Clinical Autonomic Research

, Volume 3, Issue 5, pp 291–298 | Cite as

Imbalance of heart rate regulation in cluster headache as based on continuous 24-h recordings

  • Giuseppe Micieli
  • Anna Cavallini
  • Daniele Bosone
  • Cristina Tassorelli
  • Franco Barzizza
  • Francesco Rossi
  • Giuseppe Nappi
Research Paper


An altered autonomic balance is considered to be a pathogenetic factor in cluster headache syndrome, although there is varying data on sympathetic and/or parasympathetic activation during attacks and/or attack-free intervals. The aim of the present study was to evaluate the day/night pattern of heart rate during the active and remission phases of cluster headache. In addition, the relationship between heart rate changes and the site of pain was investigated to determine if an autonomic imbalance was related to the lateralization of pain. Thirty-nine patients (34 with primary episodic cluster headache and five with primary chronic cluster headache and 30 healthy controls underwent 24-h Holter ECG recording. Nine cluster headache patients were monitored during both phases of the disease. The data obtained confirmed the existence of a disordered chrono-organization in cluster headache (phase-shift of approximately 1 h of heart rate rhythm during the cluster period) together with a low heart rate variability and a higher occurrence of arrhythmias in cluster headache patients with right-sided pain. Differences were also observed in the cluster headache patients when headache free, excluding the pain itself as a reason for the abnormality. The chronobiological data point out a transient rhythmic dysfunction, while heart rate variability changes, mostly related either to the phase of the disease or to the site of pain, probably reflects a central, site-related, dysfunction of the autonomic nervous system in cluster headache.

Key words

Cluster headache Arrhythmias Heart rate 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Headache Classification Committee of the International Headache Society. Classification and diagnostc criteria for headache disorders, cranial neuralgias and facial pain.Cephalalgia 1988;8 (suppl 7): 1–96.Google Scholar
  2. 2.
    Nappi G, Facchinetti F, Bono G, Petraglia F, Micieli G, Cicoli C, Genazzani AR. Lack of beta-endorphin and beta-lipotropin circadian rhythmicity in episodic cluster headache: a model for chronopathology. In: Pfaffenrath V,et al., eds.Updating in headache. Berlin: Springer-Verlag, 1985: 269–275.Google Scholar
  3. 3.
    Waldenlind E, Ekbom K, Friberg Y, Saaf J, Wetterberg L. Decreased nocturnal serum melatonin during active cluster headache periods.Opusc Med 1984;4: 109–112.Google Scholar
  4. 4.
    Chazot G, Claustrat B, Brun J, Jordan D, Sassolas G, Schott B. A chronobiological study of melatonin, cortisol, growth hormone and prolactin secretion in cluster headache.Cephalalgia 1984;14: 213–220.Google Scholar
  5. 5.
    Nappi G, Micieli G, Cavallini A, Zanferrari C, Sandrini G, Manzoni GC. Accompanying symptoms of cluster attacks: their relevance to the diagnostic criteria.Cephalalgia 1992;12: 165–168.PubMedGoogle Scholar
  6. 6.
    Russell D, Storsein L. Cluster headache: a computerized analysis of 24 h Holter ECG recordings and description of ECG rhythm disturbances.Cephalalgia 1983;3: 83–107.PubMedGoogle Scholar
  7. 7.
    Manzoni GC, Terzano MG, Bono G, Micieli G, Martucci N, Nappi G. Cluster headache—clinical findings in 180 patients.Cephalalgia 1983;3: 21–30.Google Scholar
  8. 8.
    Ewing DJ, Neilson JMM, Travis P. New method for assessing cardiac parasympathetic activity using 24 hour electrocardiograms.Br Heart J 1984;52: 396–402.PubMedGoogle Scholar
  9. 9.
    Fulan R, Guzzetti S, Crivellaro W, Dassi S, Tinelli M, Baselli G, Cerutti S, Lombardi F, Pagani M, Malliani A. Continuous 24-hour assessment of the neural regulation of systemic arterial pressure and RR variabilities in ambulant subjects.Circulation 1990;81: 537–547.PubMedGoogle Scholar
  10. 10.
    Molgaard H, Sorenswen KE, Bierregard P. Attenuated 24-h heart rate variability in apparently healthy subjects, subsequently suffering cardiac death.Clin Auton Res 1991;1: 233–237.PubMedGoogle Scholar
  11. 11.
    Lown B, Wolf M. Approaches to sudden death from coronary heart disease.Circulation 1971;14: 130–132.Google Scholar
  12. 12.
    Halberg F, Johnson EA, Nelson W, Runge W, Sothern R. Autorhythmometry procedures for physiologic self-measurements and their analysis.Physiol Teach 1972;1: 1–11.Google Scholar
  13. 13.
    Micieli G, Magri M, Sandrini G, Tassorelli C, Nappi G. Pupil responsiveness in cluster headache: a dynamic TV pupillometric evaluation.Cephalalgia 1988;8: 193–201.PubMedGoogle Scholar
  14. 14.
    Fanciullacci M, Fusco BM, Alessandri M, Campagnolo V, Sicuteri F. Unilateral impairment of pupillary response to trigeminal nerve stimulation in cluster headache.Pain 1989;36: 185–191.PubMedGoogle Scholar
  15. 15.
    Saunte C. Autonomic disorders in cluster headache, with special reference to salivation, nasal secretion and tearing.Cephalalgia 1984;4: 57–64.PubMedGoogle Scholar
  16. 16.
    Nappi G, Sjaastad O (eds). Chronobiological correlates of headache.Cephalalgia 1983;3 (suppl 1).Google Scholar
  17. 17.
    Kuritzki A, Hering R, Akselrod S, Zabavi I. Cardiac and autonomic nervous system manifestation in migraine. 5th International Congress ‘The Pain Clinic’, Jerusalem, Sept. 14–18, 1992 (Abstract book, p. 2).Google Scholar

Copyright information

© Rapid Communications of Oxford Ltd. 1993

Authors and Affiliations

  • Giuseppe Micieli
    • 3
  • Anna Cavallini
    • 3
  • Daniele Bosone
    • 3
  • Cristina Tassorelli
    • 3
  • Franco Barzizza
    • 1
  • Francesco Rossi
    • 2
  • Giuseppe Nappi
    • 3
  1. 1.Department of Cardiology‘S. Matteo’ HospitalPaviaItaly
  2. 2.Neurological Institute IRCSS ‘Sanatrix’PozzilliItaly
  3. 3.Autonomic Unit, Department of Neurology, ‘C. Mondino’ FoundationUniversity of PaviaItaly

Personalised recommendations