Cluster Headache Developing Following Ipsilateral Orbital Exenteration

Abstract

SYNOPSIS A patient developed cluster headache after exenteration of the ipsilateral orbit. This case illustrates that the prominent eye findings in cluster headache are epiphenomena, and not critical to the development of the pain itself.

Enucleation and development of cluster headache: a retrospective study

“…Similar mechanisms have been discussed in a patient with secondary CH due to an intracranial inflammatory pseudotumor in the posterior fossa [27]. Our result, however, does not provide evidence for the notion that a first CH attack after the removal of the bulb, as observed previously [19,20], is triggered or at least facilitated by the irritation of trigemino-autonomic nervous structures during surgery and wound healing. The techniques of evisceration and enucleation spare parts of the orbita (especially the external eye muscles) and usually do not affect the cranial nerves III, IV, and VI.…”

“…At least another 5 patients, all of them male, could be identified in the literature who developed CH, either episodic or chronic, after the removal of the eye bulb [19]. Episodic CH originated in a 45-year-old man one year after maxillectomy and exenteration due to a squamous cell carcinoma [20]. In other patients, however, CH developed up to 18 years after surgery [21].…”

Cluster Headache after Dental Extraction: Implications for the Pathogenesis of Cluster Headache?

“…In a few cases, subdural haematoma (17), aspergillus infection (18), herpes zoster ophthalmicus (19), or nasopharyngeal carcinoma encircling the internal carotid artery (20) were found in CH sufferers. There are at least 4 reports covering 6 male patients who developed ipsilateral CH after the enucleation of an eye (21–24). The latency between enucleation and CH onset ranged between 3 weeks (21) and 18 years (23).…”

Head trauma and cluster headache

“…On the other hand, we can reasonably assume that the role played by head trauma may be predominant over that of eye enucleation. If one compares the causes that led to eye enucleation in 112 patients, none of whom developed CH, who were observed by Sörös et al [34] versus the seven patients with CH reported by other authors [20,[22][23][24]30], it can be seen that head trauma was involved in only 35.7% of the former cases and in as much as 71.4% of the latter. Therefore, we think that two different aspects should be considered and discussed separately.…”

“…In two of them [22,23], the surgical procedure was needed to remove a tumor-a squamous cell carcinoma in one patient (who developed CH 1 year later) [22] and a sclerosing basal-cell carcinoma in the other patient [23]. However, in the latter case, the description of the headache that the patient developed 6 months after surgery seems to cast some doubts on the reliability of the CH diagnosis.…”