In our opinion, the paragraph on diagnostic evaluation and differential diagnosis of cluster headache is lacking any mention of the possibility of the patient’s having acute or latent pansinusitis.
The authors assume that the posterior hypothalamus has a key role in triggering the headache. It is well known that the region of the nasal sinuses—frontal sinuses, ethmoidal sinuses, sphenoidal sinus, and maxillary sinuses—is closely connected to the trigeminal nerve. The instillation of 10% procain solution into the nose—effective owing to a local anesthetic block of the sphenopalatine ganglion—requires prior differential diagnostic evaluation of possibly latent pansinusitis, especially sphenoidal sinusitis.
The authors include in the treatment modalities for acute cluster attacks the inhalation of oxygen through a close-fitting mouth-nose mask. This is interesting, but we miss a theoretical explanation of the effects of oxygen inhalation. We also wish to point out that the effect of oxygen inhalation under hyperbaric conditions in a pressure chamber may in theory be rather more effective, since only this approach increases partial oxygen pressure in the cerebrospinal fluid cavities and in the cerebrum, consistent with the gas laws.
For migraine, success stories have been published in the literature, for cluster headaches, however, there have been only individual observations
Footnotes
Conflict of interest statement
The authors declare that no conflict of interest exists.
References
- 1.Gaul C, Diener HC, Müller OM. Cluster headache—clinical features and therapeutic options. Dtsch Arztebl Int. 2011;108(33):543–549. doi: 10.3238/arztebl.2011.0543. [DOI] [PMC free article] [PubMed] [Google Scholar]