Beyond coincidence: a case series on the clinical course of coinciding cluster headache and short-lasting unilateral neuralgiform headache attacks

Abstract

Introduction:

Limited research has been conducted on co-occurring cluster headache and short-lasting unilateral neuralgiform headache attacks (SUNHA).

Objectives: This case series aims to explore whether the observed overlap of cluster headache and SUNHA reflects a coincidental co-occurrence or suggests a shared underlying mechanism while also providing insights to improve diagnosis and management of these patients. Methods: A retrospective case series of 10 patients with a diagnosis of both cluster headache and SUNHA. Results: Two patients exhibited simultaneous onset of cluster headache and SUNHA (concurrent cluster-SUNHA), whereas the remaining 8 had consecutive cluster-SUNHA. Overlapping localization of pain and autonomic symptoms were observed in 9 of 10 cases. Magnetic resonance imaging was performed in 8 patients, revealing an ipsilateral trigeminal neurovascular conflict in half of them. Four patients underwent microvascular decompression, which exhibited varying efficacy on both cluster headache and SUNHA. Conclusion: This study constitutes the most extensive description to date of individuals diagnosed with both cluster headache and SUNHA. The observed co-occurrence of these headache types could suggest a pathophysiological relationship between the 2, which might be explained by a bidirectional interaction between posterior hypothalamic function and trigeminal root demyelination. The role of a trigeminal neurovascular conflict seems likely in this context, with dedicated magnetic resonance imaging being the optimal method for its identification. The potential role of microvascular decompression as a treatment in cluster-SUNHA cases where such a conflict is identified warrants further investigation.