Flavia Pauri, Chiara Lepre
Neurology Section, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Viale dell'Università 30, 00186 Rome, Italy.
Springerplus. 2016 Mar 31;5(1):396. doi: 10.1186/s40064-016-2000-4. eCollection 2016.
The trigeminal autonomic cephalagias (TACs) are short-lasting unilateral headaches associated with autonomic features. Even if coexistence of different ipsilateral TACs in the same patient has been previously reported in few papers, the simultaneous occurrence of contralateral TACs is not described previously.
A 50 years old working man complained, at the end of his cluster period, a new TAC, fitting the criteria for probable paroxysmal hemicrania. The dramatic improvement of this last cephalalgia with indomethacin treatment confirmed the diagnosis.
There is a clear overlap in clinical diagnosis between cluster headache (CH) and paroxysmal hemicrania (PH) and similarities are somewhat greater than differences. The originality of this report is the coexistence of contralateral TACs in the same patients at the same moment. According neuroimaging studies, CH hypothalamic activation occurs ipsilateral to the side of the headache while in PH hypothalamic activation occurs contralateral to the side of headache. It could be suggested that a continuous hypothalamic activation give a maladaptive plasticity recruiting closed neuronal aggregates responsible for the developing of PH after a long period of CH, confirming the central origin of both CH and PH. Further studies need to confirm this hypothesis.
三叉自主神经性头痛（TACs）是与自主神经特征相关的短暂性单侧头痛。尽管此前已有少数文献报道同一患者同侧不同类型TACs共存的情况，但对侧TACs同时出现的情况此前尚无描述。
一名50岁的上班族在丛集性头痛发作末期抱怨出现一种新的TAC，符合可能的发作性偏侧头痛的标准。吲哚美辛治疗使这种最后的头痛症状显著改善，从而确诊。
讨论、评估与结论：丛集性头痛（CH）和发作性偏侧头痛（PH）在临床诊断上存在明显重叠，相似之处略多于不同之处。本报告的独特之处在于同一患者在同一时刻出现对侧TACs。根据神经影像学研究，CH时下丘脑激活发生在头痛侧的同侧，而PH时下丘脑激活发生在头痛侧的对侧。可以推测，持续的下丘脑激活会产生适应性不良的可塑性，募集封闭的神经元聚集物，导致在长期CH后发生PH，这证实了CH和PH的中枢起源。需要进一步研究来证实这一假设。
