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Read on to know about Cluster Headaches.
Cluster headache is characterized by recurrent attacks of unilateral pain, which are very severe and is associated with symptoms of activation of the cranial autonomic pathways like lacrimation, conjunctival stuffiness, nasal congestion, rhinorrhea, and periorbitaloedema.
The attacks are one sided, last for about 15 minutes to three hours, and have a characteristic set of cranial autonomic features as described above and are associated with agitation. Most patients describe restlessness and agitation during an attackand bang their heads and wish to rest in cold environment isolated from people.
How Long Does The Attack Last? What is The Frequency?
The attack usually last between 15 and 180 minutes. TheAttacks have a frequency of one every other day to eight each day.
What Triggers the Headache?
In over half of patients small quantities of alcohol precipitates the attack. Many people get attacks from odor of perfumes and paint.There are few drugs that have been implicated for precipitation of Acute Attack like Nitrates, Sildenafil.
Diagnostic criteria for cluster headache (British Medical Journal 11 April 2012)
A) At least five attacks fulfilling criteria B-D
B) Severe or very severe unilateral orbital, supraorbital, or temporal pain that lasts for 15-180 minutes if untreated
C) Headache accompanied by at least one of the following
- Ipsilateral conjunctival injection or lacrimation (or both)
- Ipsilateral nasal congestion or rhinorrhoea (or both)
- Ipsilateral eyelid oedema
- Ipsilateral forehead and facial sweating
- Ipsilateralmiosis or ptosis (or both)
- Restlessness or agitation
D) Attacks have a frequency of one every other day to eight each day
E) Not attributed to another disorder
What Other Conditions Mimic Cluster Headache?
- Migraine
- Trigeminal Autonomic Cephalgia’s
- Brain Tumour
- Aneurysm of carotid vessels.
- Structural Brain diseases.
How Cluster Headache’s are Managed?
Treatment of acute attacks- The mainstay of abortive treatment consists of inhaled oxygen and parenteral triptans. The pain killers NSAIDs are ineffective, so should not be used.
Inhalation of 100% oxygen at 12 L/min for 15 minutes by using non breathing face mask terminates the attack in most of the individuals.
Parenteral Sumatriptan 6 mg subcutaneous injections are useful in terminating the attack within 15 minutes. Oral Triptans are not effective.
How Can The Attacks be Prevented?
Most important is to avoid the precipitating factors. There are no drugs which are very helpful in prophylaxis of cluster headache, but there are studies and individual clinical experiences with a few drugs like Corticosteroids, calcium channel blockers like Verapamil, Lithium, Gabapentin, Sodium valproate. Many studies have found them effective in controlling the acute attacks with different success rates.
