Cluster headache : definition
Cluster headaches are severely painful headaches that occur in series or clusters.
The patient experiences attacks of severe or very severe, strictly unilateral pain (orbital, supraorbital, or temporal pain) that last 15-180 minutes and occur from once every other day to 8 times a day for weeks or months at a time.
You tend to get them at the same time each year, such as the spring or fall. Because of their seasonal nature, people often mistake cluster headaches for symptoms of allergies or business stress.
Epidemiological studies indicate that the prevalence of cluster headache is about 1 in every 1,000 people.
Genetic predominance: First-degree relatives are five to 18 times–and second-degree relatives, one to three times–more likely to have cluster headache than the general population.
Sex and age predominance: Six out of 10 cases involve men, and most of these are smokers. It usually starts after the age of 20 years.
Skull : anatomy and physiology
The cranium (skull) is the skeletal structure of the head that supports the face and protects the brain. It is subdivided into the facial bones and the brain case, or cranial vault. The facial bones underlie the facial structures, form the nasal cavity, enclose the eyeballs, and support the teeth of the upper and lower jaws. The rounded brain case surrounds and protects the brain and the middle and inner ear structures. The bones of the cranium are joined by sutures, across the cranium’s surface. These joints fuse as a person matures. There are four major sutures:
Sagittal Suture- join two parietal bones.
Coronal Suture- join frontal bone and parietal bones.
Squamous Suture- join parietal and temporal bones.
Lambdoidal Suture- join parietal bones and occipital bone.
Brain : anatomy and physiology
Deep structures in brain:
- Hypothalamus: controls behaviors such as hunger, thirst, sleep, and sexual response.
- Pituitary gland: controls other endocrine glands in the body.
- Pineal gland: regulate the body’s internal clock and circadian rhythms by secreting melatonin.
- Thalamus: plays a role in pain sensation, attention, alertness and memory.
- Basal ganglia: coordinate fine motions, such as fingertip movements.
- Limbic system: center of our emotions, learning, and memory.
The exact cause of cluster headaches is unknown, but cluster headache patterns suggest that disturbance in the body’s biological clock (hypothalamus), causes transmission signals are sent into a bundle of nerves called sphenopalatine ganglion(SPG).
The SPG acts like a fuse box, connecting the brain to nerve endings in the face or trigeminal nerves. When these signals reach the vessels, they cause dilation and activation of pain receptors.
Pain signals are returned to the “ sensory” area of the brain where they are perceived as intense pain.
The resulting cascade causes excruciating, one-sided pain around the eye that can radiate to the forehead, temple, nose, cheek, or upper gum on the affected side.
Factors that trigger the cluster headache:
When a person is in the middle of a cluster period, any of these can bring on a headache:
Sign & Symptoms
It strikes quickly, usually without warning, although migraine-like nausea, aura with light and sound sensitivity on one side usually.
Common signs and symptoms during a headache include:
Excruciating one-sided pain that is generally situated in, behind or around one eye, but may radiate to other areas of your face, head and neck with restlessness.
Excessive tearing , redness and swelling of the eye on the affected side.
Stuffy or runny nose on the affected side
Forehead or facial sweating on the affected side
Pale skin (pallor) or flushing on your face
Drooping eyelid on the affected side
A diagnosis depends on its characteristic type of severe headache and pattern of attacks with timings, durations and periodicity and associated symptoms.
To detect any neurological disorder by performing procedures to assess your brain function, including testing your senses, reflexes and nerves.
In case of complication to rule out other serious causes of head pain, such as a tumor or an aneurysm:
MRI- To produce detailed images of your brain and blood vessels.
CT scan- To create detailed cross-sectional images of your brain.
There’s no cure for cluster headaches. Treatment goal is to decrease the severity, periodicity of headache, and prevent the attacks.
Fast-acting treatments include:
Oxygen. Inhaling pure oxygen through a mask. The effects can be felt within 15 minutes.
Triptans. The injectable form of sumatriptan.
Oral medications are relatively slow to act.
Local anesthetics(lidocaine) given through the nose.
Preventive treatments: Calcium channel blockers, Corticosteroids.
Doctor recommend surgery at last:
Sphenopalatine ganglion stimulation surgery with an operating remote control.
Cluster headaches can be treated in different ways, depending on the cause, the intensity, and how often you get them.
- Apply a Cold/Hot Compress.
- Consider Acupressure.
- Get a head massage that can help relax your headache by promoting serotonin activity.
- Go for a Chiropractic Therapy.
- Essential oils i.e., eucalyptus or peppermint oil mixed with jojoba oil or coconut oil, for application on forehead.
- Life style changes like taking magnesium and vitamin B-2 in diet, deep breathing exercises, quit smoking, drink adequate amount of water, etc.
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