Cluster headache and middle meningeal artery dural arteriovenous fistulas: A case report

• Published in: Cephalalgia Vol. 38; no. 11; pp. 1792 - 1796
• Main Authors: Chang, Yu-Han, Luo, Chao-Bao, Wang, Shuu-Jiun, Chen, Shih-Pin
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.10.2018
• Subjects: Cluster headache; trigeminal autonomic cephalalgia; middle meningeal artery; dural arteriovenous fistulas; endovascular embolization
• ISSN: 0333-1024; 1468-2982; 1468-2982
• DOI: 10.1177/0333102417747229

Background Of the multiple etiologies identified for symptomatic cluster headache, vascular origin is common; however, there are no known reports of arteriovenous (AV) fistulas. Here we report a case with typical presentation of cluster headache, which might be associated with middle meningeal AV fistulas. Case report The subject is a 49-year-old man with a 7-year history of episodic left-side cluster headache, consistent with the criteria in the International Classification of Headache Disorders, 3rd edition, beta version (ICHD-3β). Magnetic resonance angiography (MRA) demonstrated dural arteriovenous fistulas at the left posterior fossa, which is supplied mainly by the left middle meningeal artery. After endovascular balloon-assisted embolization, his symptoms have disappeared without relapse for 1.5 years. Discussion We suggest that middle meningeal arteriovenous fistulas should be considered as a potential differential diagnosis of secondary cluster headache, even when the initial clinical manifestations and treatment response are typical for primary cluster headache.