Cluster Headache
Introduction
Cluster Headache has variety of other names - Paroxysmal nocturnal cephalalgia, Migrainous neuralgia, Histamine cephalalgia, Red migraine and Erythromelalgia of the head. This type of headache occurs predominantly in young adult men. Male to female ratio is about 5:1. Prevalence in males is about 0.4 - 1%. Cluster headache occurs in men in the age group of 20-50 years.
What is the cause for cluster headache?
The exact reason for cluster headache is still not found. The pain may be due to a disorder in the hypothalamus, which is responsible for the cyclic nature of the attacks. The pain may also arise from the internal carotid artery, in the canal through which it ascends in the petrous part of the temporal bone.
What are the symptoms of cluster headache?
- The pain in cluster headache is felt deep in and around the eye. Usually it is one-sided.
- The headache is intense and throbbing in nature.
- The pain may radiate to the forehead, temple, check ear, and neck.
- Cluster headache tends to occur in the nighttime, usually 1-2 hours after the onset of sleep. The headache tends to recur regularly each day and it lasts for 6-12 weeks followed by complete freedom for months or even years. Hence the term cluster headache is given.
- In 10 percent of the patients the headache becomes chronic(lasts longer than 12 weeks)
- There may be blocked nostril, rhinorrhea, redness of the eyes, watering from the eyes, flushing and edema of the cheek lasting for 15-180 minutes during the headache.
- During the attack of cluster headache, the patient arises from the bed and sits in a chair and rock or pace the floor, holding a hand to the side of the head.
- Alcohol may precipitate an attack of cluster headache.
- Cluster headache is not associated with nausea or vomiting like migraine headache.
How do you diagnose cluster headache?
The doctor diagnoses cluster headache by the typical history the patient present with. Usually there will not be any problem in diagnosing cluster headache and in rare cases of doubt, CT scan and MRI scan is necessary to rule out any lesion in the brain.
What is the differential diagnosis of cluster headache?
The following disorders may mimic cluster headache:
- Migraine
- Trigeminal neuralgia
- Carotid aneurysm
- Temporal arteritis
- Pheochromocytoma
- Tolosa-Hunt syndrome
What is the treatment for cluster headache?
The treatment for cluster headache is divided into two:
- To treat the acute attack
- To prevent the attack of cluster headache (prophylaxis).
Treatment of acute attack:
- The usual nighttime attacks of cluster headache can be treated with single dose of ergotamine at the bedtime.
- Inhalation of 100% oxygen for 10-15 minutes at the onset of attack of headache may also abort the headache. But this is not always available.
- Intranasal lidocaine can also be used.
Prevention of cluster headache:
- A course of prednisolone may be helpful.
- Verapamil upto 480mg can be tried.
- Sodium valproate is also helpful in preventing cluster headache.
- Lithium therapy is useful in preventing cluster headache. But lithium causes toxicity like nausea, vomiting, tremor, blurred vision, fasiculations and choreoathetosis (a type of movement disorder).
- Indomethacin 75 to 200 mg per day is useful in some cases.
Surgical treatmen of cluster headache:
Radiofrequency gangliorhizolysis: It abolishes the function of the Ophthalmic and maxillary divisions of the Trigeminal nerve there by reducing the pain around the eye.
