Cluster headache overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saumya Easaw, M.B.B.S.[2]
Overview
Cluster headaches are rare, extremely painful and debilitating headaches that occur in groups or clusters. Often appearing during seasonal changes. They may also be described as suicide headaches, a reference to the excruciating pain and resulting desperation that has culminated in actual suicide.[1]
Historical Perspective
Cluster headaches have been called by several other names in the past including Erythroprosopalgia of Bing, Ciliary neuralgia, Migrainous neuralgia, Erythromelagia of the head, Horton's headache (named after Bayard T. Horton, an American neurologist who was the first to accurately describe the headache in 1939[2]), Histaminic cephalalgia, Petrosal neuralgia, sphenopalatine neuralgia, Vidian neuralgia, Sluder's neuralgia, and Hemicrania angioparalyticia.[3] Sluder's neuralgia(syndrome) and cluster pain can often be temporarily stopped with nasal lidocaine spray. If successful, outpatient nasal septoplasty and splinting can resolve the condition.[4]
Epidemiology and Demographics
While migraines are diagnosed more often in women, cluster headaches are diagnosed more often in men. The male-to-female ratio in cluster headache ranges from 4:1 to 7:1. It primarily occurs between the ages of 20 to 50 years. [3]This gap between the sexes has narrowed over the past few decades, and it is not clear whether cluster headaches are becoming more frequent in women, or whether they are merely being better diagnosed. Limited epidemiological studies have suggested prevalence rates of between 56 and 326 people per 100,000.[5] Latitude plays a role in the occurrence of cluster headaches, which are more common as one moves away from the equator towards the poles. It is believed that greater changes in day length are responsible for the increase.
Medical Therapy
Cluster headaches often go undiagnosed for many years, being confused with migraine or other causes of headache.[6]
Medically, cluster headaches are considered benign, but because of the extreme and often debilitating pain associated with them, a severe attack is nevertheless treated as a medical emergency by doctors who are familiar with the condition. Because of the relative rareness of the condition and ambiguity of the symptoms, some sufferers may not receive treatment in the emergency room and patients may even be mistaken as exhibiting drug-seeking behavior.
Over-the-counter pain medications (such as aspirin, paracetamol, and ibuprofen) typically have no effect on the pain from a cluster headache. Unlike other headaches such as migraines and tension headaches, cluster headaches do not respond to biofeedback.
Some have reported partial relief from narcotic pain killers. Percocet (Oxycodone with paracetamol) has had widespread success amongst some cluster headache patients, especially males. Anecdotal evidence indicates that cluster headaches can be so excruciating that even morphine does little to ease the pain. However, some newer medications like fentanyl (and Percocet) have shown promise in early studies and use.
Medications to treat cluster headaches are classified as either abortives or prophylactics (preventatives). In addition, short-term transitional medications (such as steroids) may be used while prophylactic treatment is instituted and adjusted. With abortive treatments often only decreasing the duration of the headache and preventing it from reaching its peak rather than eliminating it entirely, preventive treatment is always indicated for cluster headaches, to be started at the first sign of a new cluster cycle.
In many cases, some doctors have tried the use of beta blockers as a treatment.
References
- ↑ Torelli P, Manzoni G (2003). "Pain and behaviour in cluster headache. A prospective study and review of the literature". Funct Neurol. 18 (4): 205–10. PMID 15055745. Unknown parameter
|month=ignored (help) - ↑ http://www.mayoclinicproceedings.com/inside.asp?AID=3032&UID=
- ↑ Stephen D. Silberstein, Richard B. Lipton. Peter J. Goadsgy. "Headache in Clinical Practice." Second edition. Taylor & Francis. 2002.
- ↑ IHS ICHD2: Mucosal contact point headache
- ↑ Torelli P, Castellini P, Cucurachi L, Devetak M, Lambru G, Manzoni G (2006). "Cluster headache prevalence: methodological considerations. A review of the literature". Acta Biomed Ateneo Parmense. 77 (1): 4–9. PMID 16856701.
- ↑ "Vast Majority of Cluster Headache Patients Are Initially Misdiagnosed, Dutch Researchers Report". World Headache Alliance. 21/8/2003. Retrieved 2006-10-08. Check date values in:
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