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Peter J. Goadsby - One of the best experts on this subject based on the ideXlab platform.
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Cluster Headache pathophysiology insights from current and emerging treatments
Nature Reviews Neurology, 2021Co-Authors: Peter J. Goadsby, Diana Y WeiAbstract:Cluster Headache is a debilitating primary Headache disorder that affects approximately 0.1% of the population worldwide. Cluster Headache attacks involve severe unilateral pain in the trigeminal distribution together with ipsilateral cranial autonomic features and a sense of agitation. Acute treatments are available and are effective in just over half of the patients. Until recently, preventive medications were borrowed from non-Headache indications, so management of Cluster Headache is challenging. However, as our understanding of Cluster Headache pathophysiology has evolved on the basis of key bench and neuroimaging studies, crucial neuropeptides and brain structures have been identified as emerging treatment targets. In this Review, we provide an overview of what is known about the pathophysiology of Cluster Headache and discuss the existing treatment options and their mechanisms of action. Existing acute treatments include triptans and high-flow oxygen, interim treatment options include corticosteroids in oral form or for greater occipital nerve block, and preventive treatments include verapamil, lithium, melatonin and topiramate. We also consider emerging treatment options, including calcitonin gene-related peptide antibodies, non-invasive vagus nerve stimulation, sphenopalatine ganglion stimulation and somatostatin receptor agonists, discuss how evidence from trials of these emerging treatments provides insights into the pathophysiology of Cluster Headache and highlight areas for future research.
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Trial of Galcanezumab in Prevention of Episodic Cluster Headache.
The New England journal of medicine, 2019Co-Authors: Peter J. Goadsby, David William Dodick, Massimo Leone, Jennifer N. Bardos, Tina M. Oakes, Brian A. Millen, Chunmei Zhou, Sherie A. Dowsett, Sheena K. Aurora, Andrew H. AhnAbstract:Abstract Background Episodic Cluster Headache is a disabling neurologic disorder that is characterized by daily Headache attacks that occur over periods of weeks or months. Galcanezumab, a humanize...
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high flow oxygen for treatment of Cluster Headache a randomized trial
JAMA, 2009Co-Authors: Anna S Cohen, Brian Burns, Peter J. GoadsbyAbstract:Context Cluster Headache is an excruciatingly painful primary Headache syndrome, with attacks of unilateral pain and cranial autonomic symptoms. The current licensed treatment for acute attacks is subcutaneous sumatriptan. Objective To ascertain whether high-flow inhaled oxygen was superior to placebo in the acute treatment of Cluster Headache. Design, Setting, and Patients A double-blind, randomized, placebo-controlled crossover trial of 109 adults (aged 18-70 years) with Cluster Headache as defined by the International Headache Society. Patients treated 4 Headache episodes with high-flow inhaled oxygen or placebo, alternately. Patients were randomized to the order in which they received the active treatment or placebo. Patients were recruited and followed up between 2002 and 2007 at the National Hospital for Neurology and Neurosurgery, London, England. Intervention Inhaled oxygen at 100%, 12 L/min, delivered by face mask, for 15 minutes at the start of an attack of Cluster Headache or high-flow air placebo delivered alternately for 4 attacks. Main Outcome Measures The primary end point was to render the patient pain free, or in the absence of a diary to have adequate relief, at 15 minutes. Secondary end points included rendering the patient pain free at 30 minutes, reduction in pain up to 60 minutes, need for rescue medication 15 minutes after treatment, overall response to the treatment and overall functional disability, and effect on associated symptoms. Results Fifty-seven patients with episodic Cluster Headache and 19 with chronic Cluster Headache were available for the analysis. For the primary end point the difference between oxygen, 78% (95% confidence interval, 71%-85% for 150 attacks) and air, 20% (95% confidence interval, 14%-26%; for 148 attacks) was significant (Wald test, χ 2 5 = 66.7, P Conclusion Treatment of patients with Cluster Headache at symptom onset using inhaled high-flow oxygen compared with placebo was more likely to result in being pain-free at 15 minutes. Trial Registration isrctn.org Identifier: ISRCTN94092997
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electrocardiographic abnormalities in patients with Cluster Headache on verapamil therapy
Neurology, 2007Co-Authors: Anna S Cohen, Manjit Matharu, Peter J. GoadsbyAbstract:Background: High dose verapamil is an increasingly common preventive treatment in Cluster Headache (CH). Side effects include atrioventricular block and bradycardia, although their incidence in this population is not clear. Method: This audit study assessed the incidence of arrhythmias on high dose verapamil in patients with Cluster Headache. Results: Of three hundred sixty-nine patients with Cluster Headache, 217 outpatients (175 men) received verapamil, starting at 240 mg daily and increasing by 80 mg every 2 weeks with a check electrocardiogram (EKG), until the CH was suppressed, side effects intervened, or to a maximum daily dose of 960 mg. One patient had 1,200 mg/day. Eighty-nine patients (41%) had no EKGs. One hundred eight had EKGs in the hospital notes, and a further 20 had EKGs done elsewhere. Twenty-one of 108 patients (19%) had arrhythmias. Thirteen (12%) had first-degree heart block (PR > 0.2 s), at 240 to 960 mg/day, with one requiring a permanent pacemaker. Four patients had junctional rhythm, and one had second-degree heart block. Four patients had right bundle branch block. There was bradycardia (HR 0.2 s. The incidence of arrhythmias on verapamil in this patient group is 19%, and bradycardia 36%. Conclusion: We therefore strongly recommend EKG monitoring in all patients with Cluster Headache on verapamil, to observe for the potential development of atrioventricular block and symptomatic bradycardia.
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subcutaneous octreotide in Cluster Headache randomized placebo controlled double blind crossover study
Annals of Neurology, 2004Co-Authors: Manjit Matharu, Miles Levy, K Meeran, Peter J. GoadsbyAbstract:Current practical evidence-based acute treatments of Cluster Headache are limited to subcutaneous and intranasal formulations of sumatriptan, and oxygen. Two small randomized, double-blind trials suggested efficacy of somatostatin in Cluster Headache. We sought to determine whether octreotide, a somatostatin analog, is effective in the abortive treatment of acute Cluster Headache. Patients with episodic and chronic Cluster Headache, as defined by the International Headache Society, were recruited to a double-blind placebo-controlled crossover study. Patients were instructed to treat two attacks of at least moderate pain severity, with at least a 24-hour break, using subcutaneous octreotide microg or matching placebo. The primary end point was the Headache response defined as very severe, severe, or moderate pain becomes mild or nil, at 30 minutes. The primary end point was examined using a multilevel analysis approach. A total of 57 patients were recruited of whom 46 provided efficacy data on attacks treated with octreotide and 45 with placebo. The Headache response rate with subcutaneous octreotide was 52%, whereas that with placebo was 36%. Modeling the treatment outcome as a binomial where response was determined by treatment, using the patient as the level 2 variable, and considering period effect, sex, and Cluster Headache type as other variables of interest, we found that the effect of subcutaneous octreotide 100 microg was significantly superior to placebo (p < 0.01). Subcutaneous octreotide 100 microg is effective in the acute treatment of Cluster Headache when compared with placebo. Nonvasconstrictor treatment of acute Cluster Headache is possible.
Bart K Chwalisz - One of the best experts on this subject based on the ideXlab platform.
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case report orbital myositis triggering oxygen responsive Cluster Headache
Cephalalgia, 2020Co-Authors: Vivian Paraskevi Douglas, Konstantinos A A Douglas, Joseph F Rizzo, Bart K ChwaliszAbstract:BackgroundOrbital myositis is an idiopathic, non-infectious condition, typically seen in young females and usually affecting one extraocular muscle. Orbital myositis mimicking Cluster Headache is a...
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Orbital Myositis Triggering Oxygen-responsive Cluster Headache
Spencer S. Eccles Health Sciences Library University of Utah, 2019Co-Authors: Vivian Paraskevi Douglas, Konstantinos Douglas, Joseph Rizzo, Bart K ChwaliszAbstract:We present a case of new onset of Headache meeting diagnostic criteria for Cluster Headache, responsive to oxygen treatment, associated with diplopia and subtle ocular misalignment. This was revealed, by a contrastenhanced MRI of the orbits, to be secondary to orbital myositis
Vivian Paraskevi Douglas - One of the best experts on this subject based on the ideXlab platform.
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case report orbital myositis triggering oxygen responsive Cluster Headache
Cephalalgia, 2020Co-Authors: Vivian Paraskevi Douglas, Konstantinos A A Douglas, Joseph F Rizzo, Bart K ChwaliszAbstract:BackgroundOrbital myositis is an idiopathic, non-infectious condition, typically seen in young females and usually affecting one extraocular muscle. Orbital myositis mimicking Cluster Headache is a...
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Orbital Myositis Triggering Oxygen-responsive Cluster Headache
Spencer S. Eccles Health Sciences Library University of Utah, 2019Co-Authors: Vivian Paraskevi Douglas, Konstantinos Douglas, Joseph Rizzo, Bart K ChwaliszAbstract:We present a case of new onset of Headache meeting diagnostic criteria for Cluster Headache, responsive to oxygen treatment, associated with diplopia and subtle ocular misalignment. This was revealed, by a contrastenhanced MRI of the orbits, to be secondary to orbital myositis
Rigmor Jensen - One of the best experts on this subject based on the ideXlab platform.
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Cluster Headache is associated with unhealthy lifestyle and lifestyle related comorbid diseases results from the danish Cluster Headache survey
Cephalalgia, 2019Co-Authors: Nunu Lund, Agneta Snoer, Rigmor Jensen, Anja S Petersen, Mads BarloeseAbstract:AimTo compare the prevalence of unhealthy lifestyle factors and comorbid disorders in Cluster Headache patients with Headache-free controls, in order to discuss pathophysiology and possible consequ...
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effect of infusion of calcitonin gene related peptide on Cluster Headache attacks a randomized clinical trial
JAMA Neurology, 2018Co-Authors: Anne Luise Haulund Vollesen, Agneta Snoer, Rigmor Jensen, Rasmus P Beske, Song Guo, Jan Hoffmann, Messoud AshinaAbstract:Importance Signaling molecule calcitonin gene-related peptide (CGRP) induces migraine attacks and anti-CGRP medications abort and prevent migraine attacks. Whether CGRP provokes Cluster Headache attacks is unknown. Objective To determine whether CGRP induces Cluster Headache attacks in episodic Cluster Headache in active phase, episodic Cluster Headache in remission phase, and chronic Cluster Headache. Design, Setting, and Participants A randomized, double-blind, placebo-controlled, 2-way crossover study set at the Danish Headache Center, Rigshospitalet Glostrup, in Denmark. Analyses were intent to treat. Inclusion took place from December 2015 to April 2017. Inclusion criteria were diagnosis of episodic/chronic Cluster Headache, patients aged 18 to 65 years, and safe contraception in women. Exclusion criteria were a history of other primary Headache (except episodic tension-type Headache Interventions Thirty-seven patients with Cluster Headaches received intravenous infusion of 1.5 μg/min of CGRP or placebo over 20 minutes on 2 study days. Main Outcomes and Measures Difference in incidence of Cluster Headache–like attacks, difference in area under the curve (AUC) for Headache intensity scores (0 to 90 minutes), and difference in time to peak Headache between CGRP and placebo in the 3 groups. Results Of 91 patients assessed for eligibility, 32 patients (35.2%) were included in the analysis. The mean (SD) age was 36 (10.7) years (range, 19-60 years), and the mean weight was 78 kg (range, 53-100 kg). Twenty-seven men (84.4%) completed the study. Calcitonin gene-related peptide induced Cluster Headache attacks in 8 of 9 patients in the active phase (mean, 89%; 95% CI, 63-100) compared with 1 of 9 in the placebo group (mean, 11%; 95% CI, 0-37) ( P = .05). In the remission phase, no patients with episodic Cluster Headaches reported attacks after CGRP or placebo. Calcitonin gene-related peptide–induced attacks occurred in 7 of 14 patients with chronic Cluster Headaches (mean, 50%; 95% CI, 20-80) compared with none after placebo ( P = .02). In patients with episodic active phase, the mean AUC from 0 to 90 minutes for CGRP was 1.903 (95% CI, 0.842-2.965), and the mean AUC from 0 to 90 minutes for the placebo group was 0.343 (95% CI, 0-0.867) ( P = .04). In patients with chronic Cluster Headache, the mean AUC from 0 to 90 minutes for CGRP was 1.214 (95% CI, 0.395-2.033), and the mean AUC from 0 to 90 minutes for the placebo group was 0.036 (95% CI, 0-0.114) ( P = .01). In the remission phase, the mean AUC from 0 to 90 minutes for CGRP was 0.187 (95% CI, 0-0.571), and the mean AUC from 0 to 90 minutes for placebo was 0.019 (95% CI, 0-0.062) ( P > .99). Conclusions and Relevance Calcitonin gene-related peptide provokes Cluster Headache attacks in active-phase episodic Cluster Headache and chronic Cluster Headache but not in remission-phase episodic Cluster Headache. These results suggest anti-CGRP drugs may be effective in Cluster Headache management. Trial Registration ClinicalTrials.gov (NCT02466334).
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pre attack signs and symptoms in Cluster Headache characteristics and time profile
Cephalalgia, 2018Co-Authors: Agneta Snoer, Rigmor Jensen, Rasmus P Beske, Nunu Lund, Mads BarloeseAbstract:Introduction In contrast to the premonitory phase of migraine, little is known about the pre-attack (prodromal) phase of a Cluster Headache. We aimed to describe the nature, prevalence, and duration of pre-attack symptoms in Cluster Headache. Methods Eighty patients with episodic Cluster Headache or chronic Cluster Headache, according to ICHD-3 beta criteria, were invited to participate. In this observational study, patients underwent a semi-structured interview where they were asked about the presence of 31 symptoms/signs in relation to a typical Cluster Headache attack. Symptoms included previously reported Cluster Headache pre-attack symptoms, premonitory migraine symptoms and accompanying symptoms of migraine and Cluster Headache. Results Pre-attack symptoms were reported by 83.3% of patients, with an average of 4.25 (SD 3.9) per patient. Local and painful symptoms, occurring with a median of 10 minutes before attack, were reported by 70%. Local and painless symptoms and signs, occurring with a median of 10 minutes before attack, were reported by 43.8% and general symptoms, occurring with a median of 20 minutes before attack, were reported by 62.5% of patients. Apart from a dull/aching sensation in the attack area being significantly ( p < 0.05) more frequent among men and episodic patients, compared with women and chronic patients respectively, no other differences in the prevalence of pre-attack symptoms were identified between groups. Conclusion Pre-attack symptoms are frequent in Cluster Headache. Since the origin of Cluster Headache attacks is still unresolved, studies of pre-attack symptoms could contribute to the understanding of Cluster Headache pathophysiology. Furthermore, identification and recognition of pre-attack symptoms could potentially allow earlier abortive treatment.
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Cluster Headache attack remission with sphenopalatine ganglion stimulation experiences in chronic Cluster Headache patients through 24 months
Journal of Headache and Pain, 2016Co-Authors: Mads Barloese, Charly Gaul, Jean Schoenen, Arne May, Tim P Jurgens, J M Lainez, Amy M Goodman, Anthony Caparso, Rigmor JensenAbstract:Background Cluster Headache (CH) is a debilitating Headache disorder with severe consequences for patient quality of life. On-demand neuromodulation targeting the sphenopalatine ganglion (SPG) is effective in treating the acute pain and a subgroup of patients experience a decreased frequency of CH attacks.
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burden of Cluster Headache
Cephalalgia, 2007Co-Authors: R M Jensen, A C Lyngberg, Rigmor JensenAbstract:The aim was to analyse the socioeconomic burden of Cluster Headache in patients from a tertiary Headache centre. One hundred consecutive patients from the Danish Headache Centre were invited to an interview about the socioeconomic impact of Cluster Headache. Work absence and use of medical services were compared with a Danish population-based survey. Eighty-five patients participated; 78% reported restrictions in daily living and 13% also outside of Cluster periods; 25% reported a major decrease in their ability to participate in social activities, family life and housework. The disease caused lifestyle changes for 96%, most frequently in sleeping habits and avoidance of alcohol. The absence rate among patients was 30%, which was significantly higher than 12% among the general population (P < 0.001). Use of health services due to Headache was also higher among the patients (P < 0.001). Cluster Headache, although periodic in most cases, has considerable impact on social functions, quality of life and use of healthcare.
Mark C Kruit - One of the best experts on this subject based on the ideXlab platform.
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the anterior hypothalamus in Cluster Headache
Cephalalgia, 2017Co-Authors: Enrico B Arkink, G G Schoonman, Jorine A Van Vliet, Joost Haan, Mark A Van Buchem, Michel D Ferrari, N Schmitz, Mark C KruitAbstract:ObjectiveTo evaluate the presence, localization, and specificity of structural hypothalamic and whole brain changes in Cluster Headache and chronic paroxysmal hemicrania (CPH).MethodsWe compared T1-weighted magnetic resonance images of subjects with Cluster Headache (episodic n = 24; chronic n = 23; probable n = 14), CPH (n = 9), migraine (with aura n = 14; without aura n = 19), and no Headache (n = 48). We applied whole brain voxel-based morphometry (VBM) using two complementary methods to analyze structural changes in the hypothalamus: region-of-interest analyses in whole brain VBM, and manual segmentation of the hypothalamus to calculate volumes. We used both conservative VBM thresholds, correcting for multiple comparisons, and less conservative thresholds for exploratory purposes.ResultsUsing region-of-interest VBM analyses mirrored to the Headache side, we found enlargement (p < 0.05, small volume correction) in the anterior hypothalamic gray matter in subjects with chronic Cluster Headache compared ...
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the cavernous sinus in Cluster Headache a quantitative structural magnetic resonance imaging study
Cephalalgia, 2017Co-Authors: Enrico B Arkink, G G Schoonman, Jorine A Van Vliet, Hannah S Bakels, Marjolein Am Sneeboer, Joost Haan, Mark A Van Buchem, Michel D Ferrari, Mark C KruitAbstract:Background It has been hypothesized that a constitutionally narrow cavernous sinus might predispose individuals to Cluster Headache. Cavernous sinus dimensions, however, have never been assessed. Methods In this case-control study, we measured the dimensions of the cavernous sinus, skull base, internal carotid and pituitary gland with high-resolution T2-weighted magnetic resonance imaging in 25 episodic, 24 chronic and 13 probable Cluster Headache patients, 8 chronic paroxysmal hemicrania patients and 22 Headache-free controls. Dimensions were compared between groups, correcting for age, sex and transcranial diameter. Results On qualitative inspection, no relevant pathology or anatomic variants that were previously associated with Cluster Headache or chronic paroxysmal hemicranias were observed in the cavernous sinus or paracavernous structures. The left-to-right transcranial diameter at the temporal fossa level (mean ± SD) was larger in the Headache groups (episodic Cluster Headache: 147.5 ± 7.3 mm, p = 0.044; chronic Cluster Headache: 150.2 ± 7.3 mm, p < 0.001; probable Cluster Headache: 146.0 ± 5.3 mm, p = 0.012; and chronic paroxysmal hemicrania: 145.2 ± 9.4 mm, p = 0.044) compared with controls (140.2 ± 8.0 mm). After adjusting for transcranial diameter and correcting for multiple comparisons, there were no differences in the dimensions of the cavernous sinus and surrounding structures between Headache patients and controls. Conclusion Patients with Cluster Headache or chronic paroxysmal hemicrania had wider skulls than Headache-free controls, but the proportional dimensions of the cavernous sinus were similar.
