Carotid angiography in cluster headache.

TLDR: The present study was undertaken on the hypothetical basis that anatomical variations in the size of the carotid artery, e.g. arteriectasis, in relation to the bony structures of the skull, particularly its foramina, might be of significance in cluster headache.

Abstract: The pathogenesis of cluster headache is not completely understood. Most authors have suggested that the pain is due to local dilatation of branches of the external carotid artery (HORTON 1956, 1961, FRIEDMAN & MIKROPOULOS 1958, WOLFF 1963) with release of a pain threshold-lowering substance into the perivascular tissues. It is well recognized, however, that some patients may exhibit signs of a partial Horner's syndrome, either permanently or only transiently during the attacks. This seems to indicate that in these patients the lesion responsible for the actual pain is localized in the internal carotid artery as well. It is a matter of interest that the headache in repeated attacks occurs strictly unilateral on the same side of the head. Only occasionally does the pain alternate from side to side. This clearly contrasts with migrainous headaches and suggests a different pathophysiologic basis for the attacks. Hitherto no definite explanation has been offered for this peculiar type of headache. The present study was undertaken on the hypothetical basis that anatomical variations in the size of the carotid artery, e.g. arteriectasis, in relation to the bony structures of the skull, particularly its foramina, might be of significance in cluster headache. All carotid angiographies performed in patients with this condition were therefore carefully examined and particular attention paid to the caliber of the internal carotid artery and its branches at different levels. The measurements were compared