scholarly journals A case of cranial autonomic dysfunctions predominant migraine: Migraine sans ache

2021 ◽  
pp. 383-385
Author(s):  
Amit Shankar Singh ◽  
Jeenendra Prakash Singhvi ◽  
Harpreet Singh Mann
Keyword(s):  
Trigeminal Nerve ◽  
Migraine Treatment ◽  
Trigeminal Autonomic Cephalalgias ◽  
Afferent Loop ◽  
Autonomic Symptoms ◽  
Direct Activation ◽  
Migraine Headaches ◽  
Cranial Autonomic Symptoms ◽  
Autonomic Dysfunctions

Pain is the essential part of migraine headaches along with other features, whereas, cranial autonomic symptoms (CAS)/signs are a predominant and essential part of trigeminal autonomic cephalalgias. What if other features of migraine are present but the pain is absent? One such variation in migraine symptomatology is reported in this case, where the pain was not there but CAS/signs were predominant along with other features of migraine. The possible mechanism for such variation, in this case, maybe desensitization of afferent loop (comprised by nociceptors in extracranial and intracranial pain-sensitive structures supplied by the trigeminal nerve) and direct activation of the trigemino-cervical complex and brainstem structures causing dissociation of pain from the rest of the features of migraine. In this case, as the pain part gets completely dissociated from CAS/signs, hence this condition can be termed as “migraine sans ache.” The patient was started on anti-migraine treatment and she responded wonderfully

Unilateral Cranial Autonomic Symptoms in Migraine

Cephalalgia ◽  
2002 ◽  
Vol 22 (4) ◽  
pp. 256-259 ◽  
Author(s):  
P Barbanti ◽  
G Fabbrini ◽  
M Pesare ◽  
N Vanacore ◽  
R Cerbo
Keyword(s):  
Large Scale ◽  
Nasal Congestion ◽  
Migraine Treatment ◽  
Conjunctival Injection ◽  
Autonomic Symptoms ◽  
Therapeutic Implications ◽  
Ocular Symptoms ◽  
Cranial Autonomic Symptoms ◽  
Nasal Symptoms ◽  
Autonomic Reflex

Unilateral cranial autonomic symptoms (UAs) such as lacrimation, conjunctival injection, eyelid oedema and nasal congestion, which are the hallmark of trigeminal autonomic cephalgias, may also occur in an as yet undetermined proportion of migraine patients. We studied 177 consecutive migraineurs to assess the frequency of UAs and the clinical characteristics of such patients. UAs were reported by 81 patients (45.8%), ocular symptoms alone or in combination with nasal symptoms being the most frequent. The headache was more severe ( P< 0.0002) and more strictly unilateral ( P< 0.0004) in patients who reported UAs than in those without. Thus, the presence of UAs suggests an activation of the trigeminal-autonomic reflex, probably related to an over-activation of the trigeminal afferent arm. These findings could have therapeutic implications, given the potential large-scale recruitment of peripheral neurovascular 5-HT1B/1D receptors (the target of acute migraine treatment) in such patients.

Familial SUNCT in mother and son

Cephalalgia ◽  
2016 ◽  
Vol 36 (10) ◽  
pp. 993-997 ◽  
Author(s):  
Isabel Pavão Martins ◽  
Pedro Viana ◽  
Patricia Pita Lobo
Keyword(s):  
Trigeminal Nerve ◽  
Case Reports ◽  
Heterogeneous Group ◽  
Familial Case ◽  
Trigeminal Autonomic Cephalalgias ◽  
Conjunctival Injection ◽  
Historical Account ◽  
Autonomic Symptoms ◽  
Genetic Nature

Background Trigeminal autonomic cephalalgias comprise a heterogeneous group of lateralized headaches associated with ipsilateral autonomic symptoms. They are usually localized within the territory of one or more rami of the trigeminal nerve, but may be localized outside its cutaneous territory. Although these headaches are considered primary disorders, the evidence supporting their genetic nature is lacking, particularly concerning their neuralgic forms, with the exception of a familial case described partly based on a historical account. Case reports We report on a mother and son with episodic, short-lasting, intense, paroxysmal headaches, with the same localization in the left retroauricular region, associated with prominent conjunctival injection and tearing, which are consistent with the diagnosis of SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing). Discussion These cases corroborate the existence of hereditary forms of this disorder, thus supporting its primary nature.

scholarly journals Termination of SUNCT with intravenous lignocaine followed by oral mexiletine

2018 ◽  
Vol 1 ◽  
pp. 251581631876882
Author(s):  
Eoin Mulroy ◽  
Oliver Armstrong-Scott ◽  
Peter Bergin
Keyword(s):  
Side Effects ◽  
Trigeminal Nerve ◽  
Facial Pain ◽  
Trigeminal Autonomic Cephalalgias ◽  
Conjunctival Injection ◽  
Autonomic Symptoms ◽  
First Report ◽  
Successful Transition

Background: The trigeminal autonomic cephalalgias (TACs) are a group of debilitating, pathophysiologically similar headache syndromes characterized by facial pain and autonomic symptoms in areas supplied by the trigeminal nerve. Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) is among the rarest of the TAC syndromes and can be particularly recalcitrant to treatment. Case: We describe the case of a 50-year old woman with difficult-to-control SUNCT whose pain was completely aborted within hours of commencing intravenous lignocaine therapy and was maintained pain-free after transitioning to oral mexiletine. Conclusion: This is the first report of successful transition from intravenous lignocaine to oral mexiletine in SUNCT, and we suggest that this treatment should be tried early in difficult-to-control SUNCT. This therapy is safe, effective and with minimal side effects if administered in an appropriate manner.

Post-Traumatic Short-Lasting Unilateral Headache With Cranial Autonomic Symptoms (SUNA)

Cephalalgia ◽  
2008 ◽  
Vol 28 (9) ◽  
pp. 991-993 ◽  
Author(s):  
S Jacob ◽  
AR Saha ◽  
YA Rajabally
Keyword(s):  
Head Injury ◽  
International Headache Society ◽  
Trigeminal Autonomic Cephalalgias ◽  
Conjunctival Injection ◽  
Traumatic Head Injury ◽  
Autonomic Symptoms ◽  
Cranial Autonomic Symptoms ◽  
Unilateral Headache ◽  
Traumatic Head ◽  
Post Traumatic

Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome is a rare headache syndrome classified among the trigeminal autonomic cephalalgias. It is usually idiopathic, although infrequent secondary forms have been described. Recently the term short-lasting unilateral headache with cranial autonomic symptoms (SUNA) has been defined by the International Headache Society (ICHD-2) as similar to SUNCT with less prominent or absent conjunctival injection and lacrimation. We report two patients with paroxysmal orbito-fronto-temporal pains, phenotypically suggesting SUNA, occurring after traumatic head injury.

scholarly journals Comparison of efficacy and safety of three drugs levetiracetam, sodium valproate, and nortriptyline in the prevention of migraine headache

2020 ◽  
pp. 336-343
Keyword(s):  
Sodium Valproate ◽  
Severe Headache ◽  
Migraine Treatment ◽  
Chi Square ◽  
Migraine Headaches ◽  
Neurology Clinic ◽  
Quasi Experimental ◽  
The Mean ◽  
Acute Attacks ◽  
Mild Headache

Background and Aim: Headache is the most common cause of referral to a physician. Two approaches of the migraine treatment include: treat the acute attacks and prevent future attacks. In this regard, the aim of this study was to investigate the effect of three drugs lutiracetam, sodium valproate and nortriptyline in the control of migraine headaches in patients with migraine in Birjand Neurology Clinic. Materials and Methods: This study is a quasi-experimental study. According to the physician, 120 migraine patients were divided into one of three groups: Lutiracetam with a daily dose of 250 mg, sodium valproate 500 mg and nortriptyline 25 mg for 4 weeks. Patientschr('39') information was collected through a questionnaire. Then the data were analyzed by SPSS) Version 16) software by using chi-square, paired t-test, and ANOVA. Results: 120 patients were divided into three groups of 40 patients. The mean age of the subjects was 33±11 years, 53.3% of them were female and 46.7% of them were male. In total, 46.7% of patients had severe headache before taking these three drugs. None of them had severe headache after taking the drug and 77.5% of them had mild headache. Lutiracetam group showed the greatest decrease in headache intensity. (P=0.01). Conclusion: Levetiracetam appears to be more effective than the other two drugs, especially sodium valproate, in reducing different degrees of headache.

scholarly journals Clinical Features of Cluster Headache without Cranial Autonomic Symptoms: Results from a Prospective multicentre study

2020 ◽  
Author(s):  
Min Kyung Chu ◽  
Byung-Su Kim ◽  
Pil-Wook Chung ◽  
Byung-Kun Kim ◽  
Mi Ji Lee ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Clinical Features ◽  
Rating Scale ◽  
Significant Proportion ◽  
Numeric Rating Scale ◽  
Autonomic Symptoms ◽  
General Anxiety Disorder ◽  
General Anxiety ◽  
Headache Intensity ◽  
Cranial Autonomic Symptoms

Abstract Background: Although cranial autonomic symptoms are typical in cluster headache, some individuals with cluster headache show no cranial autonomic symptoms during their headache attacks. Probable cluster headache is a subtype of cluster headache that fulfils all but one of the five criteria for cluster headache. This study aimed to investigate the frequency and clinical features of cluster headache and probable cluster headache without cranial autonomic symptoms in comparison to those with cranial autonomic symptoms.Methods: We analysed data from the Korea Cluster Headache Registry, a prospective multicentre registry involving data from 16 hospitals.Results: Of the 216 participants with cluster headache and 26 with probable cluster headache, 19 (8.8%) and 7 (26.9%), respectively, did not have cranial autonomic symptoms. Participants with cluster headache without cranial autonomic symptoms exhibited less severe anxiety (General Anxiety Disorder-7 score, median [interquartile range], 2.0 [1.0-6.0] vs 8.0 [3.0-12.0], p = 0.001) and depression (Patient Health Questionnaire-9 score, 3.0 [1.0-7.0] vs 7.0 [3.0-11.0], p = 0.042) than those with cranial autonomic symptoms. Other clinical features, including headache intensity, daily headache frequency, attack duration, bout duration, and location of the pain, did not differ between participants with cluster headache with and without cranial autonomic symptoms. Headache intensity was less severe in participants with probable cluster headache without cranial autonomic symptoms than in those with cranial autonomic symptoms (numeric rating scale, 8.0 [7.0-8.0] vs 9.5 [8.0-10.0], p = 0.015).Conclusions: A significant proportion of participants with cluster headache and probable cluster headache did not have cranial autonomic symptoms. Some clinical features of cluster headache and probable cluster headache differed based on the presence of cranial autonomic symptoms.

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