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Pain and Therapy Dec 2020Cluster headache is a rare form of headache associated with sleep and even speculated to be a manifestation of a sleep disorder rather than a primary headache. Cluster... (Review)
Review
Cluster headache is a rare form of headache associated with sleep and even speculated to be a manifestation of a sleep disorder rather than a primary headache. Cluster headache exhibits both circadian and circannual rhythmicity. While attacks often occur during sleep, the implication that cluster headaches might be involved with rapid eye movement (REM) sleep phases has neither been fully established nor refuted. The regulatory mechanisms governing sleep including hypothalamic activity and the autonomic nervous system response may play a role. Hypothalamic activation has been observed in cluster headache patients during positron emission tomography testing, but only during attacks. While sleep apnea is associated with morning headaches in general, the link between sleep-disordered respiration and cluster headache remains elusive. Hypoarousal during sleep and periods of hypoxia are associated with cluster headache, the latter likely involving inflammatory processes rather than apnea. Further study is needed, as cluster headaches represent a serious primary cephalgia that is incompletely understood.
PubMed: 32382871
DOI: 10.1007/s40122-020-00172-6 -
Pain Medicine (Malden, Mass.) Sep 2015The objective of this narrative review is to summarize the current state of neurostimulation therapies for the treatment of migraine and/or cluster. (Review)
Review
OBJECTIVE
The objective of this narrative review is to summarize the current state of neurostimulation therapies for the treatment of migraine and/or cluster.
METHODS
For this narrative review, publications were identified by searching PubMed using the search terms "migraine" or "cluster" combined with "vagal nerve stimulation," "transcranial magnetic stimulation," "supraorbital nerve stimulation," "sphenopalatine ganglion stimulation," "occipital nerve stimulation," "deep brain stimulation," "neurostimulation," or "neuromodulation." Publications were chosen based on the quality of data that were provided and their relevance to the chosen topics of interest for this review. Reference lists of chosen articles and the authors' own files were used to identify additional publications. Current clinical trials were identified by searching clinicaltrials.org.
RESULTS AND CONCLUSIONS
Neurostimulation of the vagal nerve, supraorbital nerve, occipital nerve and sphenopalatine ganglion, transcranial magnetic stimulation (TMS), and deep brain stimulation have been investigated for the treatment of migraine and/or cluster. Whereas invasive methods of neurostimulation would be reserved for patients with very severe and treatment refractory migraine or cluster, noninvasive methods of stimulation might serve as useful adjuncts to more conventional therapies. Currently, transcutaneous supraorbital nerve stimulation is FDA approved and commercially available for migraine prevention and TMS is FDA approved for the treatment of migraine with aura. The potential utility of each type of neurostimulation has yet to be completely defined.
Topics: Cluster Headache; Electric Stimulation Therapy; Humans; Migraine Disorders; Transcranial Magnetic Stimulation
PubMed: 26177612
DOI: 10.1111/pme.12792 -
American Family Physician Jul 2013
Topics: Adult; Cluster Headache; Female; Humans; Male; Young Adult
PubMed: 23939651
DOI: No ID Found -
Headache Apr 2022Although remarkable progress has been achieved in understanding cluster headache (CH) pathophysiology, there are still several gaps about the mechanisms through which... (Review)
Review
BACKGROUND
Although remarkable progress has been achieved in understanding cluster headache (CH) pathophysiology, there are still several gaps about the mechanisms through which independent subcortical and cortical brain structures interact with each other. These gaps could be partially elucidated by structural and functional advanced neuroimaging investigations.
OBJECTIVE
Although we are aware that substantial achievements have come from preclinical, neurophysiological, and biochemical experiments, the present narrative review aims to summarize the most significant findings from structural, microstructural, and functional neuroimaging investigations, as well as the consequent progresses in understanding CH pathophysiological mechanisms, to achieve a comprehensive and unifying model.
RESULTS
Advanced neuroimaging techniques have contributed to overcoming the peripheral hypothesis that CH is of cavernous sinus pathology, in transitioning from the pure vascular hypothesis to a more comprehensive trigeminovascular model, and, above all, in clarifying the role of the hypothalamus and its connections in the genesis of CH.
CONCLUSION
Altogether, neuroimaging findings strongly suggest that, beyond the theoretical model of the "pain matrix," the model of the "neurolimbic pain network" that is accepted in migraine research could also be extended to CH. Indeed, although the hypothalamus' role is undeniable, the genesis of CH attacks is complex and seems to not be just the result of a single "generator." Cortical-hypothalamic-brainstem functional interconnections that can switch between out-of-bout and in-bout periods, igniting the trigeminovascular system (probably by means of top-down mechanisms) and the consensual trigeminal autonomic reflexes, may represent the "neuronal background" of CH.
Topics: Cluster Headache; Functional Neuroimaging; Humans; Migraine Disorders; Neuroimaging; Pain
PubMed: 35315064
DOI: 10.1111/head.14279 -
The Journal of Headache and Pain May 2022Cluster headache is a less-prevalent primary headache disorder but is overrepresented with regards to use of health care and social services. More insight into the...
BACKGROUND
Cluster headache is a less-prevalent primary headache disorder but is overrepresented with regards to use of health care and social services. More insight into the socioeconomic impact is required.
METHODS
We investigated both the personal and societal disease burden and cost in 400 patients with well-classified cluster headache according to the ICHD-criteria and 200 sex- and age matched controls. All participants completed a cross sectional questionnaire and semi-structured interview.
RESULTS
Patients with chronic cluster headache constituted 146 out of 400 (37%). Overall, restriction in personal and/or professional life was reported by 94% of patients during attack periods. Even in remission, nine times as many episodic patients rated their health as poor/very poor compared to controls (9% vs 1%, p = 0.002). For chronic patients, the odds of rating health as good/very good were ten times lower compared to controls (OR:10.10, 95%CI:5.29-18.79. p < 0.001) and three times lower compared to episodic patients in remission (OR:3.22, 95%CI:1.90-5.47, p < 0.001). Additionally, chronic cluster headache patients were 5 times more likely to receive disability pension compared to episodic (OR:5.0, 95%CI:2.3-10.9, p < 0.001). The mean direct annual costs amounted to 9,158€ and 2,763€ for chronic and episodic patients, respectively (p < 0.001). We identified a substantial loss of productivity due to absence from work resulting in a higher indirect cost of 11,809 €/year/patient in the chronic population and 3,558 €/year/patient in the episodic population. Presenteeism could not be quantified but productivity was reduced in patients by 65% in periods with attacks compared to controls.
CONCLUSION
Cluster headache has a major negative impact on personal life, self-perceived health, and societal cost. Patients with the chronic variant are vastly more burdened. Patients with the episodic form were still markedly affected during the remission period. This study highlights the need for more effective therapy to lighten the burden on patients and society.
Topics: Cluster Headache; Cost of Illness; Cross-Sectional Studies; Humans; Presenteeism; Surveys and Questionnaires
PubMed: 35610587
DOI: 10.1186/s10194-022-01427-7 -
Headache Sep 2016To provide a summary of knowledge about the use of melatonin in the treatment of primary headache disorders. (Review)
Review
OBJECTIVE
To provide a summary of knowledge about the use of melatonin in the treatment of primary headache disorders.
BACKGROUND
Melatonin is secreted by the pineal gland; its production is regulated by the hypothalamus and increases during periods of darkness.
METHODS
We undertook a narrative review of the literature on the role of melatonin in the treatment of primary headache disorders.
RESULTS
There are randomized placebo-controlled trials examining melatonin for preventive treatment of migraine and cluster headache. For cluster headache, melatonin 10 mg was superior to placebo. For migraine, a randomized placebo-controlled trial of melatonin 3 mg (immediate release) was positive, though an underpowered trial of melatonin 2 mg (sustained release) was negative. Uncontrolled studies, case series, and case reports cover melatonin's role in treating tension-type headache, hypnic headache, hemicrania continua, SUNCT/SUNA and primary stabbing headache.
CONCLUSIONS
Melatonin may be effective in treating several primary headache disorders, particularly cluster headache and migraine. Future research should focus on elucidating the underlying mechanisms of benefit of melatonin in different headache disorders, as well as clarifying optimal dosing and formulation.
Topics: Animals; Central Nervous System Agents; Headache Disorders, Primary; Humans; Melatonin
PubMed: 27316772
DOI: 10.1111/head.12862 -
Developmental Medicine and Child... Oct 2021To describe the clinical characteristics and therapeutic options available to paediatric patients with cluster headache.
AIM
To describe the clinical characteristics and therapeutic options available to paediatric patients with cluster headache.
METHOD
Based on a literature search of the medical databases PubMed, LILACS, and Web of Science and using selected descriptors, we carried out a systematic review of case reports on cluster headache in paediatric patients published from 1990 to 2020.
RESULTS
Fifty-one patients (29 males, 22 females) with a mean (SD) age of 9 years 7 months (3y 10mo; range 2-16y) were diagnosed with cluster headache. The mean (SD) diagnosis was made 27.8 months (26.2mo) after the onset of cluster headache. Pain occurred at night or on waking up (76.5%) and consisted of 1 to 3 attacks per day (62.7%) lasting 30 to 120 minutes (68.6%). Headaches were unilateral (90.2%), had a pulsatile character (64.7%), and severe intensity (100%). There were autonomic manifestations (90.2%) predominantly ipsilateral to pain, in this order: lacrimation; conjunctival injection; nasal congestion; ptosis; eyelid oedema; and rhinorrhoea. Sumatriptan and oxygen inhalation were the most effective treatments for acute manifestation. Prophylaxis, corticosteroids, verapamil, and gabapentin were the most effective drugs.
INTERPRETATION
Due to the small number of published studies, this review could not provide reliable data; however, it appears that cluster headache in children and adolescents is similar to adults, both in clinical characteristics and treatment. What this paper adds Cluster headache in children and adolescents is poorly studied. Cluster headache is uncommon before 10 years of age and diagnosis is difficult in the first few years of life. Treatment of cluster headache in children and adolescents is similar to that used in adults. The notion of the effectiveness of prophylactic treatment is based only on authors' experience.
Topics: Adolescent; Adrenal Cortex Hormones; Blepharoptosis; Child; Child, Preschool; Cluster Headache; Gabapentin; Humans; Oxygen Inhalation Therapy; Rhinorrhea; Sumatriptan; Tears; Vasoconstrictor Agents; Verapamil
PubMed: 33987834
DOI: 10.1111/dmcn.14923 -
The Journal of Headache and Pain Dec 2016Cluster headache (CH) is a rare, excruciating and highly disabling primary headache disorder. Using non cluster headache specific measures, previous studies have shown... (Review)
Review
BACKGROUND
Cluster headache (CH) is a rare, excruciating and highly disabling primary headache disorder. Using non cluster headache specific measures, previous studies have shown that CH has a significant negative impact on patients' quality of life (QoL), but a CH-specific QoL scale is currently unavailable. Thus, the objective of this study was to develop and validate a CH-specific QoL scale.
METHODS
Based on a literature review, semi-structured patient interviews and expert panel consultation, we produced a 54-item questionnaire, which was pre-tested in a sample of CH patients and subsequently reduced to 47 items. The revised scale was then administered to CH sufferers attending a tertiary headache clinic and those registered with a patient group. A total of 406 completed questionnaires were received. To assess test-retest reliability, a subsample (N = 56) completed the scale on a second occasion, two weeks after the first. Standard statistical methods were used to analyse the data for validity and reliability.
RESULTS
Item reduction and exploratory factor analysis led to 28-items, grouped into four subscales labelled "restriction of activities of daily living", "impact on mood and interpersonal relationships", "pain and anxiety", and "lack of vitality". The final CH-specific QoL scale, the CHQ, demonstrated satisfactory internal consistency (Cronbach's alpha > 0.9) and test-retest reliability (intraclass correlation coefficient > 0.8), with good internal construct validity between subscales (range 0.52-0.75) and convergent validity with other QoL measures.
CONCLUSIONS
We have developed and validated the first patient-reported outcome measure of QoL specifically for CH sufferers, which may be used to monitor QoL in clinical care and research.
Topics: Activities of Daily Living; Adult; Aged; Cluster Headache; Factor Analysis, Statistical; Female; Humans; Male; Middle Aged; Program Development; Psychometrics; Quality of Life; Reproducibility of Results; Severity of Illness Index; Surveys and Questionnaires
PubMed: 27596922
DOI: 10.1186/s10194-016-0674-1 -
Therapeutics and Clinical Risk... 2015Cluster headache (CH), one of the most painful syndromes known to man, is managed with acute and preventive medications. The brief duration and severity of the attacks... (Review)
Review
Cluster headache (CH), one of the most painful syndromes known to man, is managed with acute and preventive medications. The brief duration and severity of the attacks command the use of rapid-acting pain relievers. Inhalation of oxygen and subcutaneous sumatriptan are the two most effective acute therapeutic options for sufferers of CH. Several preventive medications are available, the most effective of which is verapamil. However, most of these agents are not backed by strong clinical evidence. In some patients, these options can be ineffective, especially in those who develop chronic CH. Surgical procedures for the chronic refractory form of the disorder should then be contemplated, the most promising of which is hypothalamic deep brain stimulation. We hereby review the pathogenesis of CH and the evidence behind the treatment options for this debilitating condition.
PubMed: 26635477
DOI: 10.2147/TCRM.S94193 -
Pain and Therapy Dec 2021Cluster headache, apart from its legendary reputation as the most violent headache that can exist, suffers from an average 60-month delay in diagnosis. The simplicity of...
Cluster headache, apart from its legendary reputation as the most violent headache that can exist, suffers from an average 60-month delay in diagnosis. The simplicity of the clinical manifestations, although dramatic, makes this delay inexplicable. The education of emergency department physicians and various specialists not specifically dedicated to headaches allows cluster headache to remain in a lurking position with flourishing periods of disease that are often unpredictable in both onset and disappearance. Older drugs have always shown high efficacy but also an equally high rate of adverse events, often discouraging their appropriate use. The availability of a new drug class such as monoclonal antibodies for calcitonin gene-related peptide or its receptor (CGRP), which have already been efficient for migraine, shows a jeopardized geography of access in the world, and this favors the progression of the episodic form into chronic and of the chronic into refractory.
PubMed: 34091819
DOI: 10.1007/s40122-021-00278-5