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

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.