Cluster headache - Causes, symptoms and treatment. MF.

Every person is aware of the painful state of headache, and 0.1% of the population suffers from the most "hellish" - beam( or "cluster") headache. Most of them are smokers, strong physique of a man with a "lion's" face - with a square jaw and a forked chin, thick wrinkles and light blue eyes. The first attack can appear at any age - from 20 - 60. Women suffer extremely seldom.

Symptoms of cluster headache

Very strong, burning, lightning-fast headache in one eye, behind the eye, with possible irradiation into the temple, ear, cheek, forehead, accompanied by unilateral vegetative disorders - nasal congestion, lacrimation, flushing, rednesseyes, sweating of the forehead - is called a cluster headache. The headache grows rapidly, the eye turns red and the person looks for a place in excitement: he rushes, walks in circles, "wants to beat his head against the wall," holds his head in his hands, swings, moans, cries, screams. .. Horner's syndrome can often be present - ptosis( omissioncentury), miosis( narrowing of the pupil) and enophthalmos( eyelid westernization).Such severe pain can cause thoughts about suicide.

Cluster headache - occurs in series( beams, clusters) for several seizures, from 15 minutes to an hour and a half, a day, with little kickbacks and the subsequent increase in pain to the maximum wild, during weeks and months with subsequent long-term remission - months, years. There is a chronic form of cluster headache with which there is no remission. The most severe headache comes at night, always appears at the same time.

There are no precursors( auras).The patient wakes up from severe pain. The side of pain during one beam does not change, but later on, in different episodes, a side change is possible. At the beginning and at the end of the cluster period, seizures are less intense and can last several minutes. Further, seizures become heavier and pains are very intense and painful. In the intercluster period, a person feels healthy.

A bundled headache can be called a cyclic disorder associated with a human biological clock. In the mechanism of development, which has not yet been studied accurately, hypothalamus, pterygoid ganglion, trigeminal nerve, vasoactive substances - serotonin and histamine play an important role. As a result of complex neurohumoral, neurophysiological and cyclic processes, pathological vasodilation develops. It is at this phase of the development of pain and treatment is directed - it is necessary to narrow the vessels and the attack is stopped. The triadic nerve is the main conductor of pain. Autonomic symptoms of the attack are provided by the parasympathetic nervous system - parasympathetic fibers from the upper salivary nucleus to the vesicle ganglion and then provide innervation of cerebral vessels, lacrimal glands and glands of the nasal mucosa. During an episode of pain, alcohol, nitroglycerin can provoke an attack. Changes in the habitual way of life can speed up the emergence of a new cluster: changing the work schedule, changing the climatic belt, neuro-emotional stress. ..

Such a strong headache immediately leads the patient to a neurologist.

Headache examination

Differential diagnosis is performed with migraine, dysfunction of the temporomandibular joint, temporal arteritis.

The diagnosis is made clinically in the patient's detailed description of characteristic, recurring attacks at the same time. For the diagnosis, the presence of the five seizures described above for the episode period and the presence of remissions are important. At the same time, there is no focal neurological symptomatology and other causes of headache.

At the first appeal to exclude serious organic brain damage requires magnetic resonance imaging. Symptomatic cluster-like pain can occur with pathology of the pituitary and parasellar region, an aneurysm of the carotid artery, nasopharyngeal carcinoma, pathology of the upper cervical segments( meningeoma).

Treatment of cluster headache

To stop the attack, inhalation of 100% oxygen is used for 15 minutes through a mask, tryptanes( sumatriptan in the form of nasal spray or parenteral administration, zolmitriptan), nasal spray dihydroergotamine, cold to the temple, acupuncture, sedatives and hypnotics. With a long cluster period and severe attacks, steroid hormones are prescribed.

Conventional analgesics and antispasmodics do not help to relieve an attack, narcotics only slightly reduce the intensity of pain. At the beginning of the cluster, non-steroidal anti-inflammatory drugs can be used in combination with caffeine. Possible application of intranasal application of 4% lidocaine solution. You can use ergotamine 2 mg an hour before bedtime to prevent a night attack.

Prevention of cluster headache

For prevention, that is, reducing the number and severity of attacks during exacerbation, verapamil, steroids, and lithium carbonate are used. Dosages and courses are prescribed by the doctor in view of the many side effects.

It is effective to use topiramate from 25 to 200 mg, long-term use with a gradual increase and decrease in dose.

Used in treatment:

• acupuncture,
• laser therapy,
• balneotherapy,
• psychotherapy,
• auto-training,
• sedatives for normalizing the autonomic nervous system.

Tobacco and alcohol use should be excluded. B vitamins, antioxidants are welcome.

Consultation of a doctor for cluster headache

Question : what is an oxygen concentrator?
Answer : The oxygen concentrator generates oxygen from the air. The device is designed for oxygen therapy.

Oxygen concentrators

The concentrator separates nitrogen from the injected air with special carbon rods. Nitrogen is withdrawn to the side, and at the outlet to the mask the required concentrated oxygen is obtained - 90-95%.Output power of oxygen concentrators is different depending on the model and is from 3 to 10 liters per minute. Each device is equipped with a regulator of the output flow, and you can adjust the level required by you.

Doctor neurologist Kobzeva S.V.