Sunday, 24 November 2013

Cluster Headache - The Symptoms

I. Cluster Headache
Cluster Headache also known as suicide headache, is defined as an uncommon distinctive neurovascular syndrome occurring in either episodic or chronic patterns of that occur periodically over a long period of time. The diseases affects over 0.1% of the population, occurring at 45-to 60-day intervals with one to three headaches a day lasting 45 min to 2 h(a), if untreated it, can cause increased frequency of the attacks.

II. Signs and Symptoms  
1. Pain 
Pain is more intensify compared with other types of headache. Dr. Peter Goadsby, Professor of Clinical Neurology at University College London, commented:  "Cluster headache is probably the worst pain that humans experience. I know that’s quite a strong remark to make, but if you ask a cluster headache patient if they’ve had a worse experience, they’ll universally say they haven't. Women with cluster headache will tell you that an attack is worse than giving birth"(b)

2. Anxiety and depression
Researchers suggested that  Cluster headache (CH) patients who were depressed or anxious were more likely to present at a younger age and have attack-related nausea and prodromal symptoms. Depressed CH patients were also more likely to have another pain disorder and had undertaken twice as many prophylactic medication trials(1)

3.  Unilateral headaches and extreme intensity
In the study conducted by Mayo Clinic College of Medicine, cluster headache attacks are stereotypical, that is, of extreme intensity, of short duration, occurring unilaterally, and associated with robust signs and symptoms of autonomic dysfunction. Unlike migraine, during an attack the patient with cluster headache often paces about. Attacks frequently occur at night, awakening the patient from sleep(2)

4. Sense and behaviour of restlessness
In the study of comprised 86 consecutive new cluster headache patients (68 males, 18 females; mean age, 38.4 ± 12.2 years; range, 17-73 years). result showed a relatively low prevalence of chronic cluster headaches, and uncoupling of a sense of restlessness and restless behaviour(5)

5. Tearing and Rhinorrhea
Tearing and Rhinorrhea are trigeminal-autonomic headache symptoms as a result of symptoms of autonomic dysfunction, occurred during the attacks of cluster headache(7)

6. Facial and eye pain 
Facial and eye pain  are associated with the autonomic innervation of the eye and orbit as
a result of cluster headache debilitating conditions.(12)

7. Facial pain
In a study by Dr. Oomen KP and the tead suggested that correct headache and facial pain diagnosis is vital to assess the outcome of different treatment strategies. Even in a tertiary center, headache and facial pain can be misdiagnosed. RFT of the SPG may be effective in patients with facial pain(8)

8.  Other symptoms also include the following
a. Ipsilateral conjunctival injection and/or lacrimation
b. Ipsilateral nasal congestion and/or rhinorrhoea
c. Ipsilateral eyelid oedema
d. Ipsilateral forehead and facial sweating
e. Ipsilateral miosis and/or ptosis
f. A sense of restlessness or agitation(9)

8. Etc.

Although most cluster headache patients are experiences certain  symptoms of autonomic dysfunction as the connection of cluster headache (CH) attacks with rapid eye movement (REM) sleep has been suggested by various studies, in some patients Cluster headache attacks are found no association of CH with REM or sleep disordered breathing was observed. Increased heart rate temporally associated with transition from one sleep state to another was observed before patients awoke with headache. Total sleep time, total wake time, arousal index and distribution of non-REM sleep stages were different between chronic and episodic CH(4). Other study showed that patients with cranial autonomic symptoms (CAS)were experience no pain in CH attacks, whereas another five patients continued to experience typical cluster headaches(6)
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