A Horner‐like syndrome and cluster headache. What comes first?

Abstract

ABSTRACT.Purpose: To evaluate if an ocular sympathetic lesion may be a prerequisite for cluster headache to occur. Methods: Patients with a permanent Horner-like syndrome at the debut of cluster headache were identified from history and photographs. Results: Among 57 patients with cluster headache, seven patients (5 males and 2 females) exhibited a permanent Horner-like syndrome on the painful side when first seen at the outpatient department. During this study it was possible to get information from six of these patients and five of them had side constant cluster headache. In retrospect, these five patients had had a Horner-like syndrome for years prior to the onset of ipsilateral cluster headache. Conclusion:The findings indicate that a sympathetic lesion or dysfunction may be a prerequisite for the subsequent development of cluster headache.

Now dear, I have a headache! Immediate improvement of cluster headaches after sexual activity

“…Although cluster headaches have been reported to respond to indomethacin, 8 this feature usually suggests paroxysmal hemicrania 2 and raises the possibility that this phenomenon may be relevant to the trigeminal autonomic cephalgias (TAC) as a group, all of which are associated with the posterior hypothalamus. 9 The sympathetic nervous system is believed to be associated with TAC in a passive manner 1 ; however, in some cases, there is evidence of sympathetic dysfunction before the onset of TAC, 10 suggesting that sympathetic underactivity may underlie TAC pathogenesis. If TAC pain is dependent on low sympathetic tone, theoretically the episode could be reversed by the increase in sympathetic activity accompanying sexual activity and, specifically, orgasm.…”

Symptomatic Cluster Headache in Internal Carotid Artery Dissection—Consider Anhidrosis

“…Persistence of miosis and ptosis in the headache‐free intervals has been well‐described in patients with cluster headache, but it is not clear whether these autonomic features persist during the whole episode (bout) or even precede the attacks 23 . Furthermore, most of these cases had not been investigated with MRI regarding presence of ICAD.…”

SUNCT Responsive to Percutaneous Balloon Compression of the Gasserian Ganglion – 10‐Year Follow‐Up

“…The presence of a Horner's syndrome in the context of cluster headaches has been reported 5 . Our patient presented with a persistent Horner's syndrome ipsilateral to the SUNCT and, to the best of our knowledge, this is the second case of this type ever reported in the literature 6 .…”