Aura in trigeminal autonomic cephalalgia is probably mediated by comorbid migraine with aura

Peng, Kuan‐Po; Schellong, Marlene; May, Arne

doi:10.1177/03331024211030499

Cited by 10 publications

(26 citation statements)

References 26 publications

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“…In our cohort we have only found typical aura symptoms in 2% of patients, all of them visual. It could be due to the retrospective nature of our work, but a very recent, prospective study has found rst a percentage of aura similar to that of our series (3.5%) and second that the majority of patients with CH and aura have a concomitant diagnosis of migraine with aura [22]. The prevalence of migraine among patients with CH has been estimated to be similar to that of the general population [23], while we have only found the coexistence of migraine in a single patient in our series, so it is likely that this information has not been collected in the charts with rigor, perhaps hidden by the severity of the CH.…”

Section: Discussionsupporting

confidence: 59%

Four decades of experience with cluster headache: description of a series in a University Hospital of Spain

Pascual

Madera

Pérez-Pereda

et al. 2022

Preprint

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Background: There are few published series of cluster headache. Our aim was to longitudinally describe the epidemiological and clinical features of cluster headache patients in our region since 1980.Methods: Retrospective analysis of the clinical charts of patients diagnosed as cluster headache in a Spanish tertiary hospital.Results: 153 patients were included. 137 (89,5%) were males. Mean age at the beginning of symptoms and diagnosis was 32.8 years (mean deviation 11.3) and 39.5 years (mean deviation 11.4) respectively. 128 had episodic cluster headache (92.2% males) and 25 chronic cluster headache (76% males). Mean age at the beginning was delayed in chronic cluster headache versus episodic cluster headache (37.6 vs 31.8 years; p= 0.023). Four patients (2.6%) had familial antecedents. 3 (2%) referred to visual aura. At diagnosis, 66% were smokers and 15% heavy alcohol drinkers. Median duration of cluster period and median frequency was 60 days every 2 years. 16 (10.5%) had only one cluster period during follow-up.Conclusion: Theoretical prevalence of cluster headache in our area was 0.05%. The diagnostic delay close to 7 years indicates an insufficient recognition of this entity. A late beginning and being a woman were associated with chronic cluster headache, while one out of ten patients only experienced one cluster period.

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Section: Discussionsupporting

confidence: 59%

Four decades of experience with cluster headache: description of a series in a University Hospital of Spain

Pascual

Madera

Pérez-Pereda

et al. 2022

Preprint

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“…Strengths of the current study are (i) a clinically well-defined study population of patients with ECH or CCH in whom the presence or absence of visual aura was specified and in whom comorbid migraine and severe eye disorders were excluded to avoid confounding factors. The importance of this exclusion was highlighted by a recent study reporting that the presence of aura in trigeminal autonomic cephalalgias is mediated by comorbid migraine with aura in most patients (24); and (ii) the use of a validated instrument to measure visual sensitivity in combination with additional questions as to whether the participants experienced visual hypersensitivity and if so on which side.…”

Section: Discussionmentioning

confidence: 99%

Unilateral increased visual sensitivity in cluster headache: a cross-sectional study

et al. 2022

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Background and Objectives Increased sensitivity to light and patterns is typically associated with migraine, but has also been anecdotally reported in cluster headache, leading to diagnostic confusion. We wanted to assess whether visual sensitivity is increased ictally and interictally in cluster headache. Methods We used the validated Leiden Visual Sensitivity Scale (L-VISS) questionnaire (range 0-36 points) to measure visual sensitivity in people with episodic or chronic cluster headache: (i) during attacks; (ii) in-between attacks; and in episodic cluster headache (iii) in-between bouts. The L-VISS scores were compared with the L-VISS scores obtained in a previous study in healthy controls and participants with migraine. Results Mean L-VISS scores were higher for: (i) ictal vs interictal cluster headache (episodic cluster headache: 11.9 ± 8.0 vs. 5.2 ± 5.5, chronic cluster headache: 13.7 ± 8.4 vs 5.6 ± 4.8; p < 0.001); (ii) interictal cluster headache vs controls (5.3 ± 5.2 vs 3.6 ± 2.8, p < 0.001); (iii) interictal chronic cluster headache vs interictal ECH in bout (5.9 ± 0.5 vs 3.8 ± 0.5, p = 0.009), and (iv) interictal episodic cluster headache in bout vs episodic cluster headache out-of-bout (5.2 ± 5.5 vs. 3.7 ± 4.3, p < 0.001). Subjective visual hypersensitivity was reported by 110/121 (91%; 9 missing) participants with cluster headache and was mostly unilateral in 70/110 (64%) and ipsilateral to the ictal pain in 69/70 (99%) participants. Conclusion Cluster headache is associated with increased ictal and interictal visual sensitivity. In contrast to migraine, this is mostly unilateral and ipsilateral on the side of the ictal pain.

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“…Or do these cases necessarily imply the co-existence of two separate headache disorders? (See de Coo et al and Silberstein et al versus et al Peng et al ) [3][4][5][6][7] Finally, consider cases of identifiable date of onset of intractable headache without light or sound sensitivity: Should we consider these new daily persistent headaches or chronic tension type headaches? (Lobo et al vs. Robbins et al) 8,9 The reader may have ready answer for each of the scenarios above; however, one has to agree that those opinions are not likely shared among all of our colleagues.…”

Section: Glossarymentioning

confidence: 99%

Classifications of Logically Coherent Concurrent Diagnoses According to ICHD3: A Pilot Application of Automated Diagnosis Through Prime Representation

Zhang

2022

Preprint

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Introduction: In clinical practice, headache presentations may fit more than one ICHD3 diagnoses. This project seeks to exhaustively list all logically consistent "codiagnoses" according to ICHD3 criteria. We limit our project to cases where only two diagnoses are involved. Methods: We included the ICHD3 criterias for "Migraine" (1.1, 1.2, 1.3), "Tension-type headache" (2.1, 2.2, 2.3, 2.4), "Trigeminal autonomic cephalalgias" (3.1, 3.2, 3.3, 3.4, 3.5), as well as all "Other primary headache disorders". We excluded "Complications of migraine"(1.5) and "Episodic syndrome that may be associated with migraine" (1.6) since these diagnoses require codiagnoses of migraine as first assumption. We also excluded "probable" diagnosis criteria. Each phenotype in the above criteria is assigned an unique prime number. We then encoded each ICHD3 criteria into integers, call "criteria representations", through multiplication in a list format. "Codiagnoses representations" are generated by multiplying all possible pairings of criteria representations. To eliminate logical inconsistent codiagnses, we manually encode a list of logically inconsistent phenotypes through multiplication: For example, headache lasting "seconds" would be logically inconsistent with "headache lasting hours"; the prime representation for both are multiplied together. We called this list the "inconsistency representations". All codiagnoses representation divisible by any inconsistency representations are filtered out, generating a list of codiagnoses represenation that are logically consistent. This list is then translated back into ICHD3 diagnoses. Results: A total of 103 prime numbers were used to encode phenotypes from the included ICHD3 criteria diagnosis with 434 encodings generated. We generated 99 pairs of illogical phenotypes. Once illogical phenotypes were excluded, a total of 133,106 composite numbers representing unique dual-diagnosis clinical profiles were obtained. The number of profiles, although unique, yields duplicate dual diagnoses; once these duplicates are removed, we obtained 138 possible logical dual diagnoses. Of the dual diagnoses, 2 contains with intersecting phenotypes due to subset relationships, 15 dual diagnoses with intersecting phenotype without subset relationships, 101 contains dual diagnoses as a result of non-intersecting phenotypes. There are 20 co-diagnoses containing three disorders, all of them are super-sets of some dual diagnoses and contain chronic migraine as one of the diagnoses. Conclusion: Prime number representations of primary headache disorders not only offer clinicians with an automated way of diagnosing headaches but also provides a powerful method of investigating concurrent diagnosis in headache classifications. Applications of this method to the investigations of dual diagnosis and headaches may offer insight into "loopholes" in the ICHD3 as well as potential explanation for sources of a number of controversies in headache disorders. Futures applications of the method includes extending the methodology to all of ICHD3.

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Aura in trigeminal autonomic cephalalgia is probably mediated by comorbid migraine with aura

Cited by 10 publications

References 26 publications

Four decades of experience with cluster headache: description of a series in a University Hospital of Spain

Four decades of experience with cluster headache: description of a series in a University Hospital of Spain

Unilateral increased visual sensitivity in cluster headache: a cross-sectional study

Classifications of Logically Coherent Concurrent Diagnoses According to ICHD3: A Pilot Application of Automated Diagnosis Through Prime Representation

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