Topiramate in prevention of cluster headache in the Taiwanese

Neurology India. Year : 2010 Volume : 58 Issue : 2 Page : 284--287

WY Huang1, MC Lo2, SJ Wang3, JJ Tsai4, HM Wu5


1 Neuroscience & Psychiatry Research Lab, Changhua Christian Hospital, Changhua; and Department of Pediatrics, Kuang-Tein General Hospital, Taipei, Taiwan


2 Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan


3 Neurologial Institute, Taipei Veterans General Hospital, Taipei, Taiwan


4 Department of Neurology, National Cheng-Kung University Hospital, Tainan, Taiwan

5 Neuroscience & Psychiatry Research Lab, Changhua Christian Hospital, Changhua; Department of Neurology, Changhua Christian Hospital, Changhua; and Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan

Correspondence Address:

H M Wu

Department of Neurology, Changhua Christian Hospital, 135 Nanxiao St. Changhua City, Changhua

Taiwan

DOI: 10.4103/0028-3886.63784
Topiramate could potentially effective as prophylaxis for cluster headache, but the experience remains limited in Asians. We performed an open-label clinical study to evaluate the efficacy of topiramate in the tolerable dosage to prevent cluster headache. We studied patients who fulfilled the criteria of episodic or chronic cluster headaches (International Classification of Headache Disorders second edition) prospectively. Headache severity was assessed using a verbal rating scale (excruciating, severe, moderate, mild, and no headache). Treatment was started with a topiramate dose of 50 mg twice daily and was increased by 50-100 mg a day every 3 to 7 days as tolerated to a maximal daily dosage of 400 mg. Of the 12 patients with episodic cluster headache, nine patients had remission of headache at a mean daily dosage of 273 mg (range 100-400 mg ), and the patient with chronic cluster headache had remission at a daily dosage of 400 mg. The adverse effects included: paresthesia (84%), slow speech (54%), and dizziness (46%), but were tolerated by most patients. Two patients discontinued topiramate due to adverse events and one due to lack of efficacy.

This open-label study suggests that topiramate is effective in the treatment of cluster headache in Taiwanese patients.

What has functional neuroimaging done for primary headache … and for the clinical neurologist?

Journal of Clinical Neuroscience
Volume 17, Issue 5 , May 2010, Pages 547-553 

Till Sprenger^a and Peter J. Goadsby^{, a,}

^a UCSF Headache Centre, Department of Neurology, University of California, 1701 Divisadero St, Suite 480, San Francisco, CA 94115, USA

Received 30 July 2009; 

accepted 23 September 2009. 

Available online 12 March 2010.

Abstract

Our understanding of mechanisms involved in primary headache syndromes has been substantially advanced using functional neuroimaging. The data have helped establish the now-prevailing view of primary headache syndromes, such as migraine and cluster headache, as brain disorders with neurovascular manifestations, not as disorders of blood vessels.

This review focuses on the results of studies applying positron emission tomography, functional MRI, and voxel-based morphometry, and attempts to synthesize the growing body of literature to provide pathophysiological concepts. We will further outline future research directions and the clinical applicability of functional imaging in headache patients.

Article Outline

1. Introduction

2. Methods of functional neuroimaging

2.1. Positron emission tomography

2.2. Functional MRI

3. What are the data?

3.1. Experimental pain

3.2. Trigeminal autonomic cephalalgias

3.2.1. Cluster headache

3.2.2. Paroxysmal hemicrania and SUNCT

3.3. Migraine without aura

3.4. Migrane with aura

3.5. Tension-type headache

4. What do the data mean?

4.1. Peripheral versus central pathogenesis and pain control mechanisms

4.1.1. Trigeminal autonomic cephalgias

4.1.2. Migraine

4.1.3. Migraine aura

4.2. Specificity of results

5. What are the consequences for the clinical neurologist

5.1. Patient education

5.2. Clinical application of imaging findings, neuroimaging as a diagnostic tool?

6. What can be expected?

Acknowledgements

References

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Fig. 2. Statistical comparison of [¹¹C]diprenorphine positron emission tomography (PET) impulse response function at 60 minutes (IRF60) in the pineal gland between patients with cluster headache and healthy volunteers. Decreases in opioidergic receptor availability are superimposed in color on an anatomic reference MRI (single-subject sagittal T1-weighted MRI provided by the statistical parametric mapping software) (p < 0.001 uncorrected). (From Sprenger T, Willoch F, Miederer M, Schindler F, Valet M, Berthele A, Spilker ME, Förderreuther S, Straube A, Stangier I, Wester HJ, Tölle TR. Opioidergic changes in the pineal gland and hypothalamus in cluster headache: a ligand PET study. Neurology 2006;66:1108–10.⁶)

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Corresponding author. Tel.: +1 415 353 8393.

Cluster Headache: Diagnosis and Treatment

	Semin Neurol 2010; 30(2): 175-185 DOI: 10.1055/s-0030-1249226
© Thieme Medical Publishers

Sluder's neuralgia: a trigeminal autonomic cephalalgia?

Cephalalgia Published Online: 13 Jul 2009
KPQ Oomen 1 , AJM van Wijck 2 , GJ Hordijk 1 & JA de Ru 3
1 Department of Otolaryngology, 2 Pain Clinic, Department of Anaesthesiology, 3 Department of Otolaryngology, Central Militairy Hospital, Utrecht, The Netherlands
Correspondence to KPQ Oomen MD, Department of Otolaryngology, University Medical Center Utrecht, PO Box 85060, 3508 AB Utrecht, The Netherlands. Tel. 0031 88 7555555, e-mail oomenkarin@hotmail.com
 
ABSTRACT
The objective was to formulate distinctive criteria to substantiate our opinion that Sluder's neuralgia and cluster headache are two different clinical entities. A systematic review was carried out of all available, original literature on Sluder's neuralgia. Pain characteristics, periodicity and associated signs and symptoms were studied and listed according to frequency of appearance. Eleven articles on Sluder's neuralgia were evaluated. Several differences between Sluder's neuralgia and cluster headache became evident. Based on described symptoms, new criteria for Sluder's neuralgia could be formulated. Sluder's neuralgia and cluster headache could possibly be regarded as two different headache syndromes, and Sluder's neuralgia could be a trigeminal autonomic cephalalgia.

Efficacy and tolerability of intravenous methylergonovine in migraine female patients attending the emergency department: a pilot open-label study

Head & Face Medicine 2009, 5:21 

Alfredo I. Nino-Maldonado , Gary Caballero-Garcia , Wilfrido Mercado-Bochero , Fernando Rico-Villademoros  andElena P. Calandre 

Published:	8 November 2009

Abstract (provisional)

Background

Methylergonovine is an ergot alkaloid widely used in postpartum women. It is also an active metabolite of methysergide and previous studies suggest that it could be effective against refractory headache and cluster headache. The purpose of the present study was to assess the potential therapeutic effectiveness of methylergonovine in the emergency treatment of severe migraine.

Methods

One hundred and twenty five female patients with migraine attending the emergency department received 0.15 mg of methylergonovine intravenously. Pain intensity, heart rate, blood pressure, and methylergonovine side effects were checked 5, 10, 15, 30 and 60 minutes after drug administration. An additional 0.075 mg dose of methylergonovine was administered to those patients who did not experienced relevant pain relief 15 minutes after dosing. Pain intensity decreased markedly from the first minutes after dosing, the 74.4% of patients being pain free at 60 minutes. Only seven patients required an additional dose of methylergonovine. Nausea and vomiting were the most relevant side effects related with methylergonovine administration (84% of patients). A substantial decrease (10 to 25 mmHg) in systolic blood pressure values was observed in 56% of the patients. A significant correlation (p<0.0001) was found between the decrease in pain intensity and the reduction of systolic blood pressure.

Conclusions

Although limited by the non-controlled design of the study, our data suggest that intravenous methylergonovine can be an effective and safe drug in the management of severe migraine attacks in the emergency room.

Occipital Nerve Blocks: When and What to Inject?

Headache: The Journal of Head and Face Pain

Volume 49 Issue 10, Pages 1521 - 1533 Published Online: 6 Aug 2009 Copyright © 2009 American Headache Society

Joshua Tobin, MD; Stephen Flitman, MD

From 21st Century Neurology – Neurology, Phoenix, AZ, USA.

Correspondence to J. Tobin, 21st Century Neurology – Neurology, 2601 North Third Street Suite 125, Phoenix, AZ 85004, USA.

Conflict of Interest: None

ABSTRACT

Introduction.—Occipital nerve block (ONB) is a promising treatment for headaches. Its indications, selection criteria, and best techniques are not clear, however.

Objective.—To summarize in narrative format what is known about ONBs and what needs to be learned.

Methods.—MD Consult and Google Scholar were searched using the terms occipital, suboccipital, block, and injection to identify relevant articles that were reviewed. This process was repeated for all additional pertinent articles identified from these articles, and so on, until no additional articles were identified.

Results.—A total of 21 articles were identified.

Conclusions.—Occipital nerve block is an effective treatment for cervicogenic headache, cluster headache, and occipital neuralgia. While a double blinded randomized placebo controlled clinical trial is lacking, multiple open label studies reported favorable results for migraine. Two other possible uses of ONB worthy of further study are use as a rescue treatment and as an adjunctive treatment for medication overuse headache. ONB may be effective for tension headache, but only under very specific circumstances. ONB is either ineffective or only effective under as yet unstudied circumstances for hemicrania continua and chronic paroxysmal hemicrania. Some practitioners use occipital nerve (ON) tenderness to palpation (TTP) or reproduction of headache pain with ON pressure (RHPONP) as selection criteria for identifying appropriate patients. While only a clinical trial can produce a definitive answer, current evidence suggests that these selection criteria are not necessary for cervicogenic headache or cluster headache. Occipital neuralgia by definition involves TTP of the ONs. Whether RHPONP or ON TTP predicts success in migraine is unclear, and may relate to whether steroids are used. A single blinded randomized controlled trial evaluating local anesthetic with steroids vs local anesthetic alone for transformed migraine reported slightly worse results with steroids, but there are several alternate explanations for this finding other than steroids being counterproductive. The technique of repetitive ONBs deserves further study.

Cluster Headache

Pain Practice

Volume 9 Issue 6, Pages 435 - 442

Published Online: 27 Oct 2009

© 2009 by World Institute of Pain

EVIDENCE-BASED MEDICINE Evidence-Based Interventional Pain Medicine according to Clinical Diagnoses

Maarten van Kleef, MD, PhD, FIPP*; Arno Lataster, MSc ^† ; Samer Narouze, MD, MSc, FIPP ^‡ ; Nagy Mekhail, MD, PhD, FIPP ^‡ ; José W.Geurts, MSc*; Jan van Zundert, MD, PhD, FIPP*^§

*Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands; ^†Department of Anatomy and Embryology, Maastricht University, Maastricht, The Netherlands; ^‡ Pain Management Department, Cleveland Clinic, Cleveland, Anesthesiology Institute, Ohio, U.S.A.; ^§ Department of Anesthesiology and Pain Management, Ziekenhuis Oost Limburg, Genk, Belgium

Correspondence to Maarten van Kleef, MD, PhD, FIPP, Maastricht University Medical Centre, Department of Anesthesiology and Pain Management, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: maarten.van.kleef@mumc.nl.

ABSTRACT

Cluster headache is a strictly unilateral headache that is associated with ipsilateral cranial autonomic symptoms and usually has a circadian and circannual pattern. Prevalence is estimated at 0.5 to 1.0/1,000. The diagnosis of cluster headache is made based on the patient's case history. There are two main clinical patterns of cluster headache: the episodic and the chronic. Episodic is the most common pattern of cluster headache. It occurs in periods lasting 7 days to 1 year and is separated by at least a 1-month pain-free interval. The attacks in the chronic form occur for more than 1 year without remission periods or with remission periods lasting less than 1 month.

Conservative therapy consists of abortive and preventative remedies. Ergotamines and sumatriptan injections, sublingual ergotamine tartrate administration, and oxygen inhalation are effective abortive therapies. Verapamil is an effective and the safest prophylactic remedy. When pharmacological and oxygen therapies fail, interventional pain treatment may be considered. The effectiveness of radiofrequency treatment of the ganglion pterygopalatinum and of occipital nerve stimulation is only evaluated in observational studies, resulting in a 2 C+ recommendation.

In conclusion, the primary treatment is medication. Radiofrequency treatment of the ganglion pterygopalatinum should be considered in patients who are resistant to conservative pain therapy. In patients with cluster headache refractory to all other treatments, occipital nerve stimulation may be considered, preferably within the context of a clinical study.