Neuromodulatory approaches to the treatment of trigeminal autonomic cephalalgias

  • Peter J. GoadsbyEmail author
Part of the Acta Neurochirurgica Supplements book series (NEUROCHIRURGICA, volume 97/2)


The trigeminal autonomic cephalalgias (TACs) are a group of primary headache syndromes characterised by intense pain and associated activation of cranial parasympathetic autonomic outflow pathways out of proportion to the pain. The TACs include cluster headache, paroxysmal hemicrania and SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing). The pathophysiology of these syndromes involves activation of the trigeminal-autonomic reflex, whose afferent limb projects into the trigeminocervical complex in the caudal brainstem and upper cervical spinal cord. Functional brain imaging has shown activations in the posterior hypothalamic grey matter in TACs. This paper reviews the anatomy and physiology of these conditions and the brain imaging findings. Current treatments are summarised and the role of neuromodulation procedures, such as occipital nerve stimulation and deep brain stimulation in the posterior hypothalamus are reviewed. Neuromodulatory procedures are a promising avenue for these highly disabled patients with treatment refractory TACs.


Cluster headache SUNCT TAC paroxysmal hemicrania 


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  1. 1.
    Afridi S, Giffin NJ, Kaube H, Friston KJ, Ward NS, Frackowiak RS, Goadsby PJ (2005) A PET study in spontaneous migraine. Arch Neurol 62: 1270–1275PubMedCrossRefGoogle Scholar
  2. 2.
    Ambrosini A, Vandenheede M, Rossi P, Aloj F, Sauli E, Pierelli F, Schoenen J (2005) Suboccipital injection with a mixture of rapid and long-acting steroids in cluster headache: a double-blind placebo-controlled study. Pain 118: 92–96PubMedCrossRefGoogle Scholar
  3. 3.
    Andersson PG, Jespersen LT (1986) Dihydroergotamine nasal spray in the treatment of attacks of cluster headache. Cephalalgia 6: 51–54PubMedCrossRefGoogle Scholar
  4. 4.
    Anthony M (1985) Arrest of attacks of cluster headache by local steroid injection of the occipital nerve. In: Rose FC (ed) Migraine: clinical and research advances. Karger, London, pp 169–173Google Scholar
  5. 5.
    Bahra A, Matharu MS, Buchel C, Frackowiak RSJ, Goadsby PJ (2001) Brainstem activation specific to migraine headache. Lancet 357: 1016–1017PubMedCrossRefGoogle Scholar
  6. 6.
    Bahra A, May A, Goadsby PJ (2002) Cluster headache: a prospective clinical study in 230 patients with diagnostic implications. Neurology 58: 354–361PubMedGoogle Scholar
  7. 7.
    Barbanti P, Fabbrini G, Pesare M, Vanacore N, Cerbo R (2002) Unilateral cranial autonomic symptoms in migraine. Cephalalgia 22: 256–259PubMedCrossRefGoogle Scholar
  8. 8.
    Bartsch T, Levy MJ, Knight YE, Goadsby PJ (2004) Differential modulation of nociceptive dural input to [hypocretin] Orexin A and B receptor activation in the posterior hypothalamic area. Pain 109: 367–378PubMedCrossRefGoogle Scholar
  9. 9.
    Benjamin L, Levy MJ, Lasalandra MP, Knight YE, Akerman S, Classey JD, Goadsby PJ (2004) Hypothalamic activation after stimulation of the superior sagittal sinus in the cat: a Fos study. Neurobiol Dis 16: 500–505PubMedCrossRefGoogle Scholar
  10. 10.
    Benoliel R, Sharav Y (1998) Trigeminal neuralgia with lacrimation or SUNCT syndrome? Cephalalgia 18: 85–90PubMedCrossRefGoogle Scholar
  11. 11.
    Black DF, Dodick DW (2002) Two cases of medically and surgically intractable SUNCT: a reason for caution and an argument for a central mechanism. Cephalalgia 22: 201–204PubMedCrossRefGoogle Scholar
  12. 12.
    Boes CJ, Swanson JW, Dodick DW (1998) Chronic paroxysmal hemicrania presenting as otalgia with a sensation of external acoustic meatus obstruction: two cases and a pathophysiologic hypothesis. Headache 38: 787–791PubMedCrossRefGoogle Scholar
  13. 13.
    Chakravarty A, Mukherjee A (2003) SUNCT syndrome responsive to lamotrigine: documentation of the first Indian case. Cephalalgia 23: 474–475PubMedCrossRefGoogle Scholar
  14. 14.
    Cid C, Berciano J, Pascual J (2000) Retro-ocular headache with autonomic features resembling “continuous” cluster headache in a lateral medullary infarction. J Neurol Neurosurg Psychiatry 69: 134–141PubMedCrossRefGoogle Scholar
  15. 15.
    Cittadini E, May A, Straube A, Evers S, Bussone G, Goadsby PJ (2006) Effectiveness of intranasal zolmitriptan in acute cluster headache. A randomized, placebo-controlled, double-blind crossover study. Arch Neurol 63: 1537–1542PubMedCrossRefGoogle Scholar
  16. 16.
    Cohen AS, Goadsby PJ (2004) Functional neuroimaging of primary headache disorders. Curr Neurol Neurosci Rep 4: 105–110PubMedCrossRefGoogle Scholar
  17. 17.
    Cohen AS, Matharu MS, Kalisch R, Friston K, Goadsby PJ (2004) Functional MRI in SUNCT shows differential hypothalamic activation with increasing pain. Cephalalgia 24: 1098–1099CrossRefGoogle Scholar
  18. 18.
    Cooke LJ, Rose MS, Becker WJ (2000) Chinook winds and migraine headache. Neurology 54: 302–307PubMedGoogle Scholar
  19. 19.
    Cremer P, Halmagyi GM, Goadsby PJ (1995) Secondary cluster headache responsive to sumatriptan. J Neurol Neurosurg Psychiatry 59: 633–634PubMedGoogle Scholar
  20. 20.
    Curran DA, Hinterberger H, Lance JW (1967) Methysergide. Res Clin Studies Headache 1: 74–122Google Scholar
  21. 21.
    D’Andrea G, Granella F, Ghiotto N, Nappi G (2001) Lamotrigine in the treatment of SUNCT syndrome. Neurology 57: 1723–1725PubMedGoogle Scholar
  22. 22.
    de la Sayette V, Schaeffer S, Coskun O, Leproux F, Defer G (1999) Cluster headache-like attack as an opening symptom of a unilateral infarction of the cervical cord: persistent anaesthesia and dysaesthesia to cold stimuli. J Neurol Neurosurg Psychiatry 66: 397–400PubMedCrossRefGoogle Scholar
  23. 23.
    Dodick DW, Trentman T, Zimmerman R, Eross EJ (2003) Occipital nerve stimulation for intractable chronic primary headache disorders. Cephalalgia 23: 701Google Scholar
  24. 24.
    Donnet A, Valade D, Regis J (2005) Gamma knife treatment for refractory cluster headache: prospective open trial. J Neurol Neurosurg Psychiatry 76: 218–221PubMedCrossRefGoogle Scholar
  25. 25.
    Drummond PD (1988) Autonomic disturbance in cluster headache. Brain 111: 1199–1209PubMedCrossRefGoogle Scholar
  26. 26.
    Drummond PD, Lance JW (1992) Pathological sweating and flushing accompanying the trigeminal lacrimation reflex in patients with cluster headache and in patients with a confirmed site of cervical sympathetic deficit. Evidence for parasympathetic cross-innervation. Brain 115: 1429–1445PubMedCrossRefGoogle Scholar
  27. 27.
    Ekbom K, Greitz T (1970) Carotid angiography in cluster headache. Acta Radiol 10: 177–186Google Scholar
  28. 28.
    Ekbom K, Solomon S (2000) Management of cluster headache. In: Olesen J, Tfelt-Hansen P, Welch KMA (eds) The headaches, 2nd edn. Lippincott, Williams & Wilkins, Philadelphia, pp 731–740Google Scholar
  29. 29.
    Ekbom K, The Sumatriptan Cluster Headache Study Group (1991) Treatment of acute cluster headache with sumatriptan. N Engl J Med 325: 322–326CrossRefGoogle Scholar
  30. 30.
    Ertsey C, Bozsik G, Afra J, Jelencsik I (2000) A case of SUNCT syndrome with neurovascular compression. Cephalalgia 20: 325CrossRefGoogle Scholar
  31. 31.
    Feindel W, Penfield W, McNaughton F (1960) The tentorial nerves and localization of intracranial pain in man. Neurology 10: 555–563PubMedGoogle Scholar
  32. 32.
    Fogan L (1985) Treatment of cluster headache: a double blind comparison of oxygen vs air inhalation. Arch Neurol 42: 362–363PubMedGoogle Scholar
  33. 33.
    Forderreuther S, Mayer M, Straube A (2002) Treatment of cluster headache with topiramate: effects and side-effects in five patients. Cepahalalgia 22: 186–189CrossRefGoogle Scholar
  34. 34.
    Franzini A, Ferroli P, Leone M, Broggi G (2003) Stimulation of the posterior hypothalamus for treatment of chronic intractable cluster headaches. The first reported series. Neurosurgery 52: 1095–1101PubMedCrossRefGoogle Scholar
  35. 35.
    Frese A, Evers S, May A (2003) Autonomic activation in experimental trigeminal pain. Cephalalgia 23: 67–68PubMedCrossRefGoogle Scholar
  36. 36.
    Giffin N, Goadsby PJ (2001) Basilar artery aneurysm with autonomic features: an interesting pathophysiological problem. J Neurol Neurosurg Psychiatry 71: 805–808PubMedCrossRefGoogle Scholar
  37. 37.
    Gil-Gouveia R, Goadsby PJ (2005) Neuropsychiatric side effects of lidocaine: examples from the treatment of headache and a review. Cephalalgia 25 (in press)Google Scholar
  38. 38.
    Goadsby PJ (1989) Effect of stimulation of the facial nerve on regional cerebral blood flow and glucose utilization in cats. Am J Physiol 257: R517–R521PubMedGoogle Scholar
  39. 39.
    Goadsby PJ (1991) Characteristics of facial nerve elicited cerebral vasodilatation determined with laser Doppler flowmetry. Am J Physiol 260: R255–R262PubMedGoogle Scholar
  40. 40.
    Goadsby PJ (2002) Pathophysiology of cluster headache: a trigeminal autonomic cephalgia. Lancet Neurol 1: 37–43Google Scholar
  41. 41.
    Goadsby PJ (2002) Raeders Syndrome: “Paratrigeminal” paralysis of oculo-pupillary sympathetic. J Neurol Neurosurg Psychiatry 72: 297–299PubMedCrossRefGoogle Scholar
  42. 42.
    Goadsby PJ, Edvinsson L (1994) Human in vivo evidence for trigeminovascular activation in cluster headache. Brain 117: 427–434PubMedCrossRefGoogle Scholar
  43. 43.
    Goadsby PJ, Hoskin KL (1997) The distribution of trigeminovascular afferents in the nonhuman primate brain Macaca nemestrina: a c-fos immunocytochemical study. J Anat 190: 367–375PubMedCrossRefGoogle Scholar
  44. 44.
    Goadsby PJ, Macdonald GJ (1985) Extracranial vasodilatation mediated by VIP (Vasoactive Intestinal Polypeptide). Brain Res 329: 285–288PubMedCrossRefGoogle Scholar
  45. 45.
    Goadsby PJ, Lipton RB (1997) A review of paroxysmal hemicranias, SUNCT syndrome and other short-lasting headaches with autonomic features, including new cases. Brain 120: 193–209PubMedCrossRefGoogle Scholar
  46. 46.
    Goadsby PJ, Shelley S (1990) High frequency stimulation of the facial nerve results in local cortical release of vasoactive intestinal polypeptide in the anesthetised cat. Neurosci Lett 112: 282–289PubMedCrossRefGoogle Scholar
  47. 47.
    Goadsby PJ, Lambert GA, Lance JW (1983) Effects of locus coeruleus stimulation on carotid vascular resistance in the cat. Brain Res 278: 175–183PubMedCrossRefGoogle Scholar
  48. 48.
    Goadsby PJ, Lambert GA, Lance JW (1984) The peripheral pathway for extracranial vasodilatation in the cat. J Auton Nerv Syst 10: 145–155PubMedCrossRefGoogle Scholar
  49. 49.
    Goadsby PJ, Edvinsson L, Ekman R (1988) Release of vasoactive peptides in the extracerebral circulation of man and the cat during activation of the trigeminovascular system. Ann Neurol 23: 193–196PubMedCrossRefGoogle Scholar
  50. 50.
    Goadsby PJ, Edvinsson L, Ekman R (1990) Vasoactive peptide release in the extracerebral circulation of humans during migraine headache. Ann Neurol 28: 183–187PubMedCrossRefGoogle Scholar
  51. 51.
    Goadsby PJ, Edvinsson L, Ekman R (1992) Cutaneous stimulation leading to facial flushing and release of calcitonin gene-related peptide. Cephalalgia 12: 53–56PubMedCrossRefGoogle Scholar
  52. 52.
    Goadsby PJ, Uddman R, Edvinsson L (1996) Cerebral vasodilatation in the cat involves nitric oxide from parasympathetic nerves. Brain Res 707: 110–118PubMedCrossRefGoogle Scholar
  53. 53.
    Goadsby PJ, Matharu MS, Boes CJ (2001) SUNCT syndrome or trigeminal neuralgia with lacrimation. Cephalalgia 21: 82–83PubMedCrossRefGoogle Scholar
  54. 54.
    Graff-Radford SB (2000) SUNCT syndrome responsive to gabapentin. Cephalalgia 20: 515–517PubMedCrossRefGoogle Scholar
  55. 55.
    Greve E, Mai J (1988) Cluster headache-like headaches: a symptomatic feature? A report of three patients with intracranial pathologic findings. Cephalalgia 8: 79–82PubMedCrossRefGoogle Scholar
  56. 56.
    Gutierrez-Garcia JM (2002) SUNCT syndrome responsive to lamotrigine. Headache 42: 823–825PubMedCrossRefGoogle Scholar
  57. 57.
    Hannerz J (1989) A case of parasellar meningioma mimicking cluster headache. Cephalalgia 9: 265–269PubMedCrossRefGoogle Scholar
  58. 58.
    Headache Classification Committee of The International Headache Society (1988) Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 8Suppl 7: 1–96Google Scholar
  59. 59.
    Headache Classification Committee of The International Headache Society (2004) The international classification of headache disorders, 2nd edn. Cephalalgia 24Suppl 1: 1–160Google Scholar
  60. 60.
    Heidegger S, Mattfeldt T, Rieber A, Wikstroem M, Kern P, Kern W, Schreiber H (1997) Orbito-sphenoidal aspergillus infection mimicking cluster headache: a case report. Cephalalgia 17: 676–679PubMedCrossRefGoogle Scholar
  61. 61.
    Hunt CH, Dodick DW, Bosch P (2002) SUNCT responsive to gabapentin. Headache 42: 525–526PubMedCrossRefGoogle Scholar
  62. 62.
    Hunter CR, Mayfield FH (1949) Role of the upper cervical roots in the production of pain in the head. Am J Surg 78: 743–749PubMedCrossRefGoogle Scholar
  63. 63.
    Igarashi H, Sakai F (1996) Natural history of cluster headache. Cephalalgia 390–391Google Scholar
  64. 64.
    Irimia P, Cittadini E, Paemeliere K, Cohen A, Kaube H, Goadsby PJ (2006) Unilateral phonophobia and photophobia: a helpful symptom for the diagnosis of trigeminal autonomic cephalalgias (TACs) and hemicrania continua (HC). Cephalalgia (in press)Google Scholar
  65. 65.
    Jammes JL (1975) The treatment of cluster headaches with prednisone. Dis Nerv Syst 36: 375–376PubMedGoogle Scholar
  66. 66.
    Jarrar RG, Black DF, Dodick DW, Davis DH (2003) Outcome of trigeminal nerve section in the treatment of chronic cluster headache. Neurology 60: 1360–1362PubMedCrossRefGoogle Scholar
  67. 67.
    Kirkpatrick PJ, O’Brien M, MacCabe JJ (1993) Trigeminal nerve section for chronic migrainous neuralgia. Br J Neurosurg 7: 483–490PubMedCrossRefGoogle Scholar
  68. 68.
    Kitrelle JP, Grouse DS, Seybold ME (1985) Cluster headache: local anesthetic abortive agents. Arch Neurol 42: 496–498Google Scholar
  69. 69.
    Koenigsberg AD, Solomon GD, Kosmorsky DO (1994) Pseudoaneurysm within the cavernous sinus presenting as cluster headache. Headache 34: 111–113PubMedCrossRefGoogle Scholar
  70. 70.
    Krabbe A, Steiner TJ (2000) Prophylactic treatment of cluster headache. In: Sjaastad O, Nappi G (eds) Cluster headache syndrome in general practice: basic concepts. Smith-Gordon, London, pp 91–96Google Scholar
  71. 71.
    Kudrow L (1980) Cluster headache: mechanisms and management. Oxford University Press, OxfordGoogle Scholar
  72. 72.
    Kuritzky A (1984) Cluster headache-like pain caused by an upper cervical meningioma. Cephalalgia 4: 185–186PubMedCrossRefGoogle Scholar
  73. 73.
    Lainez MJ, Pascual J, Pascual AM, Santonja JM, Ponz A, Salvador A (2003) Topiramate in the prophylactic treatment of cluster headache. Headache 43: 784–749PubMedCrossRefGoogle Scholar
  74. 74.
    Lambert GA, Bogduk N, Goadsby PJ, Duckworth JW, Lance JW (1984) Decreased carotid arterial resistance in cats in response to trigeminal stimulation. J Neurosurg 61: 307–315PubMedGoogle Scholar
  75. 75.
    Lance JW (1993) Mechanism and management of headache, 5th edn. Butterworth Scientific, LondonGoogle Scholar
  76. 76.
    Lance JW, Goadsby PJ (2005) Mechanism and management of headache, 7th edn. Elsevier, New YorkGoogle Scholar
  77. 77.
    Lee MS, Lessell S (2002) Orbital myositis posing as cluster headache. Arch Neurol 59: 635–636PubMedCrossRefGoogle Scholar
  78. 78.
    Leira EC, Cruz-Flores S, Leacock RO, Abdulrauf SI (2001) Sumatriptan can alleviate headaches due to carotid artery dissection. Headache 41: 590–591PubMedCrossRefGoogle Scholar
  79. 79.
    Leone M, D’Amico D, Moschiano F, Fraschini F, Bussone G (1996) Melatonin versus placebo in the prophylaxis of cluster headache: a double-blind pilot study with parallel groups. Cephalalgia 16: 494–496PubMedCrossRefGoogle Scholar
  80. 80.
    Leone M, Rigamonti A, Usai S, D’Amico D, Grazzi L, Bussone G (2000) Two new SUNCT cases responsive to lamotrigine. Cephalalgia 20: 845–847PubMedCrossRefGoogle Scholar
  81. 81.
    Leone M, Franzini A, Bussone G (2001) Stereotatic stimulation of the posterior hypothalamic gray matter in a patient with intractable cluster headache. New Engl J Med 345: 1428–1429PubMedCrossRefGoogle Scholar
  82. 82.
    Leone M, Dodick D, Rigamonti A, D’Amico D, Grazzi L, Mea E, Bussone G (2003) Topiramate in cluster headache prophylaxis: an open trial. Cephalalgia 23: 1001–1002PubMedCrossRefGoogle Scholar
  83. 83.
    Leone M, Franzini A, Broggi G, Dodick D, Rapoport A, Goadsby PJ, Schoenen J, Bonavita V, Bussone G (2004) Deep brain stimulation for intractable chronic cluster headache: proposals for patient selection. Cephalalgia 24: 934–937PubMedCrossRefGoogle Scholar
  84. 84.
    Leone M, Franzini A, D’Andrea G, Broggi G, Casucci G, Bussone G (2005) Deep brain stimulation to relieve drug-resistant SUNCT. Ann Neurol 57: 924–927PubMedCrossRefGoogle Scholar
  85. 85.
    Lovely TJ, Kotsiakis X, Jannetta PJ (1998) The surgical management of chronic cluster headache. Headache 38: 590–594PubMedCrossRefGoogle Scholar
  86. 86.
    Mainardi F, Maggioni F, Dainese F, Amista P, Zanchin G (2002) Spontaneous carotid artery dissection with cluster-like headache. Cephalalgia 22: 557–559PubMedCrossRefGoogle Scholar
  87. 87.
    Malick A, Burstein R (1998) Cells of origin of the trigeminohy-pothalamic tract in the rat. J Comparative Neurol 400: 125–144CrossRefGoogle Scholar
  88. 88.
    Mani S, Deeter J (1982) Arteriovenous malformation of the brain presenting as a cluster headache — a case report. Headache 22: 184–185PubMedCrossRefGoogle Scholar
  89. 89.
    Manzoni GC, Micieli G, Granella F, Tassorelli C, Zanferrari C, Cavallini A (1991) Cluster headache-course over ten years in 189 patients. Cephalalgia 11: 169–174PubMedCrossRefGoogle Scholar
  90. 90.
    Matharu MS, Goadsby PJ (2002) Persistence of attacks of cluster headache after trigeminal nerve root section. Brain 175: 976–984CrossRefGoogle Scholar
  91. 91.
    Matharu MS, Boes CJ, Goadsby PJ (2002) SUNCT syndrome: prolonged attacks, refractoriness and response to topiramate. Neurology 58: 1307PubMedGoogle Scholar
  92. 92.
    Matharu MS, Boes CJ, Goadsby PJ (2003) Management of trigeminal autonomic cephalalgias and hemicrania continua. Drugs 63: 1637–1677PubMedCrossRefGoogle Scholar
  93. 93.
    Matharu MS, Cohen AS, Boes CJ, Goadsby PJ (2003) SUNCT syndrome: a review. Curr Pain Headache Rep 7: 308–318PubMedCrossRefGoogle Scholar
  94. 94.
    Matharu MS, Bartsch T, Ward N, Frackowiak RSJ, Weiner RL, Goadsby PJ (2004) Central neuromodulation in chronic migraine patients with suboccipital stimulators: a PET study. Brain 127: 220–230PubMedCrossRefGoogle Scholar
  95. 95.
    Matharu MS, Cohen AS, Goadsby PJ (2004) SUNCT syndrome responsive to intravenous lidocaine. Cephalalgia 24: 985–992PubMedCrossRefGoogle Scholar
  96. 96.
    Matharu MS, Cohen AS, McGonigle DJ, Ward N, Frackowiak RSJ, Goadsby PJ (2004) Posterior hypothalamic and brainstem activation in hemicrania continua. Headache 44: 747–761PubMedCrossRefGoogle Scholar
  97. 97.
    Matharu MS, Levy MJ, Meeran K, Goadsby PJ (2004) Subcutaneous octreotide in cluster headache-randomized placebo-controlled double-blind cross-over study. Ann Neurol 56: 488–494PubMedCrossRefGoogle Scholar
  98. 98.
    Matharu MS, Cohen AS, Frackowiak RSJ, Goadsby PJ (2006) Posterior hypothalamic activation in paroxysmal hemicrania using PET. Cephalalgia 59: 535–545Google Scholar
  99. 99.
    Mathew NT, Hurt W (1998) Percutaneous radiofrequency trigeminal gangliorhizolysis in intractable cluster headache. Headache 28: 328–331CrossRefGoogle Scholar
  100. 100.
    Mathew NT, Kailasam J, Meadors L (2002) Prophylaxis of migraine, transformed migraine, and cluster headache with topiramate. Headache 42: 796–803PubMedCrossRefGoogle Scholar
  101. 101.
    May A, Goadsby PJ (1999) The trigeminovascular system in humans: pathophysiological implications for primary headache syndromes of the neural influences on the cerebral circulation. J Cereb Blood Flow Metabo 19: 115–127CrossRefGoogle Scholar
  102. 102.
    May A, Bahra A, Buchel C, Frackowiak RSJ, Goadsby PJ (1998) Hypothalamic activation in cluster headache attacks. Lancet 352: 275–278PubMedCrossRefGoogle Scholar
  103. 103.
    May A, Kaube H, Buchel C, Eichten C, Rijntjes M, Juptner M, Weiller C, Diener HC (1998) Experimental cranial pain elicited by capsaicin: a PET-study. Pain 74: 61–66PubMedCrossRefGoogle Scholar
  104. 104.
    May A, Buchel C, Bahra A, Goadsby PJ, Frackowiak RSJ (1999) Intra-cranial vessels in trigeminal transmitted pain: a PET Study. NeuroImage 9: 453–460PubMedCrossRefGoogle Scholar
  105. 105.
    May A, Bahra A, Buchel C, Turner R, Goadsby PJ (1999) Functional MRI in spontaneous attacks of SUNCT: short-lasting neuralgiform headache with conjunctival injection and tearing. Ann Neurol 46: 791–793PubMedCrossRefGoogle Scholar
  106. 106.
    May A, Bahra A, Buchel C, Frackowiak RSJ, Goadsby PJ (2000) PET and MRA findings in cluster headache and MRA in experimental pain. Neurology 55: 1328–1335PubMedGoogle Scholar
  107. 107.
    May A, Buchel C, Turner R, Goadsby PJ (2001) MR-angiography in facial and other pain: neurovascular mechanisms of trigeminal sensation. J Cereb Blood Flow Metabol 21: 1171–1176CrossRefGoogle Scholar
  108. 108.
    McNaughton FL, Feindel WH (1977) Innervation of intracranial structures: a reappraisal. In: Rose FC (ed) Physiological aspects of clinical neurology. Blackwell Scientific Publications, Oxford, pp 279–293Google Scholar
  109. 109.
    Munoz C, Diez-Tejedor E, Frank A, Barreiro P (1996) Cluster headache syndrome associated with middle cerebral artery arteriovenous malformation. Cephalalgia 16: 202–205PubMedCrossRefGoogle Scholar
  110. 110.
    Nakai M, Tamaki K, Ogata J, Maeda M (1993) Parasympathetic cerebrovascular center of the facial nerve. Circ Res 72: 470–475PubMedGoogle Scholar
  111. 111.
    Pareja JA, Sjaastad O (1997) SUNCT syndrome. A clinical review. Headache 37: 195–202PubMedCrossRefGoogle Scholar
  112. 112.
    Pareja JA, Kruszewski P, Sjaastad O (1995) SUNCT syndrome: trials of drugs and anesthetic blockades. Headache 35: 138–142PubMedCrossRefGoogle Scholar
  113. 113.
    Pareja JA, Joubert J, Sjaastad O (1996) SUNCT syndrome. Atypical temporal patterns. Headache 36: 108–110PubMedCrossRefGoogle Scholar
  114. 114.
    Pareja JA, Ming JM, Kruszewski P, Caballero V, Pamo M, Sjaastad O (1996) SUNCT syndrome: duration, frequency and temporal distribution of attacks. Headache 36: 161–165PubMedCrossRefGoogle Scholar
  115. 115.
    Pareja JA, Ruiz J, Deisla C, Alsabbah H, Espejo J (1996) Idiopathic stabbing headache (jabs and jolts syndrome). Cephalalgia 16: 93–96PubMedCrossRefGoogle Scholar
  116. 116.
    Pareja JA, Kruszewski P, Caminero AB (1999) SUNCT syndrome versus idiopathic stabbing headache (jabs and jolts syndrome). Cephalalgia 19Suppl 25: 46–48PubMedGoogle Scholar
  117. 117.
    Peatfield R, Bahra A, Goadsby PJ (1998) Trigeminal-autonomic cephalgias (TACs). Cephalalgia 18: 358–361PubMedCrossRefGoogle Scholar
  118. 118.
    Peres MFP, Stiles MA, Siow HC, Rozen TD, Young WB, Silberstein SD (2002) Greater occipital nerve blockade for cluster headache. Cephalalgia 22: 520–522PubMedCrossRefGoogle Scholar
  119. 119.
    Piovesan EJ, Siow C, Kowacs PA, Werneck LC (2003) Influence of lamotrigine over the SUNCT syndrome: one patient follow-up for two years. Arq Neuropsiquiatr 61: 691–694PubMedGoogle Scholar
  120. 120.
    Porta-Etessam J, Martinez-Salio A, Berbel A, Benito-Leon J (2002) Gabapentin (neurontin) in the treatment of SUNCT syndrome. Cephalalgia 22: 249PubMedCrossRefGoogle Scholar
  121. 121.
    Porta-Etessam J, Ramos-Carrasco A, Berbel-Garcia A, Martinez-Salio A, Benito-Leon J (2001) Clusterlike headache as first manifestation of a prolactinoma. Headache 41: 723–725PubMedCrossRefGoogle Scholar
  122. 122.
    Raimondi E, Gardella L (1998) SUNCT syndrome. Two cases in Argentina. Headache 38: 369–371PubMedCrossRefGoogle Scholar
  123. 123.
    Rapoport AM, Bigal ME, Tepper SJ, Sheftell FD (2003) Treatment of cluster headache with topiramate: effects and side-effects in five patients. Cephalalgia 23: 69–70PubMedCrossRefGoogle Scholar
  124. 124.
    Schoenen J, Di Clemente L, Vandenheede M, Fumal A, De Pasqua V, Mouchamps M, Remacle JM, de Noordhout AM (2005) Hypothalamic stimulation in chronic cluster headache: a pilot study of efficacy and mode of action. Brain 128: 940–947PubMedCrossRefGoogle Scholar
  125. 125.
    Scorticati MC, Raina G, Federico M (2002) Cluster-like headache associated to a foreign body in the maxillary sinus. Neurology 59: 643–644PubMedGoogle Scholar
  126. 126.
    Seylaz J, Hara H, Pinard E, Mraovitch S, MacKenzie ET, Edvinsson L (1988) Effect of stimulation of the sphenopalatine ganglion on cortical blood flow in the rat. J Cereb Blood Flow Metabol 8: 875–878Google Scholar
  127. 127.
    Shields KG, Levy MJ, Goadsby PJ (2004) Alopecia and cutaneous atrophy following greater occipital nerve infiltration. Neurology 63: 2193–2194PubMedGoogle Scholar
  128. 128.
    Silberstein SD, Niknam R, Rozen TD, Young WB (2000) Cluster headache with aura. Neurology 54: 219–221PubMedGoogle Scholar
  129. 129.
    Siow HC, Young WB, Peres MF, Rozen TD, Silberstein SD (2002) Hemiplegic cluster. Headache 42: 136–139PubMedCrossRefGoogle Scholar
  130. 130.
    Sjaastad O (1992) Cluster Headache Syndrome. Saunders WB, LondonGoogle Scholar
  131. 131.
    Sjaastad O, Russell D, Horven I, Bunnaes U (1978) Multiple neuralgiform unilateral headache attacks associated with conjunctival injection and appearing in clusters. A nosological problem. Proceedings of the Scandinavian Migraine Society, Arhus, 31Google Scholar
  132. 132.
    Sjaastad O, Saunte C, Salvesen R, Fredriksen TA, Seim A, Roe OD, Fostad K, Lobben OP, Zhao JM (1989) Shortlasting unilateral neuralgiform headache attacks with conjunctival injection, tearing, sweating, and rhinorrhea. Cephalalgia 9: 147–156PubMedCrossRefGoogle Scholar
  133. 133.
    Sjaastad O, Kruszewski P (1992) Trigeminal neuralgia and “SUNCT” syndrome: similarities and differences in the clinical picture. An overview. Functional Neurology 7: 103–107PubMedGoogle Scholar
  134. 134.
    Spencer SE, Sawyer WB, Wada H, Platt KB, Loewy AD (1990) CNS projections to the pterygopalatine parasympathetic preganglionic neurons in the rat: a retrograde transneuronal viral cell body labeling study. Brain Res 534: 149–169PubMedCrossRefGoogle Scholar
  135. 135.
    Sprenger T, Boecker H, Tolle TR, Bussone G, May A, Leone M (2004) Specific hypothalamic activation during a spontaneous cluster headache attack. Neurology 62: 516–517PubMedGoogle Scholar
  136. 136.
    Tfelt-Hansen P, Paulson OB, Krabbe AE (1982) Invasive adenoma of the pituitary gland and chronic migrainous neuralgia. A rare coincidence or a causal relationship? Cephalalgia 2: 25–28PubMedCrossRefGoogle Scholar
  137. 137.
    Uddman R, Tajti J, Moller S, Sundler F, Edvinsson L (1999) Neuronal messengers and peptide receptors in the human sphenopalatine and otic ganglia. Brain Res 826: 193–199PubMedCrossRefGoogle Scholar
  138. 138.
    Weiller C, May A, Limmroth V, Juptner M, Kaube H, Schayck RV, Coenen HH, Diener HC (1995) Brainstem activation in spontaneous human migraine attacks. Nat Med 1: 658–660PubMedCrossRefGoogle Scholar
  139. 139.
    Weiner RL, Reed KL (1999) Peripheral neurostimulation for control of intractable occipital neuralgia. Neuromodulation 2: 217–222CrossRefGoogle Scholar
  140. 140.
    West P, Todman D (1991) Chronic cluster headache associated with a vertebral artery aneurysm. Headache 31: 210–212PubMedCrossRefGoogle Scholar
  141. 141.
    Wheeler SD, Carrazana EJ (1999) Topiramate-treated cluster headache. Neurology 53: 234–236PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  1. 1.The National Hospital for Neurology and NeurosurgeryInstitute of NeurologyLondonUK
  2. 2.Department of NeurologyUniversity of CaliforniaSan FranciscoUSA

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