Two Cases of Symptomatic Cluster-Like Headache Suggest the Importance of Sympathetic/Parasympathetic Balance

Straube, Andreas; Freilinger, Tobias; Rüther, Tobias; Padovan, Claudio S.

doi:10.1111/j.1468-2982.2007.01348.x

Cited by 23 publications

(24 citation statements)

References 20 publications

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“…This sign, while exceptional, might indicate a reflex sympathetic response to the initial parasympathetic preponderance, or perhaps suggests both a relative imbalance in the entire cervicocephalic autonomic system plus a unique threshold for such imbalance in each patient (11). Restlessness and agitation during pain exacerbations occurs in other TACs, such as short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) and cluster headache, and may be an association consistent with hypothalamic activation in the family of autonomic headaches (4).…”

Section: Discussionmentioning

confidence: 92%

Rigorously defined hemicrania continua presenting bilaterally

Southerland

2011

Cephalalgia

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Section: Discussionmentioning

confidence: 92%

Rigorously defined hemicrania continua presenting bilaterally

Southerland

2011

Cephalalgia

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“…A structural lesion may cause autonomic imbalance, resulting in periodic fluctuations in the activity of the autonomic nervous system, ultimately leading to an attack-wise presentation of the symptoms (Wilbrink et al 2009). Differences in the individual threshold for triggering the parasympathetic trigeminal reflexes may also play a role (Straube et al 2007). The pain mechanism in secondary CH seems ascribable to irritation of pain-sensitive structures and activation of trigeminal nerve endings (Leone & Bussone 2009).…”

Section: Discussionmentioning

confidence: 99%

Symptomatic cluster headache: a review of 63 cases

Edvardsson

2014

SpringerPlus

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Cluster headache is a primary headache by definition not caused by any known underlying structural pathology. Symptomatic cases have been described, for example tumours, dissections and infections, but a causal relationship between the underlying lesion and the headache is difficult to determine in many cases. The proper diagnostic evaluation of cluster headache is an issue unresolved. The literature has been reviewed for symptomatic cluster headache or cluster headache-like cases in which causality was likely. The review also attempted to identify clinical predictors of underlying lesions in order to formulate guidelines for neuroimaging. Sixty-three cluster headache or "cluster headache-like"/"cluster-like headache" cases in the literature were identified which were associated with an underlying lesion. A majority of the cases had a non-typical presentation that is atypical symptomatology and abnormal examination (including Horner’s syndrome). A striking finding in this appraisal was that a significant proportion of CH cases were secondary to diseases of the pituitary gland or pituitary region. Another notable finding was that a proportion of cluster headache cases were associated with arterial dissection. Even typical cluster headaches can be caused by structural lesions and the response to typical cluster headache treatments does not exclude a secondary form. It is difficult to draw definitive conclusions from this retrospective review of case reports especially considering the size of the material. However, based on this review, I suggest that neuroimaging, preferably contrast-enhanced magnetic resonance imaging/magnetic resonance angiography should be undertaken in patients with atypical symptomatology, late onset, abnormal examination (including Horner’s syndrome), or those resistant to the appropriate medical treatment. The decision to perform magnetic resonance imaging in cases of typical cluster headache remains a matter of medical art.

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“…(Wilbrink et al 2009) suggest that a structural lesion may cause autonomic imbalance, resulting in periodic fluctuations in the activity of the autonomic nervous system, ultimately leading to an attack-wise presentation of the symptoms. Differences in the individual threshold for triggering the parasympathetic trigeminal reflexes may also play a role (Straube et al 2007). …”

Section: Discussionmentioning

confidence: 99%

Cluster headache and arachnoid cyst

Edvardsson

Persson

2013

SpringerPlus

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BackgroundCluster headache is a primary headache by definition not caused by any known underlying structural pathology. However, symptomatic cases have been described, e.g. tumours, particularly pituitary adenomas, malformations, and infections/inflammations. The evaluation of cluster headache is an issue unresolved.Case descriptionWe present a case of a 43-year-old patient who presented with a 2-month history of side-locked attacks of pain located in the left orbit. He satisfied the revised International Classification of Headache Disorders criteria for cluster headache. His medical and family histories were unremarkable. There was no history of headache. A diagnosis of cluster headache was made. The patient responded to symptomatic treatment. Computer tomography and enhanced magnetic resonance imaging after 1 month displayed a supra- and intrasellar arachnoid cyst with mass effect on adjacent structures. After operation, the headache attacks resolved completely.Discussion and evaluationAlthough we cannot exclude an unintentional comorbidity, in our opinion, the co-occurrence of an arachnoid cyst with mass effect with unilateral headache, in a hitherto headache-free man, points toward the fact that in this case the CH was caused or triggered by the AC. The headache attacks resolved completely after the operation and the patient also remained headache free at the follow-up. The response of the headache to sumatriptan and other typical CH medications does not exclude a secondary form. Symptomatic CHs responsive to this therapy have been described. Associated cranial lesions such as tumours have been reported in CH patients and the attacks may be clinically indistinguishable from the primary form.ConclusionsNeuroimaging, preferably contrast-enhanced magnetic resonance imaging should always be considered in patients with cluster headache despite normal neurological examination. Late-onset cluster headache represents a condition that requires careful evaluation. Supra- and intrasellar arachnoid cyst can present as cluster headache.

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Two Cases of Symptomatic Cluster-Like Headache Suggest the Importance of Sympathetic/Parasympathetic Balance

Cited by 23 publications

References 20 publications

Rigorously defined hemicrania continua presenting bilaterally

Rigorously defined hemicrania continua presenting bilaterally

Symptomatic cluster headache: a review of 63 cases

Cluster headache and arachnoid cyst

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