Spotlight on Cluster headache

Cluster headache is a relatively common, very severe form of primary headache that belongs to the family of trigeminal autonomic cephalalgias. It involves dysfunction of central nervous system elements concerned with pain control and with links to circadian and circannual mechanisms. Acute cluster headache can be treated with oxygen, intranasal triptans (sumatriptan and zolmitriptan), and injected sumatriptan. Medicines or strategies useful in the preventive management of cluster headache include verapamil, lithium, corticosteroids, topiramate, and melatonin.

In this article, Dr. Peter Goadsby of King’s College London and the University of California, San Francisco summarizes the current understanding and management of cluster headache, including an update on the latest clinical trial data.

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Twitter Digest for October 10, 2017

Twitter Digest for October 9, 2017

Spotlight on Vestibular migraine

In this article, Dr. Thomas Lempert of Charité University Hospital discusses vestibular migraine, which presents with attacks of spontaneous or positional vertigo, head motion-induced vertigo, and visual vertigo lasting 5 minutes to 3 days. The diagnosis requires a history of migraine, temporal association of migraine symptoms with vertigo attacks, and exclusion of other causes. Because headache is often absent during acute attacks, other migraine features such as photophobia or auras have to be specifically inquired about. The pathophysiology of vestibular migraine is unknown, but several mechanisms link the trigeminal system, which is activated during migraine attacks, and the vestibular system. Treatment includes antiemetics for severe acute attacks, pharmacological migraine prophylaxis, and lifestyle changes.

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Twitter Digest for October 6, 2017

Twitter Digest for October 5, 2017

Spotlight on Neurocysticercosis

In this article, Dr. Larry Davis of the University of New Mexico School of Medicine, discusses neurocysticercosis, which continues to be the most common CNS parasite and is becoming increasingly identified in the United States. Most patients in the United States present with seizures (focal or generalized) or headaches and have come from Mexico or Latin America.

A new set of diagnostic criteria have been published. There are now 3 serological methods of diagnosing neurocysticercosis. A serum or CSF antibody assay, especially an enzyme-linked immunotransfer blot assay, is quite sensitive and specific, and is widely available. A new PCR-based assay to detect T. solium nucleic acid is more specific and is becoming more available. The third assay detects cysticercus antigen; this assay is the most valuable in diagnosing extraparenchymal neurocysticercosis in the ventricle or meninges and can be utilized to follow patient response to treatment.

It appears that the cysticercus cyst releases specific proteins that induce an anti-inflammatory host response to prevent the host from destroying viable cerebral cysts. Although some controversy continues regarding the necessity of treating single neurocysticercosis cysts in developing countries, studies find that albendazole treatment significantly hastens the disappearance of cysts and reduces the incidence of seizures with generalization.

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Twitter Digest for October 4, 2017

Twitter Digest for October 3, 2017