Headache

2015 ◽  
Author(s):  
Peter J. Goadsby
Keyword(s):  
Cluster Headache ◽  
Severe Pain ◽  
Primary Headache ◽  
Headache Disorder ◽  
Headache Disorders ◽  
Important Work ◽  
Pain Experience ◽  
Global Impact ◽  
Primary Headache Disorder ◽  
The World

Headache disorders are the dominant cause of neurological disability in the world and the most common reason for neurological referral in any country studied. Yet for much of the first half the twentieth century, research was mired in peripheral mechanistic sideshows. Migraine, the most common disabling primary headache disorder, has been established as primarily a brain problem, with important advances in classification, treatment, and biological understanding. Cluster headache, perhaps the most severe pain experience of humans, has found its nidus in the diencephalon; treatments are evolving and biology being unravelled. Contributions to headache disorders resonate across humanity, so important work here has a global impact for good.

Genetics of cluster headache

Cephalalgia ◽  
2019 ◽  
Vol 39 (10) ◽  
pp. 1298-1312 ◽  
Author(s):  
Kate F Gibson ◽  
Anita Dos Santos ◽  
Nunu Lund ◽  
Rigmor Jensen ◽  
Ioannis M Stylianou
Keyword(s):  
Cluster Headache ◽  
Candidate Gene ◽  
Gene Selection ◽  
Association Studies ◽  
Twin Studies ◽  
Primary Headache ◽  
Headache Disorder ◽  
Genome Wide Association Studies ◽  
Genetic Studies ◽  
Primary Headache Disorder

Background Cluster headache is the most severe primary headache disorder. A genetic basis has long been suggested by family and twin studies; however, little is understood about the genetic variants that contribute to cluster headache susceptibility. Methods We conducted a literature search of the MEDLINE database using the PubMed search engine to identify all human genetic studies for cluster headache. In this article we provide a review of those genetic studies, along with an overview of the pathophysiology of cluster headache and a brief review of migraine genetics, which have both been significant drivers of cluster headache candidate gene selection. Results The investigation of cluster headache genetic etiology has been dominated by candidate gene studies. Candidate selection has largely been driven by the pathophysiology, such as the striking rhythmic nature of the attacks, which spurred close examination of the circadian rhythm genes CLOCK and HCRTR2. More recently, unbiased genetic approaches such as genome-wide association studies (GWAS) have yielded new genetic avenues of interest including ADCYAP1R1 and MME. Conclusions The majority of candidate genes studied for cluster headache suffer from poor reproducibility. Broader genetic interrogation through larger unbiased GWAS, exome, and whole genome studies may provide more robust candidates, and in turn provide a clearer understanding of the causes of cluster headache.

scholarly journals Headaches in the emergency department –a survey of patients’ characteristics, facts and needs

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Alberto Doretti ◽  
◽  
Irina Shestaritc ◽  
Daniela Ungaro ◽  
John-Ih Lee ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Treatment ◽  
Primary Headache ◽  
Headache Disorder ◽  
Efficacy Rate ◽  
Headache Disorders ◽  
Secondary Headaches ◽  
Primary Headache Disorder ◽  
Life Threatening ◽  
Inflammatory Drugs

Abstract Background and aim Headache is very often the cause for seeking an emergency department (ED). However, less is known about the different diagnosis of headache disorders in the ED, their management and treatment. The aim of this survey is to analyse the management of headache patients in two different ED in Europe. Methods This retrospective survey was performed from September 2018 until January 2019. Patients were collected from the San Luca Hospital, Milan, Italy and the Ordensklinikum Barmherzige Schwestern, Linz, Austria. Only patients with a non-traumatic headache, as the primary reason for medical clarification, were included. Patients were analysed for their complexity and range of examination, their diagnoses, acute treatment and overall efficacy rate. Results The survey consists of 415 patients, with a mean age of 43.32 (SD ±17.72); 65% were female. Technical investigation was performed in 57.8% of patients. For acute treatment non-steroidal-anti-inflammatory drugs (NSAIDs) were the most used, whereas triptans were not given. A primary headache disorder was diagnosed in 45.3% of patients, being migraine the most common, but in 32% of cases the diagnosis was not further specified. Life-threatening secondary headaches accounted for less than 2% of cases. Conclusions The vast majority of patients attending an ED because of headache are suffering from a primary headache disorder. Life-threatening secondary headaches are rare but seek attention. NSAIDs are by far the most common drugs for treating headaches in the ED, but not triptans.

Headache in Sports

2016 ◽  
Author(s):  
Tad Seifert
Keyword(s):  
Primary Headache ◽  
Headache Disorder ◽  
Epidemiological Data ◽  
Return To Play ◽  
Secondary Headache ◽  
Headache Disorders ◽  
Unique Challenge ◽  
Primary Headache Disorder ◽  
Primary Headache Disorders ◽  
Headache Type

The prevalence of primary headache disorders in the general population provides a unique challenge in the evaluation of headache occurring in the context of sport. Sport-related and exercise-related headaches are not uncommon, but there is limited epidemiological data on these types of headaches in athletes. Any primary headache type can occur in the setting of sports. These scenarios are challenging in the return to play context, as it is often unclear whether an athlete has an exacerbation of a primary headache disorder, new onset headache unrelated to trauma, or has suffered a genuine concussive injury. Through careful evaluation, the practitioner can distinguish primary headache disorders from posttraumatic headaches following concussion. This chapter reviews primary headache disorders, posttraumatic headaches, and other secondary headache disorders.

scholarly journals Update on Treatment of Cluster Headache

2021 ◽  
Vol 39 (3) ◽  
pp. 113-120
Author(s):  
Jong-Hee Sohn ◽  
Mi Ji Lee ◽  
Soo-Jin Cho
Keyword(s):  
Cluster Headache ◽  
Preventive Treatment ◽  
Primary Headache ◽  
Headache Disorder ◽  
Preventive Therapy ◽  
Systemic Steroid ◽  
Novel Treatments ◽  
Primary Headache Disorder ◽  
Cranial Autonomic Symptoms ◽  
High Flow Oxygen

Cluster headache (CH) is characterized by severe unilateral short-lasting headache attacks, accompanying ipsilateral cranial autonomic symptoms or the sense of restlessness and agitation, or both. CH is a highly disabling primary headache disorder but often not optimally treated. High-flow oxygen and parenteral triptans are the most effective treatment to treat an acute CH attack. Transitional treatments include systemic steroid therapy and sub-occipital steroid injection. For preventive therapy, verapamil and lithium are recommended as first-line treatments. Novel treatments have appeared, such as neuromodulation and medication targeting calcitonin gene-related peptide (CGRP) or its receptor. Galcanezumab, the only anti-CGRP receptor monoclonal antibody with proven efficacy for the preventive treatment of episodic CH, represents an important advance for pharmacological treatment of CH. Neuromodulation strategies, such as the non-invasive vagus nerve stimulation and the sphenopalatine ganglion stimulation, have been proven effective in reducing the intensity and frequency of attacks, and also to be safe and well tolerated.

CACNA1A Gene Polymorphisms in Cluster Headache

Cephalalgia ◽  
2001 ◽  
Vol 21 (10) ◽  
pp. 953-958 ◽  
Author(s):  
C Sjöstrand ◽  
V Giedratis ◽  
K Ekbom ◽  
E Waldenlind ◽  
J Hillert
Keyword(s):  
Cluster Headache ◽  
Primary Headache ◽  
Headache Disorder ◽  
Familial Hemiplegic Migraine ◽  
Hemiplegic Migraine ◽  
Promising Candidate ◽  
Primary Headache Disorder ◽  
Increased Risk ◽  
Ihs Criteria ◽  
Cacna1a Gene

Cluster headache (CH) is a primary headache disorder where the aetiological and pathophysiological mechanisms still are largely unknown. An increased risk of CH in first- and second-degree relatives suggests the importance of genetic factors. Mutations of the P/Q type calcium channel alpha 1 subunit (CACNA1A) gene on chromosome 19p13 have been shown to cause several neurological disorders with a wide clinical spectrum, mainly episodic diseases. Missence mutations of the gene cause familial hemiplegic migraine (FHM) and it is also likely to be involved in the more common forms of migraine. The CACNA1A gene is thus a promising candidate gene for CH. In this study we performed an association analysis of an intragenic polymorphic (CA)n-repeat with marker D19S1150 and a (CAG)n-repeat in the 3′UTR region, in 75 patients with CH according to IHS criteria and 108 matched controls. Genotypes and allele frequencies were similarly distributed in patients and controls. Linkage disequilibrium between the two markers was similar in patients and controls. We conclude that an importance of the CACNA1A gene in sporadic CH is unlikely.

Cluster headache

2020 ◽  
pp. 182-189
Author(s):  
Ilse F. de Coo ◽  
Leopoldine A. Wilbrink ◽  
Joost Haan
Keyword(s):  
Nervous System ◽  
Cluster Headache ◽  
Sensory System ◽  
Primary Headache ◽  
Headache Disorder ◽  
Primary Headache Disorder ◽  
Oxygen Inhalation ◽  
First Choice ◽  
Temporal Course ◽  
Subcutaneous Sumatriptan

Cluster headache is a primary headache disorder characterized by attacks of severe-to-very severe unilateral pain, located in the orbital, supraorbital, and/or temporal regions, with ipsilateral autonomic symptoms and/or restlessness. By definition, cluster headache attacks last between 15 and 180 minutes. Based on the temporal course, cluster headache can be categorized into episodic and chronic. A subdivision can also be made in primary and secondary chronic and secondary episodic. The cause of cluster headache is unknown, but probably the hypothalamus, trigeminal sensory system, some cranial blood vessels, and the autonomic nervous system are involved. A combination of acute (oxygen inhalation and/or subcutaneous sumatriptan) and prophylactic (first choice verapamil) treatment is usually necessary. For treatment-resistant patients, some experimental invasive options exist.

Device review: Pulsante™ sphenopalatine ganglion microstimulator

2019 ◽  
Vol 9 (6) ◽  
pp. 535-541
Author(s):  
Nenna Nwazota ◽  
Srinivas Pyati ◽  
Kyle Fisher ◽  
Lance Roy
Keyword(s):  
Remote Control ◽  
Cluster Headache ◽  
Treatment Option ◽  
Primary Headache ◽  
Headache Disorder ◽  
Sphenopalatine Ganglion ◽  
Primary Headache Disorder ◽  
Fixation Plate ◽  
Stimulating Electrodes ◽  
Autonomic Reflex

Cluster headache (CH) is a primary headache disorder. The use of neuromodulation in treatment of CH is well documented. The sphenopalatine ganglion (SPG) has long been a target for management of CH. Intervention at the level of the SPG can interrupt the trigemino-autonomic reflex, which mediates CH pain. The Pulsante system is the only device on the market created for SPG stimulation. The Pulsante device consists of the device body, a lead with six stimulating electrodes placed in the pterygopalatine fossa, and a fixation plate to allow anchoring of the device to the maxilla. Stimulation is administered via a patient-controlled handheld remote control held over the cheek. SPG stimulation is an important treatment option for CH patients.

scholarly journals Perceived triggers of primary headache disorders: A meta-analysis

Cephalalgia ◽  
2017 ◽  
Vol 38 (6) ◽  
pp. 1188-1198 ◽  
Author(s):  
A Brooke Walters Pellegrino ◽  
Rachel E Davis-Martin ◽  
Timothy T Houle ◽  
Dana P Turner ◽  
Todd A Smitherman
Keyword(s):  
Meta Analysis ◽  
Experimental Studies ◽  
Primary Headache ◽  
Headache Disorder ◽  
Assessment Method ◽  
Tension Type Headache ◽  
Headache Disorders ◽  
Primary Headache Disorder ◽  
Primary Headache Disorders ◽  
Analytic Review

Objective To quantitatively synthesize extant literature on perceived triggers of primary headache disorders. Methods A meta-analytic review of headache trigger survey studies was conducted. Endorsement rates, assessment method, and headache and sample characteristics were extracted from included articles. Separate random-effects models were used to assess trigger endorsement rates and post-hoc meta-regressions examined potential moderator variables. Results 85 articles from 1958 to 2015 were included, involving 27,122 participants and querying 420 unique triggers (collapsed into 15 categories). Four-fifths (0.81; 95% CI .75 to .86) of individuals with migraine or tension-type headache endorsed at least one trigger. Rates increased with the number of categories queried (OR: 1.18, 1.08–1.30) and year of publication (OR: 1.04, 1.00–1.08). The triggers most commonly endorsed were stress (.58, .53–.63) and sleep (.41, .36–.47). Conclusions Extreme heterogeneity characterizes the headache trigger literature. Most individuals with a primary headache disorder perceive their attacks to be triggered by one or more precipitants, the most common of which are stress and sleep. However, trigger endorsement is influenced by method of assessment. Enhancing methodological consistency and prioritizing experimental studies would improve our understanding of headache triggers.

Cluster Headache

Cephalalgia ◽  
2000 ◽  
Vol 20 (9) ◽  
pp. 787-803 ◽  
Author(s):  
DW Dodick ◽  
TD Rozen ◽  
PJ Goadsby ◽  
SD Silberstein
Keyword(s):  
Gender Differences ◽  
Cluster Headache ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Primary Headache ◽  
Headache Disorder ◽  
Autonomic Symptoms ◽  
Head Pain ◽  
Primary Headache Disorder

Cluster headache is a stereotypic, primary headache disorder that is marked by repeated short-lasting attacks of severe, unilateral head pain and associated autonomic symptoms. Cluster headache is probably due to an abnormality in the circadian hypothalamic generator with subsequent trigeminovascular activation. We have reviewed the clinical manifestations, pathophysiology, gender differences, and treatment options in cluster headache.

scholarly journals Evidence That HFE H63D Variant Is a Potential Disease Modifier in Cluster Headache

2021 ◽  
Author(s):  
Maria Papasavva ◽  
Michail Vikelis ◽  
Martha-Spyridoula Katsarou ◽  
Vasileios Siokas ◽  
Emmanouil Dermitzakis ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Iron Homeostasis ◽  
Hereditary Hemochromatosis ◽  
Primary Headache ◽  
Headache Disorder ◽  
Allelic Frequency ◽  
Primary Headaches ◽  
Primary Headache Disorder ◽  
Disease Modifier ◽  
Potential Link

AbstractCluster headache (CH) is a primary headache disorder with a complex genetic background. Several studies indicate a potential link between iron homeostasis and the pathophysiology of primary headaches. The HFE gene encodes for a protein involved in iron metabolism, while genetic variants in HFE have been associated with hereditary hemochromatosis (HH), an iron overload disorder. The objective of the current study was to examine the association of the more common HFE H63D variant, with the susceptibility to develop CH and diverse clinical phenotypes in a population of Southeastern European Caucasian (SEC) origin. Genomic DNA samples from 128 CH patients and 294 neurologically healthy controls were genotyped for the HFE rs1799945 (H63D) variant. H63D genotypic and allelic frequency distribution did not differ significantly between patients and controls (p > 0.05). Subgroup analysis revealed a significantly more frequent occurrence of the variant G allele in chronic compared to episodic CH patients, indicative for a possible correlation of the HFE gene with the susceptibility for disease chronification. Although homozygosity for the less prevalent H63D variant G allele was minimal in the CH cohort, the results of the present study are in accordance with previous studies in CH and migraine patients, suggesting that HFE H63D variant modifies the disease clinical characteristics. Hence, despite the absence of a per se association with CH susceptibility in the current SEC cohort, variability in HFE gene may be potentially regarded as a disease modifier genetic factor in CH.

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