RESUMO
A review of the latest and most relevant information on different disorders of head and facial pain is presented. News from epidemiologic studies regarding the relationship between migraine and patent foramen ovale, the cardiovascular risk in migraine, and migraine behavior during menopause, and the development of white matter lesions or migraine genetics are presented. Regarding pathophysiology there are very recent insights regarding the role of the hypothalamus during prodromal phase and the interplay of brain-stem and hypothalamus during the attack. In the last year studies and metaanalysis generated new knowledge for the use of triptans in general as in menstrual related migraine and hemiplegic variants. Furthermore, new hope rises for the CGRP (calcitonin-gene related peptide)-antagonists, as the data for ubrogepant do not suggest hepatotoxicity but efficacy. In prophylactic migraine treatment the news are manly on how the new therapeutic approach with monoclonal antibodies against CGRP or its receptor is moving on. Additional newly generated data for already known prophylactic agents as for new approaches are compactly discussed. Although main developments in headache focus on migraine new data on trigemino-autonomic headache trigeminal neuralgia and new daily persistant headache became available.
Assuntos
Transtornos da Cefaleia/terapia , Cefaleia Histamínica/tratamento farmacológico , Cefaleia Histamínica/epidemiologia , Cefaleia Histamínica/genética , Transtornos da Cefaleia/epidemiologia , Transtornos da Cefaleia/genética , Transtornos da Cefaleia Secundários/epidemiologia , Transtornos da Cefaleia Secundários/genética , Transtornos da Cefaleia Secundários/terapia , Humanos , Transtornos de Enxaqueca/epidemiologia , Transtornos de Enxaqueca/genética , Transtornos de Enxaqueca/terapia , Prevalência , Cefaleia do Tipo Tensional/epidemiologia , Cefaleia do Tipo Tensional/genética , Cefaleia do Tipo Tensional/terapia , Cefalalgias Autonômicas do Trigêmeo/tratamento farmacológico , Cefalalgias Autonômicas do Trigêmeo/epidemiologia , Cefalalgias Autonômicas do Trigêmeo/genética , Neuralgia do Trigêmeo/epidemiologia , Neuralgia do Trigêmeo/genética , Neuralgia do Trigêmeo/terapiaRESUMO
Cluster headache, paroxysmal hemicrania and SUNCT syndrome are a group of primary headaches classified as "trigeminal autonomic cephalgias" (TACs) and characterised by relatively short attacks of unilateral head pain associated with ipsilateral craniofacial autonomic manifestations. Duration of attacks is the main feature to distinguish between the three forms of TACs. Modern functional neuroimaging indicates that the hypothalamus may play a crucial role in the pathophysiology of these headaches. Therapeutic regimes consist of acute treatment as well as application of prophylactic medication. After unsuccessful application of conservative treatment options, invasive neuromodulative procedures are finally justified. These treatments should be rather of neurostimulative than of neurodestructive intentions.
