The Experts below are selected from a list of 1359 Experts worldwide ranked by ideXlab platform

Todd D. Rozen - One of the best experts on this subject based on the ideXlab platform.

  • how effective is melatonin as a preventive treatment for Hemicrania Continua a clinic based study
    Headache, 2015
    Co-Authors: Todd D. Rozen
    Abstract:

    Objective To assess the efficacy of melatonin as a preventive therapy for Hemicrania Continua in a larger population of patients than has previously been studied. Background Hemicrania Continua is defined by its sensitivity to indomethacin. Rarely can patients be fully tapered off indomethacin without headache recurrence; thus, the risks associated with chronic indomethacin usage are substantial for these individuals. Melatonin, a pineal hormone with a similar chemical structure to indomethacin, has shown efficacy as a preventive agent for Hemicrania Continua in isolated case reports. Melatonin would be a preferential alternative prophylactic treatment to indomethacin because of its minimal side effect profile. How truly effective melatonin is as a preventive for Hemicrania Continua is unknown at present and needs further study. Methods Retrospective analysis of all International Classification of Headache Disorders-3 beta diagnosed Hemicrania Continua patients treated with both indomethacin and melatonin at the Geisinger Headache Center from July 2011 to January 2014. Results Eleven patients were treated (9 women, 2 men). Two patients became pain free on melatonin, while partial relief was noted in 3 other patients; thus, they were able to lower their dose of indomethacin but could not achieve pain freedom with melatonin alone. Six patients had no response. Melatonin dosing needed for response ranged from 3 to 30 mg. In the partial relief responders, indomethacin dosing decreased by 50% to 75%. Conclusion From this single clinic investigation, only a small percent of subjects with Hemicrania Continua (less than 20%) will achieve pain freedom on melatonin, thus clearly not matching the effectiveness of indomethacin. However, the addition of melatonin to indomethacin may allow around 45% of patients to have complete or partial relief of their headache with the subsequent ability to reduce or eliminate their indomethacin dosage, which may lead to a decrease in medical morbidity over time secondary to less exposure to indomethacin.

  • Treatment of Hemicrania Continua with radiofrequency ablation and long-term follow-up.
    Cephalalgia : an international journal of headache, 2015
    Co-Authors: Jennifer L Beams, Matthew T Kline, Todd D. Rozen
    Abstract:

    ObjectiveThe objective of this research is to describe novel procedural treatments for Hemicrania Continua that allow patients to remain off indomethacin.MethodsCase reports are presented.ResultsWe describe four distinct patients with indomethacin-responsive Hemicrania Continua who were unable to discontinue the use of indomethacin without headache recurrence. No other medications were effective for their syndrome. Secondary causes of headache were ruled out in each case. Each patient underwent diagnostic blockade of either the atlanto-axial joint, C2 dorsal root ganglion or sphenopalantine ganglion depending on their clinical examination and presence of cranial autonomic symptoms. A positive response led to a radiofrequency ablation of the C2 ventral ramus, C2 dorsal root ganglion or sphenopalantine ganglion, which provided headache relief in all case patients as complete as indomethacin. Long-term follow-up of these patients has shown that all have remained essentially headache free without the need for...

  • How Effective Is Melatonin as a Preventive Treatment for Hemicrania Continua? A Clinic‐Based Study
    Headache, 2015
    Co-Authors: Todd D. Rozen
    Abstract:

    Objective To assess the efficacy of melatonin as a preventive therapy for Hemicrania Continua in a larger population of patients than has previously been studied. Background Hemicrania Continua is defined by its sensitivity to indomethacin. Rarely can patients be fully tapered off indomethacin without headache recurrence; thus, the risks associated with chronic indomethacin usage are substantial for these individuals. Melatonin, a pineal hormone with a similar chemical structure to indomethacin, has shown efficacy as a preventive agent for Hemicrania Continua in isolated case reports. Melatonin would be a preferential alternative prophylactic treatment to indomethacin because of its minimal side effect profile. How truly effective melatonin is as a preventive for Hemicrania Continua is unknown at present and needs further study. Methods Retrospective analysis of all International Classification of Headache Disorders-3 beta diagnosed Hemicrania Continua patients treated with both indomethacin and melatonin at the Geisinger Headache Center from July 2011 to January 2014. Results Eleven patients were treated (9 women, 2 men). Two patients became pain free on melatonin, while partial relief was noted in 3 other patients; thus, they were able to lower their dose of indomethacin but could not achieve pain freedom with melatonin alone. Six patients had no response. Melatonin dosing needed for response ranged from 3 to 30 mg. In the partial relief responders, indomethacin dosing decreased by 50% to 75%. Conclusion From this single clinic investigation, only a small percent of subjects with Hemicrania Continua (less than 20%) will achieve pain freedom on melatonin, thus clearly not matching the effectiveness of indomethacin. However, the addition of melatonin to indomethacin may allow around 45% of patients to have complete or partial relief of their headache with the subsequent ability to reduce or eliminate their indomethacin dosage, which may lead to a decrease in medical morbidity over time secondary to less exposure to indomethacin.

  • Neurological picture. An eye of Hemicrania Continua.
    Journal of neurology neurosurgery and psychiatry, 2012
    Co-Authors: Todd D. Rozen, Jennifer L Beams
    Abstract:

    Hemicrania Continua is a recognised form of primary chronic daily headache manifested by daily one-sided head pain of mild to moderate intensity, with intermittent pain exacerbation periods marked by migrainous and cranial autonomic symptoms (conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, eyelid oedema, ptosis and/or miosis).1 Hemicrania Continua is one of the indomethacin-responsive headaches, thus, once a patient is given the correct dose of indomethacin they will become pain-free and remain so as long as they are on this particular non-steroidal anti-inflammatory agent (NSAID). Basically, all other treatments, including other NSAIDs, will provide minimal or no relief. Hemicrania Continua is often missed as a diagnosis. The probable leading cause for …

  • Melatonin Responsive Hemicrania Continua
    Headache, 2006
    Co-Authors: Todd D. Rozen
    Abstract:

    Hemicrania Continua is one of the indomethacin-responsive headache syndromes. There are very few effective alternative therapies for Hemicrania Continua, thus patients may require daily indomethacin for years. The risks of long-term indomethacin include gastrointestinal and renal dysfunction. Melatonin is a pineal hormone with a chemical structure very similar to indomethacin. Recently, melatonin was shown to be effective for primary stabbing headache, another indomethacin-responsive syndrome. Three cases of melatonin responsive Hemicrania Continua are now reported.

Peter J. Goadsby - One of the best experts on this subject based on the ideXlab platform.

  • Postoperative Hemicrania Continua-like headache - a case series
    The journal of headache and pain, 2015
    Co-Authors: Andreas R. Gantenbein, Hakan Sarikaya, Franz Riederer, Peter J. Goadsby
    Abstract:

    Hemicrania Continua (HC) is a rare chronic headache disorder, typically accompanied by cranial autonomic features and responding to therapeutic doses of indomethacin. The pathophysiology of Hemicrania Continua is not fully understood. We report a series of three patients who developed a continuous Hemicranial headache after cranial surgery. Each case presented a similar phenotype of continuous half-sided headache, cranial autonomic symptoms with exacerbations (2/3), and a response to indomethacin. The biology of Hemicrania Continua may be activated post-craniotomy just as can be seen with other primary headache disorders.

  • Trigeminal Autonomic Cephalalgias (TACs) – Hemicrania Continua
    Encyclopedia of the Neurological Sciences, 2014
    Co-Authors: Peter J. Goadsby, Elisabetta Cittadini
    Abstract:

    Hemicrania Continua (HC) is a relatively rare primary headache disorder characterized by unilateral pain and an exquisite response to indomethacin. Since the term was introduced in 1984, more than 100 cases have been reported in the literature. Useful information regarding the pathophysiology comes from functional imaging that suggests a role for subcortical neural structures. A positron emission tomography (PET) study in HC patients showed activation of the contralateral posterior hypothalamus, the ipsilateral dorsal pons, and ipsilateral ventral midbrain. Taken together with the unique effect of indomethacin to block the pain, the data point to the classification of HC as a unique syndrome that belongs to trigeminal autonomic cephalalgias (TACs).

  • trigeminal autonomic cephalalgias tacs Hemicrania Continua
    Reference Module in Neuroscience and Biobehavioral Psychology#R##N#Encyclopedia of the Neurological Sciences (Second Edition), 2014
    Co-Authors: Peter J. Goadsby, Elisabetta Cittadini
    Abstract:

    Hemicrania Continua (HC) is a relatively rare primary headache disorder characterized by unilateral pain and an exquisite response to indomethacin. Since the term was introduced in 1984, more than 100 cases have been reported in the literature. Useful information regarding the pathophysiology comes from functional imaging that suggests a role for subcortical neural structures. A positron emission tomography (PET) study in HC patients showed activation of the contralateral posterior hypothalamus, the ipsilateral dorsal pons, and ipsilateral ventral midbrain. Taken together with the unique effect of indomethacin to block the pain, the data point to the classification of HC as a unique syndrome that belongs to trigeminal autonomic cephalalgias (TACs).

  • Update on Hemicrania Continua
    Current Pain and Headache Reports, 2011
    Co-Authors: Elisabetta Cittadini, Peter J. Goadsby
    Abstract:

    Hemicrania Continua (HC) is a rare primary headache syndrome, characterized by unilateral pain and an absolute response to indometacin. Since the term was first coined in 1984, more than 100 cases have been described worldwide. Most recently, detailed case series that provide more detailed information concerning the sometimes complex clinical presentation of HC have been reported. Functional imaging studies suggest a unique pattern of subcortical involvement in HC: contralateral to the pain posterior hypothalamic region, ipsilateral dorsal pons and ipsilateral ventral midbrain, which, along with the particular effect of indometacin, probably justifies its classification as a unique entity. Increasing the awareness of this primary headache form among clinicians will aid in its diagnosis while further work is being undertaken to characterize the syndrome.

  • Trigeminal autonomic cephalalgias: paroxysmal Hemicrania, SUNCT/SUNA, and Hemicrania Continua.
    Seminars in Neurology, 2010
    Co-Authors: Peter J. Goadsby, Elisabetta Cittadini, Anna S. Cohen
    Abstract:

    The trigeminal autonomic cephalalgias (TACs) are a group of primary headache disorders that include cluster headache (CH), paroxysmal Hemicrania (PH), and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing/cranial autonomic features (SUNCT/SUNA). Hemicrania Continua (HC) is often included with this group, although the second edition of The International Classification of Headache Disorders did not link the entities. Trigeminal autonomic cephalalgias are generally characterized by relatively short-lasting attacks of severe pain and lateralized associated features including the pain, cranial autonomic symptoms, and where present, migrainous symptoms, such as photophobia. Paroxysmal Hemicrania has intermediate duration and intermediate attack frequency. Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing has the shortest attack duration and the highest attack frequency. Hemicrania Continua has a continuous pain with exacerbations that can include cranial autonomic symptoms as part of the phenotype. The syndromes share much in their pathophysiology and investigation paths; however, their treatment is distinct, so that the accurate differentiation is important for optimal management.

Ottar Sjaastad - One of the best experts on this subject based on the ideXlab platform.

  • Hemicrania Continua: major shortcomings in the new classification
    The journal of headache and pain, 2014
    Co-Authors: Torbjørn A Fredriksen, Fabio Antonaci, Ottar Sjaastad
    Abstract:

    Hemicrania Continua ( HC) was described and coined by Sjaastad and Spierings in 1984. Later cases, carrying this appellation should, grossly, conform to this original description. The proposed classification criteria (ICHD, 3rd edition beta version) for HC has major shortcomings, and ordinary HC cases do not fulfill the proposed criteria. Relatively rare symptoms and signs are e.g. made obligatory (point C 1). And the recommended dosage of indomethacin- both test and long-term dosages-is unallowably high. In this way, bogus HC cases are systematically created. This irrational diagnostic system is in urgent need of a major revision.

  • Hemicrania Continua: towards a new classification?
    The Journal of Headache and Pain, 2014
    Co-Authors: Fabio Antonaci, Ottar Sjaastad
    Abstract:

    Hemicrania Continua (HC) was described and coined in 1984 by Sjaastad and Spierings. Later cases, carrying this appellation, should conform to the original description. The proposed classification criteria (ICHD 3rd edition beta version) for HC focus e.g. on localized, autonomic and “vascular” features. Such features do, however, not belong to the core symptomatology of HC and should accordingly be removed. The genuine, original HC will then re-appear.The headache that the new criteria refer to, has in an unfair and unjustified manner been given the designation HC. A revision of the proposed criteria seems mandatory.

  • Chapter 43 – Hemicrania Continua
    Handbook of clinical neurology, 2010
    Co-Authors: Fabio Antonaci, Ottar Sjaastad
    Abstract:

    Publisher Summary Hemicrania Continua (HC) is an indomethacin-responsive headache. Whereas other unilateral headaches accompanied by local autonomic phenomena are intermittent, short-lasting headaches, HC is characterized by a continuous course. HC is also in principle a unilateral headache. HC can be classified in an episodic and chronic form. Local autonomic symptoms, mostly ipsilateral lacrimation and conjunctival injection and nasal stuffiness, are present in approximately one-third of HC patients but are not as prominent as in cluster headache or paroxysmalHemicrania (CPH). Diagnosis is based on clinical history, neurological examination, and a therapeutic trial of indomethacin. Indomethacin is the drug of choice in HC as well as CPH. Prophylatic therapy gives a prompt, complete, and enduring response. The effective dose of indo-methacin ranges from 25 to 150 mg/day. Dosage titration is necessary to cope with clinical fluctuations. Skipping or delaying doses may result in recurrence. Other drugs reported to have been partially or even completely effective, frequently in isolated cases, include ibuprofen, piroxicam, betadextrin, naproxen, aspirin, paracetamol with caffeine, and melatonin.

  • chapter 43 Hemicrania Continua
    Handbook of Clinical Neurology, 2010
    Co-Authors: Fabio Antonaci, Ottar Sjaastad
    Abstract:

    Publisher Summary Hemicrania Continua (HC) is an indomethacin-responsive headache. Whereas other unilateral headaches accompanied by local autonomic phenomena are intermittent, short-lasting headaches, HC is characterized by a continuous course. HC is also in principle a unilateral headache. HC can be classified in an episodic and chronic form. Local autonomic symptoms, mostly ipsilateral lacrimation and conjunctival injection and nasal stuffiness, are present in approximately one-third of HC patients but are not as prominent as in cluster headache or paroxysmalHemicrania (CPH). Diagnosis is based on clinical history, neurological examination, and a therapeutic trial of indomethacin. Indomethacin is the drug of choice in HC as well as CPH. Prophylatic therapy gives a prompt, complete, and enduring response. The effective dose of indo-methacin ranges from 25 to 150 mg/day. Dosage titration is necessary to cope with clinical fluctuations. Skipping or delaying doses may result in recurrence. Other drugs reported to have been partially or even completely effective, frequently in isolated cases, include ibuprofen, piroxicam, betadextrin, naproxen, aspirin, paracetamol with caffeine, and melatonin.

  • Is Occipital Nerve Stimulation Effective in Hemicrania Continua
    NEJM Journal Watch, 2009
    Co-Authors: Ottar Sjaastad
    Abstract:

    Hemicrania Continua (HC) is a rare disorder characterized by unilaterality, continuous headache, and absolute response to indomethacin. Local autonomic phenomena are common during exacerbations. In this manufacturer-sponsored study, investigators tested the effectiveness of a bion (miniature neurostimulator) implanted over the greater occipital nerve on the symptomatic side in six patients with HC. The study had an …

Fabio Antonaci - One of the best experts on this subject based on the ideXlab platform.

  • Hemicrania Continua: major shortcomings in the new classification
    The journal of headache and pain, 2014
    Co-Authors: Torbjørn A Fredriksen, Fabio Antonaci, Ottar Sjaastad
    Abstract:

    Hemicrania Continua ( HC) was described and coined by Sjaastad and Spierings in 1984. Later cases, carrying this appellation should, grossly, conform to this original description. The proposed classification criteria (ICHD, 3rd edition beta version) for HC has major shortcomings, and ordinary HC cases do not fulfill the proposed criteria. Relatively rare symptoms and signs are e.g. made obligatory (point C 1). And the recommended dosage of indomethacin- both test and long-term dosages-is unallowably high. In this way, bogus HC cases are systematically created. This irrational diagnostic system is in urgent need of a major revision.

  • Hemicrania Continua: towards a new classification?
    The Journal of Headache and Pain, 2014
    Co-Authors: Fabio Antonaci, Ottar Sjaastad
    Abstract:

    Hemicrania Continua (HC) was described and coined in 1984 by Sjaastad and Spierings. Later cases, carrying this appellation, should conform to the original description. The proposed classification criteria (ICHD 3rd edition beta version) for HC focus e.g. on localized, autonomic and “vascular” features. Such features do, however, not belong to the core symptomatology of HC and should accordingly be removed. The genuine, original HC will then re-appear.The headache that the new criteria refer to, has in an unfair and unjustified manner been given the designation HC. A revision of the proposed criteria seems mandatory.

  • Chapter 43 – Hemicrania Continua
    Handbook of clinical neurology, 2010
    Co-Authors: Fabio Antonaci, Ottar Sjaastad
    Abstract:

    Publisher Summary Hemicrania Continua (HC) is an indomethacin-responsive headache. Whereas other unilateral headaches accompanied by local autonomic phenomena are intermittent, short-lasting headaches, HC is characterized by a continuous course. HC is also in principle a unilateral headache. HC can be classified in an episodic and chronic form. Local autonomic symptoms, mostly ipsilateral lacrimation and conjunctival injection and nasal stuffiness, are present in approximately one-third of HC patients but are not as prominent as in cluster headache or paroxysmalHemicrania (CPH). Diagnosis is based on clinical history, neurological examination, and a therapeutic trial of indomethacin. Indomethacin is the drug of choice in HC as well as CPH. Prophylatic therapy gives a prompt, complete, and enduring response. The effective dose of indo-methacin ranges from 25 to 150 mg/day. Dosage titration is necessary to cope with clinical fluctuations. Skipping or delaying doses may result in recurrence. Other drugs reported to have been partially or even completely effective, frequently in isolated cases, include ibuprofen, piroxicam, betadextrin, naproxen, aspirin, paracetamol with caffeine, and melatonin.

  • chapter 43 Hemicrania Continua
    Handbook of Clinical Neurology, 2010
    Co-Authors: Fabio Antonaci, Ottar Sjaastad
    Abstract:

    Publisher Summary Hemicrania Continua (HC) is an indomethacin-responsive headache. Whereas other unilateral headaches accompanied by local autonomic phenomena are intermittent, short-lasting headaches, HC is characterized by a continuous course. HC is also in principle a unilateral headache. HC can be classified in an episodic and chronic form. Local autonomic symptoms, mostly ipsilateral lacrimation and conjunctival injection and nasal stuffiness, are present in approximately one-third of HC patients but are not as prominent as in cluster headache or paroxysmalHemicrania (CPH). Diagnosis is based on clinical history, neurological examination, and a therapeutic trial of indomethacin. Indomethacin is the drug of choice in HC as well as CPH. Prophylatic therapy gives a prompt, complete, and enduring response. The effective dose of indo-methacin ranges from 25 to 150 mg/day. Dosage titration is necessary to cope with clinical fluctuations. Skipping or delaying doses may result in recurrence. Other drugs reported to have been partially or even completely effective, frequently in isolated cases, include ibuprofen, piroxicam, betadextrin, naproxen, aspirin, paracetamol with caffeine, and melatonin.

  • The Hemicrania Continua diagnosis
    Cephalalgia : an international journal of headache, 2002
    Co-Authors: J. A. Pareja, Fabio Antonaci, Maurice B. Vincent
    Abstract:

    More than 16 years after the first description of Hemicrania Continua (HC), its aetiology and pathogenesis remain obscure. Clinically, HC is considered a syndrome with two pivotal characteristics: (i) strictly unilateral (moderate, fluctuating, relatively long-lasting) headache; and (ii) absolute response to indomethacin. HC is further characterized by some ancillary, but mostly ‘negative’, features such as: (iii) relative paucity of accompaniments; and (iv) lack of precipitating factors. The female preponderance is also remarkable, although not diagnostic in the solitary case. Finally, a non-specific, but remarkable feature is the temporal pattern. HC may present as a remitting or chronic (continuous) headache. In HC, unilaterality and absolute response to indomethacin are considered crucial diagnostically. Existing controversy, such as regarding atypical features, particularly the so-called ‘HC resistant to indomethacin’, is discussed. The nature of Hemicrania with negative indomethacin response remains...

Dimos D Mitsikostas - One of the best experts on this subject based on the ideXlab platform.