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Rasmussen AV, Jensen RH, Gantenbein A, Sumelahti ML, Braschinsky M, Lagrata S, Tamela K, Trouerbach-Kraan J, Matharu MS, Dalevi V, Smits-Kimman H, Munksgaard SB, Tröndle J, Eriksen MØ, Gravdahl GB, Larsen CN, Tomkins E, Hassinen M, Øie LR, Karlsson LE, Mose LS. Consensus recommendations on the role of nurses in headache care: A European e-Delphi study. Cephalalgia 2024; 44:3331024241252161. [PMID: 38708967 DOI: 10.1177/03331024241252161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
BACKGROUND Nurses work at headache centres throughout Europe, and their care for migraine patients is acknowledged. However, the specific roles and tasks of nursing vary, and a unified understanding is lacking, posing challenges to knowledge sharing and research. OBJECTIVES Using an e-Delphi study method, the objective is to obtain healthcare professional headache experts' opinions on nursing-specific roles and tasks and combine this into consensus statements for nurse recommendations for migraine treatment. METHODS A three-round questionnaire study was conducted with nurses and neurologists from 18 specialised headache centres in 10 countries. In round 1, statements were compiled from a systematic examination of existing literature and expert opinions. In rounds 2 and 3, the experts rated the importance of statements (from round 1) on a 5-point Likert scale. Statements were analysed using a content analysis method, and the consensus of pre-defined statements was evaluated with gradually increased predetermined criteria using descriptive statistics. RESULTS Twenty-one experts, representing all 10 countries, participated. The predetermined consensus of ≥70% agreement was reached for 42 out of the initial 63 statements. These statements formed the final recommendations within two themes: "The nurses' roles and tasks in the clinical setting" and "The nurses' roles and tasks in educating patients and colleagues." The consensus level of statements was strong, with 40% receiving unanimous agreement (100%) and 97% achieving relatively high agreement (>80%). CONCLUSION Nursing plays a vital role with diverse tasks in migraine care. This study offers practical recommendations and a framework for nurses, equipping them with a clinical tool to enhance care and promote a coordinated approach to migraine treatment.
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Affiliation(s)
| | - Rigmor Hoejland Jensen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Andres Gantenbein
- Pain & Research Department, Rehabilitation Center ZURZACH Care, Bad Zurzach, Switzerland
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | | | - Mark Braschinsky
- Department of Neurology, Tartu University Hospital, Tartu, Estonia
- Neurology Clinic, University of Tartu, Tartu, Estonia
| | - Susie Lagrata
- Headache and Facial Pain Group, The National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, UK
| | - Kristi Tamela
- Department of Neurology, Tartu University Hospital, Tartu, Estonia
| | | | - Manjit S Matharu
- Headache and Facial Pain Group, University College London, Queen Square Institute of Neurology, London, UK
- The National Hospital for Neurology and Neurosurgery, London, UK
| | - Veronica Dalevi
- Region Värmland, Neurologi- Och Rehabiliteringsmottagningen, Centralsjukhuset, Karlstad, Sweden
| | | | | | - Johannes Tröndle
- Neurorehabilitation Department, Rehaklinik Bad Zurzach, Switzerland
| | - Maren Østergaard Eriksen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Gøril Bruvik Gravdahl
- Norwegian Advisory Unit on Headaches, St. Olav University Hospital, Trondheim, Norway
- NorHEAD, Norwegian Headache Research Centre, Norway
- Department of Neuromedicine and Movement Science, NTNU, Trondheim, Norway
| | | | - Esther Tomkins
- Neurology Department, Beaumont Hospital, Dublin, Ireland
| | - Marja Hassinen
- Neurocenter, Helsinki University Hospital, Neurology Outpatient Clinic & Helsinki Headache Center, Helsinki, Finland
| | - Lise Rystad Øie
- Department of neurology, St Olav University hospital, Norwegian Headache Research Centre (Norhead), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | | | - Louise Schlosser Mose
- Research Unit of Neurology, University Hospital of Southern Denmark, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Cheema S, Ferreira F, Parras O, Lagrata S, Kamourieh S, Pakzad A, Zrinzo L, Matharu M, Akram H. Association of Clinical and Neuroanatomic Factors With Response to Ventral Tegmental Area DBS in Chronic Cluster Headache. Neurology 2023; 101:e2423-e2433. [PMID: 37848331 PMCID: PMC10752645 DOI: 10.1212/wnl.0000000000207750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/13/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Deep brain stimulation (DBS) of the ventral tegmental area (VTA) is a surgical treatment option for selected patients with refractory chronic cluster headache (CCH). We aimed to identify clinical and structural neuroimaging factors associated with response to VTA DBS in CCH. METHODS This prospective observational cohort study examines consecutive patients with refractory CCH treated with VTA DBS by a multidisciplinary team in a single tertiary neuroscience center as part of usual care. Headache diaries and validated questionnaires were completed at baseline and regular follow-up intervals. All patients underwent T1-weighted structural MRI before surgery. We compared clinical features using multivariable logistic regression and neuroanatomic differences using voxel-based morphometry (VBM) between responders and nonresponders. RESULTS Over a 10-year period, 43 patients (mean age 53 years, SD 11.9), including 29 male patients, with a mean duration of CCH 12 years (SD 7.4), were treated and followed up for at least 1 year (mean follow-up duration 5.6 years). Overall, there was a statistically significant improvement in median attack frequency from 140 to 56 per month (Z = -4.95, p < 0.001), attack severity from 10/10 to 8/10 (Z = -4.83, p < 0.001), and duration from 110 to 60 minutes (Z = -3.48, p < 0.001). Twenty-nine (67.4%) patients experienced ≥50% improvement in attack frequency and were therefore classed as responders. There were no serious adverse events. The most common side effects were discomfort or pain around the battery site (7 patients) and transient diplopia and/or oscillopsia (6 patients). There were no differences in demographics, headache characteristics, or comorbidities between responders and nonresponders. VBM identified increased neural density in nonresponders in several brain regions, including the orbitofrontal cortex, anterior cingulate cortex, anterior insula, and amygdala, which were statistically significant (p < 0.001). DISCUSSION VTA DBS showed no serious adverse events, and, although there was no placebo control, was effective in approximately two-thirds of patients at long-term follow-up. This study did not reveal any reliable clinical predictors of response. However, nonresponders had increased neural density in brain regions linked to processing of pain and autonomic function, both of which are prominent in the pathophysiology of CCH.
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Affiliation(s)
- Sanjay Cheema
- From the Headache and Facial Pain Group (S.C., S.K., M.M.), UCL Queen Square Institute of Neurology; The National Hospital for Neurology and Neurosurgery (S.C., F.F., O.P., S.L., S.K., L.Z., M.M., H.A.); Functional Neurosurgery Unit (F.F., O.P., L.Z., H.A.), UCL Queen Square Institute of Neurology; Wellcome Centre for Human Neuroimaging (F.F.), 12 Queen Square; UCL EPSRC Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare (i4health) (F.F.); Centre for Medical Image Computing (A.P.), University College London; and Department of Medical Physics and Biomedical Engineering (A.P.), University College London, London, UK.
| | - Francisca Ferreira
- From the Headache and Facial Pain Group (S.C., S.K., M.M.), UCL Queen Square Institute of Neurology; The National Hospital for Neurology and Neurosurgery (S.C., F.F., O.P., S.L., S.K., L.Z., M.M., H.A.); Functional Neurosurgery Unit (F.F., O.P., L.Z., H.A.), UCL Queen Square Institute of Neurology; Wellcome Centre for Human Neuroimaging (F.F.), 12 Queen Square; UCL EPSRC Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare (i4health) (F.F.); Centre for Medical Image Computing (A.P.), University College London; and Department of Medical Physics and Biomedical Engineering (A.P.), University College London, London, UK
| | - Olga Parras
- From the Headache and Facial Pain Group (S.C., S.K., M.M.), UCL Queen Square Institute of Neurology; The National Hospital for Neurology and Neurosurgery (S.C., F.F., O.P., S.L., S.K., L.Z., M.M., H.A.); Functional Neurosurgery Unit (F.F., O.P., L.Z., H.A.), UCL Queen Square Institute of Neurology; Wellcome Centre for Human Neuroimaging (F.F.), 12 Queen Square; UCL EPSRC Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare (i4health) (F.F.); Centre for Medical Image Computing (A.P.), University College London; and Department of Medical Physics and Biomedical Engineering (A.P.), University College London, London, UK
| | - Susie Lagrata
- From the Headache and Facial Pain Group (S.C., S.K., M.M.), UCL Queen Square Institute of Neurology; The National Hospital for Neurology and Neurosurgery (S.C., F.F., O.P., S.L., S.K., L.Z., M.M., H.A.); Functional Neurosurgery Unit (F.F., O.P., L.Z., H.A.), UCL Queen Square Institute of Neurology; Wellcome Centre for Human Neuroimaging (F.F.), 12 Queen Square; UCL EPSRC Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare (i4health) (F.F.); Centre for Medical Image Computing (A.P.), University College London; and Department of Medical Physics and Biomedical Engineering (A.P.), University College London, London, UK
| | - Salwa Kamourieh
- From the Headache and Facial Pain Group (S.C., S.K., M.M.), UCL Queen Square Institute of Neurology; The National Hospital for Neurology and Neurosurgery (S.C., F.F., O.P., S.L., S.K., L.Z., M.M., H.A.); Functional Neurosurgery Unit (F.F., O.P., L.Z., H.A.), UCL Queen Square Institute of Neurology; Wellcome Centre for Human Neuroimaging (F.F.), 12 Queen Square; UCL EPSRC Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare (i4health) (F.F.); Centre for Medical Image Computing (A.P.), University College London; and Department of Medical Physics and Biomedical Engineering (A.P.), University College London, London, UK
| | - Ashkan Pakzad
- From the Headache and Facial Pain Group (S.C., S.K., M.M.), UCL Queen Square Institute of Neurology; The National Hospital for Neurology and Neurosurgery (S.C., F.F., O.P., S.L., S.K., L.Z., M.M., H.A.); Functional Neurosurgery Unit (F.F., O.P., L.Z., H.A.), UCL Queen Square Institute of Neurology; Wellcome Centre for Human Neuroimaging (F.F.), 12 Queen Square; UCL EPSRC Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare (i4health) (F.F.); Centre for Medical Image Computing (A.P.), University College London; and Department of Medical Physics and Biomedical Engineering (A.P.), University College London, London, UK
| | - Ludvic Zrinzo
- From the Headache and Facial Pain Group (S.C., S.K., M.M.), UCL Queen Square Institute of Neurology; The National Hospital for Neurology and Neurosurgery (S.C., F.F., O.P., S.L., S.K., L.Z., M.M., H.A.); Functional Neurosurgery Unit (F.F., O.P., L.Z., H.A.), UCL Queen Square Institute of Neurology; Wellcome Centre for Human Neuroimaging (F.F.), 12 Queen Square; UCL EPSRC Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare (i4health) (F.F.); Centre for Medical Image Computing (A.P.), University College London; and Department of Medical Physics and Biomedical Engineering (A.P.), University College London, London, UK
| | - Manjit Matharu
- From the Headache and Facial Pain Group (S.C., S.K., M.M.), UCL Queen Square Institute of Neurology; The National Hospital for Neurology and Neurosurgery (S.C., F.F., O.P., S.L., S.K., L.Z., M.M., H.A.); Functional Neurosurgery Unit (F.F., O.P., L.Z., H.A.), UCL Queen Square Institute of Neurology; Wellcome Centre for Human Neuroimaging (F.F.), 12 Queen Square; UCL EPSRC Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare (i4health) (F.F.); Centre for Medical Image Computing (A.P.), University College London; and Department of Medical Physics and Biomedical Engineering (A.P.), University College London, London, UK
| | - Harith Akram
- From the Headache and Facial Pain Group (S.C., S.K., M.M.), UCL Queen Square Institute of Neurology; The National Hospital for Neurology and Neurosurgery (S.C., F.F., O.P., S.L., S.K., L.Z., M.M., H.A.); Functional Neurosurgery Unit (F.F., O.P., L.Z., H.A.), UCL Queen Square Institute of Neurology; Wellcome Centre for Human Neuroimaging (F.F.), 12 Queen Square; UCL EPSRC Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare (i4health) (F.F.); Centre for Medical Image Computing (A.P.), University College London; and Department of Medical Physics and Biomedical Engineering (A.P.), University College London, London, UK
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3
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Cheema S, Anderson J, Angus-Leppan H, Armstrong P, Butteriss D, Carlton Jones L, Choi D, Chotai A, D'Antona L, Davagnanam I, Davies B, Dorman PJ, Duncan C, Ellis S, Iodice V, Joy C, Lagrata S, Mead S, Morland D, Nissen J, Pople J, Redfern N, Sayal PP, Scoffings D, Secker R, Toma AK, Trevarthen T, Walkden J, Beck J, Kranz PG, Schievink W, Wang SJ, Matharu MS. Multidisciplinary consensus guideline for the diagnosis and management of spontaneous intracranial hypotension. J Neurol Neurosurg Psychiatry 2023; 94:835-843. [PMID: 37147116 PMCID: PMC10511987 DOI: 10.1136/jnnp-2023-331166] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/21/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND We aimed to create a multidisciplinary consensus clinical guideline for best practice in the diagnosis, investigation and management of spontaneous intracranial hypotension (SIH) due to cerebrospinal fluid leak based on current evidence and consensus from a multidisciplinary specialist interest group (SIG). METHODS A 29-member SIG was established, with members from neurology, neuroradiology, anaesthetics, neurosurgery and patient representatives. The scope and purpose of the guideline were agreed by the SIG by consensus. The SIG then developed guideline statements for a series of question topics using a modified Delphi process. This process was supported by a systematic literature review, surveys of patients and healthcare professionals and review by several international experts on SIH. RESULTS SIH and its differential diagnoses should be considered in any patient presenting with orthostatic headache. First-line imaging should be MRI of the brain with contrast and the whole spine. First-line treatment is non-targeted epidural blood patch (EBP), which should be performed as early as possible. We provide criteria for performing myelography depending on the spine MRI result and response to EBP, and we outline principles of treatments. Recommendations for conservative management, symptomatic treatment of headache and management of complications of SIH are also provided. CONCLUSIONS This multidisciplinary consensus clinical guideline has the potential to increase awareness of SIH among healthcare professionals, produce greater consistency in care, improve diagnostic accuracy, promote effective investigations and treatments and reduce disability attributable to SIH.
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Affiliation(s)
- Sanjay Cheema
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Headache and Facial Pain Group, National Hospital for Neurology and Neurosurgery, London, UK
| | - Jane Anderson
- Neurology Department, Addenbrooke's Hospital, Cambridge, UK
| | | | - Paul Armstrong
- Neuroradiology Department, Institute of Neurological Sciences, Glasgow, UK
| | - David Butteriss
- Department of Neuroradiology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Lalani Carlton Jones
- Neuroradiology Department, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- Neuroradiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - David Choi
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Amar Chotai
- Department of Neuroradiology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Linda D'Antona
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Indran Davagnanam
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Brendan Davies
- Neurology Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Paul J Dorman
- Department of Neurology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | - Simon Ellis
- Neurology Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Valeria Iodice
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Autonomic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - Clare Joy
- CSF Leak Association, Strathpeffer, UK
| | - Susie Lagrata
- Headache and Facial Pain Group, National Hospital for Neurology and Neurosurgery, London, UK
| | | | - Danny Morland
- Department of Anaesthesia, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Justin Nissen
- Neurosurgery Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | - Nancy Redfern
- Department of Anaesthesia, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Parag P Sayal
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | | | | | - Ahmed K Toma
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | | | | | - Jürgen Beck
- Department of Neurosurgery, Medical Center-University of Freiburg, Freiburg, Germany
| | - Peter George Kranz
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Wouter Schievink
- Neurosurgery Department, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Shuu-Jiun Wang
- Neurology Department, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
| | - Manjit Singh Matharu
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Headache and Facial Pain Group, National Hospital for Neurology and Neurosurgery, London, UK
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4
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Winsvold BS, Harder AVE, Ran C, Chalmer MA, Dalmasso MC, Ferkingstad E, Tripathi KP, Bacchelli E, Børte S, Fourier C, Petersen AS, Vijfhuizen LS, Magnusson SH, O'Connor E, Bjornsdottir G, Häppölä P, Wang Y, Callesen I, Kelderman T, Gallardo VJ, de Boer I, Olofsgård FJ, Heinze K, Lund N, Thomas LF, Hsu C, Pirinen M, Hautakangas H, Ribasés M, Guerzoni S, Sivakumar P, Yip J, Heinze A, Küçükali F, Ostrowski SR, Pedersen OB, Kristoffersen ES, Martinsen AE, Artigas MS, Lagrata S, Cainazzo MM, Adebimpe J, Quinn O, Göbel C, Cirkel A, Volk AE, Heilmann‐Heimbach S, Skogholt AH, Gabrielsen ME, Wilbrink LA, Danno D, Mehta D, Guðbjartsson DF, Rosendaal FR, Willems van Dijk K, Fronczek R, Wagner M, Scherer M, Göbel H, Sleegers K, Sveinsson OA, Pani L, Zoli M, Ramos‐Quiroga JA, Dardiotis E, Steinberg A, Riedel‐Heller S, Sjöstrand C, Thorgeirsson TE, Stefansson H, Southgate L, Trembath RC, Vandrovcova J, Noordam R, Paemeleire K, Stefansson K, Fann CS, Waldenlind E, Tronvik E, Jensen RH, Chen S, Houlden H, Terwindt GM, Kubisch C, Maestrini E, Vikelis M, Pozo‐Rosich P, Belin AC, Matharu M, van den Maagdenberg AM, Hansen TF, Ramirez A, Zwart J. Cluster Headache Genomewide Association Study and Meta-Analysis Identifies Eight Loci and Implicates Smoking as Causal Risk Factor. Ann Neurol 2023; 94:713-726. [PMID: 37486023 PMCID: PMC10952302 DOI: 10.1002/ana.26743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/22/2023] [Accepted: 07/07/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE The objective of this study was to aggregate data for the first genomewide association study meta-analysis of cluster headache, to identify genetic risk variants, and gain biological insights. METHODS A total of 4,777 cases (3,348 men and 1,429 women) with clinically diagnosed cluster headache were recruited from 10 European and 1 East Asian cohorts. We first performed an inverse-variance genomewide association meta-analysis of 4,043 cases and 21,729 controls of European ancestry. In a secondary trans-ancestry meta-analysis, we included 734 cases and 9,846 controls of East Asian ancestry. Candidate causal genes were prioritized by 5 complementary methods: expression quantitative trait loci, transcriptome-wide association, fine-mapping of causal gene sets, genetically driven DNA methylation, and effects on protein structure. Gene set and tissue enrichment analyses, genetic correlation, genetic risk score analysis, and Mendelian randomization were part of the downstream analyses. RESULTS The estimated single nucleotide polymorphism (SNP)-based heritability of cluster headache was 14.5%. We identified 9 independent signals in 7 genomewide significant loci in the primary meta-analysis, and one additional locus in the trans-ethnic meta-analysis. Five of the loci were previously known. The 20 genes prioritized as potentially causal for cluster headache showed enrichment to artery and brain tissue. Cluster headache was genetically correlated with cigarette smoking, risk-taking behavior, attention deficit hyperactivity disorder (ADHD), depression, and musculoskeletal pain. Mendelian randomization analysis indicated a causal effect of cigarette smoking intensity on cluster headache. Three of the identified loci were shared with migraine. INTERPRETATION This first genomewide association study meta-analysis gives clues to the biological basis of cluster headache and indicates that smoking is a causal risk factor. ANN NEUROL 2023;94:713-726.
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Affiliation(s)
- Bendik S. Winsvold
- Department of Research and Innovation, Division of Clinical NeuroscienceOslo University HospitalOsloNorway
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Department of NeurologyOslo University HospitalOsloNorway
- Norwegian Centre for Headache Research (NorHEAD), Department of Neuromedicine and Movement ScienceNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Aster V. E. Harder
- Department of Human GeneticsLeiden University Medical CenterLeidenThe Netherlands
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
| | - Caroline Ran
- Centre for Cluster Headache, Department of NeuroscienceKarolinska InstitutetStockholmSweden
| | - Mona A. Chalmer
- Department of Neurology, Danish Headache Center, Rigshospitalet‐GlostrupUniversity of Copenhagen University HospitalGlostrupDenmark
| | - Maria Carolina Dalmasso
- Division of Neurogenetics and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
- Neurosciences and Complex Systems Unit (EnyS), CONICET, Hospital El Cruce 'N. Kirchner'National University A. Jauretche (UNAJ)Florencio VarelaArgentina
| | | | - Kumar Parijat Tripathi
- Division of Neurogenetics and Molecular Psychiatry, Department of PsychiatryUniklinik KölnCologneGermany
| | - Elena Bacchelli
- Department of Pharmacy and BiotechnologyUniversity of BolognaBolognaItaly
| | - Sigrid Børte
- Department of Research and Innovation, Division of Clinical NeuroscienceOslo University HospitalOsloNorway
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Norwegian Centre for Headache Research (NorHEAD), Department of Neuromedicine and Movement ScienceNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Carmen Fourier
- Centre for Cluster Headache, Department of NeuroscienceKarolinska InstitutetStockholmSweden
| | - Anja S. Petersen
- Department of Neurology, Danish Headache Center, Rigshospitalet‐GlostrupUniversity of Copenhagen University HospitalGlostrupDenmark
| | | | | | - Emer O'Connor
- Department of Neuromuscular Diseases, Institute of NeurologyUniversity College LondonLondonUK
| | | | - Paavo Häppölä
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of HelsinkiHelsinkiFinland
| | - Yen‐Feng Wang
- Department of NeurologyTaipei Veterans General HospitalTaipeiTaiwan
- Brain Research CenterNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Ida Callesen
- Department of Neurology, Danish Headache Center, Rigshospitalet‐GlostrupUniversity of Copenhagen University HospitalGlostrupDenmark
| | - Tim Kelderman
- Department of NeurologyGhent University HospitalGhentBelgium
| | - Victor J Gallardo
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de MedicinaUniversitat Autònoma de Barcelona, Vall d'Hebron Research Institute (VHIR)BarcelonaSpain
| | - Irene de Boer
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
| | | | | | - Nunu Lund
- Department of Neurology, Danish Headache Center, Rigshospitalet‐GlostrupUniversity of Copenhagen University HospitalGlostrupDenmark
| | - Laurent F. Thomas
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Department of Clinical and Molecular MedicineNorwegian University of Science and Technology (NTNU)TrondheimNorway
- BioCore–Bioinformatics Core FacilityNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Clinic of Laboratory MedicineSt. Olavs Hospital, Trondheim University HospitalTrondheimNorway
| | - Chia‐Lin Hsu
- Institute of Biomedical Sciences, Academia SinicaTaipeiTaiwan
| | - Matti Pirinen
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of HelsinkiHelsinkiFinland
- Department of Public HealthUniversity of HelsinkiHelsinkiFinland
- Department of Mathematics and StatisticsUniversity of HelsinkiHelsinkiFinland
| | - Heidi Hautakangas
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of HelsinkiHelsinkiFinland
| | - Marta Ribasés
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and AddictionUniversitat Autònoma de Barcelona, Vall d'Hebron Research Institute (VHIR)BarcelonaSpain
- Department of PsychiatryVall d'Hebron University HospitalBarcelonaSpain
- Biomedical Network Research Centre on Mental Health (CIBERSAM)Instituto de Salud Carlos IIIMadridSpain
- Department of Genetics, Microbiology, and Statistics, Faculty of BiologyUniversitat de BarcelonaBarcelonaSpain
| | | | - Prasanth Sivakumar
- Department of Neuromuscular Diseases, Institute of NeurologyUniversity College LondonLondonUK
| | - Janice Yip
- Department of Neuromuscular Diseases, Institute of NeurologyUniversity College LondonLondonUK
| | - Axel Heinze
- Kiel Migraine and Headache CentreKielGermany
| | - Fahri Küçükali
- Complex Genetics of Alzheimer's Disease Group, Center for Molecular Neurology, VIBAntwerpBelgium
- Department of Biomedical SciencesUniversity of AntwerpAntwerpBelgium
| | - Sisse R. Ostrowski
- Department of Clinical Immunology, Centre of Diagnostic InvestigationRigshospitaletCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Ole B. Pedersen
- Department of Clinical ImmunologyZealand University HospitalKøgeDenmark
| | - Espen S. Kristoffersen
- Department of Research and Innovation, Division of Clinical NeuroscienceOslo University HospitalOsloNorway
- Norwegian Centre for Headache Research (NorHEAD), Department of Neuromedicine and Movement ScienceNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Department of General PracticeUniversity of OsloOsloNorway
- Department of NeurologyAkershus University HospitalLørenskogNorway
| | - Amy E. Martinsen
- Department of Research and Innovation, Division of Clinical NeuroscienceOslo University HospitalOsloNorway
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Norwegian Centre for Headache Research (NorHEAD), Department of Neuromedicine and Movement ScienceNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
| | - María S. Artigas
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and AddictionUniversitat Autònoma de Barcelona, Vall d'Hebron Research Institute (VHIR)BarcelonaSpain
- Department of PsychiatryVall d'Hebron University HospitalBarcelonaSpain
- Biomedical Network Research Centre on Mental Health (CIBERSAM)Instituto de Salud Carlos IIIMadridSpain
- Department of Genetics, Microbiology, and Statistics, Faculty of BiologyUniversitat de BarcelonaBarcelonaSpain
| | - Susie Lagrata
- Headache and Facial Pain GroupUniversity College London Queen Square Institute of Neurology and National Hospital for Neurology and NeurosurgeryLondonUK
| | | | - Joycee Adebimpe
- Department of Neuromuscular Diseases, Institute of NeurologyUniversity College LondonLondonUK
| | - Olivia Quinn
- Department of Neuromuscular Diseases, Institute of NeurologyUniversity College LondonLondonUK
| | - Carl Göbel
- Kiel Migraine and Headache CentreKielGermany
- Department of NeurologyUniversity Hospital Schleswig‐HolsteinLübeckGermany
| | - Anna Cirkel
- Kiel Migraine and Headache CentreKielGermany
- Department of NeurologyUniversity Hospital Schleswig‐HolsteinLübeckGermany
| | - Alexander E. Volk
- Institute of Human GeneticsUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Stefanie Heilmann‐Heimbach
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital BonnBonnGermany
| | - Anne Heidi Skogholt
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Maiken E. Gabrielsen
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | | | - Daisuke Danno
- Headache and Facial Pain GroupUniversity College London Queen Square Institute of Neurology and National Hospital for Neurology and NeurosurgeryLondonUK
| | - Dwij Mehta
- Headache and Facial Pain GroupUniversity College London Queen Square Institute of Neurology and National Hospital for Neurology and NeurosurgeryLondonUK
| | | | | | - Frits R. Rosendaal
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Ko Willems van Dijk
- Department of Human GeneticsLeiden University Medical CenterLeidenThe Netherlands
- Einthoven Laboratory for Experimental Vascular MedicineLeiden University Medical CenterLeidenThe Netherlands
- Department of Internal Medicine, Division of EndocrinologyLeiden University Medical CenterLeidenThe Netherlands
| | - Rolf Fronczek
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
| | - Michael Wagner
- Department of Neurodegenerative Diseases and Geriatric PsychiatryUniversity Hospital BonnBonnGermany
- German Center for Neurodegenerative Diseases (DZNE Bonn)BonnGermany
| | - Martin Scherer
- Department of Primary Medical CareUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | | | - Kristel Sleegers
- Complex Genetics of Alzheimer's Disease Group, Center for Molecular Neurology, VIBAntwerpBelgium
- Department of Biomedical SciencesUniversity of AntwerpAntwerpBelgium
| | - Olafur A. Sveinsson
- Faculty of Medicine, School of Health SciencesUniversity of IcelandReykjavikIceland
| | - Luca Pani
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
- Department of Psychiatry and Behavioral SciencesUniversity of MiamiMiamiFL
| | - Michele Zoli
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | - Josep A. Ramos‐Quiroga
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and AddictionUniversitat Autònoma de Barcelona, Vall d'Hebron Research Institute (VHIR)BarcelonaSpain
- Department of PsychiatryVall d'Hebron University HospitalBarcelonaSpain
- Biomedical Network Research Centre on Mental Health (CIBERSAM)Instituto de Salud Carlos IIIMadridSpain
- Department of Psychiatry and Forensic MedicineUniversitat Autònoma de Barcelona, Vall d'Hebron Research Institute (VHIR)BarcelonaSpain
| | - Efthimios Dardiotis
- Department of Neurology, Faculty of MedicineUniversity of ThessalyVolosGreece
| | - Anna Steinberg
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
- Department of NeurologyKarolinska University HospitalStockholmSweden
| | - Steffi Riedel‐Heller
- Institute of Social Medicine, Occupational Health and Public HealthUniversity of LeipzigLeipzigGermany
| | - Christina Sjöstrand
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
- Department of NeurologyDanderyd HospitalStockholmSweden
| | | | | | - Laura Southgate
- Molecular and Clinical Sciences Research InstituteSt. George's, University of LondonLondonUK
- Department of Medical & Molecular Genetics, Faculty of Life Sciences & MedicineKing's College LondonLondonUK
| | - Richard C. Trembath
- Department of Medical & Molecular Genetics, Faculty of Life Sciences & MedicineKing's College LondonLondonUK
| | - Jana Vandrovcova
- Department of Neuromuscular Diseases, Institute of NeurologyUniversity College LondonLondonUK
| | - Raymond Noordam
- Department of Internal Medicine, Section of Gerontology and GeriatricsLeiden University Medical CenterLeidenThe Netherlands
| | - Koen Paemeleire
- Department of NeurologyGhent University HospitalGhentBelgium
| | - Kari Stefansson
- deCODE genetics/Amgen Inc.ReykjavikIceland
- Faculty of Medicine, School of Health SciencesUniversity of IcelandReykjavikIceland
| | | | - Elisabet Waldenlind
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
- Department of NeurologyKarolinska University HospitalStockholmSweden
| | - Erling Tronvik
- Norwegian Centre for Headache Research (NorHEAD), Department of Neuromedicine and Movement ScienceNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Department of Neurology and Clinical NeurophysiologySt. Olavs Hospital, Trondheim University HospitalTrondheimNorway
| | - Rigmor H. Jensen
- Department of Neurology, Danish Headache Center, Rigshospitalet‐GlostrupUniversity of Copenhagen University HospitalGlostrupDenmark
| | - Shih‐Pin Chen
- Brain Research CenterNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Department of Medical Research, Division of Translational ResearchTaipei Veterans General HospitalTaipeiTaiwan
| | - Henry Houlden
- Department of Neuromuscular Diseases, Institute of NeurologyUniversity College LondonLondonUK
| | - Gisela M. Terwindt
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
| | - Christian Kubisch
- Institute of Human GeneticsUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Elena Maestrini
- Department of Pharmacy and BiotechnologyUniversity of BolognaBolognaItaly
| | | | - Patricia Pozo‐Rosich
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de MedicinaUniversitat Autònoma de Barcelona, Vall d'Hebron Research Institute (VHIR)BarcelonaSpain
- Headache Unit, Neurology DepartmentVall d'Hebron University HospitalBarcelonaSpain
| | - Andrea C. Belin
- Centre for Cluster Headache, Department of NeuroscienceKarolinska InstitutetStockholmSweden
| | - Manjit Matharu
- Headache and Facial Pain GroupUniversity College London Queen Square Institute of Neurology and National Hospital for Neurology and NeurosurgeryLondonUK
| | - Arn M.J.M. van den Maagdenberg
- Department of Human GeneticsLeiden University Medical CenterLeidenThe Netherlands
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
| | - Thomas F. Hansen
- Department of Neurology, Danish Headache Center, Rigshospitalet‐GlostrupUniversity of Copenhagen University HospitalGlostrupDenmark
- Novo Nordic Foundation Center for Protein ResearchUniversity of CopenhagenCopenhagenDenmark
| | - Alfredo Ramirez
- Division of Neurogenetics and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
- Department of Neurodegenerative Diseases and Geriatric PsychiatryUniversity Hospital BonnBonnGermany
- German Center for Neurodegenerative Diseases (DZNE Bonn)BonnGermany
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative DiseasesUniversity of Texas Health Sciences CenterSan AntonioTX
- Cluster of Excellence Cellular Stress Responses in Aging‐associated Diseases (CECAD)University of CologneCologneGermany
| | - John‐Anker Zwart
- Department of Research and Innovation, Division of Clinical NeuroscienceOslo University HospitalOsloNorway
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Norwegian Centre for Headache Research (NorHEAD), Department of Neuromedicine and Movement ScienceNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
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McBride M, Martin CA, Teece L, Irizar P, Batson M, Lagrata S, Papineni P, Nazareth J, Pan D, Leary A, Woolf K, Pareek M. Investigating the impact of financial concerns on symptoms of depression in UK healthcare workers: data from the UK-REACH nationwide cohort study. BJPsych Open 2023; 9:e124. [PMID: 37434497 PMCID: PMC10375869 DOI: 10.1192/bjo.2023.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Exploration of the association between financial concerns and depression in UK healthcare workers (HCWs) is paramount given the current 'cost of living crisis', ongoing strike action and recruitment/retention problems in the National Health Service. AIMS To assess the impact of financial concerns on the risk of depression in HCWs, how these concerns have changed over time and what factors might predict financial concerns. METHOD We used longitudinal survey data from a UK-wide cohort of HCWs to determine whether financial concerns at baseline (December 2020 to March 2021) were associated with depression (measured with the Public Health Questionnaire-2) at follow-up (June to October 2022). We used logistic regression to examine the association between financial concerns and depression, and ordinal logistic regression to establish predictors of developing financial concerns. RESULTS A total of 3521 HCWs were included. Those concerned about their financial situation at baseline had higher odds of developing depressive symptoms at follow-up. Financial concerns increased in 43.8% of HCWs and decreased in 9%. Those in nursing, midwifery and other nursing roles had over twice the odds of developing financial concerns compared with those in medical roles. CONCLUSIONS Financial concerns are increasing in prevalence and predict the later development of depressive symptoms in UK HCWs. Those in nursing, midwifery and other allied nursing roles may have been disproportionately affected. Our results are concerning given the potential effects on sickness absence and staff retention. Policy makers should act to alleviate financial concerns to reduce the impact this may have on a discontent workforce plagued by understaffing.
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Affiliation(s)
- Martin McBride
- Department of Psychiatry, Leicester Partnership NHS Trust, UK
| | - Christopher A Martin
- Department of Respiratory Sciences, University of Leicester, UK; and Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, UK
| | - Lucy Teece
- Biostatistics Research Group, Department of Population Health Sciences, University of Leicester, UK
| | - Patricia Irizar
- Department of Sociology, School of Social Sciences, Faculty of Humanities, University of Manchester, UK
| | - Megan Batson
- Leicester Medical School, University of Leicester, UK
| | - Susie Lagrata
- Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, UK
| | - Padmasayee Papineni
- Department of Infectious Diseases, Ealing Hospital, London North West University Healthcare NHS Trust, UK
| | - Joshua Nazareth
- Department of Respiratory Sciences, University of Leicester, UK; and Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, UK
| | - Daniel Pan
- Department of Respiratory Sciences, University of Leicester, UK; Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, UK; and Li Ka Shing Institute for Health Information and Discovery, Oxford Big Data Institute, UK
| | - Alison Leary
- Department of Health and Social Care, London South Bank University, UK
| | | | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, UK; and Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, UK
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6
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Martin CA, Woolf K, Bryant L, Goss C, Gogoi M, Lagrata S, Papineni P, Qureshi I, Wobi F, Nellums L, Khunti K, Pareek M. Coverage, completion and outcomes of COVID-19 risk assessments in a multi-ethnic nationwide cohort of UK healthcare workers: a cross-sectional analysis from the UK-REACH Study. Occup Environ Med 2023:oemed-2022-108700. [PMID: 37221040 DOI: 10.1136/oemed-2022-108700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/31/2023] [Indexed: 05/25/2023]
Abstract
INTRODUCTION There are limited data on the outcomes of COVID-19 risk assessment in healthcare workers (HCWs) or the association of ethnicity, other sociodemographic and occupational factors with risk assessment outcomes. METHODS We used questionnaire data from UK-REACH (UK Research study into Ethnicity And COVID-19 outcomes in Healthcare workers), an ethnically diverse, nationwide cohort of UK HCWs. We derived four binary outcomes: (1) offered a risk assessment; (2) completed a risk assessment; (3) working practices changed as a result of the risk assessment; (4) wanted changes to working practices after risk assessment but working practices did not change.We examined the association of ethnicity, other sociodemographic/occupational factors and actual/perceived COVID-19 risk variables on our outcomes using multivariable logistic regression. RESULTS 8649 HCWs were included in total. HCWs from ethnic minority groups were more likely to report being offered a risk assessment than white HCWs, and those from Asian and black ethnic groups were more likely to report having completed an assessment if offered. Ethnic minority HCWs had lower odds of reporting having their work change as a result of risk assessment. Those from Asian and black ethnic groups were more likely to report no changes to their working practices despite wanting them.Previous SARS-CoV-2 infection was associated with lower odds of being offered a risk assessment and having adjustments made to working practices. DISCUSSION We found differences in risk assessment outcomes by ethnicity, other sociodemographic/occupational factors and actual/perceived COVID-19 risk factors. These findings are concerning and warrant further research using actual (rather than reported) risk assessment outcomes in an unselected cohort.
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Affiliation(s)
- Christopher A Martin
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Katherine Woolf
- Research Department of Medical Education, University College London Medical School, London, UK
| | - Luke Bryant
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Charles Goss
- Department of Occupational Health, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Mayuri Gogoi
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Susie Lagrata
- Queen Square Insitute of Neurology and National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Padmasayee Papineni
- Department of Infectious Diseases, London North West University Healthcare NHS Trust, Harrow, UK
| | - Irtiza Qureshi
- Population and Lifespan Sciences, University of Nottingham, Nottingham, UK
| | - Fatimah Wobi
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
- School of Law, University of Leicester, Leicester, UK
| | - Laura Nellums
- Population and Lifespan Sciences, University of Nottingham, Nottingham, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Manish Pareek
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
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7
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Simmonds L, Lagrata S, Stubberud A, Cheema S, Tronvik E, Matharu M, Kamourieh S. An open-label observational study and meta-analysis of non-invasive vagus nerve stimulation in medically refractory chronic cluster headache. Front Neurol 2023; 14:1100426. [PMID: 37064192 PMCID: PMC10098146 DOI: 10.3389/fneur.2023.1100426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/08/2023] [Indexed: 04/03/2023] Open
Abstract
BackgroundMany patients with cluster headache (CH) are inadequately controlled by current treatment options. Non-invasive vagus nerve stimulation (nVNS) is reported to be effective in the management of CH though some studies suggest that it is ineffective.ObjectiveTo assess the safety and efficacy of nVNS in chronic cluster headache (CCH) patients.MethodWe prospectively analysed data from 40 patients with refractory CCH in this open-label, observational study. Patients were seen in tertiary headache clinics at the National Hospital for Neurology and Neurosurgery and trained to use nVNS as preventative therapy. Patients were reivewed at one month and then three-monthly from onset. The primary endpoint was number of patients achieving ≥50% reduction in attack frequency at 3 months. A meta-analysis of all published studies evaluating the efficacy of nVNS in CCH was also conducted. We searched MEDLINE and EMBASE for all studies investigating the use of nVNS as a preventive or adjunctive treatment for CCH with five or more participants. Combined mean difference and responder proportions with 95% confidence intervals (CI) were calculated from the included studies.Results17/40 patients (43%) achieved ≥50% reduction in attack frequency at 3 months. There was a significant reduction in monthly attack frequency from a baseline of 124 (±67) attacks to 79 (±63) attacks in month 3 (mean difference 44.7; 95% CI 25.1 to 64.3; p < 0.001). In month 3, there was also a 1.2-point reduction in average severity from a baseline Verbal Rating Scale of 8/10 (95% CI 0.5 to 1.9; p = 0.001). Four studies, along with the present study, were deemed eligible for meta-analysis, which showed a responder proportion of 0.35 (95% CI 0.07 to 0.69, n = 137) and a mean reduction in headache frequency of 35.3 attacks per month (95% CI 11.0 to 59.6, n = 108), from a baseline of 105 (±22.7) attacks per month.ConclusionThis study highlights the potential benefit of nVNS in CCH, with significant reductions in headache frequency and severity. To better characterise the effect, randomised sham-controlled trials are needed to confirm the beneficial response of VNS reported in some, but not all, open-label studies.
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Affiliation(s)
- Lucy Simmonds
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Susie Lagrata
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Anker Stubberud
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom
- Norwegian Centre for Headache Research, Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Sanjay Cheema
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Erling Tronvik
- Norwegian Centre for Headache Research, Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurology, St. Olavs Hospital, Trondheim, Norway
| | - Manjit Matharu
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom
- Norwegian Centre for Headache Research, Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Salwa Kamourieh
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom
- *Correspondence: Salwa Kamourieh,
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Woolf K, Papineni P, Lagrata S, Pareek M. Retention of ethnic minority staff is critical to resolving the NHS workforce crisis. BMJ 2023; 380:541. [PMID: 36898716 DOI: 10.1136/bmj.p541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Affiliation(s)
| | | | | | - Manish Pareek
- University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
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9
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Qureshi I, Chaloner J, Gogoi M, Al-Oraibi A, Wobi F, Reilly H, Medisauskaite A, Martin CA, Irizar P, Papineni P, Lagrata S, Agbonmwandolor J, Pareek M, Nellums L. Caring for Those Who Take Care of Others: Developing Systemic and Sustainable Mental Health Support for the Diverse Healthcare Workforce in the United Kingdom. Int J Environ Res Public Health 2023; 20:3242. [PMID: 36833937 PMCID: PMC9964273 DOI: 10.3390/ijerph20043242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/27/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
Pressures such as high workload, stretched resources, and financial stress are resulting in healthcare workers experiencing high rates of mental health conditions, high suicide rates, high rates of staff absences from work, and high vacancy rates for certain healthcare professions. All of these factors point to the fact that a systematic and sustainable approach to mental health support at different levels and in different ways is more important than ever. In response, we present a holistic analysis of the mental health and wellbeing needs of healthcare workers across the United Kingdom healthcare ecosystem. We recommend that healthcare organisations should consider the specific circumstances of these staff and develop strategies to counter the negative impact of these factors and help safeguard the mental health of their staff.
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Affiliation(s)
- Irtiza Qureshi
- Lifespan and Population Sciences, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
| | - Jonathan Chaloner
- Lifespan and Population Sciences, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
| | - Mayuri Gogoi
- Department of Respiratory Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Amani Al-Oraibi
- Department of Respiratory Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Fatimah Wobi
- Public Health Institute, Faculty of Health, Liverpool John Moores University, Liverpool L3 5UX, UK
| | - Holly Reilly
- Department of Respiratory Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Asta Medisauskaite
- Research Department of Medical Education, UCL Medical School, London WC1E 6DE, UK
| | | | - Patricia Irizar
- Department of Sociology, School of Social Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Padmasayee Papineni
- Department of Infectious Diseases, London North West University Healthcare NHS Trust, London UB1 3HW, UK
| | - Susie Lagrata
- The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Joy Agbonmwandolor
- The David Evans Medical Research Centre, Nottingham University Hospital NHS Trust, Nottingham NG5 1PB, UK
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Laura Nellums
- Lifespan and Population Sciences, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
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10
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Cheema S, Parras O, Ferreira F, Lagrata S, Hyam J, Zrinzo L, Akram H, Matharu M. Long term outcomes of deep brain stimulation for treatment refractory chronic cluster headache and SUNHA. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
ObjectiveTo present long term outcomes of ventral tegmental area (VTA) deep brain stimulation (DBS) for medically refractory chronic cluster headache (CCH) and short-lasting unilateral neuralgiform headache attacks (SUNHA)MethodsOpen label study using prospectively collected clinical data in consecutive patients treated by VTA DBS between 2009 and 2019 in a single tertiary neuroscience centre, treated by a multidisciplinary team.ResultsBetween 2009 and 2019, 71 patients (43 CCH and 28 SUNHA) were treated with VTA DBS. Mean duration of follow up was 5.6 years (range 1.0-11.7 years).Overall, there was a significant improvement in attack frequency, attack severity, and attack duration in both groups (all p<0.001). Twenty nine (67.4%) CCH patients and 20 (71.4%) SUNHA patients were classed as responders (a greater than 50% improvement in attack frequency).Adverse events were rareFour non-responders had the DBS system explanted, two of them secondary to infection and one due to post-surgical neuropathic pain around the head wound site. Four patients died from unrelated conditions during the study period.ConclusionsThis study provides open label evidence than VTA DBS is a safe and effective treatment for refractory CCH and SUNHA, an effect which is maintained at long term follow up.
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11
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Cheema S, Anderson J, Duncan C, Davagnanam I, Armstrong P, Redfern N, Ordman A, D’Antona L, Nissen J, Sayal P, Vaughan-Huxley E, Lagrata S, Iodice V, Snape-Burns J, Joy C, Matharu M. Survey of healthcare professionals’ knowledge, attitudes and practices regarding spontaneous intracranial hypotension. BMJ Neurol Open 2022; 4:e000347. [PMID: 36110926 PMCID: PMC9445790 DOI: 10.1136/bmjno-2022-000347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/26/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To assess the knowledge, attitudes and practices of healthcare professionals regarding the diagnosis and management of spontaneous intracranial hypotension (SIH). Methods We performed a cross-sectional, web-based survey of multiple healthcare professional groups in the UK from June to August 2021. There were 227 respondents to the survey, including 62 general practitioners, 39 emergency medicine physicians, 38 neurologists, 35 radiologists, 20 neurosurgeons, 18 anaesthetists and 15 headache nurse specialists. The majority of the respondents were at the consultant level and all worked in the UK National Health Service. Results Few general practitioners or emergency medicine physicians had ever been involved in the care of a patient with SIH or received teaching about SIH. Only 3 of 62 (4.8%) general practitioners and 1 of 39 (2.5%) emergency medicine physicians were confident in recognising the symptoms of SIH. Most neurologists were confident in recognising SIH and performed MRI of the brain as a first-line investigation, although there was variability in the urgency of the request, whether contrast was given or MRI of the spine organised at the same time. Most said they never or rarely performed lumbar puncture for diagnosis of SIH. Most neuroradiologists, but few general radiologists, were confident in interpreting imaging of patients with suspected SIH. Lack of access to epidural blood patching, personnel able to perform myelography, and established management pathways were identified by many respondents as barriers to the treatment of SIH. Conclusions We have identified a lack of awareness of SIH among non-specialists, several barriers to optimal treatment of SIH and a variation in current management pathways. The results highlight the need for education of healthcare professionals about SIH and the development of clinical practice guidelines to enable delivery of optimal and equitable care for patients with SIH.
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Affiliation(s)
- Sanjay Cheema
- UCL Queen Square Institute of Neurology, London, UK
- Headache and Facial Pain Group, National Hospital for Neurology and Neurosurgery, London, UK
| | - Jane Anderson
- Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Indran Davagnanam
- UCL Queen Square Institute of Neurology, London, UK
- Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Paul Armstrong
- Neuroradiology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Nancy Redfern
- Anaesthetics, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | | | - Linda D’Antona
- UCL Queen Square Institute of Neurology, London, UK
- Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Justin Nissen
- Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Parag Sayal
- Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | | | - Susie Lagrata
- Headache and Facial Pain Group, National Hospital for Neurology and Neurosurgery, London, UK
| | - Valeria Iodice
- Autonomic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | | | - Clare Joy
- CSF Leak Association, Strathpeffer, UK
| | - Manjit Matharu
- UCL Queen Square Institute of Neurology, London, UK
- Headache and Facial Pain Group, National Hospital for Neurology and Neurosurgery, London, UK
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Woolf K, Gogoi M, Martin CA, Papineni P, Lagrata S, Nellums LB, McManus I, Guyatt AL, Melbourne C, Bryant L, Gupta A, John C, Carr S, Tobin MD, Simpson S, Gregary B, Aujayeb A, Zingwe S, Reza R, Gray LJ, Khunti K, Pareek M. Healthcare workers' views on mandatory SARS-CoV-2 vaccination in the UK: A cross-sectional, mixed-methods analysis from the UK-REACH study. EClinicalMedicine 2022; 46:101346. [PMID: 35308309 PMCID: PMC8923694 DOI: 10.1016/j.eclinm.2022.101346] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 11/24/2022] Open
Abstract
Background Several countries now have mandatory SARS-CoV-2 vaccination for healthcare workers (HCWs) or the general population. HCWs' views on this are largely unknown. Using data from the nationwide UK-REACH study we aimed to understand UK HCW's views on improving SARS-CoV-2 vaccination coverage, including mandatory vaccination. Methods Between 21st April and 26th June 2021, we administered an online questionnaire via email to 17 891 UK HCWs recruited as part of a longitudinal cohort from across the UK who had previously responded to a baseline questionnaire (primarily recruited through email) as part of the United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers (UK-REACH) nationwide prospective cohort study. We categorised responses to a free-text question "What should society do if people do not get vaccinated against COVID-19?" using qualitative content analysis. We collapsed categories into a binary variable: favours mandatory vaccination or not, using logistic regression to calculate its demographic predictors, and its occupational, health, and attitudinal predictors adjusted for demographics. Findings Of 5633 questionnaire respondents, 3235 answered the free text question. Median age of free text responders was 47 years (IQR 36-56) and 2705 (74.3%) were female. 18% (n = 578) favoured mandatory vaccination (201 [6%] participants for HCWs and others working with vulnerable populations; 377 [12%] for the general population), but the most frequent suggestion was education (32%, n = 1047). Older HCWs (OR 1.84; 95% CI 1.44-2.34 [≥55 years vs 16 years to <40 years]), HCWs vaccinated against influenza (OR 1.49; 95% CI 1.11-2.01 [2 vaccines vs none]), and with more positive vaccination attitudes generally (OR 1.10; 95% CI 1.06-1.15) were more likely to favour mandatory vaccination, whereas female HCWs (OR= 0.79, 95% CI 0.63-0.96, vs male HCWs) and Black HCWs (OR=0.46, 95% CI 0.25-0.85, vs white HCWs) were less likely to. Interpretation Only one in six of the HCWs in this large, diverse, UK-wide sample favoured mandatory vaccination. Building trust, educating, and supporting HCWs who are hesitant about vaccination may be more acceptable, effective, and equitable. Funding MRC-UK Research and Innovation grant (MR/V027549/1) and the Department of Health and Social Care (DHSC) via the National Institute for Health Research (NIHR). Core funding was also provided by NIHR Biomedical Research Centres.
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Affiliation(s)
- Katherine Woolf
- Research Department of Medical Education, University College London Medical School, UK
| | - Mayuri Gogoi
- Department of Respiratory Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - Christopher A. Martin
- Department of Respiratory Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
- Department of Infection and HIV Medicine, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Jarvis Building, Leicester LE1 5WW, UK
| | - Padmasayee Papineni
- Ealing Hospital, London North West University Healthcare NHS Trust, Southall, UK
| | - Susie Lagrata
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Laura B. Nellums
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, UK
| | - I.Chris McManus
- Research Department of Medical Education, University College London Medical School, UK
| | - Anna L. Guyatt
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Carl Melbourne
- Genetic Epidemiology Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Luke Bryant
- Department of Respiratory Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - Amit Gupta
- Oxford University Hospitals NHS Foundation Trust, UK
| | - Catherine John
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Sue Carr
- Leicester Royal Infirmary, University Hospitals Leicester NHS Trust, UK
- General Medical Council, UK
| | - Martin D. Tobin
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Bindu Gregary
- Lancashire Clinical Research Facility, Royal Preston Hospital, UK
| | - Avinash Aujayeb
- Respiratory Department, Northumbria Specialist Emergency Care Hospital, UK
| | - Stephen Zingwe
- Research and Development Department, Berkshire Healthcare NHS Foundation Trust
| | - Rubina Reza
- Derbyshire Healthcare NHS Foundation Trust Centre for Research and Development, Kingsway Hospital site, UK
| | - Laura J. Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
- Department of Infection and HIV Medicine, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Jarvis Building, Leicester LE1 5WW, UK
| | - UK-REACH Study Collaborative Group
- Research Department of Medical Education, University College London Medical School, UK
- Department of Respiratory Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
- Department of Infection and HIV Medicine, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Jarvis Building, Leicester LE1 5WW, UK
- Ealing Hospital, London North West University Healthcare NHS Trust, Southall, UK
- University College London Hospitals NHS Foundation Trust, London, UK
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, UK
- Department of Health Sciences, University of Leicester, Leicester, UK
- Genetic Epidemiology Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
- Oxford University Hospitals NHS Foundation Trust, UK
- Leicester Royal Infirmary, University Hospitals Leicester NHS Trust, UK
- General Medical Council, UK
- Nottinghamshire Healthcare NHS Foundation Trust, UK
- Lancashire Clinical Research Facility, Royal Preston Hospital, UK
- Respiratory Department, Northumbria Specialist Emergency Care Hospital, UK
- Research and Development Department, Berkshire Healthcare NHS Foundation Trust
- Derbyshire Healthcare NHS Foundation Trust Centre for Research and Development, Kingsway Hospital site, UK
- Diabetes Research Centre, University of Leicester, UK
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13
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Lambru G, Lagrata S, Levy A, Cheema S, Davagnanam I, Rantell K, Kitchen N, Zrinzo L, Matharu M. Trigeminal microvascular decompression for short-lasting unilateral neuralgiform headache attacks. Brain 2022; 145:2882-2893. [PMID: 35325067 PMCID: PMC9420014 DOI: 10.1093/brain/awac109] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 02/02/2022] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
A significant proportion of patients with short-lasting unilateral neuralgiform headache attacks (SUNHA) are refractory to medical treatments. Neuroimaging studies have suggested a role for ipsilateral trigeminal neurovascular conflict with morphological changes in the pathophysiology of this disorder. We present the outcome of an uncontrolled open-label prospective single centre study conducted between 2012 and 2020, to evaluate the efficacy and safety of trigeminal microvascular decompression in refractory chronic SUNHA with magnetic resonance imaging evidence of trigeminal neurovascular conflict ipsilateral to the pain side. Primary endpoint was the proportion of patients who achieved an "excellent response", defined as 90-100% weekly reduction in attack frequency, or "good response", defined as a reduction in weekly headache attack frequency between 75% and 89% at final follow-up, compared to baseline. These patients were defined as responders. The study group consisted of 47 patients of whom 31 had SUNCT and 16 had SUNA (25 females, mean age ± SD 55.2 years ± 14.8). Participants failed to respond or tolerate a mean of 8.1 (±2.7) preventive treatments pre-surgery. Magnetic resonance imaging of the trigeminal nerves (n = 47 patients, n = 50 symptomatic trigeminal nerves) demonstrated ipsilateral neurovascular conflict with morphological changes in 39/50 (78.0%) symptomatic nerves and without morphological changes in 11/50 (22.0%) symptomatic nerves. Post-operatively, 37/47 (78.7%) patients obtained either an excellent or a good response. Ten patients (21.3%, SUNCT = 7 and SUNA = 3) reported no post-operative improvement. The mean post-surgery follow-up was 57.4 ± 24.3 months (range 11-96 months). At final follow-up, 31 patients (66.0%) were excellent/good responders. Six patients experienced a recurrence of headache symptoms. There was no statistically significant difference between SUNCT and SUNA in the response to surgery (p = 0.463). Responders at the last follow-up were however more likely not to have interictal pain (77.42% vs 22.58%, p = 0.021) and to show morphological changes on the magnetic resonance imaging (78.38% vs 21.62%, p = 0.001). The latter outcome was confirmed in the Kaplan Meyer analysis, where patients with no morphological changes were more likely to relapse overtime compared to those with morphological changes (p = 0.0001). All but one patient who obtained an excellent response without relapse, discontinued their preventive medications. Twenty-two post-surgery adverse events occurred in 18 patients (46.8%) but no mortality or severe neurological deficit was seen. Trigeminal microvascular decompression may be a safe and effective long-term treatment for short-lasting unilateral neuralgiform headache attacks patients with magnetic resonance evidence of neurovascular conflict with morphological changes.
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Affiliation(s)
- Giorgio Lambru
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Susie Lagrata
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Andrew Levy
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Sanjay Cheema
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Indran Davagnanam
- Lysholm Department of Neuroradiology, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Khadija Rantell
- Biostatistician, Education Unit, UCL Queen Square Institute of Neurology, London UK
| | - Neil Kitchen
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Ludvic Zrinzo
- Functional Neurosurgery Unit, Department of Clinical & Motor Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Manjit Matharu
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
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14
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O'Connor E, Fourier C, Ran C, Sivakumar P, Liesecke F, Southgate L, Harder AVE, Vijfhuizen LS, Yip J, Giffin N, Silver N, Ahmed F, Hostettler IC, Davies B, Cader MZ, Simpson BS, Sullivan R, Efthymiou S, Adebimpe J, Quinn O, Campbell C, Cavalleri GL, Vikelis M, Kelderman T, Paemeleire K, Kilbride E, Grangeon L, Lagrata S, Danno D, Trembath R, Wood NW, Kockum I, Winsvold BS, Steinberg A, Sjöstrand C, Waldenlind E, Vandrovcova J, Houlden H, Matharu M, Belin AC. Genome-Wide Association Study Identifies Risk Loci for Cluster Headache. Ann Neurol 2021; 90:193-202. [PMID: 34184781 DOI: 10.1002/ana.26150] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study was undertaken to identify susceptibility loci for cluster headache and obtain insights into relevant disease pathways. METHODS We carried out a genome-wide association study, where 852 UK and 591 Swedish cluster headache cases were compared with 5,614 and 1,134 controls, respectively. Following quality control and imputation, single variant association testing was conducted using a logistic mixed model for each cohort. The 2 cohorts were subsequently combined in a merged analysis. Downstream analyses, such as gene-set enrichment, functional variant annotation, prediction and pathway analyses, were performed. RESULTS Initial independent analysis identified 2 replicable cluster headache susceptibility loci on chromosome 2. A merged analysis identified an additional locus on chromosome 1 and confirmed a locus significant in the UK analysis on chromosome 6, which overlaps with a previously known migraine locus. The lead single nucleotide polymorphisms were rs113658130 (p = 1.92 × 10-17 , odds ratio [OR] = 1.51, 95% confidence interval [CI] = 1.37-1.66) and rs4519530 (p = 6.98 × 10-17 , OR = 1.47, 95% CI = 1.34-1.61) on chromosome 2, rs12121134 on chromosome 1 (p = 1.66 × 10-8 , OR = 1.36, 95% CI = 1.22-1.52), and rs11153082 (p = 1.85 × 10-8 , OR = 1.30, 95% CI = 1.19-1.42) on chromosome 6. Downstream analyses implicated immunological processes in the pathogenesis of cluster headache. INTERPRETATION We identified and replicated several genome-wide significant associations supporting a genetic predisposition in cluster headache in a genome-wide association study involving 1,443 cases. Replication in larger independent cohorts combined with comprehensive phenotyping, in relation to, for example, treatment response and cluster headache subtypes, could provide unprecedented insights into genotype-phenotype correlations and the pathophysiological pathways underlying cluster headache. ANN NEUROL 2021;90:193-202.
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Affiliation(s)
- Emer O'Connor
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK.,Neurogenetics Laboratory, Institute of Neurology, University College London, London, UK.,Headache and Facial Pain Group, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Carmen Fourier
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Caroline Ran
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Prasanth Sivakumar
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | | | - Laura Southgate
- Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.,Department of Medical & Molecular Genetics, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Aster V E Harder
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Lisanne S Vijfhuizen
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Janice Yip
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - Nicola Giffin
- Neurology Department, Royal United Hospital, Bath, UK
| | | | - Fayyaz Ahmed
- Department of Neurology, Hull Royal Infirmary, Hull, UK
| | - Isabel C Hostettler
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - Brendan Davies
- Department of Neurology, University Hospital North Midlands National Health Service Trust, Stoke-on-Trent, UK
| | - M Zameel Cader
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Benjamin S Simpson
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Roisin Sullivan
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - Stephanie Efthymiou
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - Joycee Adebimpe
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - Olivia Quinn
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - Ciaran Campbell
- Science Foundation Ireland FutureNeuro Research Centre, Royal College of Surgeons, Ireland School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland Dublin, Dublin, Ireland
| | - Gianpiero L Cavalleri
- Science Foundation Ireland FutureNeuro Research Centre, Royal College of Surgeons, Ireland School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland Dublin, Dublin, Ireland
| | | | - Tim Kelderman
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Koen Paemeleire
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | | | - Lou Grangeon
- Headache and Facial Pain Group, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK.,Department of Neurology, Rouen University Hospital, Rouen, France
| | - Susie Lagrata
- Headache and Facial Pain Group, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Daisuke Danno
- Headache and Facial Pain Group, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Richard Trembath
- Department of Medical & Molecular Genetics, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Nicholas W Wood
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK.,Neurogenetics Laboratory, Institute of Neurology, University College London, London, UK
| | - Ingrid Kockum
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Bendik S Winsvold
- Department of Research, Innovation, and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.,K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Anna Steinberg
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Christina Sjöstrand
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Elisabet Waldenlind
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Jana Vandrovcova
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - Henry Houlden
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - Manjit Matharu
- Headache and Facial Pain Group, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
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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: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Lambru G, Stubberud A, Rantell K, Lagrata S, Tronvik E, Matharu MS. Medical treatment of SUNCT and SUNA: a prospective open-label study including single-arm meta-analysis. J Neurol Neurosurg Psychiatry 2021; 92:233-241. [PMID: 33361408 PMCID: PMC7892380 DOI: 10.1136/jnnp-2020-323999] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/11/2020] [Accepted: 10/18/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The management of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) remains challenging in view of the paucity of data and evidence-based treatment recommendations are missing. METHODS In this single-centre, non-randomised, prospective open-label study, we evaluated and compared the efficacy of oral and parenteral treatments for SUNCT and SUNA in a real-world setting. Additionally, single-arm meta-analyses of the available reports of SUNCT and SUNA treatments were conducted. RESULTS The study cohort comprised 161 patients. Most patients responded to lamotrigine (56%), followed by oxcarbazepine (46%), duloxetine (30%), carbamazepine (26%), topiramate (25%), pregabalin and gabapentin (10%). Mexiletine and lacosamide were effective in a meaningful proportion of patients but poorly tolerated. Intravenous lidocaine given for 7-10 days led to improvement in 90% of patients, whereas only 27% of patients responded to a greater occipital nerve block. No statistically significant differences in responders were observed between SUNCT and SUNA. In the meta-analysis of the pooled data, topiramate was found to be significantly more effective in SUNCT than SUNA patients. However, a higher proportion of SUNA than SUNCT was considered refractory to medications at the time of the topiramate trial, possibly explaining this isolated difference. CONCLUSIONS We propose a treatment algorithm for SUNCT and SUNA for clinical practice. The response to sodium channel blockers indicates a therapeutic overlap with trigeminal neuralgia, suggesting that sodium channels dysfunction may be a key pathophysiological hallmark in these disorders. Furthermore, the therapeutic similarities between SUNCT and SUNA further support the hypothesis that these conditions are variants of the same disorder.
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Affiliation(s)
- Giorgio Lambru
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, London, UK
| | - Anker Stubberud
- Department of Neuromedicine and Movement Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology, St. Olavs Hospital, Trondheim, Norway
| | - Khadija Rantell
- Education Unit, UCL Queen Square Institute of Neurology, London, UK
| | - Susie Lagrata
- 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
| | - Erling Tronvik
- Department of Neuromedicine and Movement Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology, St. Olavs Hospital, Trondheim, Norway
| | - 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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Lagrata S, Cheema S, Watkins L, Matharu M. Long-Term Outcomes of Occipital Nerve Stimulation for New Daily Persistent Headache With Migrainous Features. Neuromodulation 2020; 24:1093-1099. [PMID: 32996695 DOI: 10.1111/ner.13282] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/04/2020] [Accepted: 07/27/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES New daily persistent headache (NDPH) is a subset of chronic headache where the pain is continuous from onset. Phenotypically it has chronic migraine or chronic tension type features. NDPH is considered to be highly refractory. Occipital nerve stimulation (ONS) has been used for treatment of refractory chronic migraine but there are no specific reports of its use for NDPH with migrainous features. MATERIALS AND METHODS Nine patients with NDPH with migrainous features were identified as having had ONS implants between 2007 and 2014 in a specialist unit with experience of using ONS in chronic migraine. Moderate to severe headache days were compared at baseline and follow-up. A positive response was defined as at least 30% reduction in monthly moderate to severe headache days. RESULTS Patients had suffered NDPH for a median of 8 years (range 3-16 years) and had failed a median of 11 previous treatments (range 8-15). After a median follow-up of 53 months (range 27-108 months), only a single patient showed a positive response to ONS. At no point did the cohort as a whole show any change in monthly moderate to severe headache days or disability scores. CONCLUSION Our experience suggests that ONS is not effective in the treatment of NDPH with migrainous features even in centers with experience in treating chronic migraine with ONS. The difference in response rates of chronic migraine and NDPH with migrainous features supports the concept of a different pathophysiology to the two conditions.
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Affiliation(s)
- Susie Lagrata
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Sanjay Cheema
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Laurence Watkins
- Department of Neurosurgery, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Manjit Matharu
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
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Kamourieh S, Lagrata S, Matharu MS. Non-invasive vagus nerve stimulation is beneficial in chronic paroxysmal hemicrania. J Neurol Neurosurg Psychiatry 2019; 90:1072-1074. [PMID: 30709897 PMCID: PMC6820155 DOI: 10.1136/jnnp-2018-319538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 11/16/2018] [Accepted: 12/05/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Salwa Kamourieh
- Headache Group, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Susie Lagrata
- Headache Group, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Manjit Singh Matharu
- Headache Group, The National Hospital for Neurology and Neurosurgery, London, UK .,UCL Institute of Neurology, London, UK
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Abstract
Background Multiple cranial nerve blocks of the greater and lesser occipital, supraorbital, supratrochlear and auriculotemporal nerves are widely used in the treatment of primary headaches. We present efficacy and safety data for these procedures. Methods In an uncontrolled open-label prospective study, 119 patients with chronic cluster headache, chronic migraine, short lasting unilateral neuralgiform attack disorders, new daily persistent headaches, hemicrania continua and chronic paroxysmal hemicrania were examined. All had failed to respond to greater occipital nerve blocks. Response was defined as a 50% reduction in either daily attack frequency or moderate-to-severe headache days after 2 weeks. Results The response rate of the whole cohort was 55.4%: Chronic cluster headache, 69.2%; chronic migraine, 49.0%; short lasting unilateral neuralgiform attack disorders, 56.3%; new daily persistent headache, 10.0%; hemicrania continua, 83.3%; and chronic paroxysmal hemicrania, 25.0%. Time to benefit was between 0.50 and 33.58 hours. Benefit was maintained for up to 4 weeks in over half of responders in all groups except chronic migraine and paroxysmal hemicrania. Only minor adverse events were recorded. Conclusion Multiple cranial nerve blocks may provide an efficacious, well tolerated and reproducible transitional treatment for chronic headache disorders when greater occipital nerve blocks have been unsuccessful.
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Affiliation(s)
- Sarah Miller
- Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Susie Lagrata
- Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Manjit Matharu
- Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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Cappon D, Ryterska A, Lagrata S, Miller S, Akram H, Hyam J, Zrinzo L, Matharu M, Jahanshahi M. Ventral tegmental area deep brain stimulation for chronic cluster headache: Effects on cognition, mood, pain report behaviour and quality of life. Cephalalgia 2019; 39:1099-1110. [DOI: 10.1177/0333102419839957] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Deep brain stimulation in the ventral tegmental area (VTA-DBS) has provided remarkable therapeutic benefits in decreasing headache frequency and severity in patients with medically refractory chronic cluster headache (CH). However, to date the effects of VTA-DBS on cognition, mood and quality of life have not been examined in detail. Methods The aim of the present study was to do so in a case series of 18 consecutive patients with cluster headache who underwent implantation of deep brain stimulation electrodes in the ventral tegmental area. The patients were evaluated preoperatively and after a mean of 14 months of VTA-DBS on tests of global cognition (Mini Mental State Examination), intelligence (Wechsler Abbreviated Scale of Intelligence), verbal memory (California Verbal Learning Test-II), executive function (Delis–Kaplan Executive Function System), and attention (Paced Auditory Serial Addition Test). Depression (Beck Depression Inventory and Hospital Anxiety and Depression Rating Scale-D), anxiety (Hospital Anxiety and Depression Rating Scale-A), apathy (Starkstein Apathy Scale), and hopelessness (Beck Hopelessness Scale) were also assessed. Subjective pain experience (McGill Pain Questionnaire), behaviour (Pain Behaviour Checklist) and quality of life (Short Form-36) were also evaluated at the same time points. Results VTA-DBS resulted in significant improvement of headache frequency (from a mean of five to two attacks daily, p < .001) and severity (from mean Verbal Rating Scale [VRS] of 10 to 7, p < .001) which was associated with significant reduction of anxiety (from mean HADS-A of 11.94 to 8.00, p < .001) and help-seeking behaviours (from mean PBC of 4.00 to 2.61, p < .001). VTA-DBS did not produce any significant change to any tests of cognitive function and any other outcome measures (BDI, HADS-D, SAS, BHS, McGill Pain Questionnaire, Short Form-36). Conclusion We confirm the efficacy of VTA-DBS in the treatment of medically refractory chronic cluster headache. The reduction of headache frequency and severity was associated with a significant reduction of anxiety. Furthermore, the result suggests that VTA-DBS for chronic cluster headache improves pain-related help-seeking behaviours and does not produce any change in cognition.
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Affiliation(s)
- Davide Cappon
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Agata Ryterska
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Psychology, Queen Mary University of London, London, UK
| | - Susie Lagrata
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
| | - Sarah Miller
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
| | - Harith Akram
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Jonatham Hyam
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Ludvic Zrinzo
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Manjit Matharu
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
| | - Marjan Jahanshahi
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
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Miller S, Lagrata S, Matharu M, Zrinzo L. WP1-1 Sphenopalatine ganglion stimulation for chronic cluster headache. J Neurol Neurosurg Psychiatry 2019. [DOI: 10.1136/jnnp-2019-abn.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
ObjectivesTo assess outcome of sphenopalatine ganglion stimulation (SPGS) in chronic cluster headache (CCH) in a UK centre.DesignUncontrolled open-label single centre prospective study.SubjectsNine patients with medically refractory CCH.MethodsParticipants underwent sphenopalatine ganglion stimulator implantation, ipsilateral to CCH symptoms via a gingival incision, with fluoroscopy guidance and dyna-CT confirmation of contact location adjacent to the Vidian canal in the pterygopalatine fossa. One month after surgery, the device was programmed. Patients were instructed to provide stimulation as early as possible after attack onset and at least twice daily. The primary outcome was change in headache frequency as well as adverse events.ResultsMean follow up was 14 months (SD 11.1, range: 3–31) with median reduction in headache frequency at last follow up of 73% (IQR: 67%–88%). At 3 months post op, 4/9 (45%) had at least 50% reduction in frequency of attacks; this increased to 8/9 patients (89%) at last follow up. Two patients became pain free (after 3 and 9 months). Preventative effects were seen in 7/9 and an acute effect in 2/9. One patient suffered numbness over the V2 distribution and did not respond to SPGS. The stimulator was removed 1 year later at the patient’s request. One wound infection settled with oral antibiotics.ConclusionsInitial data from the UK confirms the results from previous studies and compares well with the results of occipital nerve stimulation for CCH.
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Akram H, Miller S, Lagrata S, Hariz M, Ashburner J, Behrens T, Matharu M, Zrinzo L. Optimal deep brain stimulation site and target connectivity for chronic cluster headache. Neurology 2017; 89:2083-2091. [PMID: 29030455 PMCID: PMC5711503 DOI: 10.1212/wnl.0000000000004646] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 08/30/2017] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To investigate the mechanism of action of deep brain stimulation for refractory chronic cluster headache and the optimal target within the ventral tegmental area. METHODS Seven patients with refractory chronic cluster headache underwent high spatial and angular resolution diffusion MRI preoperatively. MRI-guided and MRI-verified electrode implantation was performed unilaterally in 5 patients and bilaterally in 2. Volumes of tissue activation were generated around active lead contacts with a finite-element model. Twelve months after surgery, voxel-based morphometry was used to identify voxels associated with higher reduction in headache load. Probabilistic tractography was used to identify the brain connectivity of the activation volumes in responders, defined as patients with a reduction of ≥30% in headache load. RESULTS There was no surgical morbidity. Average follow-up was 34 ± 14 months. Patients showed reductions of 76 ± 33% in headache load, 46 ± 41% in attack severity, 58 ± 41% in headache frequency, and 51 ± 46% in attack duration at the last follow-up. Six patients responded to treatment. Greatest reduction in headache load was associated with activation in an area cantered at 6 mm lateral, 2 mm posterior, and 1 mm inferior to the midcommissural point of the third ventricle. Average responders' activation volume lay on the trigeminohypothalamic tract, connecting the trigeminal system and other brainstem nuclei associated with nociception and pain modulation with the hypothalamus, and the prefrontal and mesial temporal areas. CONCLUSIONS We identify the optimal stimulation site and structural connectivity of the deep brain stimulation target for cluster headache, explicating possible mechanisms of action and disease pathophysiology.
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Affiliation(s)
- Harith Akram
- From the Unit of Functional Neurosurgery (H.A., M.H., L.Z.), Sobell Department of Motor Neuroscience and Movement Disorders, and Wellcome Trust Centre for Neuroimaging (J.A., T.B.), UCL Institute of Neurology, University College London; Victor Horsley Department of Neurosurgery (H.A., L.Z.), National Hospital for Neurology and Neurosurgery; Headache Group (S.M., S.L., M.M.), UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical Neuroscience (M.H.), Umeå University, Sweden; and Centre for Functional MRI of the Brain (T.B.), John Radcliffe Hospital, Oxford, UK.
| | - Sarah Miller
- From the Unit of Functional Neurosurgery (H.A., M.H., L.Z.), Sobell Department of Motor Neuroscience and Movement Disorders, and Wellcome Trust Centre for Neuroimaging (J.A., T.B.), UCL Institute of Neurology, University College London; Victor Horsley Department of Neurosurgery (H.A., L.Z.), National Hospital for Neurology and Neurosurgery; Headache Group (S.M., S.L., M.M.), UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical Neuroscience (M.H.), Umeå University, Sweden; and Centre for Functional MRI of the Brain (T.B.), John Radcliffe Hospital, Oxford, UK
| | - Susie Lagrata
- From the Unit of Functional Neurosurgery (H.A., M.H., L.Z.), Sobell Department of Motor Neuroscience and Movement Disorders, and Wellcome Trust Centre for Neuroimaging (J.A., T.B.), UCL Institute of Neurology, University College London; Victor Horsley Department of Neurosurgery (H.A., L.Z.), National Hospital for Neurology and Neurosurgery; Headache Group (S.M., S.L., M.M.), UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical Neuroscience (M.H.), Umeå University, Sweden; and Centre for Functional MRI of the Brain (T.B.), John Radcliffe Hospital, Oxford, UK
| | - Marwan Hariz
- From the Unit of Functional Neurosurgery (H.A., M.H., L.Z.), Sobell Department of Motor Neuroscience and Movement Disorders, and Wellcome Trust Centre for Neuroimaging (J.A., T.B.), UCL Institute of Neurology, University College London; Victor Horsley Department of Neurosurgery (H.A., L.Z.), National Hospital for Neurology and Neurosurgery; Headache Group (S.M., S.L., M.M.), UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical Neuroscience (M.H.), Umeå University, Sweden; and Centre for Functional MRI of the Brain (T.B.), John Radcliffe Hospital, Oxford, UK
| | - John Ashburner
- From the Unit of Functional Neurosurgery (H.A., M.H., L.Z.), Sobell Department of Motor Neuroscience and Movement Disorders, and Wellcome Trust Centre for Neuroimaging (J.A., T.B.), UCL Institute of Neurology, University College London; Victor Horsley Department of Neurosurgery (H.A., L.Z.), National Hospital for Neurology and Neurosurgery; Headache Group (S.M., S.L., M.M.), UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical Neuroscience (M.H.), Umeå University, Sweden; and Centre for Functional MRI of the Brain (T.B.), John Radcliffe Hospital, Oxford, UK
| | - Tim Behrens
- From the Unit of Functional Neurosurgery (H.A., M.H., L.Z.), Sobell Department of Motor Neuroscience and Movement Disorders, and Wellcome Trust Centre for Neuroimaging (J.A., T.B.), UCL Institute of Neurology, University College London; Victor Horsley Department of Neurosurgery (H.A., L.Z.), National Hospital for Neurology and Neurosurgery; Headache Group (S.M., S.L., M.M.), UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical Neuroscience (M.H.), Umeå University, Sweden; and Centre for Functional MRI of the Brain (T.B.), John Radcliffe Hospital, Oxford, UK
| | - Manjit Matharu
- From the Unit of Functional Neurosurgery (H.A., M.H., L.Z.), Sobell Department of Motor Neuroscience and Movement Disorders, and Wellcome Trust Centre for Neuroimaging (J.A., T.B.), UCL Institute of Neurology, University College London; Victor Horsley Department of Neurosurgery (H.A., L.Z.), National Hospital for Neurology and Neurosurgery; Headache Group (S.M., S.L., M.M.), UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical Neuroscience (M.H.), Umeå University, Sweden; and Centre for Functional MRI of the Brain (T.B.), John Radcliffe Hospital, Oxford, UK
| | - Ludvic Zrinzo
- From the Unit of Functional Neurosurgery (H.A., M.H., L.Z.), Sobell Department of Motor Neuroscience and Movement Disorders, and Wellcome Trust Centre for Neuroimaging (J.A., T.B.), UCL Institute of Neurology, University College London; Victor Horsley Department of Neurosurgery (H.A., L.Z.), National Hospital for Neurology and Neurosurgery; Headache Group (S.M., S.L., M.M.), UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical Neuroscience (M.H.), Umeå University, Sweden; and Centre for Functional MRI of the Brain (T.B.), John Radcliffe Hospital, Oxford, UK
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Miller S, Lagrata S, Watkins L, Matharu M. Occipital Nerve Stimulation for Medically Refractory Chronic Paroxysmal Hemicrania. Headache 2017; 57:1610-1613. [DOI: 10.1111/head.13187] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2017] [Indexed: 01/03/2023]
Affiliation(s)
- Sarah Miller
- Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square; London United Kingdom
| | - Susie Lagrata
- Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square; London United Kingdom
| | - Laurence Watkins
- Department of Neurosurgery; Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square; London United Kingdom
| | - Manjit Matharu
- Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square; London United Kingdom
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Hassan S, Lagrata S, Levy A, Matharu M, Zrinzo L. Microvascular decompression or neuromodulation in patients with SUNCT and trigeminal neurovascular conflict? Cephalalgia 2017; 38:393-398. [DOI: 10.1177/0333102417735847] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives To assess the effectiveness of neuromodulation and trigeminal microvascular decompression (MVD) in patients with medically-intractable short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT). Methods Two patients with medically refractory SUNCT underwent MVD following beneficial but incomplete response to neuromodulation (occipital nerve stimulation and deep brain stimulation). MRI confirmed neurovascular conflict with the ipsilateral trigeminal nerve in both patients. Results Although neuromodulation provided significant benefit, it did not deliver complete relief from pain and management required numerous postoperative visits with adjustment of medication and stimulation parameters. Conversely, MVD was successful in eliminating symptoms of SUNCT in both patients with no need for further medical treatment or neuromodulation. Conclusion Neuromodulation requires expensive hardware and lifelong follow-up and maintenance. These case reports highlight that microvascular decompression may be preferable to neuromodulation in the subset of SUNCT patients with ipsilateral neurovascular conflict.
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Affiliation(s)
- Samih Hassan
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Susie Lagrata
- Headache Group, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Andrew Levy
- Headache Group, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Manjit Matharu
- Headache Group, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Ludvic Zrinzo
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, London, UK
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Miller S, Akram H, Lagrata S, Hariz M, Zrinzo L, Matharu M. Ventral tegmental area deep brain stimulation in refractory short-lasting unilateral neuralgiform headache attacks. Brain 2016; 139:2631-2640. [DOI: 10.1093/brain/aww204] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/23/2016] [Indexed: 01/03/2023] Open
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Akram H, Miller S, Lagrata S, Hyam J, Jahanshahi M, Hariz M, Matharu M, Zrinzo L. Ventral tegmental area deep brain stimulation for refractory chronic cluster headache. Neurology 2016; 86:1676-82. [PMID: 27029635 DOI: 10.1212/wnl.0000000000002632] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 01/20/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To present outcomes in a cohort of medically intractable chronic cluster headache (CCH) patients treated with ventral tegmental area (VTA) deep brain stimulation (DBS). METHODS In an uncontrolled open-label prospective study, 21 patients (17 male; mean age 52 years) with medically refractory CCH were selected for ipsilateral VTA-DBS by a specialist multidisciplinary team including a headache neurologist and functional neurosurgeon. Patients had also failed or were denied access to occipital nerve stimulation within the UK National Health Service. The primary endpoint was improvement in the headache frequency. Secondary outcomes included other headache scores (severity, duration, headache load), medication use, disability and affective scores, quality of life (QoL) measures, and adverse events. RESULTS Median follow-up was 18 months (range 4-60 months). At the final follow-up point, there was 60% improvement in headache frequency (p = 0.007) and 30% improvement in headache severity (p = 0.001). The headache load (a composite score encompassing frequency, severity, and duration of attacks) improved by 68% (p = 0.002). Total monthly triptan intake of the group dropped by 57% posttreatment. Significant improvement was observed in a number of QoL, disability, and mood scales. Side effects included diplopia, which resolved in 2 patients following stimulation adjustment, and persisted in 1 patient with a history of ipsilateral trochlear nerve palsy. There were no other serious adverse events. CONCLUSIONS This study supports that VTA-DBS may be a safe and effective therapy for refractory CCH patients who failed conventional treatments. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that VTA-DBS decreases headache frequency, severity, and headache load in patients with medically intractable chronic cluster headaches.
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Affiliation(s)
- Harith Akram
- From the Unit of Functional Neurosurgery (H.A., J.H., M.J., M.H., L.Z.), Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London; Victor Horsley Department of Neurosurgery (H.A., J.H., L.Z.), National Hospital for Neurology and Neurosurgery, London; Headache Group (S.M., S.L., M.M.), Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK; and Department of Neurosurgery (M.H.), University Hospital, Umeå, Sweden.
| | - Sarah Miller
- From the Unit of Functional Neurosurgery (H.A., J.H., M.J., M.H., L.Z.), Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London; Victor Horsley Department of Neurosurgery (H.A., J.H., L.Z.), National Hospital for Neurology and Neurosurgery, London; Headache Group (S.M., S.L., M.M.), Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK; and Department of Neurosurgery (M.H.), University Hospital, Umeå, Sweden
| | - Susie Lagrata
- From the Unit of Functional Neurosurgery (H.A., J.H., M.J., M.H., L.Z.), Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London; Victor Horsley Department of Neurosurgery (H.A., J.H., L.Z.), National Hospital for Neurology and Neurosurgery, London; Headache Group (S.M., S.L., M.M.), Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK; and Department of Neurosurgery (M.H.), University Hospital, Umeå, Sweden
| | - Jonathan Hyam
- From the Unit of Functional Neurosurgery (H.A., J.H., M.J., M.H., L.Z.), Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London; Victor Horsley Department of Neurosurgery (H.A., J.H., L.Z.), National Hospital for Neurology and Neurosurgery, London; Headache Group (S.M., S.L., M.M.), Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK; and Department of Neurosurgery (M.H.), University Hospital, Umeå, Sweden
| | - Marjan Jahanshahi
- From the Unit of Functional Neurosurgery (H.A., J.H., M.J., M.H., L.Z.), Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London; Victor Horsley Department of Neurosurgery (H.A., J.H., L.Z.), National Hospital for Neurology and Neurosurgery, London; Headache Group (S.M., S.L., M.M.), Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK; and Department of Neurosurgery (M.H.), University Hospital, Umeå, Sweden
| | - Marwan Hariz
- From the Unit of Functional Neurosurgery (H.A., J.H., M.J., M.H., L.Z.), Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London; Victor Horsley Department of Neurosurgery (H.A., J.H., L.Z.), National Hospital for Neurology and Neurosurgery, London; Headache Group (S.M., S.L., M.M.), Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK; and Department of Neurosurgery (M.H.), University Hospital, Umeå, Sweden
| | - Manjit Matharu
- From the Unit of Functional Neurosurgery (H.A., J.H., M.J., M.H., L.Z.), Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London; Victor Horsley Department of Neurosurgery (H.A., J.H., L.Z.), National Hospital for Neurology and Neurosurgery, London; Headache Group (S.M., S.L., M.M.), Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK; and Department of Neurosurgery (M.H.), University Hospital, Umeå, Sweden
| | - Ludvic Zrinzo
- From the Unit of Functional Neurosurgery (H.A., J.H., M.J., M.H., L.Z.), Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London; Victor Horsley Department of Neurosurgery (H.A., J.H., L.Z.), National Hospital for Neurology and Neurosurgery, London; Headache Group (S.M., S.L., M.M.), Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK; and Department of Neurosurgery (M.H.), University Hospital, Umeå, Sweden
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Miller S, Correia F, Lagrata S, Matharu MS. OnabotulinumtoxinA for hemicrania continua: open label experience in 9 patients. J Headache Pain 2015; 16:19. [PMID: 25902798 PMCID: PMC4385246 DOI: 10.1186/s10194-015-0502-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 02/16/2015] [Indexed: 12/18/2022] Open
Abstract
Background Hemicrania continua is a strictly unilateral, continuous headache, typically mild to moderate in severity, with severe exacerbations commonly accompanied by cranial autonomic features and migrainous symptoms. It is exquisitely responsive to Indomethacin. However, some patients cannot tolerate treatment, often due to gastrointestinal side effects. Therapeutic alternatives are limited and controlled evidence lacking. Methods We present our experience of nine patients treated with OnabotulinumtoxinA for hemicrania continua. All patients were injected using the PREEMPT (Phase 3 REsearch Evaluating Migraine Prophylaxis Therapy) protocol for migraine. Results Five of nine patients demonstrated a 50% or more reduction in moderate to severe headache days with OnabotulinumtoxinA with a median reduction in moderate to severe headache days of 80%. Patient estimate of response was 80% or more in five subjects. The median and mean duration of response in the five responders was 11 and 12 weeks (range 6–20 weeks). Improvements were also seen in headache-associated disability Conclusions OnabotulinumtoxinA adds a potential option to the limited therapeutic alternatives available in hemicrania continua.
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Affiliation(s)
- Sarah Miller
- Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery Queen Square, London, WC1N 3BG, UK.
| | - Fernando Correia
- Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery Queen Square, London, WC1N 3BG, UK. .,Department of Neurology, Centro Hospitalar do Porto, Oporto, Portugal.
| | - Susie Lagrata
- Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery Queen Square, London, WC1N 3BG, UK.
| | - Manjit S Matharu
- Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery Queen Square, London, WC1N 3BG, UK.
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Miller S, Correia F, Lagrata S, Matharu M. EHMTI-0278. Onabotulinum toxin a for hemicrania continua: a case series of 8 patients. J Headache Pain 2014. [PMCID: PMC4180183 DOI: 10.1186/1129-2377-15-s1-c45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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