Pathophysiology of cluster headache: From the trigeminovascular system to the cerebral networks

Abstract

Background Despite advances in neuroimaging and electrophysiology, cluster headache’s pathogenesis remains unclear. This review will examine clinical neurophysiology studies, including electrophysiological and functional neuroimaging, to determine if they might help us construct a neurophysiological model of cluster headache. Results Clinical, biochemical, and electrophysiological research have implicated the trigeminal-parasympathetic system in cluster headache pain generation, although the order in which these two systems are activated, which may be somewhat independent, is unknown. Electrophysiology and neuroimaging have found one or more central factors that may cause seasonal and circadian attacks. The well-known posterior hypothalamus, with its primary circadian pacemaker suprachiasmatic nucleus, the brainstem monoaminergic systems, the midbrain, with an emphasis on the dopaminergic system, especially when cluster headache is chronic, and the descending pain control systems appear to be involved. Functional connection investigations have verified electrophysiological evidence of functional changes in distant brain regions connecting to wide cerebral networks other than pain. Conclusion We propose that under the impact of external time, an inherited misalignment between the primary circadian pacemaker suprachiasmatic nucleus and other secondary extra- suprachiasmatic nucleus clocks may promote disturbance of the body’s internal physiological clock, lowering the threshold for bout recurrence.

Use of Prescribed and Non-Prescribed Treatments for Cluster Headache in a Swedish Cohort

“…Despite recent research advancement, absence of complete understanding of the pathogenesis complicates the development of novel therapies. Prevailing consensus, however, does find this neurovascular headache to anatomically involve the posterior hypothalamus, brainstem, and midbrain, and it manifests through activation of cranofacial parasympathetic fibers as well as trigeminal nerve fibers [4]. One prominent symptom of CH is its rhythmicity of attacks reported by a majority of patients and possibly linked to the circadian rhythm [5].…”