Cluster headache: pathophysiology, diagnosis and treatment

Abstract

Cluster headache (CH) is characterized by attacks of severe, strictly unilateral pain that is orbital, supraorbital, temporal, or any combination of these, lasts 15-180 min, and occurs from once every other day to eight times a day. The pain is associated with ipsilateral conjunctival injection, lacrimation, nasal congestion, rhinorrhea, forehead and facial sweating, miosis, ptosis and/or eyelid edema, and/or with restlessness or agitation. The understanding of the pathophysiological mechanisms behind CH is far from complete, but CH is considered to be a neurovascular and chronobiologic headache disorder, with a pivotal role played by the central brain mechanisms. The diagnosis of CH is based on a careful history that elicits the clinical features of attacks, ipsilateral autonomic phenomena, and the cyclical nature of the bouts in which the attacks occur. Additional diagnostic interventions are needed to rule out secondary causes of CH. The main focus of therapy is to abort attacks once they have begun and to prevent future attacks. Alternative interventions in patients with CH who have not experienced any meaningful benefit from preventive drugs are well defined. Although there have been advances in the diagnosis and therapy of CH, a significant number of CH patients experience misdiagnoses and diagnostic delay, which stalls the possibility of the timely application of adequate abortive and preventive therapy.

Dermatoşalazisli hastalarda üst kapak blefaroplasti cerrahisinin baş ağrısı üzerine etkisi

“…Literatürde baş ağrısının etiyolojisine yönelik birçok çalışma bulunmaktadır 10,15,16 . Bu konudaki önemli bulgulardan biri Trigeminal sinirin oftalmik dalının supraorbital ve supratroklear sinir dalları ile corrugator ve depressor supercilii kasları arasındaki etkileşimidir 10 .…”

“…Bu konudaki önemli bulgulardan biri Trigeminal sinirin oftalmik dalının supraorbital ve supratroklear sinir dalları ile corrugator ve depressor supercilii kasları arasındaki etkileşimidir 10 . Frontal baş ağrısı nedeniyle takip edilen birçok hastada supercilii kaslarında hipertrofi tespit edilmesiyle kas hipertrofisinin migren ağrısını başlatan etmen olduğu ileri sürülmektedir 15,16 . De Rua ve ark., bu kas grubuna uygulanan botulinum enjeksiyonları ile baş ağrısı semptomları ve atak sıklıklarının azaldığını bildirmişlerdir 17 .…”

Gene polymorphism association studies in cluster headache: A field synopsis and systematic meta‐analyses

“…Cluster headache (CH) is a primary headache characterized by severe unilateral orbital, periorbital, or temporal pain, usually accompanied by a sense of restlessness or agitation and by local autonomic symptoms including reddening of the eye, lacrimation, and nasal congestion. 1 CH exists in two main forms, episodic CH, in which attacks typically occur once or more daily for a period of weeks or months, followed by a headache-free period lasting for several months or years, and chronic CH in which remission periods last less than 3 months. 2 Pharmacological treatments of CH include symptomatic drugs for pain relief, such as triptans and/or high-flow oxygen, and preventive drugs such as verapamil, topiramate, and lithium, which are effective in reducing CH attack frequency.…”

Differences in Characteristics and Comorbidity of Cluster Headache According to the Presence of Migraine

“…Most patients with CH are classified as having episodic CH since they have a headache-free period of several months or even years, the so-called remission period. Those patients without such a long remission period are classified as having chronic CH 123…”

“…Those patients without such a long remission period are classified as having chronic CH. [1][2][3] An overlap between CH and migraine has been reported. In addition to autonomic symptoms, 25-46% of patients with CH experience and report migraine-like features such as nausea, photophobia, phonophobia, and sometimes migraine itself.…”