Remission of refractory chronic cluster headache after warfarin administrations: case report

Souza, Jano Alves de; Filho, Pedro Ferreira Moreira; Jevoux, Carla; Martins, Geraldo Fortuna; Pitombo, André Bettini

doi:10.1590/s0004-282x2004000600029

Cited by 7 publications

(17 citation statements)

References 5 publications

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“…Warfarin is the only medication that has been administered a new positive recommendation (Level C). The rationale for studying this treatment for CH was derived from anecdotal reports of incidental CH benefit in patients taking warfarin for other indications . The study author hypothesized that the potential benefit of warfarin in CH treatment relates to the impact of vitamin K antagonism on dendritic and neuronal metabolism, circadian rhythms of the hypothalamus, and nitric oxide mediated neurogenic inflammation.…”

Section: Discussionmentioning

confidence: 99%

“…The rationale for studying this treatment for CH 12 was derived from anecdotal reports of incidental CH benefit in patients taking warfarin for other indications. 24,25 The study author hypothesized that the potential benefit of warfarin in CH treatment relates to the impact of vitamin K antagonism on dendritic and neuronal metabolism, circadian rhythms of the hypothalamus, and nitric oxide mediated neurogenic inflammation. We agree with the study conclusions of the author, who advocated for larger RCTs that would further elucidate the possible efficacy of warfarin for treating CH, and if effective, would help to determine the optimal level and duration of anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of Cluster Headache: The American Headache Society Evidence‐Based Guidelines

et al. 2016

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Background.-Cluster headache (CH), the most common trigeminal autonomic cephalalgia, is an extremely debilitating primary headache disorder that is often not optimally treated. New evidence-based treatment guidelines for CH will assist clinicians with identifying and choosing among current treatment options.Objectives.-In this systematic review we appraise the available evidence for the acute and prophylactic treatment of CH, and provide an update of the 2010 American Academy of Neurology (AAN) endorsed systematic review.Methods.-Medline, PubMed, and EMBASE databases were searched for double-blind, randomized controlled trials that investigated treatments of CH in adults. Exclusion and inclusion criteria were identical to those utilized in the 2010 AAN systematic review.Results and Recommendations.-For acute treatment, sumatriptan subcutaneous, zolmitriptan nasal spray, and high flow oxygen remain the treatments with a Level A recommendation. Since the 2010 review, a study of sphenopalatine ganglion stimulation was added to the current guideline and has been administered a Level B recommendation for acute treatment. For prophylactic therapy, previously there were no treatments that were administered a Level A recommendation. For the current guidelines, suboccipital steroid injections have emerged as the only treatment to receive a Level A recommendation with the addition of a second Class I study. Other newly evaluated treatments since the 2010 guidelines have been given a Level B recommendation (negative study: deep brain stimulation), a Level C recommendation (positive study: warfarin; negative studies: cimetidine/chlorpheniramine, candesartan), or a Level U recommendation (frovatriptan).Conclusions.-This AHS guideline can be utilized for understanding which therapies have superiority to placebo or sham treatment in the management of CH. In clinical practice, these recommendations should be considered in concert with other variables including safety, side effects, patient preferences, clinician experience, cost, and the invasiveness of the intervention. Given the lack of Class I evidence and Level A recommendations, particularly for a number of commonly used preventive therapies, further studies are warranted to demonstrate safety and efficacy for established and emerging therapies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Treatment of Cluster Headache: The American Headache Society Evidence‐Based Guidelines

et al. 2016

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“…A recent trial with acenocoumarol has confirmed previous anecdotal reports of the efficacy of anticoagulants in migraine prophylaxis [8], but, conversely, warfarin was reported to precipitate a cluster-like headache in a single patient [9]. In 2003, Souza et al [3] reported that warfarin used to control deep venous thrombosis in a chronic cluster headache patient resulted in his cluster headache attacks abating [3]. A placebo effect, although possible, seemed unlikely in patients with the chronic variety of the disease [10].…”

Section: Discussionmentioning

confidence: 77%

Warfarin as a therapeutic option in the control of chronic cluster headache: a report of three cases

et al. 2005

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IntroductionCluster headache is perhaps the best defined trigeminal autonomic cephalalgia. Its less frequent form, chronic cluster headache, frequently eludes available medical therapies [1]. Three cases of chronic cluster headaches that were responsive to oral anticoagulation are described. The paucity of effective therapies to treat this condition [1,2], and the puzzling effectiveness of warfarin in the cases described here, justify reporting of this uncontrolled evidence. Case reports Patient 1A 46-year-old white male presented with cluster headache since the age of 32 years, and with chronic cluster headache since the age of 35 years. He was submitted to currently available prophylactic therapies for cluster headache such as prednisone, deflazacort, verapamil, lithium carbonate, methysergide, divalproate, pizotifen, lamotrigine and topiramate, and to several other unconventional therapeutic drugs. He only responded to steroids, which produced a partial and transitory response. He took prednisone for a prolonged period, which may have contributed to the chronification of his cluster headache. A retrogasserian balloon compression led to a transitory remission. In September 2003, after an earlier communication of the case subsequently described by Souza et al. [3], warfarin 2.5 mg/day up to 10 mg/day was prescribed. Cluster headache attacks decreased during the titration period and were followed by a sustained remission in the succeeding two months, allowing him to discontinue prednisone. The attacks recurred when warfarin was withdrawn, but their frequency and intensity decreased again from 6 daily full-blown episodes to a headache-free condition after two mild episodes following J Headache Pain (2005) 6:417-419 DOI 10.1007/s10194-005-0234-6Warfarin as a therapeutic option in the control of chronic cluster headache: a report of three cases Abstract Chronic cluster headache remains refractory to medical therapy in at least 30% of those who suffer from this condition. The lack of alternative medical therapies that are as effective as, or more effective than, lithium carbonate makes new therapies necessary for this highly disabling condition. Based on a previous report, we gave oral anticoagulants to three patients with chronic cluster headache. Two of them remained cluster headachefree while taking warfarin. In the third patient, the use of warfarin for three weeks initially increased the frequency and intensity of cluster headache attacks but subsequently induced a prolonged remission. In spite of the paucity of data available, oral anticoagulation appears to be a promising therapy for chronic cluster headache.

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“…In Rio de Janeiro, São Paulo, Paraná, Santa Catarina, and Rio Grande do Sul, there are several centers dealing with headache disorders and an excellent scientific production has been made by a number of headache specialists, mentioning Abouch Krymchantowski, Carla da Cunha Jevoux, Maurice Vincent, Pedro Ferreira Moreira Filho, Jano Alves de Souza, Maria Eduarda Nobre in Rio de Janeiro; Celia P. Roesler, Deusvenir de Souza Carvalho, Eliova Zukerman, Mario Fernando Prieto Peres,…”

Section: Publications In Headache Medicinementioning

confidence: 99%

“…In Rio de Janeiro, São Paulo, Paraná, Santa Catarina, and Rio Grande do Sul, there are several centers dealing with headache disorders and an excellent scientific production has been made by a number of headache specialists, mentioning Abouch Krymchantowski, [217][218][219][220][221][222][223][224][225][226]234,287,[350][351][352][353][354][355] Carla da Cunha Jevoux, 46,204,213,214,223,224,264,265,293,[296][297][298]300,302,303,356 Maurice Vincent, [93][94][95][96][97][98]101,102,104,189,[274][275][276][277]…”

Section: Publications In Headache Medicinementioning

confidence: 99%

Headache Research and Medical Practice in Brazil: An Historical Overview

2015

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Since the creation of the Brazilian Headache Society in 1978, substantial developments have taken place in both research and clinical practice in the field of headache medicine in Brazil. The Society now has almost 300 members throughout the country, actively working to improve the health of the general population and, in particular, diagnose and treat headache disorders. In addition, in a few large cities, such as São Paulo, Rio de Janeiro, Recife, Ribeirão Preto, Curitiba, and Porto Alegre, headache specialists have come together to promote research projects and increase knowledge in the field through MSc, PhD, and postdoctoral programs. Furthermore, scientific journals have emerged and books have been published to record and disseminate Brazilian scientific production in headache medicine. In this narrative review, we will briefly describe some important aspects of headache medicine in Brazil from prehistoric times to the present day, discuss the origin of headache medicine as a specialty in Brazil, the principal publications dealing with headache disorders, the use of plants and other unconventional forms of treatment used by faith healers, the main training centers, and the research produced to date by Brazilians. In conclusion, in recent years enormous progress has been made in headache medicine in Brazil stimulating us to review and expand our role in an increasingly international scenario.

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Remission of refractory chronic cluster headache after warfarin administrations: case report

Cited by 7 publications

References 5 publications

Treatment of Cluster Headache: The American Headache Society Evidence‐Based Guidelines

Treatment of Cluster Headache: The American Headache Society Evidence‐Based Guidelines

Warfarin as a therapeutic option in the control of chronic cluster headache: a report of three cases

Headache Research and Medical Practice in Brazil: An Historical Overview

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