Department of Neurology, Vivekananda Institute of Medical Science, Kolkata, West Bengal, India.
Curr Neurol Neurosci Rep. 2024 Dec;24(12):581-592. doi: 10.1007/s11910-024-01381-8. Epub 2024 Oct 21.
To describe different pitfalls in the diagnosis of primary cluster headaches (CHs) with the guidance of seven case vignettes.
The question of whether primary CHs and migraines are totally different entities has been long debated. Autonomic features can be detected in as many as 60% of migraine patients. Although some genetic similarities have been found, CACNA1A mutations have not been detected among CH patients with hemimotor aura in contrast to hemiplegic migraine. Recently, functional MRI studies have shown that the left thalamic network was the most discriminative MRI feature in distinguishing migraine from CH patients. Compared to migraine, CH patients showed decreased functional interaction between the left thalamus and cortical areas mediating interception and sensory integration. However, clinically the most significant feature had been the restlessness and agitation seen during headache attacks patients with CHs. This feature is also important in distinguishing cluster patients from other patients having other trigeminal autonomic cephalalgias except for a subset of patients with hemicrania continua. CH is an important member of the group of headache disorders characterized by their association with one or more autonomic features in the trigeminal nerve distribution and termed Trigeminal Autonomic Cephalalgias (TACs). Although CH is a relatively rare condition, judged by the distress it generally causes to the affected individual, early diagnosis and institution of appropriate therapy seem mandatory. Correct diagnosis of CHs needs avoidance of pitfalls. Such pitfalls generally include differentiation from migraine, differentiation from other side locked headache disorders, from other trigeminal autonomic cephalalgias (TACs), and lastly, recognition of rare presentations of cluster-like manifestations with hemiplegic aura and simulating trigeminal and glossopharyngeal neuralgias. Differentiation between primary and symptomatic CHs related to sellar pathologies and systemic medical conditions is of equal importance. In the present review such issues are discussed with the assistance of seven case vignettes.
通过七个病例介绍，描述原发性丛集性头痛（CH）诊断中的不同误区。
原发性 CH 和偏头痛是否完全不同的实体，这一问题长期以来一直存在争议。多达 60%的偏头痛患者会出现自主神经症状。尽管已经发现了一些遗传相似性，但与偏瘫性偏头痛不同，CH 伴半侧面肌瘫痪的患者并未发现 CACNA1A 突变。最近，功能磁共振成像研究表明，左侧丘脑网络是区分偏头痛和 CH 患者的最具鉴别性的 MRI 特征。与偏头痛相比，CH 患者在头痛发作期间表现出丘脑与皮质区域之间的功能交互减少，这些区域介导感知中断和感觉整合。然而，临床上最显著的特征是 CH 患者在头痛发作期间表现出不安和躁动。这一特征对于将丛集性头痛患者与除了一部分慢性偏头痛患者之外的其他三叉神经自主头痛患者区分开来也很重要。CH 是一组头痛障碍的重要成员，其特征是与三叉神经分布中的一个或多个自主神经特征相关，被称为三叉神经自主头痛（TAC）。尽管 CH 是一种相对罕见的疾病，但根据它通常给患者带来的痛苦程度判断，早期诊断和适当的治疗似乎是必要的。正确诊断 CH 需要避免误区。这些误区一般包括与偏头痛的鉴别、与其他单侧头痛疾病的鉴别、与其他三叉神经自主头痛（TAC）的鉴别，以及最后，对伴有偏瘫性先兆的簇状表现和模拟三叉神经痛和舌咽神经痛的罕见表现的识别。区分与鞍区病变和全身疾病相关的原发性和症状性 CH 同样重要。在本综述中，通过七个病例介绍讨论了这些问题。
