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  Cluster headache

Cluster headache a headache condition in which the attacks occur in cycles or clusters. Frequent, extremely painful attacks occur in periods that last from weeks to months followed by pain free remissions. Patterns vary from person to person. Cluster headaches are the most painful types of headaches, affecting mostly men, in one percent of the US population.

Cluster headache
Cluster headache


Symptoms:


 Cluster headache occurs quickly without warning.
 Pain develops on the same side of the head throughout the cluster time period.
 Sharp, stabbing pain, sometimes with burning
 Pain has been described as a red hot poker in the eye or that the eye feels as if it is being pushed out of the socket.
 Patients are restless
 Lying down usually makes the pain worse
 Sleep deprivations, which makes pain worse and can cause depression
 Teary eyes
 Stuffed nose feeling
 Red, flushed face
 Swelling around the eye on the affected side of the face
 Reduced pupil size
 Drooping eyelid

Migraine like symptoms may also be present such as:

 including nausea
 sensitivity to light
 sensitivity to sound
 visual or sensory aura

Cluster usually lasts from two to twelve weeks. Chronic clusters may last for over a year. Cluster periods are startlingly consistent from cluster to cluster. Patients may have a ‘cluster’ season. During a cluster phase, headaches may last forty-five to ninety minutes and at the same time each day. Nighttime attacks are more common, occurring ninety minutes to three hours after falling asleep. After an attack, patients are usually completely pain free, but extremely tired.

Diagnosis:

Diagnosis is made via the description of the attacks, including the frequency and duration of the attacks, the severity of the pain, the location of the pain and other symptoms.

If the headache is chronic, a physician may order a neurological exam and imaging tests to determine the cause of the headache – to rule out something more serious. In order to assist the physician in making a diagnosis, it is important to keep a headache journal – that includes- description of the pain, severity of the pain, location of the pain, duration of the pain and any medication being taken.

Causes:

The International Headache society has classified cluster headaches into two types:

Chronic – daily headaches for more than a year with no remission or pain-free cycles of lasting less than two weeks.

Episodic – daily headaches for one week to one year followed by a pain-free phase lasting weeks to years before the next cluster.

Research has indicated that different mechanisms in the body explain the manifestations of cluster headache

Triggers are the usually associated with migraine and tension headaches. Cluster headaches usually do not have triggers. For people who suffer from cluster headaches and are smokers and heavy drinkers, a headache may occur within minutes after a cigarette, cigar, pipe or drink.

Since cluster attacks occur typically the same time each twenty-four hour period, and have a season, it is suggested that the individual’s “biological clock” is involved. This is located in the hypothalamus. Abnormalities of the hypothalamus may explain the schedule of cluster headaches. Cluster headache sufferers also have abnormal levels of certain hormones – testosterone and melatonin during clusters. Other studies have indicated that cluster headache patients have a larger hypothalamus than non-cluster headache patients. The cause of these abnormalities is unknown.

Treatment:

There is no cure for cluster headaches. Treatment is used to decrease pain and reduce the cluster period.

Acute medication may be used to reduce or stop the pain of a cluster headache. Pain occurs quickly and medication needs to be fast acting. Usually the medication is delivered via injection or inhaler. Over the counter drugs are not affective because of the time release characteristic.

Acute treatment may also include briefly inhaling one hundred percent oxygen at a rate of seven liters per minute. Immediate relief occurs for up to ninety percent of patients. Imitrex (generic sumatriptan is a common treatment for migraines, but has been used for cluster headaches in the form of nasal spray. Local anesthetics via nasal drops have also been noted to relieve the sudden pain of cluster headaches.

Vary rarely is surgery recommended. If a patient cannot tolerate medication and does not respond to aggressive treatments may respond to surgery. The most common procedures are on the trigeminal nerve. Side effects may include residual weaknesses in the jaw or sensory loss in the face.

A newer treatment is a pacemaker device that is used to stimulate the optical nerve that may affect the trigeminal nerve.

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