Cluster-status migrainosus with a weekly periodicity responsive to high-flow oxygen: A case report

Background There are cases in the headache literature described as “cluster-migraine,” but none of stereotyped cases of cluster headache evolving into status migrainosus. We believe this is the first documented case of “cluster-status migrainosus”. Case A 54 year-old female hospital administrator presented with headaches with a unique periodicity and semiology that were acutely responsive to high-flow oxygen. She experienced cluster headache attacks every Thursday morning at 3–4 am, which would evolve into status migrainosus lasting through Sunday evening. These attacks were preceded by prodromal depressed mood changes and fluid retention, and later followed by postdromal euphoria and auto-diuresis. These attacks initially occurred every other week and progressed to weekly attacks for 1.5 years. These headaches did not respond to trials of propanolol, sodium valproate, topiramate, amitriptyline, gabapentin, and carbamazepine for preventive treatment or to oral sumatriptan and butalbital-acetaminophen-caffeine for acute treatment. We started her on high-flow 100% oxygen for cluster headache, which successfully aborted greater than 80% of her weekly cluster headache attacks and prevented them from evolving into status migrainosus. Conclusion We believe this is the first case of “cluster-status migranosus” described in the medical literature. High-flow oxygen both aborted the cluster headaches and prevented the ensuing status migrainosus.

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High-Flow Oxygen: A Gladly Received Fresh Look at an Old but Effective Abortive Treatment for Cluster Headache

Current Neurology and Neuroscience Reports ◽

10.1007/s11910-010-0171-x ◽

2010 ◽

Vol 11 (2) ◽

pp. 121-123

Author(s):

Ivan Garza

Keyword(s):

Cluster Headache ◽

High Flow ◽

High Flow Oxygen ◽

Abortive Treatment

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High-Flow Oxygen Appears Effective In Treating Cluster Headaches

Topics in Pain Management ◽

10.1097/01.tpm.0000367948.27669.23 ◽

2010 ◽

Vol 25 (7) ◽

pp. 12

Keyword(s):

High Flow ◽

High Flow Oxygen ◽

Cluster Headaches

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Update on Treatment of Cluster Headache

Journal of the Korean Neurological Association ◽

10.17340/jkna.2021.3.1 ◽

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.

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Severe hemoptysis in post-tuberculosis bronchiectasis precipitated by SARS-CoV-2 infection

BMC Pulmonary Medicine ◽

10.1186/s12890-020-01285-6 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Julien Lopinto ◽

Marion Teulier ◽

Audrey Milon ◽

Guillaume Voiriot ◽

Muriel Fartoukh

Keyword(s):

Oxygen Therapy ◽

Lower Lobe ◽

High Flow ◽

Distal Embolization ◽

Case Presentation ◽

First Case ◽

High Flow Oxygen ◽

Chronic Pulmonary Diseases ◽

History Of ◽

Multi Detector Computed Tomography

Abstract Background Since the beginning of SARS-CoV-2 outbreak in China, severe acute respiratory syndrome has been widely descripted. Hemoptysis has rarely been observed in SARS-CoV-2 infection. We report here a case of severe hemoptysis in post-tuberculosis bronchiectasis precipitated by SARS-CoV-2 infection and managed in a referral center. Case presentation A 58-year-old man was admitted to our intensive care unit for severe hemoptysis with history of post-tuberculosis bronchiectasis. At ICU admission the patient had fever and severe acute respiratory failure requiring high flow oxygen therapy. Respiratory tract sampling was positive for SARS-CoV-2. Multi-detector computed tomography angiography pointed out localized bronchiectasis on the left lower lobe and enlarged left bronchial and phrenic arteries; bronchial arteriography with distal embolization was performed with favorable outcome and no bleeding recurrence. Conclusions To our knowledge, this is the first case of acute exacerbation of bronchiectasis related to SARS-CoV-2 infection and complicated by severe hemoptysis. Whether the virus may play a role in the dysregulation of airway haemostasis, and contribute to episodes of hemoptysis in patients with chronic pulmonary diseases and predisposing factors might be investigated.

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