Unilateral Impairment of Pupillary Responsiveness to Noxious Stimulation of Sural Nerve in Episodic Cluster Headache

Cluster headache is characterized by typical autonomic dysfunctions including facial and intracranial vascular disturbances. Both the trigeminal and the cranial parasympathetic systems may be involved in mediating these dysfunctions. An experimental model was developed in the rat to measure changes in lacrimation and intracranial blood flow following noxious chemical stimulation of facial mucosa. Blood flow was monitored in arteries of the exposed cranial dura mater and the parietal cortex using laser Doppler flowmetry. Capsaicin (0.01-1 mM) applied to oral or nasal mucosa induced increases in dural and cortical blood flow and provoked lacrimation. These responses were blocked by systemic pre-administration of hexamethonium chloride (20 mg/kg). The evoked increases in dural blood flow were also abolished by topical pre-administration of atropine (1 mM) and [Lys1, Pro2,5, Arg3,4, Tyr6]-VIP (0.1 mM), a vasoactive intestinal polypeptide (VIP) antagonist, onto the exposed dura mater. We conclude that noxious stimulation of facial mucosa increases intracranial blood flow and lacrimation via a trigemino-parasympathetic reflex. The blood flow responses seem to be mediated by the release of acetylcholine and VIP within the meninges. Similar mechanisms may be involved in the pathogenesis of cluster headache.

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SPHENOPALATINE GALGLION BLOCK FOR THE TREATMENT OF EPISODIC CLUSTER HEADACHE IN PREGNANCY: A CASE REPORT

10.26226/morressier.5ab3c880a874c60026559690 ◽

2018 ◽

Author(s):

Costanza Barcellona

Keyword(s):

Case Report ◽

Cluster Headache ◽

Episodic Cluster Headache ◽

In Pregnancy

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Deep brain stimulation modulates hypothalamic-brainstem fibers in cluster headache: case report

Journal of Neurosurgery ◽

10.3171/2018.11.jns181412 ◽

2020 ◽

Vol 132 (3) ◽

pp. 717-720 ◽

Cited By ~ 1

Author(s):

Sérgio A. F. Dantas ◽

Eduardo J. L. Alho ◽

Juliano J. da Silva ◽

Nilson N. Mendes Neto ◽

Erich Talamoni Fonoff ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Cluster Headache ◽

Brain Stimulation ◽

Clinical Effects ◽

Chronic Stimulation ◽

Mammillary Bodies ◽

Fiber Tracts ◽

White Matter Region ◽

Deep Brain ◽

Stimulation Of

Hypothalamic deep brain stimulation (DBS) has been used for more than a decade to treat cluster headache (CH) but its mechanisms remain poorly understood. The authors have successfully treated a patient with CH using hypothalamic DBS and found that the contact used for chronic stimulation was located in a white matter region posterior to the mammillary bodies. Fiber tracts crossing that region were the medial forebrain bundle and those interconnecting the hypothalamus and brainstem, including the dorsal longitudinal fasciculus. Because the stimulation of axons is an important mechanism of DBS, some of its clinical effects in CH may be related to the stimulation of fibers interconnecting the hypothalamus and brainstem.

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Faculty Opinions recommendation of Treatment of chronic facial pain including cluster headache by repetitive transcranial magnetic stimulation of the motor cortex with maintenance sessions: A naturalistic study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.728069421.793558722 ◽

2019 ◽

Author(s):

Mark Obermann

Keyword(s):

Transcranial Magnetic Stimulation ◽

Motor Cortex ◽

Cluster Headache ◽

Facial Pain ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation ◽

Naturalistic Study ◽

Stimulation Of

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Efficacy of galcanezumab in patients with episodic cluster headaches and a history of preventive treatment failure

Cephalalgia Reports ◽

10.1177/25158163211015654 ◽

2021 ◽

Vol 4 ◽

pp. 251581632110156

Author(s):

Brian Plato ◽

J Scott Andrews ◽

Mallikarjuna Rettiganti ◽

Antje Tockhorn-Heidenreich ◽

Jennifer Bardos ◽

...

Keyword(s):

Cluster Headache ◽

Treatment Failure ◽

Preventive Treatment ◽

Mean Difference ◽

Least Square ◽

Double Blind Study ◽

Double Blind ◽

Cluster Headache Attack ◽

Episodic Cluster Headache ◽

History Of

Objective: The efficacy of galcanezumab was evaluated in patients with episodic cluster headache and history of preventive treatment failure. Methods: In the randomized, 8-week, double-blind study (CGAL), patients with episodic cluster headache received once-monthly subcutaneous injections of galcanezumab 300 mg or placebo. Patients who completed CGAL and enrolled in an open-label study were queried for preventive treatment history. In a subset of patients with a known history of failure of verapamil or any other prior preventive treatment, a post hoc analysis of least square mean change from baseline in weekly cluster headache attack frequency across Weeks 1 to 3 was assessed. Results: Fifteen patients provided data for known history of prior preventive treatment failure (6 placebo, 9 galcanezumab), of whom 11 failed verapamil. The mean reduction in the weekly frequency of cluster headache attacks was greater with galcanezumab compared to placebo among patients with prior preventive treatment failure (8.2 versus 2.4); mean difference 5.8 (95% confidence interval [CI] 2.0, 13.6) and among patients with verapamil failure (10.1 versus 1.6); mean difference 8.5 (95% CI 0.4, 16.7). Conclusion: In this exploratory analysis of patients with a known history of prior preventive treatment failures, treatment with galcanezumab resulted in greater mean reductions in weekly cluster headache attacks compared with placebo. ClinicalTrials.gov: NCT02397473 (I5Q-MC-CGAL) NCT02797951 (I5Q-MC-CGAR)

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Oxygen Therapy Influences Episodic Cluster Headache and Related Cutaneous Brush and Cold Allodynia

Headache The Journal of Head and Face Pain ◽

10.1111/j.1526-4610.2008.01187.x ◽

2009 ◽

Vol 49 (1) ◽

pp. 134-136 ◽

Cited By ~ 6

Author(s):

Gerald Huber ◽

Christian Lampl

Keyword(s):

Cluster Headache ◽

Oxygen Therapy ◽

Cold Allodynia ◽

Episodic Cluster Headache

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Drastic Decrease in Isoflurane Minimum Alveolar Concentration and Limb Movement Forces after Thoracic Spinal Cooling and Chronic Spinal Transection in Rats

Anesthesiology ◽

10.1097/00000542-200503000-00022 ◽

2005 ◽

Vol 102 (3) ◽

pp. 624-632 ◽

Cited By ~ 12

Author(s):

Steven L. Jinks ◽

Carmen L. Dominguez ◽

Joseph F. Antognini

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Minimum Alveolar Concentration ◽

Tail Flick ◽

Noxious Stimulation ◽

Partial Recovery ◽

Spinal Transection ◽

Thoracic Spinal ◽

Cord Injury ◽

Stimulation Of

Background Individuals with spinal cord injury may undergo multiple surgical procedures; however, it is not clear how spinal cord injury affects anesthetic requirements and movement force under anesthesia during both acute and chronic stages of the injury. Methods The authors determined the isoflurane minimum alveolar concentration (MAC) necessary to block movement in response to supramaximal noxious stimulation, as well as tail-flick and hind paw withdrawal latencies, before and up to 28 days after thoracic spinal transection. Tail-flick and hind paw withdrawal latencies were measured in the awake state to test for the presence of spinal shock or hyperreflexia. The authors measured limb forces elicited by noxious mechanical stimulation of a paw or the tail at 28 days after transection. Limb force experiments were also conducted in other animals that received a reversible spinal conduction block by cooling the spinal cord at the level of the eighth thoracic vertebra. Results A large decrease in MAC (to </= 40% of pretransection values) occurred after spinal transection, with partial recovery (to approximately 60% of control) at 14-28 days after transection. Awake tail-flick and hind paw withdrawal latencies were facilitated or unchanged, whereas reflex latencies under isoflurane were depressed or absent. However, at 80-90% of MAC, noxious stimulation of the hind paw elicited ipsilateral limb withdrawals in all animals. Hind limb forces were reduced (by >/= 90%) in both chronic and acute cold-block spinal animals. Conclusions The immobilizing potency of isoflurane increases substantially after spinal transection, despite the absence of a baseline motor depression, or "spinal shock." Therefore, isoflurane MAC is determined by a spinal depressant action, possibly counteracted by a supraspinal facilitatory action. The partial recovery in MAC at later time points suggests that neuronal plasticity after spinal cord injury influences anesthetic requirements.

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Efficacy of transdermal rotigotine in chronic cluster headache: A case series

Cephalalgia Reports ◽

10.1177/2515816318809697 ◽

2018 ◽

Vol 1 ◽

pp. 251581631880969

Author(s):

Cherubino Di Lorenzo ◽

Lanfranco Pellesi ◽

Gianluca Coppola ◽

Vincenzo Parisi ◽

Maurizio Evangelista ◽

...

Keyword(s):

Cluster Headache ◽

Case Series ◽

Chronic Cluster Headache ◽

Drug Resistant ◽

Transdermal Patch ◽

Full Resolution ◽

Episodic Cluster Headache ◽

Monoaminergic System ◽

Rotigotine Transdermal Patch ◽

Effective Treatments

Cluster headache (CH) is one of the most severe forms of headache, but the number of effective treatments is still limited. Recently, we reported the case of a drug-resistant CH patient responsive to the rotigotine transdermal patch, which is used in the treatment of Parkinson’s disease. This report formed the basis for a case series where other drug-resistant CH patients were treated with rotigotine. Here are the results of this study. Twenty-two CH patients underwent the treatment. Eight were episodic cluster headache (ECH) patients and 14 were chronic cluster headache (CCH) patients. Of the eight ECH patients, four reported that their CH had been stopped by the treatment. Of the 14 CCH patients, 11 were considered responders to the treatment (5 experienced a full resolution of headache, and 6 had a headache reduction of at least 50% in terms of mean monthly number of attacks). Our case series confirms the previous observation that rotigotine could be helpful in the treatment of CH. It may even influence the monoaminergic system that has a key role in the pathogenesis of CH.

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