scholarly journals Hemicrania Continua Associated with Classic Scintillating Scotoma

2018 ◽  
Vol 10 (1) ◽  
pp. 83-87 ◽  
Author(s):  
Eva Auffenberg ◽  
Friedemann Bender ◽  
Tobias Freilinger
Keyword(s):  
Primary Headache ◽  
Headache Disorder ◽  
Complete Response ◽  
Hemicrania Continua ◽  
Response To Treatment ◽  
Visual Aura ◽  
Primary Headache Disorder ◽  
Cranial Autonomic Symptoms ◽  
Potential Link ◽  
Scintillating Scotoma

Hemicrania continua (HC) is a rare primary headache disorder, characterized by persistent unilateral pain associated with cranial autonomic symptoms and prompt response to indomethacin. While migrainous features (including aura) have been recognized in cluster headache, there have been only single reports of HC with aura. Here, we report the case of a 53-year-old man with constant right-sided headache and superimposed exacerbations to severe pain lasting for several hours. Secondary etiologies were excluded, and a diagnosis of HC was established after prompt and complete response to treatment with indomethacin. During an episode of pain exacerbation, for the first time the patient experienced an episode of transient visual disturbances compatible with scintillating scotoma. We propose a potential link between HC and visual aura, which parallels similar observations in other trigeminal autonomic cephalalgias and more specifically confirms previous observational data on aura in HC, thus highlighting potentially shared pathophysiological mechanisms.

scholarly journals A case of remitting hemicrania continua with seasonal variation and clustering: a diagnostic confusion with cluster headache

2019 ◽  
Vol 12 (5) ◽  
pp. e229650
Author(s):  
Sanjay Prakash ◽  
Kalu Singh Rawat
Keyword(s):  
Discrete Series ◽  
Primary Headache ◽  
Complete Response ◽  
Hemicrania Continua ◽  
Therapeutic Trial ◽  
Cranial Autonomic Symptoms ◽  
Unilateral Headache ◽  
Continuous Background ◽  
Diagnostic Confusion ◽  
History Of

Hemicrania continua (HC) is an indomethacin responsive primary headache that is characterised by a continuous strictly unilateral headache with periodic exacerbations. About 15% may have a remitting subtype of HC. Herein, we are reporting a 36-year-old man who had a 5-year history of episodic right-sided headaches. The headaches used to occur in a discrete series lasting 4–6 weeks, separated by pain-free remissions of 10–11 months. In each relapse, he had continuous background pain with superimposed exacerbations. The superimposed exacerbations were 1–2 attacks per day, lasting for 2–5 hours, and were associated with ipsilateral cranial autonomic symptoms. However, the patient did not respond to usual therapies of custer headache (CH). He had a complete response to indomethacin. We suggest that remitting subtype of HC may mimic CH. A therapeutic trial of indomethacin should be done in all strictly unilateral headaches who are not responding to other drugs.

scholarly journals Update on Treatment of Cluster Headache

2021 ◽  
Vol 39 (3) ◽  
pp. 113-120
Author(s):  
Jong-Hee Sohn ◽  
Mi Ji Lee ◽  
Soo-Jin Cho
Keyword(s):  
Cluster Headache ◽  
Preventive Treatment ◽  
Primary Headache ◽  
Headache Disorder ◽  
Preventive Therapy ◽  
Systemic Steroid ◽  
Novel Treatments ◽  
Primary Headache Disorder ◽  
Cranial Autonomic Symptoms ◽  
High Flow Oxygen

Cluster headache (CH) is characterized by severe unilateral short-lasting headache attacks, accompanying ipsilateral cranial autonomic symptoms or the sense of restlessness and agitation, or both. CH is a highly disabling primary headache disorder but often not optimally treated. High-flow oxygen and parenteral triptans are the most effective treatment to treat an acute CH attack. Transitional treatments include systemic steroid therapy and sub-occipital steroid injection. For preventive therapy, verapamil and lithium are recommended as first-line treatments. Novel treatments have appeared, such as neuromodulation and medication targeting calcitonin gene-related peptide (CGRP) or its receptor. Galcanezumab, the only anti-CGRP receptor monoclonal antibody with proven efficacy for the preventive treatment of episodic CH, represents an important advance for pharmacological treatment of CH. Neuromodulation strategies, such as the non-invasive vagus nerve stimulation and the sphenopalatine ganglion stimulation, have been proven effective in reducing the intensity and frequency of attacks, and also to be safe and well tolerated.

Hypnic headache

2020 ◽  
pp. 230-236
Author(s):  
Dagny Holle ◽  
David W. Dodick
Keyword(s):  
Primary Headache ◽  
Headache Disorder ◽  
Lithium Carbonate ◽  
Grey Matter Volume ◽  
Hypnic Headache ◽  
Diagnostic Uncertainty ◽  
Primary Headache Disorder ◽  
Cranial Autonomic Symptoms ◽  
Headache Onset ◽  
Motor Restlessness

Hypnic headache (HH) is a rare primary headache disorder. Its main clinical features are strict sleep-related headache attacks that awaken patients from sleep. As headache attacks often occur at the same time at night, HH has also been referred to as ‘alarm clock headache’. Currently, 225 cases have been reported in the literature. Patients are generally older than 50 years of age at headache onset, but occurrence in younger patients and even children has been described. More women than man are affected. The headache may be bilateral or unilateral. Some migrainous features, such as nausea or photophobia, or mild cranial autonomic symptoms, such as lacrimation, may accompany HH and create diagnostic uncertainty. While most patients display some motor activity during the headache attacks, the agitation and motor restlessness that is characteristic of cluster headache does not appear. The pathophysiology of HH is still enigmatic. Hypothalamic involvement has been considered on the basis of the circadian rhythmicity, relationship with sleep, and imaging evidence of a decrease in grey matter volume within the posterior hypothalamus. Caffeine, lithium carbonate, and indomethacin may be effective for the prevention of attacks, but randomized, placebo-controlled trials are not yet available.

scholarly journals Evidence That HFE H63D Variant Is a Potential Disease Modifier in Cluster Headache

2021 ◽  
Author(s):  
Maria Papasavva ◽  
Michail Vikelis ◽  
Martha-Spyridoula Katsarou ◽  
Vasileios Siokas ◽  
Emmanouil Dermitzakis ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Iron Homeostasis ◽  
Hereditary Hemochromatosis ◽  
Primary Headache ◽  
Headache Disorder ◽  
Allelic Frequency ◽  
Primary Headaches ◽  
Primary Headache Disorder ◽  
Disease Modifier ◽  
Potential Link

AbstractCluster headache (CH) is a primary headache disorder with a complex genetic background. Several studies indicate a potential link between iron homeostasis and the pathophysiology of primary headaches. The HFE gene encodes for a protein involved in iron metabolism, while genetic variants in HFE have been associated with hereditary hemochromatosis (HH), an iron overload disorder. The objective of the current study was to examine the association of the more common HFE H63D variant, with the susceptibility to develop CH and diverse clinical phenotypes in a population of Southeastern European Caucasian (SEC) origin. Genomic DNA samples from 128 CH patients and 294 neurologically healthy controls were genotyped for the HFE rs1799945 (H63D) variant. H63D genotypic and allelic frequency distribution did not differ significantly between patients and controls (p > 0.05). Subgroup analysis revealed a significantly more frequent occurrence of the variant G allele in chronic compared to episodic CH patients, indicative for a possible correlation of the HFE gene with the susceptibility for disease chronification. Although homozygosity for the less prevalent H63D variant G allele was minimal in the CH cohort, the results of the present study are in accordance with previous studies in CH and migraine patients, suggesting that HFE H63D variant modifies the disease clinical characteristics. Hence, despite the absence of a per se association with CH susceptibility in the current SEC cohort, variability in HFE gene may be potentially regarded as a disease modifier genetic factor in CH.

Hemicrania Continua: Who Responds to Indomethacin?

Cephalalgia ◽  
2009 ◽  
Vol 29 (3) ◽  
pp. 300-307 ◽  
Author(s):  
MJ Marmura ◽  
SD Silberstein ◽  
M Gupta
Keyword(s):  
Medication Overuse ◽  
Primary Headache ◽  
Headache Disorder ◽  
Rapid Onset ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Autonomic Symptoms ◽  
Primary Headache Disorder ◽  
Unilateral Headache ◽  
Headache Onset

Hemicrania continua (HC) is a primary headache disorder characterized by a continuous, moderate to severe, unilateral headache and defined by its absolute responsiveness to indomethacin. However, some patients with the clinical phenotype of HC do not respond to indomethacin. We reviewed the records of 192 patients with the putative diagnosis of HC and divided them into groups based on their headaches' response to indomethacin. They were compared for age, gender, presence or absence of specific autonomic symptoms, medication overuse, rapidity of headache onset, and whether or not the headaches met criteria for migraine when severe. Forty-three patients had an absolute response and 122 patients did not respond to adequate doses of indomethacin. The two groups did not differ significantly in terms of age, sex, presence of rapid-onset headache, or medication overuse. Autonomic symptoms, based on a questionnaire, did not predict response. Eighteen patients could not complete a trial of indomethacin due to adverse events. Nine patients could not be included in the HC group despite improvement with indomethacin: one patient probably had primary cough headache, another paroxysmal hemicrania; three patients improved but it was uncertain if they were absolutely pain free, and four patients dramatically improved but still had a baseline headache. We found no statistically significant differences between patients who did and did not respond to indomethacin. All patients with continuous, unilateral headache should receive an adequate trial of indomethacin. Most patients with unilateral headache suggestive of HC did not respond to indomethacin.

Hemicrania Continua: Comparison Between Two Different Classification Systems

Cephalalgia ◽  
2002 ◽  
Vol 22 (3) ◽  
pp. 242-245 ◽  
Author(s):  
ME Bigal ◽  
SJ Tepper ◽  
AM Rapoport ◽  
FD Sheftell
Keyword(s):  
International Headache Society ◽  
Primary Headache ◽  
Headache Disorder ◽  
Hemicrania Continua ◽  
Classification Systems ◽  
Primary Headache Disorder ◽  
Group 3 ◽  
International Headache Society Classification

Hemicrania continua is an uncommon primary headache disorder. This study of nine patients compares two different classification systems, proposed by Pareja et al. and Goadsby and Lipton. Although it seems logical to position the nosologic status of hemicrania continua under group 3 of the International Headache Society Classification, as proposed by Pareja et al., the Goadsby and Lipton classification is more clinically useful and should be included in future International Headache Society reclassification.

Hemicrania Continua with Aura

Cephalalgia ◽  
2002 ◽  
Vol 22 (3) ◽  
pp. 246-248 ◽  
Author(s):  
MFP Peres ◽  
Hua Chiang Siow ◽  
TD Rozen
Keyword(s):  
Severe Pain ◽  
Primary Headache ◽  
Headache Disorder ◽  
Hemicrania Continua ◽  
Moderate Severity ◽  
Primary Headache Disorder ◽  
Unilateral Headache

Hemicrania continua is a primary headache disorder that is characterized by a continuous unilateral headache of moderate severity, exacerbations of severe pain and complete responsiveness to indomethacin. We report four patients with a unique variant of hemicrania continua: visual auras that precede or accompany the pain exacerbations.

scholarly journals Effectiveness of paranasal air suction on acute migraine using portable air sucker – a randomized, double blind study

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
S. M. R. Bandara ◽  
S. Samita ◽  
A. M. Kiridana ◽  
H. M. M. T. B. Herath
Keyword(s):  
Clinical Trial ◽  
Side Effects ◽  
Sri Lanka ◽  
Primary Headache ◽  
Headache Disorder ◽  
Low Pressure ◽  
Outcome Variable ◽  
Double Blind ◽  
Primary Headache Disorder ◽  
Before And After

Abstract Background Migraine is a primary headache disorder and is the most common disabling primary headache disorder that occurs in children and adolescents. A recent study showed that paranasal air suction can provide relief to migraine headache. However, in order to get the maximum benefit out of it, an easy to use effective air sucker should be available. Aiming to fulfil the above requirement, a randomized, double blind control clinical trial was conducted to investigate the efficacy of a recently developed low–pressure portable air sucker. Methods Eighty-six Sri Lankan school children of age 16–19 years with migraine were enrolled for the study. They were randomly allocated into two groups, and one group was subjected to six intermittent ten-second paranasal air suctions using the portable air sucker for 120 s. The other group was subjected to placebo air suction (no paranasal air suction). The effect of suction using portable air sucker was the primary objective but side of headache, type of headache, and gender were also studied as source variables. The primary response studied was severity of headache. In addition, left and right supraorbital tenderness, photophobia, phonophobia, numbness over the face and scalp, nausea and generalized tiredness/weakness of the body were studied. The measurements on all those variables were made before and after suction, and the statistical analysis was performed based on before and after differences. As a follow–up, patients were monitored for 24-h period. Results There was a significant reduction in the severity of headache pain (OR = 25.98, P < 0.0001), which was the primary outcome variable, and other migraine symptoms studied, tenderness (left) (OR = 289.69, P < 0.0001), tenderness (right) (OR > 267.17, P < 0.0001), photophobia (OR = 2115.6, P < 0.0001), phonophobia (OR > 12.62, P < 0.0001) nausea (OR > 515.59, P < 0.0001) and weakness (OR = 549.06, P < 0.0001) except for numbness (OR = 0.747, P = 0.67) in the treatment group compared to the control group 2 min after the suction. These symptoms did not recur within 24-h period and there were no significant side effects recorded during the 24-h observation period. Conclusion This pilot study showed that low–pressure portable air sucker is effective in paranasal air suction, and suction for 120 s using the sucker can provide an immediate relief which can last for more than 24-h period without any side effects. Trail registration Clinical Trial Government Identification Number – 1548/2016. Ethical Clearance Granted Institute – Medical Research Institute, Colombo, Sri Lanka (No 38/2016). Sri Lanka Clinical Trial Registration No: SLCTR/2017/018. Date of registration = 29/ 06/2017. Approval Granting Organization to use the device in the clinical trial– National Medicines Regulatory Authority Sri Lanka (16 Jan 2018), The device won award at Geneva international inventers exhibition in 2016 and President award in 2018 in Sri Lanka. It is a patented device in Sri Lanka and patent number was SLKP/1/18295. All methods were carried out in accordance with CONSORT 2010 guidelines.

scholarly journals Diagnosis and management of migraine in ten steps

2021 ◽  
Author(s):  
Anna K. Eigenbrodt ◽  
Håkan Ashina ◽  
Sabrina Khan ◽  
Hans-Christoph Diener ◽  
Dimos D. Mitsikostas ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Consensus Statement ◽  
Preventive Treatment ◽  
Primary Headache ◽  
Headache Disorder ◽  
Clinical Decision ◽  
Diagnosis And Management ◽  
Primary Headache Disorder ◽  
Management Of Complications ◽  
European Headache Federation

AbstractMigraine is a disabling primary headache disorder that directly affects more than one billion people worldwide. Despite its widespread prevalence, migraine remains under-diagnosed and under-treated. To support clinical decision-making, we convened a European panel of experts to develop a ten-step approach to the diagnosis and management of migraine. Each step was established by expert consensus and supported by a review of current literature, and the Consensus Statement is endorsed by the European Headache Federation and the European Academy of Neurology. In this Consensus Statement, we introduce typical clinical features, diagnostic criteria and differential diagnoses of migraine. We then emphasize the value of patient centricity and patient education to ensure treatment adherence and satisfaction with care provision. Further, we outline best practices for acute and preventive treatment of migraine in various patient populations, including adults, children and adolescents, pregnant and breastfeeding women, and older people. In addition, we provide recommendations for evaluating treatment response and managing treatment failure. Lastly, we discuss the management of complications and comorbidities as well as the importance of planning long-term follow-up.

scholarly journals Topiramate Versus Propranolol in the Prophylaxis of Migraine in Bangladeshi Population

2020 ◽  
Vol 18 (2) ◽  
pp. 12-17
Author(s):  
Muhammad Tayeb ◽  
Md Hasanuzzaman ◽  
Abul Mansur Md Rezaul Karim ◽  
Mohammad Sanaullah ◽  
Md Ashraful Islam
Keyword(s):  
Migraine Attack ◽  
Divided Dose ◽  
Low Dose ◽  
Primary Headache ◽  
Headache Disorder ◽  
Treatment Groups ◽  
Primary Headache Disorder ◽  
Significant Difference ◽  
The Mean ◽  
Bangladeshi Population

Background : Migraine is primary headache disorder characterized by recurring attacks of pain and associated symptoms. The management modality is still unsatisfactory due to poor understanding of its cause and pathogenesis. To assess the efficacy and safety of low dose Topiramate vs Propranolol in migraine prophylaxis. Materials and methods : A randomized clinical trial including 130 patients with frequent migraine headache >5 attacks per month was performed in the out patients Department of Medicine and Neurology, CMCH for a period of 12 weeks. The patients were randomly divided into two treatment groups – treated by Topiramate 50mg/day and Propranolol 80mg/day respectively. Topiramate started with 25mg/day for 7 days then increased up to 50mg/day in two divided dose. Propranolol started with 40mg/day for 7 days then increased up to 80mg/day in two divided dose. The patients were assessed at 0, 8 and 12 weeks of the study. Results: The Topiramate group showed a reduction in the mean (±SD) of frequency of migraine attack from 6.95(±2.88) to 1.75(±1.08) episode per month, headache days per month from 7.62(±4.14) to 1.83(±1.10), intensity of headache per attack from 8.98(±1.05) to 6.10(±2.50) based on VAS scale, duration of headache per episode from 11.56(±9.16) to 5.40(±2.97) per hour and MIDAS score from 16.19(±3.91) to 8.14(±3.93). In patient treated with Propranolol, the mean (±SD) of monthly frequency of migraine attack declined from 7.09(±2.87) to 1.92(±0.98) episode per month, headache days per month from 8.17(±4.52) to 1.86(±o.83), intensity of headache per attack from 8.47(±1.10) to 6.03(±2.05) based on VAS scale, duration of headache per episode from 11.16(±8.08) to 5.97(±3.45), MIDAS score from 15.48(±3.55) to7.77(±3.49). Pre- and post-treatment values were significantly different for individual groups but no significant difference observed between groups. Conclusion: This study demonstrated that both low dose Topiramate and propranolol could significantly reduce migraine frequency, intensity and duration. Chatt Maa Shi Hosp Med Coll J; Vol.18 (2); July 2019; Page 12-17

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