Abstract
Cluster headache is an excruciating pain syndrome characterized by unilateral head pain attacks, lasting between 15 and 180 min, accompanied by marked ipsilateral cranial autonomic symptoms, such as lacrimation and conjunctival injection. Despite important insights provided by neuroimaging studies and deep brain stimulation findings, the pathophysiology of cluster headache and its pathways of chronicization are still elusive. In this mini-review, we will provide an overview of the functional and structural neuroimaging studies in episodic and chronic cluster headache conditions conducted to clarify the underlying pathophysiology.
Highlights
The distinctive clinical characteristic of cluster headache (CH), in particular the recurrence of excruciating unilateral attacks accompanied by marked ipsilateral cranial autonomic symptoms in periods separated by the spontaneous remission (1), suggested specific brain networks involved in seasonal adaptation (2) to have a role in the pathophysiology of this disorder
CH patients seem to present widespread functional connectivity (FC) and anatomical abnormalities across multiple networks and multiple cortical and subcortical areas, confined in regions involved in pain processing
The salience network seems to play a prominent role in CH pathophysiology: the here reviewed studies suggest that regions of this network presents a relatively stable functional alteration during the inbout and the out-of-bout conditions (16)
Summary
The distinctive clinical characteristic of cluster headache (CH), in particular the recurrence of excruciating unilateral attacks accompanied by marked ipsilateral cranial autonomic symptoms in periods separated by the spontaneous remission (1), suggested specific brain networks involved in seasonal adaptation (2) to have a role in the pathophysiology of this disorder. Neuroimaging can track these functional and anatomical changes (3), irrespective if they are the cause of the disease or represent a brain adaptation/maladaptation to the painful condition.
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