Pathophysiology of cluster headache: a trigeminal autonomic cephalgia

Lancet Neurol. 2002 Aug;1(4):251-7. doi: 10.1016/s1474-4422(02)00104-7.


Cluster headache is a form of primary neurovascular headache with the following features: severe unilateral, commonly retro-orbital, pain accompanied by restlessness or agitation, and cranial (parasympathetic) autonomic symptoms, such as lacrimation or conjunctival injection. It occurs in attacks typically of less than 3 h in length and in bouts (clusters) of a few months during which the patient has one or two attacks per day. The individual attack involves activation of the trigeminal-autonomic reflex; thus, such headaches can be broadly classified with the other trigeminal-autonomic cephalgias, such as paroxysmal hemicrania and the syndrome of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing. Observations of circadian biological changes and neuroendocrine disturbances have suggested a pivotal role for the hypothalamus in cluster headache. Functional neuroimaging with PET and anatomical imaging with voxel-based morphometry have identified the posterior hypothalamic grey matter as the key area for the basic defect in cluster headache.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Autonomic Nervous System Diseases / complications*
  • Autonomic Nervous System Diseases / diagnosis
  • Autonomic Nervous System Diseases / physiopathology*
  • Cluster Headache / diagnosis
  • Cluster Headache / etiology*
  • Cluster Headache / physiopathology*
  • Humans
  • Trigeminal Nerve Diseases / complications*
  • Trigeminal Nerve Diseases / diagnosis
  • Trigeminal Nerve Diseases / physiopathology*