Cluster Headache

Overview of Cluster Headache

Cluster Headache are a primary headache disorder Of Trigeminal autonomic cephalgia (in other words, TAC) type.

The condition usually first occurs between 20 and 40 years of age. Men are affected about four times more often than women. Cluster headaches are named for the occurrence of groups of headache attacks (e.g. clusters). They have also been referred to as “suicide headaches”.

Causes of Cluster Headache

The cause of cluster headache is unknown.

Nerves

• Two nerves are thought to play an important role in CH: the trigeminal nerve and the facial nerve.

Genetics

• Cluster headache may run in some families in an autosomal dominants inheritance pattern.
• People with a first degree relative with the condition are about 14–48 times more likely to develop it themselves, and around 8 to 10% of persons with CH have a positive family history.
• Several studies have found a higher number of relatives affected among female. Others have suggested these observations may be due to lower numbers of females in these studies.
• Possible genetic factors warrant further research, current evidence for genetic inheritance limit.

Tobacco smoking

• About 65% of persons with CH are, or have tobacco smokers.
• People with CH may predispose to certain traits, including smoking or other lifestyle habits.

Hypothalamus

• A review suggests that the suprachiasmatic nucleus of the hypothalamus, which is the major biological clock in the human body, may involve in cluster headaches, because CH occurs with diurnal and seasonal rhythmicity.
• Positron emission tomography  (in other words, PET) scans indicate the brain areas which are activated during attack only, compared to pain free periods.
• These pictures show brain areas that are active during pain in yellow/orange color (called “pain matrix”).
• The area in the center (in all three views) specifically activate during CH only.
• The bottom row voxel-based morphometry (in other words, VBM) shows structural brain differences between individuals with and without CH; only a portion of the hypothalamus is different.

Risk factor of Cluster Headache

• Exposure to tobacco smock
• Positive family History

Exciting or triggering factors i.e.:

• Nitroglycerine
• Alcohol
• Histamine

Sign & Symptoms of Cluster Headache

Nature of Cluster Headache

• Onset: Sudden, rapid
• Duration: 50- 180 min
• Character: Recurrent, unilateral
• Location: Around or above or behind eye also temporal region
• Pain: e.g. Stabbing, Excruciating, Burning, Drilling, Squeezing type
• A core feature of cluster headache is periodicity. At least one of the daily attacks of pain recurs at about the same hour each day for the duration of a cluster bout.
• The typical cluster headache patient has daily bouts of one to two attacks of relatively short-duration unilateral pain for 8 to 10 weeks a year; this is usually followed by a pain-free interval that averages a little less than 1 year.
• Cluster headache is characterized as chronic when there is less than 1 month of sustained remission without treatment. Patients are generally perfectly well between episodes.
• Onset is nocturnal in about 50% of patients, and men are affected three times more often than women.
• Patients with cluster headache tend to move about during attacks, pacing, rocking, or rubbing their head for relief; some may even become aggressive during attacks.
• This is in sharp contrast to patients with migraine, who prefer to remain motionless during attacks.[1]

Cluster headache attack is accompanied by at least one of the following autonomic symptoms:

• Drooping eyelid
• Pupil constriction
• Redness of the conjunctiva
• Tearing
• Runny nose and less commonly
• Facial blushing ,swelling, or sweating, typically appearing on the same side of the head as the pain.
• Similar to a migraine, sensitivity to light (photophobia) or noise (phonophobia) may occur during a CH. Nausea is a rare symptom although it has been reported.
• Restlessness (for example, pacing or rocking back and forth) may occur. Secondary effects may include the inability to organize thoughts and plans, physical exhaustion, confusion, agitation, aggressiveness, depression, and anxiety.
• People with CH may dread facing another headache and adjust their physical or social activities around a possible future occurrence. Likewise, they may seek assistance to accomplish what would otherwise be normal tasks. T
• hey may hesitate to make plans because of the regularity, or conversely, the unpredictability of the pain schedule.
• These factors can lead to generalized anxiety disorder, panic disorder, serious depressive disorder social withdrawal and isolation.
• Cluster headaches have been recently associated with obstructive sleep apnea.

Recurrence

• Cluster headaches may occasionally be referred to as “alarm clock headache” because of the regularity of their recurrence.
• CH attacks often awaken individuals from sleep; attacks typically striking at a precise time of day each morning or night.
• The recurrence of headache cluster grouping may occur more often around solstices, or seasonal changes, sometimes showing circannual periodicity. Conversely, attack frequency may be highly unpredictable, showing no periodicity at all. These observations have prompted researchers to speculate an involvement or dysfunction of the hypothalamus.
• The hypothalamus controls the body’s “biological clock” and circadian rhythm. In episodic cluster headache, attacks occur once or more daily, often at the same time each day for a period of several weeks, followed by a headache-free period lasting weeks, months, or years.
• Approximately 10–15% of cluster headaches are chronic, with multiple headaches occurring every day for years, sometimes without any remission.
• The frequency, severity, and duration of headache attacks experienced by people during these cycles varies between individuals and does not demonstrate complete remission of the episodic form. The condition may change unpredictably from chronic to episodic and from episodic to chronic. [1]

Diagnosis of Cluster Headache

• Cluster-like head pain may be diagnosed as secondary headache rather than cluster headache.
• A detailed oral history aids practitioner in correct differential diagnosis, as there are no confirmatory tests for CH.
• A headache diary can be useful in tracking when and where pain occurs, how severe it is, and how long the pain lasts.
• A record of coping strategies used may help distinguish between headache type; data on frequency, severity and duration of headache attacks are a necessary tool for initial and correct differential diagnosis in headache conditions. [1]

In accordance with the International Headache Society (IHS) diagnostic criteria,

• Cluster headaches occurring in two or more cluster periods, lasting from 7 to 365 days with a pain-free remission of one month or longer between the headache attacks may be classified as episodic.
• If headache attacks occur for more than a year without pain-free remission of at least one month, the condition is classified as chronic.
• Chronic CH both occurs and recurs without any remission periods between cycles; there may be variation in cycles, meaning the frequency and severity of attacks may change without predictability for a period of time.
• The frequency, severity, and duration of headache attacks experienced by people during these cycles varies between individuals and does not demonstrate complete remission of the episodic form. The condition may change unpredictably from chronic to episodic and from episodic to chronic. [1]

Differential Diagnosis of Cluster Headache

• Migraine
• Chronic paroxysmal hemicrania(CPH)
• Sinusitis
• Hemicrania continua
• Trigeminal neuralgia

Diet & Regimen of Cluster Headache

• Eat a well-balanced healthy diet full of green leafy vegetables, fresh foods, and low fat protein
• Eat Fresh fruits, especially brightly colored ones high in antioxidants
• Low sodium foods
• Almonds
• Do not miss meals
• consuming adequate amounts of water daily
• Avoid consuming processed foods, aged cheeses, smoked or dried fish, cultured dairy products
• Avoid high sodium foods like potato chips and foods high in carbohydrates and sugar
• Also avoid Alcohol, Caffeine, Aspartame and other artificial sweeteners
• Do some yoga and meditation
• Don’t skip your sleep

Frequently Asked Questions

What is Cluster Headache?

Cluster headache (CH) is a neurological disorder characterized by recurrent severe headaches on one side of the head, typically around the eye.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Cluster Headache?

• Cedron
• Belladona
• Spigelia
• Sanguinaria
• Spigelia
• Ignatia

What are the symptoms of Cluster Headache?

• Onset: Sudden, rapid
• Duration: 50- 180 min
• Character: Recurrent, unilateral
• Location: Around or above or behind eye and temporal region
• Pain: Stabbing, Excruciating, Burning, Drilling, Squeezing type
• Periodicity
• Drooping eyelid
• Pupil constriction
• Redness of the conjunctiva
• Tearing
• Runny nose

What are the causes of Cluster Headache?

• Trigeminal nerve and facial nerve
• Genetics
• Tobacco smoking
• Hypothalamus