The cluster headache or facial pain is a headache which is extremely intense, debilitating, non-pulsatile, which tends to reoccur in the same area of the head or of the face every time. Also described as “suicide headache”, referring to the patient’s pain and despair, even actually ending in the suicide of some people in the most extreme of cases.
Prevalence and epidemiology
While migraines are more usually diagnosed in women, the cluster headache is more common in males, with a ratio of 4:1 to 7:1. It occurs mainly between 20 and 50 years of age. The gender gap gradually decreasing over time, it is not yet clear is whether this is due to increased prevalence in women or by better diagnosis of pathology in a comprehensive manner. Latitude has an important role in the occurrence of cluster headache is more common in certain geographic latitudes. It is believed that this higher prevalence in these regions would be due to changes in day length.
It apparently affects a 0.0027% of world population, and proportionately more in men. Its causes are not known (although it has been described for centuries) and we have not developed specific drugs to treat it. It is characterized by a unilateral headache that typically appears very intense at regular intervals, usually 24 to 48 hours during certain periods (two or three months). However, periods of activity and remission can vary with different people: there are patients who suffer from the chronic variety but also have periods of remission for several years. They often appear during sleep or when waking in the morning.
Cluster headache, by JD Fletcher
Generally associated with tearing and nasal distillation, it can, like other headaches be accompanied by nausea and photophobia or fonofobia even though, unlike the migraine it does not occur with optical disturbances (aura).
Unlike other headaches, the migraine attack typically comes in bunches. Medical literature describes the pain of cluster headache as the most intense a man can endure without losing consciousness. It is therefore a highly disabling disease, it prevents the patient do any work during the attack (which lasts three hours) and leaves symptoms such as exhaustion and depression (there is a high suicide rate among those who suffer from it) It is not often recognized as a cause of disability.
The headaches appear suddenly in clusters between adolescence and youth, and often disappear when the patient is approximately 70 years old. Its causes are not known, but appear to be related to circadian rhythms and has indicated a possible deficiency in the hypothalamus. The ingestion of alcohol often triggers an attack in a maximum of two hours.
Patients are usually treated with painkillers or other drugs for migraine common, with disease that has no real connection, why the treatments have little effect.
The treatments are divided into an abortive attack relieving and preventive individual seeking to combat a full cycle.
Among abortive we can use pure oxygen at a rate of ten to twelve liters per minute, the ergotamine and triptans (sumatriptan and zolmitriptan). The latter have the highest rate of efficiency although its high price and its vasoconstrictor effects are factors limiting your prescription.
In emergency treatment, the patient is made to inhale oxygen, which also tends to have an analgesic effect. However, it is common for emergency physicians are not able to detect the disease since its incidence is low, and the patient treated with analgesics and anxiolytics.
There is controversy about the effectiveness of a number of herbal treatments (Kudzu, psychoactive mushrooms) and hormonal (melatonin)
In cases of refractory cluster, in need of multiple preventive and symptomatic treatments, surgery may be indicated by functional deep brain stimulation (Deep Brain Stimulation – DBS) in hypothalamic nuclei or by stimulation of the suboccipital nerve.