Headache, Cluster
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Basics
Description
- A primary headache disorder characterized by 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 because 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 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 [cCH]).
Epidemiology
Incidence
1-year incidence: 2 to 10/100,000
- 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
- Possible mechanisms include the following:
- Posterior hypothalamus activation may trigger an attack by activating trigeminal nociceptive pathways through perivascular activation and increased parasympathetic outflow
- Alterations in the descending pain modulation network and disordered pain modulation during cluster periods
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 and 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
- Personal history of 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%)
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
- A primary headache disorder characterized by 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 because 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 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 [cCH]).
Epidemiology
Incidence
1-year incidence: 2 to 10/100,000
- 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
- Possible mechanisms include the following:
- Posterior hypothalamus activation may trigger an attack by activating trigeminal nociceptive pathways through perivascular activation and increased parasympathetic outflow
- Alterations in the descending pain modulation network and disordered pain modulation during cluster periods
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 and 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
- Personal history of 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%)
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