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It is well established that cluster headache shows impaired functions at their neuroimmunomodulatory system level. Defect in receptor expression for 5-HT, IL-1 and IL-2 have been found in these patients. Sumatriptan, a molecule with agonistic activity for 5-HT1D receptor, truncates cluster headache attacks in 74% of patients. Flow cytometric analysis of monocytes expressing 5-HT receptor in cluster headache patients showed different trends clearly correlated with the clinical response to sumatriptan. Our findings strongly support the concept that cluster headache patients who are non responders to sumatriptan could present a block in their 5-HT receptor possibly due to specific autoantibodies for this receptor site.

Thirteen patients affected by Burkitt's lymphoma were studied. Six out of them had cluster headache associated with Burkitt's lymphoma, and in this group we observed the absence of HLA-B14 antigen. The presence of HLA-B14 antigen in the remaining seven patients, confirm the hypothesis of a protective role of this antigen against cluster headache.

Reference is made to a patient with an approximately 20-yr history of cluster headache and crises refractory to medical prophylaxis for 2 years prior to admission. Over the last 30 days, the picture had been complicated by resistance to ergotamine and motor deficiency in the right leg. Neuroradiological investigation revealed a lesion occupying the left parieto-occipital space. This remained undiagnosed. Its aetiology and clinical relations are discussed in the light of other cases of cluster headache associated with a demonstrated organic lesion described in the literature.

After analysing personal results and the data in the literature concerning the therapeutic effects of Lithium salts in cluster headache, the Authors discuss some of the pathogenetic problems related to this particular form of idiopathic headache. The results obtained seem very favourable however the therapeutic efficiency of Lithium salts, also observed in neuralgic-vasomotor syndromes (Charlin, Sluder) and in some forms of chronic headache, seems to indicate a relatively unspecific mechanism of action. The Authors suggest therefore an intervention in the stabilization of the membrane at the CNS level, with increasing efficiency of "antinociceptive" system.