Cluster headaches – severe headaches usually behind the eye, above the eye or in the temple, lasting from 15 to 180 minutes from 1 to 8 per day. Always 10 out of 10 points on the pain scale. Usually there is tearing, redness of the conjunctiva, runny nose, prolapse of the upper eyelid or edema, all from the same side of pain.
The mechanism of development is not fully known. A genetic factor and the development of nonspecific inflammation in the cavernous sinus and superior ocular vein are presumed, and the development of pain is somehow related to the trigeminal-hypothalamic route. There are also trigger factors that contribute to the appearance of: alcohol, nitroglycerin, relaxation / tension, histamine, high altitude and flashing light.
In the form of isolated episodic and chronic. Episodic is the combination of cluster pains in periods, here are respectively 2 cluster periods from 7 days to a year, separated by 1 month without pain. Chronic is when the painless period is less than a month.
Neuroimaging is also worth mentioning, such pains are secondary, and structural brain damage is found on MRI. So for all patients with cluster pains, I recommend doing an MRI scan of the brain.
It helps very well oxygen, 10-12 liters per minute. It often happens that I give a breath, and after 15 minutes everything passes. If it does not help much, I add triptans, sumprotptan for example. Triptans are good, but they can not be used often and still there are contraindications – cardiovascular sores, pregnancy. There is abortive therapy aimed not at preventing attacks, but rather at reducing the frequency of attacks. I read about drugs lithium and verapamil.
It also helps to avoid triggers – anything that causes pain. No provocation, no headache.