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        New Message Board Archives >> Medications, Treatments, Therapies 2004 >> Fresh Research - Need Lizzies Help!
        
(Message started by: floridian on Oct 18^th, 2004, 1:29pm)

Title: Fresh Research - Need Lizzies Help!
Post by floridian on Oct 18^th, 2004, 1:29pm

Just came across this - there's no abstract or summary, but Lizzie should be able to get us one. ;) :) The title of this research reminds me of the 'painless cluster headache' thread from last week, but that research was done in Norway, while this was done in Philly.

Quote:

Cephalalgia. 2004 Nov;24(11):1005-6.

Periodic autonomic dysfunction without pain in a patient with cluster headache.

Ashkenazi A, Silberstein S.

Jefferson Headache Center, Thomas Jefferson University Hospital, Philadelphia, PA, USA.

PMID: 15482367 [PubMed - in process]

Title: Re: Fresh Research - Need Lizzies Help!
Post by Lizzie2 on Oct 18^th, 2004, 8:17pm

I'll look into it ASAP. Doubt if I'll get to it tonight as it hasn't been the best of days, and I was up most of the night between studying and CH hits! Hopefully I can find some more out. :)

Lizzie :)

Title: Re: Fresh Research - Need Lizzies Help!
Post by floridian on Oct 18^th, 2004, 10:57pm

Thanks! Whenever you get a chance.

Title: Re: Fresh Research - Need Lizzies Help!
Post by Lizzie2 on Oct 19^th, 2004, 7:21am

Just sent you an PM. We don't have access to the online version, but there should be a hard copy in the library. I'll run over at some point today after clinicals to see if I can get my hands on it. I'll keep ya informed! ;)

Carrie/Lizzie2 :)

Title: Re: Fresh Research - Need Lizzies Help!
Post by Lizzie2 on Oct 20^th, 2004, 2:49pm

Hiya Jonathan,

I went to the library yesterday, but they didn't have the November issue of Cephalalgia available. Not sure if someone had pulled it off the shelf temporarily or if they haven't put that issue out yet. I'm leaving the city today because I have clinical at a different hospital Thursday and Friday, but I'll be back over the weekend, so maybe I can check again then!

Just didn't want you to think I gave up!

Lizzie :)

Title: Re: Fresh Research - Need Lizzies Help!
Post by JJA on Oct 22^nd, 2004, 11:46am

This just became available online. Maybe I can save Lizzie another trip to the library. I cut out the references to save space.
There is also a more interesting (in my opinion) article about CH and deep brain stimulation in the same issue. Let me know if you want the pdf version of either article.

Quote:

Cluster headache (CH) is characterized by episodes
of severe unilateral headache accompanied by symp-
toms of cranial parasympathetic hyperactivity and
sympathetic dysfunction that occur in cluster peri-
ods (1). Positron emission tomography (PET) studies
have demonstrated evidence of a central generator
of CH attacks located in the posterior-inferior hypo-
thalamus (2, 3). It has been suggested that the auto-
nomic symptoms in CH result from reflex activation
of the superior salivatory nucleus secondary to acti-
vation of the trigeminal nucleus caudalis (TNC) (4).
However, several cases of CH-like symptoms with
no head pain have been documented (5, 6).
We describe a patient who had suffered from typ-
ical episodic CH for two decades; it later converted
into episodic autonomic dysfunction without head
pain.

Case report

The patient is a 41-year-old man who had had epi-
sodic CH for 20 years. A typical attack consisted of
a severe (10/10) drilling pain in the right retro-
orbital and temporal areas and right jaw. The pain
was associated with nausea and photophobia. Dur-
ing an attack, he had tearing, conjunctival injection,
and ptosis on the right, as well as a congested nostril
on the same side. He would have eight attacks per
24 h, with each attack lasting 30–45 min. They
occurred day and night. Cluster periods occurred
once every 2 years and lasted 2–3 weeks. A head
magnetic resonance imaging was normal. Oxygen or
dihydroergotamine was effective for acute attacks.
Verapamil 480 mg/day was effective in reducing the
frequency and severity of attacks. He smoked two
packs of cigarettes a day for the last 23 years and
occasionally drank alcoholic beverages.
In December 2003 the patient was seen at our out-
patient clinic for a follow-up visit. At this point, he

had tapered his verapamil to 80 mg/day. He stated
that he had no headaches, but continued to have
episodes of tearing, eye-lid drooping and congested
nostril on the right. The episodes would occur twice
a day and last for approximately 5 min. Some
occurred at night at approximately 02.00 h, the same
time as his typical cluster headaches had occurred.
He did not take any medications for these episodes.
His physical and neurological examinations were
normal.
On a follow-up call the patient reported that these
episodes ceased after a period of 4 weeks.

Discussion

This patient had typical episodic CH for two decades
before the pain component of his attacks stopped.
This sequence of events in CH has not been pre-
viously described. Salvesen described a case of a
young man with episodes of unilateral miosis, pto-
sis, and nasal congestion without pain. Six years
later the patient had the same symptoms, this time
accompanied by severe unilateral headache, com-
pleting the picture of episodic CH (5). Our patient
had a reverse sequence of events, with the full CH
picture occurring first and loss of the pain compo-
nent years later. Both cases support the notion that
isolated autonomic dysfunction, occurring in a
typical temporal course, is part of the CH clinical
spectrum.
The literature further supports this notion. In a
recent report, Leone et al. described a woman who
had episodic unilateral cranial autonomic symptoms
that occurred in clusters that lasted 20–30 days (6).
Her son had typical episodic CH. The occurrence
of these two clinical pictures in one family supports
(albeit does not prove) the assumption that they are
related.

Sjaastad et al. described a patient who had a his-
tory of CH with autonomic dysfunction contralateral
to the side of the head pain (7). This case and ours
show that the autonomic dysfunction in CH may be
separated from the head pain in time or location.
These observations suggest that the autonomic
symptoms in CH are not secondary to the pain but
an independent phenomenon.
Our observation does not support the concept that
a trigemino-parasymapthetic reflex, introduced by
Goadsby, can explain the combination of pain and
cranial autonomic dysfunction in all cases of CH and
other headaches (4). Rather, it shows that the two
components of these headaches can occur indepen-
dently. The fact that the episodes of autonomic dys-
function without pain were more brief than the ones
that occurred with head pain suggests that the pain,
when present, can prolong the parasympathetic acti-
vation during CH attack. Pain, however, is not nec-
essary for the autonomic symptoms to occur.
Recent functional imaging studies show activation
of the posterior-inferior hypothalamus during a CH
attack (2, 3). This area may be the generator of both
the pain and the autonomic symptoms in CH. Some
patients, however, may have only one of these two
components activated during an attack. The mecha-
nism that leads to this limited expression of CH
attack is still to be determined.

Jesse

Title: Re: Fresh Research - Need Lizzies Help!
Post by Lizzie2 on Oct 22^nd, 2004, 4:07pm

This sounds a whole lot like Shadows to me for some of us. I have to email Avi and maybe have a discussion with him regarding that one! Very interesting...

Title: Re: Fresh Research - Need Lizzies Help!
Post by eyes_afire on Nov 13^th, 2004, 11:54am

Strangely enough, it's happening to me again... just like it did exactly 2 years ago. All ghosts and no demons. Eyeburn, eyewater, leftnoseblock, heavy shadows... no full blown CH. Glad to be off verapamil. I'll try to 'enjoy' it now in preparation for my scheduled 18-month-long relapse...
Strange stuff.

--- Steve

Title: Re: Fresh Research - Need Lizzies Help!
Post by Mr. Happy on Nov 14^th, 2004, 12:25am

on 11/13/04 at 11:54:04, eyes_afire wrote:

Strange stuff.

Indeed. It's bad enough that today's meds might not work tomorrow. To have all the symptoms w/o the pain is WAY over the line of cruel and unusual punishment. Talk about keeping you neurotic. This is defintely a personal foul, 15 yard penalty, and ejection from the game.

Strange stuff indeed,
RJ

Title: Re: Fresh Research - Need Lizzies Help!
Post by eyes_afire on Nov 17^th, 2004, 6:35pm

Game over. Back to the 4:30am beastings. Either that was a short 'painless CH' or it was a very long verapamil boomerang. I can't believe that it would take 2 or 3 weeks before I'd know if my verapamil taper failed when I used to get clobbered within 2 days after taper. At least I'm only getting hit once per 24 hours (not including the phantoms, shadows, or ISH). Strange that they're only lasting 30 minutes... which means that they are either very short CH or that the crushed imitrex pills are working within 30 minutes. Now off verapamil, I'm gonna try to go without and see how long I can hold out.

Keep away Randy, I really am a filthy chronic, LOL ;)

--- Steve