Complete alleviation of treatment refractory primary SUNCT syndrome with clomiphene citrate (a medicinal deep brain hypothalamic modulator)

Cephalalgia ◽  
2014 ◽  
Vol 34 (12) ◽  
pp. 1021-1024 ◽  
Author(s):  
Todd D Rozen
Keyword(s):  
Clomiphene Citrate ◽  
Treatment Options ◽  
Primary Headache ◽  
Headache Disorder ◽  
Decompression Surgery ◽  
Sunct Syndrome ◽  
Primary Headache Disorder ◽  
Treatment Refractory ◽  
Putative Mechanism ◽  
Deep Brain

Objective To report the first ever case of primary short-lasting unilateral neuralgiform headache attacks (SUNCT) syndrome completely responsive to clomiphene citrate. Methods Case report. Results SUNCT is a primary headache disorder marked by frequent attacks of one-sided headache with cranial autonomic associated symptoms. When SUNCT is deemed medicinally treatment refractory, it can cause tremendous patient-related disability. Surgical treatment options are available including hypothalamic deep brain stimulation, occipital nerve stimulator placement or arterial decompression surgery, but these procedures carry significant morbidity. A patient presented with a 10 month complaint of multiple, daily short-lasting, right-sided headaches each lasting from 60 to 120 seconds in duration and occurring from 100 to 200 times per day. The head pain was associated with ipsilateral eyelid ptosis and conjunctival injection. The patient was diagnosed with SUNCT but was unresponsive to multiple recognized medicinal treatments. He had complete alleviation of his attacks with clomiphene citrate, a synthetic, non-steroidal, ovulatory stimulant that directly binds to hypothalamic estrogen receptors. The clomiphene was tolerated without any adverse events. A putative mechanism of action for clomiphene in the prevention of SUNCT will be presented. Conclusion Clomiphene citrate is a unique treatment for SUNCT and appears to be very safe and effective.

scholarly journals Migraine patients in Germany - Need for Medical Recognition and New Preventive Treatments: Results from the PANORAMA Survey

2020 ◽  
Author(s):  
Mirja Koch ◽  
Zsazsa Katsarava ◽  
Caroline Baufeld ◽  
Katrin Schuh ◽  
Astrid Gendolla ◽  
...  
Keyword(s):  
Prophylactic Treatment ◽  
Treatment Options ◽  
Primary Headache ◽  
Headache Disorder ◽  
Comprehensive Overview ◽  
Treatment Algorithms ◽  
Primary Headache Disorder ◽  
Professional Perspective ◽  
Few Data ◽  
Healthcare Situation

Abstract Background: Migraine is a primary headache disorder characterized by recurrent attacks that may have a significant impact on patients’ daily life. Treatment options must often be re-evaluated in light of efficacy, tolerability and compliance issues. Few data on commonly applied treatment algorithms and treatment failures have existed in Germany in 2017/2018. The PANORAMA survey was designed to explore and characterize the migraine healthcare landscape and to demonstrate the medical treatment need at that time in Germany.Methods: Three different questionnaires were used to assess the profile of the 119 participating centers, characterize migraine patients at centers and evaluate qualitative aspects of the current migraine healthcare situation from a physician´s professional perspective. Data were analyzed as observed and summarized by descriptive statistics.Results: The results demonstrate that once referred to a migraine specialist, the majority of patients continue to be treated at a specialist. At specialized centers, 41.6% of migraine patients receive prophylactic treatment. 45.4% of prophylactic treatments are initiated with a beta-blocker and 28.1% with an anti-epileptic. Pivotal factors to initiate prophylactic treatment are migraine attack frequency and intensity (58.0%). Treatment decisions are largely based on prior / concomitant diseases and physical constitution of the patient (52.1%). Following an inadequate treatment, most patients either switch substance class or discontinue prophylactic treatment. Conclusions: PANORAMA gives a comprehensive overview of the migraine healthcare landscape in Germany in 2017/2018, elucidates a lack of common treatment algorithms and reveals a high demand for defined therapy strategies and new prophylactic treatment going forwards.

Responsiveness of short-lasting unilateral neuralgiform headache with conjunctival injection and tearing to hypothalamic deep brain stimulation

2009 ◽  
Vol 110 (2) ◽  
pp. 279-281 ◽  
Author(s):  
Mark K. Lyons ◽  
David W. Dodick ◽  
Virgilio Gerald H. Evidente
Keyword(s):  
Deep Brain Stimulation ◽  
Functional Imaging ◽  
Brain Stimulation ◽  
Primary Headache ◽  
Headache Disorder ◽  
Trigeminal Autonomic Cephalalgias ◽  
Conjunctival Injection ◽  
Imaging Studies ◽  
Primary Headache Disorder ◽  
Deep Brain

Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) is a severe primary headache disorder that is often refractory to medical therapy. Although the pathogenesis of this and other trigeminal autonomic cephalalgias is not completely understood, ipsilateral activation of the posterior and inferior hypothalamus has been identified on functional imaging studies during attacks. The authors report on a case of SUNCT syndrome successfully treated with hypothalamic deep brain stimulation and discuss the current literature.

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.

Treatment and management of migraine

2020 ◽  
pp. 138-151
Author(s):  
Miguel J. A. Láinez ◽  
Veselina T. Grozeva
Keyword(s):  
Treatment Options ◽  
Correct Diagnosis ◽  
Primary Headache ◽  
Headache Disorder ◽  
Dopamine Antagonists ◽  
Individual Treatment ◽  
Acute Migraine ◽  
Primary Headache Disorder ◽  
General Management ◽  
Status Migrainosus

The chapter is a review of the possible treatment options for acute migraine. This primary headache disorder has a huge social and economic impact. The combination of a correct diagnosis, good general management and the election of the most appropriate pharmacological treatment can significantly reduce the patient’s disability. Here we provide a thorough description of the most commonly used specific (ergots and triptans) and nonspecific (analgesics, NSAIDs, dopamine antagonists, etc.) medications, as well as some of their effective combinations. We discuss how to use the different medications in relation with the clinical presentation of the migraine attacks and in special situations as status migrainosus, or refractoriness to conventional treatment. Advantages and disadvantages of the most used strategies are pointed out to assist professionals to choose the best individual treatment for their patients with acute migraine attack.

An Overview of the Treatment Options for Acute Migraine

2011 ◽  
Vol 6 (4) ◽  
pp. 265 ◽  
Author(s):  
Fabio Antonaci ◽  
Natascia Ghiotto ◽  
Maurizio Evangelista ◽  
◽  
◽  
...  
Keyword(s):  
Acute Treatment ◽  
Treatment Options ◽  
Primary Headache ◽  
Headache Disorder ◽  
Symptomatic Therapy ◽  
Acute Migraine ◽  
Primary Headache Disorder ◽  
Inflammatory Drugs ◽  
Socioeconomic Burden ◽  
Over Time

Migraine is a primary headache disorder associated with a high socioeconomic burden. The first step in effective migraine management, following confirmation of the diagnosis, is patient education: the condition is carefully explained, to ensure that it is properly understood, and realistic expectations are set. The choice of acute treatment has changed over time as the available therapeutic options have increased. Abortive migraine therapy can be either specific (ergot derivatives and triptans) or non-specific (analgesics and non-steroidal anti-inflammatory drugs). Even though acute symptomatic therapy can be optimised, migraine remains a chronic and potentially progressive condition.

scholarly journals Migraine patients in Germany - need for medical recognition and new preventive treatments: results from the PANORAMA survey

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
M. Koch ◽  
Z. Katsarava ◽  
C. Baufeld ◽  
K. Schuh ◽  
A. Gendolla ◽  
...  
Keyword(s):  
Prophylactic Treatment ◽  
Treatment Options ◽  
Primary Headache ◽  
Headache Disorder ◽  
Comprehensive Overview ◽  
Treatment Algorithms ◽  
Primary Headache Disorder ◽  
Professional Perspective ◽  
Few Data ◽  
Healthcare Situation

Abstract Background Migraine is a primary headache disorder characterized by recurrent attacks that may have a significant impact on patients’ daily life. Treatment options must often be re-evaluated in light of efficacy, tolerability and compliance issues. Few data on commonly applied treatment algorithms and treatment failures have existed in Germany in 2017/2018. The PANORAMA survey was designed to explore and characterize the migraine healthcare landscape and to demonstrate the medical treatment need at that time in Germany. Methods Three different questionnaires were used to assess the profile of the 119 participating centers, characterize migraine patients at centers and evaluate qualitative aspects of the current migraine healthcare situation from a physician´s professional perspective. Data were analyzed as observed and summarized by descriptive statistics. Results The results demonstrate that once referred to a migraine specialist, the majority of patients continue to be treated at a specialist. At specialized centers, 41.6 % of migraine patients receive prophylactic treatment. 45.4 % of prophylactic treatments are initiated with a beta-blocker and 28.1 % with an anti-epileptic. Pivotal factors to initiate prophylactic treatment are migraine attack frequency and intensity (58.0 %). Treatment decisions are largely based on prior / concomitant diseases and physical constitution of the patient (52.1 %). Following an inadequate treatment, most patients either switch substance class or discontinue prophylactic treatment. Conclusions PANORAMA gives a comprehensive overview of the migraine healthcare landscape in Germany in 2017/2018, elucidates a lack of common treatment algorithms and reveals a high demand for defined therapy strategies and new prophylactic treatment going forwards.

scholarly journals Cluster headache and the hypothalamus – causal relationship or epiphenomenon?

2012 ◽  
pp. 188-197
Author(s):  
Dagny Holle ◽  
Mark Obermann
Keyword(s):  
Cluster Headache ◽  
Animal Studies ◽  
Primary Headache ◽  
Headache Disorder ◽  
Invasive Treatment ◽  
Primary Headache Disorder ◽  
Underlying Pathophysiology ◽  
Neuroimaging Techniques ◽  
Deep Brain

Typical clinical features of cluster headache (CH) include trigeminal distribution of pain, circadian/circannual rhythmicity, and ipisilateral cranial autonomic features. This presentation led to the assumption that the hypothalamus plays a pivotal role in this primary headache disorder. Several studies using neuroimaging techniques or measuring hormone levels supported the hypothesis of a hypothalamic involvement in the underlying pathophysiology in CH. Animal studies added further evidence regarding this hypothesis. Based on previous data even invasive treatment methods such as hypothalamic deep brain stimulation (DBS) were tried for therapy. However, the principal question whether these alterations are pathognomonic for CH or whether they might be detected in trigeminal pain disorders in general in terms of an epiphenomenon is still unsolved. This review summarizes studies on hypothalamic involvement in CH pathophysiology, demonstrates the involvement of the hypothalamus in other diseases, and tries to illuminate the role of the hypothalamus based on this synopsis.

Red ear syndrome: A review of all published cases (1996–2010)

Cephalalgia ◽  
2012 ◽  
Vol 33 (3) ◽  
pp. 190-201 ◽  
Author(s):  
Suzanne Ryan ◽  
Benjamin R Wakerley ◽  
Paul Davies
Keyword(s):  
Young Woman ◽  
Treatment Options ◽  
Primary Headache ◽  
Headache Disorder ◽  
Burning Sensation ◽  
Primary Headache Disorder ◽  
Red Ear Syndrome

Background Red ear syndrome is characterised by episodic unilateral erythema of the ear associated with pain and burning sensation. Patients and methods We describe the case of a young woman with daily, frequent, recurrent episodes of red ear syndrome in the absence of any structural lesions, primary headache disorder or obvious triggers. We review all previously described cases and discuss postulated mechanisms for this syndrome. Conclusions The exact cause of this rare headache disorder remains unknown and treatment options vary considerably.

scholarly journals Effectiveness of paranasal air suction on acute migraine using portable air sucker – a randomized, double blind study

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
S. M. R. Bandara ◽  
S. Samita ◽  
A. M. Kiridana ◽  
H. M. M. T. B. Herath
Keyword(s):  
Clinical Trial ◽  
Side Effects ◽  
Sri Lanka ◽  
Primary Headache ◽  
Headache Disorder ◽  
Low Pressure ◽  
Outcome Variable ◽  
Double Blind ◽  
Primary Headache Disorder ◽  
Before And After

Abstract Background Migraine is a primary headache disorder and is the most common disabling primary headache disorder that occurs in children and adolescents. A recent study showed that paranasal air suction can provide relief to migraine headache. However, in order to get the maximum benefit out of it, an easy to use effective air sucker should be available. Aiming to fulfil the above requirement, a randomized, double blind control clinical trial was conducted to investigate the efficacy of a recently developed low–pressure portable air sucker. Methods Eighty-six Sri Lankan school children of age 16–19 years with migraine were enrolled for the study. They were randomly allocated into two groups, and one group was subjected to six intermittent ten-second paranasal air suctions using the portable air sucker for 120 s. The other group was subjected to placebo air suction (no paranasal air suction). The effect of suction using portable air sucker was the primary objective but side of headache, type of headache, and gender were also studied as source variables. The primary response studied was severity of headache. In addition, left and right supraorbital tenderness, photophobia, phonophobia, numbness over the face and scalp, nausea and generalized tiredness/weakness of the body were studied. The measurements on all those variables were made before and after suction, and the statistical analysis was performed based on before and after differences. As a follow–up, patients were monitored for 24-h period. Results There was a significant reduction in the severity of headache pain (OR = 25.98, P < 0.0001), which was the primary outcome variable, and other migraine symptoms studied, tenderness (left) (OR = 289.69, P < 0.0001), tenderness (right) (OR > 267.17, P < 0.0001), photophobia (OR = 2115.6, P < 0.0001), phonophobia (OR > 12.62, P < 0.0001) nausea (OR > 515.59, P < 0.0001) and weakness (OR = 549.06, P < 0.0001) except for numbness (OR = 0.747, P = 0.67) in the treatment group compared to the control group 2 min after the suction. These symptoms did not recur within 24-h period and there were no significant side effects recorded during the 24-h observation period. Conclusion This pilot study showed that low–pressure portable air sucker is effective in paranasal air suction, and suction for 120 s using the sucker can provide an immediate relief which can last for more than 24-h period without any side effects. Trail registration Clinical Trial Government Identification Number – 1548/2016. Ethical Clearance Granted Institute – Medical Research Institute, Colombo, Sri Lanka (No 38/2016). Sri Lanka Clinical Trial Registration No: SLCTR/2017/018. Date of registration = 29/ 06/2017. Approval Granting Organization to use the device in the clinical trial– National Medicines Regulatory Authority Sri Lanka (16 Jan 2018), The device won award at Geneva international inventers exhibition in 2016 and President award in 2018 in Sri Lanka. It is a patented device in Sri Lanka and patent number was SLKP/1/18295. All methods were carried out in accordance with CONSORT 2010 guidelines.

scholarly journals Diagnosis and management of migraine in ten steps

2021 ◽  
Author(s):  
Anna K. Eigenbrodt ◽  
Håkan Ashina ◽  
Sabrina Khan ◽  
Hans-Christoph Diener ◽  
Dimos D. Mitsikostas ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Consensus Statement ◽  
Preventive Treatment ◽  
Primary Headache ◽  
Headache Disorder ◽  
Clinical Decision ◽  
Diagnosis And Management ◽  
Primary Headache Disorder ◽  
Management Of Complications ◽  
European Headache Federation

AbstractMigraine is a disabling primary headache disorder that directly affects more than one billion people worldwide. Despite its widespread prevalence, migraine remains under-diagnosed and under-treated. To support clinical decision-making, we convened a European panel of experts to develop a ten-step approach to the diagnosis and management of migraine. Each step was established by expert consensus and supported by a review of current literature, and the Consensus Statement is endorsed by the European Headache Federation and the European Academy of Neurology. In this Consensus Statement, we introduce typical clinical features, diagnostic criteria and differential diagnoses of migraine. We then emphasize the value of patient centricity and patient education to ensure treatment adherence and satisfaction with care provision. Further, we outline best practices for acute and preventive treatment of migraine in various patient populations, including adults, children and adolescents, pregnant and breastfeeding women, and older people. In addition, we provide recommendations for evaluating treatment response and managing treatment failure. Lastly, we discuss the management of complications and comorbidities as well as the importance of planning long-term follow-up.

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