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.

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.

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.

scholarly journals Aura in trigeminal autonomic cephalalgia is probably mediated by comorbid migraine with aura

Cephalalgia ◽  
2021 ◽  
pp. 033310242110304
Author(s):  
Kuan-Po Peng ◽  
Marlene Schellong ◽  
Arne May
Keyword(s):  
Cluster Headache ◽  
Migraine With Aura ◽  
Migraine Without Aura ◽  
Telephone Interview ◽  
Medical Center ◽  
Temporal Correlation ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Trigeminal Autonomic Cephalalgias ◽  
Trigeminal Autonomic Cephalalgia

Objective The presence of aura is rare in cluster headache, and even rarer in other trigeminal autonomic cephalalgias. We hypothesized that the presence of aura in patients with trigeminal autonomic cephalalgias is frequently an epiphenomenon and mediated by comorbid migraine with aura. Methods The study retrospectively reviewed 480 patients with trigeminal autonomic cephalalgia in a tertiary medical center for 10 years. Phenotypes and temporal correlation of aura with headache were analyzed. Trigeminal autonomic cephalalgia patients with aura were further followed up in a structured telephone interview. Results Seventeen patients with aura (3.5%) were identified from 480 patients with trigeminal autonomic cephalalgia, including nine with cluster headache, one with paroxysmal hemicrania, three with hemicrania continua, and four with probable trigeminal autonomic cephalalgia. Compared to trigeminal autonomic cephalalgia patients without aura, trigeminal autonomic cephalalgia patients with aura were more likely to have a concomitant diagnosis of migraine with aura (odds ratio [OR] = 109.0, 95% CI 30.9–383.0, p < 0.001); whereas the risk of migraine without aura remains similar between both groups (OR = 1.10, 95% CI = 0.14–8.59, p = 0.931). Aura was more frequently accompanied with migraine-like attacks, but not trigeminal autonomic cephalalgia attacks. Interpretation In most patients with trigeminal autonomic cephalalgia, the presence of aura is mediated by the comorbidity of migraine with aura. Aura directly related to trigeminal autonomic cephalalgia attack may exist but remains rare. Our results suggest that aura may not be involved in the pathophysiology of trigeminal autonomic cephalalgia.

Non-invasive vagus nerve stimulation for the management of refractory primary chronic headaches: A real-world experience

Cephalalgia ◽  
2017 ◽  
Vol 38 (7) ◽  
pp. 1276-1285 ◽  
Author(s):  
Michele Trimboli ◽  
Adnan Al-Kaisy ◽  
Anna P Andreou ◽  
Madeleine Murphy ◽  
Giorgio Lambru
Keyword(s):  
Cluster Headache ◽  
Vagus Nerve ◽  
Chronic Migraine ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Chronic Cluster Headache ◽  
Hemicrania Continua ◽  
Primary Headaches ◽  
Non Invasive ◽  
Chronic Headaches

Background Non-invasive vagus nerve stimulation has initial evidence of efficacy in migraine and cluster headache. However, little is known about its role in the management of refractory chronic headaches. Methods We evaluated the preventive and abortive effects of non-invasive vagus nerve stimulation in 41 consecutive patients with refractory primary chronic headaches in an open-label prospective clinical audit. Headache diaries were used to collect clinical information. Those who obtained at least 30% reduction in headache days/episodes after three months of treatment were considered responders and were offered treatment continuation. Results Twenty-three patients with chronic migraine, 12 with chronic cluster headache, four with hemicrania continua and two with short-lasting unilateral neuralgiform headache attacks with autonomic symptoms (SUNA) were treated. Two of 23 chronic migraine patients, one of 12 chronic cluster headache patients, and two of four hemicrania continua patients were considered responders. None of the patients with SUNA benefited from the therapy. Two chronic migraine patients were able to reduce the pain severity of moderate migraines with non-invasive vagus nerve stimulation. Conclusion Non-invasive vagus nerve stimulation may not constitute an effective acute nor preventive treatment in refractory chronic primary headaches. The encouraging effect in hemicrania continua warrants further evaluation in larger studies.

scholarly journals Patent foramen ovale in trigeminal autonomic cephalalgias and hemicrania continua: a non-specific pathophysiological occurrence?

2010 ◽  
Vol 68 (4) ◽  
pp. 627-631 ◽  
Author(s):  
Vanise Amaral ◽  
Gabriel R. de Freitas ◽  
Bruno C.B Rodrigues ◽  
Daniel de H Christoph ◽  
Carlos A. de Pinho ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Transcranial Doppler ◽  
Epworth Sleepiness Scale ◽  
Patent Foramen Ovale ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Trigeminal Autonomic Cephalalgias ◽  
Foramen Ovale ◽  
Trigger Factors ◽  
Individual Susceptibility

Patent foramen ovale (PFO), a relatively common abnormality in adults, has been associated with migraine. Few studies also linked PFO with cluster headache (CH). To verify whether right-to-left shunt (RLS) is related to headaches other than migraine and CH, we used transcranial Doppler following microbubbles injection to detect shunts in 24 CH, 7 paroxysmal hemicrania (PH), one SUNCT, two hemicrania continua (HC) patients; and 34 matched controls. RLS was significantly more frequent in CH than in controls (54% vs. 25%, p=0.03), particularly above the age of 50. In the HC+PH+SUNCT group, RLS was found in 6 patients and in 2 controls (p=0.08). Smoking as well as the Epworth Sleepiness Scale correlated significantly with CH, smoking being more frequent in patients with RLS. PFO may be non-specifically related to trigeminal autonomic cephalalgias and HC. The headache phenotype in PFO patients probably depends on individual susceptibility to circulating trigger factors.

Concomitant occurrence of different trigeminal autonomic cephalalgias: A case series and review of the literature

Cephalalgia ◽  
2013 ◽  
Vol 34 (3) ◽  
pp. 231-235 ◽  
Author(s):  
Andreas Totzeck ◽  
Hans-Christoph Diener ◽  
Charly Gaul
Keyword(s):  
Cluster Headache ◽  
Clinical Presentation ◽  
Case Series ◽  
Primary Headache ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Trigeminal Autonomic Cephalalgias ◽  
Headache Disorders ◽  
Primary Headache Disorders

Introduction The trigeminal autonomic cephalalgias (TACs) subsume four primary headache disorders. Hemicrania continua is increasingly regarded as an additional TAC. In rare cases patients may present with two different TACs or a TAC and hemicrania continua. Cases We report four patients with two different TACs or one TAC and hemicrania continua. Two patients presented with cluster headache and paroxysmal hemicrania, one patient with cluster headache and hemicrania continua, and one patient suffered from cluster headache and SUNCT. Discussion While the International Classification of Headache Disorders (ICHD-II) proposes specific diagnostic criteria, the variability of clinical presentation may make clear diagnosis difficult. All patients fulfilled the ICHD-II criteria. The manifestation of two different TACs or hemicrania continua in one patient is uncommon but possible and should be taken into account especially when chronic headache patients present with changing headache symptoms.

SUNCT/SUNA in children and adolescents: Application of ICHD-3 criteria and treatment response: Case series of 13 SUNCT/SUNA pediatric cases

Cephalalgia ◽  
2020 ◽  
pp. 033310242095452
Author(s):  
Sharoon Qaiser ◽  
Andrew D Hershey ◽  
Joanne Kacperski
Keyword(s):  
Children And Adolescents ◽  
Treatment Options ◽  
Case Series ◽  
Paroxysmal Hemicrania ◽  
Primary Headaches ◽  
Trigeminal Autonomic Cephalalgias ◽  
Pediatric Case ◽  
Trigeminal Autonomic Cephalalgia ◽  
Autonomic Symptoms

Introduction Trigeminal autonomic cephalalgias (TACs) are characterized by paroxysmal attacks of unilateral primary headaches associated with ipsilateral craniofacial autonomic symptoms. In this pediatric case series, 13 cases of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)/short-lasting unilateral neuralgiform headache with autonomic symptoms (SUNA), including children ages 3–18 years, are discussed. This paper reviews the application of International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria especially in children presenting with SUNCT or SUNA. This is the largest pediatric case series of SUNCT/SUNA reported in the literature. Background Trigeminal autonomic cephalalgias are rare in children and adolescents, with SUNCT/SUNA having the least reported cases. We will discuss the application of ICHD-3 criteria to diagnose SUNCT/SUNA in children and review overlapping cases and their response to different treatment options including indomethacin, which is typically reserved for specific subtypes of TACs; for example, paroxysmal hemicrania. Conclusion This case series presents a unique opportunity to aid in the diagnosis and treatment of similar pediatric cases in the future. It helps us to broaden the ICHD-3 criteria to diagnose and treat different overlapping trigeminal autonomic cephalalgia cases in children.

Hemicrania Continua with Contralateral Episodic Cluster Headache: A Case Report

Cephalalgia ◽  
2003 ◽  
Vol 23 (9) ◽  
pp. 929-930 ◽  
Author(s):  
C Lisotto ◽  
F Mainardi ◽  
F Maggioni ◽  
G Zanchin
Keyword(s):  
Case Report ◽  
Cluster Headache ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Simultaneous Occurrence ◽  
Headache Disorders ◽  
Sunct Syndrome ◽  
First Case ◽  
Episodic Cluster Headache ◽  
Male Patients

The trigeminal autonomic cephalgias (TACs) are characterized by short-lasting unilateral headaches with autonomic features (1). They include four headache disorders, cluster headache (CH), paroxysmal hemicrania (PH), SUNCT syndrome and hemicrania continua (HC). The coexistence of different ipsilateral TACs in the same patient has been previously reported in six published cases (2-6). In five of these patients an association of CH and PH was noted (2-5). The two varieties of attacks occurred separately in three patients, while their simultaneous occurrence was observed in two cases. In another patient the successive occurrence of trigeminal neuralgia, SUNCT syndrome, PH and CH in one active headache period was noted (6). All the reported cases concerned male patients. We describe what we believe to be the first case of coexistence of two different contralateral TACs.

scholarly journals Invasive pericranial nerve interventions

Cephalalgia ◽  
2016 ◽  
Vol 36 (12) ◽  
pp. 1156-1169 ◽  
Author(s):  
Anna Ambrosini ◽  
Jean Schoenen
Keyword(s):  
Cluster Headache ◽  
Controlled Trial ◽  
Local Anaesthetics ◽  
Chronic Cluster Headache ◽  
Surgical Decompression ◽  
Published Data ◽  
Primary Headaches ◽  
Nerve Blocks ◽  
Beneficial Effects

Background In many patients suffering from primary headaches, the available pharmacological and behavioural treatments are not satisfactory. This is a review of (minimally) invasive interventions targeting pericranial nerves that could be effective in refractory patients. Methods The interventions we will cover have in common pericranial nerves as targets, but are distinct according to their rationale, modality and invasiveness. They range from nerve blocks/infiltrations to the percutaneous implantation of neurostimulators and surgical decompression procedures. We have critically analysed the published data (PubMed) on their effectiveness and tolerability. Results and conclusions There is clear evidence for a preventative effect of suboccipital injections of local anaesthetics and/or steroids in cluster headache, while evidence for such an effect is weak in migraine. Percutaneous occipital nerve stimulation (ONS) provides significant long-term relief in more than half of drug-resistant chronic cluster headache patients, but no sham-controlled trial has tested this. The evidence that ONS has lasting beneficial effects in chronic migraine is at best equivocal. Suboccipital infiltrations are quasi-devoid of side effects, while ONS is endowed with numerous, though reversible, adverse events. Claims that surgical decompression of multiple pericranial nerves is effective in migraine are not substantiated by large, rigorous, randomized and sham-controlled trials.

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