Cluster headache

Introduction to cluster headache From cluster headaches (also known as migraine headaches, histamine headaches, rock neuralgia, pterygoid pain, Horton headaches, etc.), the patient suddenly has a series of severe headaches in a certain period of time. Generally no signs, pain is more common in one eyelid or (and) frontotemporal, may be accompanied by ipsilateral conjunctival hyperemia, tearing, eyelid edema or nasal congestion, runny nose, sometimes dilated pupils, colic, blush, cheek swelling and other symptoms. Most of the headaches are non-pulsating severe pain. The patient is restless or swaying forward and backward, and some patients use the boxing head to relieve the pain. basic knowledge The proportion of sickness: 0.002%-0.003% Susceptible population: The peak age of onset is 25 to 44 years for males and 40 to 59 years for females. Mode of infection: non-infectious Complications: anxiety

Cluster headache

Drug factors (45%):

Some vasodilator drugs, such as nitroglycerin, histamine, ethanol, etc., can induce cluster headache attacks, while vasoconstrictor drugs, such as ergotamine, norepinephrine, etc., can alleviate, and studies have found that painful side of cluster headache attacks The diameter of the middle cerebral artery of the cavernous sinus segment is enlarged, and becomes smaller after the onset of the episode. The average blood flow velocity of the middle cerebral artery in the pain side of the cluster headache is significantly higher than that of the contralateral side and the remission period. The anterior cerebral artery velocity was lower than that of the contralateral side. Thermal imaging revealed an increase in heat dissipation in the painful sacral area. It was found that there was an inflammatory change in the supraorbital vein and cavernous sinus during the episode of cluster headache cluster, which caused ocular venous reflux disorder and activated pain nerve. Fiber, causing eye pain, tears, stuffy nose, runny nose and other symptoms.

Body factor (40%):

The pain of cluster headache headache occurs in the first and second branches of the trigeminal nerve, suggesting that it is related to the trigeminal nerve. The trigeminal nerve may be retrogradely stimulated, and the release of substance P and other vasoactive peptides may be induced, causing vasodilation and headache. Side autonomic symptoms suggest a decrease in sympathetic excitability and increased parasympathetic excitability, indicating that autonomic dysfunction plays a role in the pathogenesis of cluster headache. It has been found that supraorbital vein and cavernous sinus inflammation may damage sympathetic nerve fibers, causing Autonomic symptoms, therefore, it can be considered that vascular and neurological factors may play a role in the onset of headache.

Cluster headache prevention

Avoid the cause of recurrence of the disease, patients should pay attention to diet, alcohol, and maintain peace of mind. Patients with headache should pay attention to the rationality of diet, should avoid the use of sensitizing drugs and some spicy spicy foods, fried, fried foods and high tyramine-prone foods that induce migraine, such as chocolate, cheese, citrus, alcohol Food, eat more vitamin B1-rich cereals, legumes, and fresh fruits and vegetables.

Cluster headache complications Complications

When the attack is accompanied by the affected side of the nasal congestion, runny, tears, conjunctival congestion, due to long-term headache, the patient will have emotional symptoms such as depression, personality changes.

Cluster headache symptoms Common symptoms Head swelling moderate or mild headache Eye pain begins in the eye, dilatation... Eye congestion is fixed on one side of the eye and... Tears children migraine electric shock or tingling headache

The disease is more common in young people (20 to 40 years old), males are 4 to 5 times female, and generally have no family history.

CH is divided into paroxysmal and chronic, paroxysmal CH has no aura, headache is fixed in one side of the eye and around the eyelids. The episodes are mostly in the evening, and the feeling of sensation or pressure around the eye and the eyelids is first felt. After a few minutes, it develops rapidly. Pain or pain, and spread to the ipsilateral frontal occipital and occipital occipital, accompanied by painful lateral bulbar conjunctival hyperemia, tearing, salivation, sweating, mild edema of the eyelids, less vomiting, 60% to 70% During the onset of the patient, Horner's sign appeared on the side of the disease. The patient was very painful during headache. He was restless and rested for 15 to 180 minutes. After that, the symptoms disappeared quickly. After the remission, the patient can still engage in the original activities. The episode is clustered, that is, once a day. Up to several times, about the same time every day, some like a clock, almost at a constant time, each episode of symptoms and duration is almost the same, cluster episodes can last for weeks or even months after the relief, generally 1 The onset of the disease is 1 or 2 times. Some patients have obvious seasonality, which is more common in spring and autumn. The CH remission period can last from several months to several years. The patients over 60 years old are rare, suggesting that their course of disease has a tendency to relieve themselves.

Chronic cluster headache is rare, accounting for less than 10% of CH. It can be changed from episode CH to chronic, or it can be delayed into a persistent seizure after seizure. The clinical symptoms of chronic CH are the same as the clinical symptoms of paroxysmal CH. More than 1 year, or although there is a period of time, but not more than 14 days.

Cluster headache examination

Cluster headache examination items: serotonin, amine test, brain ultrasound, brain MRI, neurological examination.

1. Cranial CI or MRI excludes intracranial and other organic diseases that cause headache. Functional MRI shows the activation of the ipsilateral hypothalamic gray matter during the attack.

2. Do a histamine test to induce typical pain to diagnose.

Cluster headache diagnosis

diagnosis

The diagnosis of CH is mainly based on the history of its repeated cluster attacks and typical clinical symptoms. There is no positive neurological signs in the remission period, and there is no basis for laboratory and other auxiliary examinations.

Differential diagnosis

(a) identification with migraine

Cluster migraine attacks are easy to distinguish from typical migraine, but they are often difficult to identify with atypical migraine (such as common migraine, facial migraine, etc.). In the case of common migraine attacks, some patients have visual impairment or Other vasospasm manifestations, headaches are often universal and not limited to one side, there is no continuous and intensive episodes, facial migraine, some patients have headaches, although they are also on the face or parts of the cluster headache, but the pain It is generally lighter and lasts longer. Of course, examination of histamine can help with further diagnosis.

(B) identification of vascular headache

The pathogenesis of cluster headache is the expansion of the extracranial artery during headache. Therefore, it is traditionally classified as a special type of vascular migraine, but this headache has no obvious relationship with endocrine disorders. The menopausal episodes are not reduced, and the plasma serotonin is No reduction, and elevated histamine, due to hypersensitivity of the neck blood vessels to histamine, stress, drinking, taking nitroglycerin can be stimulated, it is also believed that hypoxia can also be induced.

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