Cluster headache : Causes, Symptoms , Diagnosis, Treatment
Neurology / / April 26, 2016
Cluster headache video
or cluster beam (united by common attributes) headaches are one of the most painful types of headaches.They are marked as painful, piercing and penetrating, and tend to focus around the eyes.Attacks of cluster headaches occur very suddenly and without warning, with a peak within 15 minutes.
number of victims of these "infernal" headaches than 1% of the world population.Men are much more likely to suffer from headaches than women.
Many people have headaches, have a personal or family history of migraine.Headaches may be so painful that sometimes lead people to severe depression.
headaches can be:
- Episodic. attacks (i.e. episodes) occur regularly over a period of one week to one year.They are separated by long pain-free periods that last at least one month.80-90% of patients have occasional cycles.A significant number of people who experience a first cluster attack do not have a follow-up;
- Chronic. Attacks occur regularly for more than 1 year, with pain-free peri
typical cycle of cluster headaches
- Timing attacks. attacks of cluster headache tend to attack with great regularity, at one and the same time of day (for this reason they are sometimes called "alarm clock headaches").Most attacks occur between the beginning of the evening and early morning, peak times - from midnight to 3 am.
- The duration of attacks. cluster attack is usually brief but extremely painful, lasting, if not treated, - from 15 minutes to 1.5 hours.
- The number of attacks per day. During an active cycle, individuals may experience only one attack a day, but sometimes - and as many as 8 attacks a day.
- cycle time. Cycles attacks usually last 6-12 weeks, with remission of up to one year.In the chronic form attacks they are continuing, and are sometimes remission.The cycles usually occur seasonally, often in spring and autumn.
Headache is considered primary when it occurs not as a result of another disease or medical condition.Primary headaches include:
- Bouts of chronic migraine. These attacks are very similar to cluster headaches.They lead to more short and severe daily headaches with symptoms that resemble cluster headaches.But compared with clustered, these bouts shorter (lasting 1-2 minutes), and they are more frequent (occurs 15 times on average per day).These headaches are usually found in women and respond to anti-inflammatory drug treatment Indomethacin (Indocin);
- hemicrania Continua.This short strictly unilateral headaches, neuralgia resembling with lacrimation, ameliorated, usually when receiving Indomethacin, found mainly in women.When cluster headache pain, which can range from mild to severe, occurs continuously on one side of the face.Recurrent attacks may last from several days to weeks, and may resemble a migraine;
- Short-sided neuralgic headaches with injecting conjunctiva and lachrymation (sunct-syndrome). These pains pricking, causing a burning sensation and pain in the eyes, may resemble cluster headaches, but the attack is very brief (lasting about 1 minute) and can be more than a hundred times a day.Typical here are eye redness, tearing, sweating forehead congestion.These rare headaches are more common in men than women, and do not respond to conventional treatment of headaches.
reasons cluster headache
headaches as migraine, are associated with abnormalities in the blood vessels and the nervous system.Among the main reasons for the origin of the headache can be distinguished:
- Abnormalities in the hypothalamus. Studies clearly indicate that violations of the hypothalamus - a complex structure, located deep in the brain that play an important role in cluster headaches.Advanced imaging techniques have shown that a certain part of the hypothalamus is activated during an attack of cluster headache.
hypothalamus is involved in the regulation of many important chemical and neural pathways, including:
- nerve clusters that regulate the body's biological rhythms (circadian rhythms it);
- serotonin and norepinephrine.It neurotransmitters (chemical messengers in the brain), which are associated with a sense of well-being and appetite;
- cortisol (stress hormone);
- melatonin (a hormone that is associated with the body's response to light and dark);
- beta-endorphins (substances that modulate pain).
For some not very clear mechanisms, the trigeminal nerve is also involved in the regulation of chemicals and nerve pathways.Trigeminal nerve carries sensation from the face to the brain.
- Daily violation. cluster attacks often occur during certain stages of sleep.They also often follow a seasonal increase in heat and light.Many patients report an increase in attacks in daylight saving time changes, and in the fall and spring.Researchers have focused on circadian rhythms, and in particular small clusters of nerves in the hypothalamus which acts as a biological clock.The hormone melatonin is also involved in the body's biological rhythms.
- Expansion of the blood vessels. Headaches can be caused by dilation of blood vessels and inflammation of the nerves of the eye.Inflammation nearby nerves can lead to piercing, pulsating pain that usually felt in one eye.The trigeminal nerve extends from the brain behind the eye and sends impulses to the skull and face.What causes these events and how they are associated with cluster headaches is still not clear.Since the expansion of blood vessels appears to follow, rather than precede them headaches, part of the process is likely to be some action that occurs in the brain.
- Abnormalities of the sympathetic nervous system. Some evidence suggests that abnormalities in the sympathetic (autonomic) nervous system may contribute to cluster headaches.This system regulates muscle, such as the heart and blood vessels.
Risk Factors occurrence of headaches
- Gender and age. Headaches can affect people of all ages, from children to elderly people, but are most common in adolescence people.Men are 2-3 times more affected by cluster headaches than women, especially men 40 years of age.Women tend to start at such pains 60 years.Unlike the situation with migraine, cluster headaches in the fluctuations of estrogen and other female hormones that play no role.
- Lifestyle. lifestyle factors including smoking, alcohol abuse and stress (in particular, stress at work) will definitely affect headaches.Smoking can cause seizures (however, the full cessation of smoking will not stop headaches).Alcohol, especially beer, is the most common among all hazards.
- Family history and genetic factors. Headaches tend to attack in the family, which indicates a genetic component.
- History of migraine. About half of people with cluster headaches have a personal or family history of migraine.In about 15% of patients - both types of headaches.
- Head Injury. Head injury with concussion of the brain may increase the risk of headaches, although the causal link is not proven.
- Sleep apnea and other sleep disorders. Headaches usually occur during certain stages of sleep and are associated with a number of sleep disorders, including narcolepsy, insomnia, restless legs syndrome and sleep apnea.Sleep apnea - a disorder in which a person's breathing pauses at night, maybe hundreds.In some people, cluster headache during the first few hours of sleep apnea may result, making patients susceptible to subsequent attack on the afternoon of the day before the next meal.Treatment of patients with disturbances have a device called «CPAP», which opens the airways, may help to improve both conditions.
triggers cluster headaches
(triggers - in a general sense, resulting in something of action elements are here: the factors that trigger headaches) .
following conditions and substances can cause cluster attacks:
- alcohol and smoking;
- weather changes;
- high altitude (trekking, air travel);
- pungent smells;
- bright light (including sunlight or flashing lights);
- a lot of stress;
- heat (hot weather, a hot bath or shower);
- foods high in nitrites (eg, bacon, canned meat);
- certain medications (including those which cause the dilation of blood vessels - such as nitroglycerin, and various medications from high or low blood pressure).
Triggers usually have effect only during an active cluster cycle.When the disorder is in remission, it rarely causes new headaches.
Symptoms of cluster headache
Pain usually grow from moderate to severe in 15 minutes.Patients may feel anxious or distressed during the attack, and often want to be isolated from the others, to leave.Gastrointestinal symptoms are not very common.
In addition to the pain of migraine symptoms may include the following:
- swollen eyelids or fallen;
- tear your eyes;
- runny nose;
- sweating forehead;
- intolerance to light and sound;
- anxiety and agitation;
- nausea and vomiting;
- dilated pupils.
headache symptoms include stinging, severe pain behind or above one eye, eyes tearing, congestion in the corresponding nostril, change age, etc.
headache symptoms that may indicate a serious disorder
Headaches indicating a serious underlying problem - such as cerebrovascular disorder, or malignant hypertension, are rare (note that the headache is not a common symptom of a brain tumor).People with existing chronic headaches, however, might miss a more serious condition, considering that this is one of their usual headaches.Such patients should seek immediate medical attention if the quality of a headache or its attendant symptoms changed.
Everyone should consult a physician if any of the following symptoms:
- sudden and severe headache, which is maintained or increased in intensity over the next hour, sometimes accompanied by nausea, vomiting or changes in mental status (perhaps an indication of a hemorrhagic stroke, whichalso called "cerebral hemorrhage");
- sudden, very severe headache, worse than you have ever experienced (possible indication of a brain hemorrhage or aneurysm rupture);
- chronic or severe headaches that begin after 50 years;
- headache, accompanied by other symptoms - such as loss of memory, confusion, loss of balance, changes in speech or vision, loss of strength, numbness, tingling in the hands or feet (possible minor stroke in the brain);
- headache after head injury, especially if there are drowsiness and nausea (possible bleeding in the brain);
- headache, accompanied by fever, stiff neck, nausea and vomiting (possible meningitis);
- headaches that increased cough or voltage (possible swelling of the brain);
- throbbing pain around or behind the eyes or in the forehead, accompanied by redness of the eyes and perception of halos or rings around lights (possible acute glaucoma);
- sided headache in the elderly;the arteries become hard and gnarled, there is no pulse (possible temporal arteritis, which can lead to blindness or stroke if left untreated);
- sudden at first, and then persistent, throbbing pain around the eyes (perhaps their spread to the ear or neck, possible blood clot in one of the cavities of the brain veins).
Diagnostics cluster headache
Migraine-like symptoms (light and sound sensitivity, aura, nausea, vomiting) are the main causes of frequent misdiagnosis.In some cases, patients inappropriate considering other types of headaches (e.g., migraine) or sinusitis.
- Medical and personal history . cluster headaches, including repeated attacks, diagnosed and fixed in the patient's medical history, with their typical symptoms (swollen eyelids, watery eyes, runny nose).Keeping the patient diary to describe the headache attacks can help the doctor make an accurate diagnosis.The patient should describe the doctor the following:
- the frequency of attacks (if to keep a diary, write the date and time of each attack);
- description of the pain (stabbing, throbbing);
- localization of pain;
- the duration of the pain;
- pain intensity (using the scale as shown below);
- associated symptoms (eye tearing, nausea and vomiting, sweating);
- any measures that bring relief (pressure measurement, exits into the open air);
- any events that preceded the attack or may have caused them;
- any medications you are taking;
- your behavior during the headaches (anxiety, agitation);
- snoring, sleep disturbance, daytime sleepiness (this may be due to sleep apnea, which is sometimes associated with cluster headaches).
pain can be seen through a large-scale system of calculation:
1 = mild, barely noticeable;
2 = noticeable, but does not interfere with work or activity;
3 = distracts from the work or activity;
4 = doing the work or activity is very difficult;
= 5 is a complete inability to carry out any activity.
- Medical examination. To diagnose chronic headache doctor will examine your head and neck, and will perform a neurological examination, which includes a series of simple exercises to test the strength, reflexes, coordination and sensation.Also, the doctor can see your eyes.He may ask you questions to verify your short-term memory and related aspects of mental functions.
- tests with images. doctor may order a CT scan (CT) or magnetic resonance imaging (MRI) of the head to check on the brain abnormalities that can cause headaches.
- Exclusion of other headaches, and medical disorders.As part of the diagnosis TCG must rule out other disorders and headaches.If the results of the history and physical examination suggest other causes of headaches or serious complications, run extensive tests.
Diseases accompanied by headache
- Migraine. Headaches often misdiagnosed as migraine, but they are quite different.Headaches usually last from 15 minutes to several hours and may occur several times a day.One migraine attack lasts continuously for one or several days.Patients with cluster headache and migraine, as a rule, difficult to move, and usually want to go.However, in both cases, the patient may be very sensitive to light and noise.
- Other headaches.Be careful!