‘Side Locked’ Migraine and Trigeminal Autonomic Cephalgias: Evidence for Clinical Overlap

Cephalalgia ◽  
2003 ◽  
Vol 23 (1) ◽  
pp. 43-49 ◽  
Author(s):  
AO Kaup ◽  
NT Mathew ◽  
C Levyman ◽  
J Kailasam ◽  
LA Meadors ◽  
...  
Keyword(s):  
Hemicrania Continua ◽  
Primary Headaches ◽  
New Classification ◽  
Present Evidence ◽  
Pathophysiological Mechanisms ◽  
Trigeminal Autonomic Cephalgias ◽  
Made In

This paper will discuss evidence which supports a link between ‘side locked’ migraine (SLM) and the trigeminal autonomic cephalgias (TACs). Recent papers brought strictly unilateral primary headaches into focus, proposing new classification and discussing pathophysiological mechanisms. We reviewed those proposals and present evidence that SLM falls in between the well-defined TACs and side shifting migraine (SSM). It is difficult to differentiate SLM from the recently proposed headache subtype called hemicrania generis incerti (i.e. hemicrania continua unresponsive to indomethacin). We also present cases that may exemplify the considerations made in the paper.

Classification, diagnostic criteria, and epidemiology

2020 ◽  
pp. 177-181
Author(s):  
Thijs H. Dirkx ◽  
Peter J. Koehler
Keyword(s):  
Cluster Headache ◽  
Epidemiological Data ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Primary Headaches ◽  
Conjunctival Injection ◽  
Headache Disorders ◽  
Cranial Autonomic Symptoms ◽  
Unilateral Headache

The trigeminal autonomic cephalalgias (TACs), including cluster headache, paroxysmal hemicrania, SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing), SUNA (with cranial autonomic symptoms), and hemicrania continua, belong to the primary headaches. They are characterized by severe unilateral headache attacks in association with ipsilateral cranial autonomic features. Cluster headache is the most frequent of the TACs. The other TACs are rare, but epidemiological data are scarce and variable. The various types of TAC are distinguished not only by differences in attack frequency and duration, but also by differences with respect to treatment response. The typical headache syndromes, fulfilling the International Classification of Headache Disorders-3 criteria, have also been described in association with other disorders and imaging is required to exclude intracranial pathology in all newly diagnosed patients.

Unilateral Photophobia or Phonophobia in Migraine Compared With Trigeminal Autonomic Cephalalgias

Cephalalgia ◽  
2008 ◽  
Vol 28 (6) ◽  
pp. 626-630 ◽  
Author(s):  
P Irimia ◽  
E Cittadini ◽  
K Paemeleire ◽  
AS Cohen ◽  
PJ Goadsby
Keyword(s):  
Cluster Headache ◽  
Clinical Symptoms ◽  
Medication Overuse Headache ◽  
Episodic Migraine ◽  
Chronic Cluster Headache ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Primary Headaches ◽  
Trigeminal Autonomic Cephalalgias ◽  
A Prospective Study

Our objective was to compare the presence of self-reported unilateral photophobia or phonophobia, or both, during headache attacks comparing patients with trigeminal autonomic cephalalgias (TACs)—including cluster headache, shortlasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and paroxysmal hemicrania—or hemicrania continua, and other headache types. We conducted a prospective study in patients attending a referral out-patient clinic over 5 months and those admitted for an intramuscular indomethacin test. Two hundred and six patients were included. In episodic migraine patients, two of 54 (4%) reported unilateral photophobia or phonophobia, or both. In chronic migraine patients, six of 48 (13%) complained of unilateral photophobia or phonophobia, or both, whereas none of the 24 patients with medication-overuse headache reported these unilateral symptoms, although these patients all had clinical symptoms suggesting the diagnosis of migraine. Only three of 22 patients (14%) suffering from new daily persistent headache (NDPH) experienced unilateral photophobia or phonophobia. In chronic cluster headache 10 of 21 patients (48%) had unilateral photophobia or phonophobia, or both, and this symptom appeared in four of five patients (80%) with episodic cluster headache. Unilateral photophobia or phonophobia, or both, were reported by six of 11 patients (55%) with hemicrania continua, five of nine (56%) with SUNCT, and four of six (67%) with chronic paroxysmal hemicrania. Unilateral phonophobia or photophobia, or both, are more frequent in TACs and hemicrania continua than in migraine and NDPH. The presence of these unilateral symptoms may be clinically useful in the differential diagnosis of primary headaches.

Double Edged Blades: Re-visiting the British (and Irish) Flint Daggers

2014 ◽  
Vol 80 ◽  
pp. 33-65 ◽  
Author(s):  
Catherine J. Frieman
Keyword(s):  
Bronze Age ◽  
20Th Century ◽  
Western Europe ◽  
Early Bronze Age ◽  
Early 20Th Century ◽  
No Production ◽  
New Classification ◽  
Dry Land ◽  
The Subject ◽  
Made In

Flint daggers are a well-known and closely studied category of artefact found throughout western Europe during the final centuries of the Neolithic and the earliest phases of metal use. They are widely linked to the adoption of metal objects and metallurgy – in many cases being described as copies of metal daggers. In Britain, several hundred flint daggers have been recovered from a variety of contexts, among the best known of which are a handful of rich Beaker single inhumation burials. The British flint daggers were of great interest to early archaeologists, and were the subject of several publications in the early 20th century, most notably the seminal 1931 typochronology and catalogue by W.F. Grimes. However, despite 80 years of evolution in our understanding of the British Early Bronze Age, Beaker burials, European flint daggers, and lithic technology in general, little further attention has been accorded to the British flint daggers. This paper returns to the flint daggers deposited in British contexts. It proposes a new classification for British daggers, distinguishing between those probably produced in Britain and those brought in from elsewhere on the continent. It further examines thechaîne opératoirefor these daggers based on their final form as no production locales are yet known and examines in detail the choices made in their deposition, not just in funerary contexts but on dry land and, most importantly, in wet contexts. Finally, it proposes a sequence of development for British flint daggers which links them technologically and morphologically to lanceolate Scandinavian daggers in circulation in the Netherlands. It is suggested that people in south-east Britain knowingly played up this Dutch connection in order to highlight a specific ancestral identity linking them directly to communities across the Channel.

scholarly journals Euskalkien sailkapen berriaz zenbait ohar

2020 ◽  
pp. 269-292
Author(s):  
Koldo Zuazo
Keyword(s):  
Royal Academy ◽  
New Classification ◽  
Dialect Classification ◽  
Real Academia ◽  
Made In

RESUMEN En este artículo comento el libro Euskalkien sailkapen berria (2019) [“Nueva clasificación de los dialectos vascos”], basado en los resultados del atlas lingüístico de la Real Academia de la Lengua Vasca. Se ponen de manifiesto los defectos que, en general, se observan en los atlas de este tipo y, muy especialmente, en este de Euskaltzaindia. También se discuten algunos aspectos de la metodología seguida por los autores de la nueva clasificación dialectal. LABURPENA Euskalkien sailkapen berria izeneko liburuan (2019) aurkeztu den ikuspegia dut aztergai. Helduleku bakarrean oinarrituta dago: Euskaltzaindiaren atlasean. Atlasen zuzentasunaz mintzo naiz oro har eta, zehatzago, atlas honen egokitasunaz. Oinarri bakar hori azken urteotan agertu diren beste ikerlan batzuetako emaitzekin ez kontrastatzea aipatzen da. Ondoren, sailkapen berriaren egileek darabilten metodologia eta ondorioak aztertzen dira. ABSTRACT In this article I analyze the book Euskalkien sailkapen berria (2019) [“New classification of the Basque dialects”], based entirely on the Linguistic Atlas developed by the Royal Academy of the Basque language. I comment on the shortcomings that this kind of linguistic atlas quite generally has and I point out the shortcomings that the atlas made by the Royal Academy of the Basque language has in particular. I criticize that the authors of the new classification have not contrasted their findings with the advancements made in Basque dialectological research over the last years. I also discuss the methodology followed and the conclusions reached by the authors of the new dialect classification.

scholarly journals Proposal of a new system to classify possible damages in piles partially reinforced considering the results of low strain integrity tests

2019 ◽  
Vol 12 (6) ◽  
pp. 1408-1427
Author(s):  
R. P. S. PASQUAL ◽  
A. C. M. KORMANN ◽  
T. F. DE SOUZA JUNIOR
Keyword(s):  
External Factors ◽  
New Classification ◽  
Fem Simulations ◽  
Several Variables ◽  
The Difference ◽  
Integrity Tests ◽  
Different Parts ◽  
New System ◽  
Made In

Abstract Low strain integrity tests in piles are relatively cheap, of quick execution and nondestructive. Despite all these advantages, several variables are involved and the influence of external factors can complicate the interpretation of the results. Between them, the influence of the pile reinforcement can be high lighted. In piles partially reinforced, the difference in density and elastic modulus of the concrete in different parts of the pile and the influence of the process of introducing the reinforcement bars can induce some reflections in the test that can be confused with damage in the pile and, therefore, should be taken into account to analyze the tests results. In this research, the influence of the reinforcement embedded in the piles is analyzed using numerical (FEM) simulations and comparing them with tests made in the field. A new classification of possible damages is proposed based on the analysis of the reflections observed at the end of the reinforcement cage embedded in a pile partially reinforced.

Evaluation of the New Classification and Surgical Strategy for Myasthenia Gravis

2012 ◽  
Vol 78 (12) ◽  
pp. 1329-1335 ◽  
Author(s):  
Xin-Zheng Cui ◽  
Xin-Ying Ji ◽  
Feng Gao ◽  
Kun-Peng Yang ◽  
Hui-Ling Bai ◽  
...  
Keyword(s):  
Myasthenia Gravis ◽  
New Classification ◽  
New Methods ◽  
Group 3 ◽  
Group 2 ◽  
Level Group ◽  
Median Incision ◽  
Selection Of ◽  
Made In ◽  
Group 1

The aim of this study was to discuss the new methods of clinical classification and staging of patients with myasthenia gravis (MG) proposed by our group and to summarize the experiences of surgical treatment of MG with a novel incision by cutting the sternum cross-sectionally at the second intercostal level. A retrospective analysis was made for the clinical data from the patients with MG who underwent thymectomy from July 1988 to May 2009. The surgical procedures were designed into three groups, a group with Osserman classification and median incision of the sternum (Group 1), a group with MGFA typing (Myasthenia Gravis Foundation of America) and a small transverse sternal incision at the second intercostal level (Group 2), and a group with new typing and a smaller transverse sternal incision at the second intercostal level (Group 3). Observation of the clinical typing and staging was made in the patients with myasthenia crisis. The parameters such as procedure duration in Group 2 and 3 was significantly lower than those in Group 1 ( P < 0.05). The incidence of myasthenia crisis in Group 3 was significantly lower than that in Groups 2 and 3 ( P < 0.05). The procedure with a smaller transverse sternal incision at the second intercostal level (Group 3) is a safer method for patients with MG. The combination of this procedure with the new typing and staging methods proposed by our group could facilitate the selection of operation indications and opportunity, resulting in the lower incidence of myasthenia crisis and mortality. Our new procedure is well deserved to be a preferential selection by other hospitals.

scholarly journals A potential nitrergic mechanism of action for indomethacin, but not of other COX inhibitors: relevance to indomethacin-sensitive headaches

2010 ◽  
Vol 11 (6) ◽  
pp. 477-483 ◽  
Author(s):  
Oliver Summ ◽  
Anna P. Andreou ◽  
Simon Akerman ◽  
Peter J. Goadsby
Keyword(s):  
Nitric Oxide ◽  
Mechanism Of Action ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Primary Headaches ◽  
Special Effect ◽  
Cox Inhibitors ◽  
Calcitonin Gene ◽  
Inflammatory Drugs

Abstract Non-steroidal anti-inflammatory drugs (NSAIDs) that act as cyclo-oxygenase (COX) inhibitors are commonly used in the treatment of a range of headache disorders, although their mechanism of action is unclear. Indomethacin is of particular interest given its very special effect in some primary headaches. Here the in vivo technique of intravital microscopy in rats has been utilised as a model of trigeminovascular nociception to study the potential mechanism of action of indomethacin. Dural vascular changes were produced using electrical (neurogenic) dural vasodilation (NDV), calcitonin gene-related peptide (CGRP) induced dural vasodilation and nitric oxide (NO) induced dural vasodilation using NO donors. In each of these settings the effect of intravenously administered indomethacin (5 mg kg−1), naproxen (30 mg kg−1) and ibuprofen (30 mg kg−1) was tested. All of the tested drugs significantly inhibited NDV (between 30 and 52%). Whilst none of them was able to inhibit CGRP-induced dural vasodilation, only indomethacin reduced NO induced dural vasodilation (35 ± 7%, 10 min post administration). We conclude NSAIDs inhibit release of CGRP after NDV without an effect on CGRP directly. Further we describe a differentiating effect of indomethacin inhibiting nitric oxide induced dural vasodilation that is potentially relevant to understanding its unique action in disorders such as paroxysmal hemicrania and hemicrania continua.

scholarly journals Getting More Organs for Transplantation

2014 ◽  
Vol 104 (5) ◽  
pp. 425-430 ◽  
Author(s):  
Judd B. Kessler ◽  
Alvin E. Roth
Keyword(s):  
Organ Donation ◽  
Living Donor ◽  
Scarce Resource ◽  
Present Evidence ◽  
Kidney Exchange ◽  
Recent Movement ◽  
The World ◽  
Deceased Donors ◽  
Made In

Organs for transplantation are a scarce resource. Paying to increase the supply of organs is illegal in much of the world. We review efforts to increase transplantation by increasing the supply of available organs from living and deceased donors. Progress has been made in increasing the availability of living donor kidneys through kidney exchange. Recent legislation in Israel aims at encouraging deceased donation by awarding priority for receiving organs to registered donors. We also explore the manner in which organ donation is solicited and present evidence to suggest that some recent movement towards 'mandated choice' may be counterproductive.

Facial presentations of migraine, TACs, and other paroxysmal facial pain syndromes

Neurology ◽  
2019 ◽  
Vol 93 (12) ◽  
pp. e1138-e1147 ◽  
Author(s):  
Christian Ziegeler ◽  
Arne May
Keyword(s):  
Facial Pain ◽  
Care Center ◽  
Tertiary Care ◽  
Primary Headache ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Primary Headaches ◽  
Cranial Autonomic Symptoms ◽  
Pain Syndromes ◽  
The Face

ObjectiveTo assess the prevalence of facial pain (V2 and/or V3) presentations among nearly 3,000 patients with headache treated in a university tertiary care center.MethodsBetween 2010 and 2018, we routinely assessed the prevalence of facial pain presentations of all patients with primary headaches.ResultsOf 2,912 patient datasets, 291 patients reported facial pain either as an independent or as an additional symptom. Among patients with migraine, 2.3% (44 of 1,935) reported a facial involvement, most commonly in V2. Of these, 18 patients (40.9%) experienced the pain predominantly in the face. In patients with cluster headache, 14.8% (42 of 283) reported a facial involvement, of which 31.0% perceived the pain predominantly in the face. A facial involvement was seen in 45.0% of patients with paroxysmal hemicrania (9 of 20), 21.4% of patients with hemicrania continua (9 of 42), and 20.0% of patients with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing/short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (3 of 15). In addition, we present 6 patients who reported a constant side-locked facial pain with superseded well-defined facial pain attacks of 10- to 30-minute duration that appeared several times per day.ConclusionOur data suggest that a facial involvement in primary headaches is infrequent but not uncommon. A sole facial presentation of primary headache symptomatology seems to be exceptionally rare. We describe 3 different types of facial pain involvement and, in this context, distinguish patients with paroxysmal orofacial pain syndromes that have not been previously described. These patients may represent a new entity that could tentatively be called constant unilateral facial pain with added attacks.

scholarly journals Occipital Nerve Stimulation in the Treatment of Medically Intractable SUNCT and SUNA

2014 ◽  
Vol 17;1 (1;17) ◽  
pp. 29-41
Author(s):  
Manjit Singh Matharu
Keyword(s):  
Nerve Stimulation ◽  
Substantial Improvement ◽  
Hemicrania Continua ◽  
Primary Headaches ◽  
Occipital Nerve Stimulation ◽  
Rapid Improvement ◽  
Open Label ◽  
Occipital Nerve ◽  
Greater Occipital Nerve ◽  
Patient Reported

Background: Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) or with cranial autonomic symptoms (SUNA) are primary headaches characterized by frequent attacks of severe headaches in association with cranial autonomic features. Patients with chronic SUNCT or SUNA have unremitting symptoms that necessitate prolonged use of medical preventive treatments, many of which are prone to causing side effects. They can be medically intractable, in which case neurally destructive or cranially invasive surgical treatments can be offered, though these have hitherto yielded conflicting results. Occipital nerve stimulation (ONS) offers a nondestructive and relatively low risk surgical alternative. Objective: To assess the efficacy and safety of ONS in chronic, medically intractable SUNCT and SUNA patients. Study design: Prospective open-label study. Methods: Nine medically intractable, chronic SUNCT and SUNA patients were implanted with electrodes for bilateral occipital nerve stimulation. Data were collected prospectively for pre- and postimplantation headache characteristics, including frequency, intensity and duration of attacks. Diaries were used to assess headache improvement. Results: At a median follow-up of 38 months (range 24–55 months), all but one patient reported substantial improvement. Four patients became pain-free, 3 were almost pain-free (96 – 98% improvement), and one had a marked reduction in attack frequency and severity (81% improvement). After an initial rapid improvement, the maximum benefit of ONS was attained after a lag of a few months. Device malfunction was followed by recurrence or worsening of the attacks within a few days in most patients. Adverse events included lead migration, exposure of the electrode, and pain due to muscle recruitment over the leads. One patient developed hemicrania continua one month after implantation and was successfully treated with indomethacin. Conclusion: ONS appears to offer an effective and safe treatment option, without significant morbidity, for medically intractable SUNCT and SUNA. Given the variable results with cranially invasive or neurally destructive surgery, ONS might be considered the surgical treatment of choice for medically intractable SUNCT and SUNA. Key words: SUNCT, SUNA, occipital nerve stimulation, trigeminal autonomic cephalalgias, neuromodulation, peripheral nerve stimulation, trigeminal neuralgia, greater occipital nerve blockade

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