Abstract
Cluster headache is a primary headache by definition not caused by any known underlying structural pathology. Symptomatic cases have been described, for example tumours, dissections and infections, but a causal relationship between the underlying lesion and the headache is difficult to determine in many cases. The proper diagnostic evaluation of cluster headache is an issue unresolved. The literature has been reviewed for symptomatic cluster headache or cluster headache-like cases in which causality was likely. The review also attempted to identify clinical predictors of underlying lesions in order to formulate guidelines for neuroimaging. Sixty-three cluster headache or "cluster headache-like"/"cluster-like headache" cases in the literature were identified which were associated with an underlying lesion. A majority of the cases had a non-typical presentation that is atypical symptomatology and abnormal examination (including Horner’s syndrome). A striking finding in this appraisal was that a significant proportion of CH cases were secondary to diseases of the pituitary gland or pituitary region. Another notable finding was that a proportion of cluster headache cases were associated with arterial dissection. Even typical cluster headaches can be caused by structural lesions and the response to typical cluster headache treatments does not exclude a secondary form. It is difficult to draw definitive conclusions from this retrospective review of case reports especially considering the size of the material. However, based on this review, I suggest that neuroimaging, preferably contrast-enhanced magnetic resonance imaging/magnetic resonance angiography should be undertaken in patients with atypical symptomatology, late onset, abnormal examination (including Horner’s syndrome), or those resistant to the appropriate medical treatment. The decision to perform magnetic resonance imaging in cases of typical cluster headache remains a matter of medical art.
Highlights
Cluster headache (CH) is a primary headache, by definition not caused by any underlying structural pathology and belonging to the group of trigeminal-autonomic cephalalgias (Headache Subcommittee of the International Headache Society 2004)
All cases had a clear description of the localization of the underlying lesion and were only included if a therapeutic intervention directed at the underlying lesion had resulted in a significant improvement or resolution of the headache
Medical history and clinical examination are of vital importance and can point to secondary causes of the headache
Summary
Cluster headache (CH) is a primary headache, by definition not caused by any underlying structural pathology and belonging to the group of trigeminal-autonomic cephalalgias (Headache Subcommittee of the International Headache Society 2004). There are many case reports of symptomatic/secondary cases of CH in the literature (Table 1), but a causal relationship between the underlying lesion and the headache is difficult to determine in many cases (Cittadini & Matharu 2009). The question arises whether patients with CH should have a diagnostic evaluation to rule out an underlying structural lesion. To address this question, I reviewed the English language literature on symptomatic/secondary cases of CHs. The review attempts to identify clinical predictors of underlying lesions in order to formulate guidelines for neuroimaging
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