What Is an Atypical Migraine?

Cluster headache is one of the more serious headaches and belongs to vascular headache. It gets its name from the intense onset of headaches over a period of time. More common in young people, 20 to 40 years old, the incidence of men is 4 to 5 times that of women, generally no family history. Divided into two types of episodic and chronic.

Basic Information

English name: cluster headache
Visiting department: Neurology
Multiple groups: 20 to 40 year old male youth

Common symptoms: The headache is fixed on one side of the eye and around the orbit, accompanied by pain, conjunctival congestion, tearing, runny nose, sweating, mild eyelid edema, etc.

Clinical manifestations of cluster headache

There was no sign of an attack, and the headache was fixed on one eye and around the orbit. Seizures are mostly at night, and the sensation of swelling or pressure on the side of the eye and the orbit around the eye first develops into severe pain or drilling pain after a few minutes, and spreads to the ipsilateral frontotemporal and parietal occipital side, accompanied by pain. Conjunctival congestion, tearing, runny nose, sweating, mild edema of eyelids, and rarely vomiting. In most patients, Horner's sign appears on the disease side. Patients are very distressed with headaches and restlessness, usually lasting for 15 to 180 minutes, after which the symptoms quickly disappear, and they can still engage in the original activities after remission. Cluster-like attacks, that is, one to several times a day, occur at about the same time every day, and some, like a fixed clock, occur at almost constant time, and the symptoms and duration of each attack are almost the same. Cluster seizures can be relieved for several weeks or even months. Generally, the seizures occur once or twice a year. Some patients have obvious seasonal incidence, which is more common in spring and autumn. The remission period can last from several months to several years. It is rare for patients over 60 years of age, suggesting that the course of the disease has a tendency to resolve itself. Chronic cluster headaches are rare, accounting for less than 10% of cluster headaches. They can be changed from episodic cluster headaches to chronic, or they can not be relieved into persistent attacks after the attack. The clinical symptoms of chronic cluster headache are the same as those of paroxysmal cluster headache. The symptoms persist for more than one year, or although there are intermittent periods, but no more than 14 days.

Cluster headache test

1. Cranial brain CI or MRI excludes organic diseases that cause headaches inside and outside the head. MRI showed ipsilateral hypothalamic gray matter activation during the attack.

2. Histamine test can induce typical pain and can be diagnosed.

Cluster headache diagnosis

1. It is mainly based on sudden pulsating pain or soreness on one side of the orbit and forehead, which can occur several times a day, and can be stopped after several consecutive days to several months. After a few weeks, months or years, the disease recurs in its original form.

2. Sudden sudden onset of headache, the duration of the attack is relatively constant, one attack lasts from 10 minutes to several hours.

3. Seizures are often accompanied by eye congestion, tears, nasal obstruction, and runny nose. A few may have nausea and vomiting.

4. The brain impedance blood flow map showed a high blood volume type.

5. May have a history of allergies, craniocerebral trauma, sinusitis, cervical spondylopathy and other signs.

Differential diagnosis of cluster headache

Migraine

Cluster migraine attacks are easily distinguished from typical migraines, but they are often not easily distinguished from atypical migraines. During a common migraine attack, some patients have visual impairments or other manifestations of vasospasm. Headaches are common and not limited to one side, and are not characterized by continuous and intensive attacks. Facial migraine. Although some patients have the same headache on the face or cluster headache, the pain is usually mild and lasts a long time.

Vascular headache

The pathogenesis of cluster headache is the dilation of the extracranial arteries in patients with headache, so it is traditionally listed as a special type of vascular migraine. However, this headache has no obvious relationship with endocrine disorders. There is no decrease in menopausal episodes. Plasma serotonin does not decrease during the onset, while histamine increases due to the hypersensitivity of the neck blood vessels to histamine. Nervousness, drinking, and nitroglycerin can be stimulated, and some people think that hypoxia can also be induced.

Cluster headache complications

Attacks are often accompanied by nasal congestion, runny nose, tears, and conjunctival congestion. Due to prolonged headaches, patients may experience emotional symptoms such as emotional depression and personality changes.

Cluster headache treatment

1. Basically the same as migraine treatment. Ergotamine can be taken orally during an episode, or taken daily before an episode. Prevent the onset or reduce the symptoms during the onset, even for 10-14 days. Sumatriptan (Sumattan) is a 5-HT receptor agonist that binds to 5-HT receptors, thereby inhibiting the vasodilatory effect of 5-HT and achieving vascular contraction for therapeutic purposes. It can be taken orally, nasally, Subcutaneous or intravenous injection, if chest tightness, chest tightness should be stopped immediately after administration. Prednisone or methylprednisolone (methylprednisolone) was given intravenously during a cluster attack, and the drug was discontinued after the cluster attack ceased.

2. Mask inhalation or hyperbaric oxygen treatment during the attack, effective for some patients. Calcium antagonists, such as flunarizine (flunarizine). Antiepileptic drugs, such as sodium valproate, are effective in some patients. Nonsteroidal analgesics such as aspirin, indomethacin (indomethacin), diclofenac, etc. can be tried. Histamine desensitization is effective in some patients. Patients who fail to respond to drug therapy can try nerve block therapy, such as lidocaine sphenopalatine ganglion block, supraorbital or suborbital nerve alcohol injection, radiofrequency trigeminal ganglion block. The prognosis is good, and most of them are treated or resolved on their own.