1. Khurram Jehangir Khan, MD; Soma Sahai-Srivastava, M.D
Cluster Headache in a female patient with Multiple Sclerosis
Khurram Jehangir Khan, MD; Soma Sahai-Srivastava, M.D
University of Southern California Department of Neurology, Los Angeles, California, USA
1. Background
4. MRI of Patient
Multiple sclerosis (MS) – is associated with frequent headaches including
TTH
Migraine
Trigeminal Neuralgia.
Cluster headache (CH), a trigeminal autonomic cephalgia - an uncommon headache disorder with M:F ratio of 4.3
Only three male patients with MS (ages 35 – 42) with cluster headaches have been described in separate case reports from Germany and Italy showing pontine demyelinating lesions in trigeminal root entry zone.
Cluster headache has never been described in females with Multiple sclerosis
3. Results (continued)
Imaging: Gadolinium-enhanced T2-weighted MRI Brain shows hyperintense ovoid demyelinating multiple white matter lesions perpendicular to the ventricles with one lesion along the corpus callosum; Gadolinium-enhanced T1-weighted Cervical spine MRI shows left C1-2 segmental lesions. No Hypothalamic, Pontine or Trigeminal Root Entry Zone identified.
Abotive Treatment: Decadron, Zomig nasal spray and 15 liter of oxygen with non rebreather mask given during acute cluster episode with complete resolution of her symptoms within 15 minutes.
Maintenance therapy: Home O2 therapy and Medrol dose pack. At the time of diagnosis of Cluster Headache, she has not been started on MS treatment.
4. Discussion
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5. Conclusion
Although Migraine is much more common, Cluster Headache should be considered in the Differential Diagnosis of any MS patient with Headache.
Further research needs to be done to determine if it is entirely coincidental.
Based on this case report we strongly recommend considering cluster headaches in women after 40 years of age even if they have lesions on MRI.
Absence of Posterior Ipsilateral hypothalamic lesions can result in delayed diagnosis of cluster in the setting of MS.
2. Methods
Case report and review of literature.
3. Results
A 43 year old Caucasian female presents with two weeks of severe right Peri-orbital headache starting at about 5/10 & progresses within 5 minutes to a 10/10 on a pain scale. Rest and sleep does not make it better. She prefers to rock back and forth with her head in her hands till the pain stops. Each episode lasts for minutes with agitation and ipsilateral tearing.
“Female with MS plaques” was the main focus for 2 previous headache clinics, without proper diagnosis and treatment of our patient.
Neurological examination : Unremarkable except slight drooping of ipsilateral eyelid during episode.
6. References
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3: Leandri M, Cruccu G, Gottlieb A. Cluster headache-like pain in multiple sclerosis. Cephalalgia Oct;19(8): PubMed PMID:
4: Ekbom K, Svensson DA, Träff, Waldenlind E. Age at onset and sex ratio in cluster headache: observations over three decades. Cephalalgia Mar;22(2): PubMed PMID:
5. Fischera M, Marziniak M, Gralow I, Evers S. The incidence and prevalence of cluster headache: a meta-analysis of population-based studies. Cephalalgia Jun;28(6): doi: /j x. Epub 2008 Apr 16. Review. PMID:
6. Rozen TD, Fishman RS. Female cluster headache in the United States of America: what are the gender differences? Results from the United States Cluster Headache Survey. J Neurol Sci Jun 15;317(1-2): doi: /j.jns Epub 2012 Apr 5. PMID:
7. Morelli N, Pesaresi I, Cafforio G, Maluccio MR, Gori S, Di Salle F, Murri L. Functional magnetic resonance imaging in episodic cluster headache. J Headache Pain Feb;10(1):11-4. doi: /s z. Epub 2008 Dec 16. PMID: