<scp>Primary Headache Disorders and Circadian Biology: A Clinical, Imaging, and Therapy Perspective</scp>

Cohen, Anna; Kaube, Holger

doi:10.1111/j.1743-5013.2005.20415.x

Cited by 7 publications

(11 citation statements)

References 89 publications

(157 reference statements)

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“…Attacks usually occur about 90 minutes after the patient falls asleep, which coincides with the first REM sleep, 11 although this is less apparent in chronic CH 12 . It has been observed that cluster periods may be triggered by traveling through different time zones, which may reflect hypothalamic activity and diurnal variation in CH 13 …”

Section: Cluster Headachementioning

confidence: 99%

“…The apparent discrepancies between the TACs may be reflected in their responses to medications; for instance oxygen an acute abortive therapy in CH may possibly act either on abnormal mitochondrial energy metabolism 132 or in nocturnal CH attacks, which are possibly due to hypoxia in an already physiologically compromised hypothalamus 13,92,93 . The lack of response to oxygen in PH and SUNCT may be because the attacks are too short for an abortive to have a meaningful effect, or because the pathophysiology of these syndromes is different.…”

Section: The Future For Treatment Of Tacsmentioning

confidence: 99%

“…It is possible that HC and PH have a different pathophysiology to CH and SUNCT, which is why they respond to indomethacin, and CH and SUNCT do not. The hypothalamus is suggested to be the mediator of the attacks in TACs on clinical grounds largely due to evidence gathered from CH, such as biochemical abnormalities and the diurnal and seasonal variations in CH 13 . The act of including PH and SUNCT/SUNA as TACs from a phenotypic basis stems from the fact that they are all unilateral, relatively short‐lasting attacks of severe orbital, retro‐orbital or temporal pain, with ipsilateral cranial autonomic symptoms 3 .…”

Section: The Future For Treatment Of Tacsmentioning

confidence: 99%

“…Gabapentin .— SUNCT has been shown to respond to gabapentin, with complete suppression of attacks in 3 of 9 patients treated with 800 to 2,700 mg daily, 77–79 and minimally effective in 1 patient with SUNA at an unknown dose 80 . Interestingly it was effective in 60% of SUNA but only 45% of SUNCT in an open‐label trial 13 . It is therefore suggested for use in SUNA, and as a second‐line agent in SUNCT.…”

mentioning

confidence: 99%

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Trigeminal Autonomic Cephalalgias: Current and Future Treatments

Cohen

Matharu²,

Goadsby³

2007

Headache

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The trigeminal autonomic cephalgias include cluster headache, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT). The evidence for the current treatment options for each of these syndromes is considered, including oxygen, sumatriptan, and verapamil in cluster headache, indomethacin in paroxysmal hemicrania, and intravenous lidocaine and lamotrigine in SUNCT. Some treatments such as topiramate have an effect in all of these, as well as in migraine and other pain syndromes. The involvement of the hypothalamus in functional imaging studies implies that this may be a substrate for targeting treatment options in the future. Key words: trigeminal autonomic cephalalgias, cluster headache, paroxysmal hemicrania, SUNCT, treatmentThe trigeminal autonomic cephalalgias (TACs) are a group of primary headache disorders characterized by unilateral head pain that occurs in association with ipsilateral cranial autonomic features.1,2 The TACs include cluster headache (CH), paroxysmal hemicrania (PH), and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT). These headaches are grouped into section 3 of the revised International Classification of Headache Disorders (ICHD-II).3 The TACs differ in attack duration and frequency as well as the response to therapy. CH has the longest attack duration and relatively low attack frequency. PH has intermediate duration and intermediate attack frequency. SUNCT has the shortest attack duration and the highest attack frequency (Table 1). The importance of recognizing these syndromes resides in their excellent but highly selective response to treatment. CLUSTER HEADACHECluster headache is a strictly unilateral headache that occurs in association with cranial autonomic features. It is an excruciating syndrome and is probably one of the most painful conditions known to humans with female patients describing each attack as being worse than childbirth. It is located mainly around the orbital and temporal regions though any part of the head can be affected. The headache usually lasts 45 to 90 minutes but can range from 15 minutes to 3 hours. In most patients, it has a striking circannual and circadian periodicity. It is not uncommon by neurological standards at about 1 patient per 1,000 of the population. About 80% to 90% of patients have episodic cluster headache (ECH), which consists of recurrent bouts or cluster periods, each with a duration of more than a week and separated by remissions lasting more than 4 weeks. The cluster periods occur typically once or twice a year. The remaining 10% to 20% of patients have chronic cluster headache (CCH) in which either no remission occurs within 1 year or the remissions last less than 1 month. 3Triggers.-CH attacks are typically triggered by alcohol, with 90% of patients reporting sensitivity to alcohol during their cluster bout. 4 Anecdotal evidence suggests that volatile substances, such as solvents and oil-based paints, can al...

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Section: Cluster Headachementioning

confidence: 99%

Section: The Future For Treatment Of Tacsmentioning

confidence: 99%

Section: The Future For Treatment Of Tacsmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Trigeminal Autonomic Cephalalgias: Current and Future Treatments

Cohen

Matharu²,

Goadsby³

2007

Headache

Self Cite

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show abstract

“…Migraine has also been linked to somnambulism, which occurs during non‐REM stage of sleep 4 . A preponderance of migraine in the morning hours 5 has been used as an argument for a pivotal role of melatonin and the circadian clock‐system in migraine pathophysiology 6 . If this is true, studies of the circadian pattern of migraine are essential to shed light on the postulated “migraine generator.” 7 However, the prevalence of chronic morning headache was 7.6% in a general population, 8 and the morning preponderance has been questioned 9,10 .…”

mentioning

confidence: 99%