Impairment of corneal pain perception in cluster headache.
Despite many studies, the mechanisms underlying the pathogenesis of pain in cluster headache (CH) still remain obscure. An involvement of substance P (SP) containing neurons of the Gasserian ganglion and/or of the spinal trigeminal nucleus has recently been suggested, e.g., by impairment of inhibitory descending pathways on trigeminal nociceptive neurons. The electrically elicited corneal reflex was studied in 21 CH patients (15 in active phase, 6 in remission). This method allows simultaneous measurements of the trigemino-facial reflex and corneal pain perception. A significant reduction of pain thresholds (more evident on the pain side) was observed in CH during the active phase, while normal values were recorded during the remission phase. Ten out of 15 patients in the active phase showed a significantly reduced corneal pain threshold on the pain side, while tactile sensibility was normal. Moreover, latency, amplitude and duration of the corneal reflex were normal for both painful and painless stimulations during both phases. The threshold of the nociceptive muscular response in the active phase was significantly reduced, suggesting that the excitability of trigeminal nociceptive neurons or of the motor neurons is increased in CH. The results agree with the hypothesis that a reversible impairment of several integrative functions, including the activity of trigeminal pain control system, exists in CH during the active phase.
Sandrini
Giorgio
G
3rd Department of Neurology, C. Mondino Foundation, University of Pavia, Pavia Italy Department of Neurology, University of Parma, Parma Italy.
Alfonsi
Enrico
E
Ruiz
Luigi
L
Pavesi
Giovanni
G
Micieli
Giuseppe
G
Manzoni
Gian Camillo
GC
Mancia
Domenico
D
Nappi
Giuseppe
G
D000328:Adult; D000704:Analysis of Variance; D001767:Blinking / Q000502:physiology*; D003027:Cluster Headache / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology*; D010465:Perception / Q000502:physiology*; D011930:Reaction Time; D012684:Sensory Thresholds / Q000502:physiology