Headache from clinically confirmed hemicrania continua arising from the sternocleidomastoid muscle: a case report

Background A patient with a history of cluster headaches, now in remission, presented with confirmed hemicrania continua that resolved with a local anaesthetic injection into the Sternocleidomastoid (SCM) muscle. To the best of our knowledge, this is the first reported case of a trigeminal autonomic cephalalgia arising from a soft tissue source in the neck. Case presentation A 66-year-old man with a history of cluster headaches presented with a six-month history of a new constant right-sided headache. The new headaches were associated with tearing and redness of the right eye and responded to indomethacin, thus meeting the International Classification of Headache Disorders (ICHD-3) diagnostic criteria for hemicrania continua. The history and physical examination suggested a cervical source of the headache arising from the ipsilateral SCM muscle. Injection of the muscle with 1% lidocaine resulted in the elimination of the pain for 1 month without indomethacin. Conclusions Due to the convergence of trigeminal, cervical and autonomic nerve fibres, various combinations of headache syndromes can result. This case report demonstrates how a meticulous examination is a crucial component of headache evaluation. Treatment directed to this muscle spared this patient further daily indomethacin and associated side effects.

OUTCOME OF OCCIPITAL NERVE BLOCK IN PATIENTS WITH CHRONIC HEADACHES

Background: Chronic headaches are very prevalent affecting a sizable number of global populations. Occipital nerve block (OCN) can help them relieve their pain and get back to their normal life. Conditions that are treated with occipital nerve blocks include: Chronic migraine, Episodic migraine, Chronic cluster headaches, Episodic cluster headaches, Tension-type headaches, Occipital neuralgia. These may include types of pain that start at the back of the head near the neck, and then radiate outward throughout the skull. Occipital nerve block is a minimally invasive intervention, inhibits or blocks the disproportionate or chronic signals that are sent to the brain, processed and perceived as headache pain, resulting in pain relief lasting up to several months. It is our humble approach to see the effectiveness of this mode of minimal intervention. Objectives: The aim was to see the effectiveness of Occipital Nerve Block in patients of Chronic headaches. Place of study: Dept of PMR, IPGME & R and SSKM Hospital, Kolkata Period of study: 1 st. September, 2017 to 31 st. August, 2018. (12 months) Study pattern: Prospective Longitudinal Outcome Study Methods: After getting Institutional Ethical Committee clearance a total number of 98 patients with Chronic headaches who did not respond with conservative management were included. Patients with other causes of headache, patients with diabetes, severe hypertension, otherwise th th th contraindicated for injections, are excluded. Occipital nerve blocks performed to patients and were evaluated initially and at the 4 , 8 , and 12 week followed up using Numeric Pain Rating Scale (NPRS). Adverse events and patient satisfaction were recorded, number of attacks pre 4wks and after intervention. Results: Statistically signicant improvement is seen in these patients treated with Occipital Nerve Block Conclusions: Occipital Nerve Block effective mode of management in patients with Chronic headaches and may be recommended to patients with moderate to severe chronic pain that has not responded to conventional treatment such as oral painkillers or lifestyle interventions.

THE EFFECT OF AEROBIC EXERCISES ON PAIN, QUALITY OF LIFE IN PRIMARY HEADACHE

Headache disorders are among the most common disorders of the nervous system. According to World Health Organisation reports that almost half of all adults worldwide experience a headache in any given year. Based on research, headaches are classified into primary and secondary headaches. Depending on global prevalence the most common primary headaches are migraine, tension-type, and cluster headaches. If left untreated it can result in increased pain, decreased quality of life. The objective of this literature article is to analyze the effect of aerobic exercise on pain and quality of life among subjects with primary headaches like migraine, tension-type, and cluster headache and to discuss the current updates in the literature. In this article, relevant data available in PubMed, Cochrane, and Medline databases were retrieved from 2010 to February 2020 using the search terms aerobic exercise and tension-type headaches, aerobic exercise and migraine, aerobic exercise and cluster headaches, pain, and quality of life. The search strategy identified five articles that considered the effect of aerobic exercise on primary headaches like a migraine; tension-type and cluster. Results have positive effects for aerobic exercise on tension-type headache, migraine headache mainly on pain intensity, whereas the quality of life is less studied. On the other hand, these studies did not provide a specific protocol or parameter on exercise intensities. The availability of data on the influence of aerobic exercise on primary headaches though is limited, aerobic exercises are the best option for reducing pain and improving quality of life in primary headaches, especially for tension-type and migraine-type headaches.

Understanding the enigma of cluster headaches

Cluster headache is one of the most painful disorders and one of the most enigmatic. Why the condition is intimately associated with sleep remains unclear, for instance. Most cluster headache patients are managed inadequately, although recent insights into the condition's biological basis have identified potential targets for innovative treatments. Meanwhile, a new study provides long-awaited evidence supporting the use of oral steroids. Mark Greener elaborates.

A rare pediatric case of cluster headaches after cardiac catheterization in a patient with an isolated innominate artery

While cluster headaches are classified and considered a primary headache disorder, secondary causes of cluster headaches have been reported and may provide insight into cluster headaches’ potential pathophysiology. The mechanisms underlying this headache phenotype are poorly understood, and several theories have been proposed that range from the activation within the posterior hypothalamus to autonomic tone dysfunction. We provide a review of reported cases in the literature describing secondary causes after cardiac procedures. We will present a novel pediatric case report of a 16-year-old boy with an isolated innominate artery who presented with acute new-onset headaches 8 h following cardiac catheterization of the aortic arch with arteriography and left pulmonary artery stent placement. The headaches were characterized by attacks of excruciating pain behind the left eye and jaw associated with ipsilateral photophobia, conjunctival injection, rhinorrhea, with severe agitation and restlessness. These met the International Classification of Headache Disorders-3 criteria for episodic cluster headaches. The headaches failed to respond to non-steroidal anti-inflammatory medications, dopamine antagonists, and steroids. He showed an immediate response to treatment with oxygen. This unique case of cluster headaches following cardiac catheterization in a pediatric patient with an isolated innominate artery may provide new insight into cluster headaches’ pathogenesis. We hypothesize that the cardiac catheterization induced cardiac autonomic changes that contributed to the development of his cluster headaches. The role of aortic arch anomalies and procedures in potential disruption of the autonomic tone and the causation of cluster headaches is an area requiring further study.

Trigeminocardiac Reflex Induced by Maxillary Nerve Stimulation during Sphenopalatine Ganglion Implantation: A Case Series

Background: The trigeminocardiac reflex (TCR) is a brainstem reflex following stimulation of the trigeminal nerve, resulting in bradycardia, asystole and hypotension. It has been described in maxillofacial and craniofacial surgeries. This case series highlights TCR events occurring during sphenopalatine ganglion (SPJ) neurostimulator implantation as part of the Pathway CH-2 clinical trial “Sphenopalatine ganglion Stimulation for Treatment of Chronic Cluster Headache”. Methods: This is a case series discussing sphenopalatine ganglion neurostimulator implantation in the pterygopalatine fossa as treatment for intractable cluster headaches. Eight cases are discussed with three demonstrating TCR events. All cases received remifentanil and desflurane for anesthetic maintenance. Results: Each patient with a TCR event experienced severe bradycardia. In two cases, TCR resolved with removal of the introducer, while the third case’s TCR event resolved with both anticholinergic treatment and surgical stimulation cessation. Conclusion: Each TCR event occurred before stimulation of the fixed introducer device, suggesting the cause for the TCR events was mechanical in origin. Due to heightened concern for further TCR events, all subsequent cases had pre-anesthesia external pacing pads placed. Resolution can occur with cessation of surgical manipulation and/or anticholinergic treatment. Management of TCR events requires communication between surgical teams and anesthesia providers, especially during sphenopalatine ganglion implantation when maxillary nerve stimulation is possible.