A Follow-Up Study of 60 Patients After an Assumed First Period of Cluster Headache

Cephalalgia ◽  
2000 ◽  
Vol 20 (7) ◽  
pp. 653-657 ◽  
Author(s):  
C Sjöstrand ◽  
E Waldenlind ◽  
K Ekbom
Keyword(s):  
Cluster Headache ◽  
International Headache Society ◽  
Observation Time ◽  
Follow Up Study ◽  
Ihs Criteria ◽  
Lost To Follow Up ◽  
Second Period ◽  
Final Group

During 1981–96 a series of 60 consecutive out-patients was examined in relation to an assumed first period of cluster headache (CH). On follow up in 1998 we found that six were deceased at a mean age of 56.5 years (range 45–74 years), of whom one had a definitive CH diagnosis and five had one documented headache period only. Six patients were lost to follow up because they could not be reached. In the final group for evaluation ( n = 49) it was found that 13 (26.5%) patients had had one cluster period only during a mean observation time of 8.9 years. Out of 36 patients with a definitive CH diagnosis according to International Headache Society (IHS) criteria, 31 patients had episodic CH, four patients had primary chronic CH and one patient had secondary chronic CH. Of the patients with a definitive CH diagnosis, 83% on follow up had had a recurrence of a second period of CH within 3 years or continuous attacks (chronic/semichronic CH) from the onset. Evidently some patients may suffer from one cluster period only. In our patient material only 17% had a second cluster period after 3 years.

Ergotamine Abuse. Do Patients Benefit from Withdrawal?

Cephalalgia ◽  
1981 ◽  
Vol 1 (1) ◽  
pp. 29-32 ◽  
Author(s):  
P. Tfelt-Hansen ◽  
A. Æbelholt Krabbe
Keyword(s):  
Cluster Headache ◽  
Failure Rate ◽  
Family Doctor ◽  
Observation Time ◽  
Follow Up Study ◽  
The Family ◽  
Previously Treated

A follow-up study of 40 patients (migraine 39, cluster headache 1) previously treated for ergotamine abuse was conducted. Their statements regarding ergotamine intake were checked using butalbital (contained in the suppositories abused by 90% of the patients) as a tracer, and later by contact with the family doctor. Eleven patients abused ergotamine again during a median observation time of 21 months. Nineteen patients had more than a 50% reduction in headache days after withdrawal and half of the patients were relieved of other symptoms of ergotamine toxicity. Even with a failure rate of approximately 25% it is concluded that efforts to withdraw after abuse of ergotamine are worthwhile.

Natural course of untreated cluster headache: A retrospective cohort study

Cephalalgia ◽  
2017 ◽  
Vol 38 (4) ◽  
pp. 655-661 ◽  
Author(s):  
Mi Ji Lee ◽  
Hyun Ah Choi ◽  
Jong Hwa Shin ◽  
Hea Ree Park ◽  
Chin-Sang Chung
Keyword(s):  
Cluster Headache ◽  
Disease Duration ◽  
Medical Center ◽  
Natural Course ◽  
Duration Of Disease ◽  
Lost To Follow Up ◽  
Active Patients ◽  
Single Predictor ◽  
Over Time

Objective To determine the natural course of cluster headache. Methods We screened patients with cluster headache who were diagnosed at Samsung Medical Center and lost to follow-up for ≥5 years. Eligible patients were interviewed by phone about the longitudinal changes in headache characteristics and disease course. Remission was defined as symptom-free 1) for longer than twice the longest between-bout period and 2) for ≥5 years. Results Forty-two patients lost to follow-up for mean 7.5 (range, 5.0–15.7) years were included. The length of the last bout did not differ from the first one, while the last between-bout period was longer than the first one ( p = 0.012). Characteristics of cluster headache decreased over time: Side-locked unilaterality (from 92.9% to 78.9%), seasonal and circadian rhythmicity (from 63.9% to 60.9% and from 62.2 to 40.5%, respectively), and autonomic symptoms (from 95.2% to 75.0%). Remission occurred in 14 (33.3%) patients at a mean age of 42.3 (range, 27–65) years, which was not different from the age of last bouts in active patients ( p = 0.623). There was a trend for more seasonal and circadian predilection at baseline in the active group ( p = 0.056 and 0.063, respectively) and fewer lifetime bouts and shorter disease duration in patients in remission ( p = 0.063 and 0.090). Conclusions This study first shows the natural courses of cluster headache. Features of cluster headache become less prominent over time. Remission occurred regardless of age. Although no single predictor of remission was found, our data suggest that remission of cluster headache might not be a consequence of more advanced age, longer duration of disease, or accumulation of lifetime bouts.

scholarly journals An Evaluation of Survival of Space Maintainers: A Six-year Follow-up Study

2005 ◽  
Vol 6 (1) ◽  
pp. 74-84 ◽  
Author(s):  
Ozlem Tulunoglu ◽  
Tezer Ulusu ◽  
Yasemin Genç
Keyword(s):  
Survival Time ◽  
Success Rate ◽  
Median Survival ◽  
Median Survival Time ◽  
Age Groups ◽  
Age Group ◽  
Follow Up Study ◽  
Different Types ◽  
Lost To Follow Up

Abstract The aim of this study was to evaluate the median survival time of fixed and removable space maintainers related to age groups, gender, and their distribution in upper and lower dental arches. The adherence of patients to a periodic recall program and the success rate of different types of space maintainers related to different arches were also evaluated. This study included 663 patients aged between 4-15 years old that were treated between the years of 1997 and 2002. The patients were categorized into four main groups: lost to follow-up, failed, successful, and censored at the end of study. Three hundred forty-five space maintainers were considered lost to follow-up, 83 were considered failed, 206 successful, and 20 censored-at-end. The overall median survival time of the appliances was 6.51 months. Median survival time was 7.25 months in the 4-6 age group, 6.35 months in the 7-12 age group, and 7.0 months in the 13+ age groups. Median survival time was 5.76 months in girls and 7.11 months in boys. Median survival time of space maintainers was 7.17 months for maxilla and 6.69 months in the mandible. Median survival time was 5.25 months for space maintainers fabricated in both arches. Citation Tulunoglu Ö, Ulusu T, Genç Y. An Evaluation of Survival of Space Maintainers: A Six-year Follow-up Study J Contemp Dent Pract 2005 February;(6)1:074-084.

Evaluation of Clinical Criteria for Cluster Headache With Special Reference to The Classification of The International Headache Society

Cephalalgia ◽  
1990 ◽  
Vol 10 (4) ◽  
pp. 195-197 ◽  
Author(s):  
Karl Ekbom
Keyword(s):  
Cluster Headache ◽  
International Headache Society ◽  
World Federation ◽  
Definite Diagnosis ◽  
Conjunctival Injection ◽  
Clinical Criteria ◽  
Ihs Criteria ◽  
The Difference ◽  
Symptoms And Signs

The diagnostic criteria issued by the International Headache Society (IHS) (1988) and those of the World Federation of Neurology (WFN) (1969) were evaluated vis-à-vis 163 consecutive cases of cluster headache diagnosed according to the criteria of Ekbom (1970). The agreement between the IHS and Ekbom criteria was very good (96.9%). The difference was explained by five patients who all lacked local autonomous symptoms and signs (conjunctival injection, lacrimation, etc.). At least one of these signs is mandatory according to the IHS and thus the patients escaped a definite diagnosis. Agreement between the WFN and Ekbom criteria was 84.0% ( n= 163) and between the WFN and IHS criteria only 76.0% ( n= 158).

If Migraine Prophylaxis Does Not Work, Think About Compliance

Cephalalgia ◽  
1994 ◽  
Vol 14 (6) ◽  
pp. 463-464 ◽  
Author(s):  
TJ Steiner ◽  
T Catarci ◽  
R Hering ◽  
T Whirmarsh ◽  
EGM Couturier
Keyword(s):  
Side Effects ◽  
Real Time ◽  
Pressure Change ◽  
Migraine Prophylaxis ◽  
Event Recorder ◽  
Ihs Criteria ◽  
Lost To Follow Up

Data are presented on nine patients with migraine by IHS criteria, recruited from those presenting to the clinic for treatment and needing prophylaxis. Pizotifen 0.5 mg tds was prescribed for 8 weeks and dispensed in special containers with an electronic event recorder concealed in the lid. This responded to the pressure change with each opening of the container and recorded it in real time. The information was later downloaded to a PC for analysis. At trial end, two patients had been lost to follow-up, one had not started the treatment at all, two had dropped out because of alleged side effects (drowsiness), and four patients had completed the study. For these, the quantity of tablets used as a percentage of that prescribed (i.e., compliance assessed on the basis of returned-tablet count) ranged from 62.6% to 91.9%; the percentage of days in which three doses had been taken ranged from only 15.8% to 79%; the percentage of doses taken on schedule (8 h ± 25% after the previous dose) ranged from 21.1% to 47.3%. It is possible that all evaluations of efficacy and tolerance of migraine prophylactics reported so far have been unsoundly based.

scholarly journals Episodic Cluster Headache in a Community: Clinical Features and Treatment

1998 ◽  
Vol 25 (2) ◽  
pp. 141-145 ◽  
Author(s):  
C.M. Riess ◽  
W.J. Becker ◽  
M. Robertson
Keyword(s):  
Cluster Headache ◽  
Clinical Features ◽  
International Headache Society ◽  
Media Campaign ◽  
Dental Procedures ◽  
Prophylactic Drugs ◽  
Episodic Cluster Headache ◽  
Ihs Criteria ◽  
The Media ◽  
Headache Patients

ABSTRACT:Objective:To study the clinical features and treatment given to episodic cluster headache patients in the Calgary region.Patients:Fifty-one (51) patients who responded to a media campaign, had previously been diagnosed by their family physicians, and who met International Headache Society (IHS) criteria for episodic cluster headache, formed the population for this study.Methods:The media campaign consisted of newspaper advertisements and radio publicity including physician interviews and talk shows. Patients were required to complete a 200-item questionnaire detailing clinical features and treatment of their cluster headache syndrome. Each patient was also interviewed by our research nurse for clarification and proper completion of questionnaire.Results:Fifty-one percent (51%) of our patients had short headache attacks lasting one hour or less. Almost one-half (45%) had three or four attacks per 24 hour period. Eighty-six percent (86%) had been referred to a neurologist. Sixty-nine percent (69%) had never used oxygen, but of those who had, onehalf were still using it. Sumatriptan by injection had been tried by 26% of patients and of these, 93% considered it effective. Subcutaneous dihydroergotamine had been tried by 8%. For prophylaxis, 41% had tried methysergide, 31% prednisone, and 4% verapamil. Many patients had been prescribed migraine prophylactic drugs which are ineffective for cluster headache, and some had also undergone dental procedures or nasal and sinus surgeries.Conclusion:Many cluster headache patients had not, to their knowledge, been prescribed or used the best symptomatic and prophylactic treatments for cluster headache. This should be addressed through educational programs and through making up-to-date information on the treatment of cluster headache readily available to physicians and patients.

Treatment of refractory chronic cluster headache by chronic occipital nerve stimulation

Cephalalgia ◽  
2011 ◽  
Vol 31 (10) ◽  
pp. 1101-1105 ◽  
Author(s):  
Denys Fontaine ◽  
Jean Christophe Sol ◽  
Sylvie Raoul ◽  
Nelly Fabre ◽  
Gilles Geraud ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Nerve Stimulation ◽  
Prophylactic Treatment ◽  
International Headache Society ◽  
Chronic Cluster Headache ◽  
Occipital Nerve Stimulation ◽  
Occipital Nerve ◽  
Greater Occipital Nerve ◽  
International Headache Society Classification

Background: Greater occipital nerve stimulation (ONS) has been recently proposed to treat severe chronic cluster headache patients (CCH) refractory to medical treatment. We report the results of a French multidisciplinary cohort study. Methods: Thirteen CCH patients were operated and data were collected prospectively. All of them suffered from CCH according to the International Headache Society classification, lasting for more than 2 years, refractory to pharmacological prophylactic treatment with adequate trials, with at least one daily attack. Chronic ONS was delivered through a subcutaneous occipital electrode connected to an implanted generator, in order to induce paraesthesias perceived locally in the lower occipital region. Results: After surgery (mean follow-up 14,6 months), the mean attack frequency and intensity decreased by 68% and 49%, respectively. At last follow-up, 10/13 patients were considered as responders (improvement >50%). Prophylactic treatment could be stopped or reduced in 8/13 cases. Local infection occurred in one patient, leading to hardware removal. Conclusions: Our data confirmed the results of the 36 similar cases reported in the literature, suggesting that ONS may act as a prophylactic treatment in chronic CH. Considering their respective risks, ONS should be proposed before deep brain stimulation in severe refractory CCH patients.

Evaluating the IHS Criteria for Cluster Headache – a Comparison between Patients Meeting all Criteria and Patients Failing One Criterion

Cephalalgia ◽  
2006 ◽  
Vol 26 (3) ◽  
pp. 241-245 ◽  
Author(s):  
JA van Vliet ◽  
PJE Eekers ◽  
J Haan ◽  
MD Ferrari ◽  
Keyword(s):  
Cluster Headache ◽  
International Headache Society ◽  
Age At Onset ◽  
Circadian Rhythmicity ◽  
Response To Treatment ◽  
Attack Frequency ◽  
Female Ratio ◽  
Attack Pattern ◽  
Ihs Criteria ◽  
Male To Female

Cluster headache (CH) is diagnosed according to criteria of the International Headache Society (IHS), but, in clinical practice, these criteria seem too restrictive. As part of a nation-wide study, we identified a group of patients who met all criteria minus one (IHS-CH-1), and assessed in which way they differed from CH patients meeting all criteria (IHS-CH). We performed a nation-wide questionnaire study for CH and CH-like syndromes, including questions based on the IHS criteria, and additional features such as restlessness during attacks, nocturnal onset of attacks, circadian rhythmicity of attacks and response to treatment. IHS-CH and IHS-CH-1 patients were compared. Of 1452 responders to two questionnaires, 1163 were IHS-CH and 289 were IHS-CH-1. The majority of the IHS-CH-1 patients were classified as such because their attacks exceeded 3 h (64%, median attack duration: 5 h), or came in a frequency of less than 1 per 2 days (16%). Age at onset was similar between the groups. The male to female ratio was 3.7 : 1 in the IHS-CH group and around 1.6 : 1 in the IHS-CH-1 groups ( P < 0.005). Patients with attacks exceeding 3 h less often reported a circadian rhythmicity (IHS-CH-1: 49%, IHS-CH: 64%), episodic periodicity (IHS-CH-1: 65%, IHS-CH: 78%), nocturnal attacks (IHS-CH-1: 67%, IHS-CH: 78%), smoking (IHS-CH-1: 90%, IHS-CH: 80%) and restlessness during attacks (IHS-CH-1: 64%, IHS-CH: 76%) than IHS-CH patients ( P < 0.005). Photo- or phono-phobia (IHS-CH-1: 67%, IHS-CH: 54%) and nausea (IHS-CH-1: 38%, IHS-CH: 27%) were more frequently reported by patients who reported to have attacks exceeding 3 h ( P < 0.005). Similar proportions reported effect of verapamil on their attacks (IHS-CH-1: 54%, IHS-CH 61%). We conclude that average attack duration exceeding 3 h was frequently the reason for not fulfilling IHS CH criteria. Symptoms often accompanying CH such as restlessness, nocturnal attacks and an episodic attack pattern were relatively frequently present in IHS-CH-1 patients with longer attacks. These patients may therefore be diagnosed with CH. Attack frequency may not be a useful criterion for the diagnosis of CH. The upper limit of 3 h should be increased in future diagnostic criteria.

Peripheral provocation of cranial autonomic symptoms is not sufficient to trigger cluster headache attacks

Cephalalgia ◽  
2017 ◽  
Vol 38 (8) ◽  
pp. 1498-1502 ◽  
Author(s):  
Maike Möller ◽  
Ame Abdu Haji ◽  
Jan Hoffmann ◽  
Arne May
Keyword(s):  
Cluster Headache ◽  
Low Frequency ◽  
Central Component ◽  
Autonomic Symptoms ◽  
Cranial Autonomic Symptoms ◽  
Peripheral Stimulation ◽  
Low Frequency Stimulation ◽  
Frequency Stimulation ◽  
Lost To Follow Up

Background Recently it has been suggested that low frequency stimulation of the sphenopalatine ganglion (SPG) may provoke cluster-like attacks in cluster headache (CH) patients. The question arises whether a robust activation of cranial autonomic symptoms is sufficient to trigger CH attacks. Methods Kinetic oscillation stimulation (KOS) of the nasal mucosa generates ipsilateral marked autonomic symptoms, among which lacrimation is quantitatively measurable. KOS was applied to 29 CH-patients, including both episodic and chronic course. We measured lacrimation at rest and during stimulation, and assessed CH attacks within 24 hours after the experiment. Results Autonomic symptoms including lacrimation were robust and significantly generated, compared to rest. Six patients were lost to follow-up, but did not develop an attack during their stay in the clinic. Of the remaining 23 patients, none developed an attack in the next 4 hours after stimulation, despite marked cranial autonomic symptoms during stimulation. Discussion Peripheral stimulation close to the SPG generated a strong parasympathetic response. However, this stimulation was not sufficient to induce CH attacks, which suggests that a central component is crucial to attack generation.

scholarly journals Observation time and spontaneous resolution of primary phimosis in children

2017 ◽  
Vol 44 (5) ◽  
pp. 505-510
Author(s):  
Pedro Luiz Toledo de Arruda Lourenção ◽  
Dênis Silva Queiroz ◽  
Wilson Elias de-Oliveira Junior ◽  
Giovana Tuccille Comes ◽  
Rozemeire Garcia Marques ◽  
...  
Keyword(s):  
Observation Time ◽  
Spontaneous Resolution ◽  
Conservative Approach ◽  
Medical Visit ◽  
Main Determinant ◽  
Resolution Rate ◽  
Follow Up Study ◽  
Asymptomatic Patients ◽  
Medium Time

ABSTRACT Objective: to investigate spontaneous resolution rate of a series of patients with physiologic phimosis in relation to observation time and presence of symptoms. Methods: retrospective and longitudinal follow-up study of patients with physiologic phimosis, that did not apply topic treatment. These patients were invited for a new visit for reevaluation, or recent data were obtained by chart analysis. Spontaneous resolution rate was determined and statistically compared to age, presence of symptoms at first medical visit and time until reevaluation. Results: seventy one patients were included. Medium time of observation from first visit to reevaluation was 37.4 months. There was spontaneous resolution of phimosis in 32 (45%) patients. Children with spontaneous resolution were younger at initial diagnosis and were observed during a longer period of time. Most asymptomatic patients at first visit presented spontaneous resolution. However, it was not possible to stablish a significant relationship between presence of symptoms and evolution of physiologic phimosis. Conclusions: time of observation was the main determinant of spontaneous resolution of patients with physiologic phimosis, reinforcing the current more conservative approach regarding circumcision of those patients.

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