Pain, General | June 28, 2015 | Author: The Super Pharmacist
Cluster headaches are a distinct subtype of headaches, with a prevalence of about 0.1%. They are associated with pain in certain areas of the face and skull that may be severe and/or chronic. Pain typically occurs in multiple attacks in relatively rapid succession. These may occur over the course of a single day or within a week. The exact cause of these headaches has not been fully defined; however, they appear to be associated with the dysfunction of pain regulation within the central nervous system. Certain major nerves travelling to and from the brain (peripheral nerves) also may have some involvement. This indicates that cluster headaches may fall into the category of primary headache disorders (pain in the head or face that is not associated with a factor such as an underlying illness). This has been supported by recent neuroimaging studies. The origin of this disorder is not fully understood, but may be determined by genetics. Cluster headaches also seem to be linked to activity in areas in and around the hypothalamus of the brain, which control the circadian ('body clock' or 'daily') rhythms of the body. This may explain the repetitive nature of this condition. Cluster headaches are attacks of usually intense pain that are often felt over only one eye, in one temple (side of the head) or both one eye and one temple. They may last anywhere from 15 minutes to two hours. The 'clusters' for which the conditions are named are multiple attacks of this pain. Clusters may be up to eight in number, sometimes occurring in the space of one day.
Cluster headaches are often misdiagnosed as other headache types, such as migraine. However, this condition has some non-pain symptoms that tend to distinguish it from others. These may include:
There are two main types of cluster headache:
Some data indicates that cluster headaches may persist for up to 16 years. Cluster headaches have been observed to have an association with sleep disorders. A study of 275 patients found that their sleep quality was significantly impaired, and that this was associated with cluster headache onset. On the other hand, sleep disturbance is also associated with other headache disorders, such as tension-type headaches. Cluster headaches may also be accompanied by additional hallmarks shared by other conditions such as chronic migraine, such as photophobia. A recent study demonstrated that some patients diagnosed with cluster headaches also exhibited separate symptoms associated with a different headache disorder (trigeminal neuralgia). This may contribute to the delay before accurate diagnosis of cluster headache, which has been reported to have an average duration of seven years.
Patients with cluster headaches may respond to some conventional and interventional forms of treatments. These include:
Pharmaceuticals, administered orally or otherwise, are a part of conventional treatment for cluster headache.
Neuromodulation In some cases, patients may not respond to these treatment options as above. This is known as refractory or treatment-resistant cluster headache, and may involve considerable debility for the patients affected. Adequate pain relief in these instances may require invasive surgeries that implant devices to correct the 'pain' signals emitted by nervous tissue thought to be associated with cluster headache. These interventions may result in medium- to long-term relief from this condition, including a return to normal function and life quality. These techniques are known as neuromodulation (or nerve stimulation) and are an increasingly well-regarded method in the management of many chronic and/or severe pain conditions. Neuromodulation procedures associated with a positive effect in cases of cluster headache include:
Neuromodulation may seem an extreme step to take, but the surgeries associated with this treatment are minimally invasive, using modern equipment and electrode devices. Complications and adverse events are rare, and the patient is rarely disturbed or inhibited by the presence of the implants, as they are placed under the skin and are not usually visible or obtrusive.
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