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[Pathomechanisms of pain attacks in Horton's headache (cluster headache)].

In view of the still unexplained pathomechanism of Horton's cluster headaches 9 patients were given a challenge test with nitroglycerin while at the same time the attacks were blocked with indomethacin. The attacks were provoked with one dose (1 mg) of nitroglycerin. Then during 3 days the patients took 75-100 mg indomethacin which dose was quite sufficient for inhibition of the activity of arachidonic acid cyclooxygenase. On the fourth day another nitroglycerine provocation was done. No inhibitory effect of indomethacin on the attack was observed. It seems doubtful that products of arachidonic acid cyclooxygenation play any role in the pathomechanism of this headache.

Arachidonic Acid

Childhood onset cluster headaches.

Cluster headaches are rare in childhood. We identified 35 patients with cluster headaches starting at or before 18 years of age, including 7 patients with onset prior to age 10. All patients met the criteria of the International Headache Society for episodic or chronic cluster headaches. Patients experienced cluster headaches for as long as 20 years before seeking medical attention and required many medical contacts to establish the correct diagnosis. The clinical features of cluster headaches during childhood were similar to those which typically occur in adult life. Cluster headache patterns changed over 18 years of follow up. The frequency and duration of cluster periods increased in 14 subjects. The frequency of single headache attacks during cluster periods also increased in a similar number of subjects. We conclude that cluster headaches starting in childhood or adolescence closely resemble the adult form of the disease. In many patients, the frequency and duration of cluster periods and the frequency of the individual headache episodes increased over time. Cluster headache represent a treatable under-recognized cause of severe headaches in childhood and adolescence.

Adolescent

Surgical treatment of cluster headache.

Cluster headache is ordinarily managed medically, but may become refractory to such medical management. In this setting, surgical treatment has occasionally been performed, based on evidence that pertinent pain pathways and parasympathetic pathways may be interrupted at the main sensory root of the trigeminal nerve and at the nervus intermedius. Between 1976 and 1987, 13 patients underwent surgery for treatment of cluster headache that was refractory to medical therapy (15 procedures). Partial sectioning of the main sensory root and sectioning of the nervus intermedius were performed in nine patients; only partial sectioning of the main sensory root in one; only sectioning of the nervus intermedius in one; and nervus intermedius sectioning plus microvascular decompression of the trigeminal nerve in two. The average postoperative period for the 13 patients was 37 months (range 2 to 135 months). All patients had return of their headaches postoperatively except for one patient who obtained relief after a repeat procedure. Headache began to return between 2 days and 2 years postoperatively. Three patients are currently free of headache, including both patients who had nervus intermedius sectioning plus microvascular decompression of the trigeminal nerve. Together with recurrence of headache, cluster-associated autonomic disturbances recurred after 14 of the 15 operations but are currently absent in the three headache-free patients. Partial sectioning of the main sensory root and sectioning of the nervus intermedius, as performed in these patients, seem to have limited value in the treatment of cluster headache.

Cluster Headache

Pericarotid cluster headache.

Cluster headache is generally not associated with recognised disease, and the pathogenesis remains unclear. The onset of typical cluster headaches is reported in a patient with nasopharyngeal carcinoma. The tumor encircled the internal carotid artery but did not extend intracranially. It thus appears possible that cluster headaches may be triggered by processes involving the carotid artery.

Carcinoma, Squamous Cell

Diagnosis and management of cluster headaches.

Cluster headaches are vascular headaches that predominantly affect males and occur frequently, with cyclic regularity. Treatment is predominantly pharmacological in nature and is divided into symptomatic and prophylactic relief. This article discusses the pathogenesis, clinical features, and current prophylactic and symptomatic treatments used with cluster headaches.

Adult

[Dexamethasone test in cluster headache].

Cluster headache and manic depressive illness share in common similarities like: periodic symptomatology, accessibility to lithium therapy, abnormalities in circadian rhythm of cortisol. Though, in contrast to periodic depression, D.S.T. was found normal in 9 patients with cluster headache.

Cluster Headache

Cluster headaches.

Cluster headaches are episodes of excruciating unilateral facial pain, typically occurring in young men. Ipsilateral autonomic symptoms of nasal congestion, rhinorrhea, conjunctival injection and lacrimation are commonly present. Characteristic facial features may be found. Migraine and trigeminal neuralgia are two important considerations in the differential diagnosis. Prednisone and lithium are effective prophylactic medications for episodic and chronic forms of cluster headaches. Treatment with oxygen or ergotamines may be useful in aborting attacks.

Adult

Chronic pain syndromes and their treatment. I. Cluster headache.

Cluster headache is a form of unilateral headache which, in the past, has been very resistant to treatment. Lithium carbonate has been shown to be the only reliably effective treatment in this condition and, although only a few cases have so far been reported in the literature they have, with very few exceptions, been successful. Therefore we selected five patients who at one time or another had presented with cluster headache and who had no relief from conventional treatment, and treated them with lithium carbonate. This has been highly successful. Some patients who had suffered from the disease for many years have been completely or almost completely relieved of their affliction, while others have been markedly improved to the point where they can now function normally, both socially and professionally. The possible modes of action of lithium in this condition are discussed.

Adult

Ophthalmic presentations of cluster headache.

Cluster headache is frequently characterized by pain localized to the orbital area. There is often associated ipsilateral oculosympathetic paresis with varying degrees of blepharoptosis and miosis. The ophthalmologist is often confronted with such cases; however, the atypical presentations and the subtle clinical findings may obscure the diagnosis. As cluster headache is a benign condition, accurate recognition is essential to spare the patient potentially harmful diagnostic studies.

Adult

Cerebrospinal fluid pressure and venous pressure in "dynamite headache" and cluster headache attacks.

Six patients with episodic cluster headache were investigated as to blood pressure, heart rate, cerebrospinal fluid pressure (Pcsf) and frontal vein pressure (Pvf) during five nitroglycerin (NG) provoked attacks and one spontaneous attack. In a seventh studied patient the NG failed to provoke an attack. The earlier reported decrease of systolic blood pressure and increase of diastolic blood pressure and heart rate after NG administration were also found in these patients. The "dynamite headache" was related to the start and duration of an increase of the cerebrospinal fluid pressure. There was no relationship between the start or the maximum pain of the cluster headache attack and changes in Pcsf or Pvf. On breathing oxygen during a cluster headache attack, there was a decrease of Pcsf but in some patients a temporary increase of Pvf was observed, which possibly indicates that oxygen simultaneously attains constriction of arteries and veins.

Adult

[Cluster headache].

Cluster headache is a disputable and ill-defined problem of current neurology. The authors review data available on etiology, mechanisms of pathogenesis and therapy with special emphasis on biochemical and immunological disturbances; discuss nosology of the disease in the light of newly obtained evidence on its immunological aspects. An overall table of clinically justified treatments is presented.

Adult

Cluster headache.

Cluster headache is a relatively common form of vascular headache. Its characteristic clinical pattern should allow definitive diagnosis in the vast majority of cases. Extensive diagnostic evaluations are not indicated. Treatment is generally unsatisfactory but helpful in a number of cases. It has a limited natural history and is essentially a benign condition.

Headache

Immunological alterations in cluster headache during remission and cluster period. Comparison with low back pain patients.

Cluster headache is a disorder of unknown origin. Some studies have focused their attention on neuroendocrine derangement, others on immunity. To probe central alterations in cluster headache (CH), immune parameters were investigated in cluster headache patients in comparison to low back pain patients and healthy controls. Increases in peripheral blood monocytes found in remission cluster headache patients may be attributable to chronic central nervous system (hypothalamic?) noradrenergic dysfunction or altered beta-endorphin. Alterations in NK+, CD3+ and CD4+ levels found in cluster period cluster headache and low back pain patients are probably pain or stress-related.

Adult

Sexual headaches occurring in cluster headache patients.

A number of classifications of headache have appeared in medical and professional journals. In addition to these formal diagnostic classifications, a number of articles have addressed the relationship of sexual functioning to headache etiology, course, and prevalence. To this end, many headache specialists have developed a classification for what are termed "sexual headaches." To date, these sexual headaches have been limited to migraine and muscle contraction (tension) headache patterns. We present, for the first time, two case studies documenting the role of sexual activity in both etiology and course of cluster headache.

Adult

Circadian secretion of cortisol and melatonin in cluster headache during active cluster periods and remission.

The cyclic nature of cluster headache warranted a study of the 24-hour rhythms of serum cortisol and melatonin. They were both altered during cluster periods as compared with periods of remission and healthy controls. The 24-hour mean and maximal cortisol levels were higher and the timing of the cortisol minimum was delayed as compared to the same patients in remission. Although there was no relation between the cortisol and melatonin levels and headaches, the rise of cortisol following many attacks might in part represent an adaptive response to pain. The nocturnal melatonin maximum was lower during cluster periods than in remission. This finding, and the dysautonomic signs during attacks, may reflect a change of the vegetative tone in a hyposympathetic direction.

Adult