Cluster Headache Research Articles

Steroids in Headache: A Comprehensive Review of Recent Research.

Headache is an extremely common symptom of the general outpatient department and also the headache clinic, with prevalence of 48.9% in the general population. None has ever experienced headache in life time. Headache is seen in 1 patient out of 10 general practitioner (GP) consultations, 1 referral out of 3 is headache in neurology OPD, and 1 in 5 of all emergency medical admissions. Of all headaches, around 98% constitute primary headache: migraine without aura, tension headache, and cluster headache. With advancement in various drug modalities, certain headache forms respond less well to the regular approved medications, and some headaches are complicated by the analgesic itself. Steroids have been tried in many subtypes of headache, especially in primary forms of headache with dysautonomia, headache with trigeminal pathway activation and disinhibition, and in certain medication-culprit headaches. This subgroup of headaches is almost a challenge in an emergency for the headache expert as well. So, we need to assess the role of steroids in less well-responsive headaches. Current reviewed evidence on the role of steroids in primary headache suggests that steroids have a role in status migrainosus and medication overuse headache when used in the mentioned and monitored manner. Consideration and further exploration of its role in other primary headaches may reveal insight into steroid efficacy as a treatment modality in various subtypes of headache. Steroids, when used cautiously in specifically selected primary headaches under supervision, proved miraculous where other modalities failed.

Deep Brain Stimulation for Chronic Cluster Headaches: A Systematic Review and Meta-Analysis

Background: Chronic cluster headache (CCH) is a severe and debilitating sub-type of trigeminal autonomic cephalalgia that can be resistant to medical management and associated with significant impairment in quality of life. Studies of deep brain stimulation (DBS) for CCH have provided promising results but have not been assessed in a comprehensive systematic review/meta-analysis. Objective: The objective was to perform a systematic literature review and meta-analysis of patients with CCH treated with DBS to provide insight on safety and efficacy. Methods: A systematic review and meta-analysis were performed according to PRISMA 2020 guidelines. 16 studies were included in final analysis. A random-effects model was used to meta-analyze data. Results: Sixteen studies reported 108 cases for data extraction and analysis. DBS was feasible in >99% of cases and was performed either awake or asleep. Meta-analysis revealed that the mean difference in headache attack frequency and headache intensity after DBS were statistically significant (p < 0.0001). Utilization of microelectrode recording was associated with statistically significant improvement in headache intensity postoperatively (p = 0.006). The average overall follow-up period was 45.4 months and ranged from 1 to 144 months. Death occurred in <1%. The rate of major complications was 16.67%. Conclusions: DBS for CCHs is a feasible surgical technique with a reasonable safety profile that can be successfully performed either awake or asleep. In carefully selected patients, approximately 70% of patients achieve excellent control of their headaches.

Verification of a clinical decision support system for the diagnosis of headache disorders based on patient–computer interactions: a multi-center study

BackgroundAlthough headache disorders are common, the current diagnostic approach is unsatisfactory. Previously, we designed a guideline-based clinical decision support system (CDSS 1.0) for diagnosing headache disorders. However, the system requires doctors to enter electronic information, which may limit widespread use.MethodsIn this study, we developed the updated CDSS 2.0, which handles clinical information acquisition via human–computer conversations conducted on personal mobile devices in an outpatient setting. We tested CDSS 2.0 at headache clinics in 16 hospitals in 14 provinces of China.ResultsOf the 653 patients recruited, 18.68% (122/652) were suspected by specialists to have secondary headaches. According to “red-flag” responses, all these participants were warned of potential secondary risks by CDSS 2.0. For the remaining 531 patients, we compared the diagnostic accuracy of assessments made using only electronic data firstly. In Comparison A, the system correctly recognized 115/129 (89.15%) cases of migraine without aura (MO), 32/32 (100%) cases of migraine with aura (MA), 10/10 (100%) cases of chronic migraine (CM), 77/95 (81.05%) cases of probable migraine (PM), 11/11 (100%) cases of infrequent episodic tension-type headache (iETTH), 36/45 (80.00%) cases of frequent episodic tension-type headache (fETTH), 23/25 (92.00%) cases of chronic tension-type headache (CTTH), 53/60 (88.33%) cases of probable tension-type headache (PTTH), 8/9 (88.89%) cases of cluster headache (CH), 5/5 (100%) cases of new daily persistent headache (NDPH), and 28/29 (96.55%) cases of medication overuse headache (MOH). In Comparison B, after combining outpatient medical records, the correct recognition rates of MO (76.03%), MA (96.15%), CM (90%), PM (75.29%), iETTH (88.89%), fETTH (72.73%), CTTH (95.65%), PTTH (79.66%), CH (77.78%), NDPH (80%), and MOH (84.85%) were still satisfactory. A patient satisfaction survey indicated that the conversational questionnaire was very well accepted, with high levels of satisfaction reported by 852 patients.ConclusionsThe CDSS 2.0 achieved high diagnostic accuracy for most primary and some secondary headaches. Human–computer conversation data were well integrated into the diagnostic process, and the system was well accepted by patients. The follow-up process and doctor–client interactions will be future areas of research for the development of CDSS for headaches.

A Case of Intraosseous Sphenoid Lipoma Presenting as Cluster Headache

Intraosseous lipoma is an extremely rare benign primary bone tumor, most commonly found in the long bones of lower extremities and calcaneus. Very few cases have been reported in the skull base, and mostly noninvasive follow-up is proposed due to its indolent growth and the low possibility of malignant transforming. Surgical biopsy or treatment is needed only when the patient’s symptom is correlated with the location of the lesion. We report a rare case of symptomatic intraosseous sphenoid lipoma which presented ipsilateral retroorbital pain accompanied by watering eye and runny nose on the same side. Surgical excision led to immediate resolution of the symptoms and the tumor was pathologically confirmed. This case highlights the radiographic differential diagnosis based on the review of literature.

VITAMIN B1 AND ITS STATUS IN VEGETARIANS AND VEGANS

Vitamin B1 is a water-soluble vitamin whose alternative name is thiamine or thiamin. The metabolically active form of vitamin B1 is thiamin diphos-phate, also known as thiamin pyrophosphate. Thiamin diphosphate is a coenzyme in the pyruvate dehydrogenase complex and in the Krebs cycle. Thus, it is directly involved in catabolism. In addition, vitamin B1 also takes part in the pentose phosphate shunt, which contributes to the synthesis of nucleotides and their derivatives. Similarly, thiamin diphosphate plays an important role in myelin synthesis, amino acid metabolism, and the metabo-lism of neurotransmitters and hormones. There is also evidence for its direct regulation of ion channel activity. Lack of vitamin B1 affects all organs and tissues, but the earliest manifestations of its deficiency are found in the nervous system. There are several reasons for this. Firstly, the nervous tissue is extremely and continuously dependent on glucose oxidation, which can be disrupted in case of insuffi-ciency of the pyruvate dehydrogenase complex. Secondly, myelin production is interrupted. Thirdly, there is an imbalance of neurotransmitters. The fourth reason is the high activity of transmembrane ion-exchange processes in the nervous tissue. All these lead to damage to the central and periph-eral nervous system and, in severe cases, the development of beriberi or Wernicke-Korsakoff syndrome. B1 hypervitaminosis is an unlikely event. The hydrophilic thiamin diphosphate is rapidly excreted through the urine with an increase in its serum con-centrations. In addition, the intake of large amounts of thiamin with food significantly reduces its intestinal absorption. As thiamin is relatively safe even in high quantities, the high vitamin B1 dose is used to treat symptoms of chronic cluster headaches and some neurodegenerative diseases. Thiamin is quite evenly distributed in both animal- and plant-derived products. Its highest concentrations are found in the outer layer of cereals, leg-umes, seeds, or nuts. As a result, most studies show that thiamin intake is higher in vegans and vegetarians than in omnivores. But, with regard to the status of vitamin B1, not everything is so crystal clear. There are not many studies done on this topic to date. The lack of general consensus on a single accepted methodology for assessing the status of vitamin B1 seems to be the main hurdle. Although most of the data indicate a better supply of vitamin B1 in vegans and vegetarians, further research and standardization of methods are still needed.

Social Media Listening and Digital Profiling Study of People With Headache and Migraine: Retrospective Infodemiology Study.

There is an unmet need for a better understanding and management of headache, particularly migraine, beyond specialist centers, which may be facilitated using digital technology. The objective of this study was to identify where, when, and how people with headache and migraine describe their symptoms and the nonpharmaceutical and medicinal treatments used as indicated on social media. Social media sources, including Twitter, web-based forums, blogs, YouTube, and review sites, were searched using a predefined search string related to headache and migraine. The real-time data from social media posts were collected retrospectively for a 1-year period from January 1, 2018, to December 31, 2018 (Japan), or a 2-year period from January 1, 2017, to December 31, 2018 (Germany and France). The data were analyzed after collection, using content analysis and audience profiling. A total of 3,509,828 social media posts related to headache and migraine were obtained from Japan in 1 year and 146,257 and 306,787 posts from Germany and France, respectively, in 2 years. Among social media sites, Twitter was the most used platform across these countries. Japanese sufferers used specific terminology, such as "tension headaches" or "cluster headaches" (36%), whereas French sufferers even mentioned specific migraine types, such as ocular (7%) and aura (2%). The most detailed posts on headache or migraine were from Germany. The French sufferers explicitly mentioned "headache or migraine attacks" in the "evening (41%) or morning (38%)," whereas Japanese mentioned "morning (48%) or night (27%)" and German sufferers mentioned "evening (22%) or night (41%)." The use of "generic terms" such as medicine, tablet, and pill were prevalent. The most discussed drugs were ibuprofen and naproxen combination (43%) in Japan; ibuprofen (29%) in Germany; and acetylsalicylic acid, paracetamol, and caffeine combination (75%) in France. The top 3 nonpharmaceutical treatments are hydration, caffeinated beverages, and relaxation methods. Of the sufferers, 44% were between 18 and 24 years of age. In this digital era, social media listening studies present an opportunity to provide unguided, self-reported, sufferers' perceptions in the real world. The generation of social media evidence requires appropriate methodology to translate data into scientific information and relevant medical insights. This social media listening study showed country-specific differences in headache and migraine symptoms experienced and in the times of the day and treatments used. Furthermore, this study highlighted the prevalence of social media usage by younger sufferers compared to that by older sufferers.

COVID-19 vaccination elicited de novo and recurrence of cluster headache: A case series.

Recent pharmacovigilance studies suggested that cluster headache could be a potential adverse effect after coronavirus disease-2019 (COVID-19) vaccination; however, the possibility of coincidence could not be excluded. Detailed case studies might help elucidate their potential link and implicate potential pathogenic mechanisms. Patients who developed cluster headache in close temporal relationship to COVID-19 vaccination were identified from two tertiary medical centers in Japan and Taiwan respectively through 2021-2022. Detailed characteristics of the headaches and time between the onset of the index cluster episode and antecedent COVID-19 vaccination were reported. In patients with previous cluster headaches, the duration from previous bout was also recorded. Six patients with new cluster headache bout 3-17 days after COVID-19 vaccination were identified. Two of them were de novo cases. The others either had been attack-free for a long time or developed new cluster bout in seasons atypical to prior bouts. The vaccines included mRNA, viral vector, or protein subunit vaccines. COVID-19 vaccines, regardless of vaccine types, may elicit de novo or relapse of cluster headache. Future studies are needed to confirm the potential causality and explore the potential pathogenic mechanism.

Psychedelics as Transformative Therapeutics.

Over the past decade, psychedelic compounds have emerged as potentially transformative therapeutics for a variety of intractable neuropsychiatric conditions. However, historically most of the basic science has utilized these compounds as probes to interrogate various endogenous neurotransmitter systems-mainly the serotonin 5-HT2A receptor. With the renewed interest in utilizing these compounds as therapeutics and the explosion in clinical trials, psychedelics have been purported to treat many neuropsychiatric disorders, including depression, cluster headaches, migraines, anxiety, and obsessive-compulsive disorder. It is therefore imperative to understand the biology and pharmacology behind their therapeutic mechanisms as well as expose any potential pitfalls in their widespread use as treatments. This review covers the latest advances in understanding the biological mechanisms, the newest efforts in drug discovery, and potential pitfalls when it comes to utilizing this class of compounds as emerging therapeutics.

Literature Review: Pericranial Nerve Blocks for Chronic Migraines.

Headaches, especially migraines, are one of the most pervasive neurological disorders affecting up to 15.9% of the population. Current methods of migraine treatment include lifestyle changes, pharmacologic, and minimally invasive techniques such as peripheral nerve stimulation (PNS) and pericranial nerve blocks (PNB). PNBs are used to treat and prevent migraines and involves injection of local anesthetics with or without corticosteroids. PNBs include the greater occipital, supraorbital, supratrochlear, lesser occipital, auriculotemporal, sphenopalantine ganglion, and cervical root nerve blocks. Of the PNBs, the most extensively studied is the greater occipital nerve block (GONB) which has been shown to be an efficacious treatment for migraines, trigeminal neuralgia, hemi-crania continua, and post-lumbar puncture, post-concussive, cluster, and cervicogenic headaches but not medication overuse and chronic tension type headaches. In this review, we aim to summarize the recent literature on PNBs and their efficacy in the treatment of migraines including a brief discussion of peripheral nerve stimulation.

Light-Promoted Ni-Catalyzed Cross-Coupling of Aryl Chlorides with Hydrazides: Application to the Synthesis of Rizatriptan.

A general and highly efficient photochemical C-N coupling reaction of challenging (hetero)aryl chlorides with hydrazides is reported. Catalyzed by a Ni(II)-bipyridine complex, this reaction provides an efficient tool for the synthesis of arylhydrazines in the presence of a soluble organic amine base without an external photosensitizer. The reaction features a wide substrate range (54 examples) and excellent functional group tolerance. The method has also been successfully applied to the three-step concise synthesis of rizatriptan, an effective drug for migraine and cluster headaches.

Pathophysiology of Primary Headache Syndrome: A Narrative Literature Review

Primary headache syndrome is a chronic recurrent type not associated with structural abnormalities or systemic disease and includes migraine, cluster, paroxysmal hemicrania, and tension headaches. This literature review aimed to describe the types of primary headaches and their pathophysiology. Migraine is an episodic neurological disorder characterized by headaches that last 4 to 72 hours. This disorder is diagnosed when two of the following features occur: unilateral headache, throbbing pain, the pain worsening with activity, moderate or severe pain intensity, and at least one of the following: nausea and/or vomiting, or photophobia and phonophobia. Cluster headaches are one of a group of rare disorders known as trigeminal autonomic cephalgia. Tension-type headache (TTH) is the most common type of recurring headache. It's not a vascular headache or a migraine. The mean age of onset is during the second decade of life. Usually mild to moderate bilateral headaches with a feeling of tight bands or pressure around the head.

Pre-cluster symptoms and treatment response in cluster headache: A large cohort in Taiwanese patients (S41.005)

<h3>Objective:</h3> This study aimed to analyze the prevalence, symptomatology, and predictivity of upcoming bouts of pre-cluster symptoms (PCS). Also, we investigated the associations between different PCS and treatment responses for CH. <h3>Background:</h3> PCS are symptoms preceding the upcoming bouts. Some patients could predict the CH bout based on these symptoms and might have roles in pre-emptive treatment. This study analyzed the characteristic of PCS in a large Asian cohort. Moreover, we explored the linkage between PCS and the treatment outcome of CH. <h3>Design/Methods:</h3> We prospectively collected consecutive data from patients with CH. Each patient completed semi-structured interviews during CH bouts, which included 50 questions about CH symptomatology, severity, and PCS. After CH bout, we recorded responses to acute and preventive treatments. The thirty-five PCS were divided into six categories: localized (head &amp; neck) pain, general pain, fatigue &amp; mood changes, sleep problems, constitutional symptoms, and cranial autonomic symptoms. <h3>Results:</h3> A total of 131 CH patients (M: F= 98: 33) were recruited during the study period. The prevalence of PCS was 64.9%, with a mean (± SD) duration of 2.2 (± 3.9) days before CH bouts. Up to 64.1 % of CH patients were able to predict upcoming bouts. Among six categories of PCS, head and neck pain symptoms were most common (82.4%), and were more able to predict upcoming bouts (presence: absence= 68.5% vs. 43.5%, p=0.023, OR=2.8 [95% CI 1.1–7.1]). Moreover, PCS associated with response to CH preventive treatments: sleep alternation and restlessness before upcoming bouts are more likely responsive to verapamil (OR=2.1 [95% CI 1.0–4.3] and 2.3 [95% CI 1.1–4.6], respectively). <h3>Conclusions:</h3> About two-thirds of CH patients had PCS. Head and neck pain symptoms were the most common PCS with the highest predictivity of the upcoming bout. Certain PCS linked to better response to verapamil, which provides insights into future treatment strategies. <b>Disclosure:</b> The institution of ShuTing Chen has received research support from Ministry of Science and Technology (Taiwan). The institution of ShuTing Chen has received research support from Taipei Veterans General Hospital . Ms. Lin has nothing to disclose. Miss TSENG has nothing to disclose. Dr. Wu has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Eli Lilly. Dr. Wu has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen-Idec. Dr. Wu has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for International Headache Society (IHS). The institution of Dr. Wu has received research support from Ministry of Science and Technology of Taiwan. The institution of an immediate family member of Dr. Wu has received research support from Ministry of Science and Technology of Taiwan.

Patient-identified most bothersome symptom as a driver of health-related quality of life experienced by patients with migraine (P8-12.010)

Patient-identified most bothersome symptom as a driver of health-related quality of life experienced by patients with migraine (P8-12.010)

Characterizing Prodrome (Premonitory Phase) in Migraine: Results From the PRODROME Trial Screening Period (S41.009)

Characterizing Prodrome (Premonitory Phase) in Migraine: Results From the PRODROME Trial Screening Period (S41.009)

Effect of Eptinezumab on Utility Scores in Patients with Migraine: Results from the DELIVER Study (P13-12.011)

Effect of Eptinezumab on Utility Scores in Patients with Migraine: Results from the DELIVER Study (P13-12.011)

Impact of Updates in Headache Quality Measures on Adherence to Best Practices in a Neurology Resident Clinic (P8-12.001)

<h3>Objective:</h3> To assess the impact of a quality-improvement initiative on adherence to updated American Academy of Neurology (AAN) headache quality measures. <h3>Background:</h3> As an important resource for headache care, the AAN publishes quality measures, which were most recently updated in 2019. This single-site study at a large, academic tertiary referral center aimed to apply the AAN measures to its cohort of neurology resident physicians and evaluate adherence changes (primary outcome) as well as utilization of appropriate diagnostic criteria, patient education, and confidence in following AAN guidelines (secondary outcomes). <h3>Design/Methods:</h3> A pre-intervention (pre-QI) survey based on retrospective analysis of five clinic notes for adherence to the measures was designed and distributed to all neurology residents at our center. The intervention included creation of an electronic medical record template to aid residents in following the measures during clinical encounters as well as provision of direct feedback based on pre-QI results. Finally, a post-intervention (post-QI) survey was distributed for completion based on notes written during the intervention period. Significance testing of differences between pre- and post-QI values was performed using Chi-squared analysis. Analysis was limited to migraine headaches given a low percentage of cluster headaches seen in clinic. <h3>Results:</h3> An increase in adherence was seen in three of the four migraine-related quality measures, with two – utilization of migraine abortive therapies and counseling of modifiable lifestyle and chronification factors – showing significant improvement (p &lt; 0.01). For secondary outcomes, increases in utilization of appropriate diagnostic criteria and patient education were both significant (p &lt; 0.05), and a positive trend in self-assessed confidence rating for adherence to AAN guidelines was significant (p &lt; 0.0001). <h3>Conclusions:</h3> This study provided evidence that our QI intervention led to increased adherence to the AAN migraine-related measures. It is anticipated that increased adherence may lead to improved patient outcomes. <b>Disclosure:</b> Mr. Cascella has nothing to disclose. Dr. Anderson has nothing to disclose. Dr. Perez Martinez has nothing to disclose.

Safety and Tolerability of Rimegepant Every Other Day for Preventive Treatment of Migraine Plus As-Needed for Acute Treatment of Migraine: Results from A 52-Week, Open-Label Extension Phase (P12-12.006)

Safety and Tolerability of Rimegepant Every Other Day for Preventive Treatment of Migraine Plus As-Needed for Acute Treatment of Migraine: Results from A 52-Week, Open-Label Extension Phase (P12-12.006)

Atogepant for the preventive treatment of chronic migraine: results from the PROGRESS phase 3 trial (S47.005)

Atogepant for the preventive treatment of chronic migraine: results from the PROGRESS phase 3 trial (S47.005)

Efficacy of Ubrogepant for the Treatment of Migraine Symptoms During the Prodrome (Premonitory Phase): Results From the PRODROME Trial (S47.002)

Efficacy of Ubrogepant for the Treatment of Migraine Symptoms During the Prodrome (Premonitory Phase): Results From the PRODROME Trial (S47.002)

Ubrogepant for the Acute Treatment of Migraine When Administered During the Prodrome (Premonitory Phase): Results From a Phase 3, Randomized, Double-blind, Placebo-Controlled, Crossover Study (S47.001)

Ubrogepant for the Acute Treatment of Migraine When Administered During the Prodrome (Premonitory Phase): Results From a Phase 3, Randomized, Double-blind, Placebo-Controlled, Crossover Study (S47.001)