Pathophysiology of cluster headache: a trigeminal autonomic cephalgia

We report headache induced BOLD changes in an atypical case of trigeminal autonomic cephalgia (TAC). A 68-year-old patient was imaged using fMRi during three attacks of a periorbital head-pain with a average duration of 3 min. During the attacks, left sided conjunctival injection, rhinorrhea, lacrimation, facial sweating and hypersalivation were apparent. These attacks were usually partly responsive to oxygen administration but otherwise refractory to any drug. The patient described either attacks with a duration of one minute or less or longer attacks persisting for maximum of 20 min with headaches occurring up to 100 times a day. When considering the symptoms, frequency, duration and therapeutic response of the patient's headache, no clear-cut classification to one of the subtypes of trigeminal autonomic cephalgias (cluster headache, paroxysmal hemicrania, SUNCT) or trigeminal neuralgia was possible. The cerebral activation pattern was similar but not identical to those previously observed in cluster headache and SUNCT with a prominent activation in the hypothalamic grey matter. This case study underlines the conceptual value of the term TAC for the group of headaches focusing around the trigeminal-autonomic reflex. Our results emphasize the importance of the hypothalamus as key region in the pathophysiology of this entity.

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Acupuncture for Episodic Cluster Headache: A Trigeminal Approach

Acupuncture in Medicine ◽

10.1136/acupmed-2015-211984rep ◽

2016 ◽

Vol 34 (1) ◽

pp. 55-58 ◽

Cited By ~ 4

Author(s):

Simon Hayhoe

Keyword(s):

Cluster Headache ◽

Prophylactic Treatment ◽

Tension Headache ◽

Cost Effective ◽

Contralateral Side ◽

Infraorbital Nerve ◽

Episodic Cluster Headache ◽

Trigeminal Autonomic Cephalgia ◽

The Uk ◽

Severe Migraine

Following evidence that acupuncture is clinically feasible and cost-effective in the treatment of headache, the UK National Institute for Health and Care Excellence recommends acupuncture as prophylactic treatment for migraine and tension headache. There has thus been expectation that other forms of headache should benefit also. Unfortunately, acupuncture has not generally been successful for cluster headache. This may be due to acupuncturists approaching the problem as one of severe migraine. In fact, cluster headache is classed as a trigeminal autonomic cephalgia. In this case report, episodic cluster headache is treated in the same way as has been shown effective for trigeminal neuralgia. Acupuncture is applied to the contralateral side at points appropriate for stimulating branches of the trigeminal nerve. Thus, ST2 is used for the infraorbital nerve, BL2 and Yuyao for the supratrochlear and supraorbital nerves, and Taiyang for the temporal branch of the zygomatic nerve.

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Familial Cluster Headache. Is Atypical Cluster Headache in Family Members Part of the Clinical Spectrum?

Cephalalgia ◽

10.1111/j.1468-2982.2005.00964.x ◽

2005 ◽

Vol 25 (11) ◽

pp. 1068-1077 ◽

Cited By ~ 9

Author(s):

C Sjöstrand ◽

MB Russell ◽

K Ekbom ◽

J Hillert ◽

E Waldenlind

Keyword(s):

Cluster Headache ◽

First Generation ◽

Clinical Symptoms ◽

Age At Onset ◽

Third Generation ◽

Female Ratio ◽

Familial Cluster ◽

Atypical Symptoms ◽

Male Female Ratio ◽

Trigeminal Autonomic Cephalgia

Familial cluster headache (CH) was analysed in 21 Swedish families. Diagnosis was made according to The International Classification of Headache Disorders 2004. We identified 55 affected, of whom 42 had episodic or chronic CH, one had probable CH and 12 had atypical symptoms. The atypical cases did not fulfil the diagnostic criteria for CH, but had clinical symptoms with more resemblance to CH than to migraine or other trigeminal autonomic cephalgia syndromes. The overall male : female ratio was 1.8 : 1. The overall mean age at onset was significantly lower in the second/third generation than in the first generation (mean age at onset 22 vs. 31 years, SD ± 7 vs. 13 years; P < 0.01). This may be anticipation or selection bias, since individuals with late age at onset from the second/third generation may not yet have symptoms. The prevalence of migraine was 24% (13/55), i.e. similar to the prevalence in the general population. The high incidence of atypical CH cases in the Swedish families with other members affected with CH may suggest that the spectrum of CH is broader than previously thought. We suggest that atypical CH in CH families may represent an expanded spectrum of the disease with a common aetiology, i.e. a common genetic background.

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Cluster Headache

Pain Neurosurgery ◽

10.1093/med/9780190887674.003.0016 ◽

2019 ◽

pp. 125-130

Author(s):

Emily Lehmann Levin

Keyword(s):

Deep Brain Stimulation ◽

Cluster Headache ◽

Brain Stimulation ◽

Initial Treatment ◽

Chronic Cluster Headache ◽

Posterior Hypothalamus ◽

Nerve Blocks ◽

Autonomic Symptoms ◽

Occipital Nerve ◽

Trigeminal Autonomic Cephalgia

Cluster headache, a trigeminal autonomic cephalgia, is a syndrome involving unilateral head pain associated with autonomic symptoms. The diagnosis is clinical. The pathophysiology of cluster headache is unknown. It is believed to involve the trigeminal nerve and ganglion, with autonomic dysfunction and vascular irritability. Initial treatment is with parenteral triptans and inhaled oxygen. Preventive agents include topiramate, verapamil, and lithium. Occipital nerve blocks and stimulation have been effective in small studies. Surgery is limited to those patients that have persistent, chronic cluster headache with a minimum of three attacks per week, despite treatment with at least three preventative agents. Deep brain stimulation of the posterior hypothalamus has been shown to be effective in the treatment of chronic cluster headache.

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