title: Non-hypothalamic cluster headache: the role of the greater occipital nerve in cluster headache pathogenesis.
abstract: Cluster headache is marked by its circadian rhythmicity and the hypothalamus appears to have a significant influence over cluster pathogenesis. However, as not all cluster patients present in the same manner and not all respond to the same combination of medications, there is likely a nonhypothalamic form of cluster headache. A patient is presented who began to develop cluster headaches after receiving bilateral greater occipital nerve (GON) blockade. His headaches fit the IHS criteria for cluster headache but had some irregularities including frequent side shifting of pain, irregular duration and time of onset and the ability of the patient to sit completely still during a headache without any sense of agitation. This article will suggest that some forms of cluster headache are not primarily hypothalamic influenced and that the GON may play a significant role in cluster pathogenesis in some individuals.
authors.affiliation: Michigan Head-Pain and Neurological Institute, 3120 Professional Drive, Ann Arbor, MI 48104, USA. trozen@mhni.com
authors.forename: Todd D
authors.initials: TD
authors.lastname: Rozen
mesh_terms: D000344:Afferent Pathways / Q000187:drug effects / Q000503:physiopathology; D000779:Anesthetics, Local / Q000009:adverse effects; D000893:Anti-Inflammatory Agents / Q000009:adverse effects; D000927:Anticonvulsants / Q000627:therapeutic use; D002940:Circadian Rhythm / Q000187:drug effects / Q000502:physiology; D003027:Cluster Headache / Q000139:chemically induced* / Q000503:physiopathology; D005632:Fructose / Q000031:analogs & derivatives / Q000627:therapeutic use; D007839:Functional Laterality / Q000187:drug effects / Q000502:physiology; D020773:Headache Disorders / Q000150:complications / Q000188:drug therapy; D006801:Humans; D007031:Hypothalamus / Q000502:physiology / Q000503:physiopathology; D008012:Lidocaine / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects*; D009437:Neuralgia / Q000150:complications* / Q000188:drug therapy*; D009915:Orbit / Q000098:blood supply / Q000294:innervation / Q000503:physiopathology; D013127:Spinal Nerves / Q000187:drug effects* / Q000503:physiopathology*; D000077236:Topiramate; D016896:Treatment Outcome; D014221:Triamcinolone / Q000009:adverse effects; D014275:Trigeminal Caudal Nucleus / Q000187:drug effects / Q000503:physiopathology
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D000927:Anticonvulsants; D000077236:Topiramate; D014221:Triamcinolone; D005632:Fructose; D008012:Lidocaine