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Cluster Headaches

more about Cluster Headaches

  • Headaches act up in "clusters" over several weeks during which one or more headaches occur almost every day, often causing insomnia. Unlike migraines(N), Cluster Headaches commonly affect young- to middle-aged men and do not run in families.

  • Alcohol can induce a headache when a sufferer is in the cycle of clusters. Breathing pure oxygen can abort a Cluster Headache.

  • Cluster Headaches often last about 1-2 hours and cause a headache behind one eye. There also may be redness, tearing, and Nasal Congestion on the involved side. The clusters of headaches may disappear for months and return again, sometimes on the opposite side of the previous attack. Stabbing and burning pain(N) is very intense and has even lead to Suicide(O) in extreme cases.

  • Cluster Headaches are often misdiagnosed as sinus infections and patients are inappropriately treated.

  • The exact cause is not known at this time. One theory suggests that a headache occurs when nociceptors, or pain(N) sensing nerve endings, are triggered by Stress, muscular tension, or the dilation of blood vessels. The areas of the head that contain nociceptors are the scalp, face, mouth, throat, muscles of the head, and blood vessels at the base of the brain. The bones of the skull and tissues of the brain do not contain nociceptors.

  • Nociceptors transmit a message to the deep structures of the brain, which receives the signal and detects where the pain(N) has originated. Involved in this pathway of signal transmission are many chemicals known as neurotransmitters, which include epinephrine, serotonin histamine, dopamine, acetylcholine, norepinephrine, Gamma-aminobutyric acid (GABA), Glutamate, beta-endorphin, enkephalin, substance P, bradykinin, neuropeptide Y and others. Many scientists believe that most headaches occur due to the alteration in levels and functioning of these chemicals.

  • More recent theories suggest that some headaches, particularly migraines(N), may occur when blood vessels overreact to various triggers, such as a certain foods or beverages, bright lights, odors, Anxiety, or weather changes. This causes spasms that close and severely constrict several arteries supplying oxygen-rich blood to the brain and the areas nearby. As the arteries narrow, blood clotting(N) elements, such as platelets, clump together - a process that is believed to release serotonin (a brain neurotransmitter).

  • Serotonin acts as a powerful constrictor of arteries, further reducing the blood supply to the brain. In response to this reduction of oxygen-rich blood, other arteries within the brain dilate (open wider) to meet the brain's required oxygen and energy levels. The dilation of arteries leads to the release of pain(N)-producing substances called prostaglandins and other chemicals that cause inflammation and swelling, and increase sensitivity to pain(N) by stimulating the nociceptors. This vicious cycle of events results in headache and other symptoms associated with migraine.

  • Most headaches are diagnosed and treated without diagnostic tests or a specialist.

    The assessment of a headache sufferer should start with the physician taking a complete history of the patient's condition. It should include when the headache occurs, where they occur, how often, what aggravates and what retriggers them. Identifying the trigger factors may be helpful in treating and preventing further attacks.

    Examples of some triggers are:

    • Emotional: family problems, work related problems, career changes, anticipation, Anxiety.
    • Stress: strenuous physical exercise(N) or work, illness, too much or too little sleep.
    • Environmental: bright lights, perfume, tobacco, loud noises, changes in altitude, weather, barometric pressure(N) changes.
    • Chemical: hormonal changes, low blood sugar.
    • Medication use
    • Food and beverages: hard cheese(N), hot dogs, chocolate, nuts, food additives such as monosodium glutamate, wheat, sugar, milk, alcohol, caffeine(N), etc.
    • Digestion problems

    The evaluation then continues with a very thorough neurological exam and a detailed examination of the head and neck including scalp, blood vessels, eyes, ears, sinuses, temporomandibular joint, teeth, and the bones and muscles of the neck, shoulders and upper back.

    If a diagnosis is uncertain, a number of tests can be useful, such as:

    • Blood tests - may include a complete blood count; a reading for levels of Electrolytes, sodium, chloride, bicarbonate, Potassium including Calcium Magnesium, and liver enzymes; an analysis of kidney(N) functions (BUN, Creatinine levels); and the rate of erythrocyte sedimentation.
    • Imaging tests - cervical or spine X-Rays, sinus X-Rays, head CT scan, and head and neck MRI may be performed if necessary.
    • Lumbar puncture and Electroencephalography, only if necessary.

  • Preventive therapy may include Verapamil or Methysergide, an ergot derivative.

  • Acute attacks are best treated with oxygen (10 liters per minute). Injectable Sumatriptan can abort an attack in 15 minutes but are expensive. Sublingual ergotamines are also used.

  • Other drugs used in the treatment of these types of headaches are Lithium, Valproate, Baclofen, Corticosteroids, and Intranasal Lidocaine.

  • Invasive neurosurgical procedures have been tested and are under study for sufferers who do not respond to medication treatment. These procedures include glycerol injections into, or radiofrequency destruction of, sphenopalatine ganglia, and the surgical decompression of the trigeminal nerve.

  • headaches - general
  • Migraine Headaches
  • Tension Headaches
  • Ophthalmoplegic Migraine
  • Stroke
  • Subarachnoid Hemorrhage
  • Brain Tumor
  • headaches due to Brain Tumor
  • Brain Aneurysm
  • headaches due to brain hemorrhage or aneurysm
  • headaches due to substance Abuse(P)
  • headaches due to post-traumatic injuries or Concussion(P)
  • sinus infection or Sinusitis
  • headaches due to sinus infections
  • headaches due to intracranial pressure(N)
  • Meningitis
  • Shingles
  • Temporal Arteritis

  • more about Cluster Headaches

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