Chronic Paroxysmal Hemicrania: Heart Rate Changes and ECG Rhythm Disturbances. A Computerized Analysis of 24 h Ambulatory ECG Recordings

Ambulatory ECG recordings have been carried out in five patients suffering from CPH. During the study a total of 105 attacks occurred. Contrary to findings in cluster headache, no typical pattern of heart rate change was found in association with attacks of CPH. A striking finding in all patients, however, was that there were often large and rapid variations in heart rate which could be observed “before”, “during” or “after” the attacks. One patient developed bradycardia and sino-atrial block and another bundle branch block together with episodes of atrial fibrillation in association with attacks.

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Cluster Headache: A Computerized Analysis of 24 h Holter ECG Recordings and Description of ECG Rhythm Disturbances

Cephalalgia ◽

10.1046/j.1468-2982.1983.0302083.x ◽

1983 ◽

Vol 3 (2) ◽

pp. 83-107 ◽

Cited By ~ 32

Author(s):

David Russell ◽

Liv Storstein

Keyword(s):

Atrial Fibrillation ◽

Heart Rate ◽

Cluster Headache ◽

Relative Increase ◽

Holter Ecg ◽

Computerized Analysis ◽

Relative Decrease ◽

Premature Ventricular Beats

Continuous ECG recording has been carried out for at least 24 h in 27 patients suffering from cluster headache. During the study a total of 84 attacks occurred in 25 of the 27 patients who took part. A computerized analysis of the heart rate changes accompanying attacks showed the following: (i) an increase in heart rate at the onset of attacks; the degree of this increase being dependent on the heart rate before attacks, (ii) a relative decrease in heart rate and increased variations in heart rate during attacks, (iii) a relative increase in heart rate at the end of attacks, and (iv) a relative decrease in heart rate after attacks. Five patients (18.5%) showed ECG rhythm disturbances: two frequent premature ventricular beats, one transient attacks of atrial fibrillation, one first degree atrio-ventricular block, and one patient sino-atrial block.

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CHRONIC PAROXYSMAL HEMICRANIA: A COMPUTERIZED ANALYSIS OF 24 H AMBULATORY ECG RECORDINGS AND DESCRIPTION OF ECG RHYTHM DISTURBANCES

Acta Neurologica Scandinavica ◽

10.1111/j.1600-0404.1984.tb02465.x ◽

2009 ◽

Vol 69 (S98) ◽

pp. 256-257

Author(s):

David Russell ◽

Liv Storstein

Keyword(s):

Paroxysmal Hemicrania ◽

Computerized Analysis ◽

Ambulatory Ecg ◽

Chronic Paroxysmal Hemicrania

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Multiple cranial nerve blocks for the transitional treatment of chronic headaches

Cephalalgia ◽

10.1177/0333102419848121 ◽

2019 ◽

Vol 39 (12) ◽

pp. 1488-1499 ◽

Cited By ~ 7

Author(s):

Sarah Miller ◽

Susie Lagrata ◽

Manjit Matharu

Keyword(s):

Cluster Headache ◽

Chronic Migraine ◽

Cranial Nerve ◽

Chronic Cluster Headache ◽

Hemicrania Continua ◽

Paroxysmal Hemicrania ◽

Nerve Blocks ◽

Greater Occipital Nerve ◽

Chronic Paroxysmal Hemicrania ◽

Multiple Cranial Nerve

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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Neuropeptide Changes in a case of Chronic Paroxysmal Hemicrania—Evidence for Trigemino-Parasympathetic Activation

Cephalalgia ◽

10.1046/j.1468-2982.1996.1606448.x ◽

1996 ◽

Vol 16 (6) ◽

pp. 448-450 ◽

Cited By ~ 113

Author(s):

P J Goadsby ◽

L Edvinsson

Keyword(s):

Cluster Headache ◽

Vasoactive Intestinal Polypeptide ◽

Successful Treatment ◽

International Headache Society ◽

Paroxysmal Hemicrania ◽

Related Peptide ◽

Calcitonin Gene ◽

Autonomic Activation ◽

Chronic Paroxysmal Hemicrania ◽

Underlying Pathophysiology

Chronic paroxysmal hemicrania (CPH) is a rare headache syndrome of short-lasting attacks of pain, characterized clinically by trigemino-parasympathetic activation. The features of the headache are severe attacks of pain that generally last no more than minutes in association with autonomic activation, such as lacrimation or rhinorrhea. We report a patient fulfilling International Headache Society guidelines for the diagnosis of CPH in whom levels of calcitonin gene-related peptide (CGRP) and vasoactive intestinal polypeptide (VIP) were elevated in the cranial circulation during attacks. Moreover, successful treatment of the problem with indomethacin leads to normalization of the levels of both CGRP and VIP. Given that similar neuropeptide changes are seen in cluster headache the data suggest a shared underlying pathophysiology between CPH and cluster headache.

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Chronic Paroxysmal Hemicrania. IX. On the Mechanism of Attack-Related Sweating

Cephalalgia ◽

10.1046/j.1468-2982.1983.0303191.x ◽

1983 ◽

Vol 3 (3) ◽

pp. 191-199 ◽

Cited By ~ 12

Author(s):

Carsten Saunte ◽

David Russell ◽

Ottar Sjaastad

Keyword(s):

Body Weight ◽

Cluster Headache ◽

Paroxysmal Hemicrania ◽

Sweat Glands ◽

Sympathetic Stimulation ◽

Provocation Tests ◽

Denervation Supersensitivity ◽

Chronic Paroxysmal Hemicrania ◽

Exercise Induced ◽

Symptomatic Side

In eight patients with chronic paroxysmal hemicrania (CPH), forehead sweating was measured after various provocation tests-body heating, exercise, and subcutaneous pilocarpine administration (0.1 mg/kg body weight). Evaporation was measured bilaterally on the forehead with an Evaporimeter (in g/m2/h). This was carried out in a thermo room under standardized conditions. There was no definite deficit in heat-induced or exercise-induced sweating on the symptomatic side of the forehead, contrary to findings in cluster headache. Neither did pilocarpine lead to any marked initial, temporary predominance of sweating on the symptomatic side, which has previously been found in cluster headache. In cluster headache there may be denervation supersensitivity of the sweat glands in the forehead of the symptomatic side. The present study does not therefore provide evidence for supersensitivity phenomena which could explain the homolateral forehead sweating increase seen during attacks in some CPH patients. The localized sweating increase in the forehead during attacks of CPH may possibly be a result of direct sympathetic stimulation.

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Chronic Paroxysmal Hemicrania: XIII. The Pupillometric Pattern

Cephalalgia ◽

10.1046/j.1468-2982.1988.0803219.x ◽

1988 ◽

Vol 8 (3) ◽

pp. 219-226 ◽

Cited By ~ 5

Author(s):

Deusvenir de Souza Carvalho ◽

Roll Salvesen ◽

Trond Sand ◽

Stephen E Smith ◽

Ottar Sjaastad

Keyword(s):

Cluster Headache ◽

The Body ◽

Paroxysmal Hemicrania ◽

Sweat Glands ◽

Chronic Paroxysmal Hemicrania ◽

Sweating Patterns ◽

Symptomatic Side ◽

Age And Sex ◽

Headache Patients

Pupillometric studies were carried out in eight patients with chronic paroxysmal hemicrania (CPH) and in age- and sex-matched controls in the basal condition and after instillation of 2% tyramine (CPH, n = 5; controls, n = 17), 1% OH-amphetamine (CPH, n = 6; controls, n = 12), and 1% phenylephrine (CPH, n = 6; controls, n = 17). The pupil on the symptomatic and non-symptomatic sides in CPH patients was significantly smaller in the basal condition than in controls, particularly on the symptomatic side. The mydriatic responses to pharmacologic stimulation were essentially similar on the symptomatic and non-symptomatic sides. An evaporimetric study of the forehead sweat glands, using the body heating and pilocarpine tests, was also carried out in these patients and in age- and sex-matched controls. “Early”, “intermediate”, and “late” measurements demonstrated symmetry of forehead sweating. The findings for both methods of examination thus contrast with those in cluster headache patients. Pupillometric and forehead sweating patterns therefore suggest differences in the pathogenesis of the two headache entities. These tests may be used to distinguish CPH and cluster headache clinically.

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