology, Faculty of Medical Sciences, Campinas State University (UNICAMP), Sao Paulo, Brazil
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36
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Wheeler SD. Miscellaneous primary headache. Prim Care 2004; 31:331-51, vii. [PMID: 15172510 DOI: 10.1016/j.pop.2004.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There are many types of miscellaneous primary headache, but two groups have been selected for discussion: trigeminal autonomic cephalalgias (TAC) and cephalalgias without autonomic dysfunction(CWAD). TAC are strictly unilateral and CWAD are usually bilateral. Sudden onset and relatively short duration characterize most,but some are frightening to patient and doctor alike. One, thunderclap headache, is symptomatic until proven otherwise. Although the others are rarely symptomatic, therapy can be difficult until it is recognized that diagnosis often predicts treatment.
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Affiliation(s)
- Steve D Wheeler
- Ryan Wheeler Headache Treatment Center, 20601 Old Cutler Road, Miami, FL 33189, USA.
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Abstract
Patients must be cognizant of the time course of the cluster headache periods to optimally tailor their therapy. Steroids provide the fastest onset of prophylactic effect. Once steroids are initiated, it remains difficult to wean patients off of them, and that is why it is always recommended to associate another prophylactic agent from the onset with the steroids. All triptans can be considered; however, only injectable sumatriptan and zolmitriptan have been the subject of controlled studies, and the former remains the gold standard because of its speed of action. Lithium, although not a first-line therapy, remains mainly efficacious for the chronic form of cluster headache. There does not seem a significant tendency for analgesic rebound-withdrawal headache with cluster headache compared with migraine. Scientific studies of the treatment of cluster headache are inherently difficult because of the rarity of the syndrome, the short duration of attacks, and the relatively short duration of the cluster period, along with the presence of spontaneous remissions. Moreover, still a significant proportion of the available evidence on this subject is uncontrolled. Active, rather than placebo, control individuals are recommended. As far as surgical procedures are concerned, although only recently introduced and less documented, gamma-knife radiosurgery should be preferred to the procedures associated with craniotomy, which are inherently associated with a higher complication potential risk.
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Affiliation(s)
- Marc E. Lenaerts
- Department of Neurology, Headache Section, University of Oklahoma Health Sciences Center, 1100 Lindsay Avenue, Oklahoma City, OK 73104, USA.
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