Cluster Headache

Overview of Cluster Headache

Cluster Headache are a primary headache disorder Of Trigeminal autonomic cephalgia (in other words, TAC) type.

The condition usually first occurs between 20 and 40 years of age. Men are affected about four times more often than women. Cluster headaches are named for the occurrence of groups of headache attacks (e.g. clusters). They have also been referred to as "suicide headaches".

Indian epidemiology then other

Causes of Cluster Headache

The cause of cluster headache is unknown.

Nerves

• Two nerves are thought to play an important role in CH: the trigeminal nerve and the facial nerve.

Genetics

• Cluster headache may run in some families in an autosomal dominants inheritance pattern.
• People with a first degree relative with the condition are about 14–48 times more likely to develop it themselves, and around 8 to 10% of persons with CH have a positive family history.
• Several studies have found a higher number of relatives affected among female. Others have suggested these observations may be due to lower numbers of females in these studies.
• Possible genetic factors warrant further research, current evidence for genetic inheritance limit.

Tobacco smoking

• About 65% of persons with CH are, or have tobacco smokers.
• People with CH may predispose to certain traits, including smoking or other lifestyle habits.

Hypothalamus

• A review suggests that the suprachiasmatic nucleus of the hypothalamus, which is the major biological clock in the human body, may involve in cluster headaches, because CH occurs with diurnal and seasonal rhythmicity.
• Positron emission tomography  (in other words, PET) scans indicate the brain areas which are activated during attack only, compared to pain free periods.
• These pictures show brain areas that are active during pain in yellow/orange color (called "pain matrix").
• The area in the center (in all three views) specifically activate during CH only.
• The bottom row voxel-based morphometry (in other words, VBM) shows structural brain differences between individuals with and without CH; only a portion of the hypothalamus is different.

Types of Cluster Headache

There are two types of cluster headaches: episodic and chronic.

1. Episodic cluster headaches occur regularly between one week and one year, followed by a headache-free period of one month or more.
2. Chronic cluster headaches occur regularly for longer than one year, followed by a headache-free period that lasts for less than one month. (6)

Risk factors are things that make you more likely to develop a disease in the first place.

Risk factor of Cluster Headache

• Exposure to tobacco smock
• Positive family History

Exciting or triggering factors i.e.:

• Nitroglycerine
• Alcohol
• Histamine

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Sign & Symptoms of Cluster Headache

Nature of Cluster Headache

• Onset: Sudden, rapid
• Duration: 50- 180 min
• Character: Recurrent, unilateral
• Location: Around or above or behind eye also temporal region
• Pain: e.g. Stabbing, Excruciating, Burning, Drilling, Squeezing type
• A core feature of cluster headache is periodicity. At least one of the daily attacks of pain recurs at about the same hour each day for the duration of a cluster bout.
• The typical cluster headache patient has daily bouts of one to two attacks of relatively short-duration unilateral pain for 8 to 10 weeks a year; this is usually followed by a pain-free interval that averages a little less than 1 year.
• Cluster headache is characterized as chronic when there is less than 1 month of sustained remission without treatment. Patients are generally perfectly well between episodes.
• Onset is nocturnal in about 50% of patients, and men are affected three times more often than women.
• Patients with cluster headache tend to move about during attacks, pacing, rocking, or rubbing their head for relief; some may even become aggressive during attacks.
• This is in sharp contrast to patients with migraine, who prefer to remain motionless during attacks.[1]

Cluster headache attack is accompanied by at least one of the following autonomic symptoms:

• Drooping eyelid
• Pupil constriction
• Redness of the conjunctiva
• Tearing
• Runny nose and less commonly
• Facial blushing ,swelling, or sweating, typically appearing on the same side of the head as the pain.
• Similar to a migraine, sensitivity to light (photophobia) or noise (phonophobia) may occur during a CH. Nausea is a rare symptom although it has been reported.
• Restlessness (for example, pacing or rocking back and forth) may occur. Secondary effects may include the inability to organize thoughts and plans, physical exhaustion, confusion, agitation, aggressiveness, depression, and anxiety.
• People with CH may dread facing another headache and adjust their physical or social activities around a possible future occurrence. Likewise, they may seek assistance to accomplish what would otherwise be normal tasks. T
• hey may hesitate to make plans because of the regularity, or conversely, the unpredictability of the pain schedule.
• These factors can lead to generalized anxiety disorder, panic disorder, serious depressive disorder social withdrawal and isolation.
• Cluster headaches have been recently associated with obstructive sleep apnea.

Recurrence

• Cluster headaches may occasionally be referred to as "alarm clock headache" because of the regularity of their recurrence.
• CH attacks often awaken individuals from sleep; attacks typically striking at a precise time of day each morning or night.
• The recurrence of headache cluster grouping may occur more often around solstices, or seasonal changes, sometimes showing circannual periodicity. Conversely, attack frequency may be highly unpredictable, showing no periodicity at all. These observations have prompted researchers to speculate an involvement or dysfunction of the hypothalamus.
• The hypothalamus controls the body’s "biological clock" and circadian rhythm. In episodic cluster headache, attacks occur once or more daily, often at the same time each day for a period of several weeks, followed by a headache-free period lasting weeks, months, or years.
• Approximately 10–15% of cluster headaches are chronic, with multiple headaches occurring every day for years, sometimes without any remission.
• The frequency, severity, and duration of headache attacks experienced by people during these cycles varies between individuals and does not demonstrate complete remission of the episodic form. The condition may change unpredictably from chronic to episodic and from episodic to chronic. [1]

Clinical examination of Cluster Headache

• Examination findings in cluster headache are usually autonomic related; suggesting parasympathetic hyperactivity and sympathetic impairment.
• Exam findings may include ptosis, lacrimation, conjunctival injection, miosis, nasal congestion, rhinorrhea, neck stiffness and photophobia. (7)

Diagnosis of Cluster Headache

• Cluster-like head pain may be diagnosed as secondary headache rather than cluster headache.
• A detailed oral history aids practitioner in correct differential diagnosis, as there are no confirmatory tests for CH.
• A headache diary can be useful in tracking when and where pain occurs, how severe it is, and how long the pain lasts.
• A record of coping strategies used may help distinguish between headache type; data on frequency, severity and duration of headache attacks are a necessary tool for initial and correct differential diagnosis in headache conditions. [1]

In accordance with the International Headache Society (IHS) diagnostic criteria,

• Cluster headaches occurring in two or more cluster periods, lasting from 7 to 365 days with a pain-free remission of one month or longer between the headache attacks may be classified as episodic.
• If headache attacks occur for more than a year without pain-free remission of at least one month, the condition is classified as chronic.
• Chronic CH both occurs and recurs without any remission periods between cycles; there may be variation in cycles, meaning the frequency and severity of attacks may change without predictability for a period of time.
• The frequency, severity, and duration of headache attacks experienced by people during these cycles varies between individuals and does not demonstrate complete remission of the episodic form. The condition may change unpredictably from chronic to episodic and from episodic to chronic. [1]

Differential Diagnosis of Cluster Headache

• Migraine
• Chronic paroxysmal hemicrania(CPH)
• Sinusitis
• Hemicrania continua
• Trigeminal neuralgia

Complications are what happen after you have a disease. They are the negative consequences of the disease process.

Treatment of Cluster Headache

• Cluster headache attacks peak rapidly, and thus a treatment with quick onset require.
• Many patients with acute cluster headache respond very well to oxygen inhalation. This should give as 100% oxygen at 10–12 L/min for 15–20 min. It appears that high flow and high oxygen content are important.
• Sumatriptan 6 mg SC is rapid in onset and will usually shorten an attack to 10–15 min; there is no evidence of tachyphylaxis.
• Sumatriptan (20 mg) and zolmitriptan (5 mg) nasal sprays are both effective in acute cluster headache, offering a useful option for patients who may not wish to self-inject daily.
• Oral sumatriptan is not effective for prevention or for acute treatment of cluster headache.[1]
• The recommended first-line preventive therapy is verapamil, a calcium channel blocker. Verapamil was previously underused in people with cluster headache.
• There is little evidence to support a long-term benefit from glucocorticoids, but they may use until other medications take effect as they appear to be effective at three days.
• Nerve stimulators may an option in the small number of people who do not improve with medications. Two procedures, deep vein stimulation or occipital nerve stimulation may useful; early experience shows a benefit in about 60% of cases

Prevention of Cluster Headache

1. Stick to a regular sleep schedule. Cluster periods can begin when there are changes in your normal sleep schedule. During a cluster period, follow your usual sleep routine.
2. Avoid alcohol. Alcohol consumption, including beer and wine, can quickly trigger a headache during a cluster period. (9)

Homeopathic Treatment of Cluster Headache

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

Which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines.

Homeopathic Medicines for Cluster headache

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Medicine:

Cedron: Best Homeopathic medicine for Cluster Headache at precisely same hour

• Cedron is considered the top natural Homeopathic medicine that will provide immediate relief from Cluster Headaches.
• Cedron is of great help when the main symptom is severe pain around the eye at a particular hour.
• Periodicity in occurrence of periorbital pain is essentially marked. This pain may radiate into the ear.
• In other persons, the pain around the eye may radiate to the temples or back of head.
• Watering from eyes with burning may also present itself with eye pain.
• Night aggravation of pain is also noted. Although the pain may appear on any side, the pain over the left side of eye is felt more often for prescribing Homeopathic remedy Cedron.

Belladona: Homeopathic medicine for Cluster Headache with redness or swelling of eyes

• Belladona is the ideal natural Homeopathic medicine for Cluster Headache with redness or swelling of eyes and flushing of face.
• The characteristic feature for using this Homeopathic remedy is deep pain in the eyes, mostly throbbing or shooting in nature, with congestion and redness of eyes.
• The eyes also show protrusion.
• Photophobia i.e. intolerance to light or worsening of pain from light may also be noted.
• In most cases, lying down worsens the pain and tight bandage or pressure seems to provide relief.
• The sudden onset of a violent headache is also a marked feature.
• The attacks appear suddenly and with intensity and leave with the same suddenness.

Spigelia: Homeopathic medicine for left-side Cluster Headache

• Spigelia is a natural Homeopathic medicine which is very beneficial in treating the left-side Cluster Headache.
• Its use recommend when there is a severe violent pain around the eye and in the eye socket specifically on the left side. The eyeballs too appear large.
• The pain can be of varying nature like digging, boring, shooting, violent, throbbing or stitching pain, with a feeling of needles pricking in the eye on the left side.
• The main worsening factor given by a patient for using Homeopathic remedy Spigelia is pain in eye on moving or turning the eye.
• A few persons may also describe noise or touching the eye as the most aggravating factors.
• Rest in most cases seems to relieve the pain. Along with pain, redness of eyes with sensitivity to light and dropping of eyes also show their presence.
• Another marked feature for using Spigelia is occurrence of pain around the left eye in morning either on rising or while lying in bed.
• A characteristic relief from pain by washing with cold water is a peculiar symptom guiding the use of Homeopathic medicine Spigelia.

Sanguinaria Can: Right-side Cluster Headache

• For treating right-side Cluster Headache, natural Homeopathic medicine Sanguinaria Can is the ideal remedy.
• The use of Homeopathic medicine Sanguinaria Can consider in all those cases of Cluster Headache where the pain settles over or around the right eye.
• A bursting sensation with a feeling as if the eyes will be pressed out is very marked. Periodicity of pain note mostly with beginning of pain in morning and continuing till evening.
• The most aggravating factors in pain to kept in mind where Sanguinaria Can applicable are motion and light. And sleep and lying down still are the soothing factors.
• Characteristic relief from pain may also brought about by walking in open air for some patients needing Sanguinaria Can.
• Along with pain over right eye, there is a profuse watering of eyes. The eyes also very congested, and red with burning sensations.
• The face, especially cheeks, shows flushing. In a few persons, nasal congestion is a prominent feature.

Spigelia: Cluster Headache on left-side 

• Spigelia is a top natural Homeopathic medicine for left-side cluster headache.
• In most cases, the person has a need to close the eye to get relief.
• Has marked elective affinity for the eye, heart, and nervous system.
• Neuralgia of the fifth nerve is very prominent in its effects. especially adapted to anaemic, debilitated, rheumatic, and scrofulous subjects. Stabbing pains. Heart affections and neuralgia.
• Very sensitive to touch, parts feel chilly, send shudder through frame.
• A remedy for stitches due to the presence of worms.
• Child refers to the navel as the most painful part.
• Semi-lateral, involving left eye; pain violent, throbbing; worse, making a false step. Pain as if a band around head.

Ignatia Amara – Effective for Cluster Headache With Stabbing Pain Deep In The Eyes

• Ignatia Amara a beneficial medicine use to treat a cluster headache when the person experiences stabbing pain deep in the eyes.
• A sensation of pressure in the eyes may also be felt. This attend with a sensation as if the eyes would fall out.
• Along with this, redness, flowing of tearing and burning in the eyes may also feel.
• The person needing Ignatia Amara suffers from a periodical headache that can occur every week, fortnight or every month.[3]

Diet & Regimen of Cluster Headache

• Eat a well-balanced healthy diet full of green leafy vegetables, fresh foods, and low fat protein
• Eat Fresh fruits, especially brightly colored ones high in antioxidants
• Low sodium foods
• Almonds
• Do not miss meals
• consuming adequate amounts of water daily
• Avoid consuming processed foods, aged cheeses, smoked or dried fish, cultured dairy products
• Avoid high sodium foods like potato chips and foods high in carbohydrates and sugar
• Also avoid Alcohol, Caffeine, Aspartame and other artificial sweeteners
• Do some yoga and meditation
• Don’t skip your sleep

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References use for Article Cluster Headache

[1]Harrison-s_Principles_of_Internal_Medicine-_19th_Edition-_2_Volume_Set

[2] https://en.wikipedia.org/wiki/Cluster_headache

[3] https://www.drhomeo.com/headache/top-homeopathic-remedies-for-cluster-headaches/

[4]https://www.sapnamed.com/blog/what-foods-and-drinks-help-headaches/

[5]https://www.aafp.org/pubs/afp/issues/2013/0715/p122.html

[6]https://www.healthline.com/health/cluster-headache#types

[7]https://www.wikidoc.org/index.php/Cluster_headache_physical_examination

[8]https://www.google.com/search?q=investigation++of+cluster+headache

[9]https://www.google.com/search?q=prevention+++of+cluster+headach

Frequently Asked Questions

What is Cluster Headache?

Cluster headache (CH) is a neurological disorder characterized by recurrent severe headaches on one side of the head, typically around the eye.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Cluster Headache?

• Cedron
• Belladona
• Spigelia
• Sanguinaria
• Spigelia
• Ignatia

What are the symptoms of Cluster Headache?

• Onset: Sudden, rapid
• Duration: 50- 180 min
• Character: Recurrent, unilateral
• Location: Around or above or behind eye and temporal region
• Pain: Stabbing, Excruciating, Burning, Drilling, Squeezing type
• Periodicity
• Drooping eyelid
• Pupil constriction
• Redness of the conjunctiva
• Tearing
• Runny nose

What are the causes of Cluster Headache?

• Trigeminal nerve and facial nerve
• Genetics
• Tobacco smoking
• Hypothalamus