EFNS guideline on the treatment of tension-type headache - Report of an EFNS task force.
; ; et al
in European Journal of Neurology (2010)
Background: Tension-type headache (TTH) is the most prevalent headache type and is causing a high degree of disability. Treatment of frequent TTH is often difficult. Objectives: To give evidence-based or ... [more ▼]
Background: Tension-type headache (TTH) is the most prevalent headache type and is causing a high degree of disability. Treatment of frequent TTH is often difficult. Objectives: To give evidence-based or expert recommendations for the different treatment procedures in TTH based on a literature search and the consensus of an expert panel. Methods: All available medical reference systems were screened for the range of clinical studies on TTH. The findings in these studies were evaluated according to the recommendations of the EFNS resulting in level A, B or C recommendations and good practice points. Recommendations: Non-drug management should always be considered although the scientific basis is limited. Information, reassurance and identification of trigger factors may be rewarding. Electromyography (EMG) biofeedback has a documented effect in TTH, whilst cognitive-behavioural therapy and relaxation training most likely are effective. Physical therapy and acupuncture may be valuable options for patients with frequent TTH, but there is no robust scientific evidence for efficacy. Simple analgesics and non-steroidal anti-inflammatory drugs are recommended for the treatment of episodic TTH. Combination analgesics containing caffeine are drugs of second choice. Triptans, muscle relaxants and opioids should not be used. It is crucial to avoid frequent and excessive use of analgesics to prevent the development of medication-overuse headache. The tricyclic antidepressant amitriptyline is drug of first choice for the prophylactic treatment of chronic TTH. Mirtazapine and venlafaxine are drugs of second choice. The efficacy of the prophylactic drugs is often limited, and treatment may be hampered by side effects. [less ▲]Detailed reference viewed: 40 (0 ULg)
Commentary on Fontaine et al.: "Safety and efficacy of deep brain stimulation in refractory cluster headache: a randomized placebo-controlled double-blind trial followed by a 1-year open extension".
; Schoenen, Jean
in Journal of Headache & Pain (2010), 11(1), 21-2Detailed reference viewed: 17 (2 ULg)
Factors predicting the probability of relapse after discontinuation of migraine preventive treatment with topiramate.
Schoenen, Jean ; ; et al
in Cephalalgia : An International Journal of Headache (2010), 30(11), 1290-5
INTRODUCTION: Demographic and clinical variables were examined in a post hoc analysis of the PROlonged Migraine Prevention with Topiramate (PROMPT) study to determine potential contribution to relapse ... [more ▼]
INTRODUCTION: Demographic and clinical variables were examined in a post hoc analysis of the PROlonged Migraine Prevention with Topiramate (PROMPT) study to determine potential contribution to relapse. METHODS: After a six-month open-label (OL) topiramate phase, patients were randomised to continue topiramate or switch to placebo in a six-month double-blind (DB) phase. 'Relapse' was investigated in terms of change in monthly migraine days after randomisation compared with the month before randomisation, and was analysed during the first ('initial relapse') and last month ('sustained relapse') of the DB phase. More than 40 potential predicting factors were entered into analyses of variance and covariance. RESULTS: For initial relapse, variable-by-treatment interactions were significant for the Headache Impact Test (HIT-6) at DB baseline, and decline in acute medication intake or reporting of 'anxiety' in the OL phase. For sustained relapse, no statistically significant interactions were observed. CONCLUSION: Relapse after topiramate discontinuation in migraine prophylaxis appears to be unaffected by patient characteristics or baseline migraine frequency. [less ▲]Detailed reference viewed: 21 (3 ULg)
Botulinum toxin in headache treatment: finally a promising path?
in Cephalalgia : An International Journal of Headache (2010), 30(7), 771-3Detailed reference viewed: 17 (1 ULg)
Almotriptan efficacy in migraine with allodynia: a rebuttal to Burstein and Jakubowski's critique of Schoenen et al.
Schoenen, Jean ;
in Cephalalgia : An International Journal of Headache (2010), 30(9), 1147-8Detailed reference viewed: 11 (0 ULg)
Genome-wide association study of migraine implicates a common susceptibility variant on 8q22.1.
; ; et al
in Nature Genetics (2010), 42(10), 869-73
Migraine is a common episodic neurological disorder, typically presenting with recurrent attacks of severe headache and autonomic dysfunction. Apart from rare monogenic subtypes, no genetic or molecular ... [more ▼]
Migraine is a common episodic neurological disorder, typically presenting with recurrent attacks of severe headache and autonomic dysfunction. Apart from rare monogenic subtypes, no genetic or molecular markers for migraine have been convincingly established. We identified the minor allele of rs1835740 on chromosome 8q22.1 to be associated with migraine (P = 5.38 x 10, odds ratio = 1.23, 95% CI 1.150-1.324) in a genome-wide association study of 2,731 migraine cases ascertained from three European headache clinics and 10,747 population-matched controls. The association was replicated in 3,202 cases and 40,062 controls for an overall meta-analysis P value of 1.69 x 10(1)(1) (odds ratio = 1.18, 95% CI 1.127-1.244). rs1835740 is located between MTDH (astrocyte elevated gene 1, also known as AEG-1) and PGCP (encoding plasma glutamate carboxypeptidase). In an expression quantitative trait study in lymphoblastoid cell lines, transcript levels of the MTDH were found to have a significant correlation to rs1835740 (P = 3.96 x 10, permuted threshold for genome-wide significance 7.7 x 10. To our knowledge, our data establish rs1835740 as the first genetic risk factor for migraine. [less ▲]Detailed reference viewed: 65 (2 ULg)
Abnormal cortical responses to somatosensory stimulation in medication-overuse headache.
; ; et al
in BMC neurology (2010), 10
BACKGROUND: Medication-overuse headache (MOH) is a frequent, disabling disorder. Despite a controversial pathophysiology convincing evidence attributes a pivotal role to central sensitization. Most ... [more ▼]
BACKGROUND: Medication-overuse headache (MOH) is a frequent, disabling disorder. Despite a controversial pathophysiology convincing evidence attributes a pivotal role to central sensitization. Most patients with MOH initially have episodic migraine without aura (MOA) characterized interictally by an absent amplitude decrease in cortical evoked potentials to repetitive stimuli (habituation deficit), despite a normal initial amplitude (lack of sensitization). Whether central sensitization alters this electrophysiological profile is unknown. We therefore sought differences in somatosensory evoked potential (SEP) sensitization and habituation in patients with MOH and episodic MOA. METHODS: We recorded median-nerve SEPs (3 blocks of 100 sweeps) in 29 patients with MOH, 64 with MOA and 42 controls. Episodic migraineurs were studied during and between attacks. We measured N20-P25 amplitudes from 3 blocks of 100 sweeps, and assessed sensitization from block 1 amplitude, and habituation from amplitude changes between the 3 sequential blocks. RESULTS: In episodic migraineurs, interictal SEP amplitudes were normal in block 1, but thereafter failed to habituate. Ictal SEP amplitudes increased in block 1, then habituated normally. Patients with MOH had larger-amplitude block 1 SEPs than controls, and also lacked SEP habituation. SEP amplitudes were smaller in triptan overusers than in patients overusing nonsteroidal anti-inflammatory drugs (NSAIDs) or both medications combined, lowest in patients with the longest migraine history, and highest in those with the longest-lasting headache chronification. CONCLUSIONS: In patients with MOH, especially those overusing NSAIDs, the somatosensory cortex becomes increasingly sensitized. Sensory sensitization might add to the behavioral sensitization that favors compulsive drug intake, and may reflect drug-induced changes in central serotoninergic transmission. [less ▲]Detailed reference viewed: 36 (1 ULg)
Sustained efficacy of occipital nerve stimulation in drug-resistant chronic cluster headache after up to 5 years treatment
Magis, Delphine ; ; et al
in Journal of Headache & Pain (2010), 11(Suppl 1), 15
Background. Drug-resistant chronic cluster headache (drCCH) is a devastating condition for which various invasive procedures have been tempted without any satisfactory effect. Our prospective pilot study ... [more ▼]
Background. Drug-resistant chronic cluster headache (drCCH) is a devastating condition for which various invasive procedures have been tempted without any satisfactory effect. Our prospective pilot study of great occipital nerve stimulation (ONS) in 8 drCCH patients showed encouraging results at 15 months (1). Methods. We recruited 15 patients with drCCH according to the previously published criteria of intractability (2). They were implanted with suboccipital stimulators on the side of their headache. Long-term follow-up was achieved by questionnaires administered during a headache consultation and/or by telephone interviews. Results. One patient had an immediate post operative infection of the material. Mean time with ONS was 28.8 months (range 3-60 months). Nine of the 14 remaining patients were totally pain-free (64%), 2 patients had an improvement in frequency exceeding 90% and one patient a 89% amelioration. Two patients did not respond or described mild improvement. Intensity of residual attacks was not improved by ONS. Four patients (29%) were able to reduce their prophylaxis. Common technical problems were battery depletion (N=8/14, 57%) and material infection (N=3/15, 20%). Recurrent battery replacement (until 2/ year in one patient) is now avoided by the availability of rechargeable batteries. Clinical peculiarities associated with ONS were occurrence of infrequent contralateral attacks (N=5/14, 36%), and/or isolated ispilateral autonomic attacks (N=5/14, 36%). Rapid attack recurrence after stimulator switch off was reported by 7/12 improved patients (58%). Two patients found ONS-related paresthesias unbearable; one had his stimulator removed, the other switched it off though he was objectively ameliorated. Subjectively, nine patients are very satisfied by ONS and one patient moderately satisfied. Conclusions. Our long-term follow-up confirms the efficacy of ONS in drCCH, which remains a safe and well-tolerated technique. The occurrence of contralateral attacks and isolated autonomic attacks in nearly 50% of ONS responders may have therapeutic and pathophysiological implications. [less ▲]Detailed reference viewed: 64 (4 ULg)
Central neuromodulation in cluster headache patients treated with occipital nerve stimulators: A PET study
Magis, Delphine ; Bruno, Marie-Aurélie ; Fumal, Arnaud et al
in Acta Neurologica Belgica (2010), 110(Suppl 1), 17
OBJECTIVES: Use functional brain imaging to explore activity changes in centres involved in trigeminal pain processing and control before and after occipital neurostimulation in drug-resistant chronic ... [more ▼]
OBJECTIVES: Use functional brain imaging to explore activity changes in centres involved in trigeminal pain processing and control before and after occipital neurostimulation in drug-resistant chronic cluster headache patients. BACKGROUND: Occipital nerve stimulation (ONS) provides relief to about 60% of patients suffering from drug-resistant chronic cluster headache (drCCH). Its mode of action, however, remains elusive, but the long latency to meaningful effect suggests that ONS induces slow neuromodulation. METHODS: Ten drCCH patients underwent an 18FDG-PET scan after ONS durations varying between 0 and 30 months. All were scanned with ongoing ONS (ON) and with the stimulator switched OFF. RESULTS: After 6-30 months of ONS, 3 patients were pain free and 4 had a ≥ 90% reduction of attack frequency (responders). In patients overall compared to controls, several areas of the pain matrix were hypermetabolic: ipsilateral hypothalamus, midbrain and ipsilateral lower pons. All normalized after ONS, except the hypothalamus. Switching ON or OFF the stimulator had little influence on brain glucose metabolism. The perigenual anterior cingulate cortex (PACC) was hyperactive in ONS responders compared to non-responders. INTERPRETATION AND CONCLUSIONS: Metabolic normalization in the pain neuromatrix and lack of short-term changes induced by the stimulation support the hypothesis that ONS acts in drCCH through slow neuromodulatory processes. Selective activation in responders of PACC, a pivotal structure in the endogenous opioid system, suggests that ONS may restore balance within dysfunctioning pain control centres. That ONS is nothing but a symptomatic treatment might be illustrated by the persistent hypothalamic hypermetabolism which could explain why autonomic attacks may persist despite pain relief and why cluster attacks recur shortly after stimulator arrest. [less ▲]Detailed reference viewed: 60 (4 ULg)
Neurostimulation therapy in intractable headaches.
Schoenen, Jean ; ; Magis, Delphine
in Handbook of clinical neurology / edited by P.J. Vinken and G.W. Bruyn (2010), 97
A proportion of chronic headache patients become refractory to medical treatment and severely disabled. In such patients various neurostimulation methods have been proposed, ranging from invasive ... [more ▼]
A proportion of chronic headache patients become refractory to medical treatment and severely disabled. In such patients various neurostimulation methods have been proposed, ranging from invasive procedures such as deep-brain stimulation to minimally invasive ones like occipital nerve stimulation. They have been applied in single cases or small series of patients affected with varying headache disorders: cervicogenic headache, hemicrania continua, posttraumatic headache, chronic migraine, and cluster headache. Although favorable results were reported overall, it is premature to consider neurostimulation as a treatment with established utility in refractory headaches. At present, the most detailed clinical studies have been performed in intractable chronic cluster headache (iCCH) patients, who represent about 1% of all chronic cluster headache (CCH) patients. Various lesional interventions have been attempted in these patients, none with lasting benefits. In recent years, non-destructive neurostimulation methods have raised new hope. Hypothalamic deep-brain stimulation (hDBS) acts rapidly and has lasting efficacy, but is not without risk. Occipital nerve stimulation (ONS) was studied in two trials on a total of 17 iCCH patients. Clinical efficacy was found to be very satisfactory by most patients and by the investigators. Although slightly less efficacious than hDBS, ONS has the advantage of being rather harmless and reversible. At this stage, it should be preferred as first-line invasive therapy for iCCH. Recent case reports mention the efficacy of supraorbital (SNS) and vagal (VNS) nerve stimulation. Whether these neurostimulation methods have a place in the management of iCCH patients remains to be determined. [less ▲]Detailed reference viewed: 36 (4 ULg)
Migraine - clinical neurophysiology.
; Magis, Delphine ; Schoenen, Jean
in Nappi, G.; Moskowitz, M. (Eds.) Headache (2010)
Central nervous system (CNS) dysfunction is thought to be pivotal in migraine, and could occur at several levels: the brain (the cortex and its connections with subcortical nuclei), the brainstem, and ... [more ▼]
Central nervous system (CNS) dysfunction is thought to be pivotal in migraine, and could occur at several levels: the brain (the cortex and its connections with subcortical nuclei), the brainstem, and even peripheral structures (e.g., trigeminal ganglion and nerve). As it is particularly suited to functional evaluation of various components of the nervous system, neurophysiological testing has become a valuable tool for investigating migraine pathophysiology and the effects of pharmacological treatment. However it has limited value for migraine diagnosis because of a high interindividual variability. In this chapter, we critically review and summarize the available published literature on neurophysiological approaches in migraine, i.e., electroencephalography, evoked and event-related potentials, transcranial magnetic stimulation (TMS), electromyography, and cerebellar testing. The most relevant techniques for understanding migraine pathophysiological mechanisms are highlighted. [less ▲]Detailed reference viewed: 54 (4 ULg)
Gender-Dependant Effect of Acute Dietary Tryptophan Depletion on Sensitivity to Cortical Spreading Depression in Rats
Chauvel, Virginie ; Multon, Sylvie ; Schoenen, Jean
Poster (2009, September)Detailed reference viewed: 17 (1 ULg)
Expression and role of Placental Growth Factor (PLGF) in the inflammatory context resulting from nerve injury, the Wallerian Degeneration.
Chaballe, Linda ; Wouters, Murielle ; Fanielle, Julien et al
Poster (2009, May 11)Detailed reference viewed: 25 (4 ULg)
Is hypoxia-inducible factor 1 an actor in migraine pathogenesis?
TRUONG, Julie ; ; Schoenen, Jean et al
Poster (2009, May)Detailed reference viewed: 28 (0 ULg)
Gender-Dependant Effect of Acute Dietary Tryptophan Depletion on Sensitivity to Cortical Spreading Depression in Rats
Chauvel, Virginie ; Multon, Sylvie ; et al
Poster (2009, May)Detailed reference viewed: 11 (0 ULg)
Occipital nerve stimulation for drug-resistant chronic cluster headache: long term follow-up up to 3 years
Gérardy, Pierre-Yves ; Magis, Delphine ; et al
in Cephalalgia : An International Journal of Headache (2009, January), 29(1),Detailed reference viewed: 90 (19 ULg)
Mitochondrial DNA haplogroups influence response to Riboflavin in Migraineurs
; ; et al
in Cephalalgia : An International Journal of Headache (2009, January), 29(1),Detailed reference viewed: 29 (5 ULg)
NG2 and phosphacan are present in the astroglial scar after human traumatic spinal cord injury.
; ; et al
in BMC Neurology (2009), 9
BACKGROUND: A major class of axon growth-repulsive molecules associated with CNS scar tissue is the family of chondroitin sulphate proteoglycans (CSPGs). Experimental spinal cord injury (SCI) has ... [more ▼]
BACKGROUND: A major class of axon growth-repulsive molecules associated with CNS scar tissue is the family of chondroitin sulphate proteoglycans (CSPGs). Experimental spinal cord injury (SCI) has demonstrated rapid re-expression of CSPGs at and around the lesion site. The pharmacological digestion of CSPGs in such lesion models results in substantially enhanced axonal regeneration and a significant functional recovery. The potential therapeutic relevance of interfering with CSPG expression or function following experimental injuries seems clear, however, the spatio-temporal pattern of expression of individual members of the CSPG family following human spinal cord injury is only poorly defined. In the present correlative investigation, the expression pattern of CSPG family members NG2, neurocan, versican and phosphacan was studied in the human spinal cord. METHODS: An immunohistochemical investigation in post mortem samples of control and lesioned human spinal cords was performed. All patients with traumatic SCI had been clinically diagnosed as having "complete" injuries and presented lesions of the maceration type. RESULTS: In sections from control spinal cord, NG2 immunoreactivity was restricted to stellate-shaped cells corresponding to oligodendrocyte precursor cells. The distribution patterns of phosphacan, neurocan and versican in control human spinal cord parenchyma were similar, with a fine reticular pattern being observed in white matter (but also located in gray matter for phosphacan). Neurocan staining was also associated with blood vessel walls. Furthermore, phosphacan, neurocan and versican were present in the myelin sheaths of ventral and dorsal nerve roots axons. After human SCI, NG2 and phosphacan were both detected in the evolving astroglial scar. Neurocan and versican were detected exclusively in the lesion epicentre, being associated with infiltrating Schwann cells in the myelin sheaths of invading peripheral nerve fibres from lesioned dorsal roots. CONCLUSION: NG2 and phosphacan were both present in the evolving astroglial scar and, therefore, might play an important role in the blockade of successful CNS regeneration. Neurocan and versican, however, were located at the lesion epicentre, associated with Schwann cell myelin on regenerating peripheral nerve fibres, a distribution that was unlikely to contribute to failed CNS axon regeneration. The present data points to the importance of such correlative investigations for demonstrating the clinical relevance of experimental data. [less ▲]Detailed reference viewed: 17 (2 ULg)