Cephalalgia : an international journal of headache
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The mechanisms contributing to the pain of migraine are poorly understood although activation of afferent nociceptors in the trigeminovascular system has been proposed as a key event. Prior studies have shown that dural-afferent nociceptors are sensitive to both osmotic and mechanical stimuli. Based on the sensitivity to these stimuli we hypothesized that dural afferents express the osmo/mechano-sensitive channel transient receptor-potential vanilloid 4 (TRPV4). ⋯ These data indicate that activation of TRPV4 within the meninges produces afferent nociceptive signaling from the head that may contribute to migraine headache.
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Hypnic headache (HH) is a rare, short-lasting headache occurring exclusively during sleep and usually affecting the elderly population. According to the ICHD-II diagnostic criteria, HH is characterized exclusively by sleep-related dull headache attacks, either lateralized or bilateral, a recurrence of >15 times per month and a persistence of pain >15 minutes after waking. No autonomic symptoms and no more than nausea, photophobia, or phonophobia are present. ⋯ Considering the very few cases of HH reported in paediatric age, our cases may expand the clinical spectrum of this disorder, suggesting a possible revision of the diagnostic criteria, with particular regard to the developmental age.
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Deep brain stimulation (DBS) of the posterior hypothalamus has been found to be effective in the treatment of refractory chronic cluster headache (CCH). ⋯ Our results supports the efficacy of DBS in very refractory CCH with a slightly modified hypothalamic target conceived to avoid the lateral ventricle wall so as to extend the stimulated brain area and to decrease the morbidity of potential haemorrhagic complications.
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Migraine is a disabling chronic episodic disorder. Attack frequency progressively increases in some patients. Incremental cortical excitability has been implicated as a mechanism underlying progression. Cortical spreading depression (CSD) is the electrophysiological event underlying migraine aura, and a headache trigger. We hypothesized that CSD events during frequent migraine attacks condition the cortex to increase the susceptibility to further attacks. ⋯ These data do not support the hypothesis that frequent migraine attacks predispose the brain to further attacks by enhancing tissue susceptibility to CSD.