tailieunhanh - Chapter 015. Headache (Part 15)

Cluster Headache Cluster headache is a rare form of primary headache with a population frequency of . The pain is deep, usually retroorbital, often excruciating in intensity, nonfluctuating, and explosive in quality. 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 8–10 weeks a year; this is usually followed by a pain-free interval that averages 1 year. Cluster. | Chapter 015. Headache Part 15 Cluster Headache Cluster headache is a rare form of primary headache with a population frequency of . The pain is deep usually retroorbital often excruciating in intensity nonfluctuating and explosive in quality. 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 8-10 weeks a year this is usually followed by a pain-free interval that averages 1 year. Cluster headache is characterized as chronic when there is no period of sustained remission. 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. Cluster headache is associated with ipsilateral symptoms of cranial parasympathetic autonomic activation conjunctival injection or lacrimation rhinorrhea or nasal congestion or cranial sympathetic dysfunction such as ptosis. The sympathetic deficit is peripheral and likely to be due to parasympathetic activation with injury to ascending sympathetic fibers surrounding a dilated carotid artery as it passes into the cranial cavity. When present photophobia and phonophobia are far more likely to be unilateral and on the same side of the pain rather than bilateral as is seen in migraine. This phenomenon of unilateral photophobia phonophobia is characteristic of TACs. Cluster headache is likely to be a disorder involving central pacemaker neurons in the region of the posterior hypothalamus Fig. 15-2 . Cluster Headache Treatment The most satisfactory .