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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 PDFIdentifying Pain Subtypes in Patients With Craniofacial Lesions of Fibrous Dysplasia/McCune-Albright Syndrome.
J Oral Maxillofac Surg
December 2024
Assistant Professor, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA; Assistant Professor, Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA. Electronic address:
Background: Fibrous dysplasia/McCune-Albright syndrome (FD/MAS) is a genetic disorder, marked by bone lesions, often affecting the craniofacial skeleton. Pain is a prevalent yet heterogeneous symptom reported by patients with craniofacial FD. Effective treatments are currently lacking, posing a significant clinical challenge to patient care.
View Article and Find Full Text PDFTranscutaneous electrical nerve stimulation of the occipital nerves as treatment for chronic cluster headache.
Headache
December 2024
Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.
Background: Chronic cluster headache (CCH) is an excruciatingly painful condition that can be difficult to treat sufficiently with the available medical treatment options. The greater occipital nerves (GON) are of major interest in treating CCH, and various invasive treatment modalities, such as stimulating or blocking the nerves, have been applied. Because the terminal segment of the GON has a superficial course, the nerve is also accessible for non-invasive transcutaneous stimulation.
View Article and Find Full Text PDFEfficacy 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.
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