OC-10 | Assessing white matter hyperintensities in cluster headache: a distinct pathophysiological profile compared to migraine

G. Giuliani,¹ A. Viganò,² C. Zilli,¹ D. Chiffi,¹ E. Vicenzini,¹ V. Di Piero,¹ M. Altieri¹ | ¹Department of Human Neuroscience, Sapienza University of Rome; ²IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy

Background: Cluster headache (CH) is the main trigeminal autonomic cephalalgia whose pathophysiology involves neuro-inflammatory alterations in hypothalamus, trigeminovascular system, and autonomic system. Contrary to migraine, little is known about the long-term sequelae of neuroinflammation on brain structure and white matter integrity. Here, we aimed to analyze the occurrence of white matter hyperintensities (WMHs) in a large population of patients with CH independently from cardiovascular risk factors, which can be frequently comorbid with CH. 

Methods: In this retrospective study, we recruited patients affected by episodic or chronic CH, according to the ICHD-3 criteria. Headache characteristics were collected through a structured interview; all patients underwent a detailed medical history, with particular attention to the presence of cardiovascular comorbidities and smoking habits. Brain magnetic resonance imaging was performed at the time of diagnosis: images were carefully analyzed to assess the presence of WMHs. Finally, we investigated the relationship between WMHs, headache characteristics, and patient comorbidities.

Results: A total of 101 patients were enrolled, 91 (90%) with episodic CH and 10 (10%) with chronic CH. Mean age was 48.9 ± 13.8 years and 81 patients (80.1%) were men. Out of 101, 24 (23.7%) had at least one cardiovascular risk factor, 58 (57.4%) were current smokers, and 12 (11.8%) were former smokers. WMHs were found in 15 (14.8%) patients. WMH were directly dependent from smoking number and independent from CH diagnosis (p=0.01). CH onset (p=0.60), number of cluster per year (p=0.48), cluster duration in days (p=0.87), and number of attacks per day (p=0.25) did not influence the presence of WMHs.

Conclusion: CH does not appear to contribute to the development of WMHs, but rather being related to smoking habit, as a result of personality traits commonly found in CH. CH seems to not share the mechanisms commonly believed to be responsible for the formation of WMHs in migraine, such as altered cerebral vasoregulation and microvascular damage.