A Particular Variety of Headache

Symonds, C. P.

doi:10.1093/brain/79.2.217

Cited by 115 publications

(61 citation statements)

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“…Male testosterone levels drop in late adulthood, and female androgens, arising mainly from the adrenal gland, play a more prominent role as the ovaries fail [9]. A more interesting observation in CH, which has been noted for at least half a century, is the patient's appearance [1,12]. Men (and also women) suffering from CH can exhibit distinct clinical characteristics, including facial peau d'orange, leonine facies, and a tendency to be heavy smokers and/or consumers of alcohol.…”

Section: Features Of Chmentioning

confidence: 99%

“…For decades, cluster headache (CH) has challenged clinicians and researchers working in the field of head pain, leaving us with little more than was known half a century ago about this "particular variety of headache" [1]. With the advent of newer physiologic or functioning imaging technologies, the pathophysiology underlying these headaches is just being unraveled.…”

Section: Introductionmentioning

confidence: 99%

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Endocrinology of cluster headache: Potential for therapeutic manipulation

Stillman

Spears

2008

Current Science Inc

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Cluster headaches have always been among the most intriguing of the commonly recognized primary headache syndromes. This clinical interest is related to a number of factors, including the intense but short-lived nature of the pain, its sexual predilection, associated trigeminal autonomic dysfunction, and the remarkable circadian and circannual periodicity of cluster periods. Recent advances in neuroimaging and neuroendocrinology have shed light on the pivotal role of the hypothalamus in the biology of cluster headache. We discuss these revelations, along with current clinical observations in headache and sleep medicine.

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Section: Features Of Chmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endocrinology of cluster headache: Potential for therapeutic manipulation

Stillman

Spears

2008

Current Science Inc

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“…This follows logically from the use of ergotamine for this purpose. 27 Consequently naratriptan 2.5mg twice daily [28][29][30] and eletriptan 40mg twice daily 31 have been used for that purpose. It is a complex road to take with the possibility of triptan-overuse headache and the issue of how one might then dose breakthrough attacks.…”

Section: Short-term Prophylaxismentioning

confidence: 99%

Prevention and treatment of cluster headache

Cohen¹,

Goadsby²

2009

Prog Neurol Psychiatry

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CCluster headache (CH) is a stereotypical primar y headache syndrome, characterised by attacks of unilateral excruciating pain usually in the eye, periorbital region and temple, with associated cranial autonomic symptoms such as conjunctival injection, lacrimation, nasal blockage, rhinorrhea, ptosis, and eyelid oedema. Restlessness and agitation also feature prominently. Attacks last for 15-180 minutes, and have a frequency of one every other day up to eight a day. 1 They can be triggered by alcohol, 2 usually in under an hour, in contrast to migraine for which alcohol typically takes longer to trigger an attack. CH attacks often occur with so-called clock-like regularity, and may be precipitated by sleep.CH has a prevalence of 0.1 to 0.3 per cent in the general population, 3 and affects slightly more men than women, with a male: female ratio of 2.5:1 in a recent study. 2 Episodic cluster headache (ECH) is defined as bouts of attacks lasting from seven days up to one year, with breaks of one month or more between bouts. In chronic cluster headache (CCH) attacks occur for more than one year without remission, or with remissions lasting less than one month. In CCH there are micro-periods, and seasonal variation is sometimes seen. Unaware of this, clinicians and patients may feel prophylactics have 'stopped working' although in fact the disorder has changed. Over years this can lead to a creeping upwards of medicine doses and eventual accrual of side-effects. If one is aware of the phenomenon of periodicity even in CCH, the physician can, after a period of increased dosing, revert to the previous dose, or preferably use other strategies for short-term care to avoid changing the baseline preventive dose.CH is probably the most severe pain known to humans, with female patients describing each attack as worse than childbirth. Health-related quality of life is significantly impaired in CH suf ferers. 4,5 Even though it is under-recognised and often suboptimally managed in primary care, 6,7 an early diagnosis and prompt treatment are essential to alleviate the devastating morbidity of these attacks. 8 DiagnosisThe diagnosis is usually clear on taking a thorough history. The presence of autonomic symptoms, restlessness, and the length of the attacks usually distinguishes this from migraine, although a proportion of migraine patients may exhibit cranial autonomic features, 9-11 and migraine can coexist with CH by chance. The differential diagnosis for CH includes the other trigeminal autonomic cephalalgias (TACs), which are paroxysmal hemicrania (PH) and SUNCT (shor t-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing), although these dif fer from CH in that the attack lengths are shorter. 1 There is considerable overlap in attack frequency, such that typical CH patients have one to two attacks a day, typical PH patients 10 and typical SUNCT/SUNA patients 50, there is a marked skew that favours lower attack frequencies. 12 Another useful clinical pointer is the lateralisation of photo...

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“…24 Ergotamine 1-2 mg orally or rectally can be taken at bedtime or about an hour before the attack is due. It is rarely suitable for use in CCH.…”

Section: Ergotaminementioning

confidence: 99%

Trigeminal-Autonomic Cephalgias

2002

An Atlas of Headache

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T he trigeminal autonomic cephalgias (TACs) are a group of primary headache disorders characterised by unilateral trigeminal distribution pain that occurs in association with prominent ipsilateral cranial autonomic features.1 The group comprises cluster headache, paroxysmal hemicrania, hemicrania continua, and short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT syndrome). Firstly, they must be differentiated from secondary TACs, and other short lasting primary headaches (table 1), and then from each other. The concept of a short lasting headache is naturally somewhat artificial in terms of defining "short"-that said, a typical attack time is less than four hours, in contrast with the major differential diagnosis of migraine in which attacks are usually longer.2 The differentiation between TACs is essential since the treatments are very different. Hemicrania continua is a continuous headache and should be considered in the differential diagnosis of relatively long lasting chronic daily headache (see page ii2). 3The TACs are relatively rare, which is likely to be why they are poorly recognised in primary care. TACs will thus be referred to neurologists eventually, offering an excellent opportunity to diagnose and treat these patients. It is noteworthy that each of the TACs has been seen in paediatric practice. The importance of recognising these syndromes is underscored by their excellent but highly selective response to treatment. c CLUSTER HEADACHECluster headache (CH) is a strictly unilateral headache that occurs in association with cranial autonomic features and, in most patients, has a striking circannual and circadian periodicity. It is an excruciating syndrome and is probably one of the most painful conditions known to humans. Female patients describe each attack as being worse than childbirth. EpidemiologyThe prevalence of CH is estimated to be 0.1%, 4 approximately the same as that of multiple sclerosis in the UK. The male:female ratio is 3.5-7:1. 5 6 It can begin at any age though the most common age of onset is the third or fourth decade of life. Clinical featuresIt is useful for both clinician and patient to standardise the terms used in CH. A cluster headache or an attack is an individual episode of pain that can last from a few minutes to some hours. A cluster bout or period refers to the duration over which recurrent cluster attacks are occurring; it usually lasts some weeks or months. A remission is the pain-free period between two cluster bouts. CH is a disorder with highly distinctive clinical features. These features are dealt with under two headings: the cluster attack and the cluster bout. The cluster attackThe attacks are strictly unilateral, though the headache may alternate sides. The pain is excruciatingly severe. It is located mainly around the orbital and temporal regions though any part of the head can be affected. The headache usually lasts 45-90 minutes but can range from 15 minutes to three hours. It has an abrupt onset and cessation....

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A Particular Variety of Headache

Cited by 115 publications

References 0 publications

Endocrinology of cluster headache: Potential for therapeutic manipulation

Endocrinology of cluster headache: Potential for therapeutic manipulation

Prevention and treatment of cluster headache

Trigeminal-Autonomic Cephalgias

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