Cluster headache is one of the more severe of all headaches and is one of the vascular headaches. It is named after the intense attacks of headache over a period of time. It is mostly seen in young people, 20 to 40 years old, and the incidence is 4 to 5 times higher in men than in women, usually without family history. There are two types of headaches: episodic and chronic.
Clinical manifestations
The headache is fixed in one eye and around the orbit without aura. The attack is usually in the evening, with a sensation of distension or pressure around one eye and orbit at the beginning, which rapidly develops into severe distending or drilling pain after a few minutes and spreads to the frontotemporal and parieto-occipital areas on the same side, accompanied by bulbar conjunctival congestion, lacrimation, runny nose, sweating, mild eyelid edema, and rarely vomiting on the painful side.
Horner’s sign is present on the side of the attack in most patients. The headache is very painful and the patient is restless, usually lasting 15 to 180 minutes, after which the symptoms disappear rapidly and the patient can still engage in the original activities after relief. In the case of cluster attacks, the attacks occur from one to several times a day, at approximately the same time each day, or almost at a constant time like a fixed clock, with the symptoms and duration of each attack being almost the same. Cluster seizures can last for weeks or even months before remission, usually one to two seizures a year, and some patients have significant seasonal onset, with spring and fall being the most common.
The remission period can last from several months to several years, and the disease is rare in patients over 60 years old, suggesting a tendency for the disease to resolve on its own. Chronic cluster headache is rare, accounting for less than 10% of cluster headache, and can turn from episodic cluster headache to chronic, or can not remit from an attack to a persistent attack. The clinical symptoms of chronic cluster headache are the same as those of episodic cluster headache, and the symptoms last for more than 1 year, or there are intermittent periods, but they do not exceed 14 days.
I. Examination
1.Cranial CI or MRI to exclude intracranial and extracranial organic diseases causing headache. MRI shows ipsilateral hypothalamic gray matter activation during the attack period.
2.Histamine test can induce typical pain to make the diagnosis.
II. Diagnosis
1. Sudden throbbing pain or swelling pain on one side of the periorbital area and forehead is the main cause, which may occur several times in a day and discontinue after several days to months of continuous attacks. It may recur in its original form after an interval of weeks, months or years.
2. The headache comes and goes suddenly, and the duration of the attack is relatively constant, with one attack lasting from 10 minutes to several hours.
3.The attack is often accompanied by eye congestion, lacrimation, nasal obstruction, runny nose, and a few may have nausea and vomiting.
4. Cerebral impedance hemogram shows a hypervolemic pattern.
5. There may be a history of allergy, cranial trauma, sinusitis, cervical spine lesions and other corresponding signs.
Differentiation
1.Migraine
Cluster migraine attacks are easy to distinguish from typical migraine, however, it is often not easy to distinguish from atypical migraine. In common migraine attacks, some patients have visual disturbance or other manifestations of vascular spasm. The headache is often generalized and not limited to one side, and is not characterized by continuous and intense attacks. In facial migraine, some patients have headaches that are generally milder and longer in duration, although the site of the headache is on the face or the same as that of cluster headache.
2.Vascular headache
The pathogenesis of cluster headache is the phenomenon of dilation of the extracranial arteries of the head when the patient has a headache, so it is traditionally classified as a special type of vascular migraine. However, this headache is not obviously related to endocrine disorders, and menopausal attacks are not seen to decrease. 5-Hydroxytryptamine in plasma does not decrease during attacks, but histamine increases, due to the hyperallergic reaction of the neck vessels to histamine. Stress, alcohol consumption, and nitroglycerin administration can trigger it, and some people believe that hypoxia can also trigger it.
Complications
The attacks are mostly accompanied by nasal congestion, runny nose, lacrimation, and conjunctival congestion on the affected side. Due to long-term headache, patients may experience depression, personality changes and other mental symptoms.
V. Treatment
1.The treatment is basically the same as migraine. Ergotamine can be taken orally during the attack or before the attack every day. It can be taken for 10-14 days to prevent attacks or reduce the symptoms during attacks. Sumatriptan (sumatriptan)) is a 5-HT receptor agonist that binds to 5-HT receptors, thereby inhibiting the vasodilating effect of 5-HT and causing vasoconstriction for therapeutic purposes, and can be taken orally, nasal drip, subcutaneously or intravenously. In case of cluster attack, take prednisone orally, or methylprednisolone (methylprednisolone) intravenously, and stop the drug after the cluster attack stops.
2. Masked oxygen or hyperbaric oxygen therapy during seizures, which is effective for some patients. Calcium antagonists, such as flunarizine (flunarizine). Anti-epileptic drugs, such as sodium valproate, are effective in some patients. Nonsteroidal steroidal analgesics, such as aspirin, indomethacin (anti-inflammatory pain), and diclofenac can be tried. Histamine desensitization therapy is effective in some patients. Patients for whom drug therapy is ineffective can try nerve block therapy, such as lidocaine pteropalatine ganglion block, alcohol injection of supraorbital or infraorbital nerve, radiofrequency trigeminal ganglion block. The prognosis is good, and most resolve with treatment or on their own.