Trigeminal Autonomic Cephalalgia

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

  • Trigeminal Autonomic Cephalalgias presenting in a multidisciplinary tertiary orofacial pain clinic
    Journal of Headache and Pain, 2019
    Co-Authors: Diana Y Wei, Peter J. Goadsby, David Morenoajona, Tara Renton
    Abstract:

    Orofacial pain may have a variety of causes and offers a significant clinical challenge for its diagnosis and management. To assess the headache disorders presenting in a tertiary multidisciplinary orofacial pain clinic, after dental causes have been excluded. Clinic letters from the initial consultation and subsequent follow up reviews of the 142 patients, who were seen in the tertiary Multidisciplinary Orofacial Pain clinic between January 2015 until January 2018 were reviewed as a clinical audit. The most common diagnoses were possible Trigeminal Autonomic Cephalalgia (n = 62, 44%), migraine (n = 38, 27%) and painful post-traumatic Trigeminal neuropathy (n = 17, 12%). The most common Trigeminal Autonomic Cephalalgia diagnosis was hemicrania continua (n = 13, 9%), which is higher than the reported prevalence in neurology and headache clinics. This study demonstrates the importance of a multidisciplinary approach to diagnosing complex orofacial pain patients and the importance of awareness of primary headache disorders, in particular Trigeminal Autonomic Cephalalgias, thereby reducing unnecessary diagnostic delays or procedures.

  • Outcomes of greater occipital nerve injections in pediatric patients with chronic primary headache disorders.
    Pediatric neurology, 2013
    Co-Authors: Amy A. Gelfand, Amanda C. Reider, Peter J. Goadsby
    Abstract:

    Abstract Background Chronic migraine is common in pediatrics and generally disabling. In adults, infiltration of the area around the greater occipital nerve can provide short- to medium-term benefit in some patients. This study reports the efficacy of greater occipital nerve infiltrations in pediatric patients with chronic primary headache disorders. Methods Retrospective chart review of patients Results Forty-six patients were treated. Thirty-five (76%) had chronic migraine, 9 (20%) new daily persistent headache (NDPH), and 2 (4%) a chronic Trigeminal Autonomic Cephalalgia. Medication overuse was present in 26%. Ages ranged from 7 to 17 years. Follow-up data were available for 40 (87%). Overall, 53% (21/40) benefitted, and 52% (11/21) benefitted significantly. Benefit onset ranged from 0 to 14 days, mean 4.7 (SD 4.3), with mean benefit duration of 5.4 (SD 4.9) weeks. In chronic migraine, 62% (18/29) benefitted, and 56% (10/18) significantly benefitted. In NDPH, 33% (3/9) benefitted; 33% (n = 1) significantly. Neither child with a chronic Trigeminal Autonomic Cephalalgia benefitted. In logistic regression modeling, medication overuse, age, sex, and sensory change in the distribution of the infiltrated nerve did not predict outcome. There were no serious side effects. Conclusions Greater occipital nerve injections benefitted 53% of pediatric patients with chronic primary headache disorders. Efficacy appeared greater in chronic migraine than NDPH. Given the benign side effect profile, a greater occipital nerve infiltration seems appropriate before more aggressive approaches.

  • Paroxysmal hemicrania responding to topiramate
    Journal of neurology neurosurgery and psychiatry, 2007
    Co-Authors: A S Cohen, Peter J. Goadsby
    Abstract:

    Chronic paroxysmal hemicrania (CPH) is a rare primary headache syndrome, which is classified along with cluster headache and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) as a Trigeminal Autonomic Cephalalgia. CPH is exquisitely responsive to indomethacin so much so that the response is one of the current diagnostic criteria. The case of a patient with CPH, who had marked epigastric symptoms with indomethacin treatment and responded well to topiramate 150 mg daily, is reported. Cessation of topiramate caused return of episodes, and the response has persisted for 2 years. Topiramate may be a treatment option in CPH.

Maurice Vincent - One of the best experts on this subject based on the ideXlab platform.

  • hemicrania continua unquestionably a Trigeminal Autonomic Cephalalgia
    Headache, 2013
    Co-Authors: Maurice Vincent
    Abstract:

    Hemicrania continua (HC) is a well-known primary headache. The present version of the International Classification of Headache Disorders lists HC in the "other primary headaches" group. However, evidence has emerged demonstrating that HC is a phenotype that belongs to the Trigeminal Autonomic Cephalalgias together with cluster headache, paroxysmal hemicrania (PH), and short-lasting, unilateral neuralgiform headache attacks with conjunctival injection and tearing. This is supported by a common general clinical picture - paroxysmal, fluctuating, unilateral, side-locked headaches located to the ocular, frontal, and/or temporal regions, accompanied by ipsilateral Autonomic dysfunctions including for example, tearing and conjunctival injection. Apart from the remarkable clinical similarities, the absolute and incomparable effect of indomethacin in HC parallels the effect of this drug in PH, suggesting a shared core pathogenesis. Finally, neuroimage findings demonstrate a posterior hypothalamic activation in HC similarly to cluster headache, PH, and short-lasting, unilateral neuralgiform headache attacks with conjunctival injection and tearing. Taken together, data indicate that HC is certainly a type of Trigeminal Autonomic Cephalalgia that should no longer be placed in a group of miscellaneous primary headache disorders.

Seok Keun Choi - One of the best experts on this subject based on the ideXlab platform.

Richard B. Lipton - One of the best experts on this subject based on the ideXlab platform.

  • the epidemiology of primary headache disorders
    Seminars in Neurology, 2010
    Co-Authors: Matthew S. Robbins, Richard B. Lipton
    Abstract:

    Primary headache disorders encompass a heterogeneous group of neurologic disorders that cause recurrent or persistent head pain without any clear underlying cause. The epidemiology of the most common primary headache disorders, tension-type headache and migraine, the most common Trigeminal Autonomic Cephalalgia, cluster headache, as well as chronic daily headache are addressed in this review. The incidence, prevalence, burden, and comorbidities of these disorders are discussed, and the risk factors for progression from episodic to chronic daily headache are also reviewed.

  • The differential diagnosis of chronic daily headaches: an algorithm-based approach
    The Journal of Headache and Pain, 2007
    Co-Authors: Marcelo E. Bigal, Richard B. Lipton
    Abstract:

    Chronic daily headaches (CDHs) refers to primary headaches that happen on at least 15 days per month, for 4 or more hours per day, for at least three consecutive months. The differential diagnosis of CDHs is challenging and should proceed in an orderly fashion. The approach begins with a search for “red flags” that suggest the possibility of a secondary headache. If secondary headaches that mimic CDHs are excluded, either on clinical grounds or through investigation, the next step is to classify the headaches based on the duration of attacks. If the attacks last less than 4 hours per day, a Trigeminal Autonomic Cephalalgia (TAC) is likely. TACs include episodic and chronic cluster headache, episodic and chronic paroxysmal hemicrania, SUNCT, and hypnic headache. If the duration is ≥4 h, a CDH is likely and the differential diagnosis encompasses chronic migraine, chronic tension-type headache, new daily persistent headache and hemicrania continua. The clinical approach to diagnosing CDH is the scope of this review.

Hyuk Jai Choi - One of the best experts on this subject based on the ideXlab platform.

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