Highlights
- •Cortical excitability was investigated in patients with episodic cluster headache.
- •Motor cortical hyperexcitability was shown in patients both inside and outside bout.
- •Cortical excitability was asymmetric between the hemispheres.
- •Greater responses to transcranial magnetic stimulation were shown in the hemisphere ipsilateral to the pain side.
- •Abnormal cortical excitability may play a role in cluster headache pathophysiology.
Abstract
Evidence shows involvement of the cerebral cortex in the pathophysiology of cluster
headache (CH). Here we investigated cortical excitability in episodic CH patients
by using transcranial magnetic stimulation. In 25 patients with episodic CH and 13
healthy subjects we evaluated the motor cortical response to single-pulse (ie, motor
threshold, input-output curves, cortical silent period) and paired-pulse (ie, intracortical
facilitation, short intracortical inhibition) transcranial magnetic stimulation in
both hemispheres. Thirteen patients were evaluated outside bout and the remaining
12 patients inside bout. Our results showed increased slope of the input-output curves
after stimulation of both hemispheres in patients outside bout and in the hemisphere
contralateral to the headache side in patients inside bout. Increased intracortical
facilitation was observed in the hemisphere ipsilateral to the headache side in patients
evaluated both outside and inside bout; reduced short intracortical inhibition was
observed in patients inside bout ipsilateral to the side of pain. In conclusion, we
provide evidence of increased cortical excitability in episodic CH both outside and
inside bout, especially in the hemisphere ipsilateral to the side of headache attacks.
Our results suggest that an abnormal regulation of cortical excitability could be
involved in the pathophysiology of CH.
Perspectives
We investigated cortical excitability in episodic cluster headache by using transcranial
magnetic stimulation, providing evidence of cortical hyperexcitability in patients
both inside and outside bout. We suggest that an abnormal state of cortical excitability
could be involved in the pathophysiology of the disease.
Key words
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Article info
Publication history
Published online: October 31, 2014
Accepted:
October 21,
2014
Received in revised form:
October 6,
2014
Received:
August 14,
2014
Footnotes
The authors declare that they have no competing interests.
Identification
Copyright
© 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.
