scholarly journals Clinical features of cluster headache without cranial autonomic symptoms: results from a prospective multicentre study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Min Kyung Chu ◽  
Byung-Su Kim ◽  
Pil-Wook Chung ◽  
Byung-Kun Kim ◽  
Mi Ji Lee ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Clinical Features ◽  
Rating Scale ◽  
Significant Proportion ◽  
Numeric Rating Scale ◽  
Autonomic Symptoms ◽  
General Anxiety Disorder ◽  
General Anxiety ◽  
Prospective Multicentre Study ◽  
Cranial Autonomic Symptoms

AbstractAlthough cranial autonomic symptoms (CAS) are typical in cluster headache (CH), some individuals with CH show no CAS during their headache attacks. Probable cluster headache (PCH) is a subtype of CH that fulfils all but one criterion of CH. This study aimed to investigate the frequency and clinical features of CH and PCH without CAS in comparison to those with CAS. We analysed data from the Korea Cluster Headache Registry, a prospective multicentre registry involving data from 16 hospitals. Of the 216 participants with CH and 26 with PCH, 19 (8.8%) and 7 (26.9%), respectively, did not have CAS. Participants with CH without CAS exhibited less severe anxiety (General Anxiety Disorder-7 score, median [interquartile range], 2.0 [1.0–6.0] vs 8.0 [3.0–12.0], p = 0.001) and depression (Patient Health Questionnaire-9 score, 3.0 [1.0–7.0] vs 7.0 [3.0–11.0], p = 0.042) than those with CAS. Among participants with PCH, headache intensity was less severe in participants without CAS than in those with CAS (numeric rating scale, 8.0 [7.0–8.0] vs 9.5 [8.0–10.0], p = 0.015). In conclusion, a significant proportion of participants with CH and PCH did not have CAS. Some clinical features of CH and PCH differed based on the presence of CAS.

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

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

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

Pruritus and Malodour in Patients with Hidradenitis Suppurativa: Impact on Quality of Life and Clinical Features Associated with Symptom Severity

Dermatology ◽  
2019 ◽  
Vol 236 (1) ◽  
pp. 59-65 ◽  
Author(s):  
Alejandro Molina-Leyva ◽  
Carlos Cuenca-Barrales
Keyword(s):  
Quality Of Life ◽  
Clinical Features ◽  
Hidradenitis Suppurativa ◽  
Rating Scale ◽  
Life Quality ◽  
Numeric Rating Scale ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
The Impact

Background: Patients with hidradenitis suppurativa (HS) suffer from symptoms such as pruritus and malodour which can significantly impair their quality of life. Objectives: (1) To analyse the impact of pruritus and malodour on the quality of life of patients with HS and (2) to explore the potential association between clinical features and the severity of these symptoms. Patients and Methods: This is a cross-sectional study. The Numeric Rating Scale (NRS) was used to assess pruritus and malodour. Quality of life was assessed by means of the Dermatology Life Quality Index (DLQI). Results: Two hundred and thirty-three patients were included in the study. Both pruritus and malodour positively correlated with worse quality of life (p < 0.05). Pruritus intensity was associated with the number of regions affected by HS, female sex, the intensity of suppuration, and the presence of comorbid Crohn’s disease. Statin use was associated with lower levels of pruritus. Malodour intensity was associated with higher body mass index, disease duration, the number of regions affected, Hurley stage, and intensity of suppuration. Conclusions: The results of our study show that pruritus and malodour are key symptoms in patients with HS which have a great impact on their quality of life. We have identified clinical features potentially associated with the intensity of these symptoms which could be useful to identify higher-risk patients and may influence treatment decisions.

Peripheral provocation of cranial autonomic symptoms is not sufficient to trigger cluster headache attacks

Cephalalgia ◽  
2017 ◽  
Vol 38 (8) ◽  
pp. 1498-1502 ◽  
Author(s):  
Maike Möller ◽  
Ame Abdu Haji ◽  
Jan Hoffmann ◽  
Arne May
Keyword(s):  
Cluster Headache ◽  
Low Frequency ◽  
Central Component ◽  
Autonomic Symptoms ◽  
Cranial Autonomic Symptoms ◽  
Peripheral Stimulation ◽  
Low Frequency Stimulation ◽  
Frequency Stimulation ◽  
Lost To Follow Up

Background Recently it has been suggested that low frequency stimulation of the sphenopalatine ganglion (SPG) may provoke cluster-like attacks in cluster headache (CH) patients. The question arises whether a robust activation of cranial autonomic symptoms is sufficient to trigger CH attacks. Methods Kinetic oscillation stimulation (KOS) of the nasal mucosa generates ipsilateral marked autonomic symptoms, among which lacrimation is quantitatively measurable. KOS was applied to 29 CH-patients, including both episodic and chronic course. We measured lacrimation at rest and during stimulation, and assessed CH attacks within 24 hours after the experiment. Results Autonomic symptoms including lacrimation were robust and significantly generated, compared to rest. Six patients were lost to follow-up, but did not develop an attack during their stay in the clinic. Of the remaining 23 patients, none developed an attack in the next 4 hours after stimulation, despite marked cranial autonomic symptoms during stimulation. Discussion Peripheral stimulation close to the SPG generated a strong parasympathetic response. However, this stimulation was not sufficient to induce CH attacks, which suggests that a central component is crucial to attack generation.

scholarly journals Managing cluster headache

2019 ◽  
Vol 19 (6) ◽  
pp. 521-528 ◽  
Author(s):  
Diana Y Wei ◽  
Modar Khalil ◽  
Peter J Goadsby
Keyword(s):  
Cluster Headache ◽  
Neurological Disorder ◽  
Severe Headache ◽  
Accurate Diagnosis ◽  
Point Prevalence ◽  
Management Options ◽  
Trigeminal Autonomic Cephalalgia ◽  
Autonomic Symptoms ◽  
Cranial Autonomic Symptoms ◽  
Headache Patients

Cluster headache is a neurological disorder that presents with unilateral severe headache associated with ipsilateral cranial autonomic symptoms. Cluster headache attacks often occur more than once a day, and typically manifesting in bouts. It has a point prevalence of 1 in 1000 and is the most common trigeminal autonomic cephalalgia. This article aims to guide general neurologists to an accurate diagnosis and practical management options for cluster headache patients.

THUR 084 Cranial autonomic symptoms in cluster headache induced by nitroglycerin

2018 ◽  
Vol 89 (10) ◽  
pp. A9.3-A9
Author(s):  
DY Wei ◽  
PJ Goadsby
Keyword(s):  
Cluster Headache ◽  
Nasal Congestion ◽  
Ethics Committee ◽  
Conjunctival Injection ◽  
Headache Attack ◽  
Autonomic Symptoms ◽  
Cranial Autonomic Symptoms ◽  
Cluster Headache Attack ◽  
Episodic Cluster Headache ◽  
Periorbital Swelling

IntroductionCluster headache (CH) is characterised by attacks of unilateral excruciating headache, ipsilateral cranial autonomic symptoms (CAS) and/or agitation. Studying of CAS can further our understanding of CH pathophysiology, but is limited by the episodic nature of the disease. Nitroglycerin (NTG) is known to induce CH. The aim of this study is to characterise CAS induced by NTG.MethodsCH patients received intravenous NTG 0.5 mcg/kg/min over 20 min. CAS and headache phenotype were recorded. The study was approved by the NHS Research Ethics Committee.ResultsTwenty-three patients participated: 83% male and 61% episodic cluster headache. The most common spontaneous CAS reported were lacrimation, nasal congestion and conjunctival injection. Agitation was reported in 96%. Nitroglycerin induced ipsilateral CAS in 91% of the patients, with 74% with ipsilateral pain. Most commonly induced CAS were nasal congestion, lacrimation and periorbital swelling. Agitation was reported in 61%. The majority of the CAS (80%) induced by NTG presented before the onset of severe pain.ConclusionWe demonstrate that NTG effectively triggers ipsilateral cranial autonomic symptoms in CH patients and that they often present in a phase before the onset of pain reflecting the underlying pathways during a cluster headache attack.

Reduced CSF hypocretin-1 levels are associated with cluster headache

Cephalalgia ◽  
2014 ◽  
Vol 35 (10) ◽  
pp. 869-876 ◽  
Author(s):  
Mads Barloese ◽  
Poul Jennum ◽  
Nunu Lund ◽  
Stine Knudsen ◽  
Steen Gammeltoft ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cluster Headache ◽  
Clinical Features ◽  
Significant Relationship ◽  
Severe Pain ◽  
Antinociceptive Effect ◽  
Healthy Controls ◽  
Genetic Studies ◽  
Autonomic Symptoms ◽  
Hypocretin 1

Background Cluster headache (CH) is a debilitating disorder characterized by unilateral, severe pain attacks with accompanying autonomic symptoms, often waking the patient from sleep. As it exhibits strong chronobiological traits and genetic studies have suggested a link with the hypocretin (HCRT) system, the objective of this study was to investigate HCRT-1 in CH patients. Methods Cerebrospinal fluid HCRT-1 concentration was measured in 12 chronic and 14 episodic CH patients during an active bout, and in 27 healthy controls. The patients were well characterized and clinical features compared to the HCRT concentration. Results We found significantly lower HCRT levels both in chronic ( p = 0.0221) and episodic CH ( p = 0.0005) patients compared with controls. No significant relationship was found with other clinical features. Conclusions This is the first report of significantly reduced HCRT concentrations in CH patients. We speculate that decreased HCRT may reflect insufficient antinociceptive activity of the hypothalamus. The mechanism of the antinociceptive effect of HCRT is not known and requires further investigation. This study supports the hypothesis of a connection between arousal regulation and CH.

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