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Frontiers in Pain Research (Lausanne,... 2023Primary headache disorders can be remarkably disabling and the therapeutic options available are usually limited to medication with a high rate of adverse events. Here,... (Review)
Review
Primary headache disorders can be remarkably disabling and the therapeutic options available are usually limited to medication with a high rate of adverse events. Here, we discuss the mechanism of action of non-invasive vagal nerve stimulation, as well as the findings of the main studies involving patients with primary headaches other than migraine or cluster headache, such as hemicrania continua, paroxysmal hemicrania, cough headache, or short-lasting neuralgiform headache attacks (SUNCT/SUNA), in a narrative analysis. A bibliographical search of low-prevalence disorders such as rare primary headaches retrieves a moderate number of studies, usually underpowered. Headache intensity, severity, and duration showed a clinically significant reduction in the majority, especially those involving indomethacin-responsive headaches. The lack of response of some patients with a similar diagnosis could be due to a different stimulation pattern, technique, or total dose. The use of non-invasive vagal nerve stimulation for the treatment of primary headache disorders represents an excellent option for patients with these debilitating and otherwise refractory conditions, or that cannot tolerate several lines of preventive medication, and should always be considered before contemplating invasive, non-reversible stimulation techniques.
PubMed: 36994091
DOI: 10.3389/fpain.2023.1062892 -
Neurologia I Neurochirurgia Polska 2022
Topics: Cluster Headache; Functional Neuroimaging; Headache; Humans; Neuroimaging; Paroxysmal Hemicrania; Trigeminal Neuralgia
PubMed: 35312033
DOI: 10.5603/PJNNS.a2022.0025 -
Cephalalgia : An International Journal... Jul 2022Headaches with marked, specific response to indomethacin occur in children, but the phenotypic spectrum of this phenomenon has not been well-studied. (Review)
Review
BACKGROUND
Headaches with marked, specific response to indomethacin occur in children, but the phenotypic spectrum of this phenomenon has not been well-studied.
METHODS
We reviewed pediatric patients with headache showing ≥80% improvement with indomethacin, from seven academic medical centers.
RESULTS
We included 32 pediatric patients (16 females). Mean headache onset age was 10.9 y (range 2-16 y). Headache syndromes included hemicrania continua (n = 13), paroxysmal hemicrania (n = 10), primary stabbing headache (n = 2), short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (n = 1), primary exercise headache (n = 1) and primary cough headache (n = 1). Adverse events were reported in 13, most commonly gastrointestinal symptoms, which often improved with co-administration of gastro-protective agents.
CONCLUSION
Indomethacin-responsive headaches occur in children and adolescents, and include headache syndromes, such as primary cough headache, previously thought to present only in adulthood. The incidence of adverse events is high, and patients must be co-treated with a gastroprotective agent.
Topics: Adolescent; Adult; Child; Female; Headache; Humans; Indomethacin; Neuralgia; Paroxysmal Hemicrania; Tears
PubMed: 35302385
DOI: 10.1177/03331024221076483 -
Cephalalgia : An International Journal... Jan 2022The presence of aura is rare in cluster headache, and even rarer in other trigeminal autonomic cephalalgias. We hypothesized that the presence of aura in patients with...
OBJECTIVE
The presence of aura is rare in cluster headache, and even rarer in other trigeminal autonomic cephalalgias. We hypothesized that the presence of aura in patients with trigeminal autonomic cephalalgias is frequently an epiphenomenon and mediated by comorbid migraine with aura.
METHODS
The study retrospectively reviewed 480 patients with trigeminal autonomic cephalalgia in a tertiary medical center for 10 years. Phenotypes and temporal correlation of aura with headache were analyzed. Trigeminal autonomic cephalalgia patients with aura were further followed up in a structured telephone interview.
RESULTS
Seventeen patients with aura (3.5%) were identified from 480 patients with trigeminal autonomic cephalalgia, including nine with cluster headache, one with paroxysmal hemicrania, three with hemicrania continua, and four with probable trigeminal autonomic cephalalgia. Compared to trigeminal autonomic cephalalgia patients without aura, trigeminal autonomic cephalalgia patients with aura were more likely to have a concomitant diagnosis of migraine with aura (odds ratio [OR] = 109.0, 95% CI 30.9-383.0, < 0.001); whereas the risk of migraine without aura remains similar between both groups (OR = 1.10, 95% CI = 0.14-8.59, = 0.931). Aura was more frequently accompanied with migraine-like attacks, but not trigeminal autonomic cephalalgia attacks.
INTERPRETATION
In most patients with trigeminal autonomic cephalalgia, the presence of aura is mediated by the comorbidity of migraine with aura. Aura directly related to trigeminal autonomic cephalalgia attack may exist but remains rare. Our results suggest that aura may not be involved in the pathophysiology of trigeminal autonomic cephalalgia.
Topics: Cluster Headache; Comorbidity; Epilepsy; Humans; Migraine Disorders; Migraine with Aura; Retrospective Studies; Trigeminal Autonomic Cephalalgias
PubMed: 34407649
DOI: 10.1177/03331024211030499 -
Cephalalgia : An International Journal... Jan 2022Unlike other non-steroidal anti-inflammatory drugs, indomethacin has been shown to be highly effective in two forms of trigeminal autonomic cephalalgias, hemicrania... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Unlike other non-steroidal anti-inflammatory drugs, indomethacin has been shown to be highly effective in two forms of trigeminal autonomic cephalalgias, hemicrania continua and paroxysmal hemicrania and in some forms of idiopathic stabbing headaches. This specificity is unique in the headache field. Previous findings suggest the involvement of the trigeminal autonomic reflex to play an important role in the pathophysiology of these diseases.
METHODS
22 healthy participants were enrolled in a double-blind, three-day within-subject design. The participants received indomethacin, ibuprofen or placebo in a randomized order. After an incubation period of 65 min the baseline lacrimation and the lacrimation during intranasal stimulation evoked by kinetic oscillation stimulation were assessed using Schirmer II lacrimation tests. The lacrimation difference in mm was calculated and compared in a repeated measures ANOVA.
RESULTS
No significant differences were found between the three conditions.
CONCLUSION
In our study, neither indomethacin nor ibuprofen had an inhibitory effect on the trigeminal autonomic reflex. We suggest that blocking this reflex may not be the treatment mechanism of indomethacin.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Double-Blind Method; Headache; Humans; Ibuprofen; Indomethacin; Paroxysmal Hemicrania; Trigeminal Autonomic Cephalalgias
PubMed: 34407645
DOI: 10.1177/03331024211030901 -
Internal Medicine (Tokyo, Japan) Feb 2022A 26-year-old woman with a history of migraine reported right-sided, severe stabbing orbital pain with cranial autonomic symptoms (CASs) for approximately 2 years. The...
A 26-year-old woman with a history of migraine reported right-sided, severe stabbing orbital pain with cranial autonomic symptoms (CASs) for approximately 2 years. The attack duration was approximately 30 minutes, with a frequency of twice per day. Taking loxoprofen was ineffective. Six months earlier, moderate pressing continuous interictal pain without CASs had developed. Indomethacin farnesyl completely resolved the attacks but had no effect on the interictal pain. The patient was diagnosed with probable chronic paroxysmal hemicrania in accordance with the International Classification of Headache Disorders (ICHD-3) (third version). Continuous interictal pain gradually disappeared with a combination of indomethacin farnesyl and amitriptyline.
Topics: Adult; Amitriptyline; Female; Headache; Humans; Indomethacin; Migraine Disorders; Paroxysmal Hemicrania
PubMed: 34176839
DOI: 10.2169/internalmedicine.7511-21 -
Frontiers in Neurology 2021Trigeminal Autonomic Cephalalgias (TAC) are excruciating headaches with limited treatment options. The chronic forms of TACs, including chronic cluster, chronic...
Trigeminal Autonomic Cephalalgias (TAC) are excruciating headaches with limited treatment options. The chronic forms of TACs, including chronic cluster, chronic paroxysmal hemicrania, and hemicrania continua, are disabling conditions. In addition to drug therapy, there are some studies regarding nerve blocking and nerve stimulation with acceptable results. Here we report four cases of decompression nerve surgery with promising results on pain control in these difficult to treat headaches.
PubMed: 34163429
DOI: 10.3389/fneur.2021.678749 -
Neurology India 2021Migraine is a common disabling primary headache condition. Although strives have been made in treatment, there remains an unmet need for safe, effective acute, and... (Review)
Review
BACKGROUND
Migraine is a common disabling primary headache condition. Although strives have been made in treatment, there remains an unmet need for safe, effective acute, and preventative treatments. The promising concept of neuromodulation of relevant neuronal targets in a noninvasive fashion for the treatment of primary headache disorders has led to the trial of numerous devices over the years.
OBJECTIVE
We aimed to review the evidence on current neuromodulation treatments available for the management of primary headache disorders.
METHODS
Randomized controlled trial as well as open-label and real-world studies on central and peripheral cephalic and noncephalic neuromodulation modalities in primary headaches were critically reviewed.
RESULTS
The current evidence suggests a role of single-pulse transcranial magnetic stimulation, supraorbital nerve stimulation, and remote noncephalic electrical stimulation as migraine abortive treatments, with stronger evidence in episodic rather than in chronic migraine. Single-pulse transcranial magnetic stimulation and supraorbital nerve stimulation also hold promising evidence in episodic migraine prevention and initial positive evidence in chronic migraine prevention. More evidence should clarify the therapeutic role of the external vagus nerve stimulation and transcranial direct current stimulation in migraine. However, external vagus nerve stimulation may be effective in the acute treatment of episodic but not chronic cluster headache, in the prevention of hemicrania continua and paroxysmal hemicrania but not of short-lasting neuralgiform headache attacks. The difficulty in setting up sham-controlled studies has thus far prevented the publication of robust trials. This limitation along with the cost of these therapies has meant that their use is limited in most countries.
CONCLUSION
Neuromodulation is a promising nonpharmacological treatment approach for primary headaches. More studies with appropriate blinding strategies and reduction of device cost may allow more widespread approval of these treatments and in turn increase clinician's experience in neuromodulation.
Topics: Cluster Headache; Headache; Humans; Migraine Disorders; Transcranial Direct Current Stimulation; Vagus Nerve Stimulation
PubMed: 34003164
DOI: 10.4103/0028-3886.315998 -
Neurology India 2021Paroxysmal Hemicrania (PH) is classified under trigeminal autonomic cephalalgia (TAC) as per the International Classification of Headache Disorders (ICHD). Since the... (Review)
Review
Paroxysmal Hemicrania (PH) is classified under trigeminal autonomic cephalalgia (TAC) as per the International Classification of Headache Disorders (ICHD). Since the first description by 0ttar Sjaastad and Inge Dale in 1974, PH has been reported by many authors. A greater understanding of PH phenotype and pathophysiology has resulted in the evolution of its diagnostic criteria, and management. We tabulated major case series of PH to describe the epidemiology, clinical features and recent updates of PH. PH is a rare headache characterized by daily, multiple paroxysms of unilateral, short-lasting (mean duration <20 minutes), side-locked headache in the distribution of ophthalmic division of trigeminal nerve with associated profound cranial autonomic symptoms. Recent ICHD classification added "restlessness" to the criteria for PH. Pain should completely respond to indomethacin to fulfil the diagnostic criteria of PH. PH should be differentiated from cluster headache, SUNCT/SUNA, and other short-lasting side-locked headaches. Trigeminal afferents possibly produce pain in PH and trigeminal-autonomic reflex explains the occurrence of autonomic features. Recently, a "permissive" central role of the hypothalamus is unveiled based on functional imaging studies. Other Cox-2 inhibitors, topiramate, calcium-channel blockers, epicranial nerve blocks have been shown to improve headache in some patients of PH who cannot tolerate indomethacin. Hypothalamic deep brain stimulation has been used in treatment-refractory cases.
Topics: Cluster Headache; Headache; Headache Disorders; Humans; Paroxysmal Hemicrania; Trigeminal Autonomic Cephalalgias
PubMed: 34003159
DOI: 10.4103/0028-3886.315982 -
Neurology India 2021Key structures for the pathophysiology of primary headache disorders such as migraine, cluster headache, and other trigeminal autonomic cephalalgias were identified by... (Review)
Review
BACKGROUND
Key structures for the pathophysiology of primary headache disorders such as migraine, cluster headache, and other trigeminal autonomic cephalalgias were identified by imaging in the past years.
OBJECTIVE
Available data on functional imaging in primary headache disorders are summarized in this review.
MATERIAL AND METHODS
We performed a MEDLINE search on December 27, 2020 using the search terms "primary headache" AND "imaging" that returned 453 results in English, out of which 137 were labeled reviews. All articles were evaluated for content and relevance for this narrative review.
RESULTS
The structure depicted most consistently using functional imaging in different states of primary headaches (without and with pain) was the posterior hypothalamus. Whole-brain imaging techniques such as resting-state functional resonance imaging showed a wide-ranging association of cortical and subcortical areas with human nociceptive processing in the pathophysiological mechanisms underlying the different TACs. Similarities of distinct groups of primary headache disorders, as well as their differences in brain activation across these disorders, were highlighted.
CONCLUSION
The importance of neuroimaging research from clinical practice point of view remains the reliable and objective distinction of each individual pain syndrome from one another. This will help to make the correct clinical diagnosis and pave the way for better and effective treatment in the future. More research will be necessary to fulfill this unmet need.
Topics: Cluster Headache; Functional Neuroimaging; Headache; Humans; Migraine Disorders; Trigeminal Autonomic Cephalalgias
PubMed: 34003144
DOI: 10.4103/0028-3886.315987