Headache. 1996 Mar;36(3):174-7.
Chronic cluster headache: provocation with carbon dioxide breathing and nitroglycerin.
Hannerz J, Jogestrand T
Department of Neurology, Karolinska Hospital, Stockholm, Sweden.
Nine patients with chronic cluster headache were studied as to end-tidal PCO2,
heart rate, blood pressure, common carotid artery blood flow, vascular
resistance, and intensity and duration of pain before, during, and after
breathing 6% CO2 in air for 6 minutes and before and after administration of 1
mg nitroglycerin sublingually. End-tidal PCO2 was low at rest without
provocation indicating that chronic cluster headache patients hyperventilate.
Carbon dioxide provocation induced an increase in common carotid artery blood
flow. This provocation, previously shown to induce pain in episodic cluster
headache patients, did not result in unilateral pain in chronic cluster headache
patients. Nitroglycerin did not provoke any pain in 4 of 5 chronic cluster
headache patients in contrast to the effects in episodic cluster headache
patients in a cluster period. In one chronic cluster headache patient, a
short-lasting attack of moderate pain intensity was provoked. The results agree
with the hypothesis that chronic cluster headache patients have changed vascular
reactivity due to permanent sympathicoplegia unilaterally in the middle fossa in
contrast to episodic cluster headache patients who it has been suggested have a
nonpermanent sympathicoplegia unilaterally in the same region.
PMID: 8984091 [PubMed - indexed for MEDLINE]Entrez PubMed
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