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Case Reports
. 2021 Jul;61(7):1136-1139.
doi: 10.1111/head.14180.

Secondary cluster headache due to a contralateral demyelinating periaqueductal gray matter lesion

Alessia Fiore  1 , Elena Tsantes  1 , Erica Curti  1 , Veronica Bazzurri  1 , Franco Granella  1   2
Affiliations
Case Reports

Secondary cluster headache due to a contralateral demyelinating periaqueductal gray matter lesion

Alessia Fiore et al. Headache. 2021 Jul.

Abstract

Objectives/background: Tension-type headache and migraine without aura are the most common primary headaches occurring in people with demyelinating diseases, whereas cluster headache (CH) can be considered exceptional. The location of demyelinating lesions could be strategic in these cases, involving areas interacting with the trigeminovascular system.

Methods and results: We report a case of a 54-year-old woman with right-sided CH as the initial manifestation of multiple sclerosis and showing a left dorsal brainstem lesion on magnetic resonance imaging, in the region of the dorsal longitudinal fasciculus (DLF).

Conclusion: Our case seems to suggest a possible role of the DLF in the process that leads to CH attacks. Because neuroimaging clearly showed a lesion contralateral to CH pain, we hypothesize that some fibers from periaqueductal gray matter project to the contralateral side, besides the known ipsilateral connections.

Keywords: dorsal longitudinal fasciculus; multiple sclerosis; secondary cluster headache.

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References

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