Cluster headache sufferers typically experience very severe headaches of a piercing quality near one eye or temple that last for between 15 minutes and three hours. The headaches are unilateral and occasionally change sides.

Cluster headaches are frequently associated with drooping eyelids, conjunctival injection (which results in red, watery eyes), tearing, constricted pupil, eyelid edema, nasal congestion, runny nose, and sweating on the affected side of the face. The neck is often stiff or tender in association with cluster headaches, and jaw and teeth pain is sometimes reported.

During an attack, the person often is unable to be still and may pace. Sensitivity to light is more typical of a migraine, as is vomiting, but they can be present in some sufferers of cluster headache.

In episodic cluster headache, these attacks occur once or more daily, often at the same times each day, for a period of several weeks, followed by a headache-free period lasting weeks, months, or even years. Approximately 10-15% of cluster headache sufferers are chronic; they can experience multiple headaches every day for years.

Cluster headaches are occasionally referred to as "alarm clock headaches", as they can occur at night and wake a person from sleep at the same time each night or at a certain period after falling asleep. Other synonyms for cluster headache include Horton's syndrome and "suicide headaches" (a reference to the excruciating pain and resulting desperation).

The location and type of pain has been compared to a "brain-freeze" headache from rapidly eating ice cream; this analogy is limited, but may offer some insight into the cluster headache experience. Persons who have experienced both cluster headaches and other painful conditions (childbirth, migraines) report that the pain of cluster headaches is far worse. One analogy is that of a burning ice pick being repeatedly stabbed through the eye into the brain.

Incidence

Whereas other headaches, such as migraines are diagnosed more often in women, cluster headaches are diagnosed in men at a rate 2.5 to 3 times greater than in women. Between 1 and 4 people per thousand experience cluster headaches in the U.S. and Western Europe; statistics for other parts of the world are fragmentary. 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.

Pathology

While the immediate cause of pain is in the trigeminal nerve, the true cause(s) of cluster headache is complex and not fully understood. Cluster headaches are a type of vascular headache and the intense pain of an attack is also associated with the dilation of blood vessels.

Read more at Wikipedia.org

• [List your site here Free!]

IV Histamine Desensitization for Cluster Headache - Brief Article
From Family Pratice News, 5/1/00 by Barbara Baker

RANCHO MIRAGE, CALIF. -- Patients with chronic cluster headaches recalcitrant to standard prophylactic agents have an alternative before resorting to surgery--intravenous histamine desensitization.

The approach, which involves a series of infusions with increasing amounts of histamine phosphate, resulted in significant improvements in intractable cluster headache in 48 of 59 patients, Dr. Seymour Diamond reported during a poster session at a meeting on treating the difficult headache patient.

Patients who responded to the desensitization therapy had had chronic cluster headaches for an average of almost 9 years prior to desensitization. Following desensitization, they had a renewed response to standard prophylactic agents that lasted for an average of 17 months, said Dr. Diamond, director of the Diamond Headache Clinic in Chicago, which sponsored the meeting.

Just why the treatment helps is not known, but investigators have observed mast cell degranulation with histamine release during duster headache attacks. Histamine desensitization may inhibit this degranulation, he speculated.

In a separate presentation at the meeting, Dr. Donald J. Dalessio commented that histamine desensitization can be an excellent option for chronic cluster headaches unresponsive to standard prophylactic agents. "It's a benign procedure that can produce striking results," he said.

Because the protocol is complicated and usually requires about 10 days of hospitalization, he refers his patients with intractable cluster headaches to the Diamond Headache Clinic for desensitization. If physicians are interested in learning the technique themselves, he recommended they contact the clinic and arrange training.

Before using histamine desensitization, a variety of pharmacologic prophylactic medications should be tried, stressed Dr. Dalessio, who is a senior consultant in neurology at Scripps Clinic and Research Foundation in La Jolla, Calif.

Ergotamine tartrate can be a good option for cluster attacks that occur only at night. For patients with attacks at all times of the day, choices include methysergide, verapamil, and divalproex. Lithium carbonate is also an option, although it carries a risk of several drug-drug interactions that restrict its use to select patients, he said.

It's worthwhile attempting drug combinations in patients who don't respond to single agents, Dr. Dalesslo added. A 7- to 14-day course of prednisone can be given with verapamil. When the prednisone is stopped, the dosage of the verapamil may need to be raised. Verapamil also can be combined with either lithium or divalproex.

If pharmacotherapy and histamine desensitization don't work, then surgery is a last resort. Surgeries with successful outcomes include sphenopalatine ganglionectomy and radiofrequency thermocoagulation of the trigeminal ganglion with section of the trigeminal nerve. Glycerol injection into the trigeminal cistern can also be helpful.

Stereotactic radiosurgery with a gamma knife has been used, but the results have been poor, Dr. Dalessio said.

Return to Cluster headache

Home

Contact

Resources

Exchange Links

ebay