scholarly journals The anterior hypothalamus in cluster headache

Cephalalgia ◽  
2016 ◽  
Vol 37 (11) ◽  
pp. 1039-1050 ◽  
Author(s):  
Enrico B Arkink ◽  
Nicole Schmitz ◽  
Guus G Schoonman ◽  
Jorine A van Vliet ◽  
Joost Haan ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Structural Changes ◽  
Region Of Interest ◽  
Chronic Cluster Headache ◽  
Magnetic Resonance Images ◽  
Anterior Hypothalamus ◽  
Paroxysmal Hemicrania ◽  
Manual Segmentation ◽  
Whole Brain ◽  
Chronic Paroxysmal Hemicrania

Objective To evaluate the presence, localization, and specificity of structural hypothalamic and whole brain changes in cluster headache and chronic paroxysmal hemicrania (CPH). Methods We compared T1-weighted magnetic resonance images of subjects with cluster headache (episodic n = 24; chronic n = 23; probable n = 14), CPH ( n = 9), migraine (with aura n = 14; without aura n = 19), and no headache ( n = 48). We applied whole brain voxel-based morphometry (VBM) using two complementary methods to analyze structural changes in the hypothalamus: region-of-interest analyses in whole brain VBM, and manual segmentation of the hypothalamus to calculate volumes. We used both conservative VBM thresholds, correcting for multiple comparisons, and less conservative thresholds for exploratory purposes. Results Using region-of-interest VBM analyses mirrored to the headache side, we found enlargement ( p < 0.05, small volume correction) in the anterior hypothalamic gray matter in subjects with chronic cluster headache compared to controls, and in all participants with episodic or chronic cluster headache taken together compared to migraineurs. After manual segmentation, hypothalamic volume (mean±SD) was larger ( p < 0.05) both in subjects with episodic (1.89 ± 0.18 ml) and chronic (1.87 ± 0.21 ml) cluster headache compared to controls (1.72 ± 0.15 ml) and migraineurs (1.68 ± 0.19 ml). Similar but non-significant trends were observed for participants with probable cluster headache (1.82 ± 0.19 ml; p = 0.07) and CPH (1.79 ± 0.20 ml; p = 0.15). Increased hypothalamic volume was primarily explained by bilateral enlargement of the anterior hypothalamus. Exploratory whole brain VBM analyses showed widespread changes in pain-modulating areas in all subjects with headache. Interpretation The anterior hypothalamus is enlarged in episodic and chronic cluster headache and possibly also in probable cluster headache or CPH, but not in migraine.

scholarly journals Multiple cranial nerve blocks for the transitional treatment of chronic headaches

Cephalalgia ◽  
2019 ◽  
Vol 39 (12) ◽  
pp. 1488-1499 ◽  
Author(s):  
Sarah Miller ◽  
Susie Lagrata ◽  
Manjit Matharu
Keyword(s):  
Cluster Headache ◽  
Chronic Migraine ◽  
Cranial Nerve ◽  
Chronic Cluster Headache ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Nerve Blocks ◽  
Greater Occipital Nerve ◽  
Chronic Paroxysmal Hemicrania ◽  
Multiple Cranial Nerve

Background Multiple cranial nerve blocks of the greater and lesser occipital, supraorbital, supratrochlear and auriculotemporal nerves are widely used in the treatment of primary headaches. We present efficacy and safety data for these procedures. Methods In an uncontrolled open-label prospective study, 119 patients with chronic cluster headache, chronic migraine, short lasting unilateral neuralgiform attack disorders, new daily persistent headaches, hemicrania continua and chronic paroxysmal hemicrania were examined. All had failed to respond to greater occipital nerve blocks. Response was defined as a 50% reduction in either daily attack frequency or moderate-to-severe headache days after 2 weeks. Results The response rate of the whole cohort was 55.4%: Chronic cluster headache, 69.2%; chronic migraine, 49.0%; short lasting unilateral neuralgiform attack disorders, 56.3%; new daily persistent headache, 10.0%; hemicrania continua, 83.3%; and chronic paroxysmal hemicrania, 25.0%. Time to benefit was between 0.50 and 33.58 hours. Benefit was maintained for up to 4 weeks in over half of responders in all groups except chronic migraine and paroxysmal hemicrania. Only minor adverse events were recorded. Conclusion Multiple cranial nerve blocks may provide an efficacious, well tolerated and reproducible transitional treatment for chronic headache disorders when greater occipital nerve blocks have been unsuccessful.

Ipsilateral Cluster Headache and Chronic Paroxysmal Hemicrania: Two Case Reports

Cephalalgia ◽  
1992 ◽  
Vol 12 (5) ◽  
pp. 318-320 ◽  
Author(s):  
Alain Djacoba Tehindrazanarivelo ◽  
Jean Marc Visy ◽  
Marie-Germaine Bousser
Keyword(s):  
Complete Remission ◽  
Cluster Headache ◽  
Case Reports ◽  
Chronic Cluster Headache ◽  
Paroxysmal Hemicrania ◽  
Dramatic Improvement ◽  
Episodic Cluster Headache ◽  
Close Relationship ◽  
Chronic Paroxysmal Hemicrania

We report two patients with ipsilateral attacks of cluster headache and chronic paroxysmal hemicrania. The first patient, a 33-year-old man, started having attacks of chronic cluster headache at the age of 27. At 33, they were replaced by typical attacks of ipsilateral chronic paroxysmal hemicrania which showed a dramatic improvement with indomethacin 150 mg daily. After two days of complete remission, cluster headache attacks reappeared and persisted until verapamil, 360 mg a day, was added to indomethacin. The second patient, a 45-year-old man, first developed attacks of episodic cluster headache at the age of 35. At 44, he experienced ipsilateral typical attacks of chronic paroxysmal hemicrania, and two months later attacks of cluster headache. Under verapamil 240 mg daily, attacks of cluster headache disappeared, but those of chronic paroxysmal hemicrania increased in frequency until indomethacin 150 mg daily was added. These observations suggest a close relationship but not a similarity between cluster headache and chronic paroxysmal hemicrania, and show the practical therapeutic interest of maintaining this distinction. Cluster headache, chronic paroxysmal hemicrania, indomethacin, verapamil

Unilateral Photophobia or Phonophobia in Migraine Compared With Trigeminal Autonomic Cephalalgias

Cephalalgia ◽  
2008 ◽  
Vol 28 (6) ◽  
pp. 626-630 ◽  
Author(s):  
P Irimia ◽  
E Cittadini ◽  
K Paemeleire ◽  
AS Cohen ◽  
PJ Goadsby
Keyword(s):  
Cluster Headache ◽  
Clinical Symptoms ◽  
Medication Overuse Headache ◽  
Episodic Migraine ◽  
Chronic Cluster Headache ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Primary Headaches ◽  
Trigeminal Autonomic Cephalalgias ◽  
A Prospective Study

Our objective was to compare the presence of self-reported unilateral photophobia or phonophobia, or both, during headache attacks comparing patients with trigeminal autonomic cephalalgias (TACs)—including cluster headache, shortlasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and paroxysmal hemicrania—or hemicrania continua, and other headache types. We conducted a prospective study in patients attending a referral out-patient clinic over 5 months and those admitted for an intramuscular indomethacin test. Two hundred and six patients were included. In episodic migraine patients, two of 54 (4%) reported unilateral photophobia or phonophobia, or both. In chronic migraine patients, six of 48 (13%) complained of unilateral photophobia or phonophobia, or both, whereas none of the 24 patients with medication-overuse headache reported these unilateral symptoms, although these patients all had clinical symptoms suggesting the diagnosis of migraine. Only three of 22 patients (14%) suffering from new daily persistent headache (NDPH) experienced unilateral photophobia or phonophobia. In chronic cluster headache 10 of 21 patients (48%) had unilateral photophobia or phonophobia, or both, and this symptom appeared in four of five patients (80%) with episodic cluster headache. Unilateral photophobia or phonophobia, or both, were reported by six of 11 patients (55%) with hemicrania continua, five of nine (56%) with SUNCT, and four of six (67%) with chronic paroxysmal hemicrania. Unilateral phonophobia or photophobia, or both, are more frequent in TACs and hemicrania continua than in migraine and NDPH. The presence of these unilateral symptoms may be clinically useful in the differential diagnosis of primary headaches.

Chronic Paroxysmal Hemicrania: Heart Rate Changes and ECG Rhythm Disturbances. A Computerized Analysis of 24 h Ambulatory ECG Recordings

Cephalalgia ◽  
1984 ◽  
Vol 4 (2) ◽  
pp. 135-144 ◽  
Author(s):  
David Russell ◽  
Liv Storstein
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Cluster Headache ◽  
Heart Rate Change ◽  
Paroxysmal Hemicrania ◽  
Typical Pattern ◽  
Bundle Branch Block ◽  
Computerized Analysis ◽  
Ambulatory Ecg ◽  
Chronic Paroxysmal Hemicrania

Ambulatory ECG recordings have been carried out in five patients suffering from CPH. During the study a total of 105 attacks occurred. Contrary to findings in cluster headache, no typical pattern of heart rate change was found in association with attacks of CPH. A striking finding in all patients, however, was that there were often large and rapid variations in heart rate which could be observed “before”, “during” or “after” the attacks. One patient developed bradycardia and sino-atrial block and another bundle branch block together with episodes of atrial fibrillation in association with attacks.

Neuropeptide Changes in a case of Chronic Paroxysmal Hemicrania—Evidence for Trigemino-Parasympathetic Activation

Cephalalgia ◽  
1996 ◽  
Vol 16 (6) ◽  
pp. 448-450 ◽  
Author(s):  
P J Goadsby ◽  
L Edvinsson
Keyword(s):  
Cluster Headache ◽  
Vasoactive Intestinal Polypeptide ◽  
Successful Treatment ◽  
International Headache Society ◽  
Paroxysmal Hemicrania ◽  
Related Peptide ◽  
Calcitonin Gene ◽  
Autonomic Activation ◽  
Chronic Paroxysmal Hemicrania ◽  
Underlying Pathophysiology

Chronic paroxysmal hemicrania (CPH) is a rare headache syndrome of short-lasting attacks of pain, characterized clinically by trigemino-parasympathetic activation. The features of the headache are severe attacks of pain that generally last no more than minutes in association with autonomic activation, such as lacrimation or rhinorrhea. We report a patient fulfilling International Headache Society guidelines for the diagnosis of CPH in whom levels of calcitonin gene-related peptide (CGRP) and vasoactive intestinal polypeptide (VIP) were elevated in the cranial circulation during attacks. Moreover, successful treatment of the problem with indomethacin leads to normalization of the levels of both CGRP and VIP. Given that similar neuropeptide changes are seen in cluster headache the data suggest a shared underlying pathophysiology between CPH and cluster headache.

Chronic Paroxysmal Hemicrania. IX. On the Mechanism of Attack-Related Sweating

Cephalalgia ◽  
1983 ◽  
Vol 3 (3) ◽  
pp. 191-199 ◽  
Author(s):  
Carsten Saunte ◽  
David Russell ◽  
Ottar Sjaastad
Keyword(s):  
Body Weight ◽  
Cluster Headache ◽  
Paroxysmal Hemicrania ◽  
Sweat Glands ◽  
Sympathetic Stimulation ◽  
Provocation Tests ◽  
Denervation Supersensitivity ◽  
Chronic Paroxysmal Hemicrania ◽  
Exercise Induced ◽  
Symptomatic Side

In eight patients with chronic paroxysmal hemicrania (CPH), forehead sweating was measured after various provocation tests-body heating, exercise, and subcutaneous pilocarpine administration (0.1 mg/kg body weight). Evaporation was measured bilaterally on the forehead with an Evaporimeter (in g/m2/h). This was carried out in a thermo room under standardized conditions. There was no definite deficit in heat-induced or exercise-induced sweating on the symptomatic side of the forehead, contrary to findings in cluster headache. Neither did pilocarpine lead to any marked initial, temporary predominance of sweating on the symptomatic side, which has previously been found in cluster headache. In cluster headache there may be denervation supersensitivity of the sweat glands in the forehead of the symptomatic side. The present study does not therefore provide evidence for supersensitivity phenomena which could explain the homolateral forehead sweating increase seen during attacks in some CPH patients. The localized sweating increase in the forehead during attacks of CPH may possibly be a result of direct sympathetic stimulation.

Chronic Paroxysmal Hemicrania: XIII. The Pupillometric Pattern

Cephalalgia ◽  
1988 ◽  
Vol 8 (3) ◽  
pp. 219-226 ◽  
Author(s):  
Deusvenir de Souza Carvalho ◽  
Roll Salvesen ◽  
Trond Sand ◽  
Stephen E Smith ◽  
Ottar Sjaastad
Keyword(s):  
Cluster Headache ◽  
The Body ◽  
Paroxysmal Hemicrania ◽  
Sweat Glands ◽  
Chronic Paroxysmal Hemicrania ◽  
Sweating Patterns ◽  
Symptomatic Side ◽  
Age And Sex ◽  
Headache Patients

Pupillometric studies were carried out in eight patients with chronic paroxysmal hemicrania (CPH) and in age- and sex-matched controls in the basal condition and after instillation of 2% tyramine (CPH, n = 5; controls, n = 17), 1% OH-amphetamine (CPH, n = 6; controls, n = 12), and 1% phenylephrine (CPH, n = 6; controls, n = 17). The pupil on the symptomatic and non-symptomatic sides in CPH patients was significantly smaller in the basal condition than in controls, particularly on the symptomatic side. The mydriatic responses to pharmacologic stimulation were essentially similar on the symptomatic and non-symptomatic sides. An evaporimetric study of the forehead sweat glands, using the body heating and pilocarpine tests, was also carried out in these patients and in age- and sex-matched controls. “Early”, “intermediate”, and “late” measurements demonstrated symmetry of forehead sweating. The findings for both methods of examination thus contrast with those in cluster headache patients. Pupillometric and forehead sweating patterns therefore suggest differences in the pathogenesis of the two headache entities. These tests may be used to distinguish CPH and cluster headache clinically.

Sign in / Sign up

Export Citation Format

Share Document