Sistema trigémino vascular y cefalea / Trigeminovascular System and Primary Headache

La fisiopatología de las cefaleas primarias es compleja e incluye un sinnúmerode interacciones que regulan el proceso nociceptivo. Dentro de los principalesresponsables de generar el dolor se encuentra el sistema trigémino vascular, que esun conjunto de estructuras que integran vías tanto centrales corticosubcorticales comoperiféricas, que desempeñan un papel activo no solo en la génesis del dolor, sino enlas manifestaciones autonómicas y visuales que acompañan la cefalea. Así mismo, estesistema es el responsable de los mecanismos de sensibilización central característicosdel dolor. En el artículo se desarrollan brevemente las principales estructuras queparticipan en la génesis de las cefaleas primarias y sus interacciones en las diferentespartes del sistema nervioso...

The pathophysiology of primary headache iscomplex and it includes several interactionsthat regulate the nociceptive process. The trigeminal-vascular system is perhaps one of theprincipal structures that generate pain due tothe integration of several pathways both centraland peripheral. In addition to this, the trigeminalvascular system also plays a central role inthe autonomic and visual symptoms that affectindividuals with headache and in the centralsensitization process. In this article we brieflydiscuss the main structures that participate in thepathophysiology of primary headaches and theirinteractions in the different levels of the centralnervous system...

A probable cluster headache case from a textbook of 1726: Francisco Suarez de Rivera's description.

BACKGROUND: Few descriptions of cluster and cluster-like headache made before the 19th century have been reported. CASE DESCRIPTION: We present a previously unreported early description of a probable cluster headache case made by Francisco Suárez de Rivera (1686-c.1751), one of the main physicians of the Spanish Age of Enlightenment, writer of almost 40 textbooks about medicine, surgery, pharmacology, and therapeutics. DISCUSSION: The depiction here reported of a woman with probable cluster headache is possibly one of the earliest known and, to our knowledge, the first in Hispanic literature. We also review other descriptions of cluster and cluster-like headache from the same time period.

An early 18th-century case description of cluster headache.

We present a previously unreported early 18th-century description of cluster headache by the English antiquary Abraham de la Pryme (1671-1704) initially attributed to hydrophobia (rabies). We will also give a short overview of other descriptions of cluster and cluster-like headache in historical literature.

Headaches in antiquity and during the early scientific era.

This paper presents the evolution of ideas on headache symptoms from antiquity through the 19th century. A thorough study of texts, medical books and reports along with a review of the available literature in PubMed was undertaken: observations on headaches date back nearly 4,000 years to the ritual texts of Mesopotamia. Nicolaes Tulp, Thomas Willis and Gerhard van Swieten also made important contributions on various forms of headaches in the 17th and 18th centuries. Edward Liveing and William Gowers made the major contributions to the field in the late 19th century. Overall, observations on headaches span a timeline of nearly 9,000 years. The work of the physicians during the 18th and 19th century, however, set the basis for scientific research.

Epidemiology of cluster headache.

Cluster headache was first described over 300 years ago, but in the last century our knowledge of the disorder has exploded through both clinical observation and epidemiological data. Although some of the data are conflicting and more need to be obtained, much is known about the disorder. This article reviews the data to date on the prevalence and incidence of the disorder, population differences including gender and race, genetics, comorbid conditions, risk factors for development of the disorder, prognosis, and socioeconomic burden.

Cluster headache: from treatment to pathophysiology.

This key note lecture illustrates the role of clinical developments in stimulating research and discovery in the area of the pathophysiology of cluster headache (CH) and other trigeminal autonomic cephalalgias (TACs), reviewing the physiological, biochemical and neuroimaging data that have suggested involvement of the hypothalamus in CH pathogenesis. These findings suggested the use of deep brain stimulation as a treatment for chronic drug-resistant CH. The typical circadian and circannual periodicity of CH attacks were the fundamental clinical characteristics that shifted focus from peripheral hypotheses to the idea of central origin for this headache form. Functional neuroimaging demonstrated that TACs are associated with activation of the posterior hypothalamus and there is clinical evidence that patients who suffer from CH have altered biological rhythms. Furthermore, the principal seat of biorhythm regulation - the hypothalamus - is known to have a modulatory role on nociceptive and autonomic pathways, specifically trigemino-vascular nociceptive pathways. Future research will elucidate why neuromodulatory approaches are effective in CH and other TACs, determine whether the hypothalamus is itself the generator of CH attacks, or whether it is activated in response to a generator situated elsewhere, and identify pharmacological treatments that directly target the hypothalamus.

Functional imaging in primary headache disorders.

Over the past two decades, the development of new functional neuroimaging techniques has improved our understanding of the brain events underlying several primary headache disorders. In migraine and cluster headache, the advent of these techniques has shifted the emphasis in pathophysiological research away from the vessel and back to the brain.

Francis Kilvert (1840-1879): an early self-report of cluster headache?

The published selections from the diary of the clergyman Francis Kilvert, dating from the 1870s, were systematically searched for accounts of headache, face ache and face pain. Although limited, as all such retrospective studies with restricted documentation must be, nonetheless illustrative quotations from the diaries suggest he may have suffered from cluster headache. This may be one of the earliest accounts by a patient, rather than a physician, of cluster headache.

When cluster headache was called histaminic cephalalgia (Horton's headache).

The Author revives his experiences and reminiscences in the frontline research and everyday clinical practice dealing with what was then called "histaminic cephalalgia" (Horton's headache). In this context, the Author, one of the historical representatives of the School of Florence, reports an outline of the contribution of this pioneering period in order to promote research ideas concerning possible brain involvement in cluster headache (CH) pathogenesis, which is currently accepted worldwide. The recent history of CH has registered remarkable progress in revealing the mystery of this pathology and it is likely that, in the near future, through the development of better education and new treatments, the overall suffering of patients will be further minimised.

History of cluster headache.

Possibly because of the manifestation of severe debilitating pain, cluster headache has been identified in early publications, described in exquisite detail by authors dating as far back as 1641. These early descriptions focused on the symptoms of the episodes rather than the periodicity of their occurrence. Similar to most medical conditions described without anatomic or clearly defined pathophysiologic basis, cluster headache often was named for its clinical manifestations, or less helpfully, by the names of the authors of its descriptive publications. It was only in 1952 that the condition was named for its peculiar tendency to occur in clusters over a period of weeks rather than being a chronic, recurrent, episodic condition similar to migraine. Despite having such an interesting mix of autonomic and physical features, this observation seems to be most instrumental in divulging the true pathogenesis of this disease and correctly localizing its origin anatomically in the hypothalamus.

Elusive amines and primary headaches: historical background and prospectives.

Although the role of trace amines such as tyramine, octopamine and synephrine in the pathogenesis of migraine has been debated for decades, this issue remains still unresolved. In spite of a relevant body of work, the inability to demonstrate specific receptors for these compounds and the lack of sensitive non-radioactive methods for the detection of trace amines in biological samples have limited their investigation in humans. However, the recent identification of a new, large family of G protein-coupled receptors, some of which bind and are activated by trace amines, has focused renewed attention on these compounds. This discovery, together with the possibility of providing novel insights for evaluation of the pathophysiological role of trace amines in primary headaches, may offer new opportunities for pharmacological strategies acting on these receptors. In light of the new scientific background, this review outlines a historical perspective and summarizes evidence supporting a role of trace amines in the pathogenesis of migraine and cluster headache.

Wilfred Harris' early description of cluster headache.

Wilfred Harris was a London neurologist with a significant interest in the treatment of neuralgia. Harris' descriptions of what he called migrainous neuralgia were the first recorded of cluster headache in the English medical literature. He was probably one of the first to describe the cluster phenomenon itself and the effectiveness of ergotamine in treating acute attacks of cluster headache. His seminal contributions to the clinical and therapeutic spectrum of cluster headache are reviewed.