Can you have headaches without pain?

ST. PAUL, MN -- You can suffer from cluster headache without the head pain, according to a case report in the August 7 issue of Neurology, the scientific journal of the American Academy of Neurology.

The case report follows a 22-year-old man who was experiencing the neurologic symptoms of cluster headache including nasal stuffiness, a droopy eyelid, and contraction of the pupil in his left eye -- without the head pain normally associated with the condition.

This is the first case reported showing evidence that these symptoms may be initial symptoms and not a response to the pain, as experts have believed.

"This report may guide future cluster headache research in another direction, away from viewing these symptoms as a reflex reaction to the pain," said neurologist Rolf Salvesen, MD, PhD, author of the case report and associate professor at the University of Tromsø in Norway.

The man reported that these symptoms occurred every day for a few weeks with one to three attacks a day for one and two hours. After six weeks, the attacks stopped.

Six years later, he returned with his previous symptoms and severe pain in the area around his left eye that lasted for about 90 minutes about twice a day. He was treated with sumatriptan, a drug used to alleviate cluster headache pain, and within 30 minutes the pain was gone. After six weeks the pain was gone and so were most of his other symptoms.

"It's suggested by experts in cluster headache that the other symptoms experienced by people with cluster headache are a reflex response to the head pain," said Salvesen. "This report is evidence that a person can have other symptoms of cluster headache without the pain, suggesting these symptoms are primary symptoms."

Cluster headache is characterized by severe pain and several other neurologic symptoms, including tearing and redness of the eye, contraction of the pupil, stuffy nose and drooping eyelid. About one in every 1,000 peop

Contact: Cheryl Grogan
American Academy of Neurology

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