The cluster headache

The cluster headache (Bing-Horton neuralgia) is a serious primary headache disorder, which surpasses even migraines in pain intensity. The pain are can usually attack like in the area of the eyes. The periodic appearance is also typical: acute attacks of pain lasting for several weeks or months can (recurs), alternated with headache-free periods (remission phase). Although the exact cause of cluster headache is so far not yet been clarified, however, some trigger factors such as alcohol or heat are known. To relieve the symptoms of the patients, are both preventive and acute therapeutic treatment options available.

Cluster headaches: symptoms

Cluster headaches begin suddenly and are usually only on one side of the face. They occur mostly to keep around an eye, can emit and in towards the root of nose, jaw, Temple, forehead and neck. The pain is described by some stakeholders as a "glowing hot knife in the eye" and referred to also as "suicide headache" because of its strength. The duration of a pain attack can by a quarter of an hour to three hours enough. The frequency of attacks ranges from an attack every other day every day up to eight attacks. Cluster headaches are often associated with the following symptoms:

1. Eye tears and eye redness
2. Pupil constriction
3. Eyelid swelling and droopy eyelid
4. Swelling of the nasal mucosa
5. Sweating in the area of the face
6. Dizziness and nausea
7. Physical restlessness and strong urge to move

The headaches occur in our experience always at the same time: most often they are can be one to two hours after falling asleep or in the early hours of the morning. In addition, seasonal concentrations of active cluster show in spring and in autumn.

Cluster headaches are relatively rare compared to other types of headache: less than one percent of the population is affected, whereas about 10 percent suffer from migraine. The headaches occur mainly in young men aged between 20 and 40 years. Why men are around three times more often affected than women, could not be clarified so far yet.

Episodic and chronic history

Cluster headaches may occur in an episodic or chronic form. In an episodic history the complaint last for at least a week until off to over a year. In between are again symptom-free intervals of at least one month. In contrast, chronic cluster headache exist, when the attacks of headache without improvement take longer than one year, no State breaks occur, or these are shorter than four weeks. About 80 percent of patients suffer from an episodic and 20 percent under a chronic history form.

Causes and inheritance

The exact causes of cluster headache are so far not yet been clarified. It is clear that the headache is accompanied by an extension of inflamed blood vessels in the brain. Still, scientists suspect that a biological rhythm disturbance could cause the formation of cluster headaches. Here, the hypothalamus plays a central role. This forms part of the midbrain and regulates also the biological day-night cycle in addition to body temperature, cycle, and food intake. This assumption is the day - or season-linked occurrence of Cluster attack.

Some studies show that even the inheritance of the occurrence of cluster headaches plays a role: with relatives first-degree head pain five to 18 times more frequently and in related second-degree occurs one to three times more frequently than in the general population. The exact inheritance factors are not known.

Trigger of cluster headaches

During the active recurs certain internal and external stimuli, known as triggers, a Cluster attack may cause in some people. Known triggers are alcohol, histamine, and nitroglycerin.

When the alcohol, paradoxically small amounts can provoke a Cluster attack, while larger quantities can prevent partial an attack. The substance histamine is included, for example, in strawberries, tomatoes, chocolate and red wine. NITROGLYCERIN, used in medicines as an active ingredient for the expansion of blood vessels, can also lead to Cluster attack.

More provocative factors are flickering light, noise, and extreme heat or altitude changes. Such precipitating factors can trigger attacks only during the cluster, while the remission periods, they are ineffective.

This headache disorder diagnosis

Cluster headache is a condition that is diagnosed only on the basis of complaints. Imagings are at best suited to rule out other causes for the complaints procedure. The survey of the history and the common symptoms are the central means for Diagnostics.

That's why keeping a headache diary is very useful on all recurring headaches. This facilitates the diagnosis the doctor, is used to monitor the therapy and can help to identify possible triggers. Photos can be important for diagnosis, recorded during an attack by the patient's face. A clear diagnosis is made, before the average five to seven years.

The nitroglycerine provocation test

The nitroglycerine provocation test represents a procedure to secure the diagnosis of a cluster headache. However, this method is ethically controversial and is now hardly practiced.

During the test a headache attack brought about during recurs intentionally by the gift of nitroglycerin. This however only works when no spontaneous attack has occurred in the last eight hours, no vasodilator substances have been taken within the last 24 hours and no drug prophylaxis is operated.

Treat cluster headaches

Conventional analgesic drugs such as aspirin, ibuprofen or diclofenac are not effective in the treatment of cluster headaches. Alternative therapies such as acupuncture or massage show no effect. Basically it is the most important, while recurs to avoid triggers (E.g., alcohol, histamine, and nitroglycerin). General distinction is made between a therapy of acute single attack and preventive measures in the treatment of cluster headaches.

Treatment of acute: What helps?

For the treatment of an acute administration of 100% oxygen has proved extremely effective. This 8 to 16 liters of oxygen per minute run to 15 minutes concerned about a high concentration mask. The inhalation of pure oxygen stops the cluster headache attack in nearly 80 percent of cases within a short time and is also free of side effects. The application at the beginning of an attack is particularly effective.

Furthermore proved treatment with lidocaine, a local anesthetic. The substance is given in the nostril of the affected side of the headache or sprayed in the vicinity of a nerve to cause a nerve block.

The drug sumatriptan is also used for the acute treatment of cluster headaches. Sumatriptan intervenes in the metabolism of serotonin, a key neurotransmitter in pain processing. However, when taking sumatriptan, unpleasant side effects can occur such as dizziness, fatigue or drop in blood pressure.

Prevent cluster headaches

Corticosteroids, as well as the active ingredient of Verapamil used for preventive therapy for episodic as well as in chronic cluster headache prefers. Also lithium is suitable for the treatment of cluster headaches. However, side effects such as weight gain, lack of concentration or increased urination go hand in hand with taking occasionally. When drug therapy is to ensure that the medicines used for the treatment and prevention get along with each other and can be combined as a whole.

Healing cannot be the cluster headache so far although, nevertheless, can the quality of life of affected patients are improved by avoiding precipitating factors and through a targeted therapy.

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