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Cluster headache is primary headache from the group of trigeminal autonomic cephalalgia for which seizures in clusters are characteristic, with the tendency of periodic repeating after a free interval. This means that the headache occurs daily, usually in night hours for a few weeks or months, then it stops and it gets repeated in cycles at the similar time of the year. Considering the painful period, it is divided into episodic cluster headache (the pain lasts from 7 days up to one year with painless period longer than a month) and chronic cluster headache, where the patient has daily headaches for over a year.
It is also known under the name Bing-Horton syndrome, migrainous neuralgia, and „alarm-clock headache. Taking into account that this headache is extremely painful, some even call it “suicidal” headache. But despite of a very specific clinical picture, it is a type of headache that often stays unrecognized in the world so to get to the right diagnosis it can happen that a few years pass, and the patient visits several different specialists in the mean time. There are several epidemiological studies about cluster headaches that show that they are rare, they occur in younger and middle life age and unlike migraines, they are more common in men.
Of provoking factors it is known that alcohol consummation in cluster period can precipitate the headache, as can nicotine. Even though pathophysiology of the pain is not completely explained, newer studies with PET – MR of the brain have shown more activation of the foreign hypothalamus (part of the brain which regulates our internal biological clock) during the cluster period which explains the periodicity in headache occurrence.
Cluster headache is characterized with sharp, glaring pain in the area of one eye that the patient describes as incandescent or drilling. The pain lasts between 15-180 minutes, once or more times in one day, so it is characteristic that it occurs usually after falling asleep, always in the same time and night after night, and that period of daily pain repetition is called cluster period. With the pain, autonomic symptoms also occur, like tearing and eye redness, congestion or nose secretion and descent of the eyelid. Unlike migraine, these patients are meaningly psychomotorically agitated, they walk, run, yell or they sway back and forward while sitting, holding the painful area, and because of the intensity of the pain some of the patients have suicidal ideas.
Diagnosis for cluster headache is made on a base of typical clinical picture and neurological examination, so in most of the patients any other processing isn’t necessary. Simple analgesics available in free sales are not efficient considering that headache occurs suddenly and it lasts for a short period of time. Treatment can be acute treatment (treating the attack itself) or prophylactic treatment, which implies daily taking of the medication with the purpose of lowering the frequency and intensity of the headache.
In acute attack inhalation of pure oxygen within 10 minutes in a sitting position in 70-80 % of the patients it stops or at least decreases the intensity of the pain. Furthermore, to reduce the attacks triptans can be used (drugs that are usually used to treat migraines); however excessive intake can lead to addiction. Because of that in most patients prophylactic treatment has been initiated and with corticosteroids usually within 3 weeks with mandatory gastro protection. Corticosteroids are extremely efficient for complete cease of the cluster periods, however because of a large number of side effects their long term use is not recommended. So in patient with long term seizures and high frequency of their repetition long term intake of calcium canal blockers (verapamil), antiepileptics and/or lithium is recommended.
Every extremely painful, unilateral headache that occurs almost always at the same time, usually night after night, with lingering tearing and eye redness, congestion or nose dripping, requires a neurological examination in the Ambulance for headache for correct diagnosis and introduction of a corresponding therapy.
