Hypothalamic activation in cluster headache attacks

  title={Hypothalamic activation in cluster headache attacks},
  author={Arne May and Anish Bahra and Christian B{\"u}chel and Richard S. J. Frackowiak and Peter J. Goadsby},
  journal={The Lancet},

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 involvement and activation in cluster headache

Functional brain imaging with positron emission tomography and structural imaging with voxel-based morphometry have identified an area in the posterior hypothalamic gray as key in understanding cluster headache.

PET and MRA findings in cluster headache and MRA in experimental pain

Dilatation of cranial vessels is not specific to any particular headache syndrome but generic to cranial neurovascular activation, probably mediated by the trigeminoparasympathetic reflex.

Brainstem activation in cluster headache: An adaptive behavioural response?

Functional neuroimaging findings in a patient suffering from CH headache are described, finding significant activation of the bilateral red nucleus, ventral pons and trigeminal root entry zone ipsilaterally to the pain side, which may well represent a defence reaction in cluster headache, which is characterised by a "fight-or-flight" type behavioural pattern during pain attacks.

The electrophysiology of cluster headache

Structural and functional imaging data show an alteration of hypothalamic structures in CH patients, supporting the hypothesis that the hypothalamus, according to its function as a circadian pacemaker, plays a pivotal role in CH pathology.

Phase dependent hypothalamic activation following trigeminal input in cluster headache

The posterior hypothalamus might be hyperexcitable in cluster headache patients outside the bout while excitability to external nociceptive stimuli decreases during in bout periods, probably due to frequent hypothalamic activation and possible neurotransmitter exhaustion during cluster attacks.

Neuroimaging in headache

  • P. Goadsby
  • Medicine, Psychology
    Microscopy research and technique
  • 2001
The author takes the view that the known physiology and pathophysiology of the systems involved dictate that these disorders should be collectively regarded as neurovascular headaches to place emphasis on the interaction between nerves and vessels, which is the underlying characteristic of these syndromes.

Non–hypothalamic cluster headache: the role of the greater occipital nerve in cluster headache pathogenesis

  • T. Rozen
  • Medicine, Psychology
    The Journal of Headache and Pain
  • 2005
It is suggested that some forms of cluster headache are not primarily hypothalamic influenced and that the GON may play a significant role in cluster pathogenesis in some individuals.

Advances in the understanding of cluster headache

Results from ongoing clinical trials in cluster headache sufferers using monoclonal antibodies against CGRP will open soon a new era, and main findings contributing to consider cluster headache as a neurovascular disorder with an origin from within the brain are focused on.

Headache: lessons learned from functional imaging.

  • A. May
  • Medicine, Psychology
    British medical bulletin
  • 2003
Functional neuroimaging in headache patients has revolutionised this area of study and provided unique insights into some of the commonest maladies in man, suggesting that migraine and cluster headache are primarily driven from the brain.



Neuroendocrine Dysfunction in Cluster Headache

The hypothalamic-pituitary axis responsiveness with the thyrotrophin releasing hormone test was evaluated to confirm the hypothalamic involvement in cluster headache and revealed no difference between healthy controls and cluster headache patients in remission.

Human in vivo evidence for trigeminovascular activation in cluster headache. Neuropeptide changes and effects of acute attacks therapies.

Patients with episodic cluster headache fulfilling the criteria of the International Headache Society were examined during an acute spontaneous attack of headache to determine the local cranial release of neuropeptides to demonstrate in vivo human evidence for activation of the trigeminovascular system and the cranial parasympathetic nervous system.

Brain stem activation in spontaneous human migraine attacks

Findings support the idea that the pathogenesis of migraine is related to an imbalance in activity between brain stem nuclei regulating antinociception and vascular control.

Nitrolglycerin as a provocative agent in cluster headache.

  • K. Ekbom
  • Medicine
    Archives of neurology
  • 1968
A definite method for provoking an attack would therefore be of value, from both the diagnostic-therapeutic and the pathophysiological aspects, to establish the mechanism of the actual headache.

Episodic Cluster Headache From a Textbook of 1745: Van Swieten's Classic Description

  • H. Isler
  • Medicine, Psychology
    Cephalalgia : an international journal of headache
  • 1993
The first description of cluster headache is usually attributed to authors who published between 1867 and 1939, but lately several researchers have found accounts dating back to the 18th or even the

Basic Mechanisms of Headache

This work focuses on studies in migraine, tension headache and cluster headache, and investigates the role of endogenous antinociceptive systems in the central nervous system.