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Patient's face: (a) before Dysport injection showing severe blepharospasm. (b) After Dysport injection showing improvement in blepharospasm.
Source publication
Purpose
Cluster headache is one of the most serious types of headache that is accompanied by autonomic parasympathetic symptoms. Its association with hemifacial spasm in the same side had been rarely reported. The aim of this report is describing a case with this association and treatment strategies.
Case Report
Here we report a 37-year-old female...
Contexts in source publication
Context 1
... the headache was episodic; however, over time, it became constant and was accompanied by mild depression and anxiety symptoms. At the time of headache, left-sided unilateral blepharospasm, ipsilateral photophobia, tearing, and rhinorrhea were also present [ Figure 1a]. She often experienced headache at night and at waking time. ...
Context 2
... also administered two doses of 100-mg sumatriptan at 2-hour intervals, but these were also not effective. Thereafter, Dysport was injected to the periorbital, temporal, and occipital areas in small unit doses, and this resulted in an improvement in blepharospasm and, to some extent, tearing and rhinorrhea after 4 days; however, the headache continued as before [ Figure 1b]. ...
Citations
... An open label, single-center study of onabotulinumtoxinA as an add-on therapy for prophylactic treatment of cluster headache found improvement in some but not all patients with chronic cluster headache, but no benefit in those with episodic cluster headache [77]. Cluster headache may be associated with blepharospasm, which could also benefit from treatment with BT injections [78]. ...
Botulinum toxin (BT) is a neurotoxin produced by Clostridium botulinum, a gram-positive anaerobic bacterium. Systemic human intoxication from BT following oral ingestion results in acute and life-threatening muscle paralysis called botulism. BT has a wide scope of therapeutic uses, including conditions associated with increased muscle tone, smooth muscle hyperactivity, salivation, sweating, and allergies, as well as for cosmetic purposes. Several commercial forms of BT are available for medical use, including Botox (onabotulinumtoxinA). Multiple studies have found evidence of an analgesic effect of onabotulinumtoxinA and demonstrated the benefits of its use for the treatment of various chronic pain disorders. In this review, we provide an update on the use of onabotulinumtoxinA for the treatment of headache disorders.
... Autonomic dysfunction was noted in secondary unilateral blepharospasm secondary to cluster headache. [45] Attacks of bilateral blepharospasm with autonomic symptoms and photophobia have also been reported. [46] Association of primary blepharospasm with autonomic dysfunction is not described. ...
Background
Structural damage or demyelization of the sphenopalatine ganglion may cause sphenopalatine neuralgia (SN). The current International Classification of Headache Disorders, third edition (ICHD‐3) regards SN as a phenotype of cluster headache. Whether SN is an independent neuralgia entity has been debated for years.
Methods
This article presents a case series of SN, a review of all published cases, and a pooled data analysis of the identified cases.
Results
Seven patients were identified, with a median age at symptom onset of 59 years. Six cases were secondary to structural lesions surrounding the ipsilateral sphenopalatine ganglion, and all of them experienced significant clinical improvements after removing the primary causes. In the seventh patient, no evidence of underlying disease was found. The literature review showed that SN affected patients spanning a wide range of ages and both sexes. The clinical characteristics of SN might mimic cluster headache with the exception of cluster pattern and treatment response to oxygen. The typical duration of pain episodes in SN was several hours to several days; and in some cases, pain was persistent. Sixty‐seven percent (59/88) of patients with SN had structural lesions around the sphenopalatine ganglion.
Conclusion
SN could possibly be regarded as a different clinical entity from cluster headache. Based on our patients and literature review, SN can be categorized as idiopathic SN and secondary SN. Craniofacial structural lesions should be highly rating and taken into account when SN is suspected.
