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Attorre S, Burgalassi A, Vigani G, De Cesaris F, Romozzi M, Iannone LF. Sex and gender differences in the epidemiology, clinical features, and pathophysiology of trigeminal autonomic cephalalgias. CONFINIA CEPHALALGICA 2024; 34. [DOI: 10.4081/cc.2024.15775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
Emerging evidence suggests that primary headaches, classified as trigeminal autonomic cephalalgias (TACs), may exhibit sex and gender differences in clinical features, mechanisms, and treatment responses. While epidemiological and clinical gender-specific differences have been widely reported for cluster headache, limited evidence is available for other TACs. In this narrative review, we have analyzed the existing data on the influence of sex and gender on cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks, and hemicrania continua. Given the role of calcitonin gene-related peptide (CGRP) in migraine and cluster headache, sex and gender differences in the levels and function of CGRP in preclinical models and patients are reported. Future studies are warranted to elucidate the role of sex and gender in the complex interplay of genetic and neurochemical factors in TACs.
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Cappon D, Ryterska A, Akram H, Lagrata S, Cheema S, Hyam J, Zrinzo L, Matharu M, Jahanshahi M. The sensitivity to change of the cluster headache quality of life scale assessed before and after deep brain stimulation of the ventral tegmental area. J Headache Pain 2021; 22:52. [PMID: 34092221 PMCID: PMC8182939 DOI: 10.1186/s10194-021-01251-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/03/2021] [Indexed: 12/15/2022] Open
Abstract
Background Cluster headache (CH) is a trigeminal autonomic cephalalgia (TAC) characterized by a highly disabling headache that negatively impacts quality of life and causes limitations in daily functioning as well as social functioning and family life. Since specific measures to assess the quality of life (QoL) in TACs are lacking, we recently developed and validated the cluster headache quality of life scale (CH-QoL). The sensitivity of CH-QoL to change after a medical intervention has not been evaluated yet. Methods This study aimed to test the sensitivity to change of the CH-QoL in CH. Specifically we aimed to (i) assess the sensitivity of CH-QoL to change before and following deep brain stimulation of the ventral tegmental area (VTA-DBS), (ii) evaluate the relationship of changes on CH-QoL with changes in other generic measures of quality of life, as well as indices of mood and pain. Ten consecutive CH patients completed the CH-QoL and underwent neuropsychological assessment before and after VTA-DBS. The patients were evaluated on headache frequency, severity, and load (HAL) as well as on tests of generic quality of life (Short Form-36 (SF-36)), mood (Beck Depression Inventory, Hospital Anxiety and Depression Rating Scale), and pain (McGill Pain Questionnaire, Headache Impact Test, Pain Behaviour Checklist). Results The CH-QoL total score was significantly reduced after compared to before VTA-DBS. Changes in the CH-QoL total score correlated significantly and negatively with changes in HAL, the SF-36, and positively and significantly with depression and the evaluative domain on the McGill Pain Questionnaire. Conclusions Our findings demonstrate that changes after VTA-DBS in CH-QoL total scores are associated with the reduction of frequency, duration, and severity of headache attacks after surgery. Moreover, post VTA-DBS improvement in CH-QoL scores is associated with an amelioration in quality of life assessed with generic measures, a reduction of depressive symptoms, and evaluative pain experience after VTA-DBS. These results support the sensitivity to change of the CH-QoL and further demonstrate the validity and applicability of CH-QoL as a disease specific measure of quality of life for CH.
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Affiliation(s)
- Davide Cappon
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, University College London (UCL) Institute of Neurology, National Hospital for Neurology and Neurosurgery, 33 Queen Square, WC1N 3BG, London, UK.,Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, USA.,Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, MA, USA
| | - Agata Ryterska
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, University College London (UCL) Institute of Neurology, National Hospital for Neurology and Neurosurgery, 33 Queen Square, WC1N 3BG, London, UK.,Department of Psychology, Queen Mary University of London, London, UK
| | - Harith Akram
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, University College London (UCL) Institute of Neurology, National Hospital for Neurology and Neurosurgery, 33 Queen Square, WC1N 3BG, London, UK
| | - Susie Lagrata
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Sanjay Cheema
- Department of Psychology, Queen Mary University of London, London, UK
| | - Jonathan Hyam
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, University College London (UCL) Institute of Neurology, National Hospital for Neurology and Neurosurgery, 33 Queen Square, WC1N 3BG, London, UK
| | - Ludvic Zrinzo
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, University College London (UCL) Institute of Neurology, National Hospital for Neurology and Neurosurgery, 33 Queen Square, WC1N 3BG, London, UK
| | - Manjit Matharu
- Department of Psychology, Queen Mary University of London, London, UK
| | - Marjan Jahanshahi
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, University College London (UCL) Institute of Neurology, National Hospital for Neurology and Neurosurgery, 33 Queen Square, WC1N 3BG, London, UK. .,MOE Key Lab for Neuroinformation, The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu, China.
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Mollan SP, Virdee JS, Bilton EJ, Thaller M, Krishan A, Sinclair AJ. Headache for ophthalmologists: current advances in headache understanding and management. Eye (Lond) 2021; 35:1574-1586. [PMID: 33580185 PMCID: PMC8169696 DOI: 10.1038/s41433-021-01421-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 12/07/2020] [Accepted: 01/18/2021] [Indexed: 12/26/2022] Open
Abstract
Patients with headache and head pain are often referred to ophthalmologists. These symptoms can either be associated with underlying ophthalmic conditions, or more often are headache disorders unrelated to the eyes. Understanding the phenotype of the headache is critical for advice, safe discharge or onward referral. This review will provide an update on the criteria for common headache disorders that are often seen by ophthalmology and embrace disorders associated with ophthalmic diseases. It will also describe the changing management of migraine and outline recent therapies that are currently available.
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Affiliation(s)
- Susan P Mollan
- Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, B15 2TH, Birmingham, UK
| | - Jasvir S Virdee
- Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, B15 2TH, Birmingham, UK
| | - Edward J Bilton
- Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, B15 2TH, Birmingham, UK
| | - Mark Thaller
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, B15 2TH, Birmingham, UK
| | - Anita Krishan
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - Alexandra J Sinclair
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, B15 2TH, Birmingham, UK.
- Metabolic Neurology, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, B15 2TT, UK.
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Grangeon L, O'Connor E, Danno D, Ngoc TMP, Cheema S, Tronvik E, Davagnanam I, Matharu M. Is pituitary MRI screening necessary in cluster headache? Cephalalgia 2021; 41:779-788. [PMID: 33406848 PMCID: PMC8166405 DOI: 10.1177/0333102420983303] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective To determine the prevalence and clinical predictors of pituitary adenomas in cluster headache patients, in order to determine the necessity of performing dedicated pituitary magnetic resonance imaging in patients with cluster headache. Methods A retrospective study was conducted of all consecutive patients diagnosed with cluster headache and with available brain magnetic resonance imaging between 2007 and 2017 in a tertiary headache center. Data including demographics, attack characteristics, response to treatments, results of neuroimaging, and routine pituitary function tests were recorded. Results Seven hundred and eighteen cluster headache patients attended the headache clinic; 643 underwent a standard magnetic resonance imaging scan, of whom 376 also underwent dedicated pituitary magnetic resonance imaging. Pituitary adenomas occurred in 17 of 376 patients (4.52%). Non-functioning microadenomas (n = 14) were the most common abnormality reported. Two patients, one of whom lacked the symptoms of pituitary disease, required treatment for their pituitary lesion. No clinical predictors of those adenomas were identified after multivariate analysis using random forests. Systematic pituitary magnetic resonance imaging scanning did not benefit even a single patient in the entire cohort. Conclusion The prevalence of pituitary adenomas in cluster headache is similar to that reported in the general population, thereby precluding an over-representation of pituitary lesions in cluster headache. We conclude that the diagnostic assessment of cluster headache patients should not include specific pituitary screening. Only patients with standard brain magnetic resonance imaging findings or symptoms suggestive of a pituitary disorder require brain magnetic resonance imaging with dedicated pituitary views.
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Affiliation(s)
- Lou Grangeon
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, Queen Square, London, UK.,Headache and Facial Pain Group, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Emer O'Connor
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Daisuke Danno
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | | | - Sanjay Cheema
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Erling Tronvik
- Mathematics Institute of Orsay, Paris Sud University, Orsay, France.,Department of Neurology, St Olav's University Hospital, Trondheim, Norway.,NTNU (University of Science and Technology), Department of Neuromedicine and Movement Science, Trondheim, Norway
| | | | - Manjit Matharu
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, Queen Square, London, UK
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Grangeon L, O'Connor E, Chan CK, Akijian L, Pham Ngoc TM, Matharu MS. New insights in post-traumatic headache with cluster headache phenotype: a cohort study. J Neurol Neurosurg Psychiatry 2020; 91:572-579. [PMID: 32381638 PMCID: PMC7279192 DOI: 10.1136/jnnp-2019-322725] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To define the characteristics of post-traumatic headache with cluster headache phenotype (PTH-CH) and to compare these characteristics with primary CH. METHODS A retrospective study was conducted of patients seen between 2007 and 2017 in a headache centre and diagnosed with PTH-CH that developed within 7 days of head trauma. A control cohort included 553 patients with primary CH without any history of trauma who attended the headache clinic during the same period. Data including demographics, attack characteristics and response to treatments were recorded. RESULTS Twenty-six patients with PTH-CH were identified. Multivariate analysis revealed significant associations between PTH-CH and family history of CH (OR 3.32, 95% CI 1.31 to 8.63), chronic form (OR 3.29, 95% CI 1.70 to 6.49), parietal (OR 14.82, 95% CI 6.32 to 37.39) or temporal (OR 2.04, 95% CI 1.10 to 3.84) location of pain, and presence of prominent cranial autonomic features during attacks (miosis OR 11.24, 95% CI 3.21 to 41.34; eyelid oedema OR 5.79, 95% CI 2.57 to 13.82; rhinorrhoea OR 2.65, 95% CI 1.26 to 5.86; facial sweating OR 2.53, 95% CI 1.33 to 4.93). Patients with PTH-CH were at a higher risk of being intractable to acute (OR 12.34, 95% CI 2.51 to 64.73) and preventive (OR 16.98, 95% CI 6.88 to 45.52) treatments and of suffering from associated chronic migraine (OR 10.35, 95% CI 3.96 to 28.82). CONCLUSION This largest series of PTH-CH defines it as a unique entity with specific evolutive profile. Patients with PTH-CH are more likely to suffer from the chronic variant, have marked autonomic features, be intractable to treatment and have associated chronic migraine compared with primary CH.
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Affiliation(s)
- Lou Grangeon
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, London, UK.,Department of Neurology, University Hospital Centre Rouen, Rouen, Normandie, France
| | - Emer O'Connor
- Department of Molecular Neuroscience, UCL Queen Square Institute of Neurology, London, UK
| | - Chun-Kong Chan
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, London, UK
| | - Layan Akijian
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, London, UK
| | - Thanh Mai Pham Ngoc
- Mathematics Institute of Orsay, Paris-Sud University, CNRS and Paris-Saclay University, Orsay, Île-de-France, France
| | - Manjit Singh Matharu
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, London, UK .,Headache and Facial Pain Group, The National Hospital for Neurology and Neurosurgery, London, UK
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Barghouthi T, Lemley R, Figurelle M, Bushnell C. Epidemiology of neurologic disease in pregnancy. HANDBOOK OF CLINICAL NEUROLOGY 2020; 171:119-141. [PMID: 32736746 DOI: 10.1016/b978-0-444-64239-4.00006-0] [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: 06/11/2023]
Abstract
Many neurologic diseases in women are influenced by the physiologic and hormonal changes of pregnancy, and pregnancy itself poses challenges in both treatment and evaluation of these conditions. Some diseases, such as epilepsy and multiple sclerosis, have a high enough prevalence in the young female population to support robust epidemiologic data while many other neurologic diseases, such as specific myopathies and muscular dystrophies, have a low prevalence, with data limited to case reports and small case series. This chapter features epidemiologic information regarding a breadth of neurologic conditions, including stroke, epilepsy, demyelinating disease, peripheral neuropathies, migraine, sleep-disordered breathing, and meningioma, in women in the preconception, pregnancy, and postpartum stages.
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Affiliation(s)
- Tamara Barghouthi
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Regan Lemley
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Morgan Figurelle
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Cheryl Bushnell
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States.
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Buture A, Boland JW, Ahmed F, Dikomitis L. Images depicting headache pain - a tool to aid the diagnosis of cluster headache: a pilot study. J Multidiscip Healthc 2019; 12:691-698. [PMID: 31686833 PMCID: PMC6709815 DOI: 10.2147/jmdh.s207128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/18/2019] [Indexed: 12/18/2022] Open
Abstract
Introduction and objective The diagnosis of primary headaches is based on the International Classification of Headache Disorders (ICHD-3). Cluster headache (CH), a debilitating primary headache, is often misdiagnosed as migraine. In the absence of biological markers, a new visual screening tool with images depicting pain could aid the correct diagnosis of CH. The objective of the study is to test the tool on healthy participants and participants with CH and migraine. Methods In phase 1, 6 images portraying people with pain were tested on 150 healthy participants. The healthy participants were asked to rate the images as mild, moderate, severe or excruciating pain. In phase 2, the images were further tested on 116 participants with headache (16 participants with CH, 100 participants with migraine). The participants were recruited prospectively from a tertiary headache center between February and May 2017. The participants were asked to choose which image best illustrated their headache attacks. Results Phase 1 results showed that the images represent a range of headache pain severities from mild to excruciating as rated by healthy participants. They rated two images as excruciating, one image as severe, one image as moderate/severe, one image as moderate and one image as mild. Phase 2 results showed that two-thirds of participants with CH (69%) and half of the participants with migraine (52%) chose an image described as excruciating by the healthy participants. Conclusion We developed a screening tool with six drawings depicting headache pain severities from mild to excruciating as rated by the healthy participants. Although the images did not differentiate between CH and migraine, the study indicated the potential of using visual aids to assess headache severity.
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Affiliation(s)
- Alina Buture
- Hull York Medical School, University of Hull, Hull, UK
| | - Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Fayyaz Ahmed
- Hull York Medical School, University of Hull, Hull, UK.,Department of Neurology, Hull Royal Infirmary, Hull, UK
| | - Lisa Dikomitis
- School of Medicine, Keele University, Newcastle-under-Lyme, UK.,School of Primary, Community and Social Care, Keele University, Newcastle-under-Lyme, UK
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Lambru G, Rantell K, Levy A, Matharu MS. A prospective comparative study and analysis of predictors of SUNA and SUNCT. Neurology 2019; 93:e1127-e1137. [PMID: 31427501 DOI: 10.1212/wnl.0000000000008134] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/29/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Despite the similar phenotypes, comparison between short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with autonomic features (SUNA) has hitherto not been possible due to the dearth of studies validating the phenotype of SUNA. Therefore, these 2 syndromes have been kept separate in the International Classification of Headache Disorders. The aim of this study is to characterize and compare the clinical phenotypes of large clinic-based cohorts of patients with SUNA and SUNCT. METHODS The clinical phenotype of consecutive patients with SUNA identified from a single specialist headache center in the United Kingdom between 2007 and 2012 was studied and compared to that of patients with SUNCT. RESULTS Sixty-three patients with SUNA (18 male, 28.6%) and 70 patients with SUNCT (32 male, 35.7%) were included. The demographic and clinical characteristics of patients with SUNA were similar to those of patients with SUNCT. Ptosis and rhinorrhea were predictors of SUNCT. The corresponding odds ratios (ORs) (95% confidence interval) were 3.79 (1.64-8.77, p = 0.002) and 2.46 (1.09-5.59, p = 0.031), respectively. The presence of spontaneous only attacks was a predictor for SUNA (OR 2.58 [1.10-6.05], p = 0.029). CONCLUSION No major clinical differences have emerged between SUNCT and SUNA, bar the fact that SUNCT is characterized by more prominent cranial autonomic features and triggerability. We propose that the 2 disorders be placed together in a single diagnostic category for which new diagnostic criteria are proposed.
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Affiliation(s)
- Giorgio Lambru
- From the Headache Group (G.L., A.L., M.S.N.) and Education Unit (K.R.), UCL Queen Square Institute of Neurology; and National Hospital for Neurology and Neurosurgery (G.L., A.L., M.S.N.), London, UK
| | - Khadija Rantell
- From the Headache Group (G.L., A.L., M.S.N.) and Education Unit (K.R.), UCL Queen Square Institute of Neurology; and National Hospital for Neurology and Neurosurgery (G.L., A.L., M.S.N.), London, UK
| | - Andrew Levy
- From the Headache Group (G.L., A.L., M.S.N.) and Education Unit (K.R.), UCL Queen Square Institute of Neurology; and National Hospital for Neurology and Neurosurgery (G.L., A.L., M.S.N.), London, UK
| | - Manjit S Matharu
- From the Headache Group (G.L., A.L., M.S.N.) and Education Unit (K.R.), UCL Queen Square Institute of Neurology; and National Hospital for Neurology and Neurosurgery (G.L., A.L., M.S.N.), London, UK.
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Sadig RR, Wakefield D, Fraser CL. The First Case Report of Schnitzler Syndrome Presenting with Eye Pain. Ocul Immunol Inflamm 2019; 28:175-177. [PMID: 30794479 DOI: 10.1080/09273948.2018.1563704] [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: 10/27/2022]
Abstract
Schnitzler syndrome is a rare, auto inflammatory condition known to manifest with bone pain, urticarial rash, fevers, relapsing arthralgia, and fatigue. In this case report, we describe a patient who was diagnosed with Schnitzler Syndrome that had initially presented with a unilateral pressure-type headache with a sensation of a 'dagger' stabbing into the back of the eye. He also had an associated ipsilateral redness of the conjunctiva, eyelid swelling, subtle optic disc elevations bilaterally and facial flushing - but with no visual acuity, pupillary, or lacrimatory changes. Anterior segment, fundoscopy, intraocular pressures and extraocular muscle movements were otherwise normal.
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Affiliation(s)
- Richard R Sadig
- St George and Sutherland Clinical School, Faculty of Medicine, University of New South Wales, Kogarah, NSW, Australia
| | - D Wakefield
- Faculty of Medicine, University of New South Wales, NSW Health Pathology, Sutherland Centre of Immunology, The Sutherland Hospital, The Kingsway, Caringbah, NSW, Australia
| | - C L Fraser
- Save Sight Institute, University of Sydney, Sydney, NSW, Australia
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Abstract
PURPOSE OF REVIEW Headaches encompass a broad-based category of a symptom of pain in the region of the head or neck. For those patients who unfortunately do not obtain relief from conservative treatment, interventional techniques have been developed and are continuing to be refined in an attempt to treat this subset of patients with the goal of return of daily activities. This investigation reviews various categories of headaches, their pathophysiology, and types of interventional treatments currently available. RECENT FINDINGS Injection of botulinum toxin has been shown to increase the number of headache free days for patients suffering from chronic tension-type headaches. Suboccipital steroid injection has been demonstrated as a successful treatment option for patients suffering from cluster headache. Occipital nerve stimulation (ONS) has been described as a treatment for all types of trigeminal autonomic cephalgias. Percutaneous ONS is a minimally invasive and reversible approach to manage occipital neuralgia performed utilizing subcutaneous electrodes placed superficial to the cervical muscular fascia in the suboccipital area. Radiofrequency lesioning is another commonly used treatment in the management of chronic pain syndromes of the head and neck. If a diagnostic sphenopalatine ganglion block successfully resolves the patient's symptoms, neurolysis can be employed as a more permanent solution. Although many patients who suffer from headaches can be treated with conservative, less-invasive treatments, there still remains at present an ever-increasing need for those patients who are refractory to conservative measures and thus require interventional treatments. These procedures are continually evolving to become safer, more precise, and more readily available for clinicians to provide to their patients.
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Lambru G, Giakoumakis E, Al-Kaisy A. Advanced technologies and novel neurostimulation targets in trigeminal autonomic cephalalgias. Neurol Sci 2015; 36 Suppl 1:125-9. [PMID: 26017527 DOI: 10.1007/s10072-015-2171-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The trigeminal autonomic cephalalgias (TACs) are a group of rare but disabling primary headache disorders. Their management is challenging, since only few effective treatments are available and high doses may be required to control the headache, compromising patients' adherence to treatments. A significant minority of patients, who fail to respond to or tolerate established treatments, are left with enormous level of disability and disruption to their quality of life. A growing body of evidence demonstrates the efficacy of central and peripheral neuromodulation approaches for management of patients with refractory TACs. In view of the potential risks related to deep brain stimulation of the posterior hypothalamic region, occipital nerve stimulation is currently considered the first treatment option for refractory chronic TACs. However, in view of the presence of paraesthesia induced by the stimulator, no robust controlled trials have been possible so far. Additionally, the equipment used for occipital nerve stimulation is not designed specifically for peripheral nerve stimulation, thus a significant proportion of patients experience device-related complications that often require surgical revisions. To overcome these issues, new neurostimulation technologies using less invasive or non-invasive approaches and modulating different neuroanatomical targets have been recently studied.
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Affiliation(s)
- Giorgio Lambru
- Headache Service, Pain Management and Neuromodulation Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK,
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12
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Edvardsson B. Symptomatic cluster headache: a review of 63 cases. SPRINGERPLUS 2014; 3:64. [PMID: 24570848 PMCID: PMC3928394 DOI: 10.1186/2193-1801-3-64] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 01/28/2014] [Indexed: 11/25/2022]
Abstract
Cluster headache is a primary headache by definition not caused by any known underlying structural pathology. Symptomatic cases have been described, for example tumours, dissections and infections, but a causal relationship between the underlying lesion and the headache is difficult to determine in many cases. The proper diagnostic evaluation of cluster headache is an issue unresolved. The literature has been reviewed for symptomatic cluster headache or cluster headache-like cases in which causality was likely. The review also attempted to identify clinical predictors of underlying lesions in order to formulate guidelines for neuroimaging. Sixty-three cluster headache or "cluster headache-like"/"cluster-like headache" cases in the literature were identified which were associated with an underlying lesion. A majority of the cases had a non-typical presentation that is atypical symptomatology and abnormal examination (including Horner’s syndrome). A striking finding in this appraisal was that a significant proportion of CH cases were secondary to diseases of the pituitary gland or pituitary region. Another notable finding was that a proportion of cluster headache cases were associated with arterial dissection. Even typical cluster headaches can be caused by structural lesions and the response to typical cluster headache treatments does not exclude a secondary form. It is difficult to draw definitive conclusions from this retrospective review of case reports especially considering the size of the material. However, based on this review, I suggest that neuroimaging, preferably contrast-enhanced magnetic resonance imaging/magnetic resonance angiography should be undertaken in patients with atypical symptomatology, late onset, abnormal examination (including Horner’s syndrome), or those resistant to the appropriate medical treatment. The decision to perform magnetic resonance imaging in cases of typical cluster headache remains a matter of medical art.
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Affiliation(s)
- Bengt Edvardsson
- Department of Clinical Sciences Lund, Faculty of Medicine, Neurology, Skane University Hospital, S-221 85, Lund, Sweden
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