Clinical Neuroscience

[Cluster headache and its treatment]

JELENCSIK Ilona1

NOVEMBER 20, 1996

Clinical Neuroscience - 1996;49(11-12)

[Cluster headache, one of the most painful conditions known, is encountered infrequently in clinical practice. It is characterized by recurrent, unilateral attacks of severe intensity, brief duration and often accompanied by signs and symptoms of autonomic dysfunction. The actual cause of the pain has not been fully elucidated, but most authors believe that the pain arises as a result of a local vasodilatation with a release of certain neuropeptides to the perivascular tissues, resulting in sterile neurogenic inflammation and oedema. Aetiology is absolutely unknown. Treatment can be given as prophylaxis and/or as a symptomatic acute therapy for individual attacks. In the prophylaxis of episodic cluster headache ergotamine, calciumentry blockers, serotonin inhibitors and steroids are used. In chronic cluster headache lithium is the drug of choice, but verapamil may also be tried. Acute therapy has included ergotamine, oxygen inhalation and sumatriptan. Rarely, surgical intervention may be considered.]

AFFILIATIONS

  1. Semmelweis Orvostudományi Egyetem, Neurológiai Klinika, Budapest

COMMENTS

0 comments

Further articles in this publication

Clinical Neuroscience

[Repeated stroke, psychotic episode - primary antiphospholipid syndrome?]

CSIBRI Éva, FARKAS Márta

[The antiphospholipid syndrome described some 10 years ago is characterized by a predisposition to arterial and venous thrombosis and the presence of antiphospholipid antibodies. It is often associated with systemic lupus erythematosus, but its primary forms are also well known. Its clinical features are well known in neurology as well as in psychiatry. In this paper we present a case report with therapeutic implications. We discuss the importance of reccurent stroke at a young age in association with the possibility of a rare manifestation of antiphospholipid syndrome: organic brain disease, appearing in the form of schizoaffective psychopathological symptoms.]

Clinical Neuroscience

[Experiences with sumatriptan in the treatment of Cluster headache]

JELENCSIK Ilona, BOZSIK György, ÁFRA Judit, ERTSEY Csaba

[Subcutaneously administered sumatriptan 6 mg is rapid, effective and well-tolerated for the acute treatment of cluster headache. Efficacy is maintained in long-term use. The authors report the results of the 5HT1 receptor agonist sumatriptan autoinjector in the treatment of 350 attacks in 20 cluster patients. After 20 minutes post injection the complete dissolution of headache was reported in 95% of the attacks. Slight and transient side-effects were experienced therefore non of the patients were discouraged from using the autoinjector device again. It is essential in the improvement of the quality of life of patients suffering from cluster headache.]

Clinical Neuroscience

[Quantitative monitoring of EEG variability following subarachnoid hemorrhage]

JUHÁSZ Csaba, VESPA Paul, NUWER R. Marc, MARTIN Neil

[Cerebral vasospasm causing focal ischemia is a frequent complication following subarachnoid hemorrhage. Monitoring of EEG may help to reveal hemispheric dysfunction in the postoperative period. Continuous monitoring of EEG was performed on 8 bipolar channel in 30 patients with subarachnoid hemorrhage during the first two weeks after aneurysm rupture. Computerized trend analysis of 8–16 hours long periods was made. Variability of relative alpha power was evaluated visually on a 4 grade scale and it was also measured quantitatively. EEG data were compared with daily transcranial Doppler values and clinical state. Symptomatic vasospasm was detected in 16 patients while other neurological complications developed in a further 4 cases during monitoring. Significant decrease of variability was observed in all of them. This change developed 1-2 days before other signs of vasospasm in 10 patients. The onset of variability decrease was unilateral in 4 cases. No remarkable decrease of variability was found in patients without neurological complication. Our data confirm that EEG monitoring is a useful tool for sensitively detecting deterioration of brain function. Relative alpha variability is an indicative EEG parameter that can signify hemispheric dysfunction caused by ischemia in an early subclinical stage, when still no Doppler signs of vasospasm or deterioration of clinical symptoms occur.]

Clinical Neuroscience

[Intravenous perfusion anaesthesia in neurosurgey part two]

HUDVÁGNER Sándor, SZENOHRADSZKY Katalin, VIDA Gabriella, DÓCZI Tamás

[A retrospective analysis of 1300 neurosurgical perfusion narcoses performed by means of intravenously administered propofol-fentanyl-vecuron proved the advantage of this technique over traditional procedures. It decreased the recovery time, the incidence of postoperative nausea and vomiting, and muscle fibrillation. Propofol did not elevate either raised or normal intracranial pressures. Moreover, a trend reduction of raised ICP was observed. The incidence of cardiovascular complications was also reduced. Patients, especially the elderly, had a quick, subjectively well-tolerated induction of sleep and recovery. Comparison of parameters of propofol general anaesthesia with those of "combined balanced narcosis" and "perfusion ataranalgesia” statistically proved the significantly advantage of this new method. The conclusion has been drawn that propofol was a most appropriate drug for neurosurgical anaesthesia. ]

Clinical Neuroscience

[Post-traumatic ischemic stroke in childhood]

VELKEY Imre, LOMBAY Béla

[A report is given about two children with post-traumatic ischemic stroke. In the first case a blunt head injury, in the second case a minor cervical trauma caused the ischemic cerebrovascular episodes. The diagnosis was made after repeated CT scans by the help by sonography. The possible traumatic origin of acute hemiparesis due to ischemic stroke in children is emphasized. ]

All articles in the issue

Related contents

Clinical Neuroscience

[The quality of life of the cluster headache patients during the active phase of the headache]

DIÓSSY Mária, BALOGH Eszter, MAGYAR Máté, GYÜRE Tamás, CSÉPÁNY Éva, BOZSIK György, ERTSEY Csaba

[Introduction - Cluster headache (CH), which affects 0.1% of the population, is one of the most painful human conditions: despite adequate treatment, the frequent and severe headaches cause a significant burden to the patients. According to a small number of previous studies, CH has a serious negative effect on the sufferers’ quality of life (QOL). In the current study, we set out to examine the quality of life of the CH patients attending our outpatient service between 2013 and 2016, using generic and headache-specific QOL instruments. Methods - A total of 42 CH patients (16 females and 26 males; mean age: 39.1±13.5 years) completed the SF-36 generic QOL questionnaire and the headache- specific CHQQ questionnaire (Comprehensive Headache- related Quality of life Questionnaire), during the active phase of their headache. Their data were compared to those of patients suffering from chronic tension type headache (CTH) and to data obtained from controls not suffering from significant forms of headache, using Kruskal-Wallis tests. Results - During the active phase of the CH, the patients’ generic QOL was significantly worse than that of normal controls in four of the 8 domains of the SF-36 instrument. Apart from a significantly worse result in the ‘Bodily pain’ SF-36 domain, there were no significant differences between the CH patients’ and the CTH patients’ results. All the dimensions and the total score of the headache-specific CHQQ instrument showed significantly worse QOL in the CH group than in the CTH group or in the control group. Conclusion - Cluster headache has a significant negative effect on the quality of life. The decrease of QOL experienced by the patients was better reflected by the headache-specific CHQQ instrument than by the generic SF-36 instrument. ]

Clinical Neuroscience

[A prospective study evaluating the clinical characteristics of cluster headache]

ERTSEY Csaba, VESZA Zsófia, BANGÓ Márta, VARGA Tímea, NAGYIDEI Diána, MANHALTER Nóra, BOZSIK György

[Introduction - Although cluster headache (CH) is one of the most severe human pain syndromes, its symptoms and therapeutic possibilities may be suboptimally recognised in current medical practice in Hungary. Aim - To present the clinical characteristics of CH based on a prospective study of patients attending the Headache Service of the Department of Neurology, Semmelweis University. Methods - We collected information about the symptoms, diagnosis and previous treatment of CH patients by filling in a 108-item questionnaire during outpatient visits. Results - In the 5-year period between 2004 and 2008 we obtained data from 78 CH patients (57 males and 21 females; mean age: 44.6±14.6 years). The male:female ratio did not change in subgroups based on disease onset (calendar years). Ninety-three percent considered CH the most severe pain state of their life. The pain was strictly unilateral, affecting the territory of the 1st trigeminal division in all patients. The attacks were accompanied by signs of ipsilateral cranial parasympathetic activation (lactimation 83%, conjunctival injection 67%, rhinorrhea 56%, nasal congestion 43%); less frequently, signs of sympathetic dysfunction (ptosis 48%, miosis 7%) were also present. Two patients had attacks showing the typical localisation, severity and time course of CH attacks, but not accompanied by autonomic phenomena. A considerable part of the patients also observed symptoms that are usually ascribed to migraine (nausea 41%, vomiting 18%, photophobia 68%, phonophobia 58%). This may have been instrumental in the fact that, regardless of the characteristic clinical symptoms, the diagnosis of CH took 10 years on average. At the time of their examination 63% of patients were not using adequate abortive medications and 59% did not have an adequate prophylactic measure. Discussion - Cluster headache is characterised by attacks of devastating pain that warrant an early diagnosis and adequate treatment. Our study underlines that information about the diagnosis and therapy of CH should be emphasized on occasions of neurology specialty training and continuing medical education.]

Clinical Neuroscience

[Trigeminovascular hypothesis of cluster headache]

TAJTI János, SZOK Délia, VÉCSEI László

[Cluster headache is a rare, very severe disorder which is clinically well characterized with a relatively poorly defined pathomechanism. Concerning the pathomechanism of cluster type headache, from the clinical symptoms three things can be inferred. The fact that head pain is centred dominantly around the eye and fore head makes it probable that the unilateral trigeminal nociceptive pathways are involved. Lacrimation and rhinorrhoea suggest the activation of the parasympa thetic, while ptosis and miosis suggest the sympathetic innervation of the region. There is a reflex connection within the brainstem that may be activated when the Gasserion ganglion is stimulated. The afferent of the reflex circle comes from the central branch of the ophthalmic division as the sensory trigeminal nerve. The parasympathetic nuclei of the seventh and ninth cranial nerves are the centre. The efferents are the parasympathetic peripheral branches of the VIlth and IXth cranial nerves. During spontaneous and nitroglycerin induced cluster attacks the levels of CGRP and VIP increased in the blood of external jugular vein. Oxygen inhalation or subcutaneous administration of sumatriptan reduced the CGRP concentration to normal. This observation supports the function of the trigeminovascular reflex in cluster headache.]

Clinical Neuroscience

[Experiences with sumatriptan in the treatment of Cluster headache]

JELENCSIK Ilona, BOZSIK György, ÁFRA Judit, ERTSEY Csaba

[Subcutaneously administered sumatriptan 6 mg is rapid, effective and well-tolerated for the acute treatment of cluster headache. Efficacy is maintained in long-term use. The authors report the results of the 5HT1 receptor agonist sumatriptan autoinjector in the treatment of 350 attacks in 20 cluster patients. After 20 minutes post injection the complete dissolution of headache was reported in 95% of the attacks. Slight and transient side-effects were experienced therefore non of the patients were discouraged from using the autoinjector device again. It is essential in the improvement of the quality of life of patients suffering from cluster headache.]

Lege Artis Medicinae

[THE PRACTICE AND RESULTS OF OSTEOPOROSIS MANAGEMENT IN HUNGARY]

POÓR Gyula

[Osteoporosis poses a major public health problem worldwide due to the extreme number of patients and to the deterioration of quality of life, disability, excess mortality and costs associated with consequent fractures. Representative studies of the author’s group have previously shown that the average bone mineral density values of the Hungarian population are among the lowest in Europe while the prevalence of vertebral fractures is among the highest in international comparison. This revelation has led to the development of a National Osteoporosis Programme, the key element of which being the setting up of a network of osteoporosis centres that are based on the collaboration of various medical specialists, the availability of advanced diagnostic tools and outstanding therapeutic opportunities. On describing the 10-year activity of the centres, the main diagnostic, prevention and management approaches of osteoporosis are discussed. According to the WHO classification the diagnosis of osteoporosis is based on a low bone mineral density finding supported by the laboratory and radiological exclusion of other metabolic bone diseases and secondary forms of osteoporosis. According to the up-to-date treatment guidelines of osteoporosis, when considering medical treatment, preference should be given to patients with high fracture risk in giving drugs with extensive antifracture efficacy that has been confirmed by studies of evidencebased medicine. Among these drugs the most important are the antiresorptive bisphosphonates that have widely been used in Hungary and the bone forming teriparatide that is expected to gain wider use in the near future with the introduction of public health insurance financing. The efficacy of these specific antiosteoporotics is increased by supplementation with calcium and vitamin D. The internationally acknowledged Hungarian osteoporosis management system offers to Hungarian patients outstanding standards for the prevention and management of osteoporosis.]