Cluster headache and the hypothalamus: causal relationship or epiphenomenon?

  title={Cluster headache and the hypothalamus: causal relationship or epiphenomenon?},
  author={Dagny Holle and Mark Obermann},
  journal={Expert Review of Neurotherapeutics},
  pages={1255 - 1263}
  • D. Holle, M. Obermann
  • Published 1 September 2011
  • Psychology, Biology, Medicine
  • Expert Review of Neurotherapeutics
Typical clinical features of cluster headache (CH) include circadian/circannual rhythmicity and ipisilateral cranial autonomic features. This presentation has led to the assumption that the hypothalamus plays a pivotal role in this primary headache disorder. Several studies using neuroimaging techniques or measuring hormone levels supported the hypothesis of a hypothalamic involvement in the underlying pathophysiology of CH. Animal studies added further evidence to this hypothesis. Based on… 

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Primary headaches.

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A Review of Hormonal Findings in Cluster Headache. Evidence for Hypothalamic Involvement

  • M. LeoneG. Bussone
  • Medicine, Psychology
    Cephalalgia : an international journal of headache
  • 1993
The hormonal abnormalities in cluster headache support disorders of hypothalamic function, which are known to cause cluster headache and to support the role of the hypothalamus in this illness.

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Autonomic studies of patients undergoing posterior hypothalamic stimulation provide further evidence that long-term stimulation is safe, revealing that it can cause altered modulation of the mechanisms of orthostatic adaptation without affecting the baroreflex, cardiorespiratory interactions or efferent sympathetic and vagal functions.

Specific hypothalamic activation during a spontaneous cluster headache attack

Results of voxel-based morphometry support the role of the posterior hypothalamus in the pathogenesis of cluster headache because an increased gray matter density has been shown in this structure, but clinical and experimental data show NTG-provoked and spontaneous cluster attacks to be comparable.

Hypothalamic deep brain stimulation in the treatment of chronic cluster headache

Activation of the hypothalamus and of the trigeminal system are both necessary, but not sufficient to generate CH attacks, suggesting other unknown brain areas are likely to play a role in the pathophysiology of this illness.

Hypothalamic involvement in chronic migraine

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Preliminary results indicate that hypothalamic stimulation is safe and effective for the treatment of drug‐resistant, chronic CH and confirm the “central” pathogenesis for chronic CH.

Cerebrospinal fluid hypocretin-1 levels during the active period of cluster headache

CSF hypocretin-1 levels seem not to influence the clinical course of CH, but the results cannot completely exclude a functional involvement of the hypothalamic hypoc retinergic system in the pathogenesis of CH.