1. Cluster Headache and Related Syndromes in History and Literature

Gian Camillo Manzoni¹ and Paola Torelli²

(1)

Poliambulatorio Dalla Rosa Prati, Centro Diagnostico Europeo, Parma, Italy

(2)

Dipartimento di Medicina e Chirurgia, Centro Cefalee, Università di Parma, Parma, Italy

Gian Camillo Manzoni

Email: giancamillo.manzoni@unipr.it

Keywords

Cluster headacheHistory

Unlike migraine, for which there are multiple and clear indications about its knowledge since ancient times, cluster headache (CH) has been recognized only fairly recently.

The history of CH can be divided in three time periods: the first, since the mid-seventeenth century to the first part of the nineteenth century, was characterized by occasional reports of individual patients suffering from headache forms with clinical aspects suggestive of CH; the second, during the first half of the twentieth century, saw the first reports on case series with CH under the most varied names; and the third, in the second half of the twentieth century, was marked by the accurate clinical description of CH and the identification of some of its subtypes (Table 1.1).

Table 1.1

Historic periods in the development of knowledge of cluster headache

First period (mid-seventeenth century to the first part of the nineteenth century)
Nicolaas Pieterszoon Tulp	Amsterdam	1641
Thomas Willis	Oxford	1672
Abraham de la Pryme	South Yorkshire	1702
Gerhard van Swieten	Vienna	1745
Johann Christoph Ulrich Oppermann	Regensburg	1747
Johann Müller	Frankfurt	1813
Second period (first half of the twentieth century)
Robert Bing	Basel	1913
Wifred Harris	London	1926
Bayard Taylor Horton	Rochester	1939
Third period (second half of the twentieth century)
Lee Kudrow	USA	(1933–)
Karl Ekbom jr	Sweden	(1935–)
Ottar Sjaastad	Norway	(1928–)

1.1 Mid-seventeenth Century to the First Part of the Nineteenth Century

Based on a review of the studies on CH history conducted so far, the first, albeit incomplete, description can be attributed to Nicolaas Pieterszoon Tulp, a Dutch physician born in Amsterdam in 1593 who was portrayed in the famous canvas by Rembrandt The Anatomy Lesson. In his 1641 treatise Observationum medicarum libri tres [1], Tulp discussed some cases of headache and about one of them wrote: “[…] (Isaak van Halmaal) in the beginning of the summer season, was afflicted with a very severe headache, occurring and disappearing daily on fixed hours, with such an intensity that he often assured me that he could not bear the pain anymore or he would succumb shortly. For rarely it lasted longer than two hours. And the rest of the day there was no fever, nor indisposition of the urine, nor any infirmity of the pulse. But this recurring pain lasted until the fourteenth day”. The extremely severe pain and the attacks lasting 2 h and recurring every day at fixed hours for 2 weeks are highly suggestive of CH. However, in his description Tulp says nothing about the location of pain and the presence of any accompanying symptoms.

The typical temporal pattern of CH, with active periods (cluster periods) alternating with other, even longer periods without attacks (periods of remission), was precisely defined by Thomas Willis, a professor of philosophy at Oxford University in 1672 when in De anima brutorum [2] he described headache periods regularly recurring at fixed intervals: “Usually the attacks of seemingly suppressed headache recur around the solstices and equinoxes […] but the majority, provided with subordinate periods, habitually molests at fixed hours within every cycle of 24 hours”.

In 1702, the British antiques dealer Abraham de la Pryme described the headache of one of his brother’s servants and attributed its cause to hydrophobia, because 3 weeks before onset, the man had come into contact with some dogs with rabies [3]. In fact, the headache he described was actually more similar to CH [4]: “[…] my brother’s servant, a most strong laborious man, began to be troubled with an exceeding acute pain in the head, sometimes once, sometimes twice a day, so very vehement that he was forced to hold his head with both his hands to hinder it from riving in two, which fits commonly held him about an hour at a time; […] and his eyes behold every thing of a fiery red colour. Thus was he tormented for a whole week together, but being of a strong constitution, and returning to his labour in every interval, he sweat and wrought it off, without any physic”. There is no clear indication of the location of pain, but the description of the physical appearance of the patient is interesting, because it anticipates much more recent observations in this regard [5, 6]. According to Arkink [4], this would be the first CH description ever in English, because Willis [2], as well as Tulp [1], had used Latin.

In 1745, in his Commentaria in Hermanni Boerhaave aphorismos de cognoscendis et curandis morbis written in Latin [5], Gerhard van Swieten, a disciple of Herman Boerhaave who founded the Vienna Medical School and served also as the personal physician of Austrian empress Maria Theresa, described a headache attack that, according to Isler [6], had all the features modern neurologists consider necessary for a diagnosis of CH [7]: “A healthy, robust men of middle age was, each day, at the same hour troubled by pain above the orbit of the left eye, where the nerve leaves the bony frontal opening; after a short time the left eye began to redden and tears to flow; then he felt as his eye was protruding from its orbit with so much pain that he became mad. After a few hours all this evil ceased and nothing in the eye appeared at all changed”.

Two years later, Johann Christoph Ulrich Oppermann in his Dissertatio medica inauguralis de hemicrania horologica [8] reported the case of a 35-year-old woman who since age 29 had suffered from daily attacks lasting about 15 min and recurring every hour, both at night and during the day, with such regularity that she could tell time more precisely than the clock tower in the town square. Oppermann’s hemicrania horologica bears close similarities to the chronic paroxysmal hemicrania that Sjaastad and Dale were able to describe only two centuries later [9].

In 1813, 56-year-old Johann Müller, general practitioner in Frankfurt, provided a detailed description of the headache that had afflicted him from age 20 to age 54 [10]: “[…] April 28, 1777 at 8 o’clock in the morning (I felt) in correspondence of the right orbit, at the level of the eyebrow, in a region that could be covered by a threepenny piece, a particular sensation of heaviness, localized in depth, that increased from minute to minute and was becoming a more and more intense pain, until it became unbearable. The pain was dull, lancinating, bothering, throbbing, as if a blacksmith was beating on his anvil; the eye had become so sensitive that it could not tolerate light, red, spasmodically contracted and full of tears; the temporal vessels were pulsing stronger than ever […] I could not find relief in any position, until the pain became so severe that I rolled on the floor. […] The attack occurred at exactly 8 o’clock every morning for seven consecutive days. […] Fortunately it then resolved; I have been suffering for 34 years from this form of disease, that afflicts me each year in fairly irregular periods”. This is a very interesting description, especially because it points out two features that are typical of CH: the patient’s peculiar behaviour during attacks and the periodic temporal pattern of the headache.

In the following years of the nineteenth century, eminent researchers like von Moellendorff [11], Eulenburg [12], and Charcot [13] all reported migrainous conditions characterized by attacks with signs and symptoms that were more typical of CH than of migraine, but no significant progress was made in the study of CH.

1.2 First Half of the Twentieth Century

This was a crucial period for CH history, owing to two different sets of events.

The first was the descriptions, by several authors, of headache forms that seemed to have much in common with CH but were given the most diverse names [14–22] (Table 1.2).

Table 1.2

Possible names of cluster headache before 1952

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