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Posted by Todd ( on August 14, 2000 at 20:37:54:

From Reuter's'Abortive Cluster Headache' May Present Without Pain

By Karla Gale
WESTPORT, Aug 08 (Reuters Health) - In what the author believes is the first published case, a patient presented with all the typical autonomic phenomena of cluster headache except the headache itself.
Dr. Rolf Salvesen, of the University of Tromso, in Bode, Norway, describes the frequency and duration of symptoms in a 22-year-old man as typical of cluster headache. Complete remission occurred after 6 weeks.
The attacks included left-sided miosis and ptosis, injection of the left conjunctiva, and asymmetry of sweating from the forehead. "There was no accompanying pain for the overwhelming majority of attacks," the physician writes in the August 7th issue of Neurology.
Six years later, the patient again presented, this time with autonomic symptoms along with severe pain in and around the left orbit that was responsive to sumatriptan. As in the first set of attacks, the patient experienced a complete remission after 6 weeks.
As possible therapeutic agents, "it would be logical to look into a potential effect of antagonists of the parasympathetic system," Dr. Salvesen told Reuters Health
For patients presenting with similar symptoms, Dr. Salvesen recommends MRI of the head and neck, as well as a dilated ophthalmological examination.
"As such, a patient would have at least periodically a Horner's syndrome," he told Reuters Health. "It is necessary to rule out a tumor of the middle cranial fossa or the orbit, a lesion in the brainstem, and an infiltrating lesion of the sympathetic nerves (especially along the carotid arteries) in the neck. Lesions along the facial nerve should also be considered."
Dr. Salvesen suggests in his report that "this case of 'abortive cluster headache' may be consistent with the recent PET findings of primary activation of the hypothalamic region in cluster headache."

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