Cluster headache is a primary headache disorder that can occur in children and adolescents, and is a member of the broader diagnostic group of trigeminal autonomic cephalalgias. It is characterized by repeated attacks typically lasting between 15 and 180 minutes of severe unilateral side-locked headache with cranial autonomic features. Acute treatment of the cluster attack can include the use of triptans or high-flow oxygen. Preventive measures typically start with the use of verapamil. The other trigeminal autonomic cephalalgias, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT), and short-lasting unilateral neuralgiform headache with cranial autonomic features (SUNAA), have also been reported in children, and should be considered when the clinical presentation is at all unusual.
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Cluster Headache and Hypoxia: Breathing New Life into an Old Theory, with Novel Implications.
Neurol Int
December 2024
Department of Psychology, University of Maine, 301 Williams Hall, Orono, ME 04469-5742, USA.
Cluster headache is a severe, poorly understood disorder for which there are as yet virtually no rationally derived treatments. Here, Lee Kudrow's 1983 theory, that cluster headache is an overly zealous response to hypoxia, is updated according to current understandings of hypoxia detection, signaling, and sensitization. It is shown that the distinctive clinical characteristics of cluster headache (circadian timing of attacks and circannual patterning of bouts, autonomic symptoms, and agitation), risk factors (cigarette smoking; male gender), triggers (alcohol; nitroglycerin), genetic findings (GWAS studies), anatomical substrate (paraventricular nucleus of the hypothalamus, solitary tract nucleus/NTS, and trigeminal nucleus caudalis), neurochemical features (elevated levels of galectin-3, nitric oxide, tyramine, and tryptamine), and responsiveness to treatments (verapamil, lithium, melatonin, prednisone, oxygen, and histamine desensitization) can all be understood in terms of hypoxic signaling.
View Article and Find Full Text PDFExternal trigeminal nerve stimulation (eTNS) Exhibits relaxation effects in fatigue states following napping deprivation.
Neuroscience
December 2024
Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China; Intelligent Non-invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi'an, Shaanxi 710126, China; Guangzhou Institute of Technology, Xidian University, Xi'an, Shaanxi, China. Electronic address:
Background: In the face of inevitable declines in alertness and fatigue resulting from sleep deprivation, effective countermeasures are essential for maintaining performance. External trigeminal nerve stimulation (eTNS) presents a potential avenue for regulating alertness by activating the locus coeruleus and reticular activating system.
Methods: Here, we conducted a within-subject study with 66 habitual nappers, subjecting them to afternoon nap-deprivation and applying either 20-minute of 120 Hz eTNS or sham stimulation.
Efficacy and safety of galcanezumab for cluster headache preventive treatment: a systematic review and meta-analysis.
Neurol Res
January 2025
Neurology, Division of General Neurology and Headache, University of Rochester, Rochester, NY, USA.
Article Synopsis
- Galcanezumab is a monoclonal antibody that targets the CGRP pathway, representing a new treatment option for cluster headaches (CH).
- A systematic review and meta-analysis of six studies, involving 504 patients, evaluated the drug's effectiveness and safety, finding a significant reduction in CH attack frequency in 76% of participants.
- While 48% of patients experienced treatment-emergent adverse events, the side effects were notably higher in those taking the 300 mg dose compared to the 240 mg dose, suggesting galcanezumab is generally effective and safe for managing CH.
World neurology updates: Other primary headache disorder - Treatment.
eNeurologicalSci
December 2024
NIHR King's Clinical Research Facility and Wolfson Sensory, Pain and Regeneration Centre, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK.
•The trigeminal autonomic cephalalgias are a severe disabling form of primary headache disorders characterized by severe unilateral pain commonly associated with ipsilateral cranial autonomic features as well as a sense of restlessness or agitation, of which the most common is cluster headache.•Different forms of trigeminal autonomic cephalalgias include cluster headache, paroxysmal hemicrania (PH), hemicrania continua (HC), short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)/short lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) and are differentiated based on their duration and frequency•Triptans, such as sumatriptan by injection, high flow 100 % oxygen by face mask, or non-invasive vagus nerve stimulation, are mainstay acute treatments of attacks of cluster headache.•Interim preventive treatments to reduce attack frequency include a short course of high dose oral corticosteroids, local anesthetic/corticosteroid injection around the homolateral (to pain) greater occipital nerve or the CGRP monoclonal antibody galcanezumab.
View Article and Find Full Text PDFEfficacy and safety profile of Onabotulinum toxin-A injection at sphenopalatine ganglion in trigeminal neuralgia: a prospective observational study.
J Headache Pain
December 2024
Department of Anesthesiology, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.
Article Synopsis
- * Fourteen patients who struggled with traditional oral medications received fluoroscopy-guided injections, resulting in significant reductions in both pain scores and frequency of pain attacks after 60 days.
- * Complications included temporary side effects like hemifacial palsy and diplopia, which resolved within three months, suggesting the treatment is relatively safe.
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