scholarly journals Primary headache disorders

2019 ◽  
Vol 9 (3) ◽  
pp. 233-240 ◽  
Author(s):  
Peter J. Goadsby
Keyword(s):  
Cluster Headache ◽  
Nerve Stimulation ◽  
Controlled Trial ◽  
Preventive Treatment ◽  
Primary Headache ◽  
Migraine Treatment ◽  
Headache Disorders ◽  
Primary Headache Disorders ◽  
Trigeminal Nerve Stimulation ◽  
Episodic Cluster Headache

Purpose of reviewTo review 5 new areas in primary headache disorders, especially migraine and cluster headache.Recent findingsCalcitonin gene-related peptide (CGRP) receptor antagonists (gepants—rimegepant and ubrogepant) and serotonin 5-HT1F receptor agonists (ditans—lasmiditan) have completed phase 3 clinical trials and will soon offer novel, effective, well-tolerated nonvasoconstrictor options to treat acute migraine. CGRP preventive treatment is being revolutionized after the licensing of 3 monoclonal antibodies (MABs), erenumab, fremanezumab, and galcanezumab, with eptinezumab to follow, especially designed for migraine; they are effective and well tolerated. For patients seeking a nondrug therapy, neuromodulation approaches, single-pulse transcranial magnetic stimulation, noninvasive vagus nerve stimulation (nVNS), and external trigeminal nerve stimulation, represent licensed, well-tolerated approaches to migraine treatment. For the acute treatment of episodic cluster headache, nVNS is effective, well tolerated, and licensed; nVNS is effective and well tolerated in preventive treatment of cluster headache. The CGRP MAB galcanezumab was effective and well tolerated in a placebo-controlled trial in the preventive treatment of episodic cluster headache. Sphenopalatine ganglion stimulation has been shown to be effective and well tolerated in 2 randomized sham-controlled studies on chronic cluster headache. Understanding the premonitory (prodromal) phase of migraine during which patients experience symptoms such as yawning, tiredness, cognitive dysfunction, and food cravings may help explain apparent migraine triggers in some patients, thus offering better self-management.SummaryHeadache medicine has made remarkable strides, particularly in understanding migraine and cluster headache in the past 5 years. For the most common reason to visit a neurologist, therapeutic advances offer patients reduced disability and neurologists a rewarding, key role in improving the lives of those with migraine and cluster headache.

Occipital nerve stimulation for intractable chronic cluster headache or migraine: A critical analysis of direct treatment costs and complications

Cephalalgia ◽  
2013 ◽  
Vol 33 (16) ◽  
pp. 1283-1291 ◽  
Author(s):  
Oliver Mueller ◽  
Hans-Christoph Diener ◽  
Philipp Dammann ◽  
Kasja Rabe ◽  
Vincent Hagel ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Nerve Stimulation ◽  
Chronic Cluster Headache ◽  
Treatment Costs ◽  
Headache Disorders ◽  
Occipital Nerve Stimulation ◽  
Occipital Nerve ◽  
Primary Headache Disorders ◽  
Direct Treatment ◽  
Hospitalization Costs

Background Occipital nerve stimulation (ONS) has been shown to be effective for selected patients with intractable headache disorders. We performed a prospective critical evaluation of complications and direct treatment costs. Methods Twenty-seven patients with chronic cluster headache (CCH, n = 24) or chronic migraine (CM, n = 3) underwent a trial phase with bilateral ONS and subsequent implantation of a permanent generator (IPG), if responsive to treatment according to predefined criteria. Procedural and long-term complications as well as direct treatment costs of neuromodulation therapy of ONS were recorded over a mean follow-up period of 20 months (range 5–47 months). Results Twenty-five of 27 patients (93%) responded to treatment. Twenty-one complications in 14 patients were identified, necessitating reoperation in 13 cases. Overall treatment costs were €761,043, including hardware-related costs of €506,019, costs for primary hospital care of €210,496, and complications related to hospitalization costs of €44,528. This results in a per case-based cost of €9445 for hospitalization and €18,741 for hardware costs, totaling €28,186. Conclusion ONS for treatment of refractory CCH and CM is a cost-intensive treatment option with a significant complication rate. Nevertheless, patients with refractory primary headache disorders may experience substantial relief of pain attacks, and headache days, respectively.

Markers of endothelial function in migraine patients: Results from a bi-center prospective study

Cephalalgia ◽  
2014 ◽  
Vol 35 (10) ◽  
pp. 877-885 ◽  
Author(s):  
Marlene Fischer ◽  
Charly Gaul ◽  
Hind Shanib ◽  
Dagny Holle ◽  
Lorin Loacker ◽  
...  
Keyword(s):  
Endothelial Function ◽  
Cluster Headache ◽  
Primary Headache ◽  
Tension Type Headache ◽  
Healthy Controls ◽  
Headache Disorders ◽  
Endothelial Markers ◽  
Primary Headache Disorders ◽  
Significant Difference ◽  
Type Headache

Background Numerous studies suggest an increased vascular risk in patients with migraine, in particular in those with aura. A possible link between both conditions might be a dysfunction of the vascular endothelium. This observational study analyzed the endothelial markers angiopoietin-1, angiopoietin-2, Tie-2, sFlt-1 and NT-proBNP for the first time in migraineurs, patients with other primary headache disorders and healthy controls. Methods Patients with episodic migraine with and without aura, episodic cluster headache, tension-type headache and healthy controls were included. Blood samples were obtained during migraine attacks and headache-free periods in migraineurs, in and out of bout in cluster headache and during headache-free periods in tension-type headache and healthy individuals to analyze markers of endothelial function. Results No significant difference in endothelial markers between migraine, other headache disorders and healthy controls was detected. There was no significant difference between migraine attacks and headache-free intervals. Additionally, no distinction could be found between migraine with and without aura. Discussion The endothelial markers analyzed do not display a characteristic pattern in different headache disorders especially migraine compared to healthy controls. The novel findings of our study indicate that factors other than endothelial dysfunction seem to be responsible for the at least statistical association of migraine with vascular disease.

scholarly journals Greater Occipital Nerve Stimulation via the Bion® Microstimulator: Implantation Technique and Stimulation Parameters Clinical Trial: NCT00205894

2009 ◽  
Vol 3;12 (3;5) ◽  
pp. 621-628 ◽  
Author(s):  
Terrence L. Trentman
Keyword(s):  
Nerve Stimulation ◽  
Primary Headache ◽  
Implantation Technique ◽  
Headache Disorders ◽  
Occipital Nerve ◽  
Primary Headache Disorders ◽  
Stimulation Parameters ◽  
Greater Occipital Nerve ◽  
The Mean ◽  
One Year

Background: Millions of patients suffer from medically refractory and disabling primary headache disorders. This problem has led to a search for new and innovative treatment modalities, including neuromodulation of the occipital nerves. Objectives: The primary aim of this study is to describe an implantation technique for the Bion® microstimulator and document stimulation parameters and stimulation maps after Bion placement adjacent to the greater occipital nerve. The secondary aim is to document outcome measures one year post-implant. Design: Prospective, observational feasibility study. Methods: Nine patients with medically refractory primary headache disorders participated in this study. Approximately 6 months after Bion insertion, stimulation parameters and maps were documented for all patients. At one year, outcome measures were collected including the Migraine Disability Assessment Score. Results: At 6 months, the mean perception threshold was 0.47 mA, while the mean discomfort threshold was 6.8 mA (stimulation range 0.47 – 6.8 mA). The mean paresthesia threshold was 1.64 mA and the mean usage range was 16.0. There were no major complications reported such as device migration, infection, or erosion. One patient stopped using her Bion before the 12-month follow-up visit. At one year, 7 of the 8 patients were judged as having obtained fair or better results in terms of reduction of disability; 5 patients had greater than a 90% reduction in disability. Limitations: Small, heterogeneous patient population without control group. Not blinded or randomized. Conclusion: The Bion can be successfully inserted adjacent to the greater occipital nerve in an effort to treat refractory primary headache disorders. This microstimulator may provide effective occipital stimulation and headache control while minimizing the risks associated with percutaneous or paddle leads implanted subcutaneously in the occipital region. Key words: Chronic headache, migraine, cluster headache, peripheral nerve stimulation

scholarly journals Cluster Headache and the Comprehension Paradox

2022 ◽  
Vol 4 (1) ◽  
Author(s):  
Heiko Pohl ◽  
Andreas R. Gantenbein ◽  
Peter S. Sandor ◽  
Jean Schoenen ◽  
Colette Andrée
Keyword(s):  
Sick Leave ◽  
Cluster Headache ◽  
Leisure Activities ◽  
Primary Headache ◽  
Headache Disorders ◽  
Online Questionnaire ◽  
Primary Headache Disorders ◽  
The Times ◽  
Headache Patients

AbstractPatients with primary headache disorders such as cluster headache cycle between being entirely healthy and almost completely incapacitated. Sick leave or reduced performance due to headache attacks demands flexibility by their social counterparts. The objective of this study is to test the hypothesis that headache patients cause frustration that grows with the times colleagues have to take over their work. In this study, we analysed cluster headache patients’ answers to an online questionnaire. Participants self-reported their number of sick days, the number of days on which leisure activities were missed and whether they felt understood by colleagues and family. We then investigated the correlation between the number of sick days and the proportion of patients feeling understood by colleagues and friends. We found that feeling understood by colleagues and friends decreases with a growing number of sick days. However, when sick days accrue further, this proportion increases again. The number of sick days correlates similarly with both colleagues’ and friends’ understanding. The number of cluster headache patients feeling understood by others decreases with an increasing number of sick days. Their social circles’ frustration with the patients’ failure to meet obligations and expectations are a likely reason. With a growing number of sick days, however, the portion of patients feeling understood rises again despite patients meeting others’ expectations even less. This ‘comprehension paradox’ implies the influence of other factors. We suspect that growing numbers of sick days foster understanding as the disability of the disease becomes increasingly apparent.

Specific Music Therapy Techniques in the Treatment of Primary Headache Disorders in Adolescents: A Randomized Attention-Placebo-Controlled Trial

2013 ◽  
Vol 14 (10) ◽  
pp. 1196-1207 ◽  
Author(s):  
Julian Koenig ◽  
Rieke Oelkers-Ax ◽  
Michael Kaess ◽  
Peter Parzer ◽  
Christoph Lenzen ◽  
...  
Keyword(s):  
Music Therapy ◽  
Controlled Trial ◽  
Primary Headache ◽  
Headache Disorders ◽  
Primary Headache Disorders

Nocebo is the enemy, not placebo. A meta-analysis of reported side effects after placebo treatment in headaches

Cephalalgia ◽  
2011 ◽  
Vol 31 (5) ◽  
pp. 550-561 ◽  
Author(s):  
Dimos D Mitsikostas ◽  
Leonidas I Mantonakis ◽  
Nikolaos G Chalarakis
Keyword(s):  
Clinical Trials ◽  
Cluster Headache ◽  
Meta Analysis ◽  
Preventive Treatment ◽  
Primary Headache ◽  
Symptomatic Treatment ◽  
Adverse Side Effect ◽  
Primary Headaches ◽  
Nocebo Effect ◽  
Primary Headache Disorders

The aim was to determine the magnitude of the nocebo (adverse effects following placebo administration) in clinical trials for primary headache disorders. We reviewed randomized, placebo-controlled studies for migraine, tension-type headache (TTH), and cluster headache treatments published between 1998 and 2009. The frequency of nocebo was estimated by the percentage of placebo-treated patients reporting at least one adverse side effect. The dropout frequency was estimated by the percentage of placebo-treated patients who discontinued the treatment due to intolerance. In studies of symptomatic treatment for migraine, the nocebo and dropout frequencies were 18.45% and 0.33%, but rose to 42.78% and 4.75% in preventative treatment studies. In trials for prevention of TTH, nocebo and dropout frequencies were 23.99% and 5.44%. For symptomatic treatment of cluster headache, the nocebo frequency was 18.67%. Nocebo is prevalent in clinical trials for primary headaches, particularly in preventive treatment studies. Dropouts due to nocebo effect may confound the interpretation of many clinical trials.

scholarly journals Vagus nerve stimulation for primary headache disorders: An anatomical review to explain a clinical phenomenon

Cephalalgia ◽  
2019 ◽  
Vol 39 (9) ◽  
pp. 1180-1194 ◽  
Author(s):  
Dylan Jozef Hendrik Augustinus Henssen ◽  
Berend Derks ◽  
Mats van Doorn ◽  
Niels Verhoogt ◽  
Anne-Marie Van Cappellen van Walsum ◽  
...  
Keyword(s):  
Vagus Nerve ◽  
Trigeminal Nerve ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Primary Headache ◽  
Solitary Tract ◽  
Headache Disorders ◽  
Primary Headache Disorders ◽  
Non Invasive ◽  
Stimulation Of

Background Non-invasive stimulation of the vagus nerve has been proposed as a new neuromodulation therapy to treat primary headache disorders, as the vagus nerve is hypothesized to modulate the headache pain pathways in the brain. Vagus nerve stimulation can be performed by placing an electrode on the ear to stimulate the tragus nerve, which contains about 1% of the vagus fibers. Non-invasive vagus nerve stimulation (nVNS) conventionally refers to stimulation of the cervical branch of the vagus nerve, which is made up entirely of vagal nerve fibers. While used interchangeably, most of the research to date has been performed with nVNS or an implanted vagus nerve stimulation device. However, the exact mechanism of action of nVNS remains hypothetical and no clear overview of the effectiveness of nVNS in primary headache disorders is available. Methods In the present study, the clinical trials that investigated the effectiveness, tolerability and safety of nVNS in primary headache disorders were systematically reviewed. The second part of this study reviewed the central connections of the vagus nerve. Papers on the clinical use of nVNS and the anatomical investigations were included based on predefined criteria, evaluated, and results were reported in a narrative way. Results The first part of this review shows that nVNS in primary headache disorders is moderately effective, safe and well-tolerated. Regarding the anatomical review, it was reported that fibers from the vagus nerve intertwine with fibers from the trigeminal, facial, glossopharyngeal and hypoglossal nerves, mostly in the trigeminal spinal tract. Second, the four nuclei of the vagus nerve (nuclei of the solitary tract, nucleus ambiguus, spinal nucleus of the trigeminal nerve and dorsal motor nucleus (DMX)) show extensive interconnections. Third, the efferents from the vagal nuclei that receive sensory and visceral input (i.e. nuclei of the solitary tract and spinal nucleus of the trigeminal nerve) mainly course towards the main parts of the neural pain matrix directly or indirectly via other vagal nuclei. Conclusion The moderate effectiveness of nVNS in treating primary headache disorders can possibly be linked to the connections between the trigeminal and vagal systems as described in animals.

TM2-5 Percutaneous electrical nerve stimulation (PENS) therapy for refractory primary headache disorders: a pilot study

2019 ◽  
Vol 90 (3) ◽  
pp. e14.1-e14
Author(s):  
MW Weatherall ◽  
D Nandi
Keyword(s):  
Cluster Headache ◽  
Treatment Options ◽  
Primary Headache ◽  
Cervicogenic Headache ◽  
Chronic Cluster Headache ◽  
Hemicrania Continua ◽  
Single Shot ◽  
Headache Disorders ◽  
Trigeminal Neuropathy ◽  
Primary Headache Disorders

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.

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.

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