Cluster Headache | Diagnosis & Treatment All you need to know

Cluster Headache | Diagnosis & Treatment All you need to know
Introduction & Epidemiology
Headaches can manifest on their own but are also a very common symptom in neck pain patients as more than 60% of patients with a primary neck pain complaint report having concordant episodes of neck pain. Therefore it’s essential to find out what kind of headache the patient is suffering from.
To start off let’s differentiate between primary and secondary types of headaches. But what does this mean? Simply put, primary headaches are a “disease themselves” whereas, in secondary headaches, the headache is a symptom of another condition. So primary headaches would be migraines, tension-type headaches & cluster headaches. Secondary type headaches are headaches caused by tumors, hemorrhage, other trauma, TMJ dysfunction, substance overdose, or neck pain aka. The cervicogenic headache.
Now let’s take a closer look at cluster headaches, which are primary types of headaches.
Fischera et al. (2008) conducted a meta-analysis to assess the lifetime prevalence of cluster headache and found low numbers of 0,12% with a 1-year prevalence of 53 per 100,000 persons and the overall sex ratio was 4.3 (male to female). Cluster headache had a 1-year prevalence of 0,054% among the working-aged population in a Swedish cohort (Manzoni et al. 2019)
Epidemiology
The following figure shows the prevalence of headaches on different continents around the world:
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Clinical Picture & Examination
In order for a headache to qualify as a cluster headache it has to fulfill certain criteria (ICHD-III):
A. At least five attacks need to fulfill criteria B-D
B. An untreated episode lasts 15-180 minutes and shows severe or very severe unilateral orbital, supraorbital, and/or temporal pain
C. It matches either or both of the following:
- at least one of the following signs and symptoms, ipsilateral to the headache:
– conjunctival injection and/or lacrimation
– nasal congestion and/or rhinorrhoea
– eyelid edema– forehead and facial sweating
– miosis and/or ptosis - a sense of restlessness or agitation. There are reports of patients pacing back and forth through the room, banging their heads due to the severe pain.
D. It occurs with a frequency between one every other day and 8 per day
100% Free Headache Home Exercise Program
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Treatment
Treatment for cluster headache consists of medication, injections/suboccipital nerve blocks, or intracranial stimulation. We can distinguish between treatment for acute attack and preventative treatment as two facets of cluster headache management. Unfortunately, there are currently no options for physiotherapists to treat patients with cluster headaches.
Currently, only a case study has been published on the combination of endogenous neurostimulation and physiotherapy (Navarro-Fernández et al. 2019).
Acute
100% oxygen therapy is arguably the most well-known method of treating cluster headaches (Obermann et al. 2015). As compared to other types of headaches, cluster headaches are the only condition for which this strategy is a level A recommendation. A minimum of 66% of patients benefit from oxygen therapy. It takes less than ten minutes to take effect. Using oxygen has no risks or adverse effects, making it a great option for treatment. Sadly, oxygen therapy for those with cluster headaches—which can be challenging to obtain—is frequently not covered by insurance.
The only other level A-indicated therapy is triptans. Subcutaneous sumatriptan or nasal spray zolmitriptan delivery of these medications are both options (May et al. 2006). If subcutaneous injections are not tolerated, intranasal triptans might be given on the side opposite the headache. Intranasal sumatriptan (20 mg) and intranasal zolmitriptan (5 mg) are two options. As the onset period of oral medications, in whatever form, is frequently longer than the headache, they are not advised.
Alternative treatments include octreotide, ergotamine, and intranasal lidocaine (with a reported 33% response) (Matharu et al. 2004). Sadly, medication resistance develops in 10% to 20% of people with severe cluster headaches. Patients should be advised to stay away from triggers, particularly alcohol. Patients should be urged to cease smoking even though there is no evidence to suggest that doing so will reduce their likelihood of getting headaches.
Preventive Medicine
The sole tier A suboccipital blockade is advised as a method of cluster headache avoidance. Negative side effects include temporary injection site soreness and mild headaches, both of which are not significant.
The most frequently prescribed prophylactic medication is verapamil (May 2003).
For patients with persistent cluster headaches and those who have episodic cluster headaches for at least two months, it is advised as the first line of preventive treatment (Obermann et al. 2015).
For episodic and persistent cluster headaches, verapamil, which is useful as a preventive medication, is started at 240 mg once daily (Leone et al. 2000). It is advised to perform routine ECGs to check on a patient’s heart health while they are taking this medication. Verapamil has a level C recommendation, despite being widely used by healthcare professionals.
Lithium, valproic acid, melatonin, and intranasal capsaicin are some more pharmaceutical choices (Ekbom et al. 2002).
The effects of electrical stimulation have been extensively studied. The sphenopalatine ganglion, occipital, and vagus nerve are among the areas that are stimulated. The hypothalamus has benefited greatly from deep brain stimulation, which has been particularly effective in treating patients who are drug-resistant (Fontaine et al. 2010). A non-implanted device may offer the option of vagus nerve stimulation (Goadsby et al. 2018).
Want to learn more about headaches? Then check out our following blogs & research reviews:
- Physical Tests for Headaches: Useful?
- The Efficacy of Aerobic Exercise vs. Strength Training in the Treatment of Migraine
- Podcast Episode 031: Headaches with René Castien
References
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Finally Learn how to Diagnose & Treat Patients with Headaches
What customers have to say about this online course
- Danitsja Wendt11/09/23Headache Treatment in Clinical Practice UITGEBREIDE HOOFDPIJNCURSUS
Veel informatie over de drie meest voorkomende hoofdpijnsoorten. Eerst uitgebreid theoretische achtergrond.
Daarna ook veel aandacht voor onderzoeken en behandelingen, verduidelijkt met filmpjes.
Fijn dat deze informatie ten alle tijden teruggekeken kan worden voor een opfrisser.
De cursus zelf is vertaald in het Nederlands, maar de vele wetenschappelijke artikelen zijn dat helaas niet.
Hierdoor ging bij mij wel erg veel tijd zitten in het doornemen daarvan.
Comment Physiotutors: All scientific literature is in English. That is a reality that we cannot change.Willem Nijssen31/07/23Headache Treatment in Clinical Practice GOOD QUALITY COURSE WITH UP-TO-DATE LITERATURE
The course is well structured and with up-to-date literature. It provides enough practical tips. There’s definitely a lot to learn about this subject!Jesse de Louw11/07/23Headache Treatment in Clinical Practice GOOD COURSE
Good EBP study, with a nice variety of information. Sometimes a little bit hard to follow the information given in another language than my own. (Comment Physiotutors: This customer probably did not see the option to switch to Dutch) - Hamad Alkahtani16/06/23Headache Treatment in Clinical Practice Very Interesting info and practical knowledgeM.A.G. Kuipers15/06/23Headache Treatment in Clinical Practice INFORMATIEVE CURSUS MBT HOOFDPIJN
Goede cursus, helaas niet in Nederlands en helaas zijn ook niet alle artikelen makkelijk te verkrijgen
duidelijke filmpjes met goede technieken mbt onderzoek en behandeling
Opmerking Physiotutors: De gehele cursus is wel in het Nederlands verkrijgbaar.Lennart Kroes17/04/23Headache Treatment in Clinical Practice A PERFECT COURSE TO UPDATE YOUR KNOWLEDGE ABOUT HEADACHE
Evidence-based, easy to follow. Perfect! - Erik Swarts09/03/23Headache Treatment in Clinical Practice GREAT COURSE!
First time doing a Physiotutors course. great way to learn on a high level of evidence. You can watch and rewatch everything for as long as you want before you take the exam.Daniel Klimsa31/01/23Headache Treatment in Clinical Practice GREAT COURSE!
Well-structured course with lots of evidence-based material.
Theory is well explained and you get a lot of additional reading material.
I would like to see improved quality of the explanations in the video portion of the course.Barbara Fasol18/01/23Headache Treatment in Clinical Practice A LOT OF INFORMATION!
a lot of good informations, articles.
A really good help to improve your comprehension and your practice
The only downside on this course was for some videos in the practice section, the sound wasn’t working (Comment from Physiotutors: This is intended like this). However, the videos were fairly straight forward without the sound so it was fine to understand the content, so it wasn’t much of an issue to have no sound.
For some section, it didn’t include the latest research but it’s difficult to constantly update the content of a course when new research is published everyday.
One very good point was the fact that the teacher critics some of the studies that were published so you feel that it’s not just reading the conclusion. - Alice Dehout28/12/22Headache Treatment in Clinical Practice GOOD INSIGHT ON HEADACHE TREATMENT
First time doing a course with physiotutors.
I would say the content is very useful, interesting and up to date.
The only downside on this course was for some videos in the practice section, the sound wasn’t working (Comment from Physiotutors: This is intended like this). However, the videos were fairly straight forward without the sound so it was fine to understand the content, so it wasn’t much of an issue to have no sound.
For some section, it didn’t include the latest research but it’s difficult to constantly update the content of a course when new research is published everyday.
One very good point was the fact that the teacher critics some of the studies that were published so you feel that it’s not just reading the conclusion.Mathias28/11/22Headache Treatment in Clinical Practice QUALITY GUARANTEED
First time using Physiotutors; a very user friendly way of learning. An in depth theoretic background to start off with, before continuing to a more practical approach. After every chapter, you’re invited to do a little quiz and thus test yourself. Highly applicable course for your practice.Anthony02/09/22GREAT LEARNING EXPERIENCE INFORMATIEVE CURSUS
First time doing a full online formation on a subject and it was amazing, great way to move through the different topics.
The assessment and quizz keeps you accountable and you have a great, practical tool that you can apply directly into your practice like next day in.
Highly recommended - Ingeborg Dols-de Jonge16/02/22Headache Treatment in Clinical Practice INFORMATIEVE CURSUS
Leuke en interessante hoofdpijn cursus waarbij gebruik gemaakt wordt van up to date wetenschappelijke onderzoeken. Er wordt een mooie afwisseling gemaakt tussen theorie en praktijk. Na deze cursus kun je goed onderscheid maken tussen verschillende soorten hoofdpijn en weet je wat de beste behandelmethode is.Svein Inge31/01/22Headache Treatment in Clinical Practice QUALITY COURSE
I highly recommend this course. You will get many tips of articles who are relevant for diagnostic and treatment of the most common headaches and migraine. Castien is also a great teacher, and explain the stuff in a good way. He has also informative videos.Azad Khan04/01/22Headache Treatment in Clinical Practice AN EXPERTS GUIDE THROUGH THE HEADACHE LANDSCAPE!
No better tutor than René Castien to introduce us to the fascinating field of the treatment rationale and possibilities for physio- and manual therapists. Uptodate, for so far as possible in this fast moving field, practical and with a good deal of treatment options that are both evidence based and with a good deal of clinical expertise. I thoroughly enjoyed the course and was pleasantly surprised by the clear and methodogical presentation of the material. I can highly recommend this course to any clinician engaged with or interested in the treatment of patients with headache. A no nonsense, applicable and practical course! - Elisabetta12/12/21Headache Treatment in Clinical Practice DETAILED AND VERY INFORMATIVE
This course is ideal to expand one’s knowledge on headaches and how to effectively treat them.
The instructor is extremely knowledgeable and provides very practical information, easily applicable in the clinic.
I would highly recommend taking this course to anyone interested in becoming an expert at treating headaches.Dylan08/12/21Headache Treatment in Clinical Practice GREAT COURSE
Good didactic qualities of the teacher with clearly noticeable theoretical knowledge