TY - JOUR
T1 - Cranial parasympathetic activation induces autonomic symptoms but no cluster headache attacks
AU - Guo, Song
AU - Petersen, Anja Sofie
AU - Schytz, Henrik Winther
AU - Barløse, Mads
AU - Caparso, Anthony
AU - Fahrenkrug, Jan
AU - Jensen, Rigmor Højland
AU - Ashina, Messoud
PY - 2018/7/1
Y1 - 2018/7/1
N2 - Background Low frequency (LF) stimulation of the sphenopalatine ganglion (SPG) may increase parasympathetic outflow and provoke cluster headache (CH) attacks in CH patients implanted with an SPG neurostimulator. Methods In a double-blind randomized sham-controlled crossover study, 20 CH patients received LF or sham stimulation for 30 min on two separate days. We recorded headache characteristics, cephalic autonomic symptoms (CAS), plasma levels of parasympathetic markers such as pituitary adenylate cyclase-activating polypeptide-38 (PACAP38) and vasoactive intestinal peptide (VIP), and mechanical detection and pain thresholds as a marker of sensory modulation. Results In the immediate phase (0-60 min), 16 (80%) patients experienced CAS after LF stimulation, while nine patients (45%) reported CAS after sham ( p = 0.046). We found no difference in induction of cluster-like attacks between LF stimulation (n = 7) and sham stimulation (n = 5) ( p = 0.724). There was no difference in mechanical detection and pain thresholds, and in PACAP and VIP plasma concentrations between LF and sham stimulation ( p ≥ 0.162). Conclusion LF stimulation of the SPG induced autonomic symptoms, but no CH attacks. These data suggest that increased parasympathetic outflow is not sufficient to induce CH attacks in patients. Study protocol ClinicalTrials.gov registration number NCT02510729.
AB - Background Low frequency (LF) stimulation of the sphenopalatine ganglion (SPG) may increase parasympathetic outflow and provoke cluster headache (CH) attacks in CH patients implanted with an SPG neurostimulator. Methods In a double-blind randomized sham-controlled crossover study, 20 CH patients received LF or sham stimulation for 30 min on two separate days. We recorded headache characteristics, cephalic autonomic symptoms (CAS), plasma levels of parasympathetic markers such as pituitary adenylate cyclase-activating polypeptide-38 (PACAP38) and vasoactive intestinal peptide (VIP), and mechanical detection and pain thresholds as a marker of sensory modulation. Results In the immediate phase (0-60 min), 16 (80%) patients experienced CAS after LF stimulation, while nine patients (45%) reported CAS after sham ( p = 0.046). We found no difference in induction of cluster-like attacks between LF stimulation (n = 7) and sham stimulation (n = 5) ( p = 0.724). There was no difference in mechanical detection and pain thresholds, and in PACAP and VIP plasma concentrations between LF and sham stimulation ( p ≥ 0.162). Conclusion LF stimulation of the SPG induced autonomic symptoms, but no CH attacks. These data suggest that increased parasympathetic outflow is not sufficient to induce CH attacks in patients. Study protocol ClinicalTrials.gov registration number NCT02510729.
KW - Adult
KW - Aged
KW - Autonomic Pathways/physiopathology
KW - Cluster Headache/physiopathology
KW - Cross-Over Studies
KW - Double-Blind Method
KW - Electric Stimulation Therapy
KW - Electrodes, Implanted
KW - Female
KW - Ganglia, Parasympathetic/physiology
KW - Humans
KW - Male
KW - Middle Aged
KW - Pterygopalatine Fossa/innervation
U2 - 10.1177/0333102417738250
DO - 10.1177/0333102417738250
M3 - Journal article
C2 - 29082824
SN - 0333-1024
VL - 38
SP - 1418
EP - 1428
JO - Cephalalgia : an international journal of headache
JF - Cephalalgia : an international journal of headache
IS - 8
ER -