Trigemino-cervical reflex abnormalities in patients with migraine and cluster headache.
BACKGROUND
Head pain arises within the trigeminal nociceptive system. Current theories propose that the trigeminal system is intimately involved in the pathogenesis of migraine. Short-latency responses can be recorded in sternocleidomastoid muscles after stimulation of the trigeminal nerve (trigemino-cervical reflex). This brainstem reflex could be a suitable method to evaluate the trigeminal system in migraine and CH.


OBJECTIVE
The aim of the present study was to further elucidate the pathophysiology of migraine and cluster headache (CH) with special reference to the involvement of the central trigeminal system in the different forms of primary headache.


METHODS
The trigemino-cervical reflex was investigated in 15 healthy subjects, in 15 patients having migraine with aura, in 15 patients with migraine without aura, and in 10 patients with CH.


RESULTS
Significant abnormalities were observed in a great number of patients with both types of migraine and CH during the headache attacks, but only in migraine patients during the interictal period. The alterations are bilateral in migraine, unilateral in CH.


CONCLUSIONS
Our results further support the relevance of brainstem mechanisms in the pathogenesis of migraine rather than of CH. These data, taken together with that from experimental head pain and functional imaging studies, demonstrate that primary headache syndromes may be distinguished on a functional basis by areas of activation specific to the clinical syndrome.
Nardone
Raffaele
R
Department of Neurology, F. Tappeiner Hospital, Merano, Italy.
Ausserer
Harald
H
Bratti
Arianna
A
Covi
Markus
M
Lochner
Piergiorgio
P
Marth
Roland
R
Florio
Igor
I
Tezzon
Frediano
F
D000328:Adult; D002574:Cervical Vertebrae; D003027:Cluster Headache / Q000503:physiopathology*; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000503:physiopathology*; D018482:Muscle, Skeletal / Q000503:physiopathology; D009333:Neck / Q000503:physiopathology*; D012021:Reflex, Abnormal / Q000502:physiology*; D014276:Trigeminal Nerve / Q000503:physiopathology*