The cavernous sinus in cluster headache - a quantitative structural magnetic resonance imaging study

Background: It has been hypothesized that a constitutionally narrow cavernous sinus might predispose individuals to cluster headache. Cavernous sinus dimensions, however, have never been assessed. Methods: In this case-control study, we measured the dimensions of the cavernous sinus, skull base, internal carotid and pituitary gland with high-resolution T2-weighted magnetic resonance imaging in 25 episodic, 24 chronic and 13 probable cluster headache patients, 8 chronic paroxysmal hemicrania patients and 22 headache-free controls. Dimensions were compared between groups, correcting for age, sex and transcranial diameter. Results: On qualitative inspection, no relevant pathology or anatomic variants that were previously associated with cluster headache or chronic paroxysmal hemicranias were observed in the cavernous sinus or paracavernous structures. The left-to-right transcranial diameter at the temporal fossa level (mean +/- SD) was larger in the headache groups (episodic cluster headache: 147.5 +/- 7.3 mm, p = 0.044; chronic cluster headache: 150.2 +/- 7.3 mm, p< 0.001; probable cluster headache: 146.0 +/- 5.3 mm, p = 0.012; and chronic paroxysmal hemicrania: 145.2 +/- 9.4 mm, p = 0.044) compared with controls (140.2 +/- 8.0 mm). After adjusting for transcranial diameter and correcting for multiple comparisons, there were no differences in the dimensions of the cavernous sinus and surrounding structures between headache patients and controls. Conclusion: Patients with cluster headache or chronic paroxysmal hemicrania had wider skulls than headache-free controls, but the proportional dimensions of the cavernous sinus were similar.