May A, Bahra A, Büchel C, Frackowiak R S, Goadsby P J
University Department of Clinical Neurology, Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
Lancet. 1998 Jul 25;352(9124):275-8. doi: 10.1016/S0140-6736(98)02470-2.
Cluster headache, one of the most severe pain syndromes in human beings, is usually described as a vascular headache. However, the striking circadian rhythmicity of this strictly half-sided pain syndrome cannot be readily explained by the vascular hypothesis. We aimed to assess changes in regional cerebral blood flow (rCBF) in patients with cluster headache.
We used positron emission tomography (PET) to assess the changes in rCBF, as an index of synaptic activity, during nitroglycerin-induced cluster headache attacks in nine patients who had chronic cluster headache. Eight patients who had cluster headache but were not in the bout acted as a control group.
In the acute pain state, activation was seen in the ipsilateral inferior hypothalamic grey matter, the contralateral ventroposterior thalamus, the anterior cingulate cortex, and bilaterally in the insulae. Activation in the hypothalamus was seen solely in the pain state and was not seen in patients who have cluster headache but were out of the bout.
Our findings establish central nervous system dysfunction in the region of the hypothalamus as the primum movens in the pathophysiology of cluster headache. We suggest that a radical reappraisal of this type of headache is needed and that it should in general terms, be regarded as a neurovascular headache, to give equal weight to the pathological and physiological mechanisms that are at work.
丛集性头痛是人类最严重的疼痛综合征之一，通常被描述为血管性头痛。然而，这种严格单侧性疼痛综合征显著的昼夜节律性难以用血管假说轻易解释。我们旨在评估丛集性头痛患者局部脑血流量（rCBF）的变化。
我们使用正电子发射断层扫描（PET）来评估9例慢性丛集性头痛患者在硝酸甘油诱发丛集性头痛发作期间作为突触活动指标的rCBF变化。8例处于非发作期的丛集性头痛患者作为对照组。
在急性疼痛状态下，同侧下丘脑灰质、对侧腹后丘脑、前扣带回皮质以及双侧脑岛出现激活。下丘脑的激活仅在疼痛状态下可见，在处于非发作期的丛集性头痛患者中未观察到。
我们的研究结果证实下丘脑区域的中枢神经系统功能障碍是丛集性头痛病理生理学中的主要驱动因素。我们建议需要对这类头痛进行彻底重新评估，总体而言，应将其视为神经血管性头痛，以同等重视起作用的病理和生理机制。
