How to relieve an attack of cluster headache. Cluster headache

About three people out of a thousand suffer from this disease. For the first time, this severe form of pain was described by Dr. Harris in 1926. According to statistics, middle-aged men are most susceptible to cluster headaches. A spontaneous, sharp pain sensation with a pulsating character, which occurs, most often, in the area of ​​the eye or forehead, with subsequent possible spread to other parts of the head. The attack often occurs at night and is characterized by short cycles (clusters). Patients compare very severe cluster headaches to punctures eyeball hot needle. And even suicide attempts were recorded among patients who did not have the strength to cope with this most severe symptom.

What is a cluster headache

To imagine what a cluster is headache, it is necessary to translate this word “cluster” from English. This is concentration, that is, the accumulation of acute burning pain strictly at one point. Short-term attacks appear in several cycles in a row, from one to eight, at certain times of the day, often at night. Usually, each patient has his own time, as if on an alarm clock, without any warning signs, a sharp, excruciating pain appears. The minimum episode lasts about ten minutes, but without treatment, a three-hour attack can develop. Localization, each time, on a certain side of the head, most often one eye is affected. With subsequent attacks, the side rarely changes; only in 15% of cases was a change noted. With cluster pain, the patient is extremely agitated, does not find a place for himself, if he sits down, he immediately jumps up and tries to go outside. Cluster headaches, otherwise called cluster headaches, can manifest themselves at any period of a person’s life, but most likely the first attack occurs in people between twenty and forty years of age.

Cluster headache symptoms

There is a group of symptoms that will help diagnose cluster headache:

• The attack occurs suddenly, without warning symptoms.
• More often, the first sensations are observed in the ear and slowly move to the eye, and then to other parts of the head.
• The eyeball is bursting with pain, the nose is stuffy.
• There may be tears from the eyes and, rarely, mucus from the nose.
• There is pain exclusively in one part of the head.
• Photophobia and intolerance to loud noise occur.
• The part of the face affected by pain turns red, the eyelid swells, and the eye may become bloodshot.
• The heartbeat quickens, the pupils narrow and the forehead sweats.
• There may be heavy breathing, nausea and even vomiting.
• On average, a pain attack lasts about 15 minutes, but can last several hours.
• Cluster headaches occur several times in one day, but can occur one to six times a week.
• The attacks always appear at the same time of day. More often at night, in the phase of intense eye movement, the patient wakes up from a sharp piercing pain.
• The patient experiences a state of agitation and panic.
• Thus, a person suffers not only physically, but also psychologically. The subconscious expectation of an unbearable attack significantly reduces the quality of life.
• Everything stops pain symptoms just as abruptly as they begin.

Types of cluster headaches

By international classification Based on the duration of pain and remission, cluster headaches are divided into two types - chronic and episodic. Chronic cluster headaches can turn into episodic headaches and vice versa. With age, especially with chronic cluster headaches, the condition may improve. But only if the disease is not caused by organic pathologies.

Causes of cluster pain

One of the factors in the appearance of cluster pain in the head is considered to be a disruption of human biological rhythms. After all, they are the ones who regulate enzymatic, hormonal and temperature processes in the body. They can also provoke various abnormalities in the vascular and nervous system. The part of the brain that controls the human biological clock is called the hypothalamus. Some disturbances in its operation may lead to hormonal imbalance and cause cluster pain, namely:

• The primary bundle often occurs during jet lag, air travel and insomnia.
• One of the causes of cluster headaches may be inflammation of the blood vessels and nerves in the eye area.
• Dysregulation in muscular system, for example, the heart muscle.
• Various pathologies of the hypothalamus.
• Ingestion of alcohol, histamines and nitroglycerin can provoke cluster pain.
• Malicious smoking.
• Stress and frequent overwork.
• Frequent consumption of foods with high nitrate content, for example, canned meat.

Risk factors for cluster pain

Both the causes and risk factors for the occurrence of cluster pain are not fully understood. Risk factors for cluster attacks include:

• Genetics.
• Daily work.
• Frequent changes in time zones.
• Middle-aged men with a strong build who abuse alcoholic beverages and cigarettes.
• Head injuries.

Treatment of cluster pain

In order to treat cluster headaches, it is necessary to visit a neurologist and conduct a series of examinations to exclude various pathologies, which can cause cluster seizures. In such cases, Dopplerography of cerebral vessels, magnetic resonance imaging, angiography, both brain and spinal cord And duplex scanning cervical and head vessels. A complete neurological examination is necessary to completely avoid confusion in the diagnosis. For example, with multiple sclerosis, headaches may be present that are very similar in symptoms to cluster headaches. It is imperative that you contact an ophthalmologist in order to identify possible deviations inside the eyeball itself. If no serious abnormalities are found, then the diagnosis of PHB (cluster headache) itself is not difficult. The symptoms of the disease are vivid and typical for this type of pain.

Doctors advise keeping a diary in which you need to note each time the intensity, duration and nature of the headaches. This will enable the doctor to quickly understand the diagnosis and prescribe effective treatment.

In order for the treatment of cluster headache to be as effective as possible, it is especially important not only to achieve rapid relief of an acute attack, but also to prevent a subsequent relapse.

To treat cluster headaches, medications are used in combination with oxygen inhalations. The following means are used:

• Oxygen inhalations have a very good effect, it is advisable to do them at initial stage painful attack. Unfortunately, it is not available to everyone, due to the large size of the cylinder itself.
• You can try applying a heating pad with ice to the temple area.
• Sometimes increased physical activity helps relieve pain.
• Conventional analgesics are not effective. Of the drugs, triptans are considered more effective, but in no case should you exceed the permissible daily dose.
• You can use lidocaine intranasal spray, but you should study the instructions in advance, as its incorrect use can significantly reduce the analgesic effect.
• In rare cases, you can use steroid drugs. They provide positive effects, but should be used minimally due to side effects which they cause.
• In especially severe cases, it can be used surgery.

But these methods are innovative and their absolute benefits have not been proven.

In order to increase the intervals between remissions and prevent attacks of cluster pain, it is necessary to take drugs that relieve pain at its very beginning.

These include:

• Lithium carbonate.
• Verapomil.
• Valproic acid.
• Gabapentin.

Treatment of cluster pain with folk remedies

At long-term use painkillers, addiction may develop and the analgesic effect may weaken. In order to radically change the treatment, it would not be amiss to try treatment folk remedies, which include:

• Walnuts will help cope with cluster headaches. They contain many beneficial nutrients. The melatonin they contain will improve your mood and sleep. Normalizes blood counts, strengthens the immune system, and improves blood circulation. It is enough to eat 2-3 nuts every other day.
• Turmeric. Widely available, analgesic, anti-inflammatory and sedative. Doesn't cause addiction. One pinch of turmeric should be added to warm milk and can be taken every day.
• Cayenne pepper. The substance capsacin, which is contained in this pepper, is part of some painkillers. An ointment based on it should be rubbed into the temples during attacks of cluster headaches.
• Kudzu. A widely known remedy in Chinese medicine. Has a strong analgesic effect.
• Ginkgo Biloba. Improves the condition of blood vessels in the brain, a powerful analgesic. But it is possible to treat with this plant only if it is in a living form and not processed. Preparations based on it are practically useless.

Such common remedies as mint, lemon balm, oregano, and fireweed can also be very effective. The most common infusion of these herbs can prevent an attack or reduce the degree of pain.

The recipe for making the infusion is simple. It is necessary to pour two tablespoons of the listed composition of herbs into an enamel or glass container and pour one glass of boiling water. Boil in a water bath for 15 minutes. Then wait until it cools down, strain and add boiled water to bring the volume of the infusion to one glass. Take 1/3 cup three times a day.

You should not self-medicate. Even the most harmless folk remedy can cause harm, especially if there is concomitant diseases. Be sure to consult a doctor before starting any medications.

Preventing cluster headaches

Although cases of sudden and complete cessation of attacks have been described, prevention should not be forgotten. In general, preventive comprehensive measures can significantly improve the patient’s quality of life and significantly reduce the recurrence of cluster headaches.

To do this you need:

• Change your lifestyle, review your daily routine, prevent lack of sleep.
• Quit alcohol and smoking.
• Engage in moderate physical activity.
• Avoid stress and overwork.
• Make time for rest.
• Psychological training will also help you take your mind off thoughts about an imminent attack and improve your condition.

Forecast

Chronic and episodic cluster headaches resolve over time. But stabilization of the condition may take a considerable number of years. Doctors cannot say with certainty how long it will take for a long-term remission or the final stage of the disease to occur. In very rare cases, complications of cluster pain are observed. Seizures that occur suddenly are accompanied by an aura (pathological perception occurs ten to thirty minutes before the episode). Such patients are more susceptible to strokes and retinal damage.

Various kinds neurological diseases are not associated with the occurrence of cluster headaches. Neither Alzheimer's nor Parkinson's disease can cause cluster seizures. Anxiety and depression, on the contrary, are contributing factors and provoke this type of pain. The presence of the disease itself can already cause loss of interest in life and depression and stress. If you comply preventive measures and lead a healthy lifestyle, then cluster attacks will bother you much less often and the disease will soon recede.

Along with migraine, cluster headache is one of the primary forms of cephalalgia. The pathogenesis of the disease is not associated with organic damage to the brain and structures located in the head and neck area. However, for other types of headaches, this pathology accompanied by attacks of very strong, painful (some patients describe it as unbearable) pain syndrome.

Cluster (sometimes called tuft) cephalalgia is one of the rarest, but at the same time very severe forms pathology. According to various sources, such a diagnosis is made only in 0.1 - 0.4% of cases. Moreover, men suffer from this disease approximately 3-4 times more often than women, and as a rule, it manifests itself after 25 years.

In representatives of the fairer sex, cluster syndrome can manifest itself either during puberty (at 15-20 years old) or after 45 years. Although there are known cases of the development of the disease both at an early and elderly age.

The pathogenesis of cluster headaches has not been fully studied to date. However, the main role in the development of pathology is given to the hypothalamic system. Under the influence of mechanisms that have not yet been clarified, the gray matter of the hypothalamus is activated (it is called the suprachiasmic nucleus). This process triggers a chain of reactions (vascular dilatation, release of specific neuropeptides), which provokes the continuation of the pain syndrome.

The hypothalamic region is closely connected with parasympathetic and sympathetic neurons of the spinal cord, which causes additional autonomic symptoms. The subsidence of the intense headache and the improvement in the patient’s well-being indicate the restoration of normal activity of the hypothalamic system.

Experts are still arguing about the causes of symptoms of bundle cephalalgia. Most doctors agree that hereditary predisposition plays a decisive role. However, whether pathology will manifest itself in a person depends on his lifestyle and the degree of exposure to provoking factors.

These include:

• smoking;
• passion for alcoholic beverages;
• change of time zones;
• daily work schedule and other reasons affecting sleep disturbances;
• taking medications that promote vasodilation;
• pungent odors.

Cluster headaches can be of several types:

• episodic form, occurs in 90% of patients, is characterized by periodic exacerbations (up to 2 times a year, attacks are associated with changes in duration daylight hours), sometimes the period of remission can last several years;
• chronic form, in which remission is either absent or does not exceed 4 weeks.

Cluster headache: typical clinical picture

Several terms are used to characterize the clinical picture of the disease:

• attack, this definition means a single attack of pain;
• beam or cluster period, this is the time during which the patient constantly experiences recurring attacks of pain;
• remission when a person is not bothered by a headache, and usually during this period even the action of provoking factors cannot provoke an attack.

The symptoms of chronic and episodic cluster pain are almost the same. The disease is characterized by the occurrence of unilateral (usually on the left side) cephalgia, localized around the eye, in the temporal or superciliary region. Approximately half of the attacks occur between 4 and 10 a.m. (sometimes cluster headaches are called alarm headaches). In some patients, symptoms of the disease appear 1.5 - 2 hours after going to bed. Doctors suggest that this is caused by breathing problems (apnea) during the rapid phase of falling asleep.

The pain syndrome begins suddenly, acutely, gradually increases and reaches a maximum after 10 - 15 minutes. Peak intensity can last up to half an hour, less often - up to 45 minutes, then cephalalgia subsides. The average duration of an attack is from 30 minutes to 3 hours. Due to the severe pain syndrome, a person does not find a place for himself; aggression and irritability are characteristic, abruptly giving way to crying and hysterics. Patients may unconsciously use distraction "techniques." Some people apply ice to their head, put it under cold water, or vice versa, hot water. Sometimes people literally bang their heads against the wall.

At the peak of the pain syndrome, the appearance of characteristic symptoms, indicating a disruption of the autonomic nervous system on the affected side. In patients, the conjunctiva turns red, lacrimation appears, the nose becomes stuffy, or vice versa, rhinorrhea occurs. The epidermis may also turn pale or red, and the sensitivity of the scalp increases.

Sometimes symptoms that are more characteristic of migraine also develop. This is the fear of sharp sounds, bright light. In some cases, nausea and vomiting occur. Such a clinical picture may lead to the diagnosis misdiagnosis migraines.

Cluster severe headache is characterized by a series of attacks that can last from several weeks to 6 months. These periods are followed by phases of remission. Many patients are characterized by seasonal exacerbation (in spring and autumn). During the “bundle” phase, not only nocturnal, but also daytime attacks can appear.

Most people maintain the original frequency and intensity of pain for many years. But as we age, there is a tendency towards rarer cluster periods and an increase in remission time. And only in every tenth patient the pathology becomes chronic.

As a rule, making a diagnosis does not cause any special problems. Theoretically, additional research are not needed, just objective symptoms and a collected medical history are sufficient.

The diagnostic criteria for cluster headache are:

• very severe unilateral headache of characteristic localization and duration from 15 minutes to 3 hours without taking appropriate medications;
• a painful attack is accompanied by vegetative symptoms and a feeling of anxiety;
• attacks occur from 1 to 8 times a day;
• pain syndrome is not associated with organic pathologies or any systemic disorders.

To exclude other pathologies, computed tomography or magnetic resonance imaging is performed with the simultaneous administration of a contrast agent.

Differential diagnosis is carried out with migraine, since in rare cases patients have similar vegetative signs. The doctor pays attention to the frequency of attacks, duration, time of occurrence and other symptoms. In addition, migraines are more common in women, while cluster headaches are more common in the stronger sex. You should also exclude aneurysm, consequences of trauma, neuralgia trigeminal nerve, subdural hematomas, malformations.

Cluster headache: treatment with medication and using folk remedies, preventive measures

During the cluster period, the patient should avoid the influence of provoking factors: alcohol, smoking, strong odors. It is also important to maintain a sleep-wake schedule and not to overwork. The disease is not life-threatening, but the beam period can disable a person for a long time.

The treatment tactics for the disease have certain similarities with migraine therapy.

In the acute period the following are indicated:

• oxygen inhalation through a mask at a rate of 7 liters per minute, therapy is effective only during the first 10 minutes from the onset of the attack;
• triptans (Sumatriptan, Zomig), the dosage is selected individually, taken on initial stage attack, if the use of the prescribed drug does not bring the desired result, you should try another drug from the same group;
• drugs containing ergotamine (Bellataminal, Nomigren), the dosage is also selected individually.

Particular attention is paid to the tactics of managing patients during remission and preventing repeated cluster periods.

To prevent an attack, the following is prescribed:

• Verapamil 0.24 - 0.96 g per day, with level control required blood pressure;
• in an individually selected dosage depending on weight, use the maximum amount for several days, then the dosage is gradually reduced over the course of a month, however, if the drug is discontinued, attacks of pain may resume;
• Topiramate(0.025 - 0.2 g per day), the minimum dose is first prescribed, then it is gradually increased.

Effective for prevention pain for migraine, β-blockers and antidepressants for cluster headache are not effective.

As a rule, the effect of preventive therapy appears during the first week of treatment. However, you should not stop taking the medications under any circumstances. You must complete the course to the end.

If there is no effect from traditional therapy, doctors recommend surgery. Radiofrequency trigeminal rhizotomy is performed. The procedure involves inserting a needle with a connected electrode through the skin, bringing it to the desired location, delivering a shock and destroying the nerve. Positive result treatment is achieved in 75%. Sometimes seizures may occur on the opposite side, in which case repeat surgery is recommended.

The first aid remedy is to inject a mixture of lidocaine (local anesthetic) and methylprednisolone (corticosteroid) into the occipital nerve. The result of such manipulation can last up to 3 months.

According to doctors, treating cluster headaches with folk remedies is inappropriate. But they can be quite an effective addition to conservative therapy.

Advise:

• apply fresh lilac leaves scalded in boiling water to the affected side of the head;
• make compresses from juniper berries ground and mixed with dry red wine;
• insert a tampon soaked in freshly squeezed beet juice into the ear or nasal passage;
• drink 50 ml of potato or blackcurrant juice three times a day on an empty stomach;
• 3-4 times a day (during meals) eat a mixture of a teaspoon of honey and apple cider vinegar.

If a cluster headache is diagnosed, treatment should begin immediately. It is very important to strictly follow all doctor’s recommendations and avoid exposure to provoking factors. Doctors say that one of the main reasons for the development of an attack is a change in time zones or a violation of sleep patterns and duration. Surgery can significantly alleviate the condition. In any case, therapy for cluster pain should be carried out in close tandem between the doctor and the patient.

Cluster headache- This is a fairly rare syndrome that involves headaches of a narrow localization, usually in the periocular area. It is more common among men (5:1 in relation to the female population), but in the general population it occurs in three people out of a thousand. The disease usually debuts in at a young age. Some doctors consider it to be a type of migraine, but this is not the case.

The mechanism of development of cluster pain is somewhat reminiscent of migraine pain: the same trigeminovascular system is involved, pain neuropeptides are formed, and vasodilation occurs. However, detailed studies show that the pathogenesis of cluster headache is also based on a violation of the pacemaker function of the hypothalamus, which in this case determines the occurrence of painful periods and the seasonality of exacerbations. Rhythmic activation of the hypothalamic region is followed by activation of the trigeminovascular system, dilatation of the vessels of the hard meninges, the release of pain neuropeptides, after which the patient experiences an attack. The subsidence of exacerbation and the onset of remission indicate the normalization of hypothalamic activity.

The involvement of the hypothalamic zones in the process of formation of cluster pain subsequently explained the daily frequency of pain attacks, the dependence of attacks on periods of sleep (very often a cluster headache manifests itself an hour or two after falling asleep, and it will also remind itself subsequently), the peculiarity of behavior patients.

Today, research is underway into the mechanism of action of pain-provoking factors on the sensitive areas of the hypothalamus. The nature of paroxysmal hemicrania, short-term unilateral neuralgic headaches with conjunctival injection and lacrimation, also remains inexplicable.

Causes of cluster headaches In many respects they coincide with triggers of other forms, but there are also specific ones among them, for example:

• sudden change of time zones (for example, when flying),
• due to insomnia,
• shift work schedule and disruption of biorhythms (for example, with a daily work schedule),
• consumption of substances such as alcohol, histamine, nitroglycerin.

The clinical picture of cluster headache includes:

• severe attacks of pain lasting from 15 minutes to 3 hours;
• frequency of attacks (that’s why this type of pain is also called “cluster”) - they occur in series from several weeks to several months with long-term remissions (often seasonal);
• localization of pain - one-sided, not diffuse; around the eyes, in the area of ​​the brow ridges, in the temporal region; occasionally radiates to the upper and lower jaw;
• frequency of attacks - from several times a day to once every few days; often at night;
• unbearable pain provokes restlessness, throwing of the patient, crying, aggression, anxiety;
• At the peak of pain, vegetative symptoms are added - redness of the conjunctiva, lacrimation, nasal congestion, rhinorrhea, sweating of the forehead and face, swelling of the eyelids.

The most commonly observed form is an episodic form of cluster headache, less often a chronic form, when remissions are either absent altogether or do not last more than a month.

How to treat cluster?

Has several directions:

• stopping an attack, that is, symptomatic treatment,
• prevention of pain attacks, that is, preventive measures aimed at reducing the frequency of attacks and achieving the longest possible remission.

Treatment of episodic cluster pain requires fewer interventions than chronic pain. However, ignoring the syndrome at the stage of its episodic nature entails aggravation and chronicity of the process.

When relieving attacks of cluster pain, use:

• triptans (sumatriptan, eletriptan, zolmitriptan),
• ergotamine preparations (nomigren, caffeamine),
• inhalation of 100% oxygen (7-10 l/min for 15 minutes).

Efficiency can be demonstrated by local anesthetics, such as lidocaine (in the form of nasal drops or aerosol), capsaicin-containing drugs. Analgesics that are so popular in pain management, including opioids, should not be used to relieve attacks of cluster headaches.

Prevention of the episodic form of cluster pain is recommended to begin as early as possible from the beginning of the pain period. Even with a noticeable improvement during the first 1-2 weeks of therapy, patients should not interrupt the course: treatment should be continued throughout the expected pain “beam” and completed another 2 weeks after achieving complete remission. There is evidence of the effectiveness of anticonvulsants (gabapentin, topiramate) in patients with prolonged periods of pain and chronic cluster headache.

In the episodic form and relatively mild course of the syndrome, lithium carbonate and verapamil have a good effect; if necessary, a combination of these drugs is possible. With more severe course(more than five attacks per day and the duration of the pain bundle is more than 2 months), the use of anticonvulsants and gabapentin is indicated.

Treatment of chronic cluster pain is difficult. If the above approaches are ineffective, glucocorticoids may be used. In case of ineffectiveness of medicinal approaches and severe chronic forms, they can be used surgical methods treatment:

• radiofrequency thermocoagulation of the trigeminal ganglion,
• radiofrequency rhizotomy,
• microvascular decompression,
• some methods of neurostimulation, such as deep stimulation of the posterior hypothalamic region, greater occipital, vagus and other nerves.

What diseases can it be associated with?

Episodic cluster pain is complicated by the transition to chronic pain. This happens in 10-15% of cases. In some patients, the opposite trend is observed - the transition from a chronic form to an episodic one. Some patients experience a combination of cluster headache and trigeminal neuralgia - this is called cluster tic syndrome.

Treating cluster headaches at home

Treatment of cluster headaches can be easily implemented at home. Often patients do not even go to the doctor, stopping attacks with widely available analgesics and antispasmodics. At the same time, treatment prescribed by a professional physician will be more productive, because the doctor determines the form of the headache, understands the mechanisms of its development and prescribes a pharmacological drug that is effective in this particular case. Drugs must be selected based on efficacy and toxicity. Ineffectiveness of one medicine does not mean the ineffectiveness of the other; it is possible to use a combination of them. Due to the potential toxicity of the drugs, it is necessary to follow the instructions for their use.

Medication treatment of cluster headaches must certainly occur against the background of changes in the patient’s lifestyle and daily routine. The goal is to exclude factors that provoke attacks:

• don't drink alcohol
• use any medications with caution (they can become a trigger),
• consume foods with vasodilator properties with caution,
• maintain a sleep-wake schedule.

What drugs should be used to treat cluster disease?

• Verapamil - 240-960 mg per day;
• Prednisolone - 60-80 mg 1 time per day for 2-4 days, followed by a dose reduction for 2-3 weeks;
• Lithium carbonate - 600-1600 mg/day;
• Ergotamine tartrate - 2-4 mg per day rectally;
• Methysergide - 1-2 mg tablets

Treatment of cluster headaches with traditional methods

The use of folk remedies can be an excellent addition to the methods traditional medicine. The nature of the occurrence of cluster pain suggests that its elimination with folk remedies is unlikely to be effective. However, it is quite possible to reduce the symptoms of the disorder. Discuss with your doctor the advisability of using such improvised means and their compatibility with prescribed pharmacological drugs:

• turmeric - has sedative and anti-inflammatory properties, and therefore can be widely used in the diet of people suffering from headaches;
• walnuts are widely recognized antioxidants, have a beneficial effect on blood circulation, improve blood composition, calm the nervous system and strengthen the immune system;
• cayenne pepper - some substances it contains have irritating effect, and therefore pepper-based ointments provide excellent pain relief when applied to the temple area.

Don't downplay the importance of massage using essential oils, therapeutic exercises, yoga.

Treatment of cluster headaches during pregnancy

Treatment of cluster headaches during pregnancy is not very popular, since the disease itself is rare and less popular among women than among men. At the same time, it may debut in childbearing age(20-40 years) and it is possible that during pregnancy.

The occurrence or exacerbation (recurrence) of headaches in a pregnant woman should be a reason to visit a specialized specialist or discuss acceptable medicines with the gynecologist leading the pregnancy. The goal of treating cluster pain in an expectant mother is to normalize her performance and well-being. The least toxic ones are used pharmacological preparations. the benefits of their use must be many times greater than the risk to the developing fetus and the burden on cardiovascular system pregnant woman. Specific names are discussed with the attending physician during a face-to-face consultation. It is permissible to use herbal remedies and herbal components, but they do not have a clear and proven effect on cluster pain.

Which doctors should you contact if you have cluster

Diagnosis of cluster headache is based on typical clinical picture. The doctor takes into account the patient’s complaints of exclusively unilateral pain in half of the face and head, accompanied by vegetative manifestations. If the history shows a characteristic course of the disease (that is, periods of pain alternate with periods of remission), this adds confidence to the diagnosis. As additional criteria Cluster headaches are considered to be unbearable, the patient’s anxiety and agitation, and the occurrence of attacks during night sleep.

Diagnostic criteria for cluster headache:

• intense or extremely intense unilateral pain of orbital, supraorbital and/or temporal localization lasting 15-180 minutes (without taking pharmacological drugs);
• The headache is accompanied by at least one of the following symptoms on the painful side:
  • conjunctival injection and/or lacrimation;
  • nasal congestion and/or rhinorrhea;
  • swelling of the eyelids;
  • sweating of the forehead and face;
  • miosis and/or ptosis;
  • feeling of restlessness (inability to be still) or agitation
• frequency of attacks - from 1 time in 2 days to 8 times a day;
• no other abnormalities or disorders are observed.

Are considered deliberately uninformative traditional methods studies (EEG, MRI, ultrasound), their use is advisable in case of atypical clinical picture of headaches, when it is necessary to exclude their secondary nature. It is advisable to suspect the secondary nature of cluster headache if the following atypical symptoms are present:

• insufficient pain intensity, the patient is able to remain at rest during an attack,
• no night attacks,
• presence of “background” headache between attacks,
• the presence of neurological symptoms in the patient’s status (except for miosis and ptosis),
• inefficiency traditional means relief of attacks (triptans, ergotamine, oxygen inhalation).

Most informative methods diagnostics to exclude the secondary nature of cluster headache are MRI and CT with contrast.

Cluster headache (another name is cluster headache) is considered one of the strongest and most unpleasant sensations for a person. An attack may appear abruptly, making it difficult to get rid of. The patient feels severe discomfort and often uses various means for recovery. normal condition, methods that can normalize his well-being. Regular pain often provokes rash actions, sometimes even suicide.

Symptoms and causes

In most patients, cluster headache appears as an attack that occurs asymptomatically. Lasts from a few minutes to two hours. The main area of ​​pain is the area around the eyes. It is important that this sensation occurs at certain periods, often even at the same time of day, repeating up to 8 times a day. The disease is rare in children because cluster headaches occur after puberty, but sometimes they are affected before puberty.

Attacks can occur either episodic or chronically (constantly, over a long period of time). Episodic pain occurs in the interval from a week to a year, periods during which the disease does not manifest itself in any way can last a very long time. Chronic attacks consist of painful attacks that are repeated over a period of up to a month. Treat this form the disease is very complex.

Symptoms of pain

List of symptoms that characterize cluster headaches:

• there are no external signs of the disease;
• attacks do not last long and are very painful;
• the pain is localized only on one side of the face;
• widespread pain in the temporal, frontal, occipital region;
• sinus congestion appears;
• the eyes begin to water heavily;
• the eyelids swell, the pupils dilate;
• the face turns red, the pulse quickens, the heartbeat quickens;
• the person becomes very irritable and excitable;
• Sometimes there are attacks of vomiting and nausea.

Some of the symptoms of PHB (cluster headache) are characteristic of migraine, which interferes with the normal functioning of the body. But people who have had migraine attacks will be able to easily distinguish one attack from another. An interesting observation is that cluster headaches are common in people who have a muscular build, light eyes, rough skin, a double chin and a square jaw.

Causes of cluster headaches

The main causes of cluster headaches are changes in standard lifestyle. It happens when changing jobs, when flying on an airplane, or when there is a sharp increase in physical or emotional stress. It can manifest itself if a person’s well-being changes during the day, for example, with a sharp change in the length of the day, a decrease in night hours (moving to a different time zone).

Attacks occur with excessive consumption of alcoholic beverages or medications that cause enlargement of blood vessels, inflammation of the nerve endings located immediately behind the eyes. The person begins to feel sharp stabbing pains, pulsations, the causes of which are not fully understood.

Cluster headaches can be the result of changes in the nervous system, the blood vessel system, or changes in the hypothalamus, which influences the formation of many chemical processes in the human body. His work is associated with the regulation of biological rhythms, the production of many hormones, substances whose action is aimed at causing pain.

Treatment options for cluster headaches

Since there is no clear understanding of the reason why cluster headaches occur, it is not the disease itself that can be treated, but the symptoms that it causes. Medicines prescribed to relieve the next attack:

1. Oxygen mask, carrying out inhalations in which 100 percent oxygen is present. The procedure lasts up to 8 minutes.
2. Lidocaine 4%, which is injected into the sinuses.
3. Use of drugs containing capsaicin.
4. Use of sinus sprays containing dihydroergotamine.
5. Administration of drugs containing elements of opium or similar drugs.

Treatment of cluster headache requires compliance with all medical recommendations. All transferred funds are released strictly according to a doctor's prescription. Swelling of the mucous membrane and red eyes can be cured by simple means, constricting blood vessels. In order for inhalations to take place in a timely manner, you should buy a special inhaler in the form of a mask, an oxygen canister and a dispenser.

When an attack occurs, it is prohibited:

• drink alcoholic beverages;
• go to bed after the pain ends and on this day;
• increase pressure in the arteries through taking baths and drinking energy drinks;
• take painkillers with an increased dosage of drugs.

Cluster headaches cannot be treated with simple pain relievers. Only narcotic drugs capable of reducing discomfort, but they are prescribed by prescription. An excessive dosage of an anesthetic drug will not cause the required analgesic effect, but can cause poisoning of the body.

People experiencing such attacks should have a stable work schedule, a profession that does not require active physical activity. Seizures should not interfere with the performance of their functional duties.

To reduce pain in the event of an attack, you should:

1. Use an ice compress. A piece of ice is placed in a bag, which is placed in a thin piece of cloth. It should be placed on the eyes and head for no more than ¼ hour, after which a break is required until recovery standard temperature skin in places where the compress is applied. Then the application of cold can be repeated.
2. If possible, move to a dark, quiet room. Do not make contact during an attack, so that nothing distracts you during a deterioration in your health.
3. In people who experience cluster headaches, chemical dependence develops more rapidly. You may have thoughts of suicide, so you should not drink alcohol.
4. Do not go to bed during the day, even if you have a strong desire. Cluster headaches are felt by patients during the REM sleep phase.

Depression may occur with illness. To normalize the condition, it is important to consult a psychotherapist. Treatment for this doctor will not cancel the appointment medications, it can serve as an additional tool for providing assistance. It is not known whether cluster pain can be a psychosomatic disease, and how it affects mental disorder on the condition of patients. It is a fact that those susceptible to disease have a constant anxiety, expect new pain to appear, they are depressed.

If you plan to see doctors who treat disorders, it is better to choose a psychotherapist who specializes in psychosomatic disorders. Your doctor can provide assistance with:

• improvement psychological state person;
• improving the quality of life;
• developing the most appropriate techniques for the patient to overcome pain, adapt, and increase control over sensations.

To treat headache pain, you can use antidepressants or tranquilizers, which help stabilize emotional state. The use of such means is relevant in the following cases:

• frequent panic attacks;
• the presence of anxious anticipation, deterioration in the ability to leave
  far from home, decreased ability to communicate normally with people;
• the appearance of insomnia, which is caused severe pain head or due to another reason;
• increased phobias;
• the occurrence of suicidal thoughts, behavior that is clearly aimed at aggression towards others.

Sometimes it happens that over time, situations worsen, the condition of patients becomes worse. But in most patients, attacks begin to subside after 35-40 years.

Preventive medications for cluster headaches

The following substances are used to exclude the cause of cluster pain:

• blockers of channels through which calcium passes. Funds are usually used to suppress high blood pressure, heart diseases. The effect of the drugs lasts about 2 weeks, in this period the use of corticosteroid drugs is justified. It is important not to overdose, otherwise the blood pressure may drop to dangerous levels;
• lithium. Helps with bipolar disorder, used to prevent cluster headaches. The effect of the drug begins to appear within the first 7 days. There are many side effects, such as trembling hands, increased thirst, etc.;
• corticosteroids. The duration of use is up to a week, after which the use is stopped. Used for prevention;
• anti-seizure drugs. Substances used to treat epileptic seizures are prescribed to some patients to relieve headaches;
• Botox. The practice of using the substance to remove wrinkles is common, but the properties of the drug to relieve headaches and migraines are being studied;
• melatonin. A hormone that can help restore the condition of long-term headaches.

It is important not to forget that cluster headaches are one of the most severe. After an attack, you should consult a doctor and strictly follow the recommendations.

Treatment with folk remedies is widespread, but this type of treatment is justified only after consultation with a doctor. If you approach the treatment of the disease correctly, the results will not be long in coming, the condition will change for the better.

We can talk for a long time about what a cluster headache is and how it differs from a regular one, but only those who have suffered from such a headache at least once in their lives can truly understand. Their character resembles migraine, but is even more localized, while migraine can occur in the entire hemisphere or lobe of the brain.

The word "cluster" in English literally means "accumulation" or concentration. Imagine how intensified the sensations of a headache concentrated in one point are.

To understand how to develop treatment for such headaches, you need to understand the nature: how a cluster headache differs from a widespread one. After all, according to recently published WHO statistics, for every thousand of the world’s population there is someone who, depending on one reason or another, suffers from the disease cluster headache. And this is enough to declare the disease widespread and try to find a universal treatment for everyone.

Symptoms of the disease

For the most part, migraines are hereditary and affect women more often, especially during periods of hormonal surge, menopause, or severe stress. Whereas cluster headache attacks plague both men and women equally. Moreover, it is men with an athletic or heavy build who abuse smoking or alcohol, even despite doctor-prescribed treatment, who are more likely to experience headaches. The reasons seem obvious, and yet it is extremely difficult to convince an adult of them.

A curious anatomical sign: a cleft chin, square facial contours, even eye color (light gray or blue) act as causes and aggravating factors for a disease such as cluster migraine.

It is impossible to predict when the first symptom of headache occurs and at what age. It is known for sure that it almost never occurs in children - they are more often prescribed treatment for another ailment, abdominal migraine. But here are just the main primary signs that accurately indicate that a cluster headache is beginning:

• Flashes of light in the eyes of a burning nature.
• The headache syndrome has a sharp, burning character, as if piercing right through the head. Often migraines are concentrated in the area of ​​the brow ridge, which causes a feeling of pain in the eyes.
• In other cases, sensations may mistakenly radiate to the ear, temporal region, or jaw. In short, to begin treatment, it is necessary to correctly diagnose the lesion.
• Symptoms of vision pathologies - for example, Horner's syndrome (in which the eyelid droops), recession or nervous trembling of the eyeball.
• Autonomic symptoms of headache may appear - increased sweating, pallor, nausea, stuffy nose (the causes are not due to infection or cold), etc.

Sensations in the eyes develop into visible signs: So, as the headache increases, the eye begins to water and turn red. From such experiences and the physical strength of the headache, a person becomes irritable and stops enjoying life. Sometimes patients undergoing treatment describe their sensations as a desire to hit their head against a wall or gouge out their eyes, and in practice there have also been cases of suicide.

Precursors of cluster pain

Typically, attacks come and go in a short-term manner. So, for example, a person can experience 10-15 minute periods several times a day, and it happens that a cluster headache subsides for six months or several years, and no one knows the reason. Since the disease is chronic, treatment is aimed at prolonging the period of headache remission.

Usually the disease does not have attacks longer than 1.5 hours, as is the case with migraine attacks. Another characteristic feature the onset of the disease is an “exact schedule”: it happens that a migraine occurs strictly at a certain time of day, after eating, at dusk or at night during sleep. Otherwise, there is no special aura of headache. Also, treatment can rarely affect the change in the side of the lesion: sometimes headaches appear not on the right, but on the left and are less intense.

Causes of the disease

Many doctors providing treatment assume that the reasons for the deviations lie in a malfunction of the body’s biological clock, for example, due to a change in climate or time zone. Other triggers for headaches include:

• Excessive production of hormones - histamine, serotonin and other vasoactive components.
• Pathology in the functioning of the hypothalamus.
• Overwork and stress are also factors that cause migraines.
• The cluster nature lies in deviations in the functioning of the trigeminal nerve, which runs in the facial part of the head.
• Disruptions in neurophysical processes, humoral regulation. This can happen in women during menopause, pregnancy, or before menstruation.
• Vascular pathologies cause severe headaches and can lead to stroke.

It is precisely the latter that is the common treatment - taking pills that constrict blood vessels and relieve pain. Otherwise, the reasons should be determined by the doctor based on the results diagnostic examination headache. He also prescribes treatment.

Diagnosis and methods of dealing with cluster pain

To put the exact one, first admit differential diagnosis, according to which the causes lie in the most extensive areas: from headaches as a result of jaw or cranial injuries to temporal arteritis. To eliminate 70% of assumptions, the patient simply needs to thoroughly describe his symptoms, their schedule of appearance, and changes over time. What most of us cannot do and delays the treatment of cluster pain for a long time.

So, by contacting a neurologist and describing the picture of your complaints, you will most likely receive a referral for magnetic resonance imaging, which will confirm the presence of serious lesions in the head area. Also, a vascular angiogram allows you to exclude or confirm diseases vascular system. To eliminate the possibility of pain as a result cervical osteochondrosis, you may be asked to have an x-ray of your cervical spine.

Treatment of cluster migraine includes taking pills, sometimes in combination with oxygen inhalations: special mask devices through which the patient inhales an oxygen composition during a headache. The following medications are also used:

1. Triptans – for example, Zolmitriptan.
2. Nasal drops and spray containing dihydroergotamine.
3. Ice compresses.
4. Strong painkillers like Ketanov or Ledocaine tablets.
5. Steroid blockers and hormones in case of prolonged and unbearable cluster pain.
6. Sedatives and tranquilizers.

Acupuncture often helps with headaches - acupuncture procedures are carried out in specialized massage parlors.

Disease Prevention

In order not to bring your body to the critical threshold of cluster migraine, you should follow the simplest recommendations of your doctor. And first of all, refuse bad habits– alcohol and smoking cause more frequent headache attacks and aggravate their course. Also, for the purpose of prevention, it is advised to avoid excessive physical activity, lifting weights, overwork, and even reduce the amount of work, because you can’t buy health with a salary.