Headache rounds—Through a Glass Darkly

Head trauma and cluster headache

“…On the other hand, we can reasonably assume that the role played by head trauma may be predominant over that of eye enucleation. If one compares the causes that led to eye enucleation in 112 patients, none of whom developed CH, who were observed by Sörös et al [34] versus the seven patients with CH reported by other authors [20,[22][23][24]30], it can be seen that head trauma was involved in only 35.7% of the former cases and in as much as 71.4% of the latter. Therefore, we think that two different aspects should be considered and discussed separately.…”

“…Among the cases reported in the literature with CH onset after eye enucleation, the one with the shortest latency between the two events is the patient who began to suffer from CH 3 weeks after surgery (and nearly 8 months after head trauma) described by Evers et al [30]. One of the cases with eye enucleation reported by Rogado and Graham [20] began to suffer from CH shortly after a mild head injury, which had been preceded by another, more severe injury that had led to eye enucleation 4 years before. Therefore, in this case, the causal relationship between the last milder trauma and CH is very doubtful.…”

“…In 1979, in an interesting "Headache Round" aimed at discussing the possible role of eye structures in the pathophysiology of CH, Rogado and Graham [20] described five patients who suffered from CH on the side of an absent eye. In one patient, the eye had been removed after CH onset in the ridiculous attempt to "relieve the headaches in his eye," and for another patient, there was no information available about the latency between eye loss and CH onset.…”

Behavior during cluster headache

“…A very sad case was a man who had his right eye removed in the useless attempt to treat CH and during an attack killed another man who had laid a hand on him in an effort to help him after having been warned "don't touch me" [28]. In Kudrow's [15] experience, only one young man exhibited violent behavior, while Graham, in personal communication with Kudrow, wrote of a patient who committed homicide during a cluster attack [15].…”

Cluster-like headache: literature review

“…In all observations, the disease appeared in men aged 21-56 years. CLH symptoms occurred within 3 weeks to 15 years of orbital extraction [19,20]. CLH is always ipsilateral to the eye lesion and prophylactic or symptomatic treatment is that of CH.…”