scholarly journals Chronic cluster headache: a study of the telencephalic and cerebellar cortical thickness

2021 ◽  
Author(s):  
Greta Demichelis ◽  
Chiara Pinardi ◽  
Luca Giani ◽  
Jean Paul Medina ◽  
Ruben Gianeri ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Functional Characterization ◽  
Chronic Cluster Headache ◽  
Cross Sectional ◽  
Morphological Alterations ◽  
Cortical Thinning ◽  
Left Posterior ◽  
Posterior Insula ◽  
The Right ◽  
Headache Patients

AbstractPrevious studies on brain morphological alterations in chronic cluster headache revealed inconsistent findings. The present cross-sectional explorative study determined telencephalic and cerebellar cortex thickness alterations in a relatively wide sample of chronic cluster headache patients (n=28) in relation to matched healthy individuals. The combination of two highly robust state-of-the-art approaches for thickness estimation (Freesurfer and CERES) with an unbiased functional characterization of the abnormal regions, revealed two main results. First, chronic cluster headache patients show cortical thinning in the right middle cingulate cortex and the left posterior insula. This indicates abnormalities in key-regions of pain processing areas, in particular in regions belonging to the spino-thalamic-cortical tract and primarily involved in the sensory-motor aspects of nociception. Second, chronic cluster headache patients present cortical thinning in the left anterior superior temporal sulcus and the left collateral/lingual sulcus, suggesting neuroplastic maladaptations in areas possibly involved in social cognition, which may promote psychiatric comorbidity, frequently observed in these patients.

scholarly journals Chronic cluster headache: A study of the telencephalic and cerebellar cortical thickness

Cephalalgia ◽  
2021 ◽  
pp. 033310242110582
Author(s):  
Greta Demichelis ◽  
Chiara Pinardi ◽  
Luca Giani ◽  
Jean Paul Medina ◽  
Ruben Gianeri ◽  
...  
Keyword(s):  
Functional Connectivity ◽  
Cluster Headache ◽  
Functional Characterization ◽  
Chronic Cluster Headache ◽  
Cross Sectional ◽  
Morphological Alterations ◽  
Cortical Thinning ◽  
Left Posterior ◽  
Posterior Insula ◽  
Headache Patients

Purpose Previous studies on brain morphological alterations in chronic cluster headache revealed inconsistent findings. Method The present cross-sectional explorative study determined telencephalic and cerebellar cortex thickness alterations in a relatively wide sample of chronic cluster headache patients (n = 28) comparing them to matched healthy individuals. Results The combination of two highly robust state-of-the-art approaches for thickness estimation (Freesurfer, CERES), strengthened by functional characterization of the identified abnormal regions, revealed four main results: chronic cluster headache patients show 1) cortical thinning in the right middle cingulate cortex, left posterior insula, and anterior cerebellar lobe, regions involved in nociception's sensory and sensory-motor aspects and possibly in autonomic functions; 2) cortical thinning in the left anterior superior temporal sulcus and the left collateral/lingual sulcus, suggesting neuroplastic maladaptation in areas possibly involved in social cognition, which may promote psychiatric comorbidity; 3) abnormal functional connectivity among some of these identified telencephalic areas; 4) the identified telencephalic areas of cortical thinning present robust interaction, as indicated by the functional connectivity results, with the left posterior insula possibly playing a pivotal role. Conclusion The reported results constitute a coherent and robust picture of the chronic cluster headache brain. Our study paves the way for hypothesis-driven studies that might impact our understanding of the pathophysiology of this condition.

Illicit drug use in cluster headache patients and in the general population: A comparative cross-sectional survey

Cephalalgia ◽  
2012 ◽  
Vol 32 (14) ◽  
pp. 1031-1040 ◽  
Author(s):  
Paolo Rossi ◽  
Marta Allena ◽  
Cristina Tassorelli ◽  
Grazia Sances ◽  
Cherubino Di Lorenzo ◽  
...  
Keyword(s):  
Drug Use ◽  
General Population ◽  
Cluster Headache ◽  
Illicit Drug ◽  
Illicit Drug Use ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Headache Patients

scholarly journals Effect of calcitonin gene-related peptide (-receptor) antibodies in chronic cluster headache: Results from a retrospective case series support individual treatment attempts

Cephalalgia ◽  
2020 ◽  
Vol 40 (14) ◽  
pp. 1574-1584 ◽  
Author(s):  
Ruth Ruscheweyh ◽  
Gregor Broessner ◽  
Gudrun Goßrau ◽  
Katja Heinze-Kuhn ◽  
Tim P Jürgens ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Calcitonin Gene Related Peptide ◽  
Chronic Cluster Headache ◽  
Individual Treatment ◽  
Attack Frequency ◽  
Peptide Receptor ◽  
Related Peptide ◽  
Calcitonin Gene ◽  
Receptor Antibodies ◽  
Headache Patients

Objective To assess the efficacy of monoclonal antibodies targeting calcitonin gene-related peptide (CGRP) or its receptor in chronic cluster headache (CCH) treatment under real world conditions. Background Calcitonin gene-related peptide has an important pathophysiological role in cluster headache. Although the randomised controlled trial with the calcitonin gene-related peptide antibody galcanezumab was negative, chronic cluster headache patients with insufficient response to other preventive treatments have been receiving individual off-label treatment attempts with calcitonin gene-related peptide-(receptor) antibodies. Methods Data from 22 chronic cluster headache patients who received at least one dose of a calcitonin gene-related peptide(-receptor) antibody and recorded attack frequency in a headache diary were retrospectively collected at eight headache centres. Results The number of previous preventive therapies was 6.5 ± 2.4 (mean ± standard deviation, range: 2–11). The average number of attacks per week was 23.3 ± 16.4 at baseline and significantly decreased by −9.2 ± 9.7 in the first month of treatment with a calcitonin gene-related peptide(-receptor) antibody ( p < 0.001). Fifty-five percent of the patients were 50% responders and 36% were 75% responders with respect to attack frequency. Significant reduction of attack frequency started at week 1 (−6.8 ± 2.8 attacks, p < 0.01). Results were corroborated by significant decreases in weekly uses of acute headache medication (−9.8 ± 7.6, p < 0.001) and pain intensity during attacks (−1.2 ± 2.0, numerical rating scale (NRS) [0–10], p < 0.01) in the first month. In months 2 (n = 14) and 3 (n = 10), reduction of attack frequency from baseline was −8.0 ± 8.4 ( p = 0.004) and −9.1 ± 10.0 ( p = 0.024), respectively. Conclusion Under real-world conditions, individual treatment with calcitonin gene-related peptide(-receptor) antibodies was effective in 55% of our chronic cluster headache patients. This finding supports individual off-label treatment attempts with calcitonin gene-related peptide-(receptor) antibodies in chronic cluster headache patients insufficiently responding to other therapies.

scholarly journals Clomiphene treatment may be effective in refractory episodic and chronic cluster headache

2017 ◽  
Vol 75 (9) ◽  
pp. 620-624 ◽  
Author(s):  
Maria Eduarda Nobre ◽  
Mario Fernando Prieto Peres ◽  
Pedro Ferreira Moreira Filho ◽  
Antonio José Leal
Keyword(s):  
Complete Remission ◽  
Cluster Headache ◽  
Chronic Cluster Headache ◽  
Free Time ◽  
Chronic Patients ◽  
Conventional Medication ◽  
Episodic Cluster Headache ◽  
Cluster Headaches ◽  
Headache Patients

ABSTRACT Objective To describe the evolution of 15 patients who were treated for difficult-to-control episodic and chronic cluster headaches with clomiphene. Methods Clomiphene treatment was used for seven chronic and eight episodic cluster headache patients. The chronic patients were refractory to the medication being used, and the episodic patients, in addition to being resistant to conventional medication, had longer cluster headache periods, exceeding the average time of previous cluster cycles. Our main analysis was of the time to pain-free, complete remission, and the length of pain-free time and complete remission. Results Clomiphene was used for 45-180 days. The average time to being pain-free was 15 days and cluster remission was up to 60 days. The average time between being pain-free until cluster remission was 26 days. Conclusions Clomiphene treatment was significantly efficient. It interrupted chronicity in all patients, suggesting the capability of changing the pattern of attacks. It proved to be safe and well tolerated.

Abnormal tyrosine metabolism in chronic cluster headache

Cephalalgia ◽  
2016 ◽  
Vol 37 (2) ◽  
pp. 148-153 ◽  
Author(s):  
Giovanni D’Andrea ◽  
Massimo Leone ◽  
Gennaro Bussone ◽  
Paola Di Fiore ◽  
Andrea Bolner ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Plasma Levels ◽  
Primary Headache ◽  
Chronic Cluster Headache ◽  
Predisposing Factor ◽  
Episodic Cluster Headache ◽  
Tyrosine Metabolism ◽  
Low Levels ◽  
And Control ◽  
Headache Patients

Objective Episodic cluster headache is characterized by abnormalities in tyrosine metabolism (i.e. elevated levels of dopamine, tyramine, octopamine and synephrine and low levels of noradrenalin in plasma and platelets.) It is unknown, however, if such biochemical anomalies are present and/or constitute a predisposing factor in chronic cluster headache. To test this hypothesis, we measured the levels of dopamine and noradrenaline together with those of elusive amines, such as tyramine, octopamine and synephrine, in plasma of chronic cluster patients and control individuals. Methods Plasma levels of dopamine, noradrenaline and trace amines, including tyramine, octopamine and synephrine, were measured in a group of 23 chronic cluster headache patients (10 chronic cluster ab initio and 13 transformed from episodic cluster), and 16 control participants. Results The plasma levels of dopamine, noradrenaline and tyramine were several times higher in chronic cluster headache patients compared with controls. The levels of octopamine and synephrine were significantly lower in plasma of these patients with respect to control individuals. Conclusions These results suggest that anomalies in tyrosine metabolism play a role in the pathogenesis of chronic cluster headache and constitute a predisposing factor for the transformation of the episodic into a chronic form of this primary headache.

Secondary chronic cluster headache treated by posterior hypothalamic deep brain stimulation: First reported case

Cephalalgia ◽  
2012 ◽  
Vol 33 (2) ◽  
pp. 136-138 ◽  
Author(s):  
Giuseppe Messina ◽  
Michele Rizzi ◽  
Roberto Cordella ◽  
Augusto Caraceni ◽  
Ernesto Zecca ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Cluster Headache ◽  
Brain Stimulation ◽  
Soft Tissues ◽  
Chronic Cluster Headache ◽  
Successful Outcome ◽  
The Right ◽  
Fondazione Irccs ◽  
Deep Brain

Introduction Deep brain stimulation (DBS) of the posterior hypothalamus (pHyp) has been reported as an effective treatment for primary, drug-refractory and chronic cluster headache (CCH). We here describe the use of such a procedure for the treatment of secondary CCH due to a neoplasm affecting the soft tissues of the right hemiface. Methods A 27-year-old man affected by infiltrating angiomyolipoma of the right hemiface who subsequently developed drug refractory homolateral CCH underwent DBS of the right pHyp region at the Fondazione IRCCS Istituto Nazionale Neurologico Carlo Besta. Results After surgery, the patient presented a significant reduction in frequency of pain bouts. However, because of a subsequent infection, the entire system was removed. After re-implantation of the system, successful outcome was observed at 2 years follow-up. Discussion This brief report shows the feasibility of pHyp DBS in secondary drug-refractory CCH syndromes; future reports are needed in order to confirm our positive result.

Evaluation of guideline-adherent treatment in cluster headache

Cephalalgia ◽  
2015 ◽  
Vol 36 (8) ◽  
pp. 760-764 ◽  
Author(s):  
Victoria Lademann ◽  
Jan-Peter Jansen ◽  
Stefan Evers ◽  
Achim Frese
Keyword(s):  
Cluster Headache ◽  
Acute Treatment ◽  
Prophylactic Treatment ◽  
Treatment Guidelines ◽  
Acute Attack ◽  
Chronic Cluster Headache ◽  
European Federation ◽  
Efficacy Rate ◽  
History Of ◽  
Headache Patients

Background Several treatment guidelines exist for cluster headache. However, it is not yet known how many cluster headache patients are treated according to these guidelines. Methods We enrolled 434 cluster headache patients with confirmed diagnosis referred to two tertiary pain centers. The history of treatment was registered and analyzed according to the treatment guidelines of the European Federation of Neurological Societies. Results Regarding acute attack treatment, 62.1% of the episodic and 71.0% of the chronic cluster headache patients were treated according to the guidelines. The efficacy rate was above 92% in both groups. Regarding prophylactic treatment, 31.3% of the episodic and 50.9% of the chronic cluster headache patients were treated according to the guidelines. The efficacy rate was 92.8% for episodic and 70.9% for chronic cluster headache. Conclusion The rate of guideline-adherent treatment in cluster headache is about 70% for acute treatment and about 35% for prophylactic treatment. The efficacy of this treatment is significantly higher than the efficacy of non-guideline-adherent treatment.

Motor cortex stimulation in patients with deafferentation pain: activation of the posterior insula and thalamus

2007 ◽  
Vol 107 (1) ◽  
pp. 43-48 ◽  
Author(s):  
Haruhiko Kishima ◽  
Youichi Saitoh ◽  
Yasuhiro Osaki ◽  
Hiroshi Nishimura ◽  
Amami Kato ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Orbitofrontal Cortex ◽  
Spine Injury ◽  
Precentral Gyrus ◽  
Motor Cortex Stimulation ◽  
Posterior Thalamus ◽  
Deafferentation Pain ◽  
Left Posterior ◽  
Posterior Insula ◽  
The Right

Object The mechanisms underlying deafferentation pain are not well understood. Motor cortex stimulation (MCS) is useful in the treatment of this kind of chronic pain, but the detailed mechanisms underlying its effects are unknown. Methods Six patients with intractable deafferentation pain in the left hand were included in this study. All were right-handed and had a subdural electrode placed over the right precentral gyrus. The pain was associated with brainstem injury in one patient, cervical spine injury in one patient, thalamic hemorrhage in one patient, and brachial plexus avulsion in three patients. Treatment with MCS reduced pain; visual analog scale (VAS) values for pain were 82 ± 20 before MCS and 39 ± 20 after MCS (mean ± standard error). Regional cerebral blood flow (rCBF) was measured by positron emission tomography with H215O before and after MCS. The obtained images were analyzed with statistical parametric mapping software (SPM99). Results Significant rCBF increases were identified after MCS in the left posterior thalamus and left insula. In the early post-MCS phase, the left posterior insula and right orbitofrontal cortex showed significant rCBF increases, and the right precentral gyrus showed an rCBF decrease. In the late post-MCS phase, a significant rCBF increase was detected in the left caudal part of the anterior cingulate cortex (ACC). Conclusions These results suggest that MCS modulates the pathways from the posterior insula and orbitofrontal cortex to the posterior thalamus to upregulate the pain threshold and pathways from the posterior insula to the caudal ACC to control emotional perception. This modulation results in decreased VAS scores for deafferentation pain.

Dopaminergic system abnormalities in chronic cluster headache patients

2021 ◽  
Vol 429 ◽  
pp. 117736
Author(s):  
Luca Giani ◽  
Stefania Ferraro ◽  
Anna Nigri ◽  
Maria Grazia Bruzzone ◽  
Chiara Pinardi ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Dopaminergic System ◽  
Chronic Cluster Headache ◽  
Headache Patients

Changes in medication cost observed in chronic cluster headache patients treated with sphenopalatine ganglion (SPG) stimulation: Analysis based on 1-year data from the Pathway R-1 Registry

Cephalalgia ◽  
2018 ◽  
Vol 38 (8) ◽  
pp. 1455-1462 ◽  
Author(s):  
Jan B Pietzsch ◽  
Simon A Weber ◽  
Nunu Lund ◽  
Charly Gaul
Keyword(s):  
Cluster Headache ◽  
Cost Savings ◽  
Chronic Cluster Headache ◽  
Medication Cost ◽  
Base Case ◽  
Sphenopalatine Ganglion ◽  
Chronic Patients ◽  
Medication Costs ◽  
Preventive Medication ◽  
Headache Patients

Background On-demand stimulation of the sphenopalatine ganglion (SPG) by means of an implantable neurostimulation system has been shown to be a safe and effective therapy for treatment-refractory cluster headache patients. Our objective was to estimate changes in cluster headache medication cost observed in SPG-treated chronic patients. Methods Detailed patient-level data of 71 chronic patients treated with the Pulsante® SPG Microstimulator System were available from the Pathway R-1 Registry through 12 months’ follow-up. We used utilization data of preventive and acute medications reported at baseline, 3, 6, 9, and 12 months to estimate annualized drug costs for SPG-treated patients and compared it to baseline. Cost estimates for all drug/dosage combinations were developed based on German medication prices for 2016. Results In the base case analysis, mean annual acute and preventive medication costs decreased from €14,178 to €6924 (−€7254; −51%), and €559 to €328 (−€231; −41%), respectively, leading to total estimated annual drug cost savings of €7484, 97% of which were attributable to acute medications. Conclusions Our analysis suggests that SPG stimulation for the treatment of chronic cluster headache is associated with pronounced reductions in cluster headache medication usage that might lead to sizable annual savings in medication costs.

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