Neurological Disorders: Cluster Headache

Cluster headache is not very common however it is considered as one of the most painful conditions to the humankind. It is a neurological disorder and a neurologist is the specialist generally involved in the management of these patients.

There is a suggestion that with regard to the severity this condition can even compete or surpass with labor pain (child birth), pain of subarachnoid hemorrhage etc. Just to support this notion, there are evidences that patients had even attempted suicide during some of their worst attacks. Of course pain is subjective as well, and for almost every health condition there is a grading of the severity and this headache is not an exception. So not necessarily every patient will experience such intense headaches.

Generally many of the headaches are more common in women but this headache occurs more in men. There is no racial or ethnic predilection. It is more frequent in adulthood as common to majority of the primary headache syndromes (headache without any identifiable structural pathology).

What exactly precipitates this headache is still not known. It belongs to a group of headaches called as trigeminal autonomic headaches. Trigeminal nerve is the 5th cranial nerve (there are total 12 of them). The autonomic nervous system is a component of the nervous system and controls the involuntary systems of the body including heart, gastrointestinal tract, bowel, bladders, blood vessels, secretions, pupil etc. It is assumed that both these components f the nervous system are sensitized during an attack.

• Headache
• Drooping of eyelid (ptosis)
• Swelling of eyelid
• Reddening of eyes
• Eye tearing
• Increased nose (nasal) secretions
• Small sized pupils
• Flushing of the forehead

As mentioned above the cluster headache generally is very severe and excruciating in nature. Typically it is one sided and may involve the fronto temporal regions, eye, areas around the eye. The attacks characteristically come in clusters and present cyclically. During one cycle which may last for few days to weeks to months patient will experience multiple intense headache episodes. Each episode may last from about 45 minutes to few hours. There is a chronic variant too where headache episodes occur on a rather regular pattern instead of cyclical pattern.

The other manifestations mentioned above are due to involvement of the autonomic nervous system.

The diagnosis is made clinically however if presentation is atypical a CT or MRI with and without contrast is obtained to rule out any structural pathologies to explain the headache.

Some of the commonly employed treatments for acute attack of this headache include;

• Nasal oxygen
• Intranasal Lidocaine
• Sumatriptan injection
• NSAIDs (non steroidal anti inflammatory drugs
• Opioid analgesics etc

For prevention or prophylactic purpose these medications may be tried;

• Verapamil
• Sodium valproate
• Topiramate etc.