The location of pain in cluster headache: Data from the International Cluster Headache Questionnaire.

OBJECTIVE: To identify the most common locations of cluster headache pain from an international, non-clinic-based survey of participants with cluster headache, and to compare these locations to other cluster headache features as well as to somatotopic maps of peripheral, brainstem, thalamic, and cortical areas. BACKGROUND: Official criteria for cluster headache state pain in the orbital, supraorbital, and/or temporal areas, yet studies have noted pain extending beyond these locations, and the occipital nerve appears relevant, given the effectiveness of suboccipital corticosteroid injections and occipital nerve stimulation. Furthermore, cranial autonomic features vary between patients, and it is not clear if the trigeminovascular reflex is dermatome specific (e.g., do patients with maxillary or V2 division pain have more rhinorrhea?). Finally, functional imaging studies show early activation of the posterior hypothalamus in a cluster headache attack. However, the first somatosensory area to be sensitized is unclear; the first area can be hypothesized based on the complete map of pain locations. METHODS: The International Cluster Headache Questionnaire was an internet-based cross-sectional survey that included a clickable pain map of the face. These data were compared to several other datasets: (1) a meta-analysis of 22 previous publications of pain location in cluster headache (consisting of 6074 patients); (2) four cephalic dermatome maps; (3) participants' survey responses for demographics, autonomic features, and effective medications; and (4) previously published somatotopic maps of the brainstem, thalamus, primary somatosensory cortex, and higher order somatosensory cortex. RESULTS: One thousand five hundred eighty-nine participants completed the pain map portion of the survey, and the primary locations of pain across all respondents was the orbital, periorbital, and temporal areas with a secondary location in the lower occiput; these primary and secondary locations were consistent with our meta-analysis of 22 previous publications. Of the four cephalic dermatomes (V1, V2, V3, and a combination of C2-3), our study found that most respondents had pain in two or more dermatomes (range 85.7% to 88.7%, or 1361-1410 of 1589 respondents, across the four dermatome maps). Dermatomes did not correlate with their respective autonomic features or with medication effectiveness. The first area to be sensitized in the canonical somatosensory pathway is either a subcortical (brainstem or thalamus) or higher order somatosensory area (parietal ventral or secondary somatosensory cortices) because the primary somatosensory cortex (area 3b) and somatosensory area 1 have discontinuous face and occipital regions. CONCLUSIONS: The primary pain locations in cluster headache are the orbital, supraorbital, and temporal areas, consistent with the official International Classification of Headache Disorders criteria. However, activation of the occiput in many participants suggests a role for the occipital nerve, and the pain locations suggest that somatosensory sensitization does not start in the primary somatosensory cortex.

Folding of the cerebellar cortex is clade-specific in form but universal in degree.

Like the cerebralcortex, the surface of the cerebellum is repeatedly folded. Unlike the cerebralcortex, however, cerebellar folds are much thinner and more numerous; repeatthemselves largely along a single direction, forming accordion-like folds transverseto the mid-sagittal plane; and occur in all but the smallest cerebella. We haveshown previously that while the location of folds in mammalian cerebral cortex isclade-specific, the overall degree of folding strictly follows a universalpower law relating cortical thickness and the exposed and total surface areas predictedfrom the minimization of the effective free energy of an expanding, self-avoidingsurface of a certain thickness. Here we show that this scaling law extends tothe folding of the mid-sagittal sections of the cerebellum of 53 speciesbelonging to six mammalian clades. Simultaneously, we show that each clade hasa previously unsuspected distinctive spatial pattern of folding evident at themid-sagittal surface of the cerebellum. We note, however, that the mammaliancerebellum folds as a multi-fractal object, because of the difference betweenthe outside-in development of the cerebellar cortex around a preexisting coreof already connected white matter, compared to the inside-out development ofthe cerebral cortex with a white matter volume that develops as the cerebralcortex itself gains neurons. We conclude that repeated folding, one of the mostrecognizable features of biology, can arise simply from the interplay betweenthe universal applicability of the physics of self-organization and biological,phylogenetical clade-specific contingency, without the need for invokingselective pressures in evolution.

Organization of Somatosensory Cortex in the South American Rodent Paca (Cuniculus paca).

INTRODUCTION: The study of non-laboratory species has been part of a broader effort to establish the basic organization of the mammalian neocortex, as these species may provide unique insights relevant to cortical organization, function, and evolution. METHODS: In the present study, the organization of three somatosensory cortical areas of the medium-sized (5-11 kg body mass) Amazonian rodent, the paca (Cuniculus paca), was determined using a combination of electrophysiological microelectrode mapping and histochemical techniques (cytochrome oxidase and NADPH diaphorase) in tangential sections. RESULTS: Electrophysiological mapping revealed a somatotopically organized primary somatosensory cortical area (S1) located in the rostral parietal cortex with a characteristic foot-medial/head-lateral contralateral body surface representation similar to that found in other species. S1 was bordered laterally by two regions housing neurons responsive to tactile stimuli, presumably the secondary somatosensory (S2) and parietal ventral (PV) cortical areas that evinced a mirror-reversal representation (relative to S1) of the contralateral body surface. The limits of the putative primary visual (V1) and primary auditory (A1) cortical areas, as well as the complete representation of the contralateral body surface in S1, were determined indirectly by the histochemical stains. Like the barrel field described in small rodents, we identified a modular arrangement located in the face representation of S1. CONCLUSIONS: The relative location, somatotopic organization, and pattern of neuropil histochemical reactivity in the three paca somatosensory cortical areas investigated are similar to those described in other mammalian species, providing additional evidence of a common plan of organization for the somatosensory cortex in the rostral parietal cortex of mammals.