Cluster headache: an update on clinical features, epidemiology, pathophysiology, diagnosis, and treatment.

Cluster headache (CH) is one of the worst primary headaches that remain underdiagnosed and inappropriately treated. There are recent advances in the understanding of this disease and available treatments. This paper aims to review CH's recent clinical and pathophysiological findings, diagnosis, and treatment. We performed a narrative literature review on the socio-demographics, clinical presentations, pathophysiological findings, and diagnosis and treatment of CH. CH affects 0.1% of the population with an incidence of 2.07-9.8/100,00 person-years-habitants, a mean prevalence of 53/100,000 inhabitants (3-150/100,000 inhabitants). The male-to-female ratio remains inconclusive, as the ratio of 4.3:1 has recently been modified to 1.3-2.6, possibly due to previous misdiagnosis in women. Episodic presentation is the most frequent (80%). It is a polygenetic and multifactorial entity that involves dysfunction of the trigeminovascular system, the trigeminal autonomic reflex, and the hypothalamic networks. An MRI of the brain is mandatory to exclude secondary etiologies. There are effective and safe pharmacological treatments oxygen, sphenopalatine, and great occipital nerve block, with the heterogeneity of clinical trial designs for patients with CH divided into acute, transitional, or bridge treatment (prednisone) and preventive interventions. In conclusion, CH remains underdiagnosed, mainly due to a lack of awareness within the medical community, frequently causing a long delay in reaching a final diagnosis. Recent advances in understanding the principal risk factors and underlying pathophysiology exist. There are new therapeutic possibilities that are effective for CH. Indeed, a better understanding of this challenging pathology will continue to be a subject of research, study, and discoveries in its diagnostic and therapeutic approach.

Cluster headache: state of the art in treatment.

Cluster headache (CH) is the most common and devastating autonomic headache with multiple and recent advances in treatment. However, it usually goes unrecognized and is found to have a delayed and inappropriate treatment. This paper aims to review the current therapeutic options for patients with CH. We conducted a narrative literature review on the treatments available for this condition using the American Academy of Neurology (AAN) classification of therapeutic evidence. We found effective and safe pharmacological and non-pharmacological therapies with heterogeneity of clinical trial designs for patients with CH, and they are divided into three phases, namely, transitional, acute, and preventive interventions. Prednisone (A) is the most studied treatment in the transitional phase; acute attacks are treated using triptans (A), oxygen (A), and non-invasive transcutaneous vagal nerve stimulation (A). Verapamil (A) and monoclonal antibodies (possible A) are considered the first options in preventive treatments, followed by multiple pharmacological and non-pharmacological options in prophylactic treatments. In conclusion, numerous effective and safe treatments are available in treating patients with episodic, chronic, and pharmacoresistant CH according to the clinical profile of each patient.

Hemorragia intracerebral espontánea en México: resultados del Registro Hospitalario Multicéntrico Nacional en Enfermedad Vascular Cerebral (RENAMEVASC) / Spontaneous intracerebral hemorrhage in Mexico: results from a Multicenter Nationwide Hospital-based Registry on Cerebrovascular Disease (RENAMEVASC)

Introducción. Existe poca información respecto a la hemorragia intracerebral (HIC) en América Latina, y la existente ha sido derivada de registros hospitalarios de un solo centro con conclusiones no generalizables. El objetivo de este estudio es describir la frecuencia, etiología, manejo y desenlace clínico de la HIC en México.Pacientes y métodos. Se estudiaron pacientes consecutivos con HIC incluidos en el Registro Nacional Mexicano de Enfermedad Vascular Cerebral (RENAMEVASC), conducido en 25 centros de 14 estados de la República Mexicana. Se usó la Intracerebral Hemorrhage Grading Scale (ICH-GS) para estimar el pronóstico a 30 días. Resultados. De 2.000 pacientes con ictus agudo en el RENAMEVASC, 564 (28%) presentaron HIC espontánea (53% mujeres; edad media: 63 años; rango intercuartílico: 50-75 años). La hipertensión arterial (70%), las malformaciones vasculares (7%) y la angiopatía amiloidea (4%) fueron las causas más frecuentes. No se determinó la etiología en el 10% de los casos. Las localizaciones más frecuentes fueron ganglionar (50%), lobar (35%) y cerebelosa (5%). La irrupción hacia el sistema ventricular ocurrió en el 43%. La mediana en la escala ICH-GS al ingreso hospitalario fue de 8 puntos: el 49% presentó 5-7 puntos; el 37%, 8-10 puntos, y el 15%, 11-13 puntos. La tasa de mortalidad a 30 días fue del 30%, y el 31% mostró discapacidad grave. La sobrevida a 30 días fue del 92% en pacientes con 5-7 puntos en la escala ICH-GS, mientras que se redujo al 27% en aquellos con 11-13 puntos. Conclusiones. En México, la HIC representa casi un tercio de las formas de enfermedad vascular cerebral aguda, y la mayoría de los pacientes que la padecen presentan discapacidad funcional grave o muerte a 30 días. La hipertensión es la principal causa, por lo que el control de este importante factor de riesgo debería reducir la carga sanitaria de la HIC (AU)

Introduction. Scarce information exists on intracerebral hemorrhage (ICH) in Latin America, and the existent is derived from single-center registries with non-generalizable conclusions. The aim of this study is to describe the frequency, etiology, management and outcome of ICH in Mexico. Patients and methods. We studied consecutive patients with ICH pertaining to the National Multicenter Registry on Cerebrovascular Disease (RENAMEVASC), conducted in 25 centers from 14 states of Mexico. The Intracerebral Hemorrhage Grading Scale (ICH-GS) at admission was used to assess prognosis at 30 days follow-up. Results. Of 2,000 patients with acute cerebrovascular disease registered in RENAMEVASC, 564 (28%) had primary ICH (53% women; median age: 63 years; interquartile range: 50-75 years). Hypertension (70%), vascular malformations (7%) and amyloid angiopathy (4%) were the main etiologies. In 10% of cases etiology could not be determined. Main ICH locations were basal ganglia (50%), lobar (35%) and cerebellum (5%). Irruption into the ventricular system occurred in 43%. Median score of ICH-GS was 8 points: 49% had 5-7 points, 37% had 8-10 points and 15% had 11-13 points. The 30-day case fatality rate was 30%, and 31% presented severe disability. The 30-day survival was 92% for patients with ICH-GS 5-7 points, whereas it decreased to 27% in patients with ICH-GS 11-13 points. Conclusions. In Mexico, ICH represents about a third of the forms of acute cerebrovascular disease, and the majority of patients present severe disability or death at 30 days of follow-up. Hypertension is the main cause; hence, control of this important cardiovascular risk factor should reduce the health burden of ICH (AU)