Enrico Arkink1, Nicole Schmitz1,2, Guus Schoonman3, Jorien van Vliet3,4, Gisela Terwindt3, Mark van Buchem1, Michel Ferrari3, Mark Kruit1
1Radiology, Leiden University Medical Center, Leiden, Netherlands; 2Psychiatry, Amsterdam Medical Center, Amsterdam, Netherlands; 3Neurology, Leiden University Medical Center, Leiden, Netherlands; 4Neurology, Medisch Centrum Haaglanden, Den Haag, Netherlands
Trigeminal autonomic cephalalgias include cluster headache, paroxysmal hemicrania and SUNCT. An earlier voxel-based morphometry (VBM) study pointed at the posterior inferior hypothalamus to be involved in CH, but results were never reproduced. In the current study we used state of the art whole-brain and regional VBM, and manual segmentation of the hypothalamus, in analyzing the brains of 151 subjects with TACs (n=70), migraine patients (n=33) and controls (n=48). We found the anterior part (but not the posterior part) of the hypothalamus, including the suprachiasmatic nucleus (the biological clock), to be larger in TACs compared to migraineurs and controls. Our results seem to be specific for TACs, and question the validity and/or relevance of the earlier finding, including its role in deep brain stimulation as treatment for intractable cluster headaches.