What is Cluster headaches?

Although cluster headache ("migrainous neuralgia") has been recognized for over 100 years (von Möllendorff, 1867), Sir Charles Symonds' (1956) lucid account of this disorder was brought into focus. Recognition of the clinical entity almost certainly hampered by a confusing variety of names given to this condition, such as erythroprosopalgia, Raeder's syndrome, neuralgia spenopalatine, ciliary neuralgia, neuralgia vidian, and cephalalgia histamine (Sjaastad, 1986; Grimson and Thompson, 1980). Cluster headaches are now well established as a distinct syndrome (Table 6-1) that recognition is important, as they may be responsive to treatment. Episodic type, the most common, marked with 1-3 short-lived attacks periorbital pain (Fig. 6-1) per day over a period of 4 to 8 weeks, followed by pain-free interval is an average of 1 year. Chronic form, sometimes called chronic migrainous neuralgia, which may begin de novo or a few years after episodic pattern has become established, characterized by the absence of sustained periods of remission. Each type can turn into another. Cluster syndrome is genetically, biochemically, and clinically different from migraine; propranolol is effective in treating migraine but has not been proven effective in cluster headaches. Lithium is beneficial for cluster headache syndrome and not effective in migraine. However, both disorders occasionally blend into one in an occasional patient (Solomon, 1986), indicating that the mechanism they bear some degree of similarity.

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CLINICAL

Cluster headaches have a prevalence of approximately 69 cases per 100,000 people, and therefore much more common that migraine (D'Alessandro et al, 1986). Men are more often affected than women in a proportion of 06:01. Although most patients begin experiencing headache between the ages of 20 and 50 years (mean, 30 years), the syndrome may begin as early as the first decade and as late as the eighth decade (Fig. 6-2). Clearly, age alone is not sensitive diagnostic criteria (Krabbé, 1986). Women with cluster headache is more likely than male started to have attacks after age 50, among women, headache is usually not associated with menstruation, tend to quit during pregnancy (Ekbom and Waldenlind, 1981), and can begin using oral contraceptives (Peatfield et al , 1982).