Introduction to the new International Classification of Headache Disorders

Based on the first edition of the classification (already validated), the ICHD–II is intended for not only the researcher and clinician but also the neurologist and general pactitioner. All the headaches are classified into groups and sugroups to provide the level of diagnosis necessary for each user.     

Natural History of Cluster Headache

SYNOPSIS
A follow-up study of 123 patients with episodic cluster headaches and of 9 patients with chronic cluster headaches was undertaken after 10–25 years, (mean 14.7 and 13.9 years respectively). This shows a significant but low remission rate for both episodic and chronic cluster headache. It confirms the observation that some patients change from episodic to chronic pattern, and that occasionally chronic clusters may become episodic.     

The Natural History of Episodic Cluster Headache

SYNOPSIS
We studied the course of episodic cluster headache in 72 patients. Sixty-two cases (86%) had a regular frequency of clusters per year. Most patients suffered from 1 bout a year. A prolonged remission (> 1 year) did not change the frequency pattern of clusters per year. Fifty patients (69%) had a fixed pattern both of frequency and duration of bouts. Thirty-seven patients (51%) had a regular frequency of bouts per year, a fixed duration of bouts and a fixed frequency of attacks a day.
Our results show that the natural history of most cluster headache (CH) patients is characterized by a regular pattern.     

Chronic Cluster Headache Managed by Nervus Intermedius Section

Cluster headache sufferers who become candidates for surgical treatment are those relatively rare patients who are refractory to all attempts at pharmacological relief. Ablative surgical procedures have been directed against either the trigeminal nerve or the nervus intermedius/greater superficial petrosal (NI/GSP) pathway. Both carry nociceptive impulses from the head and face, and the NI also carries parasympathetic fibres which appear to be responsible for the autonomic concomitants of cluster headache. Trigeminal operative procedures are not consistently helpful in chronic cluster headache, while NI section has been shown to give potentially long lasting relief but carries the potential risks of cerebellopontine angle surgery. In eight selected cases of chronic cluster headache we have demonstrated a high early success rate for pain relief, with few complications, in the performance of NI section, combined, when indicated, with microvascular decompression of the trigeminal main sensory root. We believe that cochlear nerve monitoring helps prevent postoperative hearing impairment. An intimate relationship between the NI and arterial loops of the anterior inferior cerebellar artery (AICA) or the internal auditory artery has been frequently observed in our chronic cluster headache patients.     

Family History for Chronic Headache and Drug Overuse as a Risk Factor for Headache Chronification

Objectives.— To assess whether family history for chronic headache (CH) and drug overuse could represent a risk factor for headache chronification. Background.— Among factors investigated as risk factors for chronification of headache disorders, familial liability for CH and drug overuse has been rarely investigated. Patients and Methods.— A total of 105 consecutive patients with daily or nearly daily headache, and 102 consecutive patients with episodic headache matched by age, sex, and type of headache at onset, underwent a structured direct interview about family history for episodic headache, CH with and without medication overuse, substance abuse/dependence, and psychiatric disorders. Results.— In total, 80 out of 105 patients with CH received a diagnosis of medication overuse headache (MOH), 21 patients were classified as chronic migraine (CM), and 4 as chronic tension‐type headache (CTTH) without drug overuse. Some 38.1% of CH patients reported family history for CH vs only 13.7% of episodic headaches (P = .001). Familiality for CH with medication overuse was reported by 25.7% of cases vs 9.8% of controls (P = .0028). A familial history of substance abuse was reported by 20% of patients vs 5.9% of controls (P = .0026). In all, 28.7% of MOH patients reported family history for CH with medication overuse (P = .0014) and 21.2% for substance abuse (P = .002). Relatives of patients with MOH were more likely than control relatives to suffer from CH (OR = 4.19 [95% CI 2.05‐8.53]), drug overuse (OR = 3.7 [95% CI 1.66‐8.24]), and substance abuse (OR = 4.3 [95% CI 1.65‐11.19]). No differences regarding family history for episodic headache and for psychiatric disorders were found. No differences in family history for CH with drugs overuse and for substance abuse were found between CH patients without overuse and controls. Fifteen CH patients reported family history for alcohol abuse (P = .0003). Conclusions.— The significantly increased familial risk for CH, drug overuse, and substance abuse suggests that a genetic factor is involved in the process of headache chronification.