Yu Kimberley, Chadehumbe Madeline
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Department of Neurology, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
SAGE Open Med Case Rep. 2021 Jun 11;9:2050313X211023679. doi: 10.1177/2050313X211023679. eCollection 2021.
While cluster headaches are classified and considered a primary headache disorder, secondary causes of cluster headaches have been reported and may provide insight into cluster headaches' potential pathophysiology. The mechanisms underlying this headache phenotype are poorly understood, and several theories have been proposed that range from the activation within the posterior hypothalamus to autonomic tone dysfunction. We provide a review of reported cases in the literature describing secondary causes after cardiac procedures. We will present a novel pediatric case report of a 16-year-old boy with an isolated innominate artery who presented with acute new-onset headaches 8 h following cardiac catheterization of the aortic arch with arteriography and left pulmonary artery stent placement. The headaches were characterized by attacks of excruciating pain behind the left eye and jaw associated with ipsilateral photophobia, conjunctival injection, rhinorrhea, with severe agitation and restlessness. These met the -3 criteria for episodic cluster headaches. The headaches failed to respond to non-steroidal anti-inflammatory medications, dopamine antagonists, and steroids. He showed an immediate response to treatment with oxygen. This unique case of cluster headaches following cardiac catheterization in a pediatric patient with an isolated innominate artery may provide new insight into cluster headaches' pathogenesis. We hypothesize that the cardiac catheterization induced cardiac autonomic changes that contributed to the development of his cluster headaches. The role of aortic arch anomalies and procedures in potential disruption of the autonomic tone and the causation of cluster headaches is an area requiring further study.
虽然丛集性头痛被分类并被视为原发性头痛疾病，但丛集性头痛的继发性病因已有报道，这可能有助于深入了解丛集性头痛的潜在病理生理学。这种头痛表型的潜在机制尚不清楚，已经提出了几种理论，范围从下丘脑后部的激活到自主神经张力功能障碍。我们对文献中报道的心脏手术后继发性病因的病例进行了综述。我们将呈现一个新的儿科病例报告，一名16岁患有孤立无名动脉的男孩，在进行主动脉弓心脏导管造影和左肺动脉支架置入术后8小时出现急性新发头痛。头痛的特点是左眼和下颌后方剧烈疼痛发作，伴有同侧畏光、结膜充血、流涕，伴有严重的烦躁不安。这些符合发作性丛集性头痛的标准。头痛对非甾体类抗炎药、多巴胺拮抗剂和类固醇治疗无效。他对吸氧治疗立即有反应。在一名患有孤立无名动脉的儿科患者中，心脏导管术后出现丛集性头痛的这一独特病例可能为丛集性头痛的发病机制提供新的见解。我们推测心脏导管术引起的心脏自主神经变化促成了他丛集性头痛的发展。主动脉弓异常和手术在自主神经张力潜在破坏及丛集性头痛病因中的作用是一个需要进一步研究的领域。
