Cluster headache is a rare headache, absolutely unilateral pain, very strong attacks and eye expression occurs. The term Cluster (English: “bunch”) was chosen because this headache usually lasts periodically from several weeks to several months. Most patients often have seasonal cluster headaches in spring or autumn. Following this episode, patients often remain asymptomatic for months or years. Severe unilateral attacks usually last for 15-180 minutes. It usually occurs suddenly without a pronounced trigger. However, it is characterized by rhythm, usually at the same time asleep. There are also triggering factors for attacks. For example, alcohol (even small amounts), some medicines (eg containing nitro) and staying high. During one episode, cluster attacks can change the frequency from 2 days and 8 attacks daily. Headaches hardly change any side.
Headache is sometimes described as intolerable to violence, such as burning, boring or tearing. The main pain usually sits around the eyes or behind the eyes. Some patients monitor that the pain begins in the heart. The pain may spread to the upper jaw. Then, in addition to the time rhythm (usually night hours), the accompanying symptoms are quite characteristic for a cluster headache:
- Redness in the eye
- Eye drops at tears
- Hanging eyelid
- Existing and / or nasal congestion
- Sweating Forehead or Face
- Restlessness (shaking with the upper body, movement)
Among these symptoms, at least one of the affected pain side is required for diagnosis. In addition, many patients also complain of typical migraine symptoms (nausea, sensitivity to light and noise).
The symptoms are characteristic of the known trigeminootonomical headache group. This is a classification group within the International Headache Classification (IHS). In this group, there are other extremely rare headache syndromes such as paroxysmal hemicrania or SUNCT syndrome. These rare headache syndromes are characterized by more frequent and short attacks. They do not respond to a cluster headache treatment.
Sometimes they are confused with a disease such as a cluster headache, eye or sinus infection. Very rarely, tumors, such as pituitary gland tumors, can cause a headache that is very similar to a cluster headache. To exclude a symptomatic cause of cluster headache, an MRI of the head is usually required once. If normal, no additional research is required.
What causes cluster headaches?
One cause for cluster headaches has not yet been proven. There is evidence that a particular area of the brain, the hypothalamus, plays an important role. The hypothalamus is regarded as the “inner clock” of humans and is blamed for both the time rhythm of attacks and the seasonal increase of episodes. In addition, the attack of the trigeminal nerve and autonomic nervous system is also stimulated. The trigeminal nerve is responsible for sensory perception of the head and face.
How does a cluster headache manifest itself?
Most patients with cluster headaches are episodic and go within weeks or months. Rarely, a cluster headache may also become chronic. If the seizure period is less than a month and there is no remission within one year, there is a chronic cluster headache. It develops in about 10% of primary chronic patients, while secondary chronic develops in about 5% of episodic patients.
Cluster headache – how is it treated?
Cluster headache is a primary headache and yet cannot be completely eliminated with medical treatment. But the pain and frequency intensity of attacks can often be controlled by medication. Like most headache disorders, a distinction is made here between acute treatment and preventive treatment.
Normal painkillers are not suitable for the treatment of a cluster of headache attacks. Many patients respond to attack with pure oxygen inhalation. This treatment has no side effects and can also be prescribed for home use. Apart from oxygen, Triptan can be used as a nasal spray with fast-acting dosage forms of the drug class or lidocaine (local anesthetic).
The occurrence of extremely violent attacks can be prevented to a great extent and therefore preventive treatment (prophylactic) is generally important. Here drugs from different drug classes are used. The mechanisms of action are not yet understood. Since the disease is rare, prophylactic appropriate treatment should be performed by an experienced neurologist. The choice of agent available for treatment depends on the form of cluster headache (chronic/episodic) and any concomitant diseases of the patient. Commonly used agents for cluster headache prophylaxis are verapamil, topiramate, methysergide, and lithium. Their effect can be expected within 1-2 weeks. Short-term high-dose corticosteroids are used as a bridge therapy until the effect of these substances is fulfilled. The ingredients can also be combined. The duration of prophylactic treatment depends on the episode duration of the headache. As an alternative to pill treatment, large and small occipital cini