Cluster-like headache associated to a foreign body in the maxillary sinus.

Abstract

Cluster headache is known as one of the most painful cephalalgias to be experience by humans. They are most commonly primary, for which there are well-established diagnostic criteria; but from 3 to 5% of cluster headache cases are secondary to diverse lesions. Although its pathogenesis is uncertain, the following hypotheses have been advanced: 1) a central origin, located in the anterior hypothalamus (suprachiasmatic nucleus), as well as in the posterior hypothalamus1,2⇓; 2) a peripheral origin, with activation of the pericarotid neural plexus in the cavernous sinus3; and 3) the coexistence of a “central trigger,” located in the hypothalamus with peripheral onset of pain, and autonomic symptoms, explained by activation of the trigemino-autonomic reflex.1,2,4⇓⇓ We present a patient with symptoms consistent with cluster headache, according to the 1988 criteria of the International Headache Society,5 associated to a foreign body in the ipsilateral maxillary sinus. A 34-year-old woman sought advice for an 8-year history of right, piercing, intense orbital pain lasting from 30 to 60 …