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Hashimoto Y, Matsushige T, Kawano R, Yoshiyama M, Hara T, Kobayashi S, Ono C, Sakamoto S, Horie N. Headache characteristics to screen for cervicocerebral artery dissection in patients with acute onset unusual headache. Headache 2023; 63:283-289. [PMID: 36748124 DOI: 10.1111/head.14454] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/12/2022] [Accepted: 10/17/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The aim of this preplanned primary analysis was to investigate the clinical manifestations of headache to screen for CAD patients with acute onset headache only. BACKGROUND Spontaneous cervicocerebral artery dissection (CAD) with acute onset headache is not rare in clinical practice; however, it is underdiagnosed. On the other hand, subsequent infarction or subarachnoid hemorrhage mainly occurs within 1 week of headache onset. METHODS Between April 2017 and January 2022, we conducted a single-center, cross-sectional retrospective study on 197 consecutive referred patients from neurosurgical outpatient clinics with acute onset unusual headache (stronger or longer headache than usual). All patients underwent magnetic resonance imaging to screen for secondary headache and were diagnosed based on the diagnostic protocol. We examined patient background data and the following headache characteristics: distribution, condition at the onset of headache, accompanying vomiting or nausea, worsening headache, and analgesic effects against headache. These factors were analyzed to identify independent diagnostic predictors of CAD. In this study, the rate of missing data was 41% for improvement of headache by analgesia and multiple imputation by chained equations was performed. RESULTS A total of 93 patients (46 men and 47 women; mean age: 48 years, range: 25-73 years) were diagnosed with CAD. Univariate logistic regression analysis showed CAD was associated with current smoking, systolic blood pressure >140 mmHg, unilateral headache, worsening headache, and no headache improvement by analgesia. Unilateral, worsening headache and no headache improvement by analgesia remained independent diagnostic predictors in multivariable logistic regression after multiple imputation. No headache improvement by analgesia had the highest sensitivity (86%), while worsening headache had the highest specificity (84%). CONCLUSIONS CAD needs to be considered in patients with unilateral, worsening headache and no headache improvement by analgesia.
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Affiliation(s)
- Yukishige Hashimoto
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Toshinori Matsushige
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Reo Kawano
- Innovation Center for Translational Research, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Michitsura Yoshiyama
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Takeshi Hara
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Shohei Kobayashi
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Chiaki Ono
- Department of Radiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Shigeyuki Sakamoto
- Department of Neurosurgery Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobutaka Horie
- Department of Neurosurgery Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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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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Gallo D, Manrique L, Polanco M, González-Mandly A, Torres E, Palacio E, Vázquez JL, Pérez-Pereda S, González-Quintanilla V, Madera J, Pascual J. De novo headache in ischemic stroke patients treated with thrombectomy: a prospective study. J Headache Pain 2022; 23:85. [PMID: 35864440 PMCID: PMC9306161 DOI: 10.1186/s10194-022-01455-3] [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: 04/19/2022] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background and aim Headache attributed to intracranial endovascular procedures is described in the ICHD-3. Our aim was to study the frequency and characteristics of headache specifically related to thrombectomy in patients with ischemic stroke. Methods Prospective evaluation of clinical features of headache after thrombectomy using an ad hoc questionnaire. Results One hundred seventeen patients were included (52.1% females). Most had an anterior circulation artery occlusion (91.5%). 93 (79.5%) received general anaesthesia. 111 (94.9%) required stent retriever, 21 (24.4%) angioplasty and 19 (16.2%) aspiration thrombectomy. 31 (26.5%; 95% CI 18.8–35.5%) had headache related to thrombectomy, and it was associated with a history of primary headache (p = 0.004). No differences about sex, initial NIHSS score, or the type or complexity of the procedure were observed. Headache was usually moderate and oppressive, ipsilateral to the artery occlusion and usually lasted less than 48 hours. Conclusions Almost one-third of patients with ischemic stroke who undergo endovascular thrombectomy experience headache in the first 24 hours, occurring more frequently in patients who had a previous history of headaches regardless of the procedure complexity. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01455-3. - About one third of the patients who undergo a thrombectomy for acute stroke
experience headache directly related to the procedure. - Having a previous history of primary headache is associated with the presence
of headache after thrombectomy. - Headache related to thrombectomy usually coincides with the distribution of the affected artery, although it is bilateral in 45% of the cases, mostly oppressive, of an average duration between 1 and 2 days and of a moderate intensity.
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Affiliation(s)
- Daniel Gallo
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Leire Manrique
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Marcos Polanco
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Andrés González-Mandly
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Eduardo Torres
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Enrique Palacio
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - José Luis Vázquez
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Sara Pérez-Pereda
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Vicente González-Quintanilla
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Jorge Madera
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Julio Pascual
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain.
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Lu C, Zhang L, Wang J, Cao X, Jia X, Ma X, Zhang R, Wang L, Yang Y, Meng F, Yu S, Liu R. The applicability research of the diagnostic criteria for 6.7.2 angiography headache in the international classification of headache disorders-3rd edition. J Headache Pain 2022; 23:20. [PMID: 35100967 PMCID: PMC8903541 DOI: 10.1186/s10194-021-01373-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/14/2021] [Indexed: 11/19/2022] Open
Abstract
Background Angiography headache (AH) is common but not negligible, and the criteria for AH have been based on only a few studies. The purpose of this study was to investigate the incidence, risk factors and possible mechanism of AH and reappraise the diagnostic criteria for AH in the International Classification of Headache Disorders 3 (ICHD-3). Methods Two hundred and seventy-nine patients completed this prospective, non-randomized study, including 107 patients who underwent cerebral angiography, 101 patients who underwent coronary intervention and 71 patients who underwent extremities arterial intervention. Patients were followed up with questionnaires immediately after the procedure and 24 h, 72 h, 1 week and 2 weeks after the procedure. Results The incidence of headache was 22.4% (24/107) in cerebral angiography group, 23.8% (24/101) in coronary intervention group, and 16.9% (12/71) in extremities arterial intervention group. Headache still occurred in 12.1% (13/107), 14.9% (15/101) and 11.3% (8/71) of patients 24 h after the procedure in the three groups, respectively. Two types of headache were observed in cerebral angiography group and coronary intervention group, one during and one after the procedure, while only postoperative headache was observed in extremities arterial intervention group. Previous headache history was a risk factor for headache in the three groups (p = 0.003 in cerebral angiography group, p = 0.006 in coronary intervention group, and p = 0.016 in extremities arterial intervention group). In addition, female (p = 0.008) was a risk factor for cerebral angiography group. Headache characteristics were described in detail. Conclusions The diagnostic criteria for 6.7.2 angiography headache in ICHD-3 may miss a number of cerebral AH with onset later than 24 h after the procedure. Therefore, it is recommended to revise it according to the literature and further studies. The incidence of headache was high during and after angiography and interventional procedure. It was suggested that the definition of headache due to coronary intervention and headache due to extremities arterial intervention should be added in ICHD.
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Matsumoto H, Hanayama H, Sakurai Y, Minami H, Masuda A, Tominaga S, Miyaji K, Yamaura I, Yoshida Y, Hirata Y. Investigation of the characteristics of headache due to unruptured intracranial vertebral artery dissection. Cephalalgia 2018; 39:504-514. [PMID: 30081651 DOI: 10.1177/0333102418791818] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE It is sometimes difficult to diagnose intracranial vertebral artery dissection in patients with headache as the only symptom. Knowledge of the characteristics of the headache would facilitate the diagnosis. In this study, we aimed to clarify the characteristics of intracranial vertebral artery dissection-related headache using our original self-administered questionnaire. METHODS Via the questionnaire, we ascertained headache characteristics and investigated whether they differed between two types of unruptured intracranial vertebral artery dissection, headache type and ischemic type, based on analysis of the responses. Then, we tried to validate the consistency of commonly used criteria for intracranial artery dissection by comparing them with our results. RESULTS Thirty-seven patients were analyzed. Our results identified the following seven headache characteristics in patients with intracranial vertebral artery dissection: (i) occurring in the occipitonuchal region (89%); (ii) unilateral (81%); (iii) pulsatile (70%); (iv) of acute onset (70%); (v) severe (73%); (vi) without nausea or vomiting (73%); and (vii) with concomitant clinical symptoms unrelated to ischemia (81%). Comparison of headache characteristics between the two types of intracranial vertebral artery dissection headache showed that the pain was significantly more severe in headache type than ischemic type intracranial vertebral artery dissection ( p = 0.01). Concomitant clinical symptoms occurred significantly more often in ischemic type than headache type intracranial vertebral artery dissection ( p = 0.03). Our results generally satisfied the established headache diagnostic criteria. CONCLUSION The pain characteristics of headache type and ischemic type intracranial vertebral artery dissection shown in our study may facilitate its diagnosis.
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Affiliation(s)
- Hiroaki Matsumoto
- 1 Department of Neurosurgery, Cerebrovascular Research Institute, Eishokai Yoshida Hospital, Kobe, Japan
| | - Hiroaki Hanayama
- 1 Department of Neurosurgery, Cerebrovascular Research Institute, Eishokai Yoshida Hospital, Kobe, Japan
| | - Yasuo Sakurai
- 1 Department of Neurosurgery, Cerebrovascular Research Institute, Eishokai Yoshida Hospital, Kobe, Japan
| | - Hiroaki Minami
- 1 Department of Neurosurgery, Cerebrovascular Research Institute, Eishokai Yoshida Hospital, Kobe, Japan
| | - Atsushi Masuda
- 1 Department of Neurosurgery, Cerebrovascular Research Institute, Eishokai Yoshida Hospital, Kobe, Japan
| | - Shogo Tominaga
- 1 Department of Neurosurgery, Cerebrovascular Research Institute, Eishokai Yoshida Hospital, Kobe, Japan
| | - Katsuya Miyaji
- 1 Department of Neurosurgery, Cerebrovascular Research Institute, Eishokai Yoshida Hospital, Kobe, Japan
| | - Ikuya Yamaura
- 1 Department of Neurosurgery, Cerebrovascular Research Institute, Eishokai Yoshida Hospital, Kobe, Japan
| | - Yasuhisa Yoshida
- 1 Department of Neurosurgery, Cerebrovascular Research Institute, Eishokai Yoshida Hospital, Kobe, Japan
| | - Yutaka Hirata
- 2 Department of Neurology, Cerebrovascular Research Institute, Eishokai Yoshida Hospital, Kobe, Japan
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Zhang L, Wu X, Di H, Feng T, Wang Y, Wang J, Cao X, Li B, Liu R, Yu S. Characteristics of Headache After an Intracranial Endovascular Procedure: A Prospective Observational Study. Headache 2016; 57:391-399. [PMID: 27991669 DOI: 10.1111/head.13006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/26/2016] [Accepted: 10/26/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Two editions of the International Classification of Headache Disorders (ICHD) diagnostic criteria for "Headache attributed to an intracranial endovascular procedure" have been published, in 2004 and 2013.1,2 Despite studies that have suggested that the former is not very practical, the ICHD-3 beta did not contain major changes. Moreover, so far no consensus exists regarding characteristics of headache after intracranial endovascular procedure. Thus, there is a need for sound suggestions to improve the ICHD-3 beta diagnostic criteria. METHODS Using a prospective design, we identified consecutive patients with unruptured intracranial aneurysms (UIAs) with neuroendovascular treatment from January 2014 to December 2014. RESULTS In total, 73 patients were enrolled, and 58 patients ultimately completed the 6-month follow-up. After the procedure, five of the 29 patients (17.2%) with pre-existing headache experienced marked worsening after the procedure, while seven of the 29 patients without prior headache developed new-onset headache post-procedurally. The headaches started within 24 hours, with a mean duration of 24-72 hours. The headaches were moderate to severe. The eligibility of these events to be considered headaches caused by neuroendovascular procedures according to the ICHD-3 beta diagnostic criteria for designation was far from ideal. CONCLUSIONS Most cases of markedly worsening headaches and new-onset headaches started within 24 hours and persisted longer than that specified in the ICHD-3 beta diagnostic criteria. Moreover, considering that some items are not very practical, the ICHD-3 beta diagnostic criteria should be revised in the light of recent literature reports.
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Affiliation(s)
- Linjing Zhang
- Department of Neurology, Chinese PLA General Hospital, Beijing, PR China
| | - Xiancong Wu
- Department of Neurology, Chinese PLA General Hospital, Beijing, PR China
| | - Hai Di
- Department of Neurology, Chinese PLA General Hospital, Beijing, PR China
| | - Tao Feng
- Department of Neurology, Heilongjiang Provincial Hospital, Harbin, PR China
| | - Yunxia Wang
- Department of Neurology, The First Hospital Affiliated to the Chinese PLA General Hospital, Beijing, PR China
| | - Jun Wang
- Department of Neurology, Chinese PLA General Hospital, Beijing, PR China
| | - Xiangyu Cao
- Department of Neurology, Chinese PLA General Hospital, Beijing, PR China
| | - Baomin Li
- Department of Neurology, Chinese PLA General Hospital, Beijing, PR China
| | - Ruozhuo Liu
- Department of Neurology, Chinese PLA General Hospital, Beijing, PR China.,Department of Neurology, Hainan Branch of Chinese PLA General Hospital, Sanya, PR China
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, PR China
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Headache in subarachnoid hemorrhage and headache attributed to intracranial endovascular procedures. Neurol Sci 2016; 36 Suppl 1:67-70. [PMID: 26017515 DOI: 10.1007/s10072-015-2193-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Headache is a critical problem in the emergency setting. In this paper we briefly review the epidemiological data regarding headache in Subarachnoid Hemorrhage (SAH), considering the role of headache as a warning symptom and the other clinical manifestation of SAH. We have also introduced a recent clinical entity, represented by headache associated to intracranial endovascular procedures (IEPs).
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Fukuhara K, Ogata T, Ouma S, Tsugawa J, Matsumoto J, Abe H, Higashi T, Inoue T, Tsuboi Y. Impact of initial symptom for accurate diagnosis of vertebral artery dissection. Int J Stroke 2015; 10 Suppl A100:30-3. [PMID: 26120954 DOI: 10.1111/ijs.12546] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 04/08/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND It has been recognized that spontaneous vertebral artery dissection without neurological symptoms is not rare and easily misdiagnosed. Clinical clue for diagnosis of vertebral artery dissection includes initial symptoms such as headache, neck pain, or dizziness. AIM To assess the role of initial symptoms for diagnosis of spontaneous vertebral artery dissection. METHODS Between September 2007 and January 2014, we retrospectively reviewed clinical records of 83 patients with unilateral vertebral artery dissection without consciousness disturbance at admission. Based on the diagnostic criteria of the Spontaneous Cervicocephalic Arterial Dissections Study, the patients were divided into three groups: possible, probable, and definite cases of vertebral artery dissection. Initial symptoms were collected at the time of diagnosis from medical record for the presence or absence of headache, neck pain, tinnitus and vertigo, as well as the area of pain and its characteristics. RESULTS The numbers of definite, probable, and possible vertebral artery dissection were 39, 26, and 18, respectively. Out of 83 cases, unilateral or bilateral headache was the most commonly seen (in 60 cases), followed by neck pain (in 41 cases) and vertigo (in 20 cases). Statistically, unilateral headache and/or neck pain was more common in cases with definite vertebral artery dissection group compared with other classification of the Spontaneous Cervicocephalic Arterial Dissections Study (P = 0·040). Vertigo was also associated with the stratification of Spontaneous Cervicocephalic Arterial Dissections Study criteria (P = 0·012). CONCLUSIONS In our study, headache and/or neck pain, especially unilateral presentation, and vertigo were symptoms associated with the stratification of Spontaneous Cervicocephalic Arterial Dissections Study criteria. Physicians should carefully obtain clinical history for the presence of a unilateral headache and/or neck pain and vertigo when vertebral artery dissection is suspected in patients with or without objective neurological signs.
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Affiliation(s)
- Kousuke Fukuhara
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Toshiyasu Ogata
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Shinji Ouma
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Jun Tsugawa
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Juntaro Matsumoto
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hiroshi Abe
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Toshio Higashi
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yoshio Tsuboi
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Baron EP. Headache, cerebral aneurysms, and the use of triptans and ergot derivatives. Headache 2015; 55:739-47. [PMID: 25903747 DOI: 10.1111/head.12562] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Uncertainty exists regarding the correlation between unruptured cerebral aneurysms and their role in headache etiology. It is also unclear whether surgical endovascular treatment may improve or worsen the headache, and if there are predictable factors for headache outcome such as pre-existing headache features, aneurysm characteristics, or other medical history. There is debate regarding safe treatment of migraine in patients with aneurysms, both before and after endovascular treatments. Particularly, there is hesitancy to use the triptans and ergot derivatives such as dihydroergotamine because of their vasoconstrictive effects and concern for adverse events related to the aneurysm such as aneurysmal instability and rupture. OBJECTIVE To review the literature regarding the anatomy, pathophysiology, and association between headache, untreated vs surgically treated aneurysms, and the use of triptans and ergot derivatives for migraine treatment in this setting. CONCLUSION Associations between some headaches and aneurysms may exist. Some chronic headaches may respond to surgical aneurysm repair while others may worsen. These associations are undefined by current literature because of variable results, study methods, and limited data. Prospective studies are needed which incorporate pre- and post-procedure headache character and diagnosis, aneurysm characteristics, type of aneurysm repair, associated risk factors for worsening post-procedure headache, and ultimately combining all of these data to better predict headache outcome following surgical aneurysm treatment. Lastly, the caution and avoidance of triptan and ergot derivative use for migraine in the setting of aneurysm is not supported by the current evidence, and much of this concern may be excessive and unwarranted, although more evidence confirming safety is needed.
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Affiliation(s)
- Eric P Baron
- Department of Neurology, Cleveland Clinic Neurological Institute, Center for Headache and Pain, Cleveland, OH, USA
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Spontaneous cervicocephalic arterial dissection with headache and neck pain as the only symptom. J Headache Pain 2012; 13:247-53. [PMID: 22350749 PMCID: PMC3311823 DOI: 10.1007/s10194-012-0420-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 01/28/2012] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Cervicocephalic arterial dissection can cause both ischemic stroke and hemorrhagic stroke. However, spontaneous cervicocephalic arterial dissection presenting only with headache and neck pain has rarely been reported. The clinical features of patients with spontaneous cervicocephalic arterial dissection presenting only with headache and neck pain were investigated. METHODS The subjects were seven patients with spontaneous cervicocephalic arterial dissection with headache and neck pain alone who were admitted to our hospital during the past 3 years. The clinical features of these patients were investigated. The diagnosis of arterial dissection was based on the criteria of the Strategies Against Stroke Study for Young Adults in Japan. RESULTS The age of the patients (3 males, 4 females) ranged from 35 to 79 (mean, 51.0 ± 16.2) years. Six patients had vertebral artery dissection, one had internal carotid artery dissection, and one had an association of vertebral and internal carotid artery dissection. With the exception of one patient, the headache and neck pain were unilateral. All patients with vertebral artery dissection complained of posterior cervical or occipital pain. In the cases of internal carotid artery dissection, one patient complained of temporal pain, and one patient with co-existing vertebral artery dissection complained of posterior cervical pain. The mode of onset was acute in five patients, thunderclap in one, and gradual and progressive in one. The pain was severe in all cases. Five patients complained of continuous pain, while two had intermittent pain. The quality of the pain was described as throbbing by five patients and constrictive by two. The headache and neck pain persisted for 1 week or longer in six of the seven patients. CONCLUSION Cervicocephalic arterial dissection should be suspected when patients complain of intense unilateral posterior cervical and occipital pain or temporal pain.
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Baron EP, Moskowitz SI, Tepper SJ, Gupta R, Novak E, Hussain MS, Stillman MJ. Headache following intracranial neuroendovascular procedures. Headache 2011; 52:739-48. [PMID: 22211779 DOI: 10.1111/j.1526-4610.2011.02059.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIMS Predicting who will develop post-procedure headache (PPH) following intracranial endovascular procedures (IEPs) would be clinically useful and potentially could assist in reducing the excessive diagnostic testing so often obtained in these patients. Although limited safety data exist, the use of triptans or dihydroergotamine (DHE) often raise concern when used with pre/post-coiled aneurysms. We sought to determine risk factors for PPH following IEP, to evaluate the utility of diagnostic testing in patients with post-coil acute headache (HA), and to record whether triptans and DHE have been used safely in this clinical setting. METHODS We conducted a retrospective chart review of adult patients undergoing IEPs. Bivariate analyses were conducted to compare patients who did and did not develop PPH. RESULTS We reviewed records pertaining to 372 patients, of whom 263 underwent intracranial coil embolizations, 21 acrylic glue embolizations, and 88 stent placements. PPH occurred in 72% of coil patients, 33% of glue patients, and 14% of stent patients. Significant risk factors for post-coil HA were female gender, any pre-coil HA history, smoking, and anxiety/depression. A pre-stent history of HA exceeding 1 year's duration, and smoking were risk factors for post-stent HA. A pre-glue history of HA exceeding 1 year was the only risk factor for post-glue HA. In the small subgroup available for study, treatment with triptans or DHE was not associated with adverse events in pre/post-coiled aneurysms. Diagnostic testing was low yield. CONCLUSIONS Occurrence of PPH was common after IEPs and especially so with coiling and in women, smokers, and those with anxiety/depression, and was often of longer duration than allowed by current International Classification of Headache Disorders-II criteria. The yield of diagnostic testing was low, and in a small subgroup treatment with triptans or DHE did not cause adverse events in pre/post-coiled aneurysms. Prospective studies are needed to confirm these findings.
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Affiliation(s)
- Eric P Baron
- Cleveland Clinic Neurological Institute-Neurology, Center for Headache and Pain, Center for Regional Neurology, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Abstract
This article reviews the baffling problem of the pathophysiology behind a peripheral genesis of migraine pain--or more particularly the baffling problem of its absence. I examine a number of pathophysiological states and the effector mechanisms for these states and find most of them very plausible and that they are all supported by abundant evidence. However, this evidence is mostly indirect; to date the occurrence of any of the presumed pathological states has not been convincingly demonstrated. Furthermore, there is little evidence of increased trigeminal sensory traffic into the central nervous system during a migraine attack. The article also examines a number of observations and experimental programs used to bolster a theory of peripheral pathology and suggests reasons why they may in fact not bolster it. I suggest that a pathology, if one exists, may be in the brain and even that it may not be a pathology at all. Migraine headache might just happen because of random noise in an exquisitely sensitive and complex network. The article suggests an experimental program to resolve these issues.
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Affiliation(s)
- Geoffrey A Lambert
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Australia
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14
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Kaube H, Hoskin K, Goadsby P. Acetylsalicylic acid inhibits cerebral cortical vasodilatation caused by superior sagittal sinus stimulation in the cat*. Eur J Neurol 2011; 1:141-6. [DOI: 10.1111/j.1468-1331.1994.tb00062.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Taylor AJ, Kerry R. A ‘system based’ approach to risk assessment of the cervical spine prior to manual therapy. INT J OSTEOPATH MED 2010. [DOI: 10.1016/j.ijosm.2010.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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16
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Neurobiology of migraine. Neuroscience 2009; 161:327-41. [DOI: 10.1016/j.neuroscience.2009.03.019] [Citation(s) in RCA: 290] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Revised: 02/28/2009] [Accepted: 03/04/2009] [Indexed: 01/27/2023]
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17
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18
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Gil-Gouveia R, Fernandes Sousa R, Lopes L, Campos J, Pavão Martins I. Headaches during angiography and endovascular procedures. J Neurol 2007; 254:591-6. [PMID: 17415512 DOI: 10.1007/s00415-006-0330-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2005] [Revised: 03/24/2006] [Accepted: 05/11/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND The occurrence of headaches during cerebral angiography or endovascular procedures is an ill-defined issue, as limited information is available to define its frequency, risk factors, pathogenesis and implications for future pain management. PURPOSE To determine the frequency of headaches during endovascular procedures (HdEVP) and to define their characteristics and risk factors for their occurrence. METHODS Prospective cross-sectional observational study of adult patients undertaking cerebral angiography or endovascular procedures, recording HdEVP clinical features, previous headache history and procedural variables. RESULTS One hundred and twenty two procedures were evaluated. HdEVP occurred in 13 patients, both in diagnostic and therapeutic procedures. Pain was described as brief, stabbing or localized pressure of mild to moderate intensity, felt ipsilaterally to the manipulated vessel. Its occurrence was associated with therapeutic interventions (p = 0.007), female gender (p = 0.015) and previous history of more than 4 headache episodes per month (p = 0.018). CONCLUSION HdEVP is an uncommon brief headache that should be further evaluated in the future. Its pathogenesis is probably related to mechanical vessel distension, which activates the trigeminovascular nociceptive system in susceptible individuals.
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Affiliation(s)
- Raquel Gil-Gouveia
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular, Lisbon's Faculty of Medicine, Av. Prof. Egas Moniz, 1649-035, Lisboa, Portugal.
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19
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Abstract
In this paper, we present a clinical overview of cervical arterial dysfunction (CAD) for manual therapists who treat patients presenting with cervical pain and headache syndromes. An overview of vertebrobasilar arterial insufficiency (VBI) is given, with reference to assessment procedures recommended by commonly used guidelines. We suggest that the evidence supporting contemporary practice is limited and present a more holistic, evidence-based approach to considering CAD. This approach considers typical pain patterns and clinical progressions of both vertebrobasilar, and internal carotid arterial pathologies. Attention to the risk factors and pathomechanics of arterial dysfunction is also given. We suggest that consideration of the information provided in this Masterclass will enhance the manual therapist's clinical reasoning with regard to differential diagnosis of cervical pain syndromes, and prediction of serious adverse reactions to treatment.
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Affiliation(s)
- Roger Kerry
- Division of Physiotherapy Education, University of Nottingham, UK.
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20
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Taylor AJ, Kerry R. Neck pain and headache as a result of internal carotid artery dissection: implications for manual therapists. ACTA ACUST UNITED AC 2005; 10:73-7. [PMID: 15681272 DOI: 10.1016/j.math.2004.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2003] [Revised: 05/20/2004] [Accepted: 06/11/2004] [Indexed: 11/26/2022]
Affiliation(s)
- Alan J Taylor
- Nottingham Nuffield Hospital, 748 Mansfield Road, Woodthorpe, Nottingham NG5 3FZ, UK
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21
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Benjamin L, Levy MJ, Lasalandra MP, Knight YE, Akerman S, Classey JD, Goadsby PJ. Hypothalamic activation after stimulation of the superior sagittal sinus in the cat: a Fos study. Neurobiol Dis 2004; 16:500-5. [PMID: 15262261 DOI: 10.1016/j.nbd.2004.03.015] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2003] [Revised: 01/26/2004] [Accepted: 03/11/2004] [Indexed: 11/30/2022] Open
Abstract
Clinical observations, particularly of the premonitory phase of migraine, suggest the involvement of the hypothalamus in the earliest phases of an attack. Stimulation of the superior sagittal sinus (SSS) in humans produces head pain and permits study of the activated trigeminovascular system in experimental settings. The distribution of neurons expressing the protein product (Fos) of the c-fos immediate early gene was examined in the hypothalamus of anaesthetised (alpha-chloralose) cats. Animals were studied after either 2-h stimulation of the SSS or sham stimulation. Fos protein was detected using immunohistochemistry, and positive neurons were plotted onto standardised templates and counted by a blinded observer. In response to electrical stimulation of the superior sagittal sinus, we found significant activation of the supra-optic nucleus (SON) rising from 3 (0-13) (median, 95% confidence interval) to 53 (31-78; P = 0.005) fos-positive cells. In the posterior hypothalamic area (Hp), fos-positive cells rose from 4 (0-14) to 35 (17-45; P = 0.015) Taken together with other physiological studies, the data are consistent with a role for hypothalamic structures in the modulation of trigeminovascular nociceptive afferent information, and thus for a role in headache.
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Affiliation(s)
- Laura Benjamin
- Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
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22
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Goadsby P. Headache Basic Anatomy and Physiology of the Trigeminovascular System. Pain 2003. [DOI: 10.1201/9780203911259.ch23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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23
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Michaud TC. Uneventful upper cervical manipulation in the presence of a damaged vertebral artery. J Manipulative Physiol Ther 2002; 25:472-83. [PMID: 12214189 DOI: 10.1067/mmt.2002.126468] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To discuss a case in which a patient with a previously injured vertebral artery underwent manipulation in the upper cervical spine without alteration of her symptom pattern. The literature concerning the relative safety of specific upper cervical manipulative techniques is reviewed. CLINICAL FEATURES A 42-year-old woman had a 3-week history of unilateral suboccipital pain that she related to a sudden twisting of her head and neck that occurred while she was putting sheets of drywall on top of her car. Subsequent examination by a neurologist 2 weeks later was unremarkable, and a tension-type headache was diagnosed. Approximately 10 days later (3 weeks after injury), a single high-velocity upper-cervical manipulation (incorporating slight rotation and full lateral flexion) was performed with no change in her symptom pattern. Two weeks after that, the patient had development of a lateral medullary syndrome (also known as Wallenberg syndrome) after she briefly extended and rotated her upper cervical spine while painting a ceiling. INTERVENTION AND OUTCOME The patient was treated with anticoagulant therapy, and the lateral medullary infarct healed without incident. The spinocerebellar and subtle motor symptoms also resolved, but the ipsilateral suboccipital headache and the loss of temperature sensation associated with the spinothalamic tract lesion were still present 9 months later. CONCLUSION This case report demonstrates that vigorous manipulation of the upper cervical spine is possible without injuring an already damaged vertebral artery. It is suggested that the line of drive used during the single manipulation, almost pure lateral flexion with slight rotation, was responsible for the apparent innocuous response. Guidelines for the evaluation and management of vertebral artery dissection are reviewed. Because it is currently impossible to identify patients at risk of having a dissected vertebral artery with standard in-office examination procedures, rotational manipulation of the upper cervical spine should be abandoned by all practitioners, and schools should remove such techniques from their curriculums.
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24
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Abstract
Internal carotid artery (ICA) and vertebral artery (VA) dissections are among the common causes of stroke in middle-aged and young adults. The spectrum of clinical presentations of these dissections is broad. Many patients, especially those with ICA dissections, may never develop a stroke.
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Affiliation(s)
- Bahram Mokri
- Mayo Clinic, Department of Neurology, E8A, 200 First Street SW, Rochester, MN 55905, USA.
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25
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Affiliation(s)
- Peter J Goadsby
- Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
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26
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Abstract
OBJECTIVE To describe three cases of migraine (two with aura) after an intracranial endovascular procedure. Method.-Retrospective. RESULTS One patient had an attack of migraine with prolonged aura after embolization of a dural arteriovenous fistula. Another patient had an attack of migraine with aura (and hemiparesis) after a diagnostic angiogram. The third patient already suffered from migraine with aura and had a migraine attack after embolization of an occipital arteriovenous malformation. A quadrantanopia persisted in this patient. Outcome of the other two patients was good. CONCLUSION Intracranial endovascular procedures can induce migraine with aura. We could not identify the underlying pathophysiological mechanism, but mechanical, chemical, immunological, or hemodynamic factors could be involved.
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Affiliation(s)
- R Beekman
- Departments of Neurology, St. Elisabeth Hospital, Tilburg, The Netherlands; Radiology, St. Elisabeth Hospital, Tilburg, The Netherlands; Neurosurgery, St. Elisabeth Hospital, Tilburg, The Netherlands
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Ellrich J, Andersen OK, Messlinger K, Arendt-Nielsen L. Convergence of meningeal and facial afferents onto trigeminal brainstem neurons: an electrophysiological study in rat and man. Pain 1999; 82:229-237. [PMID: 10488673 DOI: 10.1016/s0304-3959(99)00063-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Headache is often accompanied by referred pain in the face. This phenomenon is probably due to a convergence of afferent inputs from the meninges and the face onto central trigeminal neurons within the medullary dorsal horn (MDH). The possible existence and extent of this convergence was examined in rat and man. MDH neurons activated by stimulation of the parietal meninges were tested for convergent tactile and noxious mechanical input from all three facial branches of the trigeminal nerve. All 21 units with meningeal input could also be activated by facial stimuli. Brush stimuli applied to the supraorbital nerve area activated 86%, to the infraorbital nerve area 29%, and to the mental nerve area none of the units. Pinch stimuli applied to the supraorbital nerve area activated 95%, to the infraorbital nerve area 86%, and to the mental nerve area 52% of the units. The results suggest convergence of meningeal and facial inputs concentrated on the supraorbital nerve in rat. In man convergence was examined by probing neuronal excitability of MDH applying the blink reflex (BR) during Valsalva maneuver which probably increases intracranial pressure. The BR evoked by supraorbital nerve stimulation remained unchanged, while the BR evoked by mental nerve stimulation was significantly facilitated. This facilitation may be due to convergence of meningeal and facial inputs onto trigeminal neurons in man.
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Affiliation(s)
- Jens Ellrich
- Friedrich-Alexander-University, Institute of Physiology and Experimental Pathophysiology, Universitätsstr. 17, D-91054 Erlangen, Germany Aalborg University, Center for Sensory-Motor Interaction (SMI), Frederik Bajersvej 7 D3, DK-9220 Aalborg, Denmark
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28
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HOSKIN KARENL, ZAGAMI ALESSANDROS, GOADSBY PETERJ. Stimulation of the middle meningeal artery leads to Fos expression in the trigeminocervical nucleus: a comparative study of monkey and cat. J Anat 1999; 194 ( Pt 4):579-88. [PMID: 10445825 PMCID: PMC1467956 DOI: 10.1046/j.1469-7580.1999.19440579.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The pain of a migraine attack is often described as unilateral, with a throbbing or pulsating quality. The middle meningeal artery (MMA) is the largest artery supplying the dura mater, is paired, and pain-producing in humans. This artery, or its branches, and other large intracranial extracerebral vessels have been implicated in the pathophysiology of migraine by theories suggesting neurogenic inflammation or cranial vasodilatation, or both, as explanations for the pain of migraine. Having previously studied in detail the distribution of the second order neurons that are involved in the transmission of nociceptive signals from intracranial venous sinuses, we sought to compare the distribution of second order neurons from a pain-producing intracranial artery in both monkey and cat. By electrically stimulating the middle meningeal artery in these species and using immunohistochemical detection of the proto-oncogene Fos as a marker of neuronal activation, we have mapped the sites of the central trigeminal neurons which may be involved in transmission of nociception from intracranial extracerebral arteries. Ten cats and 3 monkeys were anaesthetised with alpha-chloralose and the middle meningeal artery was isolated following a temporal craniotomy. The animals were maintained under stable anaesthesia for 24 h to allow Fos expression due to the initial surgery to dissipate. Following the rest period, the vessel was carefully lifted onto hook electrodes, and then left alone in control animals (cat n = 3), or stimulated (cat n = 6, monkey n = 3). Stimulation of the left middle meningeal artery evoked Fos expression in the trigeminocervical nucleus, consisting of the dorsal horn of the caudal medulla and upper 2 divisions of the cervical spinal cord, on both the ipsilateral and contralateral sides. Cats had larger amounts of Fos expressed on the ipsilateral than on the contralateral side. Fos expression in the caudal nucleus tractus solitarius and its caudal extension in lamina X of the spinal cord was seen bilaterally in response to middle meningeal artery stimulation. This study demonstrates a comparable anatomical distribution of Fos activation between cat and monkey and, when compared with previous studies, between this arterial structure and the superior sagittal sinus. These data add to the overall picture of the trigeminovascular innervation of the intracranial pain-producing vessels showing marked anatomical overlap which is consistent with the often poorly localised pain of migraine.
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Affiliation(s)
- KAREN L.
HOSKIN
- Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
| | | | - PETER J.
GOADSBY
- Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
- Correspondence to Professor P. J. Goadsby, Institute of Neurology, Queen Square, London WC1N 3BG, UK. Fax: +44 171 813 0349; e-mail:
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29
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Abstract
An understanding of the basic anatomy and physiology of the cranial circulation facilitates the assessment and management of patients with headache, particularly vascular-type headaches, such as migraine. At the very least, all pain is perceived and processed in the brain. With migraine it is likely that the fundamental problem and its clinical expression are driven by the CNS; thus study of the brain regarding headache is warranted. As therapy evolves during the 1900s, such an understanding will be necessary, as new and highly specific receptor-targeted compounds allow treatment and improvement of headache in many patients. Since writing this article, the nomenclature for serotonin (5HT) receptors has changed so that any reference herein to 5HTID alpha is now 5HTID and 5HTID beta is now 5HTI beta. This change in nomenclature is discussed in Martig PR, Hoyer D, Humphrey PPA, et al: Alignment of receptor nomenclature with the human genome: Classification of 5HT-1 beta and 5HT-1D receptor subtypes. Trends in the Pharmacological Sciences 17:103, 1996.
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Affiliation(s)
- P J Goadsby
- Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
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30
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Goadsby PJ, Hoskin KL. Inhibition of trigeminal neurons by intravenous administration of the serotonin (5HT)1B/D receptor agonist zolmitriptan (311C90): are brain stem sites therapeutic target in migraine? Pain 1996; 67:355-9. [PMID: 8951929 DOI: 10.1016/0304-3959(96)03118-1] [Citation(s) in RCA: 144] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Migraine is a common and debilitating condition. Its treatment has received considerable attention in recent times with the introduction into clinical use of the serotonin (5HT)1B/D-like agonist sumatriptan. It is known from human studies that the intracranial blood vessels and dura mater are important pain-sensitive structures since mechanical or electrical stimulation of these vessels, such as the superior sagittal sinus, causes pain. We have developed a model of craniovascular pain by stimulating the superior sagittal sinus and monitoring trigeminal neuronal activity using electrophysiological techniques. In this study we determined the effect of intravenous administration of the novel anti-migraine compound zolmitriptan (311C90) upon evoked neuronal activity in trigeminal neurons. Nine adult cats were anaesthetised with alpha-chloralose (60 mg/kg, i.p.; 20 mg/kg, i.v., 2-hourly) with all surgery being conducted under halothane (1-3%). The superior sagittal sinus was isolated for electrical stimulation. Recordings were made from caudal trigeminal neurons at the C2 level of the cervical spinal cord with tungsten-in-glass microelectrodes. Signals were amplified and analysed by a custom-written program that enabled software filtering and extraction of both evoked potential and single cell data. Data were collected before and after administration of zolmitriptan. Electrical stimulation of the superior sagittal sinus resulted in activation of neuronal elements within the trigeminal nucleus that could be monitored as single unit activity or as evoked potentials, the latter reflecting both primary afferent and trigeminal cell body activity. The evoked potential recorded from the trigeminal nucleus was 207 +/- 14 microV and was reduced by zolmitriptan (100 micrograms/kg, i.v.) to a mean of 98 +/- 17 microV. Similarly, the probability of firing for trigeminal neurons was reduced from a control level of 0.63 +/- 0.1 to 0.13 +/- 0.05 after a dose of 100 micrograms/kg intravenously. These effects were dose-dependent and were significantly different from the effect of vehicle (P < 0.05). These data demonstrate that systemically administered zolmitriptan can inhibit evoked trigeminovascular activity within the trigeminal nucleus. This inhibition of trigeminal activity may play a role in the anti-migraine actions of this compound and offers the prospect of a third pathophysiologically consistent target site for anti-migraine drug effects.
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Affiliation(s)
- P J Goadsby
- Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
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31
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Beattie DT, Connor HE, Hagan RM. Recent developments in tachykinin NK1 receptor antagonists: prospects for the treatment of migraine headache. Can J Physiol Pharmacol 1995; 73:871-7. [PMID: 8846424 DOI: 10.1139/y95-120] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The role of substance P and the influence of neurokinin 1 (NK1) receptor antagonists in the cranial circulation are described in the present review, particularly with respect to the mechanisms involved in the etiology of migraine headache. Substance P is distributed throughout the cranial vasculature, in the trigeminal sensory afferent nerve fibres, and its release can be demonstrated following activation of the trigeminovascular system in animals and humans. Following its release and NK1 receptor activation, dilatation and edema result, two events that are implicated in the pathogenesis of migraine headache. The recently developed selective NK1 receptor antagonists inhibit substance P mediated dilatation and plasma protein extravasation in the cranial circulation, suggesting that they may provide an effective and novel acute treatment for migraine.
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Affiliation(s)
- D T Beattie
- Glaxo Research and Development Ltd., Ware, Herts, U.K
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32
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Abstract
Glutamate (Glu) is considered here for its possible role as a naturally occurring mammalian 'age inducing' substance. The existence of 'Glu elicited headaches', may serve as an indication that Glu could negatively affect the human adult CNS. The prevalence of Glu induced headaches was found to be 28.8% in a study population of 201 subjects. Circumstantial similarities between brain aging and Glu toxicity are presented in the paper. Finally, it is mentioned that Vitamin E is partially effective in blocking Glu induced headaches.
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Affiliation(s)
- R S Pokras
- Pasadena City College, Life Sciences Department, California 91106-2003
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