A case of post-traumatic LASH syndrome responsive to indomethacin and melatonin (a man with a unique triad of indomethacin-responsive trigeminal autonomic cephalalgias)

Rozen, Todd D.; Beams, Jennifer L

doi:10.1177/0333102414544980

Cited by 7 publications

(4 citation statements)

References 13 publications

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“…Secondary LASH, of which there are now three cases reported, can occur in males and females, unlike primary LASH (4). Average age of onset is 40 years (range 29–49).…”

Section: Discussionmentioning

confidence: 98%

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LASH syndrome: New cases with a broadening clinical phenotype

Rozen

2019

Cephalalgia

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Objective To describe three new cases of the headache syndrome of long-lasting autonomic symptoms with hemicrania (LASH), and to establish a clinical phenotype utilizing all LASH cases noted in the medical literature. Methods A case series of patients was evaluated in an academic headache clinic over a two-year time period. LASH syndrome was defined by episodic headache attacks with associated cranial autonomic symptoms that start before headache onset, last the entire duration of the headache and continue on for a period of time after the headache ceases. Results Three patients were noted to have LASH syndrome in a two-year time period (2017–2018). One patient was diagnosed with primary LASH, while two others had probable secondary LASH from a secretory pituitary tumor. The primary LASH patient was female. She had on average one headache per week lasting 1–3 days in duration. She experienced migrainous associated symptoms along with their cranial autonomic symptoms. She also developed a fixed Horner's syndrome along with a typical headache attack, which was present for 6 months at the time of consultation. She had complete headache relief with indomethacin and her miosis and ptosis also resolved with treatment. Secondary LASH was diagnosed in two patients (one male, one female) both with prolactin secreting pituitary microadenomas. One of the patients had his headaches abolish with dopamine agonist therapy while the other patient did not respond to hormonal modulation but became pain free on indomethacin. Secondary LASH patients had less frequent headache episodes and lacked any migrainous associated features, but exhibited agitation with headache. Conclusion LASH syndrome may be rare, but more reported cases are entering the headache literature. The temporal profile of onset and offset of cranial autonomic symptoms is key to making the diagnosis. Primary and secondary LASH may present differently based on gender predominance, the presence of migrainous associated features, and attack frequency. Secondary LASH appears to be indomethacin responsive, suggesting that medication effectiveness should not obviate the need to do testing for secondary etiologies.

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“…Secondary LASH, of which there are now three cases reported, can occur in males and females, unlike primary LASH (4). Average age of onset is 40 years (range 29–49).…”

Section: Discussionmentioning

confidence: 98%

“…Primary LASH patients have an average mean diagnostic delay prior to diagnosis and effective therapy of about 3 years (range 1-5 years). Primary LASH episodes appear to Secondary LASH, of which there are now three cases reported, can occur in males and females, unlike primary LASH (4). Average age of onset is 40 years (range 29-49).…”

Section: Discussionmentioning

confidence: 99%

LASH syndrome: New cases with a broadening clinical phenotype

Rozen

2019

Cephalalgia

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“…78 Interestingly, melatonin achieved complete pain alleviation in the first post-traumatic/secondary case of long-lasting autonomic symptoms with hemicrania (LASH) syndrome. 80 Moreover, exogenous melatonin supplementation can significantly relieve abdominal pain caused by irritable bowel syndrome (IBS). 81 Furthermore, melatonin reduces indomethacin dosage during the treatment period of hemicrania continua and shows better pain relief effect.…”

Section: Chronic Inflammatory Painmentioning

confidence: 99%

<p>Role of Melatonin in the Regulation of Pain</p>

Xie

Fan

et al. 2020

JPR

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Melatonin is a pleiotropic hormone synthesized and secreted mainly by the pineal gland in vertebrates. Melatonin is an endogenous regulator of circadian and seasonal rhythms. Melatonin is involved in many physiological and pathophysiological processes demonstrating antioxidant, antineoplastic, anti-inflammatory, and immunomodulatory properties. Accumulating evidence has revealed that melatonin plays an important role in pain modulation through multiple mechanisms. In this review, we examine recent evidence for melatonin on pain regulation in various animal models and patients with pain syndromes, and the potential cellular mechanisms.

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“…Indomethacin-responsive headaches have been claimed to be good candidates for melatonin supplementation (112), since both share similar chemical structures (113). Case reports have been published showing melatonin efficacy in hemicrania continua (114,115), paroxysmal hemicranias (116), LASH syndrome (117) idiopathic stabbing headache (118,119), and hypnic headaches (53).…”

Section: Melatonin In Cluster Headaches Other Tacs and Other Primarymentioning

confidence: 99%

Current understanding of pineal gland structure and function in headache

et al. 2019

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Purpose The pineal gland plays an important role in biological rhythms, circadian and circannual variations, which are key aspects in several headache disorders. Overview Melatonin, the main pineal secreting hormone, has been extensively studied in primary and secondary headache disorders. Altered melatonin secretion occurs in many headache syndromes. Experimental data show pineal gland and melatonin both interfere in headache animal models, decreasing trigeminal activation. Melatonin has been shown to regulate CGRP and control its release. Discussion Melatonin has been used successfully as a treatment for migraine, cluster headaches and other headaches. There is a rationale for including the pineal gland as a relevant brain structure in the mechanisms of headache pathophysiology, and melatonin as a treatment option in primary headache.

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A case of post-traumatic LASH syndrome responsive to indomethacin and melatonin (a man with a unique triad of indomethacin-responsive trigeminal autonomic cephalalgias)

Cited by 7 publications

References 13 publications

LASH syndrome: New cases with a broadening clinical phenotype

LASH syndrome: New cases with a broadening clinical phenotype

<p>Role of Melatonin in the Regulation of Pain</p>

Current understanding of pineal gland structure and function in headache

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