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Materials and methods The observation included 6 patients (6 males; aged 1821 years). The observation started in February 2011. Inclusion criteria were: diagnosis of chronic CH according to the ICHD-II, and patient refractory to any prophylactic and acute abortive treatment. In all the patients vegetative signs, characteristic of CH attack, were not observed, whilst VAS and behaviour measures showed excruciating pain. Exclusion criteria were: psychiatric illness (DMS IV parameters), epilepsy, CNS pathology evidenced with MRI. All the volunteers overused both sumatriptan and fentanyl, when they presented to our structure. Fentanyl and sumatripan gave very moderate benefits (mean 1.5, 05%±05.5 SD on 0-10 VAS). The abuse lasted over 1 year (mean 3.6 years±1.2 SD). Nevertheless, it was impossible to obtain a real dis-habituation in these young sufferers. All patients, as well as one or both their parents, reported headache onset when the patient was 6 to 10 years old. Diagnosis of migraine without aura was made in accordance with the IHS criteria. It lasted for a period of 3-10 months (mean 4.1±4.7 SD). Furthermore, migraine switched to CH and became chronic in a very short period (mean 3.3±1.4 month SD). During the migraine period the 6 young patients underwent a SPECT observation during attack. In all the cases, thalamic hypoperfusion was evidenced at the contro-lateral side where CH manifested, another symptom was a moderate ipsilateral hypoperfusion at the frontal level. We performed (18) FDG/PET-CT, where CT implemented attenuation-corrected images and better defined anatomo-structural localization.

O013. Neuro-imaging and history of cases of refractory chronic cluster headache in young patients: a hint for reflections