What is cluster headache?
Cluster headache is a trigeminal autonomic cephalalgia characterized by extremely painful, strictly unilateral, short-lasting headache attacks accompanied by ipsilateral autonomic symptoms or the sense of restlessness and agitation, or both.
Cluster headache pattern is more common in males (5:1 Male to female) and occurs predominantly in middle-age men (20 to 50 years); male-to-female ratio approximately 5:1) and is characterized by a consistent unilateral orbital localization.
- The pain is felt deep in and around the eye. It is very intense and non-throbbing.
- It often radiates into the forehead, temple, and cheek—less often to the ear, occiput, and neck.
- Its other characteristic feature is a nightly recurrence, between 1 and 2 h after the onset of sleep, or several times during the night; less often, it occurs during the day. Most patients get up from bed during an attack and sit in a chair, holding a hand to the side of the head.
- On average these features last commonly up to 45 minutes but can be from 15 min to 3 hours.
- Not associated with aura or vomiting.
Why cluster headache is terms as Alarm clock headache?
This type of headache shows recurrent episodes with remarkable regularity each night for periods extending over 6 to 12 weeks. Most of time it is followed by complete freedom for many months or even years.
Only in 10 percent of patients, the headache becomes chronic, persisting over days, months, or even years.
What are the associated features we can give diagnostic clues?
There are several associated symptoms by which cluster headache can be identified:
- blocked nostril,
- running nose,
- conjunctival redness,
- watering from eyes,
- swelling or redness over the cheek.
Are there any precipitating factors?
Cluster headache may be triggered in sensitive patients’ by taking alcohol or nitroglycerin. Nitroglycerin medication is common in heart disease patients.
How does the cluster headache occurs?
It is still not known how the cluster headache occurs. However the role of paroxysmal parasympathetic discharges, hypothalamic involvement have been considered.
- Sumatriptan can be used to alleviate the acute episodes of cluster headache.
- Inhalation of 100 percent oxygen via mask for 10 to 15 min at the onset of cluster headache. But this is not a practical solution.
- Termination of a cycle of the cluster can also be achieved with calcium channel blockers such as Verapamil, starting with 80 mg four times a day and increasing the dose over days.
- Cluster headache is characterized by extremely painful, strictly unilateral, short-duration headache attacks accompanied by ipsilateral autonomic symptoms or the sense of restlessness and agitation.
- The severity of the disorder has major effects on the patient’s quality of life and, in some cases, might lead to suicidal ideation.
- Causative mechanisms for Cluster headache are now thought to involve a synchronized abnormal activity in the hypothalamus, and the autonomic nervous system.
- Triptans are the most effective drugs to treat an acute cluster headache attack.