title: Two cases of symptomatic cluster-like headache suggest the importance of sympathetic/parasympathetic balance.
abstract: Despite several reports on symptomatic cluster-like headache, there is no clear explanation of how different lesions thought to be causative are related to cluster-like headache. On the basis of two additional cases of symptomatic cluster headache, we discuss the possibility that an acute imbalance of the autonomic nervous system, namely a net overactivity of the parasympathetic system, may be able to trigger these headache attacks in patients who probably have an additional individual predisposition to react with a cluster-like headache. Such an imbalance can be due to an increase in parasympathetic tone (e.g. stimulation of parasympathetic fibres) or to a reduction of the sympathetic tone (e.g. a lesion of the sympathetic fibres).
authors.affiliation: Department of Neurology, Klinikum Grosshadern, Ludwig-Maximilians-University Munich, Germany. andreas.straube@med.uni-muenchen.de
authors.forename: A
authors.initials: A
authors.lastname: Straube
authors.forename: T
authors.initials: T
authors.lastname: Freilinger
authors.forename: T
authors.initials: T
authors.lastname: Rüther
authors.forename: C
authors.initials: C
authors.lastname: Padovan
mesh_terms: D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000150:complications* / Q000503:physiopathology*; D003027:Cluster Headache / Q000150:complications* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008959:Models, Neurological; D010275:Parasympathetic Nervous System / Q000503:physiopathology*