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Piovesan EJ, Utiumi MAT, Grossi DB. Cervicogenic headache - How to recognize and treat. Best Pract Res Clin Rheumatol 2024:101931. [PMID: 38388233 DOI: 10.1016/j.berh.2024.101931] [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: 01/15/2024] [Accepted: 01/20/2024] [Indexed: 02/24/2024]
Abstract
Cervicogenic headache, described almost 100 years ago, only had its clinical awakening at the end of the century with the work of Professor Sjaastad. Its classic definition is the induction of trigeminal symptoms from cervical disorders, thanks to trigeminocervical convergence mechanisms. For this reason, it can manifest several features typical of migraine, leading to diagnostic errors. Classically, subjects complain of fixed unilateral headaches, with cervical onset and trigeminal irradiation, associated with reduced neck mobility and flexion strength. The headache is mild to moderate, described as pulsatile or compressive, accompanied by nausea, vomiting, photophobia, phonophobia, and may present autonomic symptoms and dizziness. The pain duration varies from one day to weeks, and its frequency is unpredictable. A history of whiplash injury is common. The differential diagnosis encompasses migraine and tension-type headache. Management includes physiotherapy rehabilitation, anesthetic blocks, and selectively surgical procedures. In this article, all these aspects were extensively covered.
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Affiliation(s)
- Elcio Juliato Piovesan
- Serviço de Neurologia, Departamento de Clínica Médica, Complexo do Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil; Centro de Cefaleia, Clínica de Neurologia São José, São José dos Pinhais, PR, Brazil.
| | - Marco Antonio Takashi Utiumi
- Serviço de Neurologia, Departamento de Clínica Médica, Complexo do Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil; Centro de Cefaleia, Clínica de Neurologia São José, São José dos Pinhais, PR, Brazil
| | - Débora Bevilaqua Grossi
- Departamento de Ciências da Saúde, Escola de Medicina, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Paemeleire K, Vandenbussche N, Stark R. Migraine without aura. HANDBOOK OF CLINICAL NEUROLOGY 2023; 198:151-167. [PMID: 38043959 DOI: 10.1016/b978-0-12-823356-6.00007-x] [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
Migraine without aura is the commonest form of migraine in both children and adults. The diagnosis is made by applying the International Classification of Headache Disorders Third Edition subsection for migraine without aura (ICHD-3 subsection 1.1). Attacks in patients with migraine without aura are characterized by their polyphasic presentation (prodrome, headache phase, postdromal phase). The symptomatology of attacks is diverse and heterogeneous, with most common symptoms being photophobia, phonophobia, nausea, vomiting, and aggravation of pain by movement. The clinician and researcher who wants to learn about migraine without aura needs to be able to apply the ICHD-3 criteria with its specific symptomatology to make a correct diagnosis, but also needs to be aware about the plethora of symptoms patients may experience. In this chapter, the reader will explore the clinical phenotypical features of migraine without aura.
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Affiliation(s)
- Koen Paemeleire
- Department of Neurology, Ghent University Hospital, Ghent, Belgium.
| | | | - Richard Stark
- Department of Neurology, Alfred Hospital, Monash University, Melbourne, VIC, Australia; Department of Neurosciences, Monash University, Melbourne, VIC, Australia
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Crespi J, Bratbak D, Dodick DW, Matharu M, Solheim O, Gulati S, Berntsen EM, Tronvik E. Open‐Label, Multi‐Dose, Pilot Safety Study of Injection of OnabotulinumtoxinA Toward the Otic Ganglion for the Treatment of Intractable Chronic Cluster Headache. Headache 2020; 60:1632-1643. [DOI: 10.1111/head.13889] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Joan Crespi
- Department of Neurology St. Olav's University Hospital Trondheim Norway
- Department of Neuromedicine and Movement Science Norwegian University of Science and Technology Trondheim Norway
| | - Daniel Bratbak
- Department of Neuromedicine and Movement Science Norwegian University of Science and Technology Trondheim Norway
- Department of Neurosurgery St. Olav's University Hospital Trondheim Norway
| | - David W. Dodick
- Department of Neuromedicine and Movement Science Norwegian University of Science and Technology Trondheim Norway
- Department of Neurology Mayo Clinic Phoenix AZ USA
| | - Manjit Matharu
- UCL Queen Square Institute of Neurology The National Hospital of Neurology and Neurosurgery London UK
| | - Ole Solheim
- Department of Neuromedicine and Movement Science Norwegian University of Science and Technology Trondheim Norway
- Department of Neurosurgery St. Olav's University Hospital Trondheim Norway
| | - Sasha Gulati
- Department of Neuromedicine and Movement Science Norwegian University of Science and Technology Trondheim Norway
- Department of Neurosurgery St. Olav's University Hospital Trondheim Norway
| | - Erik Magnus Berntsen
- Department of Radiology and Nuclear Medicine St. Olav's University Hospital Trondheim Norway
- Department of Circulation and Medical Imaging Faculty of Medicine Norwegian University of Science and Technology Trondheim Norway
| | - Erling Tronvik
- Department of Neurology St. Olav's University Hospital Trondheim Norway
- Department of Neuromedicine and Movement Science Norwegian University of Science and Technology Trondheim Norway
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Scalp Block: Tool for Diagnosis in Postoperative Headache of Unknown Origin. J Neurosurg Anesthesiol 2017; 30:381-382. [PMID: 28723701 DOI: 10.1097/ana.0000000000000444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ahmed MAS, Grossman S, Rafique B, Momoh Ojewuyi A. Site locked headaches in paediatric patients do not require routine brain imaging and rarely have a serious aetiology. Acta Paediatr 2017; 106:791-795. [PMID: 28276083 DOI: 10.1111/apa.13743] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 10/20/2016] [Accepted: 01/09/2017] [Indexed: 01/03/2023]
Abstract
AIM The main aim of this study was to examine the aetiology and the yield of brain imaging of children with site locked headaches (SLH). METHODS This study was carried out at Queen's University Hospital, Essex, UK, from August 2011 to August 2015 and focused on patients who were at least five years of age, had experienced at least five SLH attacks and had a normal neurological examination. Bilateral or alternating unilateral headaches were excluded. Data were collected prospectively, and the headache diagnosis was based on the International Classification of Headache Disorders. RESULTS We identified 292 eligible patients (60% female) aged 5.1-17 years: 177 with unilateral SLH, 104 with occipital SLH and 11 with vertex SLH. Anterior headaches were the most frequent (n = 133), and the diagnoses included migraine (n = 192), tension type headaches (n = 30) and medication-overuse headaches (n = 22). The headache was unspecified in 43 cases. Magnetic resonance imaging was normal in 96% of the 283/292 scanned or showed a nonspecific, nonsignificant abnormality in 4%. CONCLUSION Site locked headaches were most likely to be caused by primary headaches, particularly migraine. An SLH without abnormal neurological findings is unlikely to have an underlying sinister aetiology, and routine brain imaging is not required in such cases.
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Affiliation(s)
- MAS Ahmed
- Paediatric Department; Queen's University Hospital; Essex UK
| | - S Grossman
- Department of Cardiology; Great Ormond Street Hospital for Sick Children; London UK
| | - B Rafique
- Paediatric Department; Queen's University Hospital; Essex UK
| | - A Momoh Ojewuyi
- Paediatric Department; Queen's University Hospital; Essex UK
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Prakash S, Rathore C. Side-locked headaches: an algorithm-based approach. J Headache Pain 2016; 17:95. [PMID: 27770404 PMCID: PMC5074931 DOI: 10.1186/s10194-016-0687-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 10/04/2016] [Indexed: 01/03/2023] Open
Abstract
The differential diagnosis of strictly unilateral hemicranial pain includes a large number of primary and secondary headaches and cranial neuropathies. It may arise from both intracranial and extracranial structures such as cranium, neck, vessels, eyes, ears, nose, sinuses, teeth, mouth, and the other facial or cervical structure. Available data suggest that about two-third patients with side-locked headache visiting neurology or headache clinics have primary headaches. Other one-third will have either secondary headaches or neuralgias. Many of these hemicranial pain syndromes have overlapping presentations. Primary headache disorders may spread to involve the face and / or neck. Even various intracranial and extracranial pathologies may have similar overlapping presentations. Patients may present to a variety of clinicians, including headache experts, dentists, otolaryngologists, ophthalmologist, psychiatrists, and physiotherapists. Unfortunately, there is not uniform approach for such patients and diagnostic ambiguity is frequently encountered in clinical practice. Herein, we review the differential diagnoses of side-locked headaches and provide an algorithm based approach for patients presenting with side-locked headaches. Side-locked headache is itself a red flag. So, the first priority should be to rule out secondary headaches. A comprehensive history and thorough examinations will help one to formulate an algorithm to rule out or confirm secondary side-locked headaches. The diagnoses of most secondary side-locked headaches are largely investigations dependent. Therefore, each suspected secondary headache should be subjected for appropriate investigations or referral. The diagnostic approach of primary side-locked headache starts once one rule out all the possible secondary headaches. We have discussed an algorithmic approach for both secondary and primary side-locked headaches.
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Affiliation(s)
- Sanjay Prakash
- Department of Neurology, Smt. B. K. Shah Medical institute and research Centre, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara, 391760, Gujarat, India. .,Department of Neurology, Smt B. K. Shah Medical institute and research Centre, Piperia, Waghodia, Vadodara, 391760, Gujarat, India.
| | - Chaturbhuj Rathore
- Department of Neurology, Smt. B. K. Shah Medical institute and research Centre, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara, 391760, Gujarat, India
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Prakash S, Rathore C, Makwana P, Dave A. A Cross-Sectional Clinic-Based Study in Patients With Side-Locked Unilateral Headache and Facial Pain. Headache 2016; 56:1183-93. [PMID: 27256162 DOI: 10.1111/head.12842] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To undertake the epidemiological evaluation of the patients presenting with side-locked headache and facial pain in a tertiary neurology outpatient clinic. BACKGROUND Side-locked unilateral headache and facial pain include a large number of primary and secondary headaches and cranial neuropathies. A diagnostic approach for the patients presenting with strictly unilateral headaches is important as many of these headache disorders respond to a highly selective drug. Epidemiological data may guide us to formulate a proper approach for such patients. However, the literature is sparse on strictly unilateral headache and facial pain. METHODS We prospectively recruited 307 consecutive adult patients (>18 years) with side-locked headache and facial pain presenting to a neurology outpatient clinic between July 2014 and December 2015. All patients were subjected to MRI brain and other investigations to find out the different secondary causes. The diagnosis was carried out by at least two headache specialists together. All patients were classified according to the International Classification of Headache Disorder-third edition (ICHD-3β). RESULTS The mean age at the time of examination was 42.4 ± 13.6 years (range 18-80 years). Forty-eight percent of patients were male. Strictly unilateral headaches accounted for 19.2% of the total headaches seen in the clinic. Headaches were classified as primary in 58%, secondary in 18%, and cranial neuropathies and other facial pain in 16% patients. Five percent of patients could not be classified. Three percent of patients were classified as per the Appendix section of ICHD-3β. The prevalence of secondary headaches and painful cranial neuropathies increased with age. A total of 36 different diagnoses were made. Only two diseases (migraine and cluster headache) had a prevalence of more than 10%. The prevalence of 13 diseases varied between 6 and 9%. The prevalence of other 14 groups was ≤1%. Migraine was the most common diagnosis (15%). Cervicogenic headache was the most common secondary headache. Classical trigeminal neuralgias and persistent idiopathic facial pain were two most common diagnoses in the painful cranial neuropathies and other facial pain groups. Sixty-one percent fulfilled the definition of chronic daily headaches, and hemicrania continua and cervicogenic headache were the two most common diagnoses in this group. CONCLUSIONS A large number of primary and secondary headaches and cranial neuropathies may present as side-locked headache and facial pain syndromes. Therefore, a sound knowledge of diagnostic approach is required for the optimal management of side locked headaches and facial pain.
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Affiliation(s)
- Sanjay Prakash
- Department of Neurology, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth University, Piperia, Baroda, Gujarat, 3901760, India
| | - Chaturbhuj Rathore
- Department of Neurology, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth University, Piperia, Baroda, Gujarat, 3901760, India
| | - Prayag Makwana
- Department of Neurology, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth University, Piperia, Baroda, Gujarat, 3901760, India
| | - Ankit Dave
- Department of Neurology, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth University, Piperia, Baroda, Gujarat, 3901760, India
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Lanteri-Minet M. [Epidemiology, clinical presentation, diagnosis, natural history and screening of cluster headache]. Presse Med 2015; 44:1176-9. [PMID: 26476753 DOI: 10.1016/j.lpm.2015.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 06/22/2015] [Indexed: 12/28/2022] Open
Abstract
This review is focused on the essential data about epidemiology, clinical presentation, diagnosis, natural history and screening for cluster headache.
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Affiliation(s)
- Michel Lanteri-Minet
- CHU de Nice, hôpital Cimiez, pôle neurosciences cliniques, département évaluation et traitement douleur, 4, avenue Reine-Victoria, 06003 Nice, France.
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Donnet A, Demarquay G, Ducros A, Geraud G, Giraud P, Guegan-Massardier E, Lucas C, Navez M, Valade D, Lanteri-Minet M. Recommandations pour le diagnostic et le traitement de l’algie vasculaire de la face. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.douler.2015.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Donnet A, Demarquay G, Ducros A, Geraud G, Giraud P, Guegan-Massardier E, Lucas C, Navez M, Valade D, Lanteri-Minet M. Recommandations pour le diagnostic et le traitement de l’algie vasculaire de la face. Rev Neurol (Paris) 2014; 170:653-70. [DOI: 10.1016/j.neurol.2014.03.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 03/26/2014] [Indexed: 12/24/2022]
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Abstract
Primary headache disorders are generally characterized by the pain, time course, and associated symptoms of their attacks, but often are accompanied by milder interictal pain. Patients with chronic migraine, chronic tension-type headache, hemicrania continua, and new daily-persistent headache have constant pain more often than not. Patients with trigeminal autonomic cephalalgias such as cluster headache commonly have interictal pain as well, usually much milder and unilateral to the side of attacks. Even those with rare headache types, including hypnic headache and trigeminal neuralgia, commonly have interictal pain. This review describes the incidence of interictal pain in primary headache disorders and suggests the significance and biological meanings of this pain.
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Müller K, Bekkelund S. En kvinne med ensidig hodepine. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2011; 131:693-5. [DOI: 10.4045/tidsskr.09.1406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Bogduk N, Govind J. Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment. Lancet Neurol 2009; 8:959-68. [PMID: 19747657 DOI: 10.1016/s1474-4422(09)70209-1] [Citation(s) in RCA: 201] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cervicogenic headache is characterised by pain referred to the head from the cervical spine. Although the International Headache Society recognises this type of headache as a distinct disorder, some clinicians remain sceptical. Laboratory and clinical studies have shown that pain from upper cervical joints and muscles can be referred to the head. Clinical diagnostic criteria have not proved valid, but a cervical source of pain can be established by use of fluoroscopically guided, controlled, diagnostic nerve blocks. In this Review, we outline the basic science and clinical evidence for cervicogenic headache and indicate how opposing approaches to its definition and diagnosis affect the evidence for its clinical management. We provide recommendations that enable a pragmatic approach to the diagnosis and management of probable cervicogenic headache, as well as a rigorous approach to the diagnosis and management of definite cervical headache.
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Affiliation(s)
- Nikolai Bogduk
- Newcastle Bone and Joint Institute, Royal Newcastle Centre, New South Wales, Australia.
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Lateralization in cluster headache: a Nordic multicenter study. J Headache Pain 2009; 10:259-63. [PMID: 19495933 PMCID: PMC3451747 DOI: 10.1007/s10194-009-0129-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 05/07/2009] [Indexed: 11/29/2022] Open
Abstract
A slight predominance of cluster pain on the right side has been reported in several studies. The aim of this large retrospective Nordic multicenter study was to estimate the prevalence of right- and left-sided pain in cluster headache (CH) patients with side-locked pain, the prevalence of side shifts in episodic and chronic CH patients, and the occurrence of cranial autonomic symptoms related to pain side. Among 383 cluster patients, 55 (14%) had experienced pain side shift. Of the remaining 328 individuals without side shift, there was no significant difference between the occurrence of right-sided and left-sided pain (54 vs. 46%). The prevalence of side shift was similar for episodic and chronic CH and the occurrence of cranial autonomic symptoms was not influenced by the pain side. In conclusion, previous reports of a side difference in location of cluster pain could not be confirmed in this large Nordic sample.
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