label. cluster headache
Cluster headache is a primary-type headache characterized by severe attacks of pain on one side of the head, between the forehead and the nape of the neck.
What are the causes of cluster headache?
The cause is uncertain, it may be that some parts of the brain begin to malfunction for an unknown reason. The hypothalamus is an area located at the base of the brain responsible for the body’s biological clock and can be the source of headache.
Magnetic resonance imaging performed on patients during a cluster headache attack shows abnormal activity in the hypothalamus.
The characteristics of cluster headache are:
- there is a familiarity in the development of this problem, this suggests that there may be a genetic component;
- it can be triggered by changes in sleep schedule;
- It can be caused by medications (for example nitroglycerin used for heart disease).
- If a person frequently suffers from a headache, smoking, alcohol and certain foods (for example chocolate) can be potential causes of headaches.
Cluster headache can last for weeks or months interspersed with periods of months or years without pain.
During the period in which it occurs, the pain is throbbing and it is felt once or twice a day, but some patients may feel it more than twice a day.
Each episode of pain lasts from 30 to 90 minutes.
The attacks tend to occur at approximately the same time each day and often awaken the patient at night from a deep sleep.
The pain is unbearable: it usually affects only the eye and the surrounding area, but it can extend to the entire face, head and cervical spine.
The affected eye can become red, swollen and can tear.
The nose of the affected side can drip and be congested.
Unlike patients with migraine, those with cluster headaches tend to be restless.
They often walk back and forth, hit the wall with their heads, and can resort to desperate measures.
Cluster headache is more common in men than in women.
To make the diagnosis of cluster headache, the history of the patient should be checked. In general, the description of the pain and the frequency is sufficient.
If the patient is in the middle of an attack, he is in a critical situation because of the pain and may have his eye and nose dripping as described above.
If the patient is visited by the doctor when the pain is not present, the physical examination is normal and the diagnosis depends only on the anamnesis.
Cluster headache can be very difficult to treat, you have to try different alternatives to find the most effective type of treatment. Because the headache is repeated every day, there are two requirements in the treatment: the pain caused by the first episode would have to be controlled, and the subsequent headaches would have to be prevented.
The initial treatment options consist of:
- Inhalation of high oxygen concentrations (although this will not work if the headache is well established).
- The injection of triptan drugs, for example sumatriptan (Aurobindo), zolmitriptan (Zomig) and rizatriptan (Maxalt and Apotex) are also commonly used for migraine treatments.
- Infiltration of lidocaine, a local anesthetic directly into the nostril;
- A puncture of dihydroergotamine (DHE 45, Migranal) causes vasoconstriction;
- You can administer caffeine.
The prevention of the next cluster headache can be done with:
- Calcium channel blockers (such as Verapamil, Diltiazem, Nifedipine, Nicardipine),
- Prednisone (Prednisone Alonga),
- Antidepressant drugs,
- Lithium (lithium carbonate)
- Phenobarbital, valproic acid and topiramate (often used to control epilepsy)
Prevention of cluster headache
Episodes of cluster headache can occur years away, and headache can not be anticipated before a new episode, no daily medication can guarantee it.
Changing lifestyle can help minimize the risk of cluster headache exacerbation.
Quitting smoking and minimizing alcohol can prevent future episodes.