Post-Operative Cluster Headache Following Carotid Endarterectomy

Abstract

Background: Secondary cluster headache following carotid endarterectomy (CEA) is a rare condition and may help us understand the pathophysiology of primary cluster headache. Summary: We describe 2 patients diagnosed with cluster headache, fulfilling the ICHD-IIIB criteria, following CEA. Neither of the patients had headache prior to surgery. They both responded to treatment with oxygen and verapamil. Recent medical literature does not describe any definite cases of cluster headache following CEA. Cluster-like headache has been reported in several studies in the 1990s. Recent studies in primary cluster headache patients show evidence for a central origin of cluster headache in which no peripheral drive seems necessary. Key Messages: Our findings may provide more insight into the pathophysiology and show how a peripheral cause may lead to cluster headache. We hypothesize a role of the trigemino-autonomic reflex. Damage to the carotid artery may activate this reflex and trigger cluster headache. Injury to the internal carotid artery may unleash attacks in patients who are predisposed to develop cluster headache. Further study on the subject is needed to resolve this issue.

Development of a cluster-like headache after a stent-assisted implantation of an endovascular WEB device

“…It is of interest that patients receiving stent-assisted coiling seemed to experience less improvement of headaches in this trial 10. More pertinent to our case is the report provided by Dirkx and Koehler, who describe two patients with new-onset cluster-like headache after carotid endarterioectomy (CEA), also responding to classical pharmacotherapy usually given in CH 18. However, while the temporal association to CEA was also striking in this report, no pathophysiological link such as contrast enhancement of vessel walls was described here.…”

A rare pediatric case of cluster headaches after cardiac catheterization in a patient with an isolated innominate artery

“…Cluster headaches have been reported after carotid endarterectomy, perhaps due to damage to the internal carotid artery, which carries trigeminal nerve roots (Table 1). [17][18][19] In addition, there have been multiple reports of cluster-like headaches secondary to other vascular causes such as aneurysms, arteriovenous malformations, venous sinus thrombosis, and carotid/vertebral dissection. 4 In the same family of trigeminal autonomic cephalalgias as cluster headaches, recurrent hemicrania has been reported to be triggered by aortic dissection, 20 possibly due to the referral of aortic wall pain signals to the trigeminal ganglion via the cardiac plexus, first cervical ganglion, and the internal carotid nerve.…”

Recent advances in the diagnosis and management of cluster headache

“…The role of the sympathetic pathway in cluster headache is less understood, although post-carotid endarterectomy headaches can present as cluster headache-like pain 27. Carotid endarterectomies physiologically might include damage to both sympathetic and trigeminal fibers, and some authors have proposed that damage to both of these structures could indirectly lead to parasympathetic activation 76…”

“…27 Carotid endarterectomies physiologically might include damage to both sympathetic and trigeminal fibers, and some authors have proposed that damage to both of these structures could indirectly lead to parasympathetic activation. 76 At the molecular level, the autonomic system uses several signaling molecules: it shares PACAP-38 with the trigeminovascular system and also uses vasoactive intestinal peptide. Infusions of vasoactive intestinal peptide, like PACAP-38 and CGRP, trigger cluster headache attacks in patients with cluster headache.…”