Case report: Recurrent nocturnal awakenings in cluster headache: a different type of ghost attack
IntroductionCluster headache (CH) is a trigeminal autonomic cephalalgia characterized by attacks of severe unilateral pain associated with ipsilateral autonomic symptoms. Cluster headache attacks exhibit nocturnal predilection, and sleep disorders could be the first manifestation of an incipient clu...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-07-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1230710/full |
| _version_ | 1827892928120356864 |
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| author | Giada Giuliani Maurizio Gorgoni Maurizio Gorgoni Marta Altieri Vittorio Di Piero Vittorio Di Piero |
| author_facet | Giada Giuliani Maurizio Gorgoni Maurizio Gorgoni Marta Altieri Vittorio Di Piero Vittorio Di Piero |
| author_sort | Giada Giuliani |
| collection | DOAJ |
| description | IntroductionCluster headache (CH) is a trigeminal autonomic cephalalgia characterized by attacks of severe unilateral pain associated with ipsilateral autonomic symptoms. Cluster headache attacks exhibit nocturnal predilection, and sleep disorders could be the first manifestation of an incipient cluster period. Sleep alterations in cluster headache patients may reflect the pivotal role of the hypothalamus, which is crucially involved in the pathophysiology of this primary headache. We describe the case of a patient affected by episodic cluster headache who experienced a sleep disorder after starting therapy with verapamil.Case presentationA 47-year-old man was affected by episodic cluster headache, characterized by attacks of excruciating pain in the left orbital and temporal regions, associated with prominent ipsilateral vegetative symptoms. Headaches occurred during the night, with one or two nocturnal attacks appearing at 11.30–12 p.m. and 4–4.30 a.m. Preventive treatment with verapamil was started, with immediate pain relief. Later, he experienced consecutive nocturnal awakenings for a couple of weeks, always at the same time, without any pain or autonomic symptoms. He was not agitated and did not need to get out of bed; after the awakenings, he reported sleep disturbances with vivid dreams.Discussion and conclusionThis case represents the first description of recurrent cyclic nocturnal awakenings, without pain and autonomic symptoms, in a patient with episodic cluster headache during the active phase of a cluster bout. Nocturnal awakenings, started after the introduction of effective preventive therapy, might be an unusual form of “ghost attacks.” After the beginning of prophylactic therapy, patients often describe mild pain or localized pressure in the same localization of CH attack. Similarly, the appearance of sleep disturbances, without any pain or vegetative symptoms, should be regarded as a warning sign of a still active cluster bout. Since these manifestations may influence therapeutic management, they should be carefully investigated. |
| first_indexed | 2024-03-12T21:46:57Z |
| format | Article |
| id | doaj.art-1a0ddd75946345f68ded8c7d525ded5c |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-03-12T21:46:57Z |
| publishDate | 2023-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-1a0ddd75946345f68ded8c7d525ded5c2023-07-26T09:51:59ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-07-011410.3389/fneur.2023.12307101230710Case report: Recurrent nocturnal awakenings in cluster headache: a different type of ghost attackGiada Giuliani0Maurizio Gorgoni1Maurizio Gorgoni2Marta Altieri3Vittorio Di Piero4Vittorio Di Piero5Department of Human Neurosciences, Sapienza University of Rome, Rome, ItalyDepartment of Psychology, Sapienza University of Rome, Rome, ItalyBody and Action Lab, IRCCS Fondazione Santa Lucia, Rome, ItalyDepartment of Human Neurosciences, Sapienza University of Rome, Rome, ItalyDepartment of Human Neurosciences, Sapienza University of Rome, Rome, ItalyUniversity Consortium for Adaptive Disorders and Head Pain (UCADH), Pavia, ItalyIntroductionCluster headache (CH) is a trigeminal autonomic cephalalgia characterized by attacks of severe unilateral pain associated with ipsilateral autonomic symptoms. Cluster headache attacks exhibit nocturnal predilection, and sleep disorders could be the first manifestation of an incipient cluster period. Sleep alterations in cluster headache patients may reflect the pivotal role of the hypothalamus, which is crucially involved in the pathophysiology of this primary headache. We describe the case of a patient affected by episodic cluster headache who experienced a sleep disorder after starting therapy with verapamil.Case presentationA 47-year-old man was affected by episodic cluster headache, characterized by attacks of excruciating pain in the left orbital and temporal regions, associated with prominent ipsilateral vegetative symptoms. Headaches occurred during the night, with one or two nocturnal attacks appearing at 11.30–12 p.m. and 4–4.30 a.m. Preventive treatment with verapamil was started, with immediate pain relief. Later, he experienced consecutive nocturnal awakenings for a couple of weeks, always at the same time, without any pain or autonomic symptoms. He was not agitated and did not need to get out of bed; after the awakenings, he reported sleep disturbances with vivid dreams.Discussion and conclusionThis case represents the first description of recurrent cyclic nocturnal awakenings, without pain and autonomic symptoms, in a patient with episodic cluster headache during the active phase of a cluster bout. Nocturnal awakenings, started after the introduction of effective preventive therapy, might be an unusual form of “ghost attacks.” After the beginning of prophylactic therapy, patients often describe mild pain or localized pressure in the same localization of CH attack. Similarly, the appearance of sleep disturbances, without any pain or vegetative symptoms, should be regarded as a warning sign of a still active cluster bout. Since these manifestations may influence therapeutic management, they should be carefully investigated.https://www.frontiersin.org/articles/10.3389/fneur.2023.1230710/fullcluster headachenocturnal awakeningsghost attacksprophylactic treatmentverapamil |
| spellingShingle | Giada Giuliani Maurizio Gorgoni Maurizio Gorgoni Marta Altieri Vittorio Di Piero Vittorio Di Piero Case report: Recurrent nocturnal awakenings in cluster headache: a different type of ghost attack Frontiers in Neurology cluster headache nocturnal awakenings ghost attacks prophylactic treatment verapamil |
| title | Case report: Recurrent nocturnal awakenings in cluster headache: a different type of ghost attack |
| title_full | Case report: Recurrent nocturnal awakenings in cluster headache: a different type of ghost attack |
| title_fullStr | Case report: Recurrent nocturnal awakenings in cluster headache: a different type of ghost attack |
| title_full_unstemmed | Case report: Recurrent nocturnal awakenings in cluster headache: a different type of ghost attack |
| title_short | Case report: Recurrent nocturnal awakenings in cluster headache: a different type of ghost attack |
| title_sort | case report recurrent nocturnal awakenings in cluster headache a different type of ghost attack |
| topic | cluster headache nocturnal awakenings ghost attacks prophylactic treatment verapamil |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1230710/full |
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