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Diagnosis and Management of Facial Pain
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Rajiv K. Bhalla, Timothy J. Woolford
The trigeminal autonomic cephalalgias are a group of primary headache disorders that include cluster headache, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing/cranial autonomic features (SUNCT/SUNA).25 Trigeminal autonomic cephalalgias are generally characterized by relatively short-lasting attacks of severe pain and lateralized associated features including pain, cranial autonomic symptoms and where present, migrainous symptoms, such as photophobia. Key for the otolaryngologist when diagnosing a trigeminal autonomic cephalalgia is the consideration of underlying pituitary or pituitary-region pathology, since the posterior hypothalamus is crucial in the pathophysiology of these headaches.26 Although the syndromes share much in their pathophysiology and investigation paths, their treatment is distinct, so that accurate differentiation is important for optimal management. Due to the associated autonomic symptoms, there is a great propensity for the presentation to be confused with sinus pathology, causing misdiagnosis and subsequent mismanagement. It is of great value if such patients are managed in conjunction with a neurologist and/or colleague with a special interest in pain management.
Trigeminal autonomic cephalgias I – cluster headache: diagnosis and treatment
Published in Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby, Headache in Clinical Practice, 2018
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby
Trigeminal autonomic cephalalgias (TACs) consist of a group of headache syndromes usually marked by cyclical episodes of severe head pain with cranial autonomic activation.1 Cluster headache is the most common of the TACs; while rare relative to other primary headaches, its prevalence is similar in northern climates to multiple sclerosis.2 Cluster headache is clearly a problem that can best be managed by neurologists and headache specialists. It is a distinct clinical and epidemiological entity, named by Friedman and Mikropoulos in 1958.3 Its importance as a primary headache derives from its extraordinary morbidity. The pain is devastating and the syndrome is both unique and rewarding to manage; as a consequence, physicians with an interest in head pain should be acquainted with the condition. The other TACs that may be confused with cluster headache (Table 9.1) have distinct treatment responses and will be dealt with in Chapter 10. These disorders are less common, and probably less well recognized.
The Governor Vessel (GV)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Stimulation of the supraorbital and supratrochlear nerves can aid patients with otherwise intractable trigeminal autonomic cephalalgias (TAC).7 While implanted stimulators may work, why not try for relief with noninvasive neuromodulation first?
Updated review on the link between cortical spreading depression and headache disorders
Published in Expert Review of Neurotherapeutics, 2021
Doga Vuralli, Hulya Karatas, Muge Yemisci, Hayrunnisa Bolay
As pain is transmitted through the trigeminal nerve, and the brain parenchyma is devoid of trigeminal innervation, demonstration of trigeminal activation by CSD constitutes an important causal link between CSD and headache [11]. CSD waves were shown to cause long-lasting blood flow increase in the overlying dural middle meningeal artery (MMA) and plasma protein extravasation, which were dependent on trigeminal nerve activation. The peak increase in the ipsilateral MMA blood flow was 20 min after CSD coinciding with the oligemia phase [11]. CSD waves were shown to induce mast cell degranulation in the dura mater [11,36]. These CSD-induced peripheral changes in the dura mater were associated with the activation of ipsilateral second order pain neurons in the brainstem trigeminal nuclei. Transection of trigeminal nerve or sumatriptan administration blocked the CSD-triggered activation in the brainstem trigeminal nucleus. Additionally, CSD waves were shown to evoke a brainstem reflex involving trigeminal afferents and parasympathetic efferents to cephalic vascular structures which further increased rCBF. The latter can explain autonomic symptoms seen in migraine as well as trigeminal autonomic cephalalgias.
Neuro-Ophthalmic Literature Review
Published in Neuro-Ophthalmology, 2019
David Bellows, Noel Chan, John Chen, Hui-Chen Cheng, Peter MacIntosh, Jenny Nij Bijvank, Michael Vaphiades, Konrad Weber
The authors reviewed the literature in PubMed using the following terms paired with “migraine” and “headache:” dry eye, eye pain, monocular diplopia, binocular diplopia, photophobia, visual field defect, tunnel vision, floaters, amaurosis fugax, transient visual obscuration, autonomic symptoms, anisocoria, visual snow, Alice in Wonderland syndrome, and palinopsia. They noted that patients with migraine experience a wide range of visual disturbances including aura and more complex perceptual abnormalities such as Alice in Wonderland syndrome and visual snow. Visual disturbances may consist of positive and/or negative phenomena and may be binocular or monocular. Migraine and other primary headache disorders can be associated with photophobia, eye pain, dry eye, autonomic features, and anisocoria. The trigeminal autonomic cephalgias are less common and the patients experience autonomic and ophthalmic complaints. They concluded that an understanding of the typical features of these disorders allows providers to help patients find appropriate treatment without unnecessary testing and to recognize when atypical presentations require additional evaluation.
Insights into real-world treatment of cluster headache through a large Italian database: prevalence, prescription patterns, and costs
Published in Expert Review of Clinical Pharmacology, 2021
Carlo Piccinni, Sabina Cevoli, Giulia Ronconi, Letizia Dondi, Silvia Calabria, Antonella Pedrini, Aldo P. Maggioni, Immacolata Esposito, Alice Addesi, Valentina Favoni, Giulia Pierangeli, Pietro Cortelli, Nello Martini
Cluster headache (CH) is the most common of the trigeminal autonomic cephalalgias. It is characterized by intense unilateral pain at the cranial level, accompanied variably by symptoms mediated by the autonomic nervous system, such as ipsilateral conjunctival injection, lacrimation, nasal congestion, rhinorrhea, forehead and facial sweating, miosis, ptosis and/or eyelid edema, and by restlessness or agitation [1]. This condition is defined by the 3rd version of the International Classification of Headache Disorders (ICHD-3) as a strictly unilateral headache characterized by attacks lasting from 15 to 180 minutes and commonly localized within or above the orbit [2].