scholarly journals Perceptions, experiences, and understandings of cluster headache among GPs and neurologists: a qualitative study

2020 ◽  
Vol 70 (696) ◽  
pp. e514-e522
Author(s):  
Alina Buture ◽  
Fayyaz Ahmed ◽  
Yachna Mehta ◽  
Koen Paemeleire ◽  
Peter J Goadsby ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Thematic Analysis ◽  
Secondary Care ◽  
Primary Headache ◽  
Primary Headaches ◽  
Structured Interviews ◽  
Treatment Regimens ◽  
The North ◽  
Qualitative Interview Study ◽  
Headache Diagnosis

BackgroundCluster headache is a severe primary headache with a similar prevalence to that of multiple sclerosis. Cluster headache is characterised by unilateral trigeminal distribution of pain, ipsilateral cranial autonomic features, and a tendency to circadian and circannual periodicity.AimTo explore the perceptions, experiences, and understandings of cluster headache among GPs and neurologists.Design and settingQualitative interview study in primary care surgeries and neurology departments in the north of England.MethodSemi-structured interviews were conducted with GPs and neurologists, recorded, and transcribed. A thematic analysis was applied to the dataset.ResultsSixteen clinicians participated in this study: eight GPs and eight neurologists. Four main themes were identified following thematic analysis: challenges with the cluster headache diagnosis; impact of cluster headache; challenges with treatment; and appropriateness of referrals to secondary care. Clinicians recognised the delays in the diagnosis of cluster headache, misdiagnosis, and mismanagement, and were aware of the potential impact cluster headache can have on patients’ mental health and ability to remain in employment. Findings highlighted tensions between primary and secondary care around the cost of medication and the remit of prescribing treatment regimens. Patients’ anxiety, their need for reassurance, and their insistence about seeing a specialist are some of the reasons for referrals.ConclusionClinicians acknowledged delays in diagnosis, misdiagnosis, and mismanagement of cluster headache. The responsibility of prescribing causes ongoing tensions between primary and secondary care. Clear referral and management pathways for primary headaches are required to improve patient outcomes and healthcare costs.

Automatic diagnosis of primary headaches by machine learning methods

Open Medicine ◽  
2013 ◽  
Vol 8 (2) ◽  
pp. 157-165 ◽  
Author(s):  
Bartosz Krawczyk ◽  
Dragan Simić ◽  
Svetlana Simić ◽  
Michał Woźniak
Keyword(s):  
Machine Learning ◽  
Negative Impact ◽  
Life Quality ◽  
Primary Headache ◽  
Machine Learning Techniques ◽  
Future Research ◽  
Common Disease ◽  
Primary Headaches ◽  
Starting Point ◽  
Headache Diagnosis

AbstractPrimary headaches are common disease of the modern society and it has high negative impact on the productivity and the life quality of the affected person. Unfortunately, the precise diagnosis of the headache type is hard and usually imprecise, thus methods of headache diagnosis are still the focus of intense research. The paper introduces the problem of the primary headache diagnosis and presents its current taxonomy. The considered problem is simplified into the three class classification task which is solved using advanced machine learning techniques. Experiments, carried out on the large dataset collected by authors, confirmed that computer decision support systems can achieve high recognition accuracy and therefore be a useful tool in an everyday physician practice. This is the starting point for the future research on automation of the primary headache diagnosis.

Whiplash Headache is Transitory Worsening of a Pre-Existing Primary Headache

Cephalalgia ◽  
2008 ◽  
Vol 28 (1_suppl) ◽  
pp. 28-31 ◽  
Author(s):  
LJ Stovner ◽  
D Obelieniene
Keyword(s):  
Neck Pain ◽  
Primary Headache ◽  
Control Group ◽  
Primary Headaches ◽  
Headache Diagnosis ◽  
Police Records ◽  
Characteristic Features ◽  
Long Term Prognosis ◽  
Chronic Whiplash

Acute and chronic whiplash headache are new diagnostic entities in the ICHD-2 (5.3, 5.4). In a prospective cohort study, 210 rear-end collision victims were identified consecutively from police records and asked about head and neck pain in questionnaires after 2 weeks, 3 months and 1 year. The results were compared with those of matched controls who were also followed for 1 year. Of 210 accident victims, 75 developed headache within 7 days. Of these, 37 had also neck pain and complied with the criteria for acute whiplash headache. These 37 had the same headache diagnoses, headache features, accompanying symptoms and long-term prognosis as the 38 without initial neck pain who therefore did not comply with the acute whiplash headache diagnosis. Previous headache was a major risk factor for headache both in the acute and chronic stage. Compared with the non-traumatized controls, headache in the whiplash group had the same prevalence, the same diagnoses and characteristic features, and the same prognosis. Both acute and chronic whiplash headache lack specificity compared with the headache in a control group, and have the same long-term prognosis, indicating that such headaches are primary headaches, probably elicited by the stress of the situation.

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 Calcitonin Gene-Related Peptide (CGRP) and Cluster Headache

2020 ◽  
Vol 10 (1) ◽  
pp. 30 ◽  
Author(s):  
Andrea Carmine Belin ◽  
Caroline Ran ◽  
Lars Edvinsson
Keyword(s):  
Cluster Headache ◽  
Pain Perception ◽  
Primary Headache ◽  
Active Phase ◽  
Calcitonin Gene Related Peptide ◽  
Primary Headaches ◽  
Cgrp Receptor ◽  
Related Peptide ◽  
Calcitonin Gene ◽  
Autonomic Reflex

Cluster headache (CH) is a severe primary headache with a prevalence of 1/1000 individuals, and a predominance in men. Calcitonin gene-related peptide (CGRP) is a potent vasodilator, originating in trigeminal neurons and has a central role in CH pathophysiology. CGRP and the CGRP receptor complex have recently taken center stage as therapeutic targets for primary headaches, such as migraine. Multiple CGRP and CGRP receptor monoclonal antibodies, as well as small molecule antagonists (gepants) are on their way constituting a new frontier of migraine and possibly CH medication. During a CH attack, there is an activation of the trigeminal-autonomic reflex with the release of CGRP, and inversely if CGRP is administered to a CH patient in an active disease phase, it triggers an attack. Increased levels of CGRP have been found in ipsilateral jugular vein blood during the active phase of CH. This process is hypothesized to have a key role in the intense pain perception and in the associated distinctive vasodilation. So far, clinical tests of CGRP antibodies have been inconclusive in CH patients. This review summarizes the current state of knowledge on the role of CGRP in CH pathology, and as a target for future treatments.

scholarly journals Headache diagnosis in an urgency and emergency unit: Public Health Relevance and its relationship with cost

2021 ◽  
pp. 44-50
Author(s):  
Ligia Barros Oliveira ◽  
Jessica Guimarães ◽  
Danilo Jorge da Silva ◽  
Mauro Eduardo Jurno
Keyword(s):  
Public Health ◽  
Professional Training ◽  
Public Health Problem ◽  
Primary Headache ◽  
Observation Time ◽  
Primary Headaches ◽  
Common Symptom ◽  
Adequate Treatment ◽  
Secondary Headaches ◽  
Headache Diagnosis

BackgroundHeadache is a common symptom that affects a significant portion of the general population. It constitutes a challenge for diagnosis in urgency and emergency care services, due to headache’s clinical variability and diverse possible etiologies, besides the limited time and resources of these facilities. Because of this insufficiency and the potential severity associated with the condition, headaches generate considerable expenditures to health systems, related to both diagnostic discrimination and treatment.ObjectiveEvaluating the diagnostic resources used on headache patients care, as well as its Public Health Relevanceand relation to cost in an Emergency and Urgency Care unit.MethodsCross-section study analyzing 450 medical records of patients with headache complaints in the time frame from January 1, 2019, and December 31, 2019. Patients were categorized according to the type of headache (primary and secondary), specialized evaluation, complementary exams used in the diagnosis, hospital observation time, and the final expenditure in each patient’s care.ResultsThe total estimated expenditures related to headache care equaled US$90,855.60 (average US$201.90 per patient). 38.9% of cases corresponded to primary headaches and 31.1% to secondary headaches. 30% of cases could not be classified. The resources utilized for secondary headaches diagnosis differed significantly from those used in primary headache diagnosis. However, the final expenditures were similar to both groups.ConclusionThe socio-economic impact caused by headaches is unquestionable. It is a highly frequent symptom and both its etiological distinction and adequate treatment require solid evaluation. Due to the resources spent in its evaluation and monitoring, headaches can be considered a public health problem. Therefore, this study suggests that resources should be allocated in the health education and professional training for the proper conduction of these patients, so that they may benefit from an optimized treatment of theircondition without overwhelming the health system.

scholarly journals Evidence That HFE H63D Variant Is a Potential Disease Modifier in Cluster Headache

2021 ◽  
Author(s):  
Maria Papasavva ◽  
Michail Vikelis ◽  
Martha-Spyridoula Katsarou ◽  
Vasileios Siokas ◽  
Emmanouil Dermitzakis ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Iron Homeostasis ◽  
Hereditary Hemochromatosis ◽  
Primary Headache ◽  
Headache Disorder ◽  
Allelic Frequency ◽  
Primary Headaches ◽  
Primary Headache Disorder ◽  
Disease Modifier ◽  
Potential Link

AbstractCluster headache (CH) is a primary headache disorder with a complex genetic background. Several studies indicate a potential link between iron homeostasis and the pathophysiology of primary headaches. The HFE gene encodes for a protein involved in iron metabolism, while genetic variants in HFE have been associated with hereditary hemochromatosis (HH), an iron overload disorder. The objective of the current study was to examine the association of the more common HFE H63D variant, with the susceptibility to develop CH and diverse clinical phenotypes in a population of Southeastern European Caucasian (SEC) origin. Genomic DNA samples from 128 CH patients and 294 neurologically healthy controls were genotyped for the HFE rs1799945 (H63D) variant. H63D genotypic and allelic frequency distribution did not differ significantly between patients and controls (p > 0.05). Subgroup analysis revealed a significantly more frequent occurrence of the variant G allele in chronic compared to episodic CH patients, indicative for a possible correlation of the HFE gene with the susceptibility for disease chronification. Although homozygosity for the less prevalent H63D variant G allele was minimal in the CH cohort, the results of the present study are in accordance with previous studies in CH and migraine patients, suggesting that HFE H63D variant modifies the disease clinical characteristics. Hence, despite the absence of a per se association with CH susceptibility in the current SEC cohort, variability in HFE gene may be potentially regarded as a disease modifier genetic factor in CH.

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.

Cluster tic syndrome and other combinations of primary headaches with trigeminal neuralgia

2020 ◽  
pp. 208-212
Author(s):  
Leopoldine A. Wilbrink ◽  
Joost Haan ◽  
Juan A. Pareja
Keyword(s):  
Trigeminal Neuralgia ◽  
Cluster Headache ◽  
Case Reports ◽  
Primary Headache ◽  
Paroxysmal Hemicrania ◽  
Primary Headaches ◽  
Secondary Cluster

Cluster tic syndrome (cluster headache and trigeminal neuralgia) and other combined tic syndromes are very rare and heterogeneously described as case reports in the literature. Three types of cluster tic syndromes can be distinguished: (i) simultaneously occurring trigeminal neuralgia and cluster headache according to the ICHD-2 criteria (most frequent); (2) attacks not fulfilling criteria for either cluster headache or trigeminal neuralgia but having features of both; (iii) secondary cluster tic syndrome. Trigeminal neuralgia can also co-occur with paroxysmal hemicrania (paroxysmal hemicrania tic) and with SUNCT. In case of co-occurrence of two primary headache syndromes, a combination of separate treatments aimed at the two headache syndromes is recommended. The pathophysiology of the tic combination syndromes is unknown.

scholarly journals Osmophobia in primary headache patients: associated symptoms and response to preventive treatments

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Marianna Delussi ◽  
Anna Laporta ◽  
Ilaria Fraccalvieri ◽  
Marina de Tommaso
Keyword(s):  
Cluster Headache ◽  
Rating Scale ◽  
Preventive Treatment ◽  
Primary Headache ◽  
Tension Type Headache ◽  
Primary Headaches ◽  
Self Rating ◽  
Type Headache ◽  
Headache Center ◽  
Headache Patients

Abstract Background Osmophobia, is common among primary headaches, with prevalence of migraine. The study aimed to evaluate prevalence and clinical characteristics of patients with osmophobia in a cohort of primary headache patients selected at a tertiary headache center. The second aim was to verify the possible predicting role of osmophobia in preventive treatment response in a sub cohort of migraine patients. Methods This was an observational retrospective cohort study based on data collected in a tertiary headache center. We selected patients aged 18–65 years, diagnosed as migraine without aura (MO), migraine with aura (MA) or Chronic Migraine (CM), Tension-Type Headache (TTH); and Cluster Headache (CH). We also selected a sub-cohort of migraine patients who were prescribed preventive treatment, according to Italian Guidelines, visited after 3 months follow up. Patients were considered osmophobic, if reported this symptom in at least the 20% of headache episodes. Other considered variables were: headache frequeny, the migraine disability assessment (MIDAS), Allodynia Symptom Checklist, Self-rating Depression scale, Self-rating Anxiety scale, Pain intensity evaluated by Numerical Rating Scale-NRS- form 0 to 10. Results The 37,9% of patients reported osmophobia (444 patients with osmophobia, 726 without osmophobia). Osmophobia prevailed in patients with the different migraine subtypes, and was absent in patients with episodic tension type headache and cluster headache (chi square 68.7 DF 7 p < 0.0001). Headache patients with osmophobia, presented with longer hedache duration (F 4.91 p 0.027; more severe anxiety (F 7.56 0.007), depression (F 5.3 p 0.019), allodynia (F 6 p 0.014), headache intensity (F 8.67 p 0.003). Tension type headache patients with osmophobia (n° 21), presented with more frequent headache and anxiety. A total of 711 migraine patients was visited after 3 months treatment. The change of main migraine features was similar between patients with and without osmophobia. Conclusions While the present study confirmed prevalence of osmophobia in migraine patients, it also indicated its presence among chronic tension type headache cases, marking those with chronic headache and anxiety. Osmophobia was associated to symptoms of central sensitization, as allodynia. It was not relevant to predict migraine evolution after first line preventive approach.

Suicide in primary headaches in 48 countries: A physician-survey based study

Cephalalgia ◽  
2017 ◽  
Vol 38 (4) ◽  
pp. 798-803 ◽  
Author(s):  
Jose Maria Trejo-Gabriel-Galan ◽  
Irene Aicua-Rapún ◽  
Esther Cubo-Delgado ◽  
Carmen Velasco-Bernal
Keyword(s):  
Cluster Headache ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Primary Headache ◽  
Primary Headaches ◽  
Psychiatric History ◽  
Physician Survey ◽  
Aggressive Treatment ◽  
Face To Face ◽  
The Relationship

Aim To investigate the relationship between primary headache types and accomplished or attempted suicide in countries from all world regions. Methods Data were obtained using a questionnaire about suicide due to headache in a face-to-face interview with 203 physicians with expertise in headaches. They came from 48 countries, and from all continents. Results Primary headaches cause one suicide per 1,000,000 population each year (1% of the suicide rate due to all causes). Cluster headache and migraines account for 70–80% of them. Suicide attempts are 10 times more frequent than accomplished suicides. Cluster headache poses more risk than migraine. This risk is not often acknowledged, and is increased if there is previous psychiatric history. More than half of the physicians interviewed think it could be reduced with a more aggressive treatment of headaches. Conclusions Cluster headache and migraine are not always benign, and are the cause of the majority of suicides due to headache.

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