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Horton's neuralgia

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Brief, recurrent unilateral headaches occurring in clusters, involving the templar area, eye, and neck. Occurs particularly in middle-aged males. The pain is often extremely severe. The recurrent attacks often appear within a period of 24 hours, sometimes during sleep, and usually last for less than two hours, and commonly less than 30 minutes.

The typical symptoms of Horton's headache were first described in 1641 by the Dutch physician Nicolaas Tulp (1593-1674), famous for The Anatomy Lecture of Dr. Nicolaas Tulp, painted in 1632 by Rembrandt Harmenszoon van Rijn (1606-1669), and the disease was maybe described by Thomas Willis (1621-1675).

The first extensive report was made by Wilfred Harris, who did not however, distinguish clearly between the headache and other painful conditions of long duration and alternate hemispheres. It was Horton who first described the attacks and their associated symptoms and also presented a new and attractive theory of their pathogenesis and aetiology. Klunke et al in 1952 first described the recurrent nature that distinguishes Horton's headache from other forms of headache. He therefore termed this form cluster headache.

«Our patients were disabled by the disorder and suffered from bouts of pain from two to twenty times a week. They had found no relief from the usual methods of treatment. Their pain was so severe that several of them had to be constantly watched for fear of suicide. Most of them were willing to submit to any operation which might bring relief.»
From Horton's 1939 original paper on cluster headache.


  • Nicolaas Tulp:
    Observationum medicarum libri tres. Amsterdam, 1641.
  • T. Willis:
    The London Practice of Physick.
    1st edition. London, Thomas Basset and William Crooke, 1685. Pages 386-387.
  • B. T. Harris:
    Neuritis and neuralgia. London, 1926. Ciliary (migrainous) neuralgia and its treatment.
    British Medical Journal, 1936, 1: 457-460.
  • R. Bing:
    Lehrbuch der Nervenkrankheiten. Berlin, 1913. Über traumatische Erythromelalgie und Erythroprosopalgie.
    Der Nervenarzt, Berlin, 1930, 3: 506-512.
  • B. T. Horton:
    A new syndrome of vascular headache: report of treatment with histamine: preliminary report. Proceedings of the Staff Meetings of the Mayo Clinic, Rochester, MN, 1939, 14: 257-260. The use of histamine in the treatment of specific types of headaches.
    Journal of the American Medical Association, Chicago, 1941, 116: 377-383. Histamine cephalgia (Horton's headache or syndrome).
    Maryland State Medical Journal, 1961, 10: 178-203.
  • E. C. Kunkle, J. B. Pfeiffer, W. H. Wilhoit, L. W. Hamrick:
    Recurrent brief headache in cluster pattern.
    Transactions of the American Neurological Association, 1952, 77: 240-243.

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