Abstract：
To identify the most common locations of cluster headache pain from an international, non-clinic-based survey of participants with cluster headache, and to compare these locations to other cluster headache features as well as to somatotopic maps of peripheral, brainstem, thalamic, and cortical areas.
Official criteria for cluster headache state pain in the orbital, supraorbital, and/or temporal areas, yet studies have noted pain extending beyond these locations, and the occipital nerve appears relevant, given the effectiveness of suboccipital corticosteroid injections and occipital nerve stimulation. Furthermore, cranial autonomic features vary between patients, and it is not clear if the trigeminovascular reflex is dermatome specific (e.g., do patients with maxillary or V2 division pain have more rhinorrhea?). Finally, functional imaging studies show early activation of the posterior hypothalamus in a cluster headache attack. However, the first somatosensory area to be sensitized is unclear; the first area can be hypothesized based on the complete map of pain locations.
The International Cluster Headache Questionnaire was an internet-based cross-sectional survey that included a clickable pain map of the face. These data were compared to several other datasets: (1) a meta-analysis of 22 previous publications of pain location in cluster headache (consisting of 6074 patients); (2) four cephalic dermatome maps; (3) participants\' survey responses for demographics, autonomic features, and effective medications; and (4) previously published somatotopic maps of the brainstem, thalamus, primary somatosensory cortex, and higher order somatosensory cortex.
One thousand five hundred eighty-nine participants completed the pain map portion of the survey, and the primary locations of pain across all respondents was the orbital, periorbital, and temporal areas with a secondary location in the lower occiput; these primary and secondary locations were consistent with our meta-analysis of 22 previous publications. Of the four cephalic dermatomes (V1, V2, V3, and a combination of C2-3), our study found that most respondents had pain in two or more dermatomes (range 85.7% to 88.7%, or 1361-1410 of 1589 respondents, across the four dermatome maps). Dermatomes did not correlate with their respective autonomic features or with medication effectiveness. The first area to be sensitized in the canonical somatosensory pathway is either a subcortical (brainstem or thalamus) or higher order somatosensory area (parietal ventral or secondary somatosensory cortices) because the primary somatosensory cortex (area 3b) and somatosensory area 1 have discontinuous face and occipital regions.
The primary pain locations in cluster headache are the orbital, supraorbital, and temporal areas, consistent with the official International Classification of Headache Disorders criteria. However, activation of the occiput in many participants suggests a role for the occipital nerve, and the pain locations suggest that somatosensory sensitization does not start in the primary somatosensory cortex.
Official criteria for cluster headache state pain in the orbital, supraorbital, and/or temporal areas, yet studies have noted pain extending beyond these locations, and the occipital nerve appears relevant, given the effectiveness of suboccipital corticosteroid injections and occipital nerve stimulation. Furthermore, cranial autonomic features vary between patients, and it is not clear if the trigeminovascular reflex is dermatome specific (e.g., do patients with maxillary or V2 division pain have more rhinorrhea?). Finally, functional imaging studies show early activation of the posterior hypothalamus in a cluster headache attack. However, the first somatosensory area to be sensitized is unclear; the first area can be hypothesized based on the complete map of pain locations.
The International Cluster Headache Questionnaire was an internet-based cross-sectional survey that included a clickable pain map of the face. These data were compared to several other datasets: (1) a meta-analysis of 22 previous publications of pain location in cluster headache (consisting of 6074 patients); (2) four cephalic dermatome maps; (3) participants\' survey responses for demographics, autonomic features, and effective medications; and (4) previously published somatotopic maps of the brainstem, thalamus, primary somatosensory cortex, and higher order somatosensory cortex.
One thousand five hundred eighty-nine participants completed the pain map portion of the survey, and the primary locations of pain across all respondents was the orbital, periorbital, and temporal areas with a secondary location in the lower occiput; these primary and secondary locations were consistent with our meta-analysis of 22 previous publications. Of the four cephalic dermatomes (V1, V2, V3, and a combination of C2-3), our study found that most respondents had pain in two or more dermatomes (range 85.7% to 88.7%, or 1361-1410 of 1589 respondents, across the four dermatome maps). Dermatomes did not correlate with their respective autonomic features or with medication effectiveness. The first area to be sensitized in the canonical somatosensory pathway is either a subcortical (brainstem or thalamus) or higher order somatosensory area (parietal ventral or secondary somatosensory cortices) because the primary somatosensory cortex (area 3b) and somatosensory area 1 have discontinuous face and occipital regions.
The primary pain locations in cluster headache are the orbital, supraorbital, and temporal areas, consistent with the official International Classification of Headache Disorders criteria. However, activation of the occiput in many participants suggests a role for the occipital nerve, and the pain locations suggest that somatosensory sensitization does not start in the primary somatosensory cortex.
摘要：
目的：为了确定丛集性头痛最常见的部位，对丛集性头痛参与者的非诊所调查，并将这些位置与其他丛集性头痛特征以及周围的体图进行比较，脑干,丘脑,和皮质区域。
背景：眼眶丛集性头痛状态疼痛的官方标准，眶上,和/或时间区域，然而，研究已经指出疼痛延伸到这些位置之外，枕骨神经似乎相关，考虑到枕下皮质类固醇注射和枕神经刺激的有效性。此外，颅骨自主神经特征因患者而异，并且尚不清楚三叉神经血管反射是否具有皮肤特异性（例如，上颌或V2分区疼痛的患者是否有更多的鼻漏？）。最后,功能成像研究显示，丛集性头痛发作时下丘脑后部的早期激活。然而,要致敏的第一个体感区域尚不清楚;第一个区域可以根据完整的疼痛位置图进行假设。
方法：国际集群头痛问卷是一项基于互联网的横断面调查，其中包括可点击的面部疼痛图。将这些数据与其他几个数据集进行了比较：（1）对22篇关于丛集性头痛疼痛位置的文献（包括6074例患者）的荟萃分析；（2）四个头端皮肤图；（3）参与者对人口统计学的调查响应，自主功能，和有效的药物；（4）以前发表的脑干的体图，丘脑,初级体感皮层，和高阶体感皮层。
结果：一千五百八十九名参与者完成了调查的疼痛图部分，所有受访者疼痛的主要部位是眼眶，眶周,和在下枕区有次要位置的颞区;这些主要和次要位置与我们对22篇以前出版物的荟萃分析一致。在四种头颅皮组（V1，V2，V3和C2-3的组合）中，我们的研究发现，大多数受访者在两个或两个以上的皮肤组中有疼痛（范围为85.7％至88.7％，或1589名受访者中的1361-1410，横跨四个皮刀图)。皮片与它们各自的自主神经特征或药物有效性无关。在标准体感途径中被致敏的第一个区域是皮层下(脑干或丘脑)或更高阶体感区域(顶叶腹侧或次级体感皮质),因为初级体感皮层(区域3b)和体感区域1具有不连续的面部和枕骨区域。
结论：丛集性头痛的主要疼痛部位是眼眶，眶上,和时间区域，符合官方的国际头痛疾病分类标准。然而,许多参与者枕骨的激活表明枕骨神经的作用，疼痛的位置表明，体感敏感并不是在初级体感皮层开始的。
背景：眼眶丛集性头痛状态疼痛的官方标准，眶上,和/或时间区域，然而，研究已经指出疼痛延伸到这些位置之外，枕骨神经似乎相关，考虑到枕下皮质类固醇注射和枕神经刺激的有效性。此外，颅骨自主神经特征因患者而异，并且尚不清楚三叉神经血管反射是否具有皮肤特异性（例如，上颌或V2分区疼痛的患者是否有更多的鼻漏？）。最后,功能成像研究显示，丛集性头痛发作时下丘脑后部的早期激活。然而,要致敏的第一个体感区域尚不清楚;第一个区域可以根据完整的疼痛位置图进行假设。
方法：国际集群头痛问卷是一项基于互联网的横断面调查，其中包括可点击的面部疼痛图。将这些数据与其他几个数据集进行了比较：（1）对22篇关于丛集性头痛疼痛位置的文献（包括6074例患者）的荟萃分析；（2）四个头端皮肤图；（3）参与者对人口统计学的调查响应，自主功能，和有效的药物；（4）以前发表的脑干的体图，丘脑,初级体感皮层，和高阶体感皮层。
结果：一千五百八十九名参与者完成了调查的疼痛图部分，所有受访者疼痛的主要部位是眼眶，眶周,和在下枕区有次要位置的颞区;这些主要和次要位置与我们对22篇以前出版物的荟萃分析一致。在四种头颅皮组（V1，V2，V3和C2-3的组合）中，我们的研究发现，大多数受访者在两个或两个以上的皮肤组中有疼痛（范围为85.7％至88.7％，或1589名受访者中的1361-1410，横跨四个皮刀图)。皮片与它们各自的自主神经特征或药物有效性无关。在标准体感途径中被致敏的第一个区域是皮层下(脑干或丘脑)或更高阶体感区域(顶叶腹侧或次级体感皮质),因为初级体感皮层(区域3b)和体感区域1具有不连续的面部和枕骨区域。
结论：丛集性头痛的主要疼痛部位是眼眶，眶上,和时间区域，符合官方的国际头痛疾病分类标准。然而,许多参与者枕骨的激活表明枕骨神经的作用，疼痛的位置表明，体感敏感并不是在初级体感皮层开始的。
