Trigeminal autonomic cephalalgias presenting in a multidisciplinary tertiary orofacial pain clinic

Wei, Diana Y.; Pérez‐Fernández, Nicolas; Renton, Tara; Goadsby, PJ

doi:10.1186/s10194-019-1019-7

Cited by 13 publications

(27 citation statements)

References 20 publications

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“…In our experience in a specialist TAC clinic and in running a specialist Orofacial Pain clinic 39 , patients with TAC's and indeed migraine, do report pain outside of the V1 dermatome. We have witnessed the reporting of voice change and/or a sensation of throat swelling, which may be related possible CAS, by patients affected by the primary headache disorders.…”

Section: Introductionmentioning

confidence: 87%

Cranial autonomic symptoms: prevalence, phenotype and laterality in migraine and two potentially new symptoms

Karsan

Nagaraj

Goadsby

2021

Preprint

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BackgroundWhilst cranial autonomic symptoms (CAS) are typically associated with the trigeminal autonomic cephalalgias (TAC’s), they have also been reported in migraine. Identification and understanding of these symptoms in migraine is important to ensure timely diagnosis and effective management. MethodsMigraineurs seen within our tertiary headache service between 2014-2018 ( n =340): cohort one, and a separate cohort of headache patients seen between 2014-May 2021 reporting voice change and/or throat swelling as CAS were selected ( n =64); cohort two. We examined, as a service evaluation, our records regarding age, sex, diagnosis, headache and CAS frequency and laterality as acquired from the first consultation, during which a detailed headache history is taken by a trained physician. ResultsCohort 1: Mean age 43 (range 14-94, SD 15). The most common diagnosis was chronic migraine (78%). Median monthly headache frequency was 26 days (IQR 15-75). At least one CAS was reported in 74%, with a median of two (IQR 0-3). The most common were nasal congestion (32%), lacrimation (31%) and aural fullness (25%). Most patients reported unilateral headache (80%) and strictly unilateral CAS (64%). There was a positive association between headache and CAS laterality (ꭓ 2 1 = 20.7, P < 0.001), with a positive correlation between baseline headache frequency and number of CAS reported ( r = 0.11, P = 0.047). Cohort two: mean age 49 (range 23-83, SD 14). Diagnoses were chronic migraine (50%), chronic cluster headache (11%), undifferentiated continuous lateralised headache (9%), SUNCT/SUNA (8%), hemicrania continua (8%), episodic migraine (8%), episodic cluster headache (3%) and trigeminal neuropathies (3%). Most (89%) described trigeminal distribution pain; 25% involving all three divisions. Throat swelling was reported by 54, voice change by 17, and both by 7. The most common CAS reported were lacrimation ( n = 47), facial swelling ( n = 45) and rhinorrhoea ( n = 37). There was significant agreement between the co-reporting of throat swelling (ꭓ 2 1 = 7.59, P = 0.013) and voice change (ꭓ 2 1 = 6.49, P = 0.02) with aural fullness. ConclusionsCAS are common in migraine, are associated with increasing headache frequency and tend to co-lateralise with headache. Voice change and throat swelling should be recognized as possible parasympathetically-mediated CAS. They may be co-associated and associated with aural fullness, suggesting a broadly somatotopic endophenotype.

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Section: Introductionmentioning

confidence: 87%

Cranial autonomic symptoms: prevalence, phenotype and laterality in migraine and two potentially new symptoms

Karsan

Nagaraj

Goadsby

2021

Preprint

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“…Because of the differential diagnosis with chronic migraine, the prevalence of HC is probably underestimated. In line with this, a high incidence of HC was demonstrated when reviewing consecutive patients attending an orofacial pain clinic 139 …”

Section: Trigeminal Autonomic Cephalalgiasmentioning

confidence: 56%

“…In line with this, a high incidence of HC was demonstrated when reviewing consecutive patients attending an orofacial pain clinic. 139 In a retrospective review of 192 cases using indomethacin 150 mg or more for 2 weeks or 225 mg for 1 week, 43 had an absolute response to indomethacin. In another retrospective analysis of 62 patients with diverse clinical presentations, daily doses of 25-300 mg were used.…”

Section: Paroxysmal Hemicrania and Hemicrania Continuamentioning

confidence: 99%

Indomethacin‐responsive headaches—A narrative review

2021

Self Cite

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“…The literature search identified 957 citations, of which 946 were excluded based on the title and abstract screening (Figure 1). Eleven clinic-based studies were retrieved for further review and met the eligibility criteria for inclusion (2,(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). All included data originated from the outpatient clinic of tertiary care centers.…”

Section: Resultsmentioning

confidence: 99%

Prevalence and clinical features of hemicrania continua in clinic-based studies: A systematic review and meta-analysis

Al-Khazali

Iljazi

et al. 2023

Cephalalgia

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Objective To estimate the relative frequencies of hemicrania continua and its clinical features in adult patients who were evaluated for headache in a clinic-based setting. Methods PubMed and Embase were searched for observational, clinic-based studies published between 1 January 2004 and 1 February 2022, that reported on the relative frequencies of hemicrania continua and its clinical features. Two independent investigators (HMA and SA-K) screened titles, abstracts, and full text-articles. A random-effects meta-analysis was conducted to estimate pooled relative frequencies of hemicrania continua and its clinical features across clinic-based studies. Results Eleven clinic-based studies were deemed eligible for inclusion. Of these, eight studies reported on the relative frequency of hemicrania continua among adult patients (n = 9854) who were evaluated for headache in a tertiary care unit. The pooled relative frequency of hemicrania continua was found to be 1.8% (95% CI; 1.0–3.3). Considerable heterogeneity was noted across studies (I2 = 89.8%). The three most common symptoms associated with hemicrania continua were lacrimation (72.3%), conjunctival injection (69.8%), and restlessness/agitation (60.2%). Conclusion The findings of this meta-analysis suggest that there is limited epidemiologic data on the relative frequencies of hemicrania continua and its clinical features. Standardized data acquisition and reporting are needed to estimate prevalence rates more accurately and to better understand epidemiologic patterns. This, in turn, should increase awareness of the impact that hemicrania continua has in clinical practice.

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Trigeminal autonomic cephalalgias presenting in a multidisciplinary tertiary orofacial pain clinic

Cited by 13 publications

References 20 publications

Cranial autonomic symptoms: prevalence, phenotype and laterality in migraine and two potentially new symptoms

Cranial autonomic symptoms: prevalence, phenotype and laterality in migraine and two potentially new symptoms

Indomethacin‐responsive headaches—A narrative review

Prevalence and clinical features of hemicrania continua in clinic-based studies: A systematic review and meta-analysis

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