Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cluster headache and chronic paroxysmal hemicrania are assumed to be so closely related that they from a classification point of view have been grouped together under the superstructure: cluster headache syndrome. If this grouping will prove to stand the test of time, the pathogenesis of the two subgroups ought to be quite similar. CPH per se has two subgroups: those with and those without mechanical precipitation of attacks. If the aforementioned grouping of CPH is correct, then the CPH subdivision with mechanical precipitation of attacks should also be closely akin to cluster headache. Cluster headache, however, seems to lack the "nuchal" factor. It is felt that "midline structures", like the cavernous sinus, are of importance in cluster headache (cluster headache syndrome?) pathogenesis. In CPH with mechanical precipitation, attacks may be precipitated via "cervical volleys" a.m. Kerr, activating "midline" cavernous sinus structures, while the activation mechanisms in cluster headache is unknown.
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PMID:Cluster headache. Our current concepts. 180 50

On a world-wide basis, 84 cases of CPH were found, 59 females and 25 males: i.e., a F:M ratio of 2.36. Forty-nine cases never exhibited a remitting stage, whereas in 35 cases a history of a remitting stage was obtained, 17 cases still remaining in the remitting stage. In other words, the ratio between the chronic and the remitting stage as of today is 67:17 = 3.94. Accordingly, there seems to be a reverse relationship of the chronic versus the remitting stage, when compared to cluster headache. A maximum attack frequency even of 5-6 attacks per 24 hours seems to be consistent with a diagnosis of CPH. Nocturnal attacks occurred in 55 out of 58 cases where such information was available. An unchanging unilaterality was the rule, in that only 3 exceptions have been reported.
Headache 1989 Nov
PMID:Chronic paroxysmal hemicrania (CPH): a review of the clinical manifestations. 269 8

In four patients with chronic paroxysmal hemicrania, two of whom could precipitate attacks mechanically, various autonomic function tests were carried out in connection with attacks. Not all features could be studied in all patients. Forehead sweating and temperature were measured. Sweating, tearing, and nasal secretion were studied after systemic atropine administration, which reduced attack-related sweating, tearing, and nasal secretion markedly. Intra-ocular pressure was measured before and after the topical administration of an alpha-receptor blocking agent, thymoxamine. After topical thymoxamine no definite intra-ocular pressure increase occurred during precipitated attacks. In attacks precipitated by head movements, forehead sweating occurred seconds (up to 30 sec) before the pain. This study indicates that at least in some CPH cases, forehead sweating is not caused by the pain. Nor is the pain secondary to increase in intra-ocular pressure. The thymoxamine experiments seem to indicate that alpha-receptors in some way may be connected with the intra-ocular pressure increase during attack.
Cephalalgia 1986 Jun
PMID:Chronic paroxysmal hemicrania. X. On the autonomic involvement. 294 5

In a 38-year-old woman who had had CPH since the middle 1960s and had been successfully treated with indomethacin (dosage usually within the limits of 50-175 mg/day) for approximately 10 years, the requirement for indomethacin was gradually reduced to nought in the spring of 1985. She was then pain-free without indomethacin for almost 1 1/2 years. In the late fall of 1986 she had a 3-week exacerbation. In recent months, she again seems to have a slowly increasing, although clearly fluctuating, indomethacin requirement. Long-lasting remissions may thus appear even in the chronic stage. The remission could be a spontaneous one or it could in some way be related to the protracted indomethacin treatment; the authors favour the former possibility. The recurrence of symptoms after a while shows that the attack-generating potential has not been permanently extinguished by indomethacin.
Cephalalgia 1987 Sep
PMID:Chronic paroxysmal hemicrania: a case report. Long-lasting remission in the chronic stage. 365 4

Two cases of chronic paroxysmal hemicrania are presented, both with atypical late onset of illness and lack of pre-CPH stage. In one patient the pain attacks were unusually short, and no associated symptoms during the pain attack were observed. However, the positive reaction to indomethacin substantiates the diagnosis of CPH.
Cephalalgia 1984 Sep
PMID:Chronic paroxysmal hemicrania: lack of pre-chronic stage. 649 33

A detailed clinical study of 105 CPH attacks in five patients has been carried out. Data were recorded during periods when patients were without medication and with the use of methods which were not dependent on the patients' memory of events. When overall assessments of symptoms during the study period were mild or moderate the attack frequency was from 4 to 8, mean 6.5 attacks per 24 h. However, when overall assessments of symptoms were described as severe or extremely severe the attack frequency was from 13 to 38, mean 21.8 attacks per 24 h. The mean duration of attacks was 13.3 +/- 7.6 min. No nocturnal preponderance of attacks was found.
Cephalalgia 1984 Mar
PMID:Chronic paroxysmal hemicrania: severity, duration and time of occurrence of attacks. 653 16

Attacks of cluster headache are often associated with symptoms of an autonomic nature. A test battery allowing quantitation of salivation, nasal secretion and tearing has been employed. Fourteen patients examined under basal conditions hardly differed from a group of controls (N = 20). After stimulation with pilocarpine the patients responded like the controls. During attacks we found minimal bilateral salivation, but an increase of tearing and nasal secretion, mostly on the symptomatic side. These results correspond with those found in CPH. The finding of the minimal salivation is consistent with the notion that the headache attacks are associated with increased sympathico-tonus. The results may suggest that the complexity of the innervation pattern of the different secretory organs examined is more marked than hitherto known.
Cephalalgia 1984 Mar
PMID:Autonomic disorders in cluster headache, with special reference to salivation, nasal secretion and tearing. 671 25

Ambulatory ECG recordings have been carried out in five patients suffering from CPH. During the study a total of 105 attacks occurred. Contrary to findings in cluster headache, no typical pattern of heart rate change was found in association with attacks of CPH. A striking finding in all patients, however, was that there were often large and rapid variations in heart rate which could be observed "before", "during" or "after" the attacks. One patient developed bradycardia and sino-atrial block and another bundle branch block together with episodes of atrial fibrillation in association with attacks.
Cephalalgia 1984 Jun
PMID:Chronic paroxysmal hemicrania: heart rate changes and ECG rhythm disturbances. A computerized analysis of 24 h ambulatory ECG recordings. 673 81

Evaporimeter measurements of forehead sweating during attack were carried out in six female patients with chronic paroxysmal hemicrania. The patients served as their own controls. Increased sweating on the symptomatic side was found in two patients, both when compared to the non-symptomatic side during attack and when compared with the symptomatic side outside attack. The remaining four patients, two of whom had only weak attacks at the time of study, showed sweat values within the control range. In one patient, attacks could be precipitated by head flexion and by pressure against certain circumscribed points in the neck ("mechanical" precipitation of attacks). These attacks were also associated with increased sweating on the symptomatic side. Increased forehead sweating does not seem to be a sine qua non in CPH.
Cephalalgia 1983 Mar
PMID:Chronic paroxysmal hemicrania. VIII. The sweating pattern. 685 Aug 21

Eight definite and 10 possible cases of CPH are known to the authors. Decisive diagnostic features in the differential diagnosis versus ordinary cluster headache (Horton's headache) seem to be: the presence of headache every day, a high maximum daily attack frequency (greater than or equal to attacks/24 hours) and an absolute indomethacin effect. There is increasing evidence for a female preponderance in CPH. It emerges from this study that there frequently (or invariably?) is a pre-CPH stage with atypical attack pattern, usually lasting several years. Pregnancy seems to have a rather clear ameliorating effect on attack frequency and severity. In other patients, the very onset of headache is immediately after delivery. The importance of recognizing this special headache from a clinical point of view is clear since this disabling disorder can be completely abolished by drug therapy.
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PMID:Chronic paroxysmal hemicrania (CPH). The clinical manifestations. A review. 693 56


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