{"id":14857,"date":"2023-02-23T10:48:32","date_gmt":"2023-02-23T09:48:32","guid":{"rendered":"https:\/\/www.physiotutors.com\/?post_type=condition&p=14857"},"modified":"2024-05-20T19:41:17","modified_gmt":"2024-05-20T17:41:17","slug":"cluster-headache","status":"publish","type":"condition","link":"https:\/\/www.physiotutors.com\/conditions\/cluster-headache\/","title":{"rendered":"Cluster Headache"},"featured_media":14858,"template":"","class_list":["post-14857","condition","type-condition","status-publish","has-post-thumbnail","hentry"],"acf":{"sections":[{"acf_fc_layout":"page-header-detail-page","background":{"background_image":14858,"background_image_alt_text":"Cluster Headache | Diagnosis & Treatment All you need to know"},"heading":"Cluster Headache | Diagnosis & Treatment All you need to know","subheading":"Headache","content_editor":"","button_type":"url","button_label":"","button_style":"button-five","button_internal_link":4646,"button_anchor":"","button_url":"https:\/\/study.physiotutors.com\/course\/headache-treatment-in-clinical-practice\/","button_file":"","label":""},{"acf_fc_layout":"submenu","links":[{"button_type":"anchor","button_label":"Introduction & Epidemiology","button_internal_link":null,"button_anchor":"section-number-3","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Clinical Picture & Examination","button_internal_link":null,"button_anchor":"section-number-4","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Treatment","button_internal_link":null,"button_anchor":"section-number-5","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Headache Online Course","button_internal_link":"","button_anchor":"section-number-6","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Reviews","button_internal_link":"","button_anchor":"section-number-7","button_url":"","button_file":null}],"dropdown_label":"Go to","button_right":{"button_type":"internal_link","button_label":"Become a member","button_style":"button-three","button_internal_link":22104,"button_anchor":"","button_url":"","button_file":""},"button_description":""},{"acf_fc_layout":"content-with-sidebar","content_editor":"

Cluster Headache | Diagnosis & Treatment All you need to know<\/h2>\r\n

Introduction & Epidemiology<\/h3>\r\nHeadaches 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.\r\n\r\nTo start off let\u2019s differentiate between primary and secondary types of headaches. But what does this mean? Simply put, primary headaches are a \u201cdisease themselves\u201d 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.\r\n\r\nNow let\u2019s take a closer look at cluster headaches, which are primary types of headaches.\r\nFischera et al. (2008)<\/a> 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%\u00a0 among the working-aged population in a Swedish cohort (Manzoni et al. 2019<\/a>)<\/a>\r\n\r\nEpidemiology<\/strong><\/em>\r\n\r\nThe following figure shows the prevalence of headaches on different continents around the world:\"\""},{"acf_fc_layout":"content-with-sidebar","content_editor":"

Clinical Picture & Examination<\/h3>\r\nIn order for a headache to qualify as a cluster headache it has to fulfill certain criteria (ICHD-III<\/a>):\r\n\r\nA.<\/strong> At least five attacks need to fulfill criteria B-D\r\n\r\nB.<\/strong> An untreated episode lasts 15-180 minutes and shows severe or very severe unilateral orbital, supraorbital, and\/or temporal pain\r\n\r\nC.<\/strong> It matches either or both of the following:\r\n
    \r\n \t
  1. at least one of the following signs and symptoms, ipsilateral to the headache:\r\n- conjunctival injection and\/or lacrimation\r\n- nasal congestion and\/or rhinorrhoea\r\n- eyelid edema\u2013 forehead and facial sweating\r\n- miosis and\/or ptosis<\/li>\r\n \t
  2. 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.<\/li>\r\n<\/ol>\r\nD.<\/strong> It occurs with a frequency between one every other day and 8 per day\r\n
    \r\n\r\n[embed]https:\/\/www.youtube.com\/watch?v=ms281RCYuB4[\/embed]\r\n\r\n<\/div>\r\n[cta]"},{"acf_fc_layout":"content-with-sidebar","content_editor":"

    Treatment<\/strong><\/h3>\r\nTreatment 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.\r\nCurrently, only a case study has been published on the combination of endogenous neurostimulation and physiotherapy (Navarro-Fern\u00e1ndez et al. 2019<\/a>).\r\n\r\nAcute<\/em><\/strong>\r\n\r\n100% oxygen therapy is arguably the most well-known method of treating cluster headaches (Obermann et al. 2015<\/a>). 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\u2014which can be challenging to obtain\u2014is frequently not covered by insurance.\r\n\r\nThe 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<\/a>). 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.\r\n\r\nAlternative treatments include octreotide, ergotamine, and intranasal lidocaine (with a reported 33% response) (Matharu et al. 2004<\/a>). 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.\r\n
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    \r\n\r\nPreventive Medicine<\/strong><\/em>\r\n\r\nThe 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.\r\nThe most frequently prescribed prophylactic medication is verapamil (May 2003<\/a>).\r\nFor 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<\/a>).\r\n\r\nFor episodic and persistent cluster headaches, verapamil, which is useful as a preventive medication, is started at 240 mg once daily (Leone et al. 2000<\/a>). 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.\r\n\r\n<\/div>\r\n
    Patients with episodic cluster headaches and active cluster periods that occur infrequently and last less than two months are advised to take glucocorticoids as a preventive treatment. A study found that 70\u201380% of patients responded to treatment (Ekbom et al. 2002<\/a>). However, they are not given for a longer period of time when alternative therapy are effective since they have severe long-term negative effects. They are especially useful when other preventive treatments take a while to start working. There is no one regimen that has been shown to be superior to the others. Oral prednisone 60 to 100 mg once daily for five days or more, with a daily dose reduction of 10 mg, is one such regimen. Combining oral and intravenous formulations is possible (Mir et al. 2003<\/a>).<\/div>\r\n
    \r\n\r\nLithium, valproic acid, melatonin, and intranasal capsaicin are some more pharmaceutical choices (Ekbom et al. 2002<\/a>).\r\n\r\nThe 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>). A non-implanted device may offer the option of vagus nerve stimulation (Goadsby et al. 2018<\/a>).\r\n\r\n<\/div>\r\nWant to learn more about headaches? Then check out our following blogs & research reviews:\r\n