The Journal of Headache and Pain

Official Journal of the "European Headache Federation" and of "Lifting The Burden - The Global Campaign against Headache"

The Journal of Headache and Pain Cover Image

Volume 15 Supplement 1

Abstracts from the 4th European Headache and Migraine Trust International Congress: EHMTIC 2014

Open Access

EHMTI-0220. Cortical excitability in episodic cluster headache

  • G Cosentino1,
  • B Fierro1,
  • S Brancato1,
  • P Paladino1,
  • R Baschi1,
  • S Talamanca1,
  • S Indovino1 and
  • F Brighina1
The Journal of Headache and Pain201415(Suppl 1):E11

Published: 18 September 2014


Transcranial Magnetic StimulationCluster HeadacheCortical ExcitabilityIntracortical InhibitionPrimary Headache Disorder


Cluster headache (CH) is a severe primary headache disorder, whose pathophysiological processes remain largely unknown. Along with central disinhibition of the trigeminal nociceptive system and hypothalamic impairment, a cortical involvement has been supposed.


To evaluate cortical excitability in episodic CH patients by using different paradigms of transcranial magnetic stimulation (TMS).


Twenty-five patients with episodic CH and thirteen healthy subjects underwent an experimental session where we evaluated, in both hemispheres, motor-cortical response to: 1) single-pulse TMS: i.e. motor threshold (MT); input-output (IO) curves and cortical silent period (CSP) and 2) paired-pulse TMS: i.e. intracortical facilitation (ICF) and short intracortical inhibition (SICI). Thirteen patients were evaluated outside bout, while the remaining twelve patients were inside bout at the time of recording.


We showed increased ICF values in the hemisphere ipsilateral to the side of pain in patients evaluated both outside and inside bout. Differently, IO curves showed increased slope in both hemispheres in patients examined outside bout, but only in the hemisphere contralateral to the affected side in those evaluated during bout.


Our results show a condition of increased cortical excitability in episodic CH both outside and inside bout. Interestingly, cortical excitability was greater in the hemisphere ipsilateral to the side of pain in patients outside bout, but decreased in patients inside bout possibly due to activation of compensatory inhibitory mechanisms of cortical excitability. Along with subcortical and peripheral mechanisms, changes in cortical excitability could also play an important role in the pathophysiology of CH.

No conflict of interest.

Authors’ Affiliations

Department of Experimental Biomedicine and Clinical Neuroscience (BioNeC), University of Palermo, Palermo, Italy


© Cosentino et al; licensee Springer. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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