Clues in the Tempos of Cluster Headache


  • Ninth Annual Distinguished Clinician Award Lecture.



Three striking features of the usual time patterns of cluster headache, each involving a trade-off, offer provocative clues to headache mechanisms: (1) The high intensity is consistent with involvement of the internal carotid within its canal in an unproven but plausible process of dilatation with edema and possible sterile inflammation; the brevity of the attack may result from factors instrinsic to this arterial segment or from unusually effective pain-suppressing feedback. (2) Rarely, in the patient with cluster headache a separate kind of pain develops, even more intense but tic-like, possible arising from compromise of the trigeminal ganglion by the subjacent “carotid process”. (3) The major enigmatic tempo, clustering of attacks of headache separated by prolonged remissions, may denote fluctuations in autonomic vasomotor function, secondary in some individuals to changing life stress and in others to endogenous biologic rhythms. A search is warranted for biochemical evidence for cycles in activating or suppressor mechanisms, through serial assays, as of serum, in patients accessible to long-term study.