Skip to main content

EHMTI-0220. Cortical excitability in episodic cluster headache


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.

Author information



Corresponding author

Correspondence to G Cosentino.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Cosentino, G., Fierro, B., Brancato, S. et al. EHMTI-0220. Cortical excitability in episodic cluster headache. J Headache Pain 15, E11 (2014).

Download citation


  • Transcranial Magnetic Stimulation
  • Cluster Headache
  • Cortical Excitability
  • Intracortical Inhibition
  • Primary Headache Disorder