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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 PDFWorld 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 PDFComprehensive Analysis of Garcin Syndrome: A Systematic Review of the Etiology, Diagnosis, and Treatment.
Cureus
September 2024
Department of Surgery, Baghdad Teaching Hospital, Medical City Complex, Baghdad, IRQ.
Garcin syndrome is a rare neurological condition characterized by progressive unilateral involvement of multiple cranial nerves, without typical intracranial hypertension. It is often linked with aggressive malignancies and invasive infections; hence, it presents significant diagnostic and therapeutic challenges. Despite the advances in medical technology, the prognosis still remains poor, and there is limited literature on comprehensive reviews regarding its etiology, diagnosis, and management.
View Article and Find Full Text PDFObliteration of the Superior Petrosal Vein During Cerebellopontine Angle-Surgery: More Cons than Pros?
World Neurosurg
November 2024
Saint Gallen Cantonal Hospital, Ostschweizer Schulungs- und Trainingszentrum, Saint Gallen, Switzerland.
Article Synopsis
- A thorough understanding of the anatomy and surgical management of the superior petrosal vein (SPV) is crucial for neurosurgeons operating in the posterior fossa.
- The ongoing debate revolves around whether to preserve the SPV or allow for its obliteration, highlighting differing opinions and methods found in historical medical literature since Walter Dandy.
- The review concludes that occluding the SPV presents unacceptable risks to patient safety, suggesting that such practices should no longer be endorsed.
Post-Traumatic Trigeminal Neuropathic Pain: A Narrative Review of Understanding, Management, and Prognosis.
Biomedicines
September 2024
Department of Oral Medicine, College of Dentistry, Chosun University, Gwangju 61452, Republic of Korea.
This study provides an updated overview of the clinical characteristics of post-traumatic trigeminal neuropathic pain (PTNP) resulting from dental procedures or facial trauma, addressing its etiology, prevalence, evaluation, management, and prognosis. PTNP arises from injury to the trigeminal nerve, which governs sensory and motor functions in the maxillofacial region. The prevalence and characteristics of PTNP vary considerably across studies, with a reported prevalence ranging from 1.
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