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Neurological Sciences : Official... Dec 2020Cluster headache (CH), paroxysmal hemicrania (PH), short-lasting unilateral neuralgiform headache attacks (including SUNCT and SUNA), and hemicrania continua (HC)... (Review)
Review
Cluster headache (CH), paroxysmal hemicrania (PH), short-lasting unilateral neuralgiform headache attacks (including SUNCT and SUNA), and hemicrania continua (HC) compose the group of trigeminal autonomic cephalalgias (TACs). Here, we review the recent advances in the field and summarize the current knowledge about the origin of these headaches. Similar to the other primary headaches, the pathogenesis is still much obscure. However, advances are being made in both animal models and humans studies. Three structures clearly appear to be crucial in the pathophysiology of TACs: the trigeminal nerve, the facial parasympathetic system, and the hypothalamus. The physiologic and pathologic functioning of each of these elements and their interactions is being progressively clarified, but critical questions are still open.
Topics: Animals; Cluster Headache; Headache; Humans; Paroxysmal Hemicrania; SUNCT Syndrome; Trigeminal Autonomic Cephalalgias
PubMed: 32845489
DOI: 10.1007/s10072-020-04639-4 -
Pain Feb 2021Nonsteroidal anti-inflammatory drugs, cyclooxygenase inhibitors, are used routinely in the treatment of primary headache disorders. Indomethacin is unique in its use in...
Nonsteroidal anti-inflammatory drugs, cyclooxygenase inhibitors, are used routinely in the treatment of primary headache disorders. Indomethacin is unique in its use in the diagnosis and treatment of hemicrania continua and paroxysmal hemicrania. The mechanism of this specific action is not fully understood, although an interaction with nitric oxide (NO) signaling pathways has been suggested. Trigeminovascular neurons were activated by dural electrical stimulation, systemic administration of an NO donor, or local microiontophoresis of L-glutamate. Using electrophysiological techniques, we subsequently recorded the activation of trigeminovascular neurons and their responses to intravenous indomethacin, naproxen, and ibuprofen. Administration of indomethacin (5 mg·kg-1), ibuprofen (30 mg·kg-1), or naproxen (30 mg·kg-1) inhibited dural-evoked firing within the trigeminocervical complex with different temporal profiles. Similarly, both indomethacin and naproxen inhibited L-glutamate-evoked cell firing suggesting a common action. By contrast, only indomethacin was able to inhibit NO-induced firing. The differences in profile of effect of indomethacin may be fundamental to its ability to treat paroxysmal hemicrania and hemicrania continua. The data implicate NO-related signaling as a potential therapeutic approach to these disorders.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Headache; Humans; Ibuprofen; Indomethacin; Naproxen
PubMed: 32796319
DOI: 10.1097/j.pain.0000000000002032 -
Nederlands Tijdschrift Voor Geneeskunde Jul 2020Trigeminal autonomic cephalalgias (TACs) are a group of 4 different primary headache syndromes that have a lot of pathophysiological and clinical features in common. The... (Review)
Review
Trigeminal autonomic cephalalgias (TACs) are a group of 4 different primary headache syndromes that have a lot of pathophysiological and clinical features in common. The 4 different TACs are: cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks and hemicrania continua. TACs are characterized by frequent, strictly unilateral, (very) intense headache attacks with ipsilateral cranial autonomic symptoms or intrinsic restlessness or both. A distinction can be made between the 4 TACs on the basis of the duration and frequency of the headache attacks. The treatment of cluster headache consists of an acute treatment and a maintenance treatment. Headache attacks in the context of paroxysmal hemicrania and hemicrania continua (almost) always respond to treatment with indomethacin. More and more neuromodulation therapies are becoming available, such as vagus nerve stimulation, stimulation and blocking of the sphenopalatine ganglion, stimulation and blocking of the occipital nerve and deep brain stimulation.
Topics: Autonomic Nervous System; Cluster Headache; Diagnosis, Differential; Female; Functional Laterality; Humans; Male; Trigeminal Autonomic Cephalalgias
PubMed: 32779921
DOI: No ID Found -
Cephalalgia : An International Journal... Oct 2020Trigemino-autonomic cephalalgias are very rare disorders and even rarer in children and adolescents. We report the onset of paroxysmal hemicrania in a very young girl... (Review)
Review
BACKGROUND
Trigemino-autonomic cephalalgias are very rare disorders and even rarer in children and adolescents. We report the onset of paroxysmal hemicrania in a very young girl and reviewed the scientific literature for similar cases.
FINDINGS
We describe the case of a 1.6-year-old girl with left-sided headache attacks fulfilling the criteria of paroxysmal hemicrania including prompt responsiveness to indomethacin. In addition, we detected at least two children for every trigemino-autonomic cephalalgias subtype with an age of under 7 years at the onset of the trigemino-autonomic cephalalgias. Remarkable features were a vast majority of chronic course from onset on and left-sided attacks.
CONCLUSION
Although very rare, trigemino-autonomic cephalalgias can occur even in very young children under the age of 6 years. This should be known in neuropaediatrics.
Topics: Age of Onset; Female; Humans; Infant; Trigeminal Autonomic Cephalalgias
PubMed: 32664738
DOI: 10.1177/0333102420942220 -
Aerospace Medicine and Human Performance Apr 2020Airplane headache (AH) is unique to plane travel and looks like a short duration migraine attack or paroxysmal hemicrania (PH) attack without any autonomic symptoms....
Airplane headache (AH) is unique to plane travel and looks like a short duration migraine attack or paroxysmal hemicrania (PH) attack without any autonomic symptoms. Until now, there has been no documented association between AH and PH. We report a 50-yr-old healthy woman with a very severe and sudden pulsating headache located in the left frontal region with radiation into the left eye during takeoff which diminished within 10-15 min during her airplane journeys. The patient was diagnosed with AH and she had good response to indomethacin. The pain was unique to plane travel but looked like PH. We discuss the association between AH and PH attack in the light of diagnostic criteria and therapeutic approach in the report.
Topics: Aerospace Medicine; Air Travel; Anti-Inflammatory Agents, Non-Steroidal; Aviation; Female; Headache; Humans; Indomethacin; Middle Aged; Paroxysmal Hemicrania
PubMed: 32493562
DOI: 10.3357/AMHP.5540.2020 -
Current Pain and Headache Reports May 2020Primary headaches are less common and differ in presentation in older versus younger individuals. Secondary headaches become more common among older patients. (Review)
Review
PURPOSE OF REVIEW
Primary headaches are less common and differ in presentation in older versus younger individuals. Secondary headaches become more common among older patients.
RECENT FINDINGS
Diagnosis and management of headaches in those > 65 years are discussed. Migraine and tension-type headaches are rarely new onset in this age group and should be a diagnosis of exclusion. In older individuals, migraine is more likely to be bilateral with less sensory sensitivities. Migraine aura may present without headache; careful assessment is needed to exclude stroke. Other primary headaches discussed include cough, hypnic, and other headaches. Secondary causes discussed include giant cell arteritis, trigeminal post-herpetic neuropathy, sleep apnea, cardiac cephalgia, cervicogenic pain, vascular etiologies, medications, and burning-mouth syndrome. In older individuals, primary headaches are diagnoses of exclusion, and treatment is affected by comorbidities and polypharmacy. Secondary headaches are a major consideration requiring appropriate workup. Many treatments can safely be offered regardless of age.
Topics: Aged; Burning Mouth Syndrome; Cluster Headache; Giant Cell Arteritis; Headache Disorders, Primary; Headache Disorders, Secondary; Humans; Migraine Disorders; Neuralgia, Postherpetic; Paroxysmal Hemicrania; Post-Traumatic Headache; SUNCT Syndrome; Sleep Apnea Syndromes; Tension-Type Headache; Trigeminal Neuralgia
PubMed: 32472308
DOI: 10.1007/s11916-020-00866-8 -
Headache May 2020
Topics: Aged; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Male; Paroxysmal Hemicrania; Sinus Thrombosis, Intracranial
PubMed: 32118290
DOI: 10.1111/head.13781 -
Neurologic Clinics Nov 2019The trigeminal autonomic cephalalgias (TACs) are a group of primary headache syndromes all marked by unilateral headache and ipsilateral cranial autonomic features. The... (Review)
Review
The trigeminal autonomic cephalalgias (TACs) are a group of primary headache syndromes all marked by unilateral headache and ipsilateral cranial autonomic features. The TACs include cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing, and hemicrania continua. Pathophysiology includes the trigeminal pain system, autonomic system, hypothalamus, and more recently an identified role for the vagus nerve. Diagnosis is made after looking at headache frequency, duration, and accompanying symptoms. Each TAC has its own unique treatment, which is discussed in depth.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Diagnosis, Differential; Headache; Humans; Hypothalamus; Indomethacin; Lithium Carbonate; Melatonin; Trigeminal Autonomic Cephalalgias; Vagus Nerve
PubMed: 31563236
DOI: 10.1016/j.ncl.2019.07.001 -
Neurology Sep 2019To assess the prevalence of facial pain (V2 and/or V3) presentations among nearly 3,000 patients with headache treated in a university tertiary care center.
OBJECTIVE
To assess the prevalence of facial pain (V2 and/or V3) presentations among nearly 3,000 patients with headache treated in a university tertiary care center.
METHODS
Between 2010 and 2018, we routinely assessed the prevalence of facial pain presentations of all patients with primary headaches.
RESULTS
Of 2,912 patient datasets, 291 patients reported facial pain either as an independent or as an additional symptom. Among patients with migraine, 2.3% (44 of 1,935) reported a facial involvement, most commonly in V2. Of these, 18 patients (40.9%) experienced the pain predominantly in the face. In patients with cluster headache, 14.8% (42 of 283) reported a facial involvement, of which 31.0% perceived the pain predominantly in the face. A facial involvement was seen in 45.0% of patients with paroxysmal hemicrania (9 of 20), 21.4% of patients with hemicrania continua (9 of 42), and 20.0% of patients with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing/short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (3 of 15). In addition, we present 6 patients who reported a constant side-locked facial pain with superseded well-defined facial pain attacks of 10- to 30-minute duration that appeared several times per day.
CONCLUSION
Our data suggest that a facial involvement in primary headaches is infrequent but not uncommon. A sole facial presentation of primary headache symptomatology seems to be exceptionally rare. We describe 3 different types of facial pain involvement and, in this context, distinguish patients with paroxysmal orofacial pain syndromes that have not been previously described. These patients may represent a new entity that could tentatively be called constant unilateral facial pain with added attacks.
Topics: Adult; Diagnosis, Differential; Facial Neuralgia; Facial Pain; Female; Humans; Male; Middle Aged; Migraine Disorders; Retrospective Studies; Tertiary Care Centers; Trigeminal Autonomic Cephalalgias
PubMed: 31434691
DOI: 10.1212/WNL.0000000000008124 -
Medicine Aug 2019Paroxysmal hemicrania (PH) is a chronic headache disorder characterized by unilateral pain attacks accompanied by cranial autonomic symptoms and responds to indomethacin...
INTRODUCTION
Paroxysmal hemicrania (PH) is a chronic headache disorder characterized by unilateral pain attacks accompanied by cranial autonomic symptoms and responds to indomethacin completely. There are few alternative treatment options for the patients who cannot tolerate indomethacin. Studies exploring the effects of repetitive peripheral cranial nerve blocks in the management of chronic PH are limited.
PATIENT CONCERNS AND DIAGNOSIS
A 34-year-old woman with a 4-year history of PH was evaluated. Her pain was prevented by indomethacin without side effects; however, she wanted to try to conceive.
INTERVENTIONS
Repetitive pericranial nerve blocks, great occipital nerve, infraorbital nerve, supraorbital nerve, and sphenopalatine ganglion block, using local anesthetics and steroids were performed once a week for a 6 weeks period.
OUTCOMES
A follow-up of 3 months showed that there was no pain relief following the injections and patient was needed to be maintained on indomethacin.
CONCLUSION
Although pericranial nerve blocks have been tried in chronic PH cases with positive influences, this case indicated that repetitive nerve blocks were not always a successful therapy option.
Topics: Adult; Anesthetics, Local; Disease Management; Female; Headache; Humans; Lidocaine; Magnetic Resonance Imaging; Nerve Block; Pain Management; Paroxysmal Hemicrania
PubMed: 31374009
DOI: 10.1097/MD.0000000000016484