Cluster headache due to structural lesions: A systematic review of published cases

BACKGROUND Cluster headache(CH)is a severe incapacitating headache disorder.By definition,its diagnosis must exclude possible underlying structural conditions.AIM To review available information on CLH caused by structural lesions and to provide better guides in the distinguishing process and to ensure that there is not a potentially treatable structural lesion.METHODS We conducted a systematic review of 77 published cases of symptomatic CH and cluster-like headache(CLH)in PubMed and Google Scholar databases.RESULTS Structural pathologies associated with CH were vascular(37.7%),tumoral(32.5%)and inflammatory(27.2%).Brain mass-like lesions(tumoural and inflammatory)were the most common diseases(28.6%),among which 77.3%lesions were at the suprasellar(pituitary)region.Cases of secondary CH related to sinusitis rose dramatically,occupying 19.5%.The third most common disease was internal carotid artery dissection,accounting for 14.3%.Atypical clinical features raise an early suspicion of a secondary cause:Late age at onset and eye and retroorbital pains were common conditions requiring careful evaluation and were present in at least one-third of cases.Abnormal neurological examination was the most significant red flag for impaired cranial nerves.CLH patients may be responsive to typical CH treatments;therefore,the treatment response is not specific.CLH can be triggered by contralateral structural pathologies.CLH associated with sinusitis and cerebral venous thrombosis required more attention.CONCLUSION Since secondary headache could perfectly mimick primary CH,neuroimaging should be conducted in patients in whom primary and secondary headaches are suspected.Cerebral magnetic resonance imaging scans is the diagnostic management of choice,and further examinations include vessel imaging with contrast agents and dedicated scans focusing on specific cerebral areas(sinuses,ocular and sellar regions).Neuroimaging is as necessary at follow-up visits as at the first observation.

Altered regional homogeneity in spontaneous cluster headache attacks： a resting-state functional magnetic resonance imaging study

Background Functional neuroimaging study has opened an avenue for exploring the pathophysiology of cluster headache （CH）.The aim of our study was to assess the changes in brain activity in CH patients by the regional homogeneity method using resting-state functional magnetic resonance imaging technique.Methods The functional magnetic resonance imaging scans were obtained for 12 male CH patients with spontaneous right-sided headache attacks during “in attack” and “out of attack” periods and 12 age- and sex-matched normal controls.The data were analyzed to detect the altered brain activity by the regional homogeneity method using statistical parametric mapping software.Results Altered regional homogeneity was detected in the anterior cingulate cortex,the posterior cingulate cortex,the prefrontal cortex,insular cortex,and other brain regions involved in pain processing and modulation among different groups.Conclusion It is referred that these brain regions with altered regional homogeneity might be related to the pain processing and modulation of CH.