Bob Johnson
CH.com Alumnus
 
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"Only the educated are free." -Epictetus
Posts: 5965
Kennett Square, PA (USA)
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Peter Goadsby and his team (author of following being one of them) discovered a revolutionary perspective on the origin of Cluster. ========== Headache:lessons learned from functional imaging British Medical Bulletin 2003; 65: 223-234
Arne May Department of Neurology, University of Regensburg, Regensburg, Germany
Using PET in a larger patient series, significant activations ascribable to the acute cluster headache were observed in the ipsilateral hypothalamic grey matter when compared to the headache-free state44. This highly significant activation was not seen in cluster headache patients out of the bout when compared to the patients experiencing an acute cluster headache attack45. In contrast to migraine25, no brainstem activation was found during the acute attack compared to the resting state. This is remarkable, as migraine and cluster headache are often discussed as related disorders and identical specific compounds, such as ergotamine and sumatriptan, are currently used in the acute treatment of both types of headache46. These data suggest that while primary headaches such as migraine and cluster headache may share a common pain pathway, the trigeminovascular innervation, the underlying pathogenesis differs significantly as might be inferred from the different patterns of presentation and responses to preventative agents46. Just as it is striking that no brainstem activation occurs in contrast to acute migraine, no hypothalamic activation was seen in experimental pain induced by capsaicin injection into the forehead47. This is important because injection of the forehead would activate first (ophthalmic) division afferents which are the trigeminal division predominantly responsible for pain activation in cluster headache. Thus two other types of first division of trigeminal nerve pain, while sharing neuro-anatomical pathways with cluster headache, do not give rise to
VASCULAR HEADACHE: ARE BLOOD VESSELS INVOLVED?
Taking these observations on acute cluster headache together with what has been observed in experimental head-pain and migraine, the data establish that migraine and CLUSTER HEADACHE, FAR FROM BEING PRIMARILY VASCULAR DISORDERS, ARE CONDITIONS WHOSE GENESIS IS TO BE FOUND IN THE CENTRAL NERVOUS SYSTEM IN PACEMAKER OR CIRCADIAN REGIONS SPECIFIC TO THE SYNDROME. If further studies confirm these findings, a better understanding will be gained of where and how acute and preventative therapy can be targeted. =========== =========== In the years you have been away from us, a new perspective has been gaining interest. Increasingly, finding headache situations which are NOT primary headache disorders, i.e., disorders which mimic Cluster.
One of the hallmarks is that the usual Cluster meds work for a brief time, then stop being effective OR don't work at all. If you wish to discuss this potential with your doc, print out this message:
Link to: cluster-LIKE headache. Section, "Medications, Treatments, Therapies --> "Important Topics" --> "Cluster-LIKE headache"
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