Cluster Headache

Overview

Cluster Headache can be mistaken as frequent migraine episodes as characterized by unilateral type of severe headache which occurs in a cyclical pattern with pain- free interval known as cluster periods. Additional symptoms mimic a case of acute sinusitis or chronic allergic rhinitis. The headaches will last from weeks or months and enter remission for 1 month to years before the next excruciating cycle repeats itself. Unlike migraine, patients with cluster headaches do not experience an aura before an attack and are more common among men. Its pathophysiology is still unknown but triggering factors have been identified. Management is targeted at shortening the duration of an attack and reducing the severity of pain. Besides, it is not a life-threatening and rare diagnosis.

Signs and Symptoms

A sudden attack of severe unilateral pain in areas innervated by the first and second divisions of the trigeminal nerve (orbital, supraorbital, or temporal pain) that last 15-180 minutes and occur from once every other day to 8 times a day. - Accompanied by one or more of the following symptoms: Excessive tearing, redness or swelling of your eye on the affected side, runny nose on the affected side, forehead or facial sweating on the affected side, pale skin or flushing on your face or drooping eyelid on the affected side. - During an attack, patients may become agitated and restless. To help cope with the attack, they prefer to pace or move around, rock back and forth, sit, pace or even to an extent of banging themselves against a hard surface.

Common Causes

Hot weather, Seasonal, Watching television, Nitroglycerin, Histamine, Stress, Glare, Allergic rhinitis, Sexual activity,

Risk Factors

Male sex Age older than 30 years Small amounts of vasodilators (eg, alcohol) Previous head trauma or surgery (occasionally)

Investigation Techniques

Physical examination Neurological examination MRI of brain and its neurovascular component. CT scan of brain

Treatment and Prevention

Treatment : -Oxygen: 8 L/min for 10 minutes or 100% by mask. -5-Hydroxytryptamine-1 (5-HT1) receptor agonists in the form of nasal spray, such as triptans or ergot alkaloids with metoclopramide, are often the first line of treatment. Other triptans that may be considered for abortive treatment of CH are zolmitriptan, naratriptan or rizatriptan. -Dihydroergotamine is commonly given as injections via intravenous (IV) or intramuscular route (IM) and may be self-administered as intranasal spray. - Local anesthetics such as lidocaine, may be effective against cluster headache pain in some people when given through the nose (intranasal). Prevention: - Lifestyle modifications: Stick to a regular 7 to 8 hours of sleep schedule and avoid alcohol as well as smoking. -Calcium channel blockers Verapamil -Corticosteroids. - Lithium carbonate. - Nerve block into the area around the occipital nerve - Anti-seizure medications, such as topiramate.