Trigeminal autonomic cephalalgias: a review

• Authors: Michał Modestowicz , Wojciech Kozubski

Title variants

PL

Trójdzielno-autonomiczne bóle głowy – przegląd piśmiennictwa

• Languages of publication: EN

Abstracts

EN

Trigeminal autonomic cephalalgias are a group of primary headache disorders presenting as unilateral pain in the somatic distribution of the trigeminal nerve, associated with ipsilateral cranial autonomic symptoms. This clinicopathologic group includes cluster headache, paroxysmal hemicrania, hemicrania continua and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing/cranial autonomic features, which differ mainly as regards the duration and frequency of pain as well as response to treatment. These disorders are not as rare as they were thought to be and due to the severity of the pain can substantially affect the patients’ quality of life. Many other forms of primary headaches, such as migraine, trigeminal neuralgia and primary stabbing headache, as well as secondary headaches, particularly those caused by pituitary, posterior fossa, orbital, paranasal sinus and vascular pathology, need to be carefully considered in the diagnosis of trigeminal autonomic cephalalgias. Research in this field, particularly using functional neuroimaging, has resulted in a much better understanding of these disorders. Dysfunction in the nociceptive modulatory pathways in brain’s pain matrix is currently thought to produce a permissive state for the occurrence of a trigeminal autonomic cephalalgia attack, with posterior hypothalamus serving as a terminator rather than the generator of the attack. The current treatment strategies include medical and surgical approaches; of the latter, neuromodulation techniques, particularly deep brain stimulation of posterior hypothalamus, have proven to be particularly effective and promising.

PL

Trójdzielno-autonomiczne bóle głowy stanowią grupę pierwotnych bólów głowy, w których jednostronny ból w okolicy zaopatrywanej przez nerw trójdzielny związany jest z tożstronnymi objawami autonomicznymi w obrębie czaszki. Ta kliniczno-patologiczna grupa obejmuje klasterowy ból głowy, hemikranię napadową, hemikranię ciągłą i krótkotrwałe napady jednostronnego bólu głowy przypominającego nerwoból z przekrwieniem spojówek i łzawieniem/objawami autonomicznymi w obrębie czaszki. Postaci te różnią się przede wszystkim czasem trwania i częstością występowania bólu, a także odpowiedzią na leczenie. Zaburzenia te nie są tak rzadkie, jak dawniej przyjmowano, a ich nasilenie może znacząco wpływać na jakość życia pacjentów. W diagnostyce różnicowej trójdzielno-autonomicznych bólów głowy należy wziąć pod uwagę wiele innych rodzajów pierwotnych bólów głowy, takich jak migrena, neuralgia trójdzielna i pierwotny kłujący ból głowy, jak również wtórne bóle głowy, zwłaszcza te spowodowane przez patologię przysadki mózgowej, tylnego dołu czaszki, oczodołów, zatok przynosowych i naczyń. Badania na tym polu, w szczególności z wykorzystaniem neuroobrazowania funkcjonalnego, zaowocowały znacznie lepszym zrozumieniem tych chorób. Obecnie uważa się, że zaburzenia modulacyjnych dróg nocyceptywnych w macierzy bólu ośrodkowego układu nerwowego wytwarzają permisywny stan dla wystąpienia napadu trójdzielno-autonomicznego bólu głowy, przy czym tylna część podwzgórza wydaje się służyć raczej jako terminator niż generator napadu. W leczeniu tej grupy schorzeń stosuje się środki farmakologiczne, jak również techniki chirurgiczne; z tych ostatnich neuromodulacja, szczególnie głęboka stymulacja mózgu w obrębie tylnej części podwzgórza, okazała się szczególnie skuteczna i obiecująca.

Keywords

EN

SUNA; SUNCT; cluster headache; hemicrania continua; paroxysmal hemicrania; trigeminal autonomic cephalalgia

Discipline

• MEDICINE: MEDICINE

• Journal: Aktualności Neurologiczne
• Year: 2016
• Volume: 16
• Issue: 4
• Pages: 180–186

Contributors

author

Michał Modestowicz

• Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland,

author

Wojciech Kozubski

• Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland

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• Document Type: article