Headache and Autonomic Dysfunction: a Review

Iser, Courtney; Arca, Karissa N.

doi:10.1007/s11910-022-01225-3

Cited by 9 publications

(7 citation statements)

References 89 publications

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“…From here, postsynaptic parasympathetic impulses travel via the maxillary nerve (7) and meningeal nerves (8) to reach the meninges (10,11) and extraparenchymal meningeal blood vessels (12), which are dilated and inflammatory mediators are released. Either the vasodilatation or the inflammation or both cause nociception, and the nociception impulses travel via the trigeminal ganglion (16) and trigeminal nerve (17) to the principal (18), mesencephalic (19), and spinal (20) nuclei of the trigeminal nerve causing the release of further inflammatory mediators to spread to other areas of the brain and be interpreted as pain (reproduced with the kind permission of Mary K. Bryson and Lumina Health). PHD, primary headache disorder; TVT, trigeminovascular theory.…”

Section: Discussionmentioning

confidence: 99%

Refractory primary and secondary headache disorders that dramatically responded to combined treatment of ultrasound-guided percutaneous suprazygomatic pterygopalatine ganglion blocks and non-invasive vagus nerve stimulation: a case series

Boezaart,

Smith,

Zasimovich

et al. 2023

Reg Anesth Pain Med

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In 1981, Devoghel achieved an 85.6% success rate in treating patients with treatment-refractory cluster headaches with alcoholization of the pterygopalatine ganglion (PPG) via the percutaneous suprazygomatic approach. Devoghel’s study led to the theory that interrupting the parasympathetic pathway by blocking its transduction at the PPG could prevent or treat symptoms related to primary headache disorders (PHDs). Furthermore, non-invasive vagus nerve stimulation (nVNS) has proven to treat PHDs and has been approved by national regulatory bodies to treat, among others, cluster headaches and migraines.In this case series, nine desperate patients who presented with 11 longstanding treatment-refractory primary headache disorders and epidural blood patch–resistant postdural puncture headache (PDPH) received ultrasound-guided percutaneous suprazygomatic pterygopalatine ganglion blocks (PPGB), and seven also received nVNS. The patients were randomly selected and were not part of a research study. They experienced dramatic, immediate, satisfactory, and apparently lasting symptom resolution (at the time of the writing of this report). The report provides the case descriptions, briefly reviews the trigeminovascular and neurogenic inflammatory theories of the pathophysiology, outlines aspects of these PPGB and nVNS interventions, and argues for adopting this treatment regime as a first-line or second-line treatment rather than desperate last-line treatment of PDPH and PHDs.

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Section: Discussionmentioning

confidence: 99%

Refractory primary and secondary headache disorders that dramatically responded to combined treatment of ultrasound-guided percutaneous suprazygomatic pterygopalatine ganglion blocks and non-invasive vagus nerve stimulation: a case series

Boezaart,

Smith,

Zasimovich

et al. 2023

Reg Anesth Pain Med

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“…Although CH is mainly characterized by local autonomic manifestations, there are several studies in the literature that tried to reveal a possible systemic involvement of the sympathetic or parasympathetic nervous system [ 68 , 69 ]. Neurophysiological studies demonstrated how around 15% of patients may present orthostatic hypotension during bouts, as well as alterations in the forehead sympathetic skin reflex, compared to out-of-bouts periods or healthy subjects [ 70 ].…”

Section: Melatonin and Autonomic Dysfunctionmentioning

confidence: 99%

Sleep and Chronobiology as a Key to Understand Cluster Headache

Pilati

Torrente

Alonge

et al. 2023

Neurology International

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The cluster headache is a primary headache characterized by attacks of unilateral pain associated with ipsilateral cranial autonomic features. These attacks recur in clusters during the years alternating with periods of complete remission, and their onset is often during the night. This annual and nocturnal periodicity hides a strong and mysterious link among CH, sleep, chronobiology and circadian rhythm. Behind this relationship, there may be the influence of genetic components or of anatomical structures such as the hypothalamus, which are both involved in regulating the biological clock and contributing even to the periodicity of cluster headaches. The bidirectional relationship manifests itself also with the presence of sleep disturbances in patients affected by cluster headaches. What if the key to studying the physiopathology of such disease could rely on the mechanisms of chronobiology? The purpose of this review is to analyze this link in order to interpret the pathophysiology of cluster headaches and the possible therapeutic implications.

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“…Additionally, the lethargic and avoidant behavior experienced during migraine attacks is engendered by the trigeminovascular system third-order neurons. These latter neurons also exert control of cerebral blood flow, cortical hyperexcitability, and pain signaling (21). Furthermore, emotional and behavioral prodromes argue for a pivotal role of the autonomic nervous system in the migraine attack (1,3).…”

Section: The Role Of the Autonomic Nervous System In Migrainementioning

confidence: 99%

The evolutionary meaning of migraine

Pensato,

Cevoli,

Pierangeli

et al. 2023

Cephalalgia

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Introduction Migraine’s astonishing prevalence and preserved genetic background contrast with the definition of a disease and the biological meaning of experiencing recurrent, severe headache attacks is still puzzling. Methods To provide a comprehensive explanation of the migraine evolutionary meaning, we review (i) the putative role of the autonomic nervous system in migraine attacks, (ii) the inter-ictal autonomic, functional, and metabolic signature of migraine patients, (iii) the bio-behavioral perspective of pain, and (iv) the allostatic perception of migraine chronification. Results Migraineurs have inter-ictal cortical hyperexcitability and metabolic dysfunction that predisposes to brain energetic imbalance. Multiple precipitating factors may lead to brain energy consumption over the migraine attack generation threshold. In response, the brain engenders adaptive, evolutionary conserved, autonomic-behavior responses through the antidromic activation of the trigeminovascular system. The sickness behavior and severe pain experienced during migraine attacks result in avoiding mental and physical activity, allowing brain energy restoration. Chronic exposure to stressors may result in an allostatic overload, leading to maladaptive chronic activation of these responses. In this bio-behavioral perspective, the chronification of migraine should be envisioned as a pathological process, whereas the migraine itself should not. Conclusion Migraine has an evolutionary (Darwinian) meaning.

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Headache and Autonomic Dysfunction: a Review

Cited by 9 publications

References 89 publications

Refractory primary and secondary headache disorders that dramatically responded to combined treatment of ultrasound-guided percutaneous suprazygomatic pterygopalatine ganglion blocks and non-invasive vagus nerve stimulation: a case series

Refractory primary and secondary headache disorders that dramatically responded to combined treatment of ultrasound-guided percutaneous suprazygomatic pterygopalatine ganglion blocks and non-invasive vagus nerve stimulation: a case series

Sleep and Chronobiology as a Key to Understand Cluster Headache

The evolutionary meaning of migraine

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