Navigating the waves of cluster headache: clinical aspects and GON modulation

Naber, W.C.

doi:doi:10.60602/1887-4306536

This dissertation explored the factors underlying the “waves” of cluster headache and investigated strategies to reduce disease burden and improve quality of life. The first part focused on disease mechanisms, prognosis, and patient experiences. Long-term remission was associated with episodic disease, later onset age, more painful attacks, and smoking cessation, suggesting a multifactorial process and a possible role of smoking in disease development. Studies on illicit drug use showed that people with cluster headache more often used substances such as psilocybin and LSD, with some reporting reduced attack frequency or duration. Risk-taking behavior appeared increased in episodic cluster headache but reduced in chronic disease, suggesting adaptive changes over time. Hormonal studies demonstrated an increased prevalence of testosterone deficiency, particularly in chronic cluster headache, likely originating centrally in the brain.

To better assess disease burden, a...

This dissertation explored the factors underlying the “waves” of cluster headache and investigated strategies to reduce disease burden and improve quality of life. The first part focused on disease mechanisms, prognosis, and patient experiences. Long-term remission was associated with episodic disease, later onset age, more painful attacks, and smoking cessation, suggesting a multifactorial process and a possible role of smoking in disease development. Studies on illicit drug use showed that people with cluster headache more often used substances such as psilocybin and LSD, with some reporting reduced attack frequency or duration. Risk-taking behavior appeared increased in episodic cluster headache but reduced in chronic disease, suggesting adaptive changes over time. Hormonal studies demonstrated an increased prevalence of testosterone deficiency, particularly in chronic cluster headache, likely originating centrally in the brain.

To better assess disease burden, a Dutch version of the Cluster Headache Quality of Life questionnaire (CHQ-D) was developed and validated. Quality of life was more strongly associated with mental health and activity limitations than with attack frequency alone.

The second part investigated greater occipital nerve (GON) infiltration as a preventive treatment. Although clinically effective, neurophysiological studies found no evidence that symptom relief was mediated through altered trigeminal conduction, leaving the mechanism unresolved.

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Navigating the waves of cluster headache: clinical aspects and GON modulation