Retro-ocular headache with autonomic features resembling "continuous" cluster headache in lateral medullary infarction

Lateral Medullary Infarction Secondary to Vertebral Artery Dissection Presenting as a Trigeminal Autonomic Cephalalgia

“…The study conducted by Silbert et al showed the presence of head and neck pain in 79% of the patients with carotid artery dissection (CAD) and in 88% of the patients with VAD 4 . Despite its frequency, autonomic features associated to the headache, resembling a trigeminal autonomic cephalalgia, rarely have been reported in stroke 6–11 . We present a patient with this type of headache as the initial symptom of a lateral medullary infarction secondary to bilateral VAD.…”

“…Despite its frequency, there are only a few case reports of patients with VAD or lateral medullary infarction with ipsilateral anterior headache, 7 , 11 para sympathetic autonomic activation, and sympathetic dysfunction, resembling a trigeminal autonomic cephalalgia. Similar headaches related to cerebrovascular disease have been described in infarction of the cervical cord, 6 right middle cerebral artery infarct, a right parietal arteriovenous malformation, 8 and CAD 9,10 .…”

Undifferentiated Trigeminal Autonomic Cephalalgia in Lateral Medullary Infarction

“…Undifferentiated trigeminal autonomic cephalalgias have been reported in various intracranial and extracranial neurovascular and CNS structural lesions, including pituitary tumours, cavernous sinus disease, spinal cord infarctions, [3][4][5] and vertebral dissection. 6,7 Although our patient did not have a cervico-cranial dissection on MR and CT angiography, these tests have been reported to show variable specificity and sensitivity in the diagnosis of arterial dissection when compared with digital subtraction four-vessel angiography. 8 The occurrence of TAC in lateral medullary infarction suggests trigeminal dysfunction, possibly due to involvement of the spinal trigeminal nucleus and central disinhibition of the trigeminal nociceptive pathways.…”

Cluster-Like Headache: Association with Cervical Syringomyelia and Arnold-Chiari Malformation

“…We speculate that, in the present case, discrete dilatations of the cord cavity induced a mechanical irritation of the upper cervical segments and consequent activation of the more caudal portions of the spinal trigeminal nucleus, which may descend to C2-C3 level. Recent reports indicate that medullary infarcts may present as a cluster-like attack (9,10). Various extraaxial cervical lesions have been associated with cluster-like headache, including cervical trauma (7) and meningiomas (8), possibly by activation of the trigeminal-autonomic reflex.…”