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.

Clinical Observation on Tuina Therapy for Cervicogenic Headache

Objective： To observe the clinical effects of tuina therapy for cervicogenic headache. Methods： Fifty-four cases were randomized allocated into tuina group and medicine group, 27 cases in each group. The patients in the tuina group treated with tuina therapy, and the patients in the medicine group take ibuprofen orally. The headache degree （Visual Analogue Scale, VAS）, frequency of headache occurrence and the neck disability index （NDI） were compared 2 weeks pre-treatment and 2 weeks post-treatment. Results： Before treatment, there were no significant differences in the headache VAS, frequency and NDI between the two groups. After treatment, headache VAS, frequency and NDI were significantly decreased, and there were statistical differences between the tuina group and the medicine group （P 〈 0.01）. Conclusion： Tuina therapy is more effective for treating cervicogenic headache than routine dose of ibuprofen.