Multiple cranial nerve blocks for the transitional treatment of chronic headaches

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.

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Unilateral Photophobia or Phonophobia in Migraine Compared With Trigeminal Autonomic Cephalalgias

Cephalalgia ◽

10.1111/j.1468-2982.2008.01565.x ◽

2008 ◽

Vol 28 (6) ◽

pp. 626-630 ◽

Cited By ~ 69

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.

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Multiple Cranial Nerve Blocks as an Alternative Preventative Therapy for Chronic Migraine

Headache The Journal of Head and Face Pain ◽

10.1111/head.13792 ◽

2020 ◽

Vol 60 (5) ◽

pp. 981-987 ◽

Cited By ~ 2

Author(s):

Linford Fernandes ◽

Nashaba Khan ◽

Jessica Dobson ◽

Marc Randall ◽

Luis Idrovo

Keyword(s):

Chronic Migraine ◽

Cranial Nerve ◽

Preventative Therapy ◽

Nerve Blocks ◽

Multiple Cranial Nerve

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A Patient With Chronic Cluster Headache Responsive to High-Dose Indomethacin: Is There an Overlap With Chronic Paroxysmal Hemicrania?

Cephalalgia ◽

10.1111/j.1468-2982.2008.01581.x ◽

2008 ◽

Vol 28 (7) ◽

pp. 778-781 ◽

Cited By ~ 10

Author(s):

S Prakash ◽

SY Dholakia ◽

KA Shah

Keyword(s):

Cluster Headache ◽

Chronic Cluster Headache ◽

Paroxysmal Hemicrania ◽

High Dose ◽

Chronic Paroxysmal Hemicrania

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Ipsilateral Cluster Headache and Chronic Paroxysmal Hemicrania: Two Case Reports

Cephalalgia ◽

10.1046/j.1468-2982.1992.1205318.x ◽

1992 ◽

Vol 12 (5) ◽

pp. 318-320 ◽

Cited By ~ 27

Author(s):

Alain Djacoba Tehindrazanarivelo ◽

Jean Marc Visy ◽

Marie-Germaine Bousser

Keyword(s):

Complete Remission ◽

Cluster Headache ◽

Case Reports ◽

Chronic Cluster Headache ◽

Paroxysmal Hemicrania ◽

Dramatic Improvement ◽

Episodic Cluster Headache ◽

Close Relationship ◽

Chronic Paroxysmal Hemicrania

We report two patients with ipsilateral attacks of cluster headache and chronic paroxysmal hemicrania. The first patient, a 33-year-old man, started having attacks of chronic cluster headache at the age of 27. At 33, they were replaced by typical attacks of ipsilateral chronic paroxysmal hemicrania which showed a dramatic improvement with indomethacin 150 mg daily. After two days of complete remission, cluster headache attacks reappeared and persisted until verapamil, 360 mg a day, was added to indomethacin. The second patient, a 45-year-old man, first developed attacks of episodic cluster headache at the age of 35. At 44, he experienced ipsilateral typical attacks of chronic paroxysmal hemicrania, and two months later attacks of cluster headache. Under verapamil 240 mg daily, attacks of cluster headache disappeared, but those of chronic paroxysmal hemicrania increased in frequency until indomethacin 150 mg daily was added. These observations suggest a close relationship but not a similarity between cluster headache and chronic paroxysmal hemicrania, and show the practical therapeutic interest of maintaining this distinction. Cluster headache, chronic paroxysmal hemicrania, indomethacin, verapamil

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The anterior hypothalamus in cluster headache

Cephalalgia ◽

10.1177/0333102416660550 ◽

2016 ◽

Vol 37 (11) ◽

pp. 1039-1050 ◽

Cited By ~ 26

Author(s):

Enrico B Arkink ◽

Nicole Schmitz ◽

Guus G Schoonman ◽

Jorine A van Vliet ◽

Joost Haan ◽

...

Keyword(s):

Cluster Headache ◽

Structural Changes ◽

Region Of Interest ◽

Chronic Cluster Headache ◽

Magnetic Resonance Images ◽

Anterior Hypothalamus ◽

Paroxysmal Hemicrania ◽

Manual Segmentation ◽

Whole Brain ◽

Chronic Paroxysmal Hemicrania

Objective To evaluate the presence, localization, and specificity of structural hypothalamic and whole brain changes in cluster headache and chronic paroxysmal hemicrania (CPH). Methods We compared T1-weighted magnetic resonance images of subjects with cluster headache (episodic n = 24; chronic n = 23; probable n = 14), CPH ( n = 9), migraine (with aura n = 14; without aura n = 19), and no headache ( n = 48). We applied whole brain voxel-based morphometry (VBM) using two complementary methods to analyze structural changes in the hypothalamus: region-of-interest analyses in whole brain VBM, and manual segmentation of the hypothalamus to calculate volumes. We used both conservative VBM thresholds, correcting for multiple comparisons, and less conservative thresholds for exploratory purposes. Results Using region-of-interest VBM analyses mirrored to the headache side, we found enlargement ( p < 0.05, small volume correction) in the anterior hypothalamic gray matter in subjects with chronic cluster headache compared to controls, and in all participants with episodic or chronic cluster headache taken together compared to migraineurs. After manual segmentation, hypothalamic volume (mean±SD) was larger ( p < 0.05) both in subjects with episodic (1.89 ± 0.18 ml) and chronic (1.87 ± 0.21 ml) cluster headache compared to controls (1.72 ± 0.15 ml) and migraineurs (1.68 ± 0.19 ml). Similar but non-significant trends were observed for participants with probable cluster headache (1.82 ± 0.19 ml; p = 0.07) and CPH (1.79 ± 0.20 ml; p = 0.15). Increased hypothalamic volume was primarily explained by bilateral enlargement of the anterior hypothalamus. Exploratory whole brain VBM analyses showed widespread changes in pain-modulating areas in all subjects with headache. Interpretation The anterior hypothalamus is enlarged in episodic and chronic cluster headache and possibly also in probable cluster headache or CPH, but not in migraine.

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EHMTI-0373. Adrenal suppression associated with greater occipital nerve and multiple cranial nerve blocks using triamcinolone

The Journal of Headache and Pain ◽

10.1186/1129-2377-15-s1-i5 ◽

2014 ◽

Vol 15 (S1) ◽

Cited By ~ 1

Author(s):

B Hywel ◽

N Silver

Keyword(s):

Cranial Nerve ◽

Adrenal Suppression ◽

Nerve Blocks ◽

Occipital Nerve ◽

Greater Occipital Nerve ◽

Multiple Cranial Nerve

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

Cephalalgia ◽

10.1177/0333102417731349 ◽

2017 ◽

Vol 38 (7) ◽

pp. 1276-1285 ◽

Cited By ~ 15

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.

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