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UNDERSTANDING THE TRIGEMINAL CERVICAL CONNECTIONS; AN OBSERVATION
  1. Catherine Gillies,
  2. Alok Tyagi
  1. Southern General Hospital; Southern General Hospital

    Abstract

    Introduction Cluster headache is a severe primary headache disorder characterised by a strictly unilateral pain in the distribution of the trigeminal nerve and associated autonomic symptoms such as redness or tearing from the eye or eyelid drooping. The pathophysiological basis for the autonomic symptoms in cluster headache is unclear although the trigeminal autonomic reflex is thought to contribute to their development.

    Greater occipital nerve blocks are sometimes used for managing cluster headaches as a transitional prophylactic while awaiting response from oral preventive medications. The anatomical and functional convergence of the trigeminal spinal nucleus and the 2nd and 3rd cervical roots is thought to be the basis for the therapeutic response obtained in patients with headache disorders who undergo this procedure.

    Methods We report two patients with cluster headaches and prominent eyelid drooping, who received a greater occipital nerve block during a headache bout. In each of the patients the eyelid drooping dramatically resolved within minutes of the procedure being carried out. This was observed by the injector, rather than being self reported. One of the patients has chronic medically intractable cluster headache and the eyelid drooping was more or less constant prior to the nerve block being carried out.

    Conclusion In our view the resolution of eyelid drooping within minutes of the greater occipital nerve block being carried out is evidence to support the presence of a trigeminal autonomic reflex and its importance in the pathophysiological basis of cluster headaches. We also believe that this observation confirms the anatomical and functional convergence of the trigeminal and the cervical neural pathways and helps to understand the mechanisms by which greater occipital nerve blocks lead to substantial improvement in symptoms reported by patients with headache disorders who undergo this procedure.

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