Cluster Headaches, Signs and Symptoms, Treatment

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Cluster Headaches, sign and symptoms, pathology, types, and treatment choices.

Relatively rare. Population frequency of approximately 0.1%.

Cluster headaches are the only headache syndrome that is more common in men than women. 50% of the men experience these attacks at night.
Repetitive episodes occur for 8 to 10 weeks a year. Usually at the same time of the day and can awaken a patient from sleep.

Chronic cluster headache is when there is no remission between the attacks or if the remission is less than a month without treatment.

Headache is always unilateral, no associated nausea or vomiting is present. Starts as retro-orbital pain that then spreads to the hemicranium. Pain is severe, deep, excruciating, non-fluctuating, and explosive. It is usually associated with ipsilateral cranial parasympathetic system activation causing lacrimation, rhinorrhea, stuffy nose, and red eye. Cranial sympathetic dysfunction may cause ptosis. Pallor or even Horner's syndrome may be present.

Pathology seems to be the disorder of the central pacemaker or circadian neurons in the posterior hypothalamic region.

Patients with this headache tend to move about during the attack. They will pace, rock, and rub their heads for relief. In contrast, the migraine headache patients tend to stay motionless during the attacks.

Treatment
Acute Attacks
100% oxygen is the most effective and rapid abortive treatment in the acute attack.
Subcutaneous or nasal sumatriptan is abortive as well. But not as effective and rapid as the nasal oxygen. Ergots, Indomethacin, and other NSAIDs may be used to abort an acute attack, but again, they are not as effective and rapid as 100% oxygen.

Prophylaxis
After an acute attack, prophylactic therapy with verapamil should be immediately started.
Prednisone, ergotamine, methysergide, cyproheptadine, and indomethacin can also be used.

Chronic Cluster Headache Treatment
Lithium is used for the chronic form of cluster headaches.

Reference: https://americanmigrainefoundation.org/resource-library/cluster-headache-2/

Harrison 9th Edition Volume 2

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