February 2009




Cluster headaches and cataract

by Matt Young EyeWorld Contributing Editor



You thought your headache was bad? Wait until you hear about cluster headaches, described as attacks of severe, unilateral pain that can occur up to eight times a day. The pain is orbital, supraorbital, and temporal, or a combination of these, and could last 15 to 180 minutes per episode. The headache “has a striking circannual and circadian periodicity,” according to a scientific article by Silvia Benemei, M.D., unit of clinical pharmacology, University of Florence, Italy, published in the Journal of Headache and Pain online in August 2008.

Of special interest should be the fact that Dr. Benemei recently reported in the same article two case studies of patients developing cataract after cluster headache. The journal article suggested a possible link, although it remains unproven. “We describe the cases of two men (not relative, but with the same last name, which originates from north-eastern Italy) that in young adult age, after years of suffering from chronic CH [cluster headache], developed cataract on the same side of the pain attacks,” Dr. Benemei reported. At this point, given the lack of plentiful data, Dr. Benemei hopes this report will instigate other possible similar cases to come out of the woodwork.

Related or unrelated cases?

The first case involved a 44-year-old man who had been diagnosed with cluster headache since he was 21. “Daily pain attacks, lasting about 90 min, were localized to the left periorbital area with ipsilateral lacrimation and rhinorrhea,” Dr. Benemei reported. “The cluster headache that initially occurred sporadically, from the age of 43 years became chronic.”

The patient developed cataract at age 39, and it was surgically removed the same year. “The sole risk factor for developing cataract at anamnesis was smoking habit,” Dr. Benemei reported. “A detailed pharmacological anamnesis excluded any kind of exposure to prolonged treatment with steroid drugs.”

In the second case, a 53-year-old man experienced cluster headache first at 44 years old and developed cataract when he was 50. “Cluster periods were characterized by 3 to 4 attacks/day of severe right-sided pain localized to the periorbital region, lasting about 45 min and associated to ipsilateral lacrimation,” Dr. Benemei reported. “The cluster headache was chronic from onset.”

This patient, too, was a smoker, but also did not have any chronic treatment with steroids. “This is the first report of cataract occurring in cluster headache patients and, interestingly, on the same eye affected by the pain attack,” Dr. Benemei reported. Clearly, though, the reports themselves are not enough to establish a definitive link between cluster headache and cataract. Although the patients weren’t at risk for developing cataract because of steroid use, they did smoke—a risk factor for developing cataract. The researchers could not speculate “on a possible causal relationship between repeated episodes of pain, inflammation and autonomic abnormalities that are considered to contribute to the cluster headache attack, and the precocious occurrence of the cataract.”

But Dr. Benemei was confident of the importance of this study “because underlining this uncommon type of comorbidity may favour the report of additional similar cases.”

According to Dr. Benemei, cluster headaches are associated with one or more of the following: conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, forehead and facial sweating, miosis, ptosis, and eyelid edema.

Additional studies may help determine whether there is a link between cluster headache and cataract or not. In the meantime, if you happen to have any cataract patients also suffering from cluster headache, why not report it? William Trattler, M.D., director, Cornea, Center for Excellence in Eye Care, Miami, said that the nice thing about case reports is that they alert physicians to potential associations that may exist. In this case, that would be the potential link between cluster headache and cataract. Dr. Trattler suggested that in these case reports, it’s interesting to note the patients had the same last name and were from the same region in Italy. It’s unclear if they were distant cousins, Dr. Trattler said. “There might be more to the story for these two patients,” Dr. Trattler said, adding that there could be some genetic basis for these case reports. In investigating a potential link further, Dr. Trattler suggested that examining the level of control of the cluster headaches is key.

“If there is a relationship between cluster headache and cataract, we have to find out the level of control of the cluster headaches,” Dr. Trattler said. “Not only is this important for patient comfort, but a physician also might have to keep such headaches under control to reduce the rate of cataract.” Patients with diabetes who are well controlled, for example, don’t develop complications of the eye nearly as much as ones who aren’t, he said. Clearly, though, more research is warranted to determine if cluster headache and cataract are indeed linked.

Editors’ note: Dr. Benemei has no financial interests related to his study. Dr. Trattler has no financial interests related to his comments.

Contact information

: silvia.benemei@unifi.it.
Trattler: 305-598-2020, wtrattler@earthlink.net

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