An hypothesis regarding the possible role of the carotid body in the pathogenesis of cluster headache is presented. It states: 1. The pathways concerned with cyclic cluster periods may begin centrally involving specific areas in the hypothalamus. The major influence of this physiological change is proposed to be an inhibition of the sympathetic and disinhibition of parasympathetic supplies to the carotid body. The result, whether due to increased vasomotor tonus or interruption of intrinsic sympathetic stimulation, is suggested to cause diminished peripheral chemoreceptor activity. 2. The pathway concerned with onset of spontaneous or induced attacks begins, as proposed, with oxygen desaturation-which, upon reaching threshold levels may induce a hyperactive chemoreceptor response, and stimulate through afferent pathways the nuclei of the 7th and 10th cranial nerves and respiratory centers, via the nucleus solitarius. 3. The consequence of this excitation may involve the third suggested pathway resulting in stimulation of peripheral secretory and other receptors innervated by the cranial nerves.
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References
1.
KudrowL.Cluster headache: mechanisms & management.London:Oxford University Press,1980:21–32.
2.
EkbomK.Nitroglycerin as a provocative agent in cluster headache.Arch Neurol1968;19:487–93.
3.
KudrowL.Response of cluster headache attacks to oxygen inhalation.Headache1981;21:1–4.
4.
KunkleECPfeifferJBJrWilhoitWMHamrickLWJrRecurrent brief headache in “cluster” pattern.Trans Am Neurol Assoc1954;77:240.
LanceJW.Mechanism and management of headache.3rd ed.London:Butterworths,1978.
7.
HortonBTMacLeanARCraigWM.A new syndrome of vascular headache: results of treatment with histamine; a preliminary report.Mayo Clin Proc1939;14:257–60.
8.
SuttonJ.Acute mountain sickness: an historical review, with some experiences from the Peruvian Andes.Med J Aust1971;2:243–8.
9.
ZakFGLawsonW.The paraganglionic chemoreceptor system.Physiology, pathology, and clinical medicine. New York:Springer-Verlag,1982:144.
10.
LeverJDLewisPRBoydJD.Observations on the fine structure and histochemistry of the carotid body in the cat and the rabbit.J Anat1959;93:478–90.
11.
EyzaguirreCNishiKFidoneS.Chemoreceptor synapses in the carotid body.Fed Proc Fed Am Socs Exp Biol1972;31:1385–93.
12.
McDonaldDMMitchellRA.The innervation of glomus cells, ganglion cells and blood vessels in the rat carotid body; a quantitative ultrastructural analysis.J Neurocytol1975;4:177–230.
13.
MillsEJöbsisFF.Mitochondrial respiratory chain of carotid body and chemoreceptor response to changes in oxygen tension.J Neurophysiol1972;35:405–28.
14.
HeymansCBouckaertJJ.Dissociation des deux sensibilités réflexogènes de la bifurcation carotidienne: sensibilité chimique et sensibilité à la pression.CR Soc Biol (Paris)1933;112:1240–3.
15.
BuchananAR.Functional neuro-anatomy,3rd ed.Philadephia:Lea and Febiger,1957:204.
16.
de B DalyMLambertsenCJSchweitzerAObservations on the volume of blood flow and oxygen utilisation of the carotid body in the cat.J Physiol (Lond)1954;125:67–89.
17.
EyzaguirreCLewinJ.The effect of sympathetic stimulation on carotid nerve activity. J.Physiol (Lond)1961;159:251–67.
18.
PurvesMJ.The role of the cervical sympathetic nerve in the regulation of oxygen consumption of the carotid body of the cat.J Physiol (Lond)1970;209:417–31.
19.
BiscoeTJPurvesMJ.Factors affecting the cat carotid chemoreceptor and cervical sympathetic activity with special reference to passive hind-limb movements.J Physiol (Lond)1967;190:425–41.
20.
O'ReganRGAckerH.Effects of efferent nerves upon total blood flow, local flow, tissue PO2 and chemoreceptor activity of the cat carotid body. In: BelmonteCPallotDJAckerHFidoneS edsArterial chemoreceptors. Proceedings of the VI International Meeting.Leicester:Leicester University Press,1981:448–54.
21.
DeGroatWCMorganCNadelhaftLSchaubleT.Localization by the horseradish peroxidase technique of medullary neurons projecting efferent fibers to the carotid sinus nerve of the cat.Soc Neurosci Abstr1978;4:549.
22.
MajcherczykSColeridgeJCGColeridgeHMKaufmanMPBakerDG.Carotid sinus nerve efferents: properties and physiological significance.Fed Proc1980;39:2662–7.
23.
ZapataP.Effects of dopamine on carotid chemo-and baroreceptors in vivo.J Physiol (Lond)1975;244:235–51.
24.
StowellA.Physiologic mechanisms and treatment of histaminic or petrosal neuralgia.Headache1970;9:187–94.
25.
KudrowL.Cluster headache: mechanisms and management.London:Oxford University Press,1980:99–126.
26.
MedinaJThe nature of cluster headache.Headache1979;19:309–22.
HiltonSMSpyerKM.Participation of the anterior hypothalamus in the baroreceptor reflex.J Physiol (Lond)1971;218:271–93.
30.
MillsESampsonSR.Respiratory responses to electrical stimulation of the cervical sympathetic nerves in decerebrate, unanaesthetized cats.J Physiol (Lond)1969;202:271–82.
31.
PurvesMJ.Carotid body blood flow and oxygen usage in the cat.J Physiol (Lond)1969;202:1P–2P.
ReiteMJacksonDCahoonRLSleep physiology at high altitude.Electroencephalogr Clin Neurophysiol1975;38:463–71.
34.
PowlesACPSuttonJRGrayGWSleep hypoxemia at altitude: its relationship to acute mountain sickness and ventilatory responsiveness to hypoxia and hypercapnia. In:FolinsbeeLJWagnerJABorgiaJF. edsEnvironmental stress: individual human adaptations.New York:Academic Press,1978:373–81.
35.
EkbomK.Pattern of cluster headache with a note on the relation to angina pectoris and peptic ulcer.Acta Neurol Scand1970;46:225–37.
36.
GlennLLFoutzASDementWC.Membrane potential of spinal motoneurons during natural sleep in the cat.Sleep1978;1:199–204.
37.
BaustWBohnertB.The regulation of heart rate during sleep.Exp Brain Res1969;7:169–80.
38.
DexterJDRileyTL.Studies in nocturnal migraine.Headache1975;15:51–62.
39.
GardnerWJStowellADutlingerR.Resection of the greater superficial petrosal nerve in the treatment of unilateral headache.J Neurosurg1947;4:105–14.
40.
SachsEJrThe role of the nervus intermedius in facial neuralgia. Report of four cases with observations on the pathways for taste, lacrimation, and pain in the face.J Neurosurg1968;23:54–60.
41.
GillilanLA.Clinical aspects of the autonomic nervous system.Boston:Little, Brown and Company,1954:178.
42.
EkbomKGreitzT.Carotid angiography in cluster headache.Acta Radiol Diagnosis1970;10:177–86.
43.
MorganMPackRJHoweA.Structure of cells and nerve endings in abdominal vagal paraganglia of the rat.Cell Tiss Res1976;196:467–84.
44.
Cervós-NavarroJ.The structural basis of an innervatory system of brain vessels. In:OwmanCEdvinsson eds.Neurogenic control of brain circulation.Oxford:Pergamon Press,1977:75–89.
45.
AlborchEVilaCBaguenaJ.Possibility of a functional relationship between adrenergic and cholinergic innervation in cerebral arteries of the goat. In:GotohFNagaiHTazaki edsThe cerebral blood flow and metabolism.Copenhagen:Munksgaard,1979:126–7.
46.
GotohFMuramatsuFKandaTRole of noradrenergic system in cerebral arterial spasm after subarachnoid hemorrhage.Acta Neurol Scand(suppl 56)1977;64:342.
47.
D'AlecyLGFeiglEO.Sympathetic control of cerebral blood flow in dogs.Circulat Res1972;31:267.
48.
JamesIMMacDonellLA.Factors affecting the cerebrovascular response to noradrenaline in the dog.Br J Pharmacol Chemother1975;54:129.
49.
Cervos-NavarroJ.The structural basis of an inner-vatory system of brain vessels. In:OvarianCEdvinssonL. edsNeurogenic control of brain circulation. Proc Int Symp Wenner-Gren vol. 30,Oxford and New York:Pergamon Press,1977:75–89.
50.
PonteJPurvesMJ.Role of the carotid body chemoreceptors and carotid sinus baroreceptors in the control of cerebral blood vessels.J Physiol (Lond)1974;237:315.
51.
NorrisJWHachinskiVCCooperPW.Cerebral blood flow changes in cluster headache.Acta Neurol Scand1976;54:371–4.
52.
SakaiFMeyerJS.Regional cerebral hemodynamics during migraine and cluster headaches measured by the 133Xe inhalation method.Headache1978;18:122–32.
53.
JacobsonLB.Cluster headache: a rare cause of bradycardia.Headache1969;8:159–61.
54.
EkbomK.Heart rate, blood pressure and electrocardiographic changes during provoked attacks of cluster headache.Acta Neurol Scand1970;46:215–24.
55.
BruynGWBootsmaBKKlawansHL.Cluster headache and bradycardia.Headache1976;16:11–15.
56.
RussellDvon der LippeA.Cluster headache: heart rate and blood pressure changes during spontaneous attacks.Cephalalgia1982;2:61–70.
57.
CirignottaFSacquegnaTD'AlessandroRBaldratiADeCarolisPCoccagnaGLugaresiE.Systemic arterial pressure and heart rate changes during migraine and cluster headaches: preliminary study.Headache1982;22:35–7.
