Distinguishing Primary Headache Disorders from Cervicogenic Headache: Clinical and Therapeutic Implications

ObjectivesPrimary headache disorders are common, but many patients are refractory to medical treatment. PENS therapy involves the stimulation of one or more individual nerves or dermatomes using needle probes. We assessed whether a ‘single shot with single probe’ strategy would benefit patients with refractory headache disorders, including chronic migraine (CM), and chronic cluster headache (CCH).DesignService evaluation of 36 patients treated with PENS therapy between September 2012 and June 2016. Follow-up data was available for 33 patients.Subjects16 patients with CM, nine with CCH, and one with hemicrania continua. Secondary headaches comprised occipital neuralgia, cervicogenic headache, and trigeminal neuropathy.MethodsPENS was given using Algotec® disposable 21 gauge PENS therapy probes (8 cm) to the occipital nerve ipsilateral to the pain (or bilaterally in cases of bilateral pain). Stimulation was delivered at 2 Hz/100 Hz, at 3 cycles/second, between 1.2–2.5 V depending on patient tolerability, for 25–28 min.Results6/9 patients with CCH improved significantly after the first session. In all patients with CCH, PENS therapy was well tolerated, with no significant adverse events reported. One patient with CCH reverted to episodic cluster. Only four patients with CM experienced any benefit.ConclusionsPENS therapy shows potential as a relatively non-invasive, low-risk, and inexpensive component of the treatment options for refractory primary headache disorders, particularly chronic cluster headache.

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MIGRAINE;

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.02.3097 ◽

2019 ◽

Vol 26 (02) ◽

Author(s):

Muslim Ali Lakhiar ◽

Abdul Hafeez Bughio ◽

Ashique Ali Arain ◽

Manzoor Ali Lakhiar

Keyword(s):

Primary Headache ◽

Headache Disorder ◽

Cervicogenic Headache ◽

Cross Sectional Study ◽

University Hospital ◽

Secondary Headache ◽

Headache Disorders ◽

Cross Sectional ◽

Primary Headache Disorders ◽

Cranial Neuropathies

Objectives: To determine the various patterns of headache presenting to Neurology OPD Liaquat University Hospital Jamshoro/Hyderabad. Study Design: Descriptive, cross-sectional study. Setting: Department of Neurology, Liaquat University of Medical & Health Sciences (LUMHS). Period: July to December 2016. Methods: Data was collected on developed profoma, the same was analyzed on SPSS 22nd version. Results: Out of 238 patients, 61 (25.6%) were male 177 (74.4%) were female patients. Age group distribution of study population ranged from 04 - 65 years with mean age was 31.66 with standard deviation of12.72. Out of 238 patients 170 (71.4%) were diagnosed as primary headache disorders, 56 (17%) were secondary headache while 12 (%) were labeled as cranial neuropathies and facial pains. Migraine without aura 113(65.3%) followed by tension type headache 35(20.2%) were most common primary headache disorder. Among secondary headaches Cervicogenic headache 16(30.2%) was most common cause followed by headache secondary to sinusitis, hypertension and trauma 8(15.1%), 7 (13.2%) and 6(11.3%) respectively. Trigeminal Neuralgia 9 (75.0%) was most common painful cranial neuropathies. Conclusion: Primary as well as secondary headache disorders are most prevalent in female at an age range of 21-40 years with majority of them suffering from migraine followed by tension and Cervical origin respectively.

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