Focus on therapy of primary stabbing headache.

Dato: Sep 28, 2010

RE: Superkorte anfald med skarp smerte

Dato: Apr 11, 2010

Kære Lulle

Det lyder ganske forfærdeligt - for hvert enkelt anfald er jo særdeles ubehageligt, selvom det kun varer kort tid.

Desværre ved jeg ikke ret meget om hvordan anfaldene udvikler sig og om det er noget man kan forvente fortsætter. Har du været hos en enurolog??

Lægernes definition (samme kilde som nedenfor om Cluster) er indsat lige nedenfor.

4.1 Primary stabbing headache

Previously used terms:

Ice-pick pains, jabs and jolts, ophthalmodynia periodica

Description:

Transient and localised stabs of pain in the head that occur spontaneously in the absence of organic disease of underlying structures or of the cranial nerves.

Diagnostic criteria:

A. Head pain occurring as a single stab or a series of stabs and fulfilling criteria B-D
B. Exclusively or predominantly felt in the distribution of the first division of the trigeminal nerve (orbit, temple and parietal area)
C. Stabs last for up to a few seconds and recur with irregular frequency ranging from one to many per day
D. No accompanying symptoms
E. Not attributed to another disorder1

Note:

1. History and physical and neurological examinations do not suggest any of the disorders listed in groups 5-12, or history and/or physical and/or neurological examinations do suggest such disorder but it is ruled out by appropriate investigations, or such disorder is present but pain does not occur for the first time in close temporal relation to the disorder.

Comments:

In a single published descriptive study, 80% of stabs lasted 3 seconds or less. In rare cases, stabs occur repetitively over days, and there has been one description of status lasting one week.

Stabs may move from one area to another in either the same or the opposite hemicranium. When they are strictly localised to one area, structural changes at this site and in the distribution of the affected cranial nerve must be excluded.

Stabbing pains are more commonly experienced by people subject to migraine (about 40%) or cluster headache (about 30%), in which cases they are felt in the site habitually affected by these headaches.

A positive response to indomethacin has been reported in some uncontrolled studies, whilst others have observed partial or no responses.

En helt ny artikel synes at fortælle lidt om behandlinger, som måske duer?J Headache Pain. 2010 Apr;11(2):157-60. Epub 2010 Jan 30.

Focus on therapy of primary stabbing headache.

Ferrante E, Rossi P, Tassorelli C, Lisotto C, Nappi G.

Department of Neuroscience, Niguarda Ca' Granda Hospital, Milan, Italy.

Abstract

Primary stabbing headache (PSH) is a short-lasting but troublesome headache disorder, which has been known for several decades. The head pain occurs as a single stab or as a series of stabs generally involving the area supplied by the first division of trigeminal nerve. Stabs last for approximately a few seconds, occurring and recurring from once to multiple times per day in an irregular pattern. For the diagnosis of PSH, it is mandatory that any other underlying disorder is ruled out. Indomethacin represents the principal option in the treatment of PSH, despite therapeutic failure in up to 35% of the cases. Recent reports showed that cyclooxygenase-2 (COX-2) inhibitors, gabapentin, nifedipine, paracetamol and melatonin may also be effective. In this report, we focus on the therapy of PSH summarizing the information collected from a systematic analysis of the international literature over the period 1980-2009.

Lyrica er Gabapentin, og er et epilepsimiddel, som også bruges til nervebetændelse hos diabetikere. Confortid er en NSAID - dvs. et gigtmiddel som er smertestillende.

Det er ikke meget jeg kan bidrage med - desværre.

Mange venlige hilsner

Anne Bülow-Olsen

Dato: Dec 30, 2009

Hej AnnaBo

Det lyder som om du har kendskab til primary stabbing headache (psh), som den også hedder, har du et kendskab til forløbet, om det ebber ud med tiden, eller hvad fremtidsudsigterne er, for lægerne er mgeet sparsomme med udsigterne. jeg har selv psh og har haft det i 1½ år, jeg har anfald minimum hver 15 minut, og nogen gange i flere timer i træk, så lægerne siger at det er en atypisk variation!!!! jeg er på lyrica, og confortid, og det tager toppen, så jeg kan både overleve og leve i hverdagen.

håber at du har lidt svar, da uvisheden er lidt svær at takle

på forhånd tak
lulle

Dato: Dec 30, 2009

Hej Sophia

Jeg tror det du oplever er issylshovedpine. Navnet siger en del om hvordan det føles - som en issyl (eller en kniv) som stikkes ind omkring øjet og ud bag på hovedet. Anfaldene varer kort tid (få sekunder).

Den internationale definition på denne type migræne er indsat nedenfor. Det er ikke en lidelse, som lægerne ser ret tit, for man skal være ret 'heldig' for at få et anfald lige netop mens man er hos lægen. Fordi anfaldene er så kortvarige, er det også svært at få medicin, med mindre man har rigtigt mange af dem, og de forstyrrer dagligdagen.

Håber det letter lidt at vide at det nok er noget som mange af os oplever, en gang i mellem.

Du har helt ret - klyngehovedpine-anfald varer sådan ca. en halv times tid (med en del variation fra patient til patient). Definitionen på klyngehovedpine (Cluster headache på engelsk) er også indsat nedenfor. Jeg beklager at teksterne er på engelsk.

Mange venlige hilsner

Anne BO

4.1 Primary stabbing headachePreviously used terms:

Ice-pick pains, jabs and jolts, ophthalmodynia periodica

Description:

Transient and localised stabs of pain in the head that occur spontaneously in the absence of organic

disease of underlying structures or of the cranial nerves.

Diagnostic criteria:

A. Head pain occurring as a single stab or a series of stabs and fulfilling criteria B-D

B. Exclusively or predominantly felt in the distribution of the first division of the trigeminal

nerve (orbit, temple and parietal area)

C. Stabs last for up to a few seconds and recur with irregular frequency ranging from one to

many per day

D. No accompanying symptoms

E. Not attributed to another disorder

1

Note:

1. History and physical and neurological examinations do not suggest any of the disorders

listed in groups 5-12, or history and/or physical and/or neurological examinations do suggest

such disorder but it is ruled out by appropriate investigations, or such disorder is present but

pain does not occur for the first time in close temporal relation to the disorder.

Comments:

In a single published descriptive study, 80% of stabs lasted 3 seconds or less. In rare cases, stabs

occur repetitively over days, and there has been one description of

status lasting one week.Stabs may move from one area to another in either the same or the opposite hemicranium. When

they are strictly localised to one area, structural changes at this site and in the distribution of the

affected cranial nerve must be excluded.

Stabbing pains are more commonly experienced by people subject to migraine (about 40%) or

cluster headache (about 30%), in which cases they are felt in the site habitually affected by these

headaches.

A positive response to indomethacin has been reported in some uncontrolled studies, whilst others

have observed partial or no responses.

3.1 Cluster headachePreviously used terms:Ciliary neuralgia, erythro-melalgia of the head, erythroprosopalgia of Bing, hemicrania

angioparalytica, hemicrania neuralgiformis chronica, histaminic cephalalgia, Hortons headache,

62

Harris-Hortons disease, migrainous neuralgia (of Harris), petrosal neuralgia (of Gardner), Sluders

neuralgia, spheno-palatine neuralgia, vidian neuralgia

Coded elsewhere:

Symptomatic cluster headache is coded to the underlying causative disorder.

Description:

Attacks of severe, strictly unilateral pain which is orbital, supraorbital, temporal or in any

combination of these sites, lasting 15-180 minutes and occurring from once every other day to 8

times a day. The attacks are associated with one or more of the following, all of which are

ipsilateral: conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, forehead and facial

sweating, miosis, ptosis, eyelid oedema. Most patients are restless or agitated during an attack.

Diagnostic criteria:

A. At least 5 attacks fulfilling criteria B-D

B. Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180

minutes if untreated

1

C. Headache is accompanied by at least one of the following:

1. ipsilateral conjunctival injection and/or lacrimation

2. ipsilateral nasal congestion and/or rhinorrhoea

3. ipsilateral eyelid oedema

4. ipsilateral forehead and facial sweating

5. ipsilateral miosis and/or ptosis

6. a sense of restlessness or agitation

D. Attacks have a frequency from one every other day to 8 per day

2

E. Not attributed to another disorder

3

Notes:

1. During part (but less than half) of the time-course of cluster headache, attacks may be less

severe and/or of shorter or longer duration.

2. During part (but less than half) of the time-course of cluster headache, attacks may be less

frequent.

3. History and physical and neurological examinations do not suggest any of the disorders

listed in groups 5-12, or history and/or physical and/or neurological examinations do suggest

such disorder but it is ruled out by appropriate investigations, or such disorder is present but

attacks do not occur for the first time in close temporal relation to the disorder.

Comments:

Acute attacks involve activation of the posterior hypothalamic grey matter. Cluster headache may

be inherited (autosomal dominant) in about 5% of cases.

Attacks usually occur in series (

cluster periods) lasting for weeks or months separated by remissionperiods usually lasting months or years. However, about 10-15% of patients have chronic symptoms

without remissions.

In a large series with good follow-up, 27% of patients had only a single cluster period. These should

be coded as 3.1

Cluster headache.63

During a cluster period, and in the chronic subtype, attacks occur regularly and may be provoked by

alcohol, histamine or nitroglycerine. Pain is maximal orbitally, supraorbitally, temporally or in any

combination of these sites, but may spread to other regions of the head. Pain almost invariably

recurs on the same side during an individual cluster period. During the worst attacks, the intensity

of pain is excruciating. Patients are usually unable to lie down and characteristically pace the floor.

Age at onset is usually 20-40 years. For unknown reasons prevalence is 3-4 times higher in men

than in women.

Cluster headache with coexistent trigeminal neuralgia (cluster-tic syndrome):Some patients have been described who have both 3.1

Cluster headache and 13.1 Trigeminalneuralgia 3.1.1 Episodic cluster headacheDescription:Cluster headache attacks occurring in periods lasting 7 days to 1 year separated by pain-free periodslasting 1 month or longer.Diagnostic criteria:A. Attacks fulfilling criteria A-E for 3.1

Cluster headacheB. At least two cluster periods lasting 7-365 days

1 and separated by pain-free remission periods of

1 month

Note:

1. Cluster periods usually last between 2 weeks and 3 months.

Comment:

The duration of the remission period has been increased in this second edition to a minimum of 1

month.

3.1.2 Chronic cluster headacheDescription:Cluster headache attacks occurring for more than 1 year without remission or with remissions

lasting less than 1 month.

Diagnostic criteria:A. Attacks fulfilling criteria A-E for 3.1

Cluster headacheB. Attacks recur over >1 year without remission periods or with remission periods lasting <1

month

Comments:Chronic cluster headache may arise

de novo (previously referred to as primary chronic clusterheadache

Dato: Nov 15, 2009

Hej.

Jeg er en pige på 19 år, som har har haft migræneanfald siden jeg var ca. 5 år og har fået stillet diagnosen migræne uden aura her i foråret. Jeg er dog siden sommer, og især her på det sidste begyndt at få nogle anfald, der varer kun ca. 10 sekunder, men som er en meget stærk smerte ved tindingen eller over venstre øjenbryn, hvor min migræne normalt sidder. Det føles som en kniv der bliver vredet ind, og jeg kan slet ikke fokusere på andet i den periode det varer. Nogle gange kan det medføre migræne.

Jeg har nogle få gange også prøvet at vågne om natten med en meget skarp smerte i et punkt på næsen, der ligesom fører smerten op til over mit venstre øje, hvor min migræne er. Her har det været så stærkt at jeg ikke har kunnet bevæge mig men heller ikke ligget stillet, hvilket har ført til at jeg er begyndt at græde pga. smerten. Det har jeg prøvet 2 gange nu, og jeg er bange for det måske kan være starten på noget klyngehovedpine? Jeg er bare i tvivl fordi anfaldet er så kort, og så vidt jeg forstår varer klyngehovedpine 15-30 min.

Jeg har fået en MR-scanning af min hjerne i august, og der var intet unormalt.

Jeg ville høre om nogen af jer har nogen idé om, hvad det kan være eller evt. selv har prøvet noget lignende. Jeg har ikke været til lægen endnu med de skarpe smerter, men anfaldene om natten sagde min læge var en del af migrænen.