{"id":1480,"date":"2013-05-20T00:27:33","date_gmt":"2013-05-19T22:27:33","guid":{"rendered":"http:\/\/viscontitoscoalda.com\/?p=1480"},"modified":"2013-05-20T00:27:33","modified_gmt":"2013-05-19T22:27:33","slug":"dr-poli-trattamento-cefalea-a-grappolo-lo-stato-dellarte","status":"publish","type":"post","link":"https:\/\/viscontitoscoalda.com\/index.php\/2013\/05\/20\/dr-poli-trattamento-cefalea-a-grappolo-lo-stato-dellarte\/","title":{"rendered":"Dr Poli: Trattamento cefalea a grappolo: lo stato dell'arte"},"content":{"rendered":"

by\u00a0 Otello\u00a0 POLI<\/a><\/span><\/h4>\n
<\/address>\n
Ringrazio il Dottor Poli Otello per la fattiva e gratuita collaborazione alla realizzazione di questa mia pagina relativa alla neurologia e alle problematiche insite nel “ramo”<\/address>\n
Il Dr Otello Poli:\u00a0 \u00e8 neurologo, il\u00a0 medico \u00e8 perferzionato anche\u00a0 in “Medicina non convenzionale” e “Terapia del dolore” ed informazioni le trovate anche qui:
\n<\/address>\n
<\/address>\n

www.otellopoli.com<\/a><\/p>\n

Introduzione<\/strong><\/h4>\n

La cefalea a grappolo<\/strong> (o “cluster migraine”) costituisce patologia rara ma altamente invalidante per la vita quotidiana dei pazienti che ne sono affetti. Nella seconda edizione della International HeadAche Socieaty (IHS) la medesima costituisce il corpo portante delle cos\u00ec dette di un ristretto gruppo di cefalee denominate “autonomico-trigeminali” (TACs). Nel corso di una crisi cefalalgica ha una attivazione delle vie nocicettive afferenti al cos\u00ec detto “sistema trigemino-vascolare” cui segue una attivazione riflessa del sistenma nervoso autonomico a livello endocranico.<\/p>\n

\n

Segni e Sintomi<\/strong><\/h4>\n

Il disturbo doloroso crano-facciale si contraddistingue per un andamento degli episodi con distribuzione temporale a grappolo (possono verificarsi da uno a dieci epidodi al d\u00ec). Un grappolo solitamente dura da 4 a 12 settimane mentre un episodio singolo da 15 a 180 minuti. I periodi liberi ovvero di remissione possono protrarsi per 12-18 mesi. Rispetto alla comune emicrania la cefalea a grappolo colpisce i due sessi in un rapporto M:F=3:1. Il dolore monolaterale presenta una localizzazione temporo-frontale con madalit\u00e0 pulsante noche peri- e retro-orbitaria con modalit\u00e0 trafittiva. La cefalea a grappolo pu\u00f2 essere definita come la forma di cefalea pi\u00f9 intensa. La medesima presenta un andamento parosissitico e monolaterale. Per lo pi\u00e0 si accompagna ad una sintomatologia autonomica omolaterale al dolore quale: ptosi ed edema palpebrale, iperemia congiuntivale, lacrimazione, rinorrea e congestione nasale.<\/p>\n

\n

Cause<\/strong><\/h4>\n

Non ben conosciute. In ogni caso viente chiamato in causa uno squilibrio tra vie eccitatorie Grutammatergiche e vie inibitorie Gabaergiche a livello sinaptico e neurorecettoriale coninvolgente il nucleo sensitivo del trigemino e la componente nervosa autonomica che provvede alla innervazione dei vasi endocranici.<\/p>\n

\n

Quando rivolgersi al medico<\/strong><\/h4>\n

Quando compare un mal di testa intenso e frequente, invalidante per le attivit\u00e0 quotidiane della vita, di recente insorgenza. La competenza specialistica \u00e8 strettamente neurologica e dedicata a quegli specialisti adusi a trattare il dolore cronico severo.<\/p>\n

\n

Controlli e Diagnosi<\/strong><\/h4>\n

La diagnosi \u00e8 sempre formulata sulla base di elementi clinici. In ogni caso una risonanza magnetica dell’encefalo con mezzo di contrasto e sequenze angiografiche appare indicata.<\/p>\n

\n

Terapia e trattamento<\/strong><\/h4>\n

Trattamento della crisi<\/strong><\/p>\n

La inalazione di ossigeno puro al 100% <\/strong>mediante ventimask appartenente ad un circuito chiuso con erogazione per 15 minuti di almeno 7 litri\/minuto ma fino al oltre 10 litri\/minuto risulta assolutamente efficace in oltre i 2\/3 dei pazienti con risoluzione del dolore entro 30 minuti. Non si conoscono controindicazioni a questa tipologia di trattamento n\u00e8 effetti collaterali.<\/p>\n

L’agonista 5HT Sumatriptan al dosaggio di 6 mg per via sottocutanea<\/strong> risulta efficace nei 3\/4 dei pazienti. Esso tuttavia \u00e8 gravato da controindicazioni quali le patologie cardiovascolari, la ipertensione arteriosa non in controllo o non trattata e le patologie cerebrovascolari. Gli effetti collaterali sono rappresentati da senso di costrizione e da dolore toracico.<\/p>\n

I due approcci appena indicati possono essere indicato l’approccio di prima scelta sulla crisi dolorosa.<\/p>\n

Alternative valide<\/strong> sono il Sumatriptan orale o spray e lo Zolmitriptan orale o spray. Entrambe le alterative per quanto valide e praticate presentano sia minor efficacia che maggiori effetti collaterali, rispettivamente.<\/p>\n

\n

Profilassi delle crisi<\/strong><\/p>\n

Gli steroidi<\/strong> somministrati precocemente e per brevi periodi rappresentano una opzione molto efficace nella prima fase di profilassi cos\u00ec da consentire ai farmaci di prima scelta di divenire efficaci. Il Verapamil<\/strong> a dosi quotidiane variabili ma non superiori a valori compresi tra 40mgx3\/die e 160mgx3\/die, in rapporto a risposta e tolleranza, rappresenta il farmaco di prima scelta. <\/strong>Per l’effetto bradicardizzante, ipotensivo e broncocostrittore sono indicati controlli cardiologici e pneumologici. Nella quotidianit\u00e0 clinica spesso si rende necessaria la somministrazione di dosi minori di Verapamil associato ad un secondo farmaco che il pi\u00f9 spesso delle volte pu\u00f2 essere il CarbioLitio al dosaggio medio di 300mgx3\/die.<\/p>\n

\n

Trattamento non farmacologico<\/strong><\/p>\n

Il blocco antalgico\/anestetico<\/strong> (mediante steroide pi\u00f9 anestetico locale) del nervo grando occipitale<\/strong> ed eventualmente del nervo sopraorbitario <\/strong>omolateralmente al dolore conduce ad una riduzione della frequenza e della intensit\u00e0 degli attacchi di cefalea a grappolo nei 3\/4 dei pazienti. Il “razionale” di questa tipologia di procedura mini-invasiva<\/strong> pu\u00f2 essere considerato il seguente: l’anestetico locale agisce prima cos\u00ec come pi\u00f9 rapidamente ne svanisce l’effetto, lo steroide che diviene efficace successivamente perdura per maggior tempo la propria azione. La attivit\u00e0 di entrambe le sostanze non va considerata n\u00e8 esclusivamente sintomatica n\u00e8 esclusivamente loco-regionale. La maggior importanza di questa tecnica \u00e8 quella progressivamente profilattica: entrambi i farmaci conducono ad una diminuzione della frequenza e della intensit\u00e0 del dolore fino alla risoluzione del medesimo.<\/p>\n

Il meccanismo di azione<\/strong> \u00e8 quello di rallentare fino a bloccare le afferenze dei neuromodulatori e della altre sostanza veicolo di flogosi che seguono il flusso assonale lungo i nervi epicranici suddetti dalla periferisa al Sistema Nervoso Centrale fino al sitema trigemino-vascolare.<\/p>\n

In pratica il breve decorso epicranico dei due nervi rappresenta le uniche due “porte di ingresso”<\/strong> esterna per raggiungere in maniera non cruente l’endocranio. Questa tipologia di approccio costituisce una alternativa a quella farmacologica classica per via generale ovvero pu\u00f2 essere adottata in integrazione a quest’ultima. Essa va comunque valutata ed esperita prima di classificare un paziente affetto da cefalea a grappolo come “non responder”.<\/p>\n

Inoltre di dubbia efficacia ma ampiamente praticata la infiltrazione loco-regionale di steroide <\/strong>in sede suboccipitale con modalit\u00e0 simile a quella mesoterapica. Eventuale la efficacia sulla componente muscotensiva del disturbo doloroso.<\/p>\n

\n

Gli interventi neurochirurgici<\/strong>, infine, dovrebbero essere presi in considerazioni in pazienti con cefalea a grappolo e ad altre forme dolorose cranio-facciali solamente come ultima ratio, per il rischio di recidive e per il rischio di produrre aree di anestesia dolorosa.<\/p>\n

Pertanto i pazienti con dolore cranio facciale cronico severo non responder dovrebbero rivolgersi a centri di eccellenza con ampia casistica in procedure neurochirurgiche lesionali nel momento in cui venga preso in considerazione un intervento demolitivo su strutture anatomiche endocraniche.<\/p>\n

by Otello Poli
\nI thank Dr Poli Othello for the effective and free collaboration in the organization of my page on the neurology and the problems inherent in the “branch”
\nDr Othello Poli is neurologist who is also perferzionato in “unconventional medicine” and “Pain Management” and information can be found here:<\/p>\n

www.otellopoli.com
\nIntroduction<\/p>\n

Cluster headache (or “cluster migraine”) is a rare but highly debilitating to the daily lives of patients who are affected. In the second edition of the International Headache Socieaty (IHS), the same is the backbone of the so-called body of a small group of headaches called “trigeminal autonomic” (TACs). During a crisis cefalalgica has an activation of nociceptive pathways related to the so-called “trigeminal-vascular system” followed by a reflex activation of the autonomic nervous sistenma intracranial level.<\/p>\n

Signs and Symptoms<\/p>\n

The Crano-facial pain disorder is characterized by a pattern of episodes with temporal distribution cluster (likely to occur from one to ten epidodi day). A cluster usually lasts from 4 to 12 weeks, while a single episode from 15 to 180 minutes. The free periods of remission that can last for 12-18 months. Compared to common migraine cluster headache affects both sexes in a M: F ratio = 3:1. The unilateral pain has a location temporo-frontal with madalit\u00e0 button noche peri-and retro-orbital mode with stabbing. Cluster headache can be defined as the form of headache more intense. The same trend has a parosissitico and unilateral. Mostly is accompanied by an autonomic symptoms ipsilateral to the pain which ptosis and eyelid edema, conjunctival hyperemia, tearing, runny nose and nasal congestion.<\/p>\n

Causes<\/p>\n

Not well known. In any case, wind is called into question an imbalance between excitatory pathways Grutammatergiche and GABAergic inhibitory pathways at the synaptic level and neurorecettoriale coninvolgente the sensory nucleus of the trigeminal nerve and the autonomic nervous component which provides the innervation of the intracranial vessels.<\/p>\n

When to seek medical attention<\/p>\n

When an intense headache and frequent, disabling for the daily activities of life, of recent onset. The specialist expertise is closely neurological and dedicated to those specialists accustomed to treat severe chronic pain.<\/p>\n

Controls and Diagnosis<\/p>\n

The diagnosis is always made on the basis of clinical elements. In any case, an MRI of the brain with contrast and angiographic sequences is indicated.<\/p>\n

Therapy and treatment<\/p>\n

Treatment of crisis<\/p>\n

The inhalation of pure oxygen to 100% by ventimask belonging to a closed circuit with provision for 15 minutes of at least 7 liters \/ minute, but up to more than 10 liters \/ minute is highly effective in more than 2\/3 of patients with resolution of pain within 30 minutes. There are no known contraindications to this type of treatment nor side effects.<\/p>\n

The 5HT agonist Sumatriptan at a dose of 6 mg subcutaneously is effective in 3\/4 of the patients. However, it is burdened with contraindications such as cardiovascular disease, uncontrolled hypertension in the control or untreated and cerebrovascular diseases. Side effects are represented by tightness and chest pain.<\/p>\n

The two approaches just mentioned can be indicated the approach of first choice on the painful crisis.<\/p>\n

Alternatives are oral sumatriptan and zolmitriptan oral or aerosol or spray. Both alterative as valid and have practiced both less effective than more side effects, respectively.<\/p>\n

Prophylaxis of crisis<\/p>\n

Steroids administered early and for short periods represent a very effective option in the first phase of prophylaxis so as to allow the drugs of first choice to become effective. The Verapamil in daily doses variables but not exceeding values \u200b\u200bbetween 40mgx3\/die and 160mgx3\/die, in relation to response and tolerance, is the drug of first choice. For the heart rate lowering effects, lowering blood pressure and cardiac and bronchoconstrictor controls are indicated pneumological. In everyday clinical often necessitates the administration of lower doses of Verapamil associated with a second drug that most often of times may be the CarbioLitio to the average dosage of 300mgx3\/die.<\/p>\n

Non-pharmacological treatment<\/p>\n

The block analgesic \/ anesthetic (through steroid more local anesthetic) grando occipital nerve and possibly supraorbital nerve ipsilateral to pain leads to a reduction in the frequency and intensity of attacks of cluster headache in 3\/4 of the patients. The “rational” of this type of minimally invasive procedure can be considered as follows: the local anesthetic acts first as quickly as it wears off, the steroid that becomes effective subsequently continues for more time its action. The activity of both substances should not be considered neither exclusively nor exclusively symptomatic locoregional. Most importance of this technique is to gradually prophylactic: both drugs lead to a decrease in the frequency and intensity of pain until the resolution of the same.<\/p>\n

The mechanism of action is to slow down to a block of afferent neuromodulators and other carrier substance of inflammation following the axonal flow along the nerves from these epicranic periferisa Central Nervous System to the gaming trigeminal-vascular system.<\/p>\n

In practice, the short course of the two nerves epicranico represents the only two “input ports” external to achieve in a non-bloody the endocranio. This type of approach is an alternative to the classical drug for general or may be adopted in integration to the latter. It should however be considered and experienced before classifying a patient suffering from cluster headaches as “non-responders”.<\/p>\n

Also of dubious effectiveness but widely practiced loco-regional infiltration of steroid in the suboccipital a manner similar to that mesotherapy. Any component on the effectiveness of muscotensiva painful disorder.<\/p>\n

par Otello Poli
\n<\/span>Je remercie le Dr Poli Othello pour la collaboration efficace et gratuit dans l’organisation de ma page sur la neurologie et les probl\u00e8mes inh\u00e9rents \u00e0 la \u00abbranche\u00bb
\n<\/span>Dr Othello Poli est neurologue qui est \u00e9galement perferzionato en \u00abm\u00e9decine non conventionnelle\u00bb et \u00abGestion de la douleur\u00bb et informations peuvent \u00eatre trouv\u00e9es ici:<\/span><\/span><\/p>\n

www.otellopoli.com
\n<\/span>Pr\u00e9sentation<\/span><\/p>\n

Algie vasculaire de la (ou \u00abmigraine cluster”) est une maladie rare mais tr\u00e8s invalidante pour la vie quotidienne des patients qui sont touch\u00e9s. <\/span>Dans la deuxi\u00e8me \u00e9dition de l’International Headache Socieaty (IHS), celui-l\u00e0 est l’\u00e9pine dorsale de la soi-disant corps d’un petit groupe de maux de t\u00eate appel\u00e9 \u00abtrijumeau autonome” (TAC). <\/span>Lors d’une crise cefalalgica a une activation des voies nociceptives li\u00e9es au \u00absyst\u00e8me trijumeau-vasculaire” soi-disant suivie d’une activation r\u00e9flexe du niveau intracr\u00e2nienne nerveux autonome sistenma.<\/span><\/p>\n

Signes et sympt\u00f4mes<\/span><\/p>\n

Le trouble de la douleur Crano-faciale se caract\u00e9rise par un motif d’\u00e9pisodes avec cluster de r\u00e9partition temporelle (susceptibles de survenir d’une to dix jours epidodi). <\/span>Un cluster dure habituellement de 4 \u00e0 12 semaines, alors qu’un seul \u00e9pisode de 15 \u00e0 180 minutes. <\/span>Les p\u00e9riodes libres de r\u00e9mission qui peuvent durer pendant 12-18 mois. <\/span>Par rapport au bon algie vasculaire de la migraine affecte les deux sexes dans un M: F = rapport 3:1. <\/span>La douleur unilat\u00e9rale b\u00e9n\u00e9ficie d’un emplacement temporo-frontale avec madalit\u00e0 bouton noche p\u00e9ri et en mode r\u00e9tro-orbital avec coups de couteau. <\/span>L’algie vasculaire peut \u00eatre d\u00e9finie comme la forme de maux de t\u00eate plus intense. <\/span>La m\u00eame tendance a un parosissitico et unilat\u00e9rale. <\/span>Un peu s’accompagne d’une sympt\u00f4mes autonomes ipsilat\u00e9raux \u00e0 la douleur qui ptose et \u0153d\u00e8me des paupi\u00e8res, hyper\u00e9mie conjonctivale, larmoiement, un \u00e9coulement nasal et la congestion nasale.<\/span><\/p>\n

Causes<\/span><\/p>\n

Peu connu. <\/span>En tout cas, le vent est remise en cause d’un d\u00e9s\u00e9quilibre entre les voies d’excitation Grutammatergiche et voies inhibitrices GABAergiques au niveau synaptique et neurorecettoriale coninvolgente Le noyau sensitif du nerf trijumeau et la composante nerveux autonome qui fournit l’innervation des vaisseaux intracr\u00e2niens.<\/span><\/p>\n

Quand consulter un m\u00e9decin<\/span><\/p>\n

Quand un mal de t\u00eate intense et fr\u00e9quente, invalidante pour les activit\u00e9s de la vie quotidienne, d’apparition r\u00e9cente. <\/span>L’expertise de sp\u00e9cialiste est \u00e9troitement neurologique et d\u00e9di\u00e9 \u00e0 ces sp\u00e9cialistes habitu\u00e9s \u00e0 traiter la douleur chronique s\u00e9v\u00e8re.<\/span><\/p>\n

Contr\u00f4les et diagnostic<\/span><\/p>\n

Le diagnostic est toujours effectu\u00e9e sur la base d’\u00e9l\u00e9ments cliniques. <\/span>En tout cas, une IRM du cerveau avec un contraste et des s\u00e9quences angiographiques est indiqu\u00e9.<\/span><\/p>\n

Th\u00e9rapie et traitement<\/span><\/p>\n

Traitement de la crise<\/span><\/p>\n

L’inhalation d’oxyg\u00e8ne pur \u00e0 100% en ventimask appartenant \u00e0 un circuit ferm\u00e9 avec possibilit\u00e9 de 15 minutes d’au moins 7 litres \/ minute, mais \u00e0 plus de 10 litres \/ minute est tr\u00e8s efficace en plus des 2\/3 des patients avec une r\u00e9solution de douleur au sein <\/span>30 minutes. <\/span>Il n’y a aucune contre-indication connue \u00e0 ce type d’effets de traitement ni c\u00f4t\u00e9.<\/span><\/p>\n

Le sumatriptan agoniste 5HT \u00e0 une dose de 6 mg par voie sous cutan\u00e9e est efficace dans 3\/4 des patients. <\/span>Cependant, il est accabl\u00e9 par les contre-indications telles que les maladies cardiovasculaires, l’hypertension non contr\u00f4l\u00e9e dans le contr\u00f4le des maladies non trait\u00e9es ou et c\u00e9r\u00e9brovasculaires. <\/span>Les effets secondaires sont repr\u00e9sent\u00e9s par des tiraillements et des douleurs thoraciques.<\/span><\/p>\n

Les deux approches viennent d’\u00eatre mentionn\u00e9es peuvent \u00eatre indiqu\u00e9s l’approche de premier choix sur la crise douloureuse.<\/span><\/p>\n

Les alternatives sont sumatriptan oral et zolmitriptan oral ou d’a\u00e9rosol ou de spray. <\/span>Les deux alt\u00e9rant comme valides et ont pratiqu\u00e9 la fois moins efficace que d’autres effets secondaires, respectivement.<\/span><\/p>\n

Prophylaxie de la crise<\/span><\/p>\n

Les st\u00e9ro\u00efdes sont administr\u00e9s rapidement et pour de courtes p\u00e9riodes repr\u00e9sentent une option tr\u00e8s efficace dans la premi\u00e8re phase de la prophylaxie de mani\u00e8re \u00e0 permettre les m\u00e9dicaments de premier choix pour devenir effective. <\/span>Le v\u00e9rapamil dans les variables des doses quotidiennes, mais ne d\u00e9passant pas les valeurs entre 40mgx3\/die et 160mgx3\/die, par rapport \u00e0 la r\u00e9ponse et de la tol\u00e9rance, est le m\u00e9dicament de premier choix. <\/span>Pour le rythme cardiaque des effets d’abaissement, abaisser la tension art\u00e9rielle et les contr\u00f4les cardiaques et broncho sont indiqu\u00e9s pneumologie. <\/span>En clinique quotidienne n\u00e9cessite souvent l’administration de faibles doses de v\u00e9rapamil associ\u00e9s \u00e0 un deuxi\u00e8me m\u00e9dicament le plus souvent de fois peut-\u00eatre le CarbioLitio \u00e0 la dose moyenne de 300mgx3\/die.<\/span><\/p>\n

Traitement non pharmacologique<\/span><\/p>\n

Le bloc analg\u00e9sique \/ anesth\u00e9sie (par st\u00e9ro\u00efde anesth\u00e9sique plus local) Grando nerf occipital et le nerf sus-orbitaire peut ipsilat\u00e9ral \u00e0 la douleur conduit \u00e0 une r\u00e9duction de la fr\u00e9quence et l’intensit\u00e9 des attaques de maux de t\u00eate de cluster dans 3\/4 des patients. <\/span>Le \u00abrationnelle\u00bb de ce type de proc\u00e9dure minimalement invasive peut \u00eatre consid\u00e9r\u00e9 comme suit: l’anesth\u00e9sique local agit d’abord aussi vite qu’elle se dissipe, le st\u00e9ro\u00efde qui devient effective continue par la suite pour plus de temps son action. <\/span>L’activit\u00e9 de ces deux substances ne doit pas \u00eatre consid\u00e9r\u00e9 ni exclusivement ni exclusivement symptomatique locor\u00e9gionale. <\/span>La plupart importance de cette technique est de progressivement prophylactique: deux m\u00e9dicaments entra\u00eenent une diminution de la fr\u00e9quence et de l’intensit\u00e9 de la douleur jusqu’\u00e0 ce que la r\u00e9solution de m\u00eame.<\/span><\/p>\n

Le m\u00e9canisme d’action est de ralentir \u00e0 un bloc de neuromodulateurs aff\u00e9rentes et autre substance porteuse d’une inflammation apr\u00e8s l’\u00e9coulement le long des axones des nerfs de ces epicranic periferisa syst\u00e8me nerveux central pour le syst\u00e8me trijumeau-vasculaire jeux.<\/span><\/p>\n

Dans la pratique, le cours court des deux nerfs epicranico repr\u00e9sente les seuls \u00abports d’entr\u00e9e” deux externes \u00e0 r\u00e9aliser dans un non sanglante le endocranio. <\/span>Ce type d’approche est une alternative \u00e0 la drogue classique g\u00e9n\u00e9rale ou peut \u00eatre adopt\u00e9e dans l’int\u00e9gration de celle-ci. <\/span>Il faut cependant \u00eatre consid\u00e9r\u00e9 et v\u00e9cu avant de classer un patient souffrant de c\u00e9phal\u00e9es en grappe comme des \u00abnon-r\u00e9pondeurs\u00bb.<\/span><\/p>\n

\u00c9galement d’une efficacit\u00e9 douteuse, mais largement pratiqu\u00e9e infiltration loco-r\u00e9gionale des st\u00e9ro\u00efdes dans la mani\u00e8re suboccipital similaire \u00e0 celle m\u00e9soth\u00e9rapie. <\/span>Tout composant sur l’efficacit\u00e9 de trouble douloureux muscotensiva.<\/span><\/p>\n

La neurochirurgie, enfin, doit \u00eatre prise en compte chez les patients souffrant de c\u00e9phal\u00e9es de cluster et d’autres formes de douleur craniofaciale seulement comme un dernier recours en raison du risque de r\u00e9cidive et le risque de zones de production de dolorosa anesth\u00e9sie.<\/span><\/p>\n

Par cons\u00e9quent, les patients souffrant de graves non-r\u00e9pondeurs de douleur cranio-faciales chroniques devraient communiquer avec les centres d’excellence avec une vaste affaire interventions neurochirurgicales l\u00e9sionnelles lorsqu’une intervention est prise en compte demolitive des structures anatomiques intracr\u00e2niennes.<\/span><\/p>\n

\n

\n

The neurosurgery, finally, should be taken into consideration in patients with cluster headache and other forms of craniofacial pain only as a last resort because of the risk of recurrence and the risk of producing areas of anesthesia dolorosa.<\/p>\n

Therefore, patients with severe chronic craniofacial pain nonresponders should contact centers of excellence with extensive case in lesional neurosurgical procedures when an intervention is taken into account demolitive of intracranial anatomical structures.<\/p>\n","protected":false},"excerpt":{"rendered":"

by\u00a0 Otello\u00a0 POLI Ringrazio il Dottor Poli Otello per la fattiva e gratuita collaborazione alla realizzazione di questa mia pagina relativa alla neurologia e alle problematiche insite nel “ramo” Il Dr Otello Poli:\u00a0 \u00e8 neurologo, il\u00a0 medico \u00e8 perferzionato anche\u00a0 in “Medicina non convenzionale” e “Terapia del dolore” ed informazioni le trovate anche qui: www.otellopoli.com … Continua a leggere Dr Poli: Trattamento cefalea a grappolo: lo stato dell'arte<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[24,25],"tags":[91,117,155,231,249],"class_list":["post-1480","post","type-post","status-publish","format-standard","hentry","category-neurologia-2","category-neurologia-e-trattamento-del-dolore-nelle-patologie-critiche-a-cura-del-dr-otello-poli","tag-cefalea","tag-dolore","tag-grappolo","tag-otello","tag-poli"],"_links":{"self":[{"href":"https:\/\/viscontitoscoalda.com\/index.php\/wp-json\/wp\/v2\/posts\/1480","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/viscontitoscoalda.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/viscontitoscoalda.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/viscontitoscoalda.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/viscontitoscoalda.com\/index.php\/wp-json\/wp\/v2\/comments?post=1480"}],"version-history":[{"count":0,"href":"https:\/\/viscontitoscoalda.com\/index.php\/wp-json\/wp\/v2\/posts\/1480\/revisions"}],"wp:attachment":[{"href":"https:\/\/viscontitoscoalda.com\/index.php\/wp-json\/wp\/v2\/media?parent=1480"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/viscontitoscoalda.com\/index.php\/wp-json\/wp\/v2\/categories?post=1480"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/viscontitoscoalda.com\/index.php\/wp-json\/wp\/v2\/tags?post=1480"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}