Headache, Cluster

Headache, Cluster is a topic covered in the 5-Minute Clinical Consult.

To view the entire topic, please or purchase a subscription.

Medicine Central™ is a quick-consult mobile and web resource that includes diagnosis, treatment, medications, and follow-up information on over 700 diseases and disorders, providing fast answers—anytime, anywhere. Explore these free sample topics:

Medicine Central

-- The first section of this topic is shown below --

Basics

Description

  • Primary headache disorder
  • Multiple attacks of unilateral, excruciating, sharp, searing, or piercing pain; typically localized in the periorbital area and temple accompanied by signs of ipsilateral parasympathetic autonomic features, along with restlessness and agitation
  • Autonomic symptoms: parasympathetic hyperactivity signs (ipsilateral lacrimation, eye redness, nasal congestion) and sympathetic hypoactivity (ipsilateral ptosis and miosis)
  • Patients often pace the floor during an acute attack, as lying down seems to exacerbate the pain.
  • Symptoms usually remain on the same side during a single cluster attack.
  • Individual attacks last 15 to 180 minutes if untreated and occur from once every other day to 8 times per day.
  • Attacks usually occur in series (cluster periods) that are often seasonal, lasting for weeks or months; separated by remission periods usually lasting months or years
  • About 10–15% of patients have chronic symptoms without remissions (i.e., chronic cluster headache [CH]).

Epidemiology

Incidence
1-year incidence: 2 to 10/100,000


Prevalence
  • Lifetime prevalence: 124/100,000
  • Predominant sex: male > female; 2.1:1 overall
  • Women often develop earlier in life (20s).
  • Mean age of onset: 30 years
  • Episodic/chronic ratio: 6:1

Etiology and Pathophysiology

  • Complex and incompletely understood
  • Proposed mechanism include the following:
    • Posterior hypothalamus activation may trigger an attack by activating trigeminal nociceptive pathways through perivascular activation and increased parasympathetic outflow, causing unilateral pain.

Genetics
  • Usually sporadic: autosomal dominant in 5% of cases; autosomal recessive or multifactorial in other families
  • Evidence varies: first-degree relatives carry 5- to 8-fold; second degree, 1- to 3-fold increased relative risk of disease
  • >50% with migraine and 18% with CH in family history

Risk Factors

  • Male gender
  • Age (70% onset before age 30 years)
  • Cigarette smoking or childhood exposure to cigarette smoke
  • Family history of CH
  • Head trauma

Commonly Associated Conditions

  • Depression (24%)
  • Increased risk of suicide secondary to the extreme nature of the pain
  • Medication-overuse headache
  • Asthma (9%)
  • History of migraine, frequently in female patients
  • Sleep apnea (30–80%)
  • Increased prevalence of cardiac right-to-left shunt and patent foramen ovale (relationship unclear)

-- To view the remaining sections of this topic, please or purchase a subscription --

Citation

* When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Headache, Cluster ID - 116254 ED - Baldor,Robert A, ED - Domino,Frank J, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116254/all/Headache__Cluster PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -