More cases which make it clear that CH is a complex disorder which requires caution in making a diagnosis and a sophisticated skill so often missing in our docs.
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J Neurol. 2010 Oct 26. [Epub ahead of print]

Trigeminal autonomic cephalalgia sine headache.
Haane DY, Koehler PJ, Te Lintelo MP, Peatfield R.

Department of Neurology, Atrium Medical Centre, PO Box 4446, 6401 CX, Heerlen, The Netherlands, ass641@atriummc.nl.

Abstract
Cluster headache without headache (CH-H) has been described several times. We add three new CH-H patients and a patient with (probable) paroxysmal hemicrania without headache (PH-H). We searched the literature and found some more cases of CH-H and PH-H. CH-H attacks may have a shorter minimal attack duration than CH attacks. We propose the term trigeminal autonomic cephalalgia without headache (TAC-H) for autonomic attacks and/or extracephalic pain or sensory symptoms with an attack duration and distribution and/or response to therapy suggesting one of the trigeminal autonomic cephalalgias, but without accompanying headache. Secondary TAC-H may develop after treatment for painful TAC attacks. We discuss pathophysiological issues, particularly the central role of the hypothalamus and the suggestion that the superior salivatory nucleus (SSN) might be triggered by the diencephalic pacemaker without nociceptive activation.

PMID: 20976466 [PubMed
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Cephalalgia. 2010 May 17.

Mere surgery will not cure cluster headache - implications for neurostimulation.
Hidding U, May A.

University Medical Centre Hamburg Eppendorf, Germany.

Abstract
This case study concerns a patient with primary chronic cluster headache, who was unresponsive to all treatments and consecutively underwent hypothalamic deep brain stimulation (DBS). DBS had no effect on the cluster attacks, but cured an existing polydipsia as well as restlessness. However, hypothalamic DBS produced a constant, dull headache without concomitant symptoms and a high-frequent tremor. All of these effects were repeated when the stimulation was stopped and than started again. DBS had no effect on a pathological weight gain from 70 kg to 150 kg due to bulimia at night, usually during headache attacks.

THIS CASE ILLUSTRATES THAT CLUSTER HEADACHE IS, IN SOME PATIENTS, ONLY ONE SYMPTOM OF A COMPLEX HYPOTHALAMIC SYNDROME.

This case also underlines that the stimulation parameters and anatomical target area for hypothalamic DBS may be too unspecific to do justice to the clinical variety of patients and concomitant symptoms. Hypothalamic DBS is an exquisite and potentially life-saving treatment method in otherwise intractable patients, but needs to be better characterised and should only be considered when other stimulation methods, such as stimulation of the greater occipital nerve, are unsuccessful.

PMID: 20974592 [PubMed

Another reminder of how critical it is to get the headache specialist to take a look see!

Joe