Cluster headache: ultrastructural evidence for mast cell degranulation and interaction with nerve fibres in the human temporal artery

It has been suggested that histamine plays an important role in the pathogenesis of cluster headache. In addition, both neurogenic and vascular components have been described during cluster headache attacks without an obvious anatomical link between them. Our ultrastructural observations of human temporal arteries from cluster headache patients and their comparison to those from a control group strongly suggest that mast cells may be this link.

Lithium Carbonate in Cluster Headache: Assessment of Its Short- and Long-Term Therapeutic Efficacy

The short- and long-term effects of administration of lithium carbonate in cluster headache (CH) have been investigated. Of the 90 patients treated (78 males and 12 females), 68 had episodic CH and 22 had the chronic form of the disease. The doses used were almost always 900 mg/day. Eleven of the 22 patients with chronic CH showed a definite, constant improvement both short and long term. In 7 of the 22 patients, lithium treatment provided excellent results initially but was later followed by some transient worsening; in the remaining 4 only partial benefits were observed initially and treatment proved still less effective after a few months.

Lithium carbonate in the treatment of cluster headaches

Twenty-one patients with cluster headaches participated in an open trial to assess the effectiveness of lithium carbonate in the acute treatment and prevention of cluster headaches. Three women and 18 men ranging from 28 to 70 years of age were divided into episodic cluster [8] and chronic cluster [12]. One patient was in his first cluster. The chronic cluster group was further subdivided into primary chronic (5 patients) and secondary chronic (5 patients). In 11 patients there was absolute improvement, in 5 patients there was partial improvement and in 5 patients there was either no response or the improvement was not sustained. Beneficial results were obtained with dosages lower than those used for effective treatment of bipolar illness. It appears that lithium can be a useful drug in the treatment of cluster headaches provided drug levels and renal function are carefully monitored. No serious side effects were noted.