Cluster Headaches
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Definition/Description[edit | edit source]
Cluster headaches are the rarest but the most painful of the primary headaches.[1] Cluster headaches are the most common of trigeminal autonomic cephalaligias (TACs). Primary headaches are caused by spontaneous activation of nociceptive pathways and also include migraines or tension-type headaches.[2] Cluster headaches are characterized by recurring short lasting attacks (15 to 180 minutes). The attacks typically consist of exruciating unilateral periorbital or temporal pain as well as at least one ipsilateral autonomic symptoms. Accompanying ipsilateral symptoms include conjunctival injection and lacrimation, nasal congestion or rhinorrhea, forehead and facial sweating, facial flushing, eyelid edema, miosis and ptosis.[2][3]
There are two types of cluster headaches, episodic and chronic. Episodic is defined by periods of susceptibility to headache known as cluster periods, that alternate with periods of remission.[1] The headache can occur for 1 to 3 months (the cluster period) where patients experience ≥ 1 attack/day, followed by remission for months to years.[1][3] The headache can then reoccur in the same pattern. Around 80% of of all cases are episodic cluster headaches.[1][2] Around 20% of all cases are chronic cluster headaches. Chronic is defined by the cluster periods occuring for one year or more, without more than one month of remission or the remission lasts less than 14 days.[2][1] Chronic cluster headaches are preceded by episodic cluster headaches and develop overtime.[1]
Prevalence[edit | edit source]
Cluster headaches (CHs) are reported as affecting either 1% to 4%[1] of the population with 0.4%[3] prevalence in the population of the US. Other sources have the prevalence at 0.5 - 1 out of 1,000 people.[2] One study reported 2.73% of patients in a tertiary care headache clinic being diagnosed with cluster headaches.[2] CHs are diagnosed most commonly in men between the ages of 20 to 50 and onset of the condition typically occurs in the third decade.[1][2] African American males have a higher incidence of CHs than other racial backgrounds and increased recognition of the disease in women is causing the ratio of men to women with CHs to decrease.[2] Children are rarely diagnosed with CHs and symptoms often decrease after the age of 70 years old.[2]
CHs and prior head trauma shows some correlation as well as heavy smoking being frequently documented among affected patients.[1][2] Genetic studies show a prevalence of CH in certain families with a history of the condition.[1]
Characteristics/Clinical Presentation[edit | edit source]
- severe headache - localized to one eye and the frontotemporal region. Pain is boring and nonthrobbing
- temporal artery bulging and pulsating
- unilateral ptosis, swelling, and redness of eyelid
- miosis, conjunctival injection
- tearing
- nasal congestion, rhinorrhea
- flushing of side of the face, sweating[1][2][3]
Attacks usually occur at the same time each day, often when a patient wakes up from an afternoon nap or sleep during the night.[3] CHs follow a circadian rhythm and cluster periods occur during the same time each year. They occur most commonly after the shortest or longest days of the year.[1]
Pain is described typically in the area of the first trigeminal branch and almost always on the same side of the head. CH is described as one of the most painful conditions known to man and female patients say the pain is worse than giving birth.[2] Patients compare the sensation to a red hot needle or nail being driven into their eye, or their eyeball being ripped from its socket. Suicidal ideas or feelings are somtimes expressed because of the severity of the pain and CHs are sometimes referred to as "suicide headaches." Pain increases suddenly and remains incredibly intense for 15 to 180 minutes until it suddenly subsides.[1][2]
Physical activity seems to alleviate pain during a CH so patients often prefer standing or sitting erect over lying down or reclining. During the cluster period, patients are restless and may rock from side to side, hit their heads, hit objects with their fists or even hit their head against a wall. This behavior is so typical that it is accepted as a criterion in the International Classification of Headaches Diseases (ICHD-II).[2]
Associated Co-morbidities[edit | edit source]
- sleep apnea
- hypoxemia
- anxiety
- compulsiveness
- hypochondria
- stroke
- hypertension
- diabetes
- asthma
- obesity
- fibromyalgia
- low back pain
- depression
- cardiovascular diseases[1][4]
Medications[edit | edit source]
Preventitive
Aborting Attacks
- parenteral triptans, dihydroergotamine, 100% O2 inhalation given by nonbreathing facemask[3], sumatriptan, ergotamine[1], intransal topical lidocaine[2]
Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
Any patient with a refractory (unmanageable) case should undergo an MRI to exlude any treatable cause. The pituitary, orbit, and trigeminal pathway have to be specifically examined with a CT Scan and MRI.[2]
Causes[edit | edit source]
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Systemic Involvement[edit | edit source]
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Medical Management (current best evidence)[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
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Alternative/Holistic Management (current best evidence)[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Case Reports[edit | edit source]
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Resources
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 Goodman Catherine C., Fuller Kenda S. Pathology: Implications for the Physical Therapist. 3rd ed. St. Louis: Saunders Elsevier, 2009. p1559-1561
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 Leroux E, Ducros A. Cluster headache. Orphanet Journal of Rare Diseases. 2008; 3:20. doi: 10.1186/1750-1172-3-20. http://ukpmc.ac.uk/articlerender.cgi?tool=pubmed&pubmedid=18651939 (Accessed 2 March 2010).
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Silberstein, Stephen D. Cluster Headache. Merck Manual for Healthcare Professionals http://www.merck.com/mmpe/sec16/ch216/ch216b.html?qt=Cluster%20Headaches&alt=sh (Accessed 2 March 2010).
- ↑ Jensen R, Stovner LJ. Epidemiology and comorbidity of headache. The Lancet Neurology April 2008;7(4):354-361. http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6X3F-4S1CYX9-F&_user=134779&_coverDate=04%2F30%2F2008&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1237461465&_rerunOrigin=google&_acct=C000011238&_version=1&_urlVersion=0&_userid=134779&md5=0f44f307c7b2d98b693a1866f9b95f73#secx9 (accessed 4 March 2010).
