The pathophysiology of autonomic disturbances in cluster headache

摘要

Local signs of parasympathetic overactivity (lacrimation and nasal discharge) often develop during attacks of cluster headache, and persistent signs of ocular sympathetic paralysis (miosis and ptosis) sometimes develop and intensify during attacks. Sweating and skin blood flow increase on the painful side, particularly in areas of sympathetic deficit. In patients with ocular and thermoregulatory signs of sympathetic deficit, supersensitivity to adrenergic and cholinergic drugs develops in symptomatic parts of the face. This chapter opens with an overview of the neural circuits which influence autonomic activity in the face. How these circuits interact to produce autonomic disturbances in cluster headache will then be discussed.