Recurrent Reversible Cognitive Impairment in a Cluster Headache Patient: A Case Report

Cluster headache (CH) is a disabling primary headache disorder sometimes dubbed the “suicide headache.” CH is characterized by a severe or very severe unilateral head pain lasting from 15 to 180 minutes with a frequency ranging from once every other day to 8 times daily, accompanied by ipsilateral autonomic symptoms and/or restlessness or agitation. Behavior during attacks may range to include not just restlessness but a variety of complex, even violent, self-injurious behaviors and even suicide attempts. CH has been previously associated with psychiatric comorbidities such as depression, anxiety disorders, and aggressiveness. However, little is known about cognition in CH patients. Here we report a patient presenting with progressive worsening of cognitive functions and behavioral modifications during CH bouts. An extensive neuropsychological assessment, including global cognition indexes, verbal and visual memory, attention, executive and visuospatial function, language, and depression, was performed during 2 active CH periods, and during a pain-free period. Selective deficits in attention and executive functions were found only during the active CH bouts. We describe a 50-year-old man with a medical history of hypertension presenting with a 6-year history of episodic CH. He described strictly right-sided episodes of severe pain occurring in the periorbital area, accompanied by ipsilateral lacrimation, conjunctival injection, eyelid edema, and nasal congestion. The attacks had prominent psychiatric features with agitation and violent self-injurious behaviors. The pain occurred only during the daytime. The onset was never at night. The attacks usually lasted from 30 minutes to 2 hours when untreated, occurring with a frequency of one every other day, for nearly a month once a year. Attacks responded to subcutaneous sumatriptan 6 mg and high-flow inhaled oxygen. A trial with quietapine (up to 100 mg/die) was added to a From the IRCCS Institute of Neurological Sciences of Bologna, UOC Clinica Neurologica, Bologna, Italy (V. Favoni, L. Sambati, F. Oppi, M. Stanzani Maserati, S. Cevoli, and G. Pierangeli); Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Alma Mater Studiorum University of Bologna, Italy (V. Favoni, L. Sambati, and G. Pierangeli).