Beta-oscillations in the posterior hypothalamus are associated with spontaneous cluster headache attack

Dear Sirs,

The etiology of chronic cluster headache (CH), manifesting as episodes of severe head pain with cranial autonomic features is still unknown, but a central role of the hypothalamus has been discussed recently. For example, during acute CH attacks (but not during migraine) PET revealed activation of the ipsilateral posterior inferior hypothalamus (PIH) [9]. In addition, increased grey matter density of the ipsilateral PIH has been found [7, 8]. These findings have prompted the use of deep brain stimulation (DBS) of the ipsilateral PIH in CH, which has been shown to be a promising option in cases refractory to other therapies. Currently available series suggest that the procedure is working in about 50% of operated patients [1, 6].

While suggestive, the previously described structural and functional changes of the PIH in CH leave open the question as to the neural events that precipitate and mediate spontaneous CH attacks within the hypothalamus. Spontaneous discharge...