Orbital phlebography: a comparison between cluster headache and other headaches

Area of Science:

• Neurology
• Radiology
• Vascular Imaging

Background:

• Previous studies indicated a high rate of orbital phlebography pathology in episodic cluster headache.
• The diagnostic significance of these findings in cluster headache compared to other headache disorders remained unclear.

Purpose of the Study:

• To compare the frequency and pattern of orbital phlebography findings in cluster headache with those in cervicogenic headache, migraine, and tension-type headache.
• To determine if orbital phlebography reveals unique pathology in cluster headache.

Main Methods:

• Orbital phlebographies were performed on patients diagnosed with cluster headache, cervicogenic headache, migraine, and tension-type headache.
• Two radiologists independently evaluated the phlebograms, with one blinded to the clinical diagnoses.
• Inter-rater reliability was assessed for the interpretation of the imaging studies.

Main Results:

• Pathologic findings were observed in 2/12 cluster headache patients, 2/11 cervicogenic headache patients, 5/12 migraine patients, and 5/15 tension-type headache patients.
• Complete agreement between radiologists occurred in 39 out of 50 phlebograms.
• The frequency and pattern of orbital phlebography pathology did not significantly differ between cluster headache and the other headache categories.

Conclusions:

• Orbital phlebography pathology is not more common in cluster headache than in cervicogenic headache, migraine, or tension-type headache.
• The imaging patterns of pathology observed via orbital phlebography are similar across these different headache classifications.
• Orbital phlebography may not be a distinguishing diagnostic tool for episodic cluster headache compared to other headache types.