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Cluster headache is a type of spontaneous paroxysmal headache that occurs periodically. This pain is characterized by the fact that it returns once or several times a year and lasts for several weeks. There is no known cause for cluster headaches – there are several theories in medicine that try to explain it.
Definition of cluster headache
Cluster headaches are primary headaches in which the problem is discomfort affecting the head area. We include cluster headaches in the so-called trigeminal autonomic headaches that occur unilaterally around the trigeminal nerve (facial sensory nerves) with additional autonomic symptoms (vegetative symptoms).
In addition to headaches, there may be:
- paroxysmal short-term headaches (occurring rarely),
- half-time short-term pain with conjunctival injection and lacrimation;
- constant hemicransmission (short-term headache).
Types of cluster headaches
Among cluster headaches we can distinguish:
- episodic pains – they appear practically every day and can last for days or even months. They are at least 2 clusters separated by a minimum two-week remission period and persist from one week to one year;
- chronic pains – attacks appear for more than a year and do not have a remission period of more than 2 weeks. Pains can attack at night, disturbing the patient’s sleep and therefore arousing fear of falling asleep.
Cluster headache – causes
The causes and genesis of cluster headaches are not fully known. There are two hypotheses:
1. The theory of the existence of aseptic (sterile) inflammation – this is inflammation that is not caused by fungi, bacteria, viruses or other pathogens. This inflammation affects the bone structure where the trigeminal nerve runs with the artery, supplying the brain. When inflammation occurs, blood flow in the artery is slowed down, causing the tissues to swell and widen. As a consequence, this state of affairs leads to pressure on the trigeminal nerve fibers, and then pain and vegetative symptoms appear.
2. A theory that assumes that cluster pain is caused by the structure of the brain (hypothalamus), which controls human biological rhythms. It has been shown that the hypothalamus is more active than other parts of the brain during pain attacks, which somehow explains the rhythm of cluster pain.
Symptoms of cluster headache
Cluster headache is accompanied by other symptoms: reddening of the conjunctiva, tearing of the eye, sweating of the face, eyelid swelling, runny or blocked nose and sometimes constriction of the pupil and drooping eyelid. Pain attacks usually appear at a certain time of the year and day, and can be very severe and radiate into the jaw. Cluster headache can be episodic or chronic, in which the affected person has to struggle with it daily for many months or years.
Cluster headaches are quite specific, therefore their diagnosis is not very difficult. The main symptom of cluster headaches is pain one-sidedness. Patients describe the pain as stinging and burning. It usually attacks the parietal area, the eyeball, and rarely radiates to the neck or shoulders. Cluster headaches occur with varying frequency, this can be once a day, and it can be up to eight times. Pain usually occurs during sleep (even during the day).
During cluster headaches, the patient behaves in a characteristic way – he is motorically agitated, and he compresses the painful areas. Unlike other headaches, we can provoke cluster headaches with:
- alcohol;
- turn around;
- vasodilators.
About 20% of patients have an atypical course of the disease. They develop characteristic headaches that are paroxysmal, but these attacks do not group and do not form the so-called clusters (the cluster usually lasts from several weeks to several months). In a part of the KGB population, paroxysmal headaches develop from the very beginning of the disease, while in others, we can first notice the symptom in the form of clusters, which over time develops into secondary chronic cluster headaches that occur almost every day.
Cluster headaches can also be associated with:
- vomiting;
- nausea;
- psychomotor agitation;
- redness of the face;
- tingling sensation in the face around the eye socket and temples;
- constriction of the pupil;
- weakened corneal reflex.
Cluster headache diagnosis
Cluster headache is suspected when migraine and tension headaches are excluded. If we complain of orbital, recurring headache and other symptoms described above, spontaneous pain may be suspected.
The diagnosis of cluster headache is based primarily on the medical history that the doctor carries out with the patient and on the characteristic clinical picture. They are presented below factors helpful in diagnostics:
- narrowing of the pupil and eyelid gap;
- Stuffed nose;
- conjunctival hyperemia;
- severe unilateral headache, radiating to the eye sockets / temples (lasts 15 to 180 minutes without treatment, at least five times a month);
- swelling of the eyelids;
- pain is not related to other conditions;
- pain occurs one to eight times a day.
Treatment of cluster headache
Cluster headaches do not improve with age, and effective treatment is essential. Treatment of cluster headache can be based on three strategies:
1. Combating a single seizure – it is briefly speaking an emergency procedure which consists in inhaling pure oxygen at a dose of 7 l / min for about a quarter of an hour. In addition, pharmacological preparations can be used, e.g. sumatriptan applied subcutaneously. Remember not to exceed the recommended daily dose of drugs!
2. Breaking the cluster – most often it is done at the beginning of its duration with the use of steroid drugs, such as methylprednisolone or dexamethasone. These preparations are administered intravenously first, and then orally in a smaller dose.
3. Prophylaxis – in addition to the above-mentioned methods, prophylaxis is important in combating cluster pain. This is where the sodium salt of valproic acid or verapamil and lithium carbonate come in handy (they help to prevent cluster attacks).
4. In drug-resistant patients, stimulation of the posterior part of the hypothalamus is used.
Do non-pharmacological treatments work?
Massage, acupuncture, special diets? It’s useless. Above all, you should avoid the cluster pain trigger, namely alcohol.
Cluster headache – is surgery possible?
There are some surgical methods performed under radiological control of Gessar ganglion thermocoagulation or by cutting the sensory root of the trigeminal nerve from the access through the posterior cranial cavity. These methods have eliminated cluster headaches in most people, so the results are encouraging. There have been some failures due to inaccurate rupture of the first branch of the trigeminal nerve. In addition, in some patients the pain persisted even though the denervation was normal.
It is considered the newest operating method of this ailment stereotaxic implantation of a stimulating electrode into the periventricular area of the hypothalamus. However, in order for this method to be applied on a wider scale, numerous observations are necessary.