migrainous neuralgia

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Previously termed migrainous neuralgia, cluster headache is a primary headache disorder classified with similar conditions known as trigeminal autonomic cephalalgias (TACs) (1).

  • it is probably one of the most painful conditions known to man (1)
    • some women may describe the pain to be worse than pain experienced during childbirth (3)
  • attacks usually cluster together into bouts which may last several weeks (1)
  • acute attacks involve activation in the region of the posterior hypothalamic grey matter
  • may be autosomal dominant in about 5% of cases (2)

Studies have estimated that the one-year prevalence to be as high as 53 per 100,000 adults

  • more common in males with male-to-female ratio of 3:1
    • this figure is much higher in  chronic cluster headache than for the episodic form (15 and 3.8, respectively).
  • onset is usually between the ages of 20 to 40 years (patients as young as 4 years and as old as 96 years can be affected.)
  • around 80% of patients reported that the condition restricted their daily activities (1,4).

Attacks may be triggered by alcohol. Other possible triggers include strong smells such as paints and solvents, nitroglycerine, exercise, and elevated environmental temperature (2,4).

Pain of cluster headache:

  • is maximal orbitally, supraorbitally, temporally or in any combination of these sites, but may spread to other regions
  • during the worst attacks, the intensity of pain is excruciating
  • patients are usually unable to lie down, and characteristically pace the floor
  • pain usually recurs on the same side of the head during a single cluster period

Reference:

Last edited 11/2020 and last reviewed 05/2021

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