Cluster headache and neuropsychological functioning

Abstract

Background: Despite significant advances in unravelling the pathophysiology of cluster headache (CH), little is known about neuropsychological functioning. Apart from neuroimaging studies indicating involvement of posterior hypothalamic and other areas frequently involved in nociception, some studies suggest involvement of prefrontal areas. Among others, these mediate executive functioning (EF). Methods: Therefore, three neuropsychological tests (Trail Making Test (TMT), Go/Nogo Task and Stroop Task) were completed by four headache patient samples (chronic CH, episodic CH in the active or inactive period, and migraine patients) and compared to healthy controls. Results: Analyses revealed that patients especially with chronic and active episodic CH were particularly impaired in tests relying more on intact EF (i.e. TMT-B, Stroop interference) than on basal cognitive processes (i.e. TMT-A, Stroop naming). Within the CH groups performance decreased linearly with increasing severity. Discussion: These findings are in line with a recently proposed involvement of prefrontal structures in CH pathophysiology as patients performed worse on neuropsychological tasks relying on these structures. Impaired EF could also result from medication and sleep disturbances due to active CH. Because the decreased performance was also present outside the attacks it may hint at generally altered brain functions, but do not necessarily reflect clinically relevant behaviour.

Impact of continuing or quitting smoking on episodic cluster headache: a pilot survey

“…Moreover, CH patients might be biologically more vulnerable to compulsive pursuit of legal and illegal substances for a partial overlap/sharing of pathways which mediate addiction and are involved in the pathophysiology of CH. Indeed, changes in the prefrontal cortex have recently been found in CH patients [31,32], but dysfunction in prefrontal cortex is also involved in drug addiction [33]. Orexin neuropeptide systems have been suggested to have an important role in both CH pathogenesis [34] and the regulation of the reinforcing properties of most major drugs of abuse [35], including nicotine [36].…”

Recurrent Reversible Cognitive Impairment in a Cluster Headache Patient: A Case Report

“…CH has been previously associated with psychiatric comorbidities such as depression, anxiety disorders, and aggressiveness. However, little is known about cognition in CH patients . Here we report a patient presenting with progressive worsening of cognitive functions and behavioral modifications during CH bouts.…”

“…Cognitive function remains largely intact in CH patients, although Meyer et al reported decreased performances in 11 episodic CH patients assessed during the headache episodes with the MMSE combined with the Cognitive Capacity screening examination . Moreover, impairments in verbal memory functions, executive functions, or working memory were previously reported with conflicting results . Notably, Torkamani et al in a cross‐sectional study investigated cognitive functions in 11 episodic CH patients during the active period, 11 chronic CH patients, and healthy controls .…”

“…They found that CH patients had a worse working memory compared to controls, whereas intelligence and executive functions were intact. Dresler et al assessed executive functioning using Trail making test, Go/Nogo Task, and the Stroop Task in 75 CH patients, of whom 27 had chronic CH, 26 episodic CH during the active period, and 22 CH in the inactive period . None of the episodic CH patients were investigated inside and outside active bouts.…”

Interictal Burden of Cluster Headache

“…Different studies have done so in the past, usually focussing on migraine and tension-type headache (TTH). [6][7][8][9][10] The aim of this study was to evaluate the interictal burden (IIB) in CH using the data collected as part of the EUROLIGHT Cluster Headache Project. Snoer et al concentrated on postictal symptoms which were reported to last up to 120 minutes after attacks.…”