{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T01:27:05Z","timestamp":1790731625616,"version":"4.1.0"},"reference-count":35,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2017,10,30]],"date-time":"2017-10-30T00:00:00Z","timestamp":1509321600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Cephalalgia"],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In a double-blind randomized sham-controlled crossover study, 20 CH patients received LF or sham stimulation for 30\u2009min 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the immediate phase (0\u201360\u2009min), 16 (80%) patients experienced CAS after LF stimulation, while nine patients (45%) reported CAS after sham ( p\u2009=\u20090.046). We found no difference in induction of cluster-like attacks between LF stimulation (n\u2009=\u20097) and sham stimulation (n\u2009=\u20095) ( p\u2009=\u20090.724). There was no difference in mechanical detection and pain thresholds, and in PACAP and VIP plasma concentrations between LF and sham stimulation ( p\u2009\u2265\u20090.162).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study protocol<\/jats:title>\n                    <jats:p>ClinicalTrials.gov registration number NCT02510729<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0333102417738250","type":"journal-article","created":{"date-parts":[[2017,10,30]],"date-time":"2017-10-30T08:05:57Z","timestamp":1509350757000},"page":"1418-1428","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":39,"title":["Cranial parasympathetic activation induces autonomic symptoms but no cluster headache attacks"],"prefix":"10.1177","volume":"38","author":[{"given":"Song","family":"Guo","sequence":"first","affiliation":[{"name":"Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja Sofie","family":"Petersen","sequence":"additional","affiliation":[{"name":"Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik Winther","family":"Schytz","sequence":"additional","affiliation":[{"name":"Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mads","family":"Barl\u00f8se","sequence":"additional","affiliation":[{"name":"Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark"},{"name":"Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Glostrup, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Caparso","sequence":"additional","affiliation":[{"name":"Autonomic Technologies Inc, Redwood City, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Fahrenkrug","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry, Bispebjerg Hospital, University of Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rigmor H\u00f8jland","family":"Jensen","sequence":"additional","affiliation":[{"name":"Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Messoud","family":"Ashina","sequence":"additional","affiliation":[{"name":"Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2017,10,30]]},"reference":[{"key":"bibr1-0333102417738250","doi-asserted-by":"publisher","DOI":"10.1016\/S0006-8993(99)01260-3"},{"key":"bibr2-0333102417738250","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(02)00104-7"},{"key":"bibr3-0333102417738250","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/120.1.193"},{"key":"bibr4-0333102417738250","doi-asserted-by":"publisher","DOI":"10.1177\/0333102413483933"},{"key":"bibr5-0333102417738250","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(12)70139-4"},{"key":"bibr6-0333102417738250","doi-asserted-by":"publisher","DOI":"10.1177\/0333102412473667"},{"key":"bibr7-0333102417738250","doi-asserted-by":"publisher","DOI":"10.1177\/0333102413476370"},{"key":"bibr8-0333102417738250","first-page":"17","volume":"38","author":"Iversen HK","year":"1989","journal-title":"Basic characteristics. 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