cluster headache

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Cluster Headache

 

Definition

Cluster headaches are characterized by an intense one-sided pain centered by the eye or temple. The pain lasts for one to two hours on average and may recur several times in a day.

Description

Cluster headaches have been known as histamine headaches, red migraines, and Horton's disease, among others. The constant factor is the pain, which transcends by far the distress of the more common tension-type headache or even that of a migraine headache.
Cluster headaches afflict less than 0.5% of the population and predominantly affect men; approximately 80% of sufferers are male. Onset typically occurs in the late 20s, but there is no absolute age restriction. Approximately 80% of cluster headaches are classified as episodic; the remaining 20% are considered chronic. Both display the same symptoms. However, episodic cluster headaches occur during oneto five-month periods followed by six to 24-month attack-free, or remission, periods. There is no such reprieve for chronic cluster headache sufferers.

Causes and symptoms

Biochemical, hormonal, and vascular changes induce cluster headaches, but why these changes occur remains unclear. Episodic cluster headaches seem to be linked to changes in day length, possibly signaling a connection to the so-called biological clock. Alcohol, tobacco, histamine, or stress can trigger cluster headaches. Decreased blood oxygen levels (hypoxemia) can also act as a trigger, particularly during the night when an individual is sleeping. Interestingly, the triggers do not cause cluster headaches during remission periods.
The primary cluster headache symptom is excruciating one-sided head pain centered behind an eye or near the temple. This pain may radiate outward from the initial focus and encompass the mouth and teeth. For this reason, some cluster headache sufferers may mistakenly attribute their pain to a dental problem. Secondary symptoms, occurring on the same side as the pain, include eye tearing, nasal congestion followed by a runny nose, pupil contraction, and facial drooping or flushing.
The primary cluster headache symptom is excruciating one-sided head pain located behind an eye or near the temple. Secondary symptoms include eye tearing, nasal congestion, and a runny nose.
The primary cluster headache symptom is excruciating one-sided head pain located behind an eye or near the temple. Secondary symptoms include eye tearing, nasal congestion, and a runny nose.
(Illustration by Electronic Illustrators Group.)

Diagnosis

Cluster headache symptoms guide the diagnosis. A medical examination includes recording headache details, such as frequency and duration, when it occurs, pain intensity and location, possible triggers, and any prior symptoms. This history allows other potential problems to be discounted.

Treatment

Treatment for cluster headaches is composed of induction, maintenance, and symptomatic therapies. The first two therapies are prophylactic treatments, geared toward preventing headaches. Symptomatic therapy is meant to stop or shorten a headache.
Induction and maintenance therapies begin together. Induction therapy is intended to break the headache cycle with drugs such as corticosteroids (for example, prednisone) or dihydroergotamine. These drugs are not meant for long-term therapy, but rather as a jump-start for maintenance therapy. Maintenance therapy drugs include verapamil, lithium carbonate, ergotamine, and methysergide. These drugs have long-term effectiveness, but must be taken for at least a week before a response is observed. With long-term treatment, methysergide must be stopped for one month each year to avoid dangerous side effects (formation of fibrous tissue inside the abdominal artery, lungs, and heart valves).
Despite prophylactic treatment, headaches may still occur. Symptomatic therapy includes oxygen inhalation, sumatriptan injection, and application of local anesthetics inside the nose. Surgery is a last resort for chronic cluster headaches that fail to respond to therapy.

Alternative treatment

Since some cluster headaches are triggered by stress, stress reduction techniques, such as yoga, meditation, and regular exercise, may be effective. Some cluster headaches may be an allergic response triggered by food or environmental substances, therefore identifying and removing the allergen(s) may be key to resolution of the problem. Histamine is another suspected trigger of cluster headaches, and this response may be controlled with vitamin C and the bioflavonoids quercetin and bromelain (pineapple enzyme). Supplementation with essential fatty acids (EFA) will help decrease any inflammatory response.
Physical medicine therapies such as adjustments of the spine, craniosacral treatment, and massage at the temporomandibular joint (TMJ) can clear blockages, as can traditional Chinese medical therapies including acupuncture. Homeopathic treatment can also be beneficial. Nervous system relaxant herbs, used singly or in combination, can allow the central nervous system to relax as well as assist in peripheral nerve response. A few herbs to consider for relaxation are valerian (Valeriana officinalis), chamomile (Matricaria recutita), rosemary (Rosemarinus officinalis), and skullcap (Scutellaria baicalensis).

Prognosis

In general, drug therapy offers effective treatment.

Prevention

Avoiding triggers, adhering to medical treatment, and controlling stress can help ward off some cluster headaches.

Resources

Organizations

American Council for Headache Education (ACHE). 19 Mantua Road, Mt. Royal, NJ 08061. (800) 255-2243. http://www.achenet.org.
National Headache Foundation. 428 W. St. James Place, Chicago, IL 60614. (800) 843-2256. http://www.headaches.org.

Key terms

Biological clock — A synonym for the body's circadian rhythm, the natural biological variations that occur over the course of a day.
Migraine headache — An intense throbbing pain that occurs on one or both sides of the head. The headache is usually accompanied by other symptoms, such as nausea, vomiting, and aversion to light.
Prophylactic — Referring to treatment that prevents symptoms from occurring.
Tension-type headache — A dull pain that seems to exert pressure on the head; the most common form of headache.

headache

 [hed´āk]
pain in the head; see also migraine. One of the most common ailments of humans, it is a symptom rather than a disorder in itself; it accompanies many diseases and conditions, including emotional distress. Although recurring headache may be an early sign of serious organic disease, relatively few headaches are caused by disease-induced structural changes. Most result from vasodilation of blood vessels in tissues surrounding the brain, or from tension in the neck and scalp muscles.

Immediate attention by a health care provider is indicated when (1) a severe headache comes on suddenly without apparent cause; (2) there are accompanying symptoms of neurological abnormality, for example, blurring of vision, mental confusion, loss of mental acuity or consciousness, motor dysfunction, or sensory loss; or (3) the headache is highly localized, as behind the eye or near the ear, or in one location in the head. Fever and stiffness of the neck accompanying the headache may indicate meningitis.
cluster headache a migraine-like disorder marked by attacks of unilateral intense pain over the eye and forehead, with flushing and watering of the eyes and nose; attacks last about an hour and occur in clusters.
exertional headache one occurring after exercise.
histamine headache cluster headache.
lumbar puncture headache headache in the erect position, and relieved by recumbency, following lumbar puncture, due to lowering of intracranial pressure by leakage of cerebrospinal fluid through the needle tract.
migraine headache migraine.
organic headache headache due to intracranial disease or other organic disease.
tension headache a type due to prolonged overwork or emotional strain, or both, affecting especially the occipital region.
toxic headache headache due to systemic poisoning or associated with illness.
vascular headache a classification for certain types of headaches, based on a proposed etiology involving abnormal functioning of the blood vessels or vascular system of the brain; included are migraine, cluster headache, toxic headache, and headache caused by elevated blood pressure.

clus·ter head·ache

possibly due to a hypersensitivity to histamine; characterized by recurrent, severe, unilateral orbitotemporal headaches associated with ipsilateral photophobia, lacrimation, and nasal congestion.

cluster headache

n.
A recurring headache similar to migraine and characterized by severe pain in the eye or temple on one side of the head, watering of the eye, and a runny nose.

cluster headache

a condition characterized by attacks of intense unilateral pain, occurring most often over the eye and forehead. It is accompanied by flushing and watering of the eyes and nose. Cluster headaches are more common in males and are associated with alcohol use. The attacks occur in groups with a duration of several hours. See also histamine headache.
An idiopathic syndrome consisting of recurrent brief attacks of sudden, severe, unilateral periorbital pain, which is more common in younger men, attributed to histamine release; CHs are intense, but short-lived—1/2–2 hours—unilateral, often periorbital headache with a ‘clock-setting' predictability, which often occurs with spring to fall seasonality, over 3–8 weeks, disappears for months to years, and may begin within 2–3 hours of falling asleep
Prevalence Unknown; a report from the US estimates the frequency in males of 0.4%, in females 0.08%; in San Marino, 0.08% in the entire population
Autonomic phenomena is typical of CH: ipsilateral nasal congestion and rhinorrhea, lacrimation, conjunctival hyperemia, facial diaphoresis, palpebral edema, tachycardia, and Horner syndrome which may persist between attacks
Management Prevention—ergotamine tartrate, methysergide is more effective than analgesics once acute attack begins

cluster headache

Histamine headache, migrainous neuralgia Neurology
A chronic recurring headache which is more common in younger ♂, attributed to histamine release; CHs are intense, but short-lived–12-2 hrs, unilateral, often periorbital headache with a 'clock-setting' predictability, which often occurs with spring to fall seasonality, over 3-8 wks, disappears for months to yrs, and may begin within 2-3 hrs of falling asleep Clinical Knife-like intranasal or retrobulbar pain; unlike migraines in which the Pts prefer to lie still in a darkened room, CH victims restlessly pace, bang their heads against the wall and have suicidal ideation; CHs may be of vascular origin and accompanied by a blocked, runny nose, tearing, facial flushing and swelling, ptosis, pupil constriction Management Prevention–ergotamine tartrate, methysergide is more effective than analgesics once acute attack begins

clus·ter head·ache

(klŭs'tĕr hed'āk)
Condition possibly due to a hypersensitivity to histamine; usually characterized by recurrent, severe, unilateral orbitotemporal headaches associated with ipsilateral photophobia, lacrimation, and nasal congestion.
Synonym(s): histaminic headache, Horton headache.

cluster headache

A migrainous type of headache, usually centred around one eye, and occurring in clusters often several times daily for weeks, then ceasing for periods of weeks or months.

Horton,

Bayard T., U.S. physician, 1895-1980.
Horton arteritis - a subacute, granulomatous arteritis involving the external carotid arteries, especially the temporal artery. Synonym(s): temporal arteritis
Horton cephalalgia - unilateral orbitotemporal headaches associated with ipsilateral photophobia, lacrimation, and nasal congestion. Synonym(s): cluster headache; Horton headache
Horton headache - Synonym(s): Horton cephalalgia

cluster headache,

n headache characterized by constant pain on one side of the head, around the eye. May be accompanied by constricted pupils, facial swelling, flushed ap-pearance, nasal blockage, runny nose, and/or lacrimation.

clus·ter head·ache

(klŭs'tĕr hed'āk)
Headache possibly due to a hypersensitivity to histamine.