Aggressiveness in different presentations of cluster headache: Results from a controlled multicentric study

Abstract

Background: The hypothalamus has been discussed as a pivotal structure for both cluster headache (CH) and aggressiveness, but little is known about the extent of self-reported aggressiveness in patients with CH. Patients and methods: Twenty-six patients with chronic, 25 with active episodic and 22 with episodic CH outside the active period were examined interictally with a validated questionnaire quantifying factors of aggression and compared with 24 migraine patients and 31 headache-free volunteers. Results: The ANOVA was significant for the subscale 'self-aggression/depression' (F 4, 123 ¼ 5.771, p < 0.001) with significant differences between chronic and episodic CH and healthy volunteers. No significant changes were found for other subscales and the sum scale (F 4, 123 < 1.421, p > 0.230). Especially in the clinically most affected group of patients (chronic CH and active episodic CH), high levels of ''self-aggression/depression'' correlate with higher prevalence of depressive symptoms and higher impairment measured on an emotional and functional level. Discussion: Self-aggressive and depressive cognitions with highest scores in chronic CH seem to be reactive as they correlate with depressive symptoms and impairment. They should be considered as an important therapeutic target since they impair the patient's life significantly.

Cluster headache and neuropsychological functioning

“…Headache patients were recruited at the Departments of Neurology, University Hospitals of Regensburg and Halle, and at the Kiel Headache Centre as part of a larger study on different facets of cluster headache (4,28). Patients were diagnosed according to the ICHD-II criteria for migraine without and with aura (IHS 1.1 and 1.2) and for episodic and chronic cluster headache (IHS 3.1.1 and 3.1.2) by an experienced headache specialist (29).…”

The development and validation of the Cluster Headache Quality of life scale (CHQ)

“…In CH, assessment of QoL is currently limited to use of generic scales, such as the SF-36, and headache disability instruments, which have shown significantly diminished scores compared to headache-free controls [2, 5, 7, 16, 21]. Moreover, a study found significant differences between CH patients in the ictal versus the interictal period, but no significant differences between CH patients and migraineurs [7].…”

Emerging relevance of circadian rhythms in headaches and neuropathic pain

“…The hypothalamus contains several areas with potential roles in cluster headache, including the central clock (the SCN) and an area anterior and medial to the fornix that has been implicated in defensive rage and might explain the restlessness and self-aggression seen in the disease. 53,54 These three systems-the trigeminovascular pain system, the autonomic system and the hypothalamus-appear to be strongly interconnected in cluster headache patients. Deep brain stimulation of the hypothalamus is a proposed treatment for cluster headache based on preliminary studies, 55,56 and cluster headache patients with implanted hypothalamic deep brain stimulators show higher cold pain thresholds.…”

“…The ipsilateral hypothalamus showed increased regional cerebral blood flow only during the headache period and only in the cluster headache group. The hypothalamus contains several areas with potential roles in cluster headache, including the central clock (the SCN) and an area anterior and medial to the fornix that has been implicated in defensive rage and might explain the restlessness and self‐aggression seen in the disease …”