[Neurophysiological assessment of afferent-efferent interaction in the trigeminal-cervical system in patients with secondary headaches].

We carried out the neurophysiological assessment of functional state of the trigeminal-cervical system and studied peculiarities of afferent-efferent interaction in patients with the most frequent variants of secondary headaches: chronic posttraumatic headaches, cervicogenic headaches, vascular headaches and painful dysfunction of temporomandibular articulation. According to the results of neurophysiological studies (somatosensory, trigeminal evoked potentials, blink reflex and stimulation EMG of masticatory muscles), the functional activity of the trigeminal system in patients with secondary headaches changes less significantly compared to patients with primary headaches. In most secondary headaches, the reflex activity of the trigeminal system and the EMG activity of masticatory muscles are determined by the functional state of spinal and brainstem structures.

Central nervous system vasculitis.

PURPOSE OF REVIEW: In the past decade, primary and secondary central nervous system (CNS) vasculitides have been more commonly diagnosed and recognized than previously. With the increasing awareness of these disorders, it is crucial for the treating physician to differentiate between causes of CNS vasculitis and to recognize their marked clinical and pathophysiological heterogeneity. This review focuses on the major forms of primary CNS vasculitis, as well as secondary CNS vasculitis with emphasis on their clinical findings, diagnoses, and treatment. RECENT FINDINGS: The proposal of reversible cerebral vasoconstriction syndromes (RCVS) as a unifying concept for a group of disorders which are characterized by acute-onset severe recurrent headaches, with or without additional neurologic signs and symptoms, and prolonged but reversible vasoconstriction of the cerebral arteries, has been a major breakthrough in this field over the past decade. Recognition of this common mimic (i.e. RCVS) has allowed optimal management of a sizable group of patients previously confused with pathologically documented CNS vasculitis. SUMMARY: Sound treatment decisions are based on accurate diagnosis. It is essential for the clinicians involved in the evaluation of patients with CNS vasculitis to be aware of its mimics especially RCVS. This article provides a comprehensive review of CNS vasculitis and its differential diagnosis. Furthermore, it touches upon workup and treatment of CNS vasculitis.

[Electroencephalographic changes in headaches under the influence of pharmaceuticals]. / Elektroencefa ografske promjene u glavoboljama pod uticajem farmaka.

UNLABELLED: Headache can be manifested as primary disorder or it is a secondary symptom of some other illnes. Electroencephalography (EEG) is electrodiagnostic method which registers electric activity of brain cells and by this method therapeutic effect of single medicaments can be followed by comparing of EEG before and after medication. The aim of work was to test if there are changes in EEG in headaches under the influence of naproxen and sumatriptan in the acute attack of headache and during the prevention of often attacks of pain. PATIENTS, METHODS AND RESULTS: The retrospectiveprospective study was conducted on 92 patients, average age of 42.9 with regular CT of cranium, craniogram and fundus. They were divided in two groups based on drugs they were taking for the prevention or treatment of acute attack of pain. Group A 44 patients preventively took naproxen in the daily dose of 550 mg and in acute attack of pain sumatriptan and group B 48 patients in the acute attack of pain took sumatripanin one dose of 50 mg. Two EEG were recorded before and after medication and concentration of certain waves in EEG was followed. Statistics proved that there is no statistic difference in the EEG before and after medication. Hi square test (Hi Sq. = 1.087) does not show statistically important difference within the number of patients divided in groups, significance is on leve p = 0.297. T-test does not show existence of statistically important difference between concentration of Alpha, beta, teta and delta waves in starting EEG and in EEG at the end of testing after taking on Naproxen 550 mg daily for one month for group A and a pill of Sumatriptan in the acute attack for group B. CONCLUSION: It means that naproxen and sumatriptan at patients with headaches do not cause changes in EEG, nor percent concentration of single waves in starting and control EEG and statistically significant reduce pain at tested patients with vascular headaches.

SUNCT: bilateral hypothalamic activation during headache attacks and resolving of symptoms after trigeminal decompression.

Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) is a primary head-pain syndrome, which is often refractory to any medical treatment. Concerning the pathophysiology of SUNCT, hypothalamic involvement ipsilaterally to the pain has been suggested based on the clinical features and one functional imaging case report. Here we now report a new case with SUNCT and the concomitant cerebral activation pattern (fMRI) during the pain attacks. In addition to an activation of several brain structures known to be generally involved in pain processing, bilateral hypothalamic activation occurred during the pain attacks, arguing for a central origin of the headache. Interestingly, this patient became completely pain free after surgical decompression of the ipsilateral trigeminal nerve. We hypothesize that in this case with a central predisposition for trigeminal autonomic cephalgias, a peripheral trigger with ectopic excitation might have contributed to the clinical picture of SUNCT.

Chronic paroxysmal hemicrania, hemicrania continua and SUNCT syndrome in association with other pathologies: a review.

We present a review of 22 cases of headache mimicking chronic paroxysmal hemicrania (CPH) (17 female and five male; F : M ratio 3.4), nine cases mimicking hemicrania continua (HC) (seven female and two male) and seven cases mimicking SUNCT syndrome (five male and two female) found in association with other pathologies published from 1980 up to the present. All case reports were discussed with respect to diagnostic criteria proposed by International Headache Society (IHS) for CPH, by Goadsby and Lipton for HC and SUNCT, and evaluated to identify a possible causal relationship between the pathology and the onset of headache. The aim of the present review was to evaluate if the presence of associated lesions and their location could help elucidate the pathogenesis of trigeminal autonomic cephalalgias (TACs).

A pilot study of feasibility and efficacy of telemedicine-delivered psychophysiological treatment for vascular headache.

Headache is a common complaint. Psychological treatment has been effective in managing the symptoms of vascular (migraine and combined migraine-tension) headache. Traditional office-based treatment may be inconvenient for many patients in terms of time and travel constraints, thereby limiting access. Telemedicine has emerged as a promising delivery medium to address these barriers to access. However, the efficacy of remotely delivered treatment for vascular headache remains untested. This case series is a preliminary evaluation of effectiveness and feasibility of an analogue telemedicine system for delivery of psychophysiological treatment for vascular headache. Three of four subjects showed improvement. These findings are encouraging for follow-up study of the clinical utility and broader viability of headache treatment via distance technology.

Management of trigeminal autonomic cephalgias and hemicrania continua.

The trigeminal autonomic cephalgias (TACs) are a group of primary headache disorders characterised by unilateral trigeminal distribution pain that occurs in association with ipsilateral cranial autonomic features. This group of headache disorders includes cluster headache, paroxysmal hemicrania and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT syndrome). Although hemicrania continua has previously been classified amongst the TACs, its nosological status remains unclear. Despite their similarities, these disorders differ in their clinical manifestations and response to therapy, thus underpinning the importance of recognising them. We have outlined the clinical manifestations, differential diagnoses, diagnostic workup and the treatment options for each of these syndromes.

Headache: lessons learned from functional imaging.

Most idiopathic headache syndromes are still recognized as vascular headaches although the clinical picture points towards a central triggering cause. The early functional imaging work using PET shed light on the genesis of some syndromes, implying that the observed activation in migraine (brainstem) and in cluster headache (hypothalamic grey) is involved in the pain process in a permissive or triggering manner rather than simply as a response to first division nociception per se. Using the advanced method of voxel-based morphometry (VBM), it has been suggested that there is a correlation between the brain area activated particularly in acute cluster headache, the posterior hypothalamic grey matter, and some change in grey matter in the same region. Moreover, also in a PET study in cluster headache and experimental headache, a vasodilation of major basal vessels has been observed which is non-specific to the cause and most likely the effect of a trigemino-parasympathetic reflex. Taken together, functional neuroimaging in headache patients has revolutionised this area of study and provided unique insights into some of the commonest maladies in man, suggesting that migraine and cluster headache are primarily driven from the brain.

Headache following cervical sympathectomy and results of a blood flow study in the cat.

BACKGROUND: A patient developed severe, continuous, unilateral headache that was "vascular" in nature, following cervical sympathectomy. OBJECTIVE: To determine the changes in cranial blood flow in the cat following lesioning and stimulation of the cervical sympathetic nerve. METHOD: Carotid blood flow was determined by electromagnetic flowmetry and its tissue distribution by intra-arterial injection of 15-microm radioactive microspheres. RESULTS: Following sympathetic lesioning, an increase in carotid blood flow was observed and reversed with stimulation. The distribution of carotid blood flow changed for the brain only, maintaining relatively constant tissue perfusion. CONCLUSION: An increase in cerebral blood flow could not have accounted for the sympathectomy-induced headache. Dilation of major cerebral arteries and cranial noncerebral vasodilation probably constitutes its mechanism.

[Trigemino-autonomic cephalalgias. Report of two cases]. / Trójdzielno-autonomiczne bóle glowy. Opis dwóch przypadków.

Trigemino-autonomic cephalalgias (TAC) constitute a rare group of primary headache conditions associated with unilateral fluctuating head pain and autonomic symptoms. These syndromes, including cluster headache, hemicrania continua, paroxysmal hemicrania and SUNCT, are much less prevalent than migraine and tension-type headache. The pathogenesis of TAC is unknown. Similar neuropeptide changes seen in all TAC syndromes suggest a shared underlying pathophysiology in these headaches. Some of them respond to the treatment with indomethacin and sumatriptan. Two patients suffering from one of the trigemino-autonomic cephalalgias are presented in the paper.

Reproducibility and feasibility of neurophysiological assessment of the sensory trigeminal system for future application to paroxysmal headaches.

As the distribution of pain in primary headaches suggests involvement of the trigeminal sensory pathways, trigeminal somatosensory evoked potentials (TSEP) and blink reflexes (BR) may provide important information about their functional integrity. Functional differences between symptomatic and non-symptomatic sides and between measurements during and outside attacks may be particularly informative. These tests should therefore be reproducible and should require a suitable number of patients for future studies in patients with primary, paroxysmal headaches. We performed TSEP and BR twice in 22 healthy volunteers, in order to calculate sample sizes based on reproducibility data. This is, to our knowledge, the first study investigating the reproducibility of TSEP and BR measurements. Latencies of TSEP and BR are appropriate for future studies, as their reproducibility allows practical sample sizes (less than 25 subjects). Duration, amplitude and area parameters of the BR responses were less appropriate for longitudinal studies.

CGRP may play a causative role in migraine.

Calcitonin gene-related peptide (CGRP) has been detected in increased amounts in external jugular venous blood during migraine attacks. However, it is unknown whether this is secondary to migraine or whether CGRP may cause headache. In a double-blind crossover study, the effect of human alphaCGRP (2 microg/min) or placebo infused intravenously for 20 min was studied in 12 patients suffering from migraine without aura. Headache intensity was scored on a scale from 0 to 10. Two patients were excluded due to severe hypotension and one because she had an infection. In the first hour median peak headache score was 1.0 in the halphaCGRP group vs. 0 in the placebo group (P < 0.01). During the following 11 h all patients experienced headaches after halphaCGRP vs. one patient after placebo (P = 0.0004). The median maximal headache score was 4 after CGRP and 0 after placebo (P = 0.006). In three patients after halphaCGRP, but in no patients after placebo, the delayed headache fulfilled the IHS criteria for migraine without aura. As intravenous administration of halphaCGRP causes headache and migraine in migraineurs, our study suggests that the increase in CGRP observed during spontaneous migraine attacks may play a causative role.