Surgical treatment of chronic migrainous neuralgia
Robert S. Kunkel, M.D.
Department of Internal Medicine
Donald F. Dohn, M.D.
Department of Neurological Surgery
Cluster headache seems to be the preferred term at present for a particular type of vascular headache which has also been known as ciliary neuralgia, periodic migrainous neuralgia, histamine cephalgia, Horton’s headache, and petrosal neuralgia. This characteristic pain syndrome was first described by Harris,1 in 1926, redefined and named histamine cephalgia by Horton et al.2
This headache syndrome occurs mainly in men. The symptoms are severe, unilateral pain, usually in the retroorbital region, and parasympathetic discharge with lacrimation, injection of the eye, and nasal stuffiness with rhinorrhea. The pain usually lasts less than 2 hours, sometimes less than 1 hour, and rarely more than 4 hours. Cluster headache, the term used by Kunkle et al,3 may occur daily for a few weeks to 3 months or more. Symptoms then disappear only to return after a pain free interval of months to years.
Although most persons suffering from cluster headaches have periodic remissions of a few months to a few years, a certain number have chronic, typical headaches for years. Ekbom,4 in 1947, noted that both chronic and periodic attacks could occur in the same patient. In 1962, Rooke et al5 reported that Horton’s headache occurs in both typical cluster form and chronic form. Ekbom and Olivarius,6 in 1971, reported on 17 cases of chronic migrainous neuralgia, about 10% of the total of 167 patients with cluster headache seen in two neurological clinics in Sweden. Ekbom used the criteria of at least two headaches a week for 1 year or more. . .