Subcutaneous Administration of Histamine in Cluster Headache

Objective: To test whether limiting of excessive vascular inflammatory responses might preclude the presentation of autonomic and clockwise characteristic features of cluster headache. Background: Dysfunction in the inferior hypothalamic gray matter has been proposed in the pathophysiology of cluster headache, rendering vascular flow changes as an epiphenomenon of the trigeminal activation. However further data is necessary to validate this last assumption. Methods: Three male patients, with active episodic cluster headache, were subjected to a one year regimen of subcutaneous administration of histamine (1-10 μg) twice a week. Results: After a four years follow-up period, two patients remained asymptomatic; whereas in the third case, after a five years follow-up, the time between episodes shifted from every two years to three, duration of episodes from 4 weeks to 1, and frequency of attacks from 8 per day to 2. Discussion: Prophylactic treatment aimed at limiting excessive inflammatory responses, through the activation of H3 receptors, disrupts the triggering of autonomic and clockwise characteristic features of cluster headache.