SYNOPSIS 23 patients and 6 healthy controls were requested to participate in this study. Examination of skin samples consisted of light microscopic estimation as well as, transmission electron microscopic techniques (TEM) and immunohistochemical techniques. The total number of mast cells (MCs) was significantly higher in cluster headache (CH) patients than in controls, but differences between painful region and opposite temporal site were inconclusive. TEM search revealed presence of MCs around nerve fibres. There were no plasma cells containing polyclonal Ig, IgA, IgG and IgM according to horseradish peroxidase techniques. These observations suggest the role of MCs in CH pathogenesis, which support author's previous findings and results of others as well. The lack of PCs may indicate no involvement of B-cell mediated phenomena but of T-cell one, of which MCs are special part.

Cluster headache remains a disease with almost totally unknown etiology and poorly understood pathogenesis. Some evidence has been presented to suggest that histamine released from mast cells might possibly be responsible for the initiation of pain attack. The authors present ultrastructural data concerning cutaneous mast cells in the painful region in patients suffering from cluster headache. The biopsies were taken between attacks in a bout. The fine structure of the mast cells (namely swollen granules, zones of decreased density, membrane-bound vesicles and granular fusion) are consistent with the dissolution pattern of secretion. The possible role of antidromic-reflex activation of the mast cells is also discussed.