Headache, Cluster
Basics
Basics
Basics
Description
Description
- Excruciatingly painful primary headache disorder:
- Infrequent cause of ED visits and affects only 0.1% of the population
- Often has abated by time of presentation:
- Attacks last between 15–180 min (75% last <60 min)
- More common in men (∼3:1)
- Onset usually between 30–50 yr of age
- Headaches occur in clusters lasting weeks to months followed by remission >1 mo
- Commonly occur 1–3 times per day during cluster period
- Often occur during the same time of day
- Often occur during the same time of the year:
- Highest incidence in spring and fall
- Chronic cluster headache:
- Remission <1 mo
- Do not experience remission
- 10% of patients
- Often evolves from episodic cluster headaches
- May have many clinical and pathophysiologic similarities with migraine and variants
- Often follows a trigeminal nerve dermatome
Etiology
Etiology
- A well-described physiologic reflex arc:
- The trigeminovascular reflex potentiates the trigeminal pain and cranial autonomic features of cluster headache by positive feedback mechanisms and subsequent hypothalamic dysfunction
- Release of CGRP from trigeminal perivascular afferents causes vasodilation/modulation of nociceptive activity of trigeminal neurons leading to severe pain
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