We present a patient with known episodic cluster headache, who presented with cluster-like headache in the course of internal carotid artery dissection (ICAD) and discuss possible pathophysiological links between the two diseases. It is well known that cluster-like headache could be the presenting symptom of ICAD. However, ICAD occurring in a patient with a known episodic cluster headache was only once previously described.
While headache is not an uncommon symptom in patients suffering from pituitary adenomas, cluster headache (CH) has rarely been reported in such cases. Headache associated with hyperprolactinemia has been reported to be responsive to dopamine agonists (DA agonists) in many patients. We report on a patient with refractory CH secondary to a macroprolactinoma who showed immediate and permanent clinical and radiologic recovery following medical treatment with DA agonists. Measurement of prolactin levels in addition to cranial magnetic resonance imaging might be considered in patients with refractory CH, until the significance of this potential causality becomes clearer.
There are limited literature data on migraine-like accompanying features (MLF) in patients with cluster headache (CH). These symptoms are frequently reported by patients and may delay CH diagnosis. The aim of the present study was to investigate the occurrence of migraine-like symptoms in an Italian case series of CH patients and to determine whether these features influence the clinical phenotype of CH.
Cluster headache is characterized by unilateral attacks of severe pain accompanied by cranial autonomic features.
Apart from these there are also sleep-related complaints and strong chronobiological features. The interaction
between sleep and headache is complex at any level and evidence suggests that it may be of critical importance in
our understanding of primary headache disorders. In cluster headache several interactions between sleep and the
severe pain attacks have already been proposed. Supported by endocrinological and radiological findings as well as
the chronobiological features, predominant theories revolve around central pathology of the hypothalamus. We
aimed to investigate the clinical presentation of chronobiological features, the presence of concurrent sleep
disorders and the relationship with particular sleep phases or phenomena, the possible role of hypocretin as well as
the possible involvement of cardiac autonomic control
Optimal management of patients with classical trigeminal neuralgia (TN) requires specific treatment programs and close collaboration between medical, radiological and surgical specialties. Organization of such treatment programs has never been described before. With this paper we aim to describe the implementation and feasibility of an accelerated cross-speciality management program, to describe the collaboration between the involved specialties and to report the patient flow during the first 2 years after implementation. Finally, we aim to stimulate discussions about optimal management of TN.