scholarly journals Sleep disturbance management in patients with trigeminal autonomic cephalalgias

2021 ◽  
pp. 100-108
Author(s):  
N. V. Vashchenko ◽  
A. M. Uzhakhov ◽  
Ju. E. Azimova
Keyword(s):  
Cluster Headache ◽  
Vagus Nerve ◽  
Sleep Disturbances ◽  
Primary Headaches ◽  
Prophylactic Therapy ◽  
Trigeminal Autonomic Cephalalgias ◽  
Trigeminovascular System ◽  
Acute Therapy

Trigeminal autonomic cephalalgias (TACs) are rare but are the most intense primary headaches that severely limit patients’ ability to work and be socially active. This article reviews the modern classification of TACs, based on the International Classification of Headache Disorders-3, and the key differences between TAC types, as well as the pathophysiological mechanisms – the role of the trigeminovascular system, autonomic nervous system, hypothalamus and vagus nerve – and their relation to circadian rhythms. The sleep disturbances that can occur in patients with TACs, exacerbating the course of the disease, and the role of melatonin, hypothalamus and suprachiasmatic nucleus in these conditions are also discussed. In addition, current therapies for cluster headache are described, which include acute therapy and prophylactic therapy, with recommendations regarding the timing of prophylactic therapy discontinuation. The review also includes the available data on melatonin as well as new therapies such as CGRP monoclonal antibodies and neuromodulation, which includes the two most promising techniques: non-invasive vagus nerve stimulation and sphenopalatine ganglion microstimulation. Furthermore, the authors present the clinical case of a patient with chronic cluster headache, which was significantly reduced in frequency and intensity when melatonin was added to the therapy.

Classification, diagnostic criteria, and epidemiology

2020 ◽  
pp. 177-181
Author(s):  
Thijs H. Dirkx ◽  
Peter J. Koehler
Keyword(s):  
Cluster Headache ◽  
Epidemiological Data ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Primary Headaches ◽  
Conjunctival Injection ◽  
Headache Disorders ◽  
Cranial Autonomic Symptoms ◽  
Unilateral Headache

The trigeminal autonomic cephalalgias (TACs), including cluster headache, paroxysmal hemicrania, SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing), SUNA (with cranial autonomic symptoms), and hemicrania continua, belong to the primary headaches. They are characterized by severe unilateral headache attacks in association with ipsilateral cranial autonomic features. Cluster headache is the most frequent of the TACs. The other TACs are rare, but epidemiological data are scarce and variable. The various types of TAC are distinguished not only by differences in attack frequency and duration, but also by differences with respect to treatment response. The typical headache syndromes, fulfilling the International Classification of Headache Disorders-3 criteria, have also been described in association with other disorders and imaging is required to exclude intracranial pathology in all newly diagnosed patients.

SUNCT/SUNA in children and adolescents: Application of ICHD-3 criteria and treatment response: Case series of 13 SUNCT/SUNA pediatric cases

Cephalalgia ◽  
2020 ◽  
pp. 033310242095452
Author(s):  
Sharoon Qaiser ◽  
Andrew D Hershey ◽  
Joanne Kacperski
Keyword(s):  
Children And Adolescents ◽  
Treatment Options ◽  
Case Series ◽  
Paroxysmal Hemicrania ◽  
Primary Headaches ◽  
Trigeminal Autonomic Cephalalgias ◽  
Pediatric Case ◽  
Trigeminal Autonomic Cephalalgia ◽  
Autonomic Symptoms

Introduction Trigeminal autonomic cephalalgias (TACs) are characterized by paroxysmal attacks of unilateral primary headaches associated with ipsilateral craniofacial autonomic symptoms. In this pediatric case series, 13 cases of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)/short-lasting unilateral neuralgiform headache with autonomic symptoms (SUNA), including children ages 3–18 years, are discussed. This paper reviews the application of International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria especially in children presenting with SUNCT or SUNA. This is the largest pediatric case series of SUNCT/SUNA reported in the literature. Background Trigeminal autonomic cephalalgias are rare in children and adolescents, with SUNCT/SUNA having the least reported cases. We will discuss the application of ICHD-3 criteria to diagnose SUNCT/SUNA in children and review overlapping cases and their response to different treatment options including indomethacin, which is typically reserved for specific subtypes of TACs; for example, paroxysmal hemicrania. Conclusion This case series presents a unique opportunity to aid in the diagnosis and treatment of similar pediatric cases in the future. It helps us to broaden the ICHD-3 criteria to diagnose and treat different overlapping trigeminal autonomic cephalalgia cases in children.

Unilateral Photophobia or Phonophobia in Migraine Compared With Trigeminal Autonomic Cephalalgias

Cephalalgia ◽  
2008 ◽  
Vol 28 (6) ◽  
pp. 626-630 ◽  
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.

Hypothalamic Deep-Brain Stimulation: Target and Potential Mechanism for the Treatment of Cluster Headache

Cephalalgia ◽  
2008 ◽  
Vol 28 (7) ◽  
pp. 799-803 ◽  
Author(s):  
A May
Keyword(s):  
Deep Brain Stimulation ◽  
Cluster Headache ◽  
Brain Stimulation ◽  
Antinociceptive Effect ◽  
Primary Headaches ◽  
Imaging Data ◽  
Pain Transmission ◽  
Positron Emission ◽  
Deep Brain

Recently, functional imaging data have underscored the crucial role of the hypothalamus in trigemino-autonomic headaches, a group of severe primary headaches. This prompted the application of hypothalamic deep-brain stimulation (DBS), with the intention to preventing cluster headache (CH) attacks in selected severe therapy-refractory cases. To date, a total of 50 operated intractable CH patients, one patient with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing and three with atypical facial pain, have been reported. However, it is not apparent why the spontaneous bursts of activation in the inferior posterior hypothalamus result in excruciating head pain, whereas continuous electrical stimulation of the identical area is able to prevent these attacks. Recently, this issue has been addressed by examining 10 operated chronic CH patients, using H215O-positron emission tomography and alternately switching the hypothalamic stimulator on and off. The stimulation-induced activation in the ipsilateral posterior inferior hypothalamic grey (the site of the stimulator tip) as well as activation and de-activation in several cerebral structures belonging to neuronal circuits usually activated in pain transmission. These data argue against an unspecific antinociceptive effect or pure inhibition of hypothalamic activity as the mode of action of hypothalamic DBS and suggest functional modulation of the pain-processing network.

scholarly journals The Trigeminovascular System in Humans: Pathophysiologic Implications for Primary Headache Syndromes of the Neural Influences on the Cerebral Circulation

1999 ◽  
Vol 19 (2) ◽  
pp. 115-127 ◽  
Author(s):  
Arne May ◽  
Peter J. Goadsby
Keyword(s):  
Positron Emission Tomography ◽  
Cluster Headache ◽  
Primary Headache ◽  
Emission Tomography ◽  
Primary Headaches ◽  
Trigeminovascular System ◽  
Pain Attack ◽  
Trigeminal Pain ◽  
Positron Emission ◽  
Neural Influences

Primary headache syndromes, such as cluster headache and migraine, are widely described as vascular headaches, although considerable clinical evidence suggests that both are primarily driven from the brain. The shared anatomical and physiologic substrate for both of these clinical problems is the neural innervation of the cranial circulation. Functional imaging with positron emission tomography has shed light on the genesis of both syndromes, documenting activation in the midbrain and pons in migraine and in the hypothalamic gray in cluster headache. These areas are involved in the pain process in a permissive or triggering manner rather than as a response to first-division nociceptive pain impulses. In a positron emission tomography study in cluster headache, however, activation in the region of the major basal arteries was observed. This is likely to result from vasodilation of these vessels during the acute pain attack as opposed to the rest state in cluster headache, and represents the first convincing activation of neural vasodilator mechanisms in humans. The observation of vasodilation was also made in an experimental trigeminal pain study, which concluded that the observed dilation of these vessels in trigeminal pain is not inherent to a specific headache syndrome, but rather is a feature of the trigeminal neural innervation of the cranial circulation. Clinical and animal data suggest that the observed vasodilation is, in part, an effect of a trigeminoparasympathetic reflex. The data presented here review these developments in the physiology of the trigeminovascular system, which demand renewed consideration of the neural influences at work in many primary headaches and, thus, further consideration of the physiology of the neural innervation of the cranial circulation. We take the view that the known physiologic and pathophysiologic mechanisms of the systems involved dictate that these disorders should be collectively regarded as neurovascular headaches to emphasize the interaction between nerves and vessels, which is the underlying characteristic of these syndromes. Moreover, the syndromes can be understood only by a detailed study of the cerebrovascular physiologic mechanisms that underpin their expression.

scholarly journals Modern ideas about cluster headache. Literature review

2019 ◽  
Vol 2 (19) ◽  
pp. 19-23
Author(s):  
A. Savitskaya ◽  
E. G. Filatova
Keyword(s):  
Cluster Headache ◽  
Channel Blocker ◽  
Prophylactic Therapy ◽  
Review Of The Literature ◽  
Delay In Diagnosis ◽  
Leading Role ◽  
Separate Form ◽  
History Of ◽  
Acute Attacks

The article presents a review of the literature where, starting with the publication of Ekbom K. (1947), the history of the allocation of cluster headache into a separate form of primary head pain is described, modern diagnostic criteria are presented, the pathogenesis, clinical features of the disease are described. It is shown that due to the rarity of this type of headache and low awareness of doctors, the delay in diagnosis is on average 6–7 years. Patients are prescribed a lot of unnecessary examinations and expert consultations: oculists, ENT doctors, neurosurgeons, psychiatrists, etc. Favorite incorrect diagnoses are migraine and trigeminal neuralgia. The evidence of the leading role of the hypothalamus in the pathogenesis of cluster headache is presented. The principles of therapy are discussed: for the relief of acute attacks, triptans are used as in migraine, the leader of prophylactic therapy is a calcium channel blocker verapamil. In chronic forms and attacks resistant to pharmacological treatment, neurostimulation methods are used.

scholarly journals Neurovascular mechanisms of migraine and cluster headache

2017 ◽  
Vol 39 (4) ◽  
pp. 573-594 ◽  
Author(s):  
Jan Hoffmann ◽  
Serapio M Baca ◽  
Simon Akerman
Keyword(s):  
Cluster Headache ◽  
Vascular Response ◽  
Trigeminovascular System ◽  
The Past ◽  
Anatomical Basis ◽  
Calcitonin Gene ◽  
Pituitary Adenylate Cyclase ◽  
Acute Attacks ◽  
Trigeminal Activation

Vascular theories of migraine and cluster headache have dominated for many years the pathobiological concept of these disorders. This view is supported by observations that trigeminal activation induces a vascular response and that several vasodilating molecules trigger acute attacks of migraine and cluster headache in susceptible individuals. Over the past 30 years, this rationale has been questioned as it became clear that the actions of some of these molecules, in particular, calcitonin gene-related peptide and pituitary adenylate cyclase-activating peptide, extend far beyond the vasoactive effects, as they possess the ability to modulate nociceptive neuronal activity in several key regions of the trigeminovascular system. These findings have shifted our understanding of these disorders to a primarily neuronal origin with the vascular manifestations being the consequence rather than the origin of trigeminal activation. Nevertheless, the neurovascular component, or coupling, seems to be far more complex than initially thought, being involved in several accompanying features. The review will discuss in detail the anatomical basis and the functional role of the neurovascular mechanisms relevant to migraine and cluster headache.

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

Cephalalgia ◽  
2017 ◽  
Vol 38 (7) ◽  
pp. 1276-1285 ◽  
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.

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.

scholarly journals Chronobiological features of primary headaches and the role of melatonin in the regulation of biological rhythms

2019 ◽  
pp. 33-38
Author(s):  
E. M. Evdokimova ◽  
M. G. Poluektov ◽  
G. R. Tabeyeva
Keyword(s):  
Circadian Rhythm ◽  
Cluster Headache ◽  
Suprachiasmatic Nucleus ◽  
Seasonal Pattern ◽  
Biological Rhythms ◽  
Primary Headaches ◽  
Melatonin Secretion ◽  
Clinical Observations

Frequency is considered as a key sign of the course of some forms of primary headaches (PH). One of the most prominent representatives is the hypnical and cluster headache, which predetermined their name. Clinical observations demonstrate a clear circadian rhythm and seasonal pattern of cluster headache (CH) and migraine (M) attacks. In accordance with modern concepts, the phenomenon of the periodicity of painful episodes of a number of forms of primary headaches is associated with dysfunction of the suprachiasmatic nucleus of the hypothalamus, the main pacemaker of biological rhythms. The connection of PH with chronopathology is confirmed by revealing the disturbances of melatonin secretion in CH and M. Melatonin has proven to be effective in treatment of these PH.

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