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Monday, March 19, 2012

Study Shows that Cluster Headaches Mediated By Trigeminal Nerve

This study confirms the role of the trigeminal nerve in cluster headaches. A diagnostic neuromuscular orthotic is a reasonable and positive step in confirming not only trigeminal involvement but may alleviate or eliminate cluster headaches. A negative result from a neuromuscular diagnostic orthotic can be followed by addition of a SPG block with safe lidocaine.

In my experience almost all patients have a positive response to SPG blocks (spenopalatine ganglion blocks) or neuromuscular orthotics. Combination of these treatments brings about almost universal sucess of varying levels.

Neurology. 2012 Mar 14. [Epub ahead of print]

Lateralized central facilitation of trigeminal nociception in cluster headache.


From the Department of Neurology (D.H., C.G., S.Z., S.N., S.K., H.-C.D., Z.K., M.O.), University of Duisburg-Essen, Essen; and Interdisciplinary Pain Center (H.K.), University of Freiburg, Freiburg, Germany.



To investigate whether central facilitation of trigeminal pain processing is part of the pathophysiology of cluster headache (CH).


Sixty-six patients with CH (18 episodic CH inside bout, 28 episodic CH outside bout, 20 chronic CH) according to the International Classification of Headache Disorders-II classification, as well as 30 healthy controls, were investigated in a case-control study using simultaneous recordings of the nociceptive blink reflex (nBR) and pain-related evoked potentials (PREP) following nociceptive electrical stimulation on both sides of the forehead (V1).


nBR latency ratio (headache side/nonheadache side) was decreased in all CH patients independent from CH subtype compared with healthy controls indicating central facilitation at brainstem level. Area under the curve ratio was increased in patients with episodic CH inside bout only. PREP showed decreased N2 latency ratio in patients with chronic CH indicating central facilitation at supraspinal (thalamic or cortical) level.


Asymmetric facilitation of trigeminal nociceptive processing predominantly on brainstem level was detected in patients with CH. This alteration is most pronounced in the acute pain phase of the disease, but appears to persist in remission periods. Only chronic CH patients show additional changes of PREP prompting to supraspinal changes of pain processing related to the chronic state of disease in regard to neuronal plasticity, which exceeds changes observed in episodic CH.

[PubMed - as supplied by publisher]

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posted by Dr Shapira at 5:43 PM

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