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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cluster headache sufferers who become candidates for surgical treatment are those relatively rare patients who are refractory to all attempts at pharmacological relief. Ablative surgical procedures have been directed against either the trigeminal nerve or the nervus intermedius/greater superficial petrosal (NI/GSP) pathway. Both carry nociceptive impulses from the head and face, and the NI also carries parasympathetic fibres which appear to be responsible for the autonomic concomitants of cluster headache. Trigeminal operative procedures are not consistently helpful in chronic cluster headache, while NI section has been shown to give potentially long lasting relief but carries the potential risks of cerebellopontine angle surgery. In eight selected cases of chronic cluster headache we have demonstrated a high early success rate for pain relief, with few complications, in the performance of NI section, combined, when indicated, with microvascular decompression of the trigeminal main sensory root. We believe that cochlear nerve monitoring helps prevent postoperative hearing impairment. An intimate relationship between the NI and arterial loops of the anterior inferior cerebellar artery (AICA) or the internal auditory artery has been frequently observed in our chronic cluster headache patients.
Headache 1990 Jun
PMID:Chronic cluster headache managed by nervus intermedius section. 240 21

Chronic cluster headache, also known as chronic migrainous neuralgia, is frequently unresponsive to medical management. Although neuronal factors may be involved in the pathogenesis of this form of recurrent hemicranial pain, vasodilatation within the distribution of the trigeminal nerve is believed to be important. Attempts to provide relief by surgical means have primarily involved interruption of the vasodilator pathways of the greater superficial petrosal nerve and the sphenopalatine ganglion. A more direct approach of interrupting the pain pathways of the trigeminal nerve has been attempted sporadically for more than 50 years. Recent interest in the role of substance P in the production of pain in cluster headache suggests that trigeminal ablative procedures might have a dual role in the relief of medically intractable cases. Among 26 patients who underwent posterior fossa trigeminal sensory rhizotomy or percutaneous radio-frequency trigeminal gangliorhizolysis at our institution, relief of pain was excellent in 14 (54%), fair to good in 4 (15%), and poor in 8 (31%).
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PMID:Surgical treatment of chronic cluster headache. 242 15

The patient with cluster headaches will be afflicted with the most severe type of pain that one will encounter. If the physician can do something to help this patient either by symptomatic or, more importantly, prophylactic treatment, he or she will have a most thankful patient. This type of headache is seen most frequently in men, and occurs in a cyclic manner. During an acute cycle, the patient will experience a daily type of pain that may occur many times per day. The pain is usually unilateral and may be accompanied by unilateral lacrimation, conjunctivitis, and clear rhinorrhea. Prednisone is the first treatment we employ. Patients are seen for follow-up approximately twice a week, and their medication is lowered in an appropriate manner, depending on their response to the treatment. Regulation of dosage has to be individualized, and when one reaches the lower dose such as 5 to 10 mg per day, the drug may have to be tapered more slowly, or even maintained at that level for a period of time to prevent further recurrence of symptoms. We frequently will use an intravenous histamine desensitization technique to prevent further attacks. We will give the patient an ergotamine preparation to use for symptomatic relief. As these patients often have headaches during the middle of the night, we will place the patient on a 2-mg ergotamine preparation to take prior to going to bed in the evening. This often works in a prophylactic nature, and prevents the nighttime occurrence of a headache. We believe that following these principles to make the accurate diagnosis and institute the proper therapy will help the practicing otolaryngologist recognize and treat patients suffering from this severe pain.
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PMID:Cluster headaches. 251 46

The effects were assessed of peripheral stimulation (chemical acupuncture and electroacupuncture) on the character of pain and duration of remission in 48 patients with Horton's headaches. A direct analgesic effect was obtained in about 48% of cases, and a prolongation of the time interval without pain was 2 to 21 times longer than the duration of the longest interval without pain before the treatment with acupuncture in about 40% of cases. In some cases, despite absence of a direct analgesic effect, prolongation of remission was obtained.
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PMID:[Late results of Horton's headache treatment using peripheral stimulation]. 263 49

Vascular headaches are among the most prevalent yet poorly understood problems in clinical neurology. Headaches may develop in association with hypertension, seizures, stroke or without a recognizable pathophysiology such as during migraine and cluster headaches. Cephalic blood vessels (pial and dural vessels) are implicated as the most important source for all headaches and are innervated by sensory fibers which arise from ganglia innervating the forehead, scalp and neck. Sensory fibers contain vasoactive neuropeptides which become released from peripheral (perivascular) and central terminations to mediate vasodilation and pain, respectively. The presence of vascular headache implies activation of this final common pain pathway which we have termed the trigeminovascular system. The presence of vascular headache implies activation of this final common pain pathway which we have termed the trigeminovascular system. The existence of such a system a) clarifies certain pain patterns which develop following stimulation of cephalic blood vessels, b) suggests a mechanism to explain the referral of pain to the forehead, c) provides a mechanism to explain the action of certain antimigraine drugs, d) suggests a local mechanism which enhances blood flow under certain pathological conditions. Hence, this review will update existing knowledge about the trigeminovascular system and its role in headache pathophysiology.
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PMID:Pain mechanisms underlying vascular headaches. Progress Report 1989. 266 74

Periocular pain may result from local pathology or be referred from distant sites. Ophthalmic examination will detect most local disease, although a careful search may be needed to determine the cause of subtle entities. Painful ophthalmoplegia results from a variety of neoplasms and inflammations, often in the area of the cavernous sinus. Cluster headache should be differentiated from more sinister causes of painful Horner's syndrome. Systemic diseases that cause periocular pain and migraine and other classic headache syndromes that may present with eye pain alone are also discussed.
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PMID:Ocular and periocular pain. 268 63

A patient with severe cluster headaches was treated in a hyperbaric chamber on two occasions. Her symptoms had been refractory to other treatment modalities including conventional oxygen therapy. On both occasions her pain was promptly relieved while breathing 100% oxygen at two atmospheres of pressure. This is the first known reported case of a cluster headache treated with hyperbaric oxygen. A prospective study is needed to substantiate the efficacy of this treatment modality for cluster headaches.
Headache 1989 Feb
PMID:Treatment of a cluster headache patient in a hyperbaric chamber. 270 39

We describe the case of a forty-four year old man who had typical right sided cluster headaches and an arteriovenous malformation supplied mainly by the right anterior cerebral artery. Following endovascular embolisation of this artery the AVM was supplied mainly by the left anterior cerebral artery. Subsequent headaches have always been on the left. Transcranial Doppler studies now suggested an increase of middle cerebral artery flow velocity. We suggest that the change in haemodynamics was responsible for the change in headache side.
Headache 1989 Jul
PMID:Reversal of cluster headache side following treatment of arteriovenous malformation. 275 53

8 cases of vasogenic facial pain are presented with delineation of differentiating clinical features. These vasogenic syndromes include classic episodic cluster headache, chronic cluster headache, and indomethacin responsive chronic cluster headache. Open clinical trials employing inhalation O2 therapy as an abortive treatment strategy utilized in combination with prophylactic nifedipine therapy proved highly efficacious in controlling pain among most classic and chronic cluster headaches. A single case of chronic paroxysmal hemicrania responded favorably to indomethacin.
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PMID:Vasogenic facial pain (cluster headache). 310 92

Cluster headache is an uncommon form of headache syndrome. It is characterised by paroxysms of severe unilateral head pain typically involving the orbit. There are often associated autonomic changes on the affected side such as lacrimation, nasal congestion and Horner's syndrome. Apart from episodic cluster headache, various subtypes such as chronic cluster headache, cluster headache variant and chronic paroxysmal hemicrania have been identified. There have been few reports of the incidence and clinical features of cluster headache in blacks; 7 black patients with various types of cluster headache are described.
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PMID:Cluster headache in black patients. A report of 7 cases. 313 88


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