Cluster headache in children and adolescents: ten years of follow-up in three pediatric cases.

BACKGROUND: Cluster headache (CH) is a rare cause of headache in children. Onset before 12 years of age is unusual, and long-term follow-up of pediatric cases has been not reported. OBJECTIVES: To report three cases of CH with onset at childhood and at least ten years of follow-up. METHODS: Case report. RESULTS: The first case is that of a 12-year-old boy with episodic CH with unilateral pain and striking, bilateral autonomic manifestations, remitted for over eight years. The second case is unique in that it reports a case of chronic CH in a 13-year-old boy with Down syndrome. The third case is that of a 9-year-old girl with episodic CH with remissions of 2 and 5 years. All cases had prominent autonomic features. The frequency and duration of the attacks were similar to those that have been reported in adults. Good response to indomethacin was obtained in two cases, although tolerability issues occurred in one. CONCLUSION: Sustained, long-term, medical and/or spontaneous remission occurs in CH of early onset. The phenotype and response to therapy in children, at least in these case examples, are similar to equivalent observations in adult patients with CH.

Abordaje diagnóstico y terapéutico de la cefalea en racimos (cluster headache): aplicación de un modelo de análisis de decisión / Diagnostic and therapeutic approach to cluster headache: application of a decision-making analysis model

Introducción: Las ciencias de la decisión conforman el conjunto de técnicas y teorías surgido del método cuantitativo y matemático dirigido al auxilio de una toma de decisiones con criterio aplicable a varias disciplinas y en los más variados contextos, donde la multicausalidad y la influencia de múltiples factores hace difícil la elección de una decisión unívoca, dado que la incertidumbre es el patrón común situacional. Se presenta a continuación el caso concreto de un paciente de 50 años portador de una cefalea en racimos, en el que se aplica el análisis de decisión de abordaje diagnóstico-terapéutico, y se elige la conducta a seguir basándose en esta metodología. Objetivos: Aplicar este modelo de análisis de la decisión a un problema clínico individual: un paciente de 50 años, portador de una cefalea en racimos o acuminada. Demostrar que en este caso clínico puntual, ante varias opciones diagnósticas y terapéuticas, el intervencionismo antálgico es una de las herramientas más efectivas y elegidas por los pacientes, teniendo en cuenta aspectos tales como la evidencia científica de respaldo de cada alternativa, la calidad de vida de los pacientes con dolor crónico no oncológico de tipo invalidante y el uso de una metodología concreta para la toma de decisión. Material y métodos: Aplicación de un análisis de decisión diagnóstico (terapéutico concreto), presentando un caso clínico real de cefalea en racimos. Búsqueda bibliográfica en Medline y OVID. Para la formulación de los valores umbrales, el análisis de sensibilidad y la graficación del árbol de decisión se utilizó el paquete estadístico STATA - DATA TREE AGE 3.5. Como outcome principal se determinó la expectativa de vida ajustada por calidad (medida en QALYs)...

Introduction: The science of decision-making is a set of techniques and theories arising from the quantitative and mathematic method, aimed at assisting in decision-making with criterion, applicable to many disciplines and numerous different contexts in which multi-causality and the influence of multiple factors make the choice of an unequivocal decision difficult, as uncertainty is the common pattern of the situation. Following is the case history of a 50-year-old patient suffering from cluster headaches; the analysis of decision-making as to the diagnostic-therapeutic approach is applied and the choice of conduct is based on this methodology. Objectives: To apply this decision-making analysis model to a clinical problem: a 50-year-old patient with cluster or acuminate headaches. To prove that in this specific clinical case, faced with different diagnostic and therapeutic options, antalgic interventionism is one of the most effective tools and is chosen by patients, taking into account aspects such as scientific backing proof of each alternative, quality of life of patients with chronic non-oncology invalidating pain and the use of a specific methodology for making the decision. Material and methods: Application of a diagnostic decision analysis, with a real clinical case of cluster headaches. Bibliographic research in Medline and OVID. To formulate threshold values, the sensitivity analysis and graphing the decision tree, the STATA - DATA TREE AGE 3.5 was used. As main outcome, the life expectancy adjusted by quality (measured in QALYs) was determined. Results: Once the sequence of the analysis was developed, the model firmly showed that the best diagnosis prognosis decision is to make a best diagnosis-prognosis block with local anesthetics and, should it be positive, to proceed to denervate the sphenoid-palatine ganglion by radiofrequency...

Introdução: As ciências da decisão conformam um conjunto de técnicas e teorias surgido do método quantitativo e matemático direcionado ao auxílio de uma tomada de decisão criteriosa, aplicável a diversas disciplinas e nos mais variados contextos, onde a multicausalidade e a influencia de múltiplos fatores torna difícil a escolha de uma decisão unívoca, já que a incerteza é o padrão situacional genérico. Apresenta-se o caso de um paciente de 50 anos, portador de cefaléia em cacho, em que foi aplicado o processo de análise de decisão de abordagem diagnóstica-terapêutica, sendo escolhida a conduta a seguir tomando como base esta metodologia. Objetivos: Aplicar este modelo de análise de decisão a um problema clínico individual: um paciente de 50 anos, portador de uma cefaléia em cacho ou acuminada. Provar que neste caso clínico particular, a intervenção antálgica, diante de várias opções diagnósticas e terapêuticas, é uma das ferramentas mais eficazes e escolhidas pelos pacientes, considerando aspectos tais como a evidência científica de apoio a cada alternativa, a qualidade de vida dos pacientes com dor crônica não oncológica incapacitante e o uso de uma metodologia concreta para a tomada de decisão. Material e métodos: Aplicação de uma análise de decisão diagnóstica (terapêutica concreta), apresentando um caso clínico real de cefaléia em cacho. Busca bibliográfica na Medline e na OVID. Para a formulação dos valores limiares, a análise de sensibilidade e a representação gráfica da árvore de decisão, foi utilizado o pacote estatístico STATA - DATA TREE AGE 3.5. Como outcome principal, determinou-se a expectativa de vida ajustada à qualidade (medida em QALYs). Resultados: Desenvolvida a seqüência da análise, o modelo mostra, de forma contundente, que a melhor decisão diagnóstica-terapêutica é o bloqueio diagnóstico-prognóstico com anestésicos locais, e caso esse bloqueio seja satisfatório, fazer a denervação por radiofreqüência do ganglio esfenopalatino...

Abordaje diagnóstico y terapéutico de la cefalea en racimos (cluster headache): aplicación de un modelo de análisis de decisión / Diagnostic and therapeutic approach to cluster headache: application of a decision-making analysis model

Introducción: Las ciencias de la decisión conforman el conjunto de técnicas y teorías surgido del método cuantitativo y matemático dirigido al auxilio de una toma de decisiones con criterio aplicable a varias disciplinas y en los más variados contextos, donde la multicausalidad y la influencia de múltiples factores hace difícil la elección de una decisión unívoca, dado que la incertidumbre es el patrón común situacional. Se presenta a continuación el caso concreto de un paciente de 50 años portador de una cefalea en racimos, en el que se aplica el análisis de decisión de abordaje diagnóstico-terapéutico, y se elige la conducta a seguir basándose en esta metodología. Objetivos: Aplicar este modelo de análisis de la decisión a un problema clínico individual: un paciente de 50 años, portador de una cefalea en racimos o acuminada. Demostrar que en este caso clínico puntual, ante varias opciones diagnósticas y terapéuticas, el intervencionismo antálgico es una de las herramientas más efectivas y elegidas por los pacientes, teniendo en cuenta aspectos tales como la evidencia científica de respaldo de cada alternativa, la calidad de vida de los pacientes con dolor crónico no oncológico de tipo invalidante y el uso de una metodología concreta para la toma de decisión. Material y métodos: Aplicación de un análisis de decisión diagnóstico (terapéutico concreto), presentando un caso clínico real de cefalea en racimos. Búsqueda bibliográfica en Medline y OVID. Para la formulación de los valores umbrales, el análisis de sensibilidad y la graficación del árbol de decisión se utilizó el paquete estadístico STATA - DATA TREE AGE 3.5. Como outcome principal se determinó la expectativa de vida ajustada por calidad (medida en QALYs)...(AU)

Introduction: The science of decision-making is a set of techniques and theories arising from the quantitative and mathematic method, aimed at assisting in decision-making with criterion, applicable to many disciplines and numerous different contexts in which multi-causality and the influence of multiple factors make the choice of an unequivocal decision difficult, as uncertainty is the common pattern of the situation. Following is the case history of a 50-year-old patient suffering from cluster headaches; the analysis of decision-making as to the diagnostic-therapeutic approach is applied and the choice of conduct is based on this methodology. Objectives: To apply this decision-making analysis model to a clinical problem: a 50-year-old patient with cluster or acuminate headaches. To prove that in this specific clinical case, faced with different diagnostic and therapeutic options, antalgic interventionism is one of the most effective tools and is chosen by patients, taking into account aspects such as scientific backing proof of each alternative, quality of life of patients with chronic non-oncology invalidating pain and the use of a specific methodology for making the decision. Material and methods: Application of a diagnostic decision analysis, with a real clinical case of cluster headaches. Bibliographic research in Medline and OVID. To formulate threshold values, the sensitivity analysis and graphing the decision tree, the STATA - DATA TREE AGE 3.5 was used. As main outcome, the life expectancy adjusted by quality (measured in QALYs) was determined. Results: Once the sequence of the analysis was developed, the model firmly showed that the best diagnosis prognosis decision is to make a best diagnosis-prognosis block with local anesthetics and, should it be positive, to proceed to denervate the sphenoid-palatine ganglion by radiofrequency...(AU)

IntroduþÒo: As ciÛncias da decisÒo conformam um conjunto de técnicas e teorias surgido do método quantitativo e matemático direcionado ao auxílio de uma tomada de decisÒo criteriosa, aplicável a diversas disciplinas e nos mais variados contextos, onde a multicausalidade e a influencia de múltiplos fatores torna difícil a escolha de uma decisÒo unívoca, já que a incerteza é o padrÒo situacional genérico. Apresenta-se o caso de um paciente de 50 anos, portador de cefaléia em cacho, em que foi aplicado o processo de análise de decisÒo de abordagem diagnóstica-terapÛutica, sendo escolhida a conduta a seguir tomando como base esta metodologia. Objetivos: Aplicar este modelo de análise de decisÒo a um problema clínico individual: um paciente de 50 anos, portador de uma cefaléia em cacho ou acuminada. Provar que neste caso clínico particular, a intervenþÒo antálgica, diante de várias opþ§es diagnósticas e terapÛuticas, é uma das ferramentas mais eficazes e escolhidas pelos pacientes, considerando aspectos tais como a evidÛncia científica de apoio a cada alternativa, a qualidade de vida dos pacientes com dor cr¶nica nÒo oncológica incapacitante e o uso de uma metodologia concreta para a tomada de decisÒo. Material e métodos: AplicaþÒo de uma análise de decisÒo diagnóstica (terapÛutica concreta), apresentando um caso clínico real de cefaléia em cacho. Busca bibliográfica na Medline e na OVID. Para a formulaþÒo dos valores limiares, a análise de sensibilidade e a representaþÒo gráfica da árvore de decisÒo, foi utilizado o pacote estatístico STATA - DATA TREE AGE 3.5. Como outcome principal, determinou-se a expectativa de vida ajustada O qualidade (medida em QALYs). Resultados: Desenvolvida a seq³Ûncia da análise, o modelo mostra, de forma contundente, que a melhor decisÒo diagnóstica-terapÛutica é o bloqueio diagnóstico-prognóstico com anestésicos locais, e caso esse bloqueio seja satisfatório, fazer a denervaþÒo por radiofreq³Ûncia do ganglio esfenopalatino...(AU)

[Cluster headache: study of autonomic alterations and other associated manifestations in 28 cases]. / Cefaléias em salvas: estudo das alterações autonômicas e outras manifestações associadas em 28 casos.

The short lasting primary headaches are classified as those without autonomic activation and those with important activation, which includes the cluster headache. This study focuses on the pathophysiology of cluster headache mainly in its autonomic phenomenon (conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, partial ptosis and eyelid oedema) showing the involvement of superior salivatory nucleus with the pain stimulus propagation, which begins in the trigeminal nerve. The autonomic alterations were studied in 28 patients being lacrimation and conjunctival injection, the main features.

Cefaléias em salvas: estudo das alterações autonômicas e outras manifestações associadas em 28 casos / Cluster headache: study of autonomic alterations and other associated manifestations in 28 cases

As cefaléias de curta duração dividem-se entre aquelas com pouca ativação; autonômica e aquelas com importante ativação, este grupo inclui a cefaléia em salvas. Este trabalho tem por objetivo discutir a fisiopatologia da cefaléia em salvas, com maior enfoque nos fenômenos autonômicos, como injeção conjuntival, lacrimejamento, congestão nasal, rinorréia, semiptose e edema palpebral, mostrando o nítido envolvimento do núcleo salivatório superior com a propagação do estímulo doloroso, originado no nervo trigêmeo. As alterações autonômicas foram estudadas em 28 pacientes com cefaléia em salvas e as prevalentes foram o lacrimejamento e a hiperemia conjuntival.

Cluster headache associated with sleep apnoea.

This study of sleep changes in patients with cluster headache (CH) was conducted in view of the nocturnal predominance of this condition, the efficacy of oxygen and the fact that the attacks follow oxygen desaturation. Proposed mechanisms include impairment of carotid body activity secondary to hypothalamic vasomotor regulatory dysfunction. Sixteen patients with episodic CH and 29 healthy volunteers underwent nocturnal polysomnography. Five (31.3%) patients with episodic CH were found to have sleep apnoea (SA). Two patients with SA experienced two attacks during the study period. The attacks followed episodes of oxygen desaturation and were associated with REM sleep. In two patients with SA and CH, treatment with continuous positive airway pressure abolished their oxygen desaturation, sleep apnoeas and headaches. Our study confirmed the high percentage of CH associated with SA. We suggest that oxygen desaturation may be a trigger factor in some patients and play a role in the pathogenesis of CH.

Diagnóstico diferencial del dolor orofacial II. Asociado a desórdenes neurovasculares, vasculares y musculoesqueléticos / Differential diagnosis of orofacial pain II. Associated with neurovascular, vascular and musculoskeletal disorders

Este es el segundo de tres artículos que tienen como propósito presentar una revisión de la literatura de las condiciones que se han considerado para el establecimiento del diagnóstico diferencial del dolor orofacial. Los desórdenes neurovasculares (migrañas, cefaleas tipo cluster, paroxismo hemicraneano), vasculares (arteritis temporal, carotidinia) y musculoesqueléticos (cefaleas de tipo tensional, desórdenes temporomandibulares, dolor miofascial, fibromialgia, desórdenes espinocervicales) serán revisados

Premonitory symptoms in cluster headache.

Cluster headache is one of the most excruciating headaches affecting human beings--especially the male sex. Most of the cluster headache cases are of episodic nature, with active cluster periods lasting generally between a few weeks and 2 or 3 months. A still undetermined percentage of patients report nonpainful sensations preceding the onset of the pain attack for a variable period of time. If occurring only a few minutes or a few hours before the onset of pain, such symptoms are called prodromal. When occurring for several days, weeks, or months before the pain, they are termed premonitory symptoms. The author believes that premonitory symptoms have not been properly diagnosed and emphasizes the need to investigate their presence, because by knowing them advances can be made in the understanding of the physiopathology of this particular cephalalgia. Furthermore, it can also allow the physician to be ahead, by giving preventive treatment and stopping or diminishing the intensity and duration of the pain attacks.

Cluster-tic syndrome: report of five new cases

The so-called short lasting primary headaches include heterogenic entities that can be divided between those without pronounced autonomic activation and those where this activation is evident, which includes the cluster-tic syndrome. We report five new cases with age closer to the trigeminal neuralgia's one, and concomitance of cluster headache and trigeminal neuralgia, which is less frequent in the literature. We also discuss briefly the pathophysiology of these clinical entities, suggesting that the trigeminus nerve is a common pathway of pain manifestation.

Use of streptomycin-lidocaine injections in the treatment of the cluster-tic syndrome. Clinical perspectives and a case report.

Trigeminal neuralgia and cluster headache syndrome are complex pain conditions of the craniofacial region. Both diseases can coexist in the same patient, comprising the cluster-tic syndrome. This article reviews the literature on this condition and reports a new case who responded well to peripheral streptomycin-lidocaine injections.

[Paroxysmal epileptic headache]. / Cefalea paroxística epiléptica.

Epileptic paroxystic headache consists of an episode of pain that starts suddenly, in a varying area that is usually the same for the same patient, of medium to high intensity, lasting from a few seconds to minutes and, rarely, hours; the episode subsides spontaneously and tends to recur. This was found in 32 of 125 patients studied by the author. Average age of onset was 11 years, with 80% of cases presenting it in the first or second decade of life. Once diagnosed, the condition was present a maximum of 41 years and a minimum of one month, with an average of six years. Headache lasted from 30 seconds to 4 hours; in 62% of cases it was 15 minutes or less. Pain was severe in 24 patients and moderate in 8. Epileptic paroxystic headache can be the only epileptic symptom (31%) or be associated with other ictal manifestations, independently (56.2%) or simultaneously (12.5%). EEG studies showed focalization in temporal lobe (56%), in the midbrain (12.5%) or in other areas. Treatment with hydantoine, primidone and methylsuccimide gave excellent results. Differential diagnosis with other paroxystic headaches is noted.