CLUSTER HEADACHES

Cluster headache is pain that occurs alongside one side of the head. It is mainly described as soreness that occurs around, in the back of, or above and along the temple in cyclic patterns or clusters. The ache of a cluster headache is very severe.

Many sufferers describe a “drilling” kind of sensation. There is also tearing/watering of the eyes, redness of the conjunctiva, rhinorrhea or nasal stuffiness, eyelid drooping, sweating on one part of the face, or alterations in pupil size (with the pupil on the affected area becoming particularly smaller) that are there. The headache lasts from minutes to about 3 hours. Nevertheless, the headache can recur up to eight times daily.

Men are two to four times more likely to have cluster headache than women; nevertheless, the overall frequency is particularly low, with a prevalence of about 1 per 1,000. Considering the the rarity of the situation, limited information is on hand.

Although the substantial majority of sufferers are adults, cluster headache was also found in children as younger as 6 years of age.

The unique cause and anatomic origin of cluster headaches is not known. MRI reports propose dilation of the ophthalmic artery during an acute cluster headache, even as PET scans reveal activity inside the cavernous sinus. However, many sufferers with other headache types even have abnormalities in identical regions, so these assessments aren’t definitive.

There may be some evidence that the hypothalamus is also involved in the recurrence cycle of cluster headaches. Activation of the trigeminal ganglion can lead to many alterations related to cluster headache, however the trigger for activation of this region hasn’t been identified.

What triggers cluster headaches? Here are some of them:

  • While sleeping
  • Alcohol
  • Histamines and nitroglycerin
  • Seasonal variation
  • Other risk factors include smoking and a family history of the problem.

Symptoms include the following:

  • Unilateral, or one-sided
  • Pain as occurring around or behind the eye
  • Pain radiating along the forehead, into the jaw or along the gum line and into the teeth, or across the cheek of the affected side
  • Pain may extend into the ear, neck, or shoulder
  • Watering (tearing) of the eye
  • Redness of the conjunctiva
  • Eyelid drooping or swelling
  • Runny nose (rhinorrhea)
  • Symptoms more commonly identified with migraine headaches, including sensitivity to light, sounds, or odors
  • Movement does not worsen the pain of a cluster headache
  • The headaches associated with cluster occur in groups.
  • Headaches may be brief (as short as 15 minutes), but can recur up to eight times in 24 hours.
  • Headaches may last as long as 3 hours
  • Cluster cycles may last for only a single day, or may linger for many weeks.

DIAGNOSIS

Cluster headaches are diagnosed through the following:

  • Medical history of headaches
  • Physical examination
  • MRI or CT scan of the brain to confirm that there are no other contributing factors that may mimic cluster headache symptoms

 

TREATMENT

The treatment of cluster headache can be divided into two distinct categories — relief of the acute headache and prevention of future headaches.

  • Sumatriptan
  • Dihydroergotamine
  • Intranasal lidocaine
  • Steroids can be extremely effective to decrease a headache cycle
  • Verapamil, lithium, valproic acid, topiramate, and melatonin can all be of benefit in reducing the frequency and severity of cluster cycles
  • Radiofrequency lesioning of the trigeminal ganglion

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