Cluster headache: heart rate and blood pressure changes during spontaneous attacks

Area of Science:

• Neurology
• Cardiology
• Pain Medicine

Background:

• Cluster headache is a severe primary headache disorder characterized by unilateral excruciating pain.
• Understanding the autonomic nervous system's role in cluster headache pathophysiology is crucial.

Observation:

• Electrocardiography (ECG) and Holter monitoring were used to record cardiac activity during 81 spontaneous cluster headache attacks in 24 patients.
• Blood pressure was measured during 11 attacks, and heart rate and blood pressure were monitored during induced head pain in six patients.

Findings:

• No significant overall change in mean heart rate was observed across all cluster headache attacks.
• Attacks starting during wakefulness were associated with a decrease in mean heart rate (61%), while those starting during sleep showed no change or an increase (67.5%).
• Patients exhibited higher mean heart rate values before, during, and after awake-onset attacks compared to sleep-onset attacks.
• A significant increase in both systolic and diastolic blood pressure was noted during cluster headache attacks.
• Induced head pain in six patients typically resulted in increased heart rate and blood pressure.

Implications:

• The distinct cardiovascular responses suggest different underlying mechanisms for awake-onset versus sleep-onset cluster headaches.
• Autonomic dysregulation, particularly parasympathetic withdrawal during awake-onset attacks and sympathetic activation during sleep-onset attacks, may play a role.
• These findings could inform the development of targeted therapies for cluster headache management based on attack timing and associated physiological changes.