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Headache Disorders
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
Chronic paroxysmal hemicrania is a rare syndrome marked by headaches of short duration, a high frequency of attacks, and associated autonomic symptoms. CPH pain location is normally orbital, temporal, and above or behind the ear and is one-sided. The pain is severe in intensity. Normal headache duration is between 2 and 30 minutes and frequency is greater than five attacks per day. Unlike cluster headache, there is no predilection for nocturnal attacks, although attacks can certainly awaken a patient from sleep. Associated symptoms are marked by autonomic phenomena. CPH attacks can sometimes be triggered by rotating the neck or flexing the head to the side of the headaches, or by applying external pressure to the transverse processes of C4–C5 or the C2 nerve root on the symptomatic side. This syndrome used to be termed female cluster headache but it is not cluster headache based on the frequency and duration of attacks, and a misdiagnosis can lead to continued disability as indomethacin is not suggested for CH but is for CPH. Hemicrania Continua
Sleep and headache disorders
Published in S.R. Pandi-Perumal, Meera Narasimhan, Milton Kramer, Sleep and Psychosomatic Medicine, 2017
C. Rains Jeanetta, J. Steven Poceta, B. Penzien Donald
Chronic paroxysmal hemicrania (CPH) is a variant of cluster headache, except with female rather than male preponderance and higher-frequency and shorter-duration attacks.3 Headache symptoms closely resemble cluster, with severe and unilateral orbital, supraorbital, or temporal pain associated with one or more cranial autonomic features. Conversely, attacks usually last only 2–30 minutes, but may recur often, with at least five attacks per day. Attacks are more likely to occur at night, similarly to cluster.13 In the 1980s, polysomnographic studies found that attacks often occurred in rapid eye movement (REM) sleep, and thus the term “REM-locked” headache disorder became synonymous with CPH.14,15
Trigeminal Autonomic Cephalalgias
Published in Gary W. Jay, Clinician’s Guide to Chronic Headache and Facial Pain, 2016
Trigeminal autonomic cephalalgias (TACs) are a collective term for headache disorders that are characterized by unilateral head and/or face pain with accompanying autonomic features (1,2). The International Classification of Headache Disorders II (ICHD-II) classifies TACs as (i) episodic or chronic cluster headache (CH); (ii) episodic or chronic paroxysmal hemicrania (PH); and (iii) short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) (2). This chapter is aimed at increasing awareness and providing information regarding PH and SUNCT (information regarding CH is presented in Chap. 5) as patients often consult with health care providers for symptoms and management of these types of headaches (3-7). For purposes of clarity, TACs will refer to CH, PH and SUNCT in this chapter.
Tolerability of pharmacological agents in the treatment of headache following brain injury: a scoping review
Published in Brain Injury, 2023
Heather M. MacKenzie, Michael Robinson, Amanda McIntyre
There were more female (n = 88) than male (n = 68) subjects overall; two studies (21,22) did not report sex (Table 1). Most studies (N = 9) reported a mean age between 29 and 49 years old. One study (21) did not report age and the other (22) provided an age range of 13–18 years. Incidentally, articles studied only subjects with mild traumatic brain injury (mTBI) (N = 10), with the exception of one case report (16) where the subject experienced a period of loss of consciousness lasting at least 30 minutes in duration, which is in keeping with a moderate severity TBI (2). The full spectrum of time post TBI was reflected in the included articles: <4 weeks (n = 33), 1–6 months (n = 74), 6–12 months (n = 21), and >12 months (n = 63). Another 50 subjects (20) were studied during the first 12 weeks post injury, and 15 subjects (23) were studied 1–12 months post injury. One study (22) did not report on time post TBI. The most common headache phenotype was migraine (n = 12) (14,18), but the articles also reported on individuals with hemicrania continua (n = 5) (13,15), and chronic paroxysmal hemicrania (n = 1) (16). The headache phenotype was not described for the majority of participants (89%, n = 286).
Neuromodulation for the treatment of primary headache syndromes
Published in Expert Review of Neurotherapeutics, 2019
Tso et al. [13]. explored the potential efficacy of nVNS in indomethacin-sensitive trigeminoautonomic cephalalgias (TAC), namely chronic paroxysmal hemicrania and hemicrania continua. All observed patients were responsive to indomethacin but either had to reduce or even discontinue the treatment due to adverse effects so that in this study in some patients nVNS was used as a monotherapy, in some as an add-on therapy to indomethacin used at the maximum tolerated dose. Of the nine patients with hemicrania continua and the six patients with chronic hemicrania continua had a significant improvement of their condition while only four patients (two with hemicrania continua and two with chronic paroxysmal hemicrania) had no response to nVNS [13]. Sham-controlled studies are clearly needed to confirm these findings.