Cephalalgia : an international journal of headache
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Objectives The sphenopalatine ganglion (SPG) plays a pivotal role in cluster headache (CH) pathophysiology as the major efferent parasympathetic relay. We evaluated the long-term effectiveness of SPG stimulation in medically refractory, chronic CH patients. Methods Thirty-three patients were enrolled in an open-label follow-up study of the original Pathway CH-1 study, and participated through 24 months post-insertion of a microstimulator. ⋯ Conclusions In the population of disabled, medically refractory chronic CH patients treated in this study, SPG stimulation is an effective acute therapy in 45% of patients, offering sustained effectiveness over 24 months of observation. In addition, a maintained, clinically relevant reduction of attack frequency was observed in a third of patients. These long-term data provide support for the use of SPG stimulation for disabled patients and should be considered after medical treatments fail, are not tolerated or are inconvenient for the patients.
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Background Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) or with autonomic symptoms (SUNA) are grouped together within the trigeminal autonomic cephalalgias (TACs). However, the SUNCT and SUNA phenotype and management overlap with those of trigeminal neuralgia (TN). ⋯ Case report We present the first case of coexisting chronic SUNCT- and TN-like phenotypes caused by haemorrhagic infarct of the dorsolateral medulla. Discussion In light of our case, a perturbation of the dorsolateral medullary circuits may constitute an important pathophysiological component, supporting a unifying nosological hypothesis that considers SUNCT, SUNA and TN clinical variants of the same disorder.
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Background Many studies have shown that migraine patients have an interictal habituation deficit of visual evoked potentials (VEPs). Some discordant results were attributed to non-blinded analyses and a lack of repeatability. Aims In this study, we compared blinded and non-blinded analyses of the same recordings and assessed test-retest repeatability. ⋯ Results In both blinded and non-blinded analyses, VEP habituation was normal in HVs and EMs during an attack, but deficient in EMs interictally. Intra-individual habituation percentages were highly correlated in two recordings separated by ≥7 days. Conclusions The studies showing a VEP habituation deficit in migraineurs between attacks are unlikely to be biased by non-blinding analysis or poor repeatability.
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Background Headaches associated with pituitary adenoma have been reported to be related to the structural characteristics and endocrine factors of the tumour itself. Objectives The objective of this study was to investigate the prevalence and clinical characteristics of, and the risk factors for, non-functioning pituitary adenoma (NFPA)-associated headaches in Chinese patients with normal endocrine activity. Methods Ninety-seven patients with a NFPA with normal endocrine laboratory results were prospectively enrolled in this study. ⋯ The sides of the headaches and of cavernous sinus invasion were significantly concordant (48.9% agreement; κ = 0.257; p = 0.007). Conclusions Migraine-like headaches are a common clinical manifestation in patients with NFPAs. A family history of primary headaches and cavernous sinus invasion are risk factors for NFPA-associated headaches.
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Objective A prospective clinical imaging study has been conducted to investigate pain processing functional pathways during trigeminal heat stimulation (THS) in patients with migraine without aura experiencing ictal cutaneous allodynia (CA) (MwoA CA+). Methods Using whole-brain BOLD-fMRI, functional response to THS at three different intensities (41°, 51° and 53℃) was investigated interictally in 20 adult MwoA CA+ patients compared with 20 MwoA patients without ictal CA (MwoA CA-) and 20 healthy controls (HCs). Secondary analyses evaluated associations between BOLD signal change and clinical features of migraine. ⋯ Furthermore, during high-noxious THS (53℃) a significantly decreased activation in the secondary somatosensory cortices was observed in (a) MwoA CA- patients compared to both MwoA CA+ patients and HCs and (b) MwoA CA+ patients compared to HCs. CA severity was positively correlated with the secondary somatosensory cortices activation. Conclusions Our findings suggest that CA may be subtended by both a dysfunctional analgesic compensatory mechanism and an abnormal internal representation of pain in migraine patients.