Chronic Paroxysmal Hemicrania: XIII. The Pupillometric Pattern

Cephalalgia ◽  
1988 ◽  
Vol 8 (3) ◽  
pp. 219-226 ◽  
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.

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

Cephalalgia ◽  
1983 ◽  
Vol 3 (3) ◽  
pp. 191-199 ◽  
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.

Cluster Headache: On the Mechanism Behind Attack-Related Sweating

Cephalalgia ◽  
1983 ◽  
Vol 3 (3) ◽  
pp. 175-185 ◽  
Author(s):  
Carsten Saunte ◽  
David Russell ◽  
Ottar Sjaastad
Keyword(s):  
Cluster Headache ◽  
The Other ◽  
Sweat Glands ◽  
Control Group ◽  
Exercise Tests ◽  
Other Hand ◽  
Exercise Induced ◽  
Symptomatic Side ◽  
Headache Patients

Eighteen cluster headache patients were studied using body heating or exercise tests; all but two of them were also studied with a pilocarpine test (0.1 mg/kg body wt, s.c.). Evaporimeter measurements were made on both sides of the forehead under standard conditions in a thermo room. Heat- and exercise-induced sweating was dearly less pronounced on the symptomatic side than on the non-symptomatic side of the forehead, and was significantly different compared to controls. Pilocarpine on the other hand induced a clearly more pronounced response on the symptomatic side than on the non-symptomatic side, which was also statistically significantly higher than in the control group. These findings suggest a supersensitivity of the sweat glands to pilocarpine on the symptomatic side of the forehead in most cases of cluster headache.

The cavernous sinus in cluster headache – a quantitative structural magnetic resonance imaging study

Cephalalgia ◽  
2016 ◽  
Vol 37 (3) ◽  
pp. 208-213
Author(s):  
Enrico B Arkink ◽  
Guus G Schoonman ◽  
Jorine A van Vliet ◽  
Hannah S Bakels ◽  
Marjolein AM Sneeboer ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cluster Headache ◽  
Cavernous Sinus ◽  
Imaging Study ◽  
Paroxysmal Hemicrania ◽  
Resonance Imaging ◽  
Temporal Fossa ◽  
Chronic Paroxysmal Hemicrania ◽  
Headache Patients

Background It has been hypothesized that a constitutionally narrow cavernous sinus might predispose individuals to cluster headache. Cavernous sinus dimensions, however, have never been assessed. Methods In this case–control study, we measured the dimensions of the cavernous sinus, skull base, internal carotid and pituitary gland with high-resolution T2-weighted magnetic resonance imaging in 25 episodic, 24 chronic and 13 probable cluster headache patients, 8 chronic paroxysmal hemicrania patients and 22 headache-free controls. Dimensions were compared between groups, correcting for age, sex and transcranial diameter. Results On qualitative inspection, no relevant pathology or anatomic variants that were previously associated with cluster headache or chronic paroxysmal hemicranias were observed in the cavernous sinus or paracavernous structures. The left-to-right transcranial diameter at the temporal fossa level (mean ± SD) was larger in the headache groups (episodic cluster headache: 147.5 ± 7.3 mm, p = 0.044; chronic cluster headache: 150.2 ± 7.3 mm, p < 0.001; probable cluster headache: 146.0 ± 5.3 mm, p = 0.012; and chronic paroxysmal hemicrania: 145.2 ± 9.4 mm, p = 0.044) compared with controls (140.2 ± 8.0 mm). After adjusting for transcranial diameter and correcting for multiple comparisons, there were no differences in the dimensions of the cavernous sinus and surrounding structures between headache patients and controls. Conclusion Patients with cluster headache or chronic paroxysmal hemicrania had wider skulls than headache-free controls, but the proportional dimensions of the cavernous sinus were similar.

Chronic Paroxysmal Hemicrania. VII. Mechanical Precipitation of Attacks: New Cases and Localization of Trigger Points

Cephalalgia ◽  
1984 ◽  
Vol 4 (2) ◽  
pp. 113-118 ◽  
Author(s):  
Ottar Sjaastad ◽  
Carsten Saunte ◽  
JR Graham
Keyword(s):  
Posterior Part ◽  
Transverse Process ◽  
Trigger Points ◽  
Paroxysmal Hemicrania ◽  
Sensitive Area ◽  
Manual Pressure ◽  
Chronic Paroxysmal Hemicrania ◽  
Local Tenderness ◽  
Symptomatic Side

Two new chronic paroxysmal hemicrania patients are described. In both, attacks can be precipitated mechanically by applying firm manual pressure to certain sensitive points on the neck, i.e. in the C2 area, in the transverse processes of the C4–C5 vertebrae, or beneath the posterior part o15 the skull on the symptomatic side. The most sensitive area seems to be the transverse process of C4–C5. Susceptibility to this type of attack is dependent on the flow of spontaneous attacks; attacks are easily precipitated in a phase with multiple spontaneous attacks, but are not readily precipitated otherwise. Under indomethacin protection, local tenderness is clearly diminished and attacks cannot be precipitated.

scholarly journals Multiple cranial nerve blocks for the transitional treatment of chronic headaches

Cephalalgia ◽  
2019 ◽  
Vol 39 (12) ◽  
pp. 1488-1499 ◽  
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.

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

Cephalalgia ◽  
1984 ◽  
Vol 4 (2) ◽  
pp. 135-144 ◽  
Author(s):  
David Russell ◽  
Liv Storstein
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Cluster Headache ◽  
Heart Rate Change ◽  
Paroxysmal Hemicrania ◽  
Typical Pattern ◽  
Bundle Branch Block ◽  
Computerized Analysis ◽  
Ambulatory Ecg ◽  
Chronic Paroxysmal Hemicrania

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.

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

Cephalalgia ◽  
1996 ◽  
Vol 16 (6) ◽  
pp. 448-450 ◽  
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.

“Hemicrania Continua”. An Indomethacin Responsive Headache. II. Autonomic Function Studies

Cephalalgia ◽  
1984 ◽  
Vol 4 (4) ◽  
pp. 265-273 ◽  
Author(s):  
O Sjaastad ◽  
ELH Spierings ◽  
C Saunte ◽  
Maria M Wysocka Bakowska ◽  
I Sulg ◽  
...  
Keyword(s):  
Autonomic Function ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Unilateral Headache ◽  
Different Types ◽  
Chronic Paroxysmal Hemicrania ◽  
Symptomatic Side

Various autonomic parameters have been studied in two patients with “hemicrania continua”, a newly described unilateral headache which is aborted by indomethacin. Striking findings were made on pupillometry: In both patients, isocoria was present when untreated. Bilateral instillation of tyramine in the conjunctival sac resulted in a late appearing anisocoria, with the smaller pupil on the symptomatic side. Indomethacin medication corrected this anomaly. These findings add further evidence to our firm belief that “hemicrania continua” differs fundamentally from chronic paroxysmal hemicrania, where such pupillometric changes are not found. There thus seem to be at least two different types of hemicranias with an absolute indomethacin effect.

Circulating Nociceptin Levels During the Cluster Headache Period

Cephalalgia ◽  
2004 ◽  
Vol 24 (4) ◽  
pp. 280-283 ◽  
Author(s):  
C Ertsey ◽  
M Hantos ◽  
G Bozsik ◽  
K Tekes
Keyword(s):  
Cluster Headache ◽  
Trigeminal Ganglion ◽  
Ganglion Cells ◽  
Endogenous Ligand ◽  
Related Peptide ◽  
Calcitonin Gene ◽  
Site Of Action ◽  
Circulating Levels ◽  
Age And Sex ◽  
Headache Patients

The trigeminal innervation of the dura and its vessels has a prominent role in the mechanism of cluster headache. Nociceptin, an opioid neuropeptide, is the endogenous ligand of the OP-4 receptor, with both algesic and analgesic properties depending on the site of action. Nociceptin and its receptor are expressed by trigeminal ganglion cells where they co-localize with calcitonin gene-related peptide, a marker peptide of the trigeminovascular neurones. Nociceptin inhibits neurogenic dural vasodilatation, a phenomenon related to trigeminovascular activation. To explore its possible involvement in cluster headache, we studied circulating levels of nociceptin when attack-free during the cluster period, and also after the termination of the cluster period, using radioimmunoassay. In 14 cluster headache patients nociceptin levels during the cluster period were significantly lower than in age-, and sex-matched controls (4.91 ± 1.96 vs. 9.58 ± 2.57 pg/ml, P < 0.01). After the termination of the cluster period nociceptin levels (8.60 ± 1.47 pg/ml) were not statistically different from controls. Nociceptin levels did not correlate with age, length of disease or episode length. Lower nociceptin levels during the cluster period may result in a defective regulation of trigeminal activity that might not protect sufficiently against the attacks.

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