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Cluster headache. Our current concepts
1Department of Neurology-Regionsykehuset i Trondheim, Trondheim University Hospital, Norway.
Insights
Cluster headache and chronic paroxysmal hemicrania (CPH) may share similar causes within the cluster headache syndrome. Mechanical precipitation in CPH might involve cervical structures, unlike cluster headache.
Area of Science:
- Neurology
- Headache Medicine
- Pain Pathophysiology
Background:
- Cluster headache and chronic paroxysmal hemicrania (CPH) are often classified together under the cluster headache syndrome.
- This grouping suggests potentially similar underlying pathogenesis for both headache disorders.
- CPH presents two distinct subgroups: those with and without mechanical precipitation of attacks.
Purpose of the Study:
- To explore the potential similarities in pathogenesis between cluster headache and CPH, particularly the subgroup with mechanical precipitation.
- To investigate the role of specific anatomical structures and mechanisms in the precipitation of attacks for each condition.
Main Methods:
- Comparative analysis of the clinical features and proposed pathogenetic mechanisms of cluster headache and CPH.
- Review of existing literature on the role of 'midline structures' and 'cervical volleys' in headache precipitation.
Main Results:
- If the cluster headache syndrome classification holds, cluster headache and CPH should share similar pathogenetic mechanisms.
- CPH with mechanical precipitation may be triggered by 'cervical volleys' activating 'midline' cavernous sinus structures.
- Cluster headache appears to lack the 'nuchal' factor, and its specific activation mechanisms remain unknown.
Conclusions:
- The close classification of cluster headache and CPH suggests shared pathogenetic pathways.
- Mechanical precipitation in CPH involves cervical input to midline structures, a mechanism not clearly identified in cluster headache.
- Further research is needed to elucidate the precise activation mechanisms in cluster headache.
Abstract:
Cluster headache and chronic paroxysmal hemicrania are assumed to be so closely related that they from a classification point of view have been grouped together under the superstructure: cluster headache syndrome. If this grouping will prove to stand the test of time, the pathogenesis of the two subgroups ought to be quite similar. CPH per se has two subgroups: those with and those without mechanical precipitation of attacks. If the aforementioned grouping of CPH is correct, then the CPH subdivision with mechanical precipitation of attacks should also be closely akin to cluster headache. Cluster headache, however, seems to lack the "nuchal" factor. It is felt that "midline structures", like the cavernous sinus, are of importance in cluster headache (cluster headache syndrome?) pathogenesis. In CPH with mechanical precipitation, attacks may be precipitated via "cervical volleys" a.m. Kerr, activating "midline" cavernous sinus structures, while the activation mechanisms in cluster headache is unknown.