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Cluster headache research:- Recent research publications"Recent cluster headache research publications are scanned daily from major neurology journals and updated here"
"Recent cluster headache research publications are scanned daily from major neurology journals and updated here" December 2007 archive:- A computed tomography scan and anatomical cadaveric study of the pterygopalatine ganglion for use in Gamma Knife treatment of cluster headache. Related Articles
A computed tomography scan and anatomical cadaveric study of the pterygopalatine ganglion for use in Gamma Knife treatment of cluster headache.
J Neurosurg. 2007 Oct;107(4):805-8
Cluster headache research Authors: Alvernia JE, Spomar DG, Olivero WC
OBJECT: Gamma Knife surgery has recently been used to treat patients with cluster headaches. Both the trigeminal nerve root and the pterygopalatine ganglion (PPG) have been targeted. However, there are no clear-cut anatomical landmarks on computed tomography (CT) scans or magnetic resonance images that accurately identify the PPG. Therefore, the Cluster headache research Authors performed microsurgical dissections on latex-injected cadaver heads to expose the PPG and correlated the findings with thin-slice axial CT scans obtained in the same heads to determine how best to target the PPG. METHODS: Three cadaver heads (five sides) previously injected with colored latex were dissected using skull base approaches and microsurgical techniques to identify the PPG and surrounding structures. Measurements were then made to different osseous anatomical landmarks such as the foramen rotundum, vidian canal, and so on. The PPG was marked with a radiopaque marker and thin-slice CT scans were obtained in the cadaver heads to develop some correlates that could be used to identify where the PPG is located on CT scans. RESULTS: The PPG was clearly identified in all specimens and had a mean diameter of 3.58 +/- 0.6 mm. The PPG was always located in the same plane (lateral and vertical) as the vidian canal and was located on average 2.7 +/- 0.3 mm from the end of the canal. The vidian canal was clearly identified on coronal CT scans and had a diameter of 3.05 mm. CONCLUSIONS: There was a clear and constant relationship between the PPG and vidian canal. The vidian canal is easily identified on coronal CT scans and can be used as a landmark to target the PPG with the Gamma Knife.
Cluster headache research PMID: 17937227 [PubMed - indexed for MEDLINE]Zolmitriptan nasal spray in the acute treatment of cluster headache: a double-blind study. Related Articles
Zolmitriptan nasal spray in the acute treatment of cluster headache: a double-blind study.
Neurology. 2007 Aug 28;69(9):821-6
Cluster headache research Authors: Rapoport AM, Mathew NT, Silberstein SD, Dodick D, Tepper SJ, Sheftell FD, Bigal ME
OBJECTIVE: To evaluate the efficacy and tolerability of zolmitriptan 5 mg and 10 mg nasal spray (ZNS) vs placebo in the acute treatment of cluster headache. Design/ METHODS: We conducted a multicenter, double-blind, randomized, three-period crossover study using ZNS 5 mg, ZNS 10 mg, and placebo. Headache intensity was rated by a 5-point scale: none, mild, moderate, severe, or very severe. The primary efficacy measure was headache response (pain reduced from moderate, severe, or very severe at baseline, to mild or none) at 30 minutes. Logistic regression was used to account for treatment period effect as well as for cluster headache subtype effect. RESULTS: A total of 52 adult patients treated 151 attacks. For the primary endpoint, both doses reached significance at 30 minutes (placebo = 30%, ZNS 5 mg = 50%, ZNS 10 mg = 63.3%). For headache relief, ZNS 10 mg separated from placebo at 10 minutes (24.5% vs 10%). Zolmitriptan 5 mg separated from placebo at 20 minutes (38.5% vs 20%). For pain-free status, ZNS 10 mg was superior to placebo at 15 minutes (22.0% vs 6%). Both doses had higher pain-free rates than placebo at 30 minutes (placebo = 20%, ZNS 5 mg = 38.5%, ZNS 10 mg = 46.9%). Side effects were mild and seen in 16% of those attacks treated with placebo, 25% of attacks treated with ZNS 5 mg, and 32.7% treated with ZNS 10 mg. Conclusions/Relevance: Zolmitriptan nasal spray, at doses of 5 and 10 mg, is effective and tolerable for the acute treatment of cluster headache.
Cluster headache research PMID: 17724283 [PubMed - indexed for MEDLINE]Electrocardiographic abnormalities in patients with cluster headache on verapamil therapy. Related Articles
Electrocardiographic abnormalities in patients with cluster headache on verapamil therapy.
Neurology. 2007 Aug 14;69(7):668-75
Cluster headache research Authors: Cohen AS, Matharu MS, Goadsby PJ
BACKGROUND: High dose verapamil is an increasingly common preventive treatment in cluster headache (CH). Side effects include atrioventricular block and bradycardia, although their incidence in this population is not clear. METHOD: This audit study assessed the incidence of arrhythmias on high dose verapamil in patients with cluster headache. RESULTS: Of three hundred sixty-nine patients with cluster headache, 217 outpatients (175 men) received verapamil, starting at 240 mg daily and increasing by 80 mg every 2 weeks with a check electrocardiogram (EKG), until the CH was suppressed, side effects intervened, or to a maximum daily dose of 960 mg. One patient had 1,200 mg/day. Eighty-nine patients (41%) had no EKGs. One hundred eight had EKGs in the hospital notes, and a further 20 had EKGs done elsewhere. Twenty-one of 108 patients (19%) had arrhythmias. Thirteen (12%) had first-degree heart block (PR > 0.2 s), at 240 to 960 mg/day, with one requiring a permanent pacemaker. Four patients had junctional rhythm, and one had second-degree heart block. Four patients had right bundle branch block. There was bradycardia (HR < 60 bpm) in 39 patients (36%), but verapamil was stopped in only 4 patients. In eight patients the PR interval was lengthened, but not to >0.2 s. The incidence of arrhythmias on verapamil in this patient group is 19%, and bradycardia 36%. CONCLUSION: We therefore strongly recommend EKG monitoring in all patients with cluster headache on verapamil, to observe for the potential development of atrioventricular block and symptomatic bradycardia.
Cluster headache research PMID: 17698788 [PubMed - indexed for MEDLINE]Chronic stimulation of the posterior hypothalamic region for cluster headache: technique and 1-year results in four patients. Related Articles
Chronic stimulation of the posterior hypothalamic region for cluster headache: technique and 1-year results in four patients.
J Neurosurg. 2007 Jun;106(6):999-1005
Cluster headache research Authors: Starr PA, Barbaro NM, Raskin NH, Ostrem JL
OBJECT: Cluster headache (CH) is the most severe of the primary headache disorders. Based on the finding that regional cerebral blood flow is increased in the ipsilateral posterior hypothalamic region during a CH attack, a novel neurosurgical procedure for CH was recently introduced: hypothalamic deep brain stimulation (DBS). Two small case series have been described. Here, the Cluster headache research Authors report their technical approach, intraoperative physiological observations, and 1-year outcomes after hypothalamic DBS in four patients with medically intractable CHs. METHODS: Patients underwent unilateral magnetic resonance (MR) imaging-guided stereotactic implantation of a Medtronic DBS (model 3387) lead and Soletra pulse generator system. Intended tip coordinates were 3 mm posterior, 5 mm inferior, and 2 mm lateral to the midcommissural point. Microelectrode recording and intraoperative test stimulation were performed. Lead locations were measured on postoperative MR images. The intensity, frequency, and severity of headaches throughout a 1-week period were tracked in patient diaries immediately prior to surgery and after 1 year of continuous stimulation. At the I-year follow-up examination, DBS had produced a greater than 50% reduction in headache intensity or frequency in two of four cases. Active contacts were located 3 to 6 mm posterior to the mammillothalamic tract. Neurons in the target region showed low-frequency tonic discharge. CONCLUSIONS: In two previously published case series, headache relief was obtained in many but not all patients. The results of these open-label studies justify a larger, prospective trial but do not yet justify widespread clinical application of this technique.
Cluster headache research PMID: 17564171 [PubMed - indexed for MEDLINE]Treatment of medically intractable cluster headache by occipital nerve stimulation: long-term follow-up of eight patients. Related Articles
Treatment of medically intractable cluster headache by occipital nerve stimulation: long-term follow-up of eight patients.
Lancet. 2007 Mar 31;369(9567):1099-106
Cluster headache research Authors: Burns B, Watkins L, Goadsby PJ
BACKGROUND: Cluster headache is a form of primary headache that features repeated attacks of excruciatingly severe headache usually occurring several times a day. Patients with chronic cluster headache have unremitting illness that necessitates daily preventive medical treatment for years. When medically intractable, the condition has previously been treatable only with cranially invasive or neurally destructive methods. METHODS: Eight patients with medically intractable chronic cluster headache were implanted in the suboccipital region with electrodes for occipital nerve stimulation. Other than the first patient, who was initially stimulated unilaterally before being stimulated bilaterally, all patients were stimulated bilaterally during treatment. FINDINGS: At a median follow-up of 20 months (range 6-27 months for bilateral stimulation), six of eight patients reported responses that were sufficiently meaningful for them to recommend the treatment to similarly affected patients with chronic cluster headache. Two patients noticed a substantial improvement (90% and 95%) in their attacks; three patients noticed a moderate improvement (40%, 60%, and 20-80%) and one reported mild improvement (25%). Improvements occurred in both frequency and severity of attacks. These changes took place over weeks or months, although attacks returned in days when the device malfunctioned (eg, with battery depletion). Adverse events of concern were lead migrations in one patient and battery depletion requiring replacement in four. INTERPRETATION: Occipital nerve stimulation in cluster headache seems to offer a safe, effective treatment option that could begin a new era of neurostimulation therapy for primary headache syndromes.
Cluster headache research PMID: 17398309 [PubMed - indexed for MEDLINE]Occipital nerve stimulation for intractable cluster headache.
Occipital nerve stimulation for intractable cluster headache.
Lancet. 2007 Mar 31;369(9567):1063-5
Cluster headache research Authors: Ambrosini A
Cluster headache research PMID: 17398291 [PubMed - indexed for MEDLINE]G protein beta3 polymorphism and triptan response in cluster headache. Related Articles
G protein beta3 polymorphism and triptan response in cluster headache.
Clin Pharmacol Ther. 2007 Oct;82(4):396-401
Cluster headache research Authors: Schürks M, Kurth T, Stude P, Rimmbach C, de Jesus J, Jonjic M, Diener HC, Rosskopf D
Only about 70% of migraine and cluster headache (CH) patients report significant treatment responses to triptans, which are agonists at 5-HT(1B/D) receptors belonging to the family of G protein-coupled receptors. We analyzed whether a common polymorphism in the gene for the G protein beta3 subunit (GNB3 C825T) modulates responder rates to triptans among a cohort of 231 unrelated Caucasian CH patients. A total of 180 CH patients used triptans, of whom 71.1% reported treatment success. The adjusted odds ratio for treatment response to triptans for heterozygous carriers of the GNB3 825T allele was 2.96 (95% confidence interval 1.34-6.56; P=0.0074) vs carriers of the 825CC genotype. The GNB3 genotype status did not affect responses to other acute and preventive therapeutic regimes including oxygen, verapamil, and corticosteroids, i.e., drugs not directly affecting G proteins. We conclude that pain relief by triptans is significantly modulated by a common genetic GNB3 variant.
Cluster headache research PMID: 17361120 [PubMed - indexed for MEDLINE]Trigeminal autonomic cephalgias due to structural lesions: a review of 31 cases. Related Articles
Trigeminal autonomic cephalgias due to structural lesions: a review of 31 cases.
Arch Neurol. 2007 Jan;64(1):25-31
Cluster headache research Authors: Favier I, van Vliet JA, Roon KI, Witteveen RJ, Verschuuren JJ, Ferrari MD, Haan J
Trigeminal autonomic cephalgias (TACs) include cluster headache, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache with conjunctival injection and tearing. Associated structural lesions may be found, but a causal relationship is often difficult to establish. We sought to identify clinical predictors of underlying structural abnormalities by reviewing previously described and new TAC and TAC-like cases associated with a structural lesion. We found that even typical TACs can be caused by an underlying lesion. Clinical warning signs and symptoms are relatively rare. We recommend neuroimaging in all patients with a TAC or TAC-like syndrome.
Cluster headache research PMID: 17210806 [PubMed - indexed for MEDLINE]Objective assessment of bilateral conjunctival injection during cluster headache attacks. Related Articles
Objective assessment of bilateral conjunctival injection during cluster headache attacks.
Neurology. 2007 Jan 2;68(1):75-6
Cluster headache research Authors: Barón M, Gili P, Sánchez-Del-Río M, Barriga FJ, Yangüela J, Vela L, Sánchez C, Dobato JL, Pardo FJ, Pareja JA
Cluster headache research PMID: 17200498 [PubMed - indexed for MEDLINE]Acute hypothalamic stimulation and ongoing cluster headache attacks. Related Articles
Acute hypothalamic stimulation and ongoing cluster headache attacks.
Neurology. 2006 Nov 28;67(10):1844-5
Cluster headache research Authors: Leone M, Franzini A, Broggi G, Mea E, Cecchini AP, Bussone G
Long-term hypothalamic stimulation is effective in improving drug-resistant chronic cluster headache (CH). We assessed acute hypothalamic stimulation to resolve ongoing CH attacks in 16 patients implanted to prevent chronic CH, investigating 136 attacks. A pain intensity reduction of > or =50% occurred in 25 of 108 evaluable attacks (23.1%). Acute hypothalamic stimulation is not effective in resolving ongoing CH attacks, suggesting that hypothalamic stimulation acts by complex mechanisms in CH prevention.
Cluster headache research PMID: 17130420 [PubMed - indexed for MEDLINE]Does this patient with headache have a migraine or need neuroimaging? Related Articles
Does this patient with headache have a migraine or need neuroimaging?
JAMA. 2006 Sep 13;296(10):1274-83
Cluster headache research Authors: Detsky ME, McDonald DR, Baerlocher MO, Tomlinson GA, McCrory DC, Booth CM
CONTEXT: In assessing the patient with headache, clinicians are often faced with 2 important questions: Is this headache a migraine? Does this patient require neuroimaging? The diagnosis of migraine can direct therapy, and information obtained from the history and physical examination is used by physicians to determine which patients require neuroimaging. OBJECTIVE: To determine the usefulness of the history and physical examination that distinguish patients with migraine from those with other headache types and that identify those patients who should undergo neuroimaging. DATA SOURCES AND STUDY SELECTION: A systematic review was performed using articles from MEDLINE (1966-November 2005) that assessed the performance characteristics of screening questions in diagnosing migraine (with the International Headache Society diagnostic criteria as a gold standard) and addressed the accuracy of the clinical examination in predicting the presence of underlying intracranial pathology (with computed tomography/magnetic resonance imaging as the reference standard). DATA EXTRACTION: Two Cluster headache research Authors independently reviewed each study to determine eligibility, abstract data, and classify methodological quality using predetermined criteria. Disagreement was resolved by consensus with a third author. DATA SYNTHESIS: Four studies of screening questions for migraine (n = 1745 patients) and 11 neuroimaging studies (n = 3725 patients) met inclusion criteria. All 4 of the migraine studies illustrated high sensitivity and specificity if 3 or 4 criteria were met. The best predictors can be summarized by the mnemonic POUNDing (Pulsating, duration of 4-72 hOurs, Unilateral, Nausea, Disabling). If 4 of the 5 criteria are met, the likelihood ratio (LR) for definite or possible migraine is 24 (95% confidence interval [CI], 1.5-388); if 3 are met, the LR is 3.5 (95% CI, 1.3-9.2), and if 2 or fewer are met, the LR is 0.41 (95% CI, 0.32-0.52). For the neuroimaging question, several clinical features were found on pooled analysis to predict the presence of a serious intracranial abnormality: cluster-type headache (LR, 10.7; 95% CI, 2.2-52); abnormal findings on neurologic examination (LR, 5.3; 95% CI, 2.4-12); undefined headache (ie, not cluster-, migraine-, or tension-type) (LR, 3.8; 95% CI, 2.0-7.1); headache with aura (LR, 3.2; 95% CI, 1.6-6.6); headache aggravated by exertion or a valsalva-like maneuver (LR, 2.3; 95% CI, 1.4-3.8); and headache with vomiting (LR, 1.8; 95% CI, 1.2-2.6). No clinical features were useful in ruling out significant pathologic conditions. CONCLUSIONS: The presence of 4 simple historical features can accurately diagnose migraine. Several individual clinical features were found to be associated with a significant intracranial abnormality, and patients with these features should undergo neuroimaging.
Cluster headache research PMID: 16968852 [PubMed - indexed for MEDLINE]Lifetime prevalence and concordance risk of cluster headache in the Swedish twin population. Related Articles
Lifetime prevalence and concordance risk of cluster headache in the Swedish twin population.
Neurology. 2006 Sep 12;67(5):798-803
Cluster headache research Authors: Ekbom K, Svensson DA, Pedersen NL, Waldenlind E
OBJECTIVE: To examine the lifetime prevalence and the concordance risk of cluster headache (CH) in a twin sample representative of the Swedish general population. METHODS: The Cluster headache research Authors assessed CH as defined by the second edition of the International Classification of Headache Disorders in 31,750 registered twins born from 1935 to 1958. Structured lay screening interviews were followed by neurologist interviews of possible cases. Co-twins of affected index twins were follow-up interviewed regardless of their screening outcome. RESULTS: A total of 250 screening-positives (0.8%) were found, of which 218 (88%) were follow-up interviewed. Forty-five (21%) had the CH diagnosis verified. Among screen-negatives, hospitalization records pointed at two more verified cases and index twins at one more verified case. A total of 48 CH cases provided a crude lifetime prevalence of 151 per 100,000 (95% CI: 108, 194). The male-to-female sex ratio corresponded to 4.8 (95% CI: 2.3, 9.9). The crude lifetime prevalence of CH was higher in the twins born from 1945 to 1958 than in the twins born from 1935 to 1944 (190 vs 90/100,000). CH recurred in 2 of 12 co-twins of monozygous index twins (including 1 nonparticipant twin), whereas all co-twins of 25 dizygous index twins proved to be unaffected. CONCLUSION: As many as 1 per 500 of the general population are affected by cluster headache. Twin concordance seems low, but genetic factors may play a role for familial clustering.
Cluster headache research PMID: 16966540 [PubMed - indexed for MEDLINE]Effectiveness of intranasal zolmitriptan in acute cluster headache: a randomized, placebo-controlled, double-blind crossover study. Related Articles
Effectiveness of intranasal zolmitriptan in acute cluster headache: a randomized, placebo-controlled, double-blind crossover study.
Arch Neurol. 2006 Nov;63(11):1537-42
Cluster headache research Authors: Cittadini E, May A, Straube A, Evers S, Bussone G, Goadsby PJ
BACKGROUND: Cluster headache is a form of primary headache in which attacks are rapid in onset with very severe pain. The mainstays of acute therapy are inhaled oxygen and sumatriptan succinate injection. OBJECTIVE: To evaluate zolmitriptan nasal spray in the acute treatment of cluster headache. METHODS: Ninety-two patients, aged 40 +/- 10 years (mean +/- SD) (80 men and 12 women), with International Headache Society-defined cluster headache were randomized into a placebo-controlled, double-blind crossover study. Patients treated 3 headache attacks using placebo for 1 attack, 5 mg of zolmitriptan nasal spray (ZNS5) for 1 attack, and 10 mg of zolmitriptan nasal spray for 1 attack. The primary end point was headache relief at 30 minutes, defined as reduction from moderate, severe, or very severe pain to no or mild pain. The study was approved by the appropriate ethics committees. RESULTS: Sixty-nine patients were available for an intention-to-treat analysis. The 30-minute headache relief rates were placebo, 21%; ZNS5, 40%; and ZNS10, 62%. Modeling the response as a binary outcome, the Wald test was significant for the overall regression (chi(2)(1) = 29.4; P<.001), with both ZNS5 and ZNS10 giving significant effects against placebo. Headache relief rates for patients with episodic cluster headache were 30% for placebo, 47% for ZNS5, and 80% for ZNS10, while corresponding rates for patients with chronic cluster headache were 14%, 28%, and 36%, respectively. Zolmitriptan was also well tolerated. CONCLUSION: Five-milligram and 10-mg doses of zolmitriptan intranasal spray are effective within 30 minutes and well tolerated in the treatment of acute cluster headache. Trial Registration controlled-trials.com Identifier ISCRTN27362692.
Cluster headache research PMID: 16966497 [PubMed - indexed for MEDLINE]Hypothalamic stimulation for intractable cluster headache: long-term experience. Related Articles
Hypothalamic stimulation for intractable cluster headache: long-term experience.
Neurology. 2006 Jul 11;67(1):150-2
Cluster headache research Authors: Leone M, Franzini A, Broggi G, Bussone G
The Cluster headache research Authors report long-term results of continuous hypothalamic stimulation in 16 chronic drug-refractory patients with cluster headache (CH). At a mean follow-up of 23 months, 13 patients are persistently pain-free or almost pain-free, and the other 3 are improved. There are no persistent side effects. Hypothalamic stimulation is an effective, safe, and well-tolerated alternative to surgery for chronic patients with drug-refractory CH.
Cluster headache research PMID: 16832097 [PubMed - indexed for MEDLINE]Medication-overuse headache in patients with cluster headache. Related Articles
Medication-overuse headache in patients with cluster headache.
Neurology. 2006 Jul 11;67(1):109-13
Cluster headache research Authors: Paemeleire K, Bahra A, Evers S, Matharu MS, Goadsby PJ
OBJECTIVE: Medication-overuse headache (MOH) in cluster headache (CH) patients is incompletely described, perhaps because of the relatively low prevalence of CH. METHODS: The Cluster headache research Authors describe a retrospective series of 17 patients (13 men, 4 women) with CH who developed MOH in association with overuse of a wide range of monotherapies or varying combinations of simple analgesics (n = 9), caffeine (n = 1), opioids (n = 10), ergotamine (n = 3), and triptans (n = 14). The series includes both episodic (n = 7) and chronic (n = 10) CH patients. RESULTS: A specific triptan-overuse headache diagnosis was made in 3 patients, an opioid-overuse headache diagnosis was made in 1 patient, and an ergotamine-overuse headache diagnosis was made in 1 patient. In approximately half of the patients (n = 8), the MOH phenotype was a bilateral, dull, and featureless daily headache. In the other 9 patients, the MOH was characterized by at least one associated feature, most commonly nausea (n = 6), exacerbation with head movement (n = 5), or throbbing character of the pain (n = 5). The common denominator in 15 patients was a personal or family history, or both, of migraine. The 2 other patients gave a family history of unspecified headaches. Medication withdrawal was attempted and successful in 13 patients. CONCLUSIONS: Medication-overuse headache is a previously underrecognized and treatable problem associated with cluster headache (CH). CH patients should be carefully monitored, especially those with a personal or family history of migraine.
Cluster headache research PMID: 16832088 [PubMed - indexed for MEDLINE]Gabapentin, estrogen, and placebo for treating hot flushes: a randomized controlled trial. Related Articles
Gabapentin, estrogen, and placebo for treating hot flushes: a randomized controlled trial.
Obstet Gynecol. 2006 Jul;108(1):41-8
Cluster headache research Authors: Reddy SY, Warner H, Guttuso T, Messing S, DiGrazio W, Thornburg L, Guzick DS
OBJECTIVE: To compare the efficacy of gabapentin, estrogen, and placebo in the treatment of hot flushes. METHODS: We performed a randomized, double-blind, placebo-controlled trial of 60 postmenopausal women to assess the efficacy of estrogen and gabapentin in the treatment of moderate-to-severe hot flushes. Participants were randomly assigned to receive either 0.625 mg/d of conjugated estrogens (n = 20), placebo (n = 20), or gabapentin titrated to 2,400 mg/d (n = 20) for 12 weeks. Participants recorded frequency and severity of baseline hot flushes on a hot flush diary for 2 weeks before randomization and for 12 weeks after randomization. The primary outcome measure was the weekly hot flush composite score, which takes into account both severity and frequency of hot flushes. Secondary outcome measures were differences in pre- and posttreatment scores pertaining to depression (Zung Depression Scale) and other climacteric symptoms (Greene Climacteric Scale). RESULTS: Intention-to-treat analysis showed that the reduction in the hot flush composite score for both estrogen (72%, P = .016) and gabapentin (71%, P = .004) was greater than the reduction associated with placebo (54%) at the conclusion of the 12th week. The extent of reduction in hot flush composite score, however, was not significantly different between estrogen and gabapentin (P = .63). No differences were seen between groups in the Zung Depression Scale, or in any of the Greene Climacteric subscales except for the Somatic Symptom cluster, which was significantly greater in the gabapentin arm than in the placebo arm. Despite a lack of group differences in adverse events, the Headache, Dizziness, and Disorientation cluster appeared with greater frequency in the gabapentin group. Estimation of the number needed to harm in this cluster suggests that these symptoms may occur with every fourth patient treated with gabapentin. CONCLUSION: Despite the small scale of this study, gabapentin appears to be as effective as estrogen in the treatment of postmenopausal hot flushes. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, NCT 00276081. LEVEL OF EVIDENCE: I.
Cluster headache research PMID: 16816054 [PubMed - indexed for MEDLINE]Response of cluster headache to psilocybin and LSD. Related Articles
Response of cluster headache to psilocybin and LSD.
Neurology. 2006 Jun 27;66(12):1920-2
Cluster headache research Authors: Sewell RA, Halpern JH, Pope HG
The Cluster headache research Authors interviewed 53 cluster headache patients who had used psilocybin or lysergic acid diethylamide (LSD) to treat their condition. Twenty-two of 26 psilocybin users reported that psilocybin aborted attacks; 25 of 48 psilocybin users and 7 of 8 LSD users reported cluster period termination; 18 of 19 psilocybin users and 4 of 5 LSD users reported remission period extension. Research on the effects of psilocybin and LSD on cluster headache may be warranted.
Cluster headache research PMID: 16801660 [PubMed - indexed for MEDLINE]A genome-wide scan and HCRTR2 candidate gene analysis in a European cluster headache cohort. Related Articles
A genome-wide scan and HCRTR2 candidate gene analysis in a European cluster headache cohort.
Neurology. 2006 Jun 27;66(12):1888-93
Cluster headache research Authors: Baumber L, Sjöstrand C, Leone M, Harty H, Bussone G, Hillert J, Trembath RC, Russell MB
OBJECTIVE: To investigate the molecular genetic basis of cluster headache (CH), using a genome-wide scan and candidate gene strategy. METHODS: Northern European CH families and a case-control cohort of Danish, Swedish, and British origin (total n = 259 sporadic CH patients), including 267 control subjects matched for ancestry, participated in the study. A genome-wide genetic screen using approximately 400 microsatellite markers was performed for five informative Danish CH families. Additional markers were typed for those loci generating statistical evidence suggestive of linkage, together with genotypes for 111 individuals from further Danish and Italian kindreds. Sporadic CH patients and controls were investigated by association analysis for variation in the candidate gene, HCRTR2. Finally, complete HCRTR2 sequencing was undertaken for eight independent probands. RESULTS: Potential linkage was identified at four possible disease loci in Danish kindreds, yet no single chromosome location generated a lod or NPL score of recognized significance. No deleterious sequence variants of the HCRTR2 gene were detected by comparison to wild-type sequence. Association of the HCRTR2 gene was not replicated in this large dataset, even when the data were stratified into distinct populations. CONCLUSIONS: Cluster headache is a complex genetic disorder, with possible phenotypic and genetic heterogeneity compounding attempts at gene identification.
Cluster headache research PMID: 16801656 [PubMed - indexed for MEDLINE]Study of hypothalamic metabolism in cluster headache by proton MR spectroscopy. Related Articles
Study of hypothalamic metabolism in cluster headache by proton MR spectroscopy.
Neurology. 2006 Apr 25;66(8):1264-6
Cluster headache research Authors: Lodi R, Pierangeli G, Tonon C, Cevoli S, Testa C, Bivona G, Magnifico F, Cortelli P, Montagna P, Barbiroli B
The Cluster headache research Authors used 1H-MRS to investigate hypothalamic metabolism in 26 patients with cluster headache (CH) and 12 healthy subjects. Hypothalamic N-acetylaspartate/creatine was reduced in patients with CH vs controls (p < 0.01). Dividing the patients into episodic CH outside- and in-cluster periods and chronic CH, the hypothalamic N-acetylaspartate/creatine in all three subgroups of patients was reduced. The reduction of the neuronal marker N-acetylaspartate is consistent with hypothalamic neuronal dysfunction in patients with CH.
Cluster headache research PMID: 16636250 [PubMed - indexed for MEDLINE]Opioidergic changes in the pineal gland and hypothalamus in cluster headache: a ligand PET study. Related Articles
Opioidergic changes in the pineal gland and hypothalamus in cluster headache: a ligand PET study.
Neurology. 2006 Apr 11;66(7):1108-10
Cluster headache research Authors: Sprenger T, Willoch F, Miederer M, Schindler F, Valet M, Berthele A, Spilker ME, Förderreuther S, Straube A, Stangier I, Wester HJ, Tölle TR
Using PET with the opioidergic ligand [11C]diprenorphine, the Cluster headache research Authors demonstrate decreased tracer binding in the pineal gland of cluster headache patients vs healthy volunteers. Opioid receptor availability in the hypothalamus and cingulate cortex depended on the duration of the headache disorder. Therefore, the pathophysiology of cluster headache may relate to opioidergic dysfunction in circuitries generating the biologic clock.
Cluster headache research PMID: 16606930 [PubMed - indexed for MEDLINE]Cluster headache is associated with the G1246A polymorphism in the hypocretin receptor 2 gene. Related Articles
Cluster headache is associated with the G1246A polymorphism in the hypocretin receptor 2 gene.
Neurology. 2006 Jun 27;66(12):1917-9
Cluster headache research Authors: Schürks M, Kurth T, Geissler I, Tessmann G, Diener HC, Rosskopf D
The G1246A polymorphism in the gene of the hypocretin receptor 2 (HCRTR2) has been linked to the risk for cluster headache (CH). The Cluster headache research Authors examined this association in a large sample of 226 patients with CH and 266 controls from Germany. The genotype and allele distribution varied significantly between patients and controls. Homozygous carriers of the G-allele had a twofold increase in risk for CH (OR 1.97; 95% CI 1.32 to 2.92; p = 0.0007).
Cluster headache research PMID: 16554494 [PubMed - indexed for MEDLINE]Tearing without pain after trigeminal root section for cluster headache. Related Articles
Tearing without pain after trigeminal root section for cluster headache.
Neurology. 2005 Nov 22;65(10):1650-1
Cluster headache research Authors: Lin H, Dodick DW
The cranial autonomic symptoms (CAS) in patients with cluster headache (CH) are considered to occur as a result of intense ophthalmic division pain. Five CH patients underwent transection of the trigeminal nerve root but continued to experience periodic CAS without pain, whereas another five patients continued to experience typical cluster headaches. These findings confirm that CH is generated by a central pacemaker and the pain may be expressed without activation of the peripheral trigeminovascular network.
Cluster headache research PMID: 16301498 [PubMed - indexed for MEDLINE]Cluster headache: pathogenesis, diagnosis, and management. Related Articles
Cluster headache: pathogenesis, diagnosis, and management.
Lancet. 2005 Sep 3-9;366(9488):843-55
Cluster headache research Authors: May A
Cluster headache is a stereotyped primary pain syndrome characterised by strictly unilateral severe pain, localised in or around the eye and accompanied by ipsilateral autonomic features. The syndrome is characterised by the circadian rhythmicity of the short-lived attacks, and the regular recurrence of headache bouts, which are interspersed by periods of complete remission in most individuals. Headaches often start about 1-2 h after falling asleep or in the early morning, and show seasonal variation, suggesting that the hypothalamus has a role in the illness. Consequently, the vascular theory has been superseded by recognition that neurovascular factors are more important. The increased familial risk suggests that cluster headache has a genetic component in some families. Neuroimaging has broadened our pathophysiological view and has led to successful treatment by deep brain stimulation of the hypothalamus. Although most patients can be treated effectively, some do not respond to therapy. Fortunately, time to diagnosis of cluster headache has improved. This is probably the result of a better understanding of the pathophysiology in combination with efficient treatment strategies, leading to a broader acceptance of the syndrome by doctors.
Cluster headache research PMID: 16139660 [PubMed - indexed for MEDLINE]The clinical characteristics of headache in patients with pituitary tumours. Related Articles
The clinical characteristics of headache in patients with pituitary tumours.
Brain. 2005 Aug;128(Pt 8):1921-30
Cluster headache research Authors: Levy MJ, Matharu MS, Meeran K, Powell M, Goadsby PJ
The clinical characteristics of 84 patients with pituitary tumour who had troublesome headache were investigated. The patients presented with chronic (46%) and episodic (30%) migraine, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT; 5%), cluster headache (4%), hemicrania continua (1%) and primary stabbing headache (27%). It was not possible to classify the headache according to International Headache Society diagnostic criteria in six cases (7%). Cavernous sinus invasion was present in the minority of presentations (21%), but was present in two of three patients with cluster headache. SUNCT-like headache was only seen in patients with acromegaly and prolactinoma. Hypophysectomy improved headache in 49% and exacerbated headache in 15% of cases. Somatostatin analogues improved acromegaly-associated headache in 64% of cases, although rebound headache was described in three patients. Dopamine agonists improved headache in 25% and exacerbated headache in 21% of cases. In certain cases, severe exacerbations in headache were observed with dopamine agonists. Headache appears to be a significant problem in pituitary disease and is associated with a range of headache phenotypes. The presenting phenotype is likely to be governed by a combination of factors, including tumour activity, relationship to the cavernous sinus and patient predisposition to headache. A proposed modification of the current classification of pituitary-associated headache is given.
Cluster headache research PMID: 15888539 [PubMed - indexed for MEDLINE]Intractable cluster headache and therapeutic stimulation of the hypothalamus: pathophysiological and management insights from a rare experiment. Related Articles
Intractable cluster headache and therapeutic stimulation of the hypothalamus: pathophysiological and management insights from a rare experiment.
Brain. 2005 Apr;128(Pt 4):E26
Cluster headache research Authors: Gupta VK
Cluster headache research PMID: 15788548 [PubMed - indexed for MEDLINE]Management of cluster headache. Related Articles
Management of cluster headache.
Am Fam Physician. 2005 Feb 15;71(4):717-24
Cluster headache research Authors: Beck E, Sieber WJ, Trejo R
Cluster headache, an excruciating, unilateral headache usually accompanied by conjunctival injection and lacrimation, can occur episodically or chronically, and can be difficult to treat. Existing effective treatments may be underused because of underdiagnosis of the syndrome. Oxygen and sumatriptan have been demonstrated to be effective in the acute treatment of cluster headaches. Verapamil has been shown to be effective for prophylaxis. For cluster headache completely refractory to all treatments, surgical modalities and newer interventions such as the implantation of stereotactic electrodes may be useful. Patients should be encouraged to avoid possible triggers such as smoking or alcohol consumption, especially during the duster period. The intensity of duster headache pain leads to ethical concerns among researchers over the use of placebo, making randomized controlled trials difficult. As new technology and genetic studies clarify the etiology of duster headache, it is possible that more specific therapies will emerge.
Cluster headache research PMID: 15742909 [PubMed - indexed for MEDLINE]Cluster headache prevalence in the Italian general population. Related Articles
Cluster headache prevalence in the Italian general population.
Neurology. 2005 Feb 8;64(3):469-74
Cluster headache research Authors: Torelli P, Beghi E, Manzoni GC
BACKGROUND: Prevalence of cluster headache (CH) is estimated at 56 to 69 per 100,000. OBJECTIVE: To calculate the CH lifetime prevalence in a sample representative of the Italian general population over age 14 years. METHODS: Possible CH cases according to the diagnostic criteria of the 1988 International Headache Society classification were screened from a sample of 10,071 patients (5,311 women and 4,760 men; mean age 50.4 years, SD 19.7 years) registered in the lists of seven Parma-based general practitioners (GPs), using a previously validated, specially designed, self-administered questionnaire. RESULTS: Seven thousand five hundred twenty-two subjects (74.7%; 3,971 women and 3,551 men; mean age 50.8 years, SD 19.0 years) responded to the questionnaire in their GP's office (n = 3,338; 1,885 women and 1,453 men) or at home by mail (n = 1,914; 1,030 women and 884 men) or by phone (n = 2,270; 1,056 women and 1,214 men). Of the 111 suspected cases (76 women and 35 men), 105 were seen by a neurologist and 6 were contacted on the phone. The diagnosis of CH was confirmed in 21 (9 women and 12 men), including 7 already followed at the Cluster headache research Authors' center for CH. Seventeen patients had episodic CH, and four (all men) had chronic CH. The estimated prevalence rate was 279 per 100,000 (95% CI 173 to 427), 227 per 100,000 (95% CI 104 to 431) in women, and 338 per 100,000 (95% CI 175 to 592) in men. CONCLUSION: These results point to a higher cluster headache lifetime prevalence than previous reports.
Cluster headache research PMID: 15699377 [PubMed - indexed for MEDLINE]Hypothalamic stimulation in chronic cluster headache: a pilot study of efficacy and mode of action. Related Articles
Hypothalamic stimulation in chronic cluster headache: a pilot study of efficacy and mode of action.
Brain. 2005 Apr;128(Pt 4):940-7
Cluster headache research Authors: Schoenen J, Di Clemente L, Vandenheede M, Fumal A, De Pasqua V, Mouchamps M, Remacle JM, de Noordhout AM
We enrolled six patients suffering from refractory chronic cluster headache in a pilot trial of neurostimulation of the ipsilateral ventroposterior hypothalamus using the stereotactic coordinates published previously. After the varying durations needed to determine optimal stimulation parameters and a mean follow-up of 14.5 months, the clinical outcome is excellent in three patients (two are pain-free; one has fewer than three attacks per month), but unsatisfactory in one patient, who only has had transient remissions. Mean voltage is 3.28 V, diplopia being the major factor limiting its increase. When the stimulator was switched off in one pain-free patient, attacks resumed after 3 months until it was turned on again. In one patient the implantation procedure had to be interrupted because of a panic attack with autonomic disturbances. Another patient died from an intracerebral haemorrhage that developed along the lead tract several hours after surgery; there were no other vascular changes on post-mortem examination. After 1 month, the hypothalamic stimulation induced resistance against the attack-triggering agent nitroglycerin and tended to increase pain thresholds at extracephalic, but not at cephalic, sites. It had no detectable effect on neurohypophyseal hormones or melatonin excretion. We conclude that hypothalamic stimulation has remarkable efficacy in most, but not all, patients with treatment-resistant chronic cluster headache. Its efficacy is not due to a simple analgesic effect or to hormonal changes. Intracerebral haemorrhage cannot be neglected in the risk evaluation of the procedure. Whether it might be more prevalent than in deep-brain stimulation for movement disorders remains to be determined.
Cluster headache research PMID: 15689358 [PubMed - indexed for MEDLINE]Lower-half facial migraine: a report of 11 cases. Related Articles
Lower-half facial migraine: a report of 11 cases.
J Oral Maxillofac Surg. 2004 Dec;62(12):1453-6
Cluster headache research Authors: Peñarrocha M, Bandrés A, Peñarrocha M, Bagán JV
PURPOSE: Vascular pain of the face constitutes a variant of pain of the head, and includes migraine, cluster headache, paroxysmal hemicrania, and a facial variant of the so-called lower-half migraine. Lower-half facial migraine is a condition difficult to classify; according to the international classifications it could not be found as an individual entity. The objective of the present study is to determine the difficulties we encountered in diagnosis, the ineffective treatments provided, and the pharmacologic treatment effect. PATIENTS AND METHODS: A study is made of 11 cases of lower-half facial migraine, corresponding to 10 women and 1 man (mean age, 35 years), commenting on the clinical characteristics of the disorder and its treatment options. The location of the pain often mimics dental pain, and can lead to a mistaken diagnosis and to the application of inappropriate therapeutic measures. Forty-five percent of the patients had a history of endodontic treatment before the development of pain in the initially affected quadrant. Once the pain had developed, extractions were carried out in 36% of cases in an unsuccessful attempt to secure symptom relief. Our pharmacologic treatment consisted of ergotamine in 9 cases and the remaining 2 patients received indomethacin. RESULTS: Nine patients (82%) improved as a result of treatment, with an important reduction in the frequency of the pain episodes and intensity of pain. One patient failed to respond to ergotamine, while another patient failed to improve with indomethacin. Both were prescribed only minor analgesics. CONCLUSION: The treatment of migraine occurring in the face is no different than that provided for pain occurring in the head.
Cluster headache research PMID: 15573344 [PubMed - indexed for MEDLINE]Cluster headache and right-to-left shunt on contrast transcranial Doppler: a case-control study. Related Articles
Cluster headache and right-to-left shunt on contrast transcranial Doppler: a case-control study.
Neurology. 2004 Oct 12;63(7):1309-10
Cluster headache research Authors: Finocchi C, Del Sette M, Angeli S, Rizzi D, Gandolfo C
The Cluster headache research Authors evaluated the prevalence of right-to-left shunt in 40 subjects with cluster headache (CH) vs 40 subjects without primary headaches or cerebrovascular disease. The diagnosis of shunt was made by means of transcranial Doppler with contrast medium. A shunt was found in 17 CH patients (42.5%) and in 7 controls (17.5%) (p = 0.029; OR = 3.48; 95% CI = 1.13 to 10.69).
Cluster headache research PMID: 15477561 [PubMed - indexed for MEDLINE]A polymorphism of the hypocretin receptor 2 gene is associated with cluster headache. Related Articles
A polymorphism of the hypocretin receptor 2 gene is associated with cluster headache.
Neurology. 2004 Oct 12;63(7):1286-8
Cluster headache research Authors: Rainero I, Gallone S, Valfrè W, Ferrero M, Angilella G, Rivoiro C, Rubino E, De Martino P, Savi L, Ferrone M, Pinessi L
Several polymorphisms of the hypocretin/orexin system genes were evaluated in 109 cluster headache patients and 211 controls. The 1246 G>A polymorphism of the gene was significantly different between cases and controls. Homozygosity for the G allele was associated with an increased disease risk (OR: 6.79, 95% CI, 2.25 to 22.99). The data suggest that the HCRTR2 gene or a linked locus significantly modulates the risk for cluster headache.
Cluster headache research PMID: 15477554 [PubMed - indexed for MEDLINE]Long-term follow-up of bilateral hypothalamic stimulation for intractable cluster headache.
Long-term follow-up of bilateral hypothalamic stimulation for intractable cluster headache.
Brain. 2004 Oct;127(Pt 10):2259-64
Cluster headache research Authors: Leone M, Franzini A, Broggi G, May A, Bussone G
We provide a detailed case history of the first patient to receive bilateral hypothalamic stimulation to control severe bilateral chronic intractable cluster headaches initially occurring mostly on the left. These attacks were accompanied by life-threatening hypertensive crises and a grave deterioration in the patient's psychological state. Destructive surgery to the left trigeminal was absolutely contraindicated. Electrode implantation and continuous stimulation of the left posterior inferior hypothalamus resolved the left attacks. After four destructive operations on the right trigeminal, right side attacks recurred. Electrode implantation (with continuous stimulation) to the right resulted in immediate resolution of the right side pain and the hypertensive crises. On several occasions, both known and unknown to the patient, the stimulators were turned off: in all cases, crises reappeared and in all instances disappeared relatively quickly after turning stimulation back on. Pain crises have never reappeared when ipsilateral stimulation is ongoing. The only side effects were observed during long-term bilateral stimulation, consisting of transient vertigo and bradycardia. After 42 months (left) and 31 months (right) of follow-up, the patient remains crisis free without the need for pharmacological prophylaxis.
Cluster headache research PMID: 15329350 [PubMed - indexed for MEDLINE]High oxygen flow rates for cluster headache. Related Articles
High oxygen flow rates for cluster headache.
Neurology. 2004 Aug 10;63(3):593
Cluster headache research Authors: Rozen TD
Cluster headache research PMID: 15304611 [PubMed - indexed for MEDLINE]Classification of primary headaches. Related Articles
Classification of primary headaches.
Neurology. 2004 Aug 10;63(3):427-35
Cluster headache research Authors: Lipton RB, Bigal ME, Steiner TJ, Silberstein SD, Olesen J
Given the range of disorders that produce headache, a systematic approach to classification and diagnosis is an essential prelude to clinical management. For the last 15 years, the diagnostic criteria of the International Headache Society (IHS) have been the accepted standard. The second edition of The International Classification of Headache Disorders (January 2004) reflects our improved understanding of some disorders and the identification of new disorders. Neurologists who treat headache should become familiar with the revised criteria. Like its predecessor, the second edition of the IHS classification separates headache into primary and secondary disorders. The four categories of primary headaches include migraine, tension-type headache, cluster headache and other trigeminal autonomic cephalalgias, and other primary headaches. There are eight categories of secondary headache. Important changes in the second edition include a restructuring of these criteria for migraine, a new subclassification of tension-type headache, introduction of the concept of trigeminal autonomic cephalalgias, and addition of previously unclassified primary headaches. Several disorders were eliminated or reclassified. In this article, the Cluster headache research Authors present an overview of the revised IHS classification, highlighting the primary headache disorders and their diagnostic criteria. They conclude by presenting an approach to headache diagnosis based upon these criteria.
Cluster headache research PMID: 15304572 [PubMed - indexed for MEDLINE]Elevated levels of circulating trace amines in primary headaches. Related Articles
Elevated levels of circulating trace amines in primary headaches.
Neurology. 2004 May 25;62(10):1701-5
Cluster headache research Authors: D'Andrea G, Terrazzino S, Leon A, Fortin D, Perini F, Granella F, Bussone G
BACKGROUND: Trace amines, including tyramine, octopamine, and synephrine, are closely related to classic biogenic amines. They have been hypothesized to promote migraines and other types of primary headaches, but there is no direct evidence supporting this hypothesis. METHODS: Using a multichannel electrochemical high-performance liquid chromatography system, the Cluster headache research Authors evaluated whether changes in circulating trace amines occur in subjects with migraine (with or without aura) during headache-free periods as well as in patients with cluster headache (CH) during the remission and active phases as compared with healthy control subjects. RESULTS: Plasma levels of all trace amines were significantly higher in CH patients, in both the remission and the active phases, when compared with control subjects or subjects with migraine. In addition, intraplatelet levels of octopamine, synephrine, and tyramine were higher in CH patients than in control subjects. In migraine patients, plasma levels of octopamine and synephrine were higher compared with controls, although in migraine with aura, the difference was not significant. CONCLUSIONS: Whereas the elevation of plasma trace amine levels in both migraine and CH supports the hypothesis that disorders of biogenic amine metabolism may be a characteristic biochemical trait in primary headache sufferers, the observation that such alterations are more prominent in patients with CH than migraine patients suggests that they may reflect sympathetic or hypothalamic dysfunction.
Cluster headache research PMID: 15159465 [PubMed - indexed for MEDLINE]Specific hypothalamic activation during a spontaneous cluster headache attack. Related Articles
Specific hypothalamic activation during a spontaneous cluster headache attack.
Neurology. 2004 Feb 10;62(3):516-7
Cluster headache research Authors: Sprenger T, Boecker H, Tolle TR, Bussone G, May A, Leone M
Cluster headache research PMID: 14872051 [PubMed - indexed for MEDLINE]A large outbreak of histoplasmosis among American travelers associated with a hotel in Acapulco, Mexico, spring 2001. Related Articles
A large outbreak of histoplasmosis among American travelers associated with a hotel in Acapulco, Mexico, spring 2001.
Am J Trop Med Hyg. 2003 Dec;69(6):663-9
Cluster headache research Authors: Morgan J, Cano MV, Feikin DR, Phelan M, Monroy OV, Morales PK, Carpenter J, Weltman A, Spitzer PG, Liu HH, Mirza SA, Bronstein DE, Morgan DJ, Kirkman LA, Brandt ME, Iqbal N, Lindsley MD, Warnock DW, Hajjeh RA,
During spring 2001, college students from Pennsylvania reported an acute febrile respiratory illness after returning from spring break vacation in Acapulco, Mexico. Acute pulmonary histoplasmosis was presumptively diagnosed and the cluster of illness was reported to the Centers of Disease Control and Prevention. A large investigation then ensued, which included finding student-travelers for interviews and requesting sera for histoplasmosis testing. We defined a clinical case by fever and at least one of the following: cough, shortness of breath, chest pain, or headache, in an Acapulco traveler during March-May 2001. A laboratory-confirmed case had positive serology. An initial study determined that the likely site of histoplasmosis exposure was Hotel H; we therefore performed a large cohort study among travelers who stayed at Hotel H. Of 757 contacted, 262 (36%) met the clinical case definition. Of 273 serum specimens tested, 148 (54%) were positive. Frequent use of Hotel H's stairwells, where construction was ongoing, was associated with increased risk of illness (relative risk = 10.5, 95% confidence interval = 3.7-30.5; P < 0.001). This is the first histoplasmosis outbreak associated with a hotel undergoing construction. Hotels in endemic areas should consider construction precaution measures to prevent histoplasmosis among their guests.
Cluster headache research PMID: 14740886 [PubMed - indexed for MEDLINE]Diminished nocturnal lipolysis in cluster headache: a sign of central sympathetic dysregulation? Related Articles
Diminished nocturnal lipolysis in cluster headache: a sign of central sympathetic dysregulation?
Neurology. 2003 Nov 11;61(9):1250-4
Cluster headache research Authors: Meyer EL, Waldenlind E, Marcus C
BACKGROUND: It is unclear whether the autonomic symptoms during cluster headache (CH) attacks are of central or peripheral origin. A metabolic change such as altered lipolysis would reflect a central autonomic dysfunction. OBJECTIVE: To study nocturnal lipolysis in CH patients and healthy control subjects. METHODS: Microdialysis technique was used to measure glycerol levels, the end-product of lipolysis, in subcutaneous adipose tissue. Ten CH patients participated, of whom six were studied in remission as well as during symptomatic periods but between headache attacks. Fifteen healthy control subjects were studied. Mean glycerol, glucose, and lactate concentrations were calculated for three 2-hour intervals between 2400 and 0600 hours. RESULTS: Compared with healthy control subjects, symptomatic CH patients had lower glycerol levels during all three intervals (69, 61, and 73% of control levels; p < 0.05). CH patients in remission showed lower glycerol levels from 0200 to 0600 hours (68 and 63% of control levels; p < 0.05). There were no significant differences between the CH groups. Compared with healthy control subjects, patients in remission also showed a significantly different nocturnal temporal pattern, demonstrating declining glycerol levels during the first part of the night. CONCLUSIONS: Altered lipolysis was found in patients with CH, both in symptomatic periods and in remission. The altered lipolysis may be due to a reduced nocturnal sympathetic activity and consequently an indication of central sympathetic dysregulation and hypothalamic dysfunction.
Cluster headache research PMID: 14610129 [PubMed - indexed for MEDLINE]A cluster headache family with possible autosomal recessive inheritance. Related Articles
A cluster headache family with possible autosomal recessive inheritance.
Neurology. 2003 Aug 26;61(4):578-9
Cluster headache research Authors: De Simone R, Fiorillo C, Bonuso S, Castaldo G
Cluster headache research PMID: 12939449 [PubMed - indexed for MEDLINE]Increased responses in trigeminocervical nociceptive neurons to cervical input after stimulation of the dura mater. Related Articles
Increased responses in trigeminocervical nociceptive neurons to cervical input after stimulation of the dura mater.
Brain. 2003 Aug;126(Pt 8):1801-13
Cluster headache research Authors: Bartsch T, Goadsby PJ
Pain referral and spread in headache patients may be attributed to a sensitization of central nociceptive neurons with an increased excitability to afferent input. We investigated if noxious dural stimulation evokes sensitization of second-order neurons that leads to an increased responsiveness to stimulation of cervical afferents. Recordings were made from 29 nociceptive neurons in the C2 dorsal horn of the rat that received convergent synaptic input from trigeminal and cervical afferents. Trigeminal afferents of the supratentorial dura mater were activated by mustard oil (MO) and the responses of second-order neurons to stimulation of the greater occipital nerve (GON) were studied before and after dural stimulation. Projection sites to the contralateral thalamus were determined by antidromic stimulation. After dural application with MO, mechanical thresholds of the dura significantly decreased (P < 0.05) and an enlargement of the trigeminal and cervical cutaneous mechanoreceptive fields was observed in 71% of neurons. The responses to noxious mechanical stimulation of deep paraspinal muscles increased after MO application (P < 0.001). Similarly, an increase in the excitability to electrical stimulation of the GON was observed in C-fibre responses (P < 0.001). These results suggest that stimulation of nociceptive afferent C-fibres of the dura mater leads to a sensitization of second-order neurons receiving cervical input. This mechanism might be involved in the referral of pain from trigeminal to cervical structures and might contribute to the clinical phenomena of cervical hypersensitivity in migraine and cluster headache. Understanding this interaction is likely to be pivotal in characterizing the physiology of treatment with manipulations involving cervical input, such as GON injection.
Cluster headache research PMID: 12821523 [PubMed - indexed for MEDLINE]What is Sluder's neuralgia? Related Articles
What is Sluder's neuralgia?
J Laryngol Otol. 2003 Jun;117(6):437-43
Cluster headache research Authors: Ahamed SH, Jones NS
In 1908 Sluder described a symptom complex consisting of neuralgic, motor, sensory and gustatory manifestations that he attributed to the sphenopalatine ganglion. He stated that treatment directed at the ganglion successfully alleviated these symptoms. Over the last 90 years several reports have described patients as having sphenopalatine neuralgia and have directed treatment at the ganglion. The symptoms described and the criteria for patient selection in these studies has often been varied and deviated from Sluder's description. In reports claiming cures with treatment directed at the ganglion the duration of post-treatment follow-up has been short. This article discusses Sluder's description and attempts to analyse its features in the light of current understanding of the different mechanisms and categories of facial pain. It is proposed that the condition described by Sluder is a neurovascular headache that most closely resembles cluster headache in its aetiology and clinical manifestations. We propose that the term Sluder's neuralgia should be discarded as there are serious flaws in its original description and many Cluster headache research Authors have misused the term leading to persistent confusion about it.
Cluster headache research PMID: 12818050 [PubMed - indexed for MEDLINE]Monozygotic twin sisters suffering from cluster headache and migraine without aura. Related Articles
Monozygotic twin sisters suffering from cluster headache and migraine without aura.
Neurology. 2003 Jun 10;60(11):1864-5
Cluster headache research Authors: Schuh-Hofer S, Meisel A, Reuter U, Arnold G
Cluster headache research PMID: 12796556 [PubMed - indexed for MEDLINE]Outcome of trigeminal nerve section in the treatment of chronic cluster headache. Related Articles
Outcome of trigeminal nerve section in the treatment of chronic cluster headache.
Neurology. 2003 Apr 22;60(8):1360-2
Cluster headache research Authors: Jarrar RG, Black DF, Dodick DW, Davis DH
Chronic cluster headache accounts for 10 to 15% of all patients with cluster headache and is often resistant to medical management. The Cluster headache research Authors followed 17 patients with intractable chronic cluster headache who underwent trigeminal nerve section. They found that trigeminal nerve section is an effective treatment with acceptable morbidity for a carefully selected group of patients.
Cluster headache research PMID: 12707445 [PubMed - indexed for MEDLINE]A cluster of cases of severe acute respiratory syndrome in Hong Kong. Related Articles
A cluster of cases of severe acute respiratory syndrome in Hong Kong.
N Engl J Med. 2003 May 15;348(20):1977-85
Cluster headache research Authors: Tsang KW, Ho PL, Ooi GC, Yee WK, Wang T, Chan-Yeung M, Lam WK, Seto WH, Yam LY, Cheung TM, Wong PC, Lam B, Ip MS, Chan J, Yuen KY, Lai KN
BACKGROUND: Information on the clinical features of the severe acute respiratory syndrome (SARS) will be of value to physicians caring for patients suspected of having this disorder. METHODS: We abstracted data on the clinical presentation and course of disease in 10 epidemiologically linked Chinese patients (5 men and 5 women 38 to 72 years old) in whom SARS was diagnosed between February 22, 2003, and March 22, 2003, at our hospitals in Hong Kong, China. RESULTS: Exposure between the source patient and subsequent patients ranged from minimal to that between patient and health care provider. The incubation period ranged from 2 to 11 days. All patients presented with fever (temperature, >38 degrees C for over 24 hours), and most presented with rigor, dry cough, dyspnea, malaise, headache, and hypoxemia. Physical examination of the chest revealed crackles and percussion dullness. Lymphopenia was observed in nine patients, and most patients had mildly elevated aminotransferase levels but normal serum creatinine levels. Serial chest radiographs showed progressive air-space disease. Two patients died of progressive respiratory failure; histologic analysis of their lungs showed diffuse alveolar damage. There was no evidence of infection by Mycoplasma pneumoniae, Chlamydia pneumoniae, or Legionella pneumophila. All patients received corticosteroid and ribavirin therapy a mean (+/-SD) of 9.6+/-5.42 days after the onset of symptoms, and eight were treated earlier with a combination of beta-lactams and macrolide for 4+/-1.9 days, with no clinical or radiologic efficacy. CONCLUSIONS: SARS appears to be infectious in origin. Fever followed by rapidly progressive respiratory compromise is the key complex of signs and symptoms from which the syndrome derives its name. The microbiologic origins of SARS remain unclear.
Cluster headache research PMID: 12671062 [PubMed - indexed for MEDLINE]Cluster-like headache time-locked to the menstrual cycle. Related Articles
Cluster-like headache time-locked to the menstrual cycle.
Neurology. 2003 Mar 25;60(6):1049
Cluster headache research Authors: Petzold GC, Dreier JP, Einhäupl KM, Arnold G
Cluster headache research PMID: 12654985 [PubMed - indexed for MEDLINE]Intranasal sumatriptan in cluster headache: randomized placebo-controlled double-blind study. Related Articles
Intranasal sumatriptan in cluster headache: randomized placebo-controlled double-blind study.
Neurology. 2003 Feb 25;60(4):630-3
Cluster headache research Authors: van Vliet JA, Bahra A, Martin V, Ramadan N, Aurora SK, Mathew NT, Ferrari MD, Goadsby PJ
BACKGROUND: Current evidence-based acute treatments of cluster headache are limited to oxygen inhalation and subcutaneous sumatriptan. Intranasal sumatriptan is a new formulation with better tolerability than the subcutaneous route. Two open-label studies suggested efficacy of intranasal sumatriptan in cluster headache. METHODS: In a double-blind placebo-controlled randomized trial, patients with episodic or chronic cluster headache whose attacks lasted at least 45 minutes each treated one attack with 20 mg sumatriptan nasal spray and another one, at least 24 hours later, with matching placebo. They scored their headache on a five-point scale (very severe, severe, moderate, mild, or none) at 5, 10, 15, 20, and 30 minutes. The primary outcome measure was headache response (a decrease in pain from very severe, severe, or moderate to mild or none) at 30 minutes. Secondary outcome measures included pain-free rates, relief of associated symptoms, and rates of adverse events. Multilevel multivariate analysis was used for statistical analysis. RESULTS: Five study centers enrolled 118 patients in whom 154 attacks were treated: 77 with sumatriptan and 77 with placebo. The responder rates at 30 minutes were 57% for sumatriptan and 26% for placebo (p = 0.002). Pain-free rates at 30 minutes were 47% for sumatriptan and 18% for placebo (p = 0.003). Sumatriptan was also superior to placebo considering initial response, meaningful relief, and relief of associated symptoms. There were no serious adverse events. CONCLUSION: Sumatriptan nasal spray is effective and well tolerated in the acute treatment of cluster headache attacks of at least 45 minutes' duration.
Cluster headache research PMID: 12601104 [PubMed - indexed for MEDLINE]The many causes of headache. Migraine, vascular, drug-induced, and more. Related Articles
The many causes of headache. Migraine, vascular, drug-induced, and more.
Postgrad Med. 2002 Dec;112(6):67-8, 71-2, 75-6 passim
Cluster headache research Authors: Levin M
Accurate diagnosis of headache can be challenging when the pain pattern and the source are not immediately recognized. The most common types of headache are primary (i.e., migraine, tension-type, and cluster). In addition, many secondary causes of head pain have been identified. Dr Levin reviews the major types of headache as categorized by the International Headache Society and provides a list of red flags that may signal a secondary headache.
Cluster headache research PMID: 12510448 [PubMed - indexed for MEDLINE]Cluster-like headache associated to a foreign body in the maxillary sinus. Related Articles
Cluster-like headache associated to a foreign body in the maxillary sinus.
Neurology. 2002 Aug 27;59(4):643-4
Cluster headache research Authors: Scorticati MC, Raina G, Federico M
Cluster headache research PMID: 12196671 [PubMed - indexed for MEDLINE]Intranasal civamide for the treatment of episodic cluster headaches. Related Articles
Intranasal civamide for the treatment of episodic cluster headaches.
Arch Neurol. 2002 Jun;59(6):990-4
Cluster headache research Authors: Saper JR, Klapper J, Mathew NT, Rapoport A, Phillips SB, Bernstein JE
OBJECTIVE: To evaluate the safety and efficacy of intranasal civamide solution for preventive treatment during an episodic cluster headache period. SUBJECTS AND METHODS: This was a multicenter, double-blind, randomized, vehicle-controlled study with a 7-day treatment period and a 20-day posttreatment period performed at 14 headache/neurology centers in the United States. Twenty-eight subjects were randomized to receive civamide or its vehicle in a 2:1 ratio; 18 received civamide and 10 received the vehicle. Subjects received 100 microL of 0.025% civamide (25 microg) or 100 microL of the vehicle to each nostril via dropper once daily for 7 days. The total daily dose of civamide was 50 microg. MAIN OUTCOME MEASURES: The number of cluster headaches per week during the treatment and posttreatment periods, pain intensity, presence of associated symptoms, and the incidence of adverse events were assessed. RESULTS: Subjects in the civamide group had a significantly greater percent decrease in the number of headaches from baseline to posttreatment during days 1 through 7 (-55.5% vs -25.9%; P =.03) and a trend toward significance during days 8 through 14 (-66.9% vs -32.3%; P =.07) and days 15 through 20 (-70.6% vs -34.9%; P =.07), as well as a near-significant decrease during the entire posttreatment period (days 1 through 20 [P =.054]) compared with the vehicle group. There were larger decreases in the number of headaches per week during the posttreatment period in the civamide-treated group, with trends toward significance during posttreatment days 8 through 14 (-8.6 vs -3.6; P =.09) and days 15 through 20 (-8.9 vs -3.6; P =.07). There were no significant differences between groups in cluster headache pain intensity, number of severe headaches, or associated symptoms. The most common adverse events included nasal burning (14 of 18 civamide-treated subjects, 1 of 10 vehicle-treated subjects; P =.001) and lacrimation (9 of 18 civamide-treated subjects, 0 of 10 vehicle-treated subjects; P =.01). CONCLUSION: Intranasal civamide solution at a dose of 50 microg may be modestly effective in the preventive treatment of episodic cluster headache.
Cluster headache research PMID: 12056936 [PubMed - indexed for MEDLINE]Adenosine A1 receptor agonists inhibit trigeminovascular nociceptive transmission. Related Articles
Adenosine A1 receptor agonists inhibit trigeminovascular nociceptive transmission.
Brain. 2002 Jun;125(Pt 6):1392-401
Cluster headache research Authors: Goadsby PJ, Hoskin KL, Storer RJ, Edvinsson L, Connor HE
There is a considerable literature to suggest that adenosine A1 receptor agonists may have anti-nociceptive effects, and we sought to explore the role of adenosine A1 receptors in a model of trigeminovascular nociceptive transmission. Cats were anaesthetized (alpha-chloralose 60 mg/kg, intraperitoneally), and prepared for physiological monitoring. The superior sagittal sinus (SSS) was stimulated electrically, and linked units were recorded in the trigeminocervical complex. Post-stimulus histograms were constructed to analyse the responses and the effect of drug administration. Blood was sampled from the external jugular vein to determine levels of calcitonin gene-related peptide (CGRP) release before and after drug administration. Intravenous administration of the highly selective adenosine A1 receptor agonist, GR79236 (3-100 microg/kg) had a dose-dependent inhibitory effect on SSS-evoked trigeminal activity. The maximal effect (80 +/- 6% reduction in probability of firing) was seen at 100 microg/kg. The neuronal inhibitory effect of GR79236 could be inhibited by the selective adenosine A1 receptor antagonist DPCPX (300 microg/kg; P < 0.05). SSS stimulation increased cranial CGRP levels from 33 +/- 2 pmol/l (n = 6) to 64 +/- 3 pmol/l, an effect substantially reduced by pre-treatment with GR79236 (30 microg/kg; P < 0.01). The selective low efficacy adenosine A1 receptor agonist, GR190178 (30-1000 microg/kg i.v.), also inhibited SSS-evoked neuronal activity in a dose-dependent fashion. In this model of trigeminovascular nociception, adenosine A1 receptor activation leads to neuronal inhibition without concomitant vasoconstriction, suggesting a novel avenue for the treatment of migraine and cluster headache.
Cluster headache research PMID: 12023327 [PubMed - indexed for MEDLINE] "Recent cluster headache research publications are scanned daily from major neurology journals and updated here"
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