cluster headache essays
cluster headache essays
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Bob, a 38 year old male, has been experiencing severe intermittent headaches for about 10 years. When they occur, he experiences intense burning pain on one side of his head, tearing in his eye, congestion and a runny nose. These headaches generally occur several times a day and last approximately one hour. The headaches are episodic; Bob can be headache free for several months but then experience an attack.
Based on the case scenario, provide a diagnosis for Bob. Provide the pathophysiology for this type of headache and discuss current treatment options.
Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight. Both responses must be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text). Refer to grading rubric for online discussioncluster headache essays.
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Candice Russell posted Mar 30, 2021 5:09 PM
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“Headache is a common neurologic disorder and is usually a benign symptom” (Boss & Huether, 2020, p. 400). There are times when headaches are associated with serious illness or disease. “Headaches can be so severe that patients and doctors often fear life-threatening underlying cerebral pathologies” (Michl & Michl, 2017, para. 1). There are many different types of headaches, chronic headaches can occur constantly, for many days out of the month. “The constant nature of chronic daily headaches makes them one of the most disabling headache conditions” (Mayo Clinic, 2019). Trigeminal autonomic cephalalgia (TAC) is a primary headache disorder “characterized by pain in the distribution of the first division of the trigeminal nerve in parallel with cranial autonomic features on the same side of the head” (Ljubisavljevic & Jasana, 2019, p. 1059). Cluster headaches (CH) are said to be the most common TAC, “headaches involving the autonomic division of the trigeminal nerve” (Boss & Huether, 2020, p. 401). Cluster headaches are one of the most studied forms of TAC, however, “the pathophysiology of cluster headache is complex and the underlying mechanisms are not fully elucidated” (Wei et al., 2018, para. 11). Neurovascular and chronobiological headache disorder, TAC can be broken down into three major features: trigeminal pain, rhythmicity (particularly in cluster headache), and autonomic signs. Various structures within the peripheral nervous system and central nervous system (CNS) are associated with the causation of CH.Figure 1(Wei et al., 2018) documents a detailed description of the pathophysiology in CH:Due to the severe pain caused by CH, it has earned the nickname “suicide headache”, “and a suicidal risk exists in this condition” (Rozen & Fishman, 2012, as cited by Rossi et al., 2018, p. 57). CH can have a rapid onset without warning, some individuals experience aura and nausea. Some common symptoms include rapid intense pain, usually one-sided head pain, restlessness, tearing, eye redness on the affected side, nasal congestion and runny nose on the affected side, sweating of the face or forehead on the affected side, eye swelling of the affected side. Pallor and dropping of the eye on the affected side may be present, pain is usually continuous. Men between the ages of 20 and 50 are more commonly affected. Episodic headaches may alternate sides, severe stabbing and throbbing pain may be present (Boss & Huether, 2020, p. 401) cluster headache essays. Individuals typically experience 1-3 headaches a day, however, as many as 8 attacks are possible. Another nickname earned by CH is “alarm clock headaches”, as they are linked to circadian rhythm. Attacks can happen around the same time each day, nighttime attacks can be more severe than daytime attacks. CH attacks can last from minutes to hours, for several days, followed by remission. Huether, S. E., McCance, K. L., & Brashers, V. L. (2020). Understanding pathophysiology / Sue E. Huether, Kathryn L. McCance ; section editor, Valentina L. Brashers (7th ed.). Elsevier.Ljubisavljevic, S., & Jasna, Z. T. (2019). Cluster headache: pathophysiology, diagnosis and treatment. Journal of Neurology, 266(5), 1059-1066. http://dx.doi.org.wilkes.idm.oclc.org/10.1007/s00415-018-9007-4Michl, M., & Michl, G. M. (2017). headaches. Der Internist (Berlin), 58(9), 892. less1 UnreadUnread4 ViewsViews
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Wei, D. Y., Yuan Ong, J. J., & Goadsby, P. J. (2018). Cluster Headache: Epidemiology, Pathophysiology, Clinical Features, and Diagnosis. Annals of Indian Academy of Neurology, 21(Suppl 1), S3–S8. https://doi.org/10.4103/aian.AIAN_349_17
Rossi, P., PhD., Little, P., De La Torre, Elena Ruiz, & Palmaro, A., PhD. (2018). If you want to understand what it really means to live with cluster headache, imagine… fostering empathy through European patients’ own stories of their experiences. Functional Neurology, 33(1), 57-59. https://wilkes.idm.oclc.org/login?url=https://www-proquest-com.wilkes.idm.oclc.org/scholarly-journals/if-you-want-understand-what-really-means-live/docview/2045245091/se-2?accountid=62703
Mayo Foundation for Medical Education and Research. (2019, April 9). Chronic daily headaches. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/chronic-daily-headaches/symptoms-causes/syc-20370891 cluster headache essays.
Hoffmann, J., & May, A. (2018). Diagnosis, pathophysiology, and management of cluster headache. The Lancet Neurology, 17(1), 75-83. http://dx.doi.org.wilkes.idm.oclc.org/10.1016/S1474-4422(17)30405-2 cluster headache essays
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Based on symptoms and hx described by our patient, a diagnosis of Cluster Headaches seems appropriate. There is no existing cure for cluster headaches. The goal of treatment is to reduce pain, decrease the time of each headache and prevent CH attacks (Mayo Clinic, 2019). Acute treatment includes oxygen therapy, administration of triptans, octreotide, the use of local anesthetics, and administration of dihydroergotamine. Each of the treatment options has varying effects on CH. For individuals with new-onset cluster headaches, preventive measures are available. Preventive measures, which should be implemented at the onset of CH episodes. The goal of preventive therapy is to suppress attacks (Mayo Clinic, 2019). Some prevention treatment includes the use of CCB, corticosteroids, Lithium carbonate, and administration of nerve blocking agents. Surgery is rarely used, however, may be recommended for those suffering from chronic cluster headaches who experience no relief from other forms of treatment. Lifestyle modifications may be effective in avoiding attacks.
Pain afferents from the trigeminovascular system traverse the ophthalmic division of the trigeminal nerve, taking signals from the cranial vessels and dura mater (shown by purple fibers). These inputs synapse in the TCC and project to higher brain structures such as the thalamus (T) and cortex resulting in pain perception (shown in blue fibers). Activation of the trigeminovascular system by stimulation of dural structures also causes neuronal activation in the SSN within the pons, which is the origin of cells for the cranial parasympathetic autonomic vasodilator pathway cluster headache essays. There is subsequent activation of this parasympathetic reflex through the outflow from the SSN and is relayed through the SPG (shown by pink fibers), but also through the facial (VIIth cranial) nerve (not shown). Activation of both trigeminal and autonomic nerves defines the trigeminal autonomic reflex arc, which is integral to the pathophysiology of cluster headache and the other TACs. The HT is functionally connected to the ipsilateral trigeminal system and other brain areas of the pain matrix. Red dashed lines indicate the pathways by which the HT controls or triggers pain. A third-order sympathetic nerve lesion thought to be caused by vascular changes to the ICA in the cavernous sinus with subsequent irritation of the local plexus of nerve fibers, can give rise to sympathetic symptoms (incomplete Horner syndrome). (Wei et al., 2018, para. 11)
For a sequence of attacks to take place, three key structures need to interact: the trigeminovascular system, the parasympathetic nerve fibers (trigeminal autonomic reflex), and the hypothalamus. Only if all three systems are involved can cluster headache attacks be initiated, and subsequently cortical areas of the CNS—known to be involved in the processing and perception of pain—will be activated. (Hoffmann & May, 2018, p. 77)
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Hilary Szpara posted Mar 30, 2021 8:12 PM
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Based on the case scenario, I would diagnose Bob with cluster headaches. Cluster headaches are characterized by being unilateral, last on average 45 minutes to 90 minutes, happen multiple times during the day, and often include eye discomfort and nasal symptoms such as congestion and/or runny nose (Wei et al., 2018). There are many other symptoms of cluster headaches including aural fullness, throat swelling. Flushing, agitation and restlessness, and ptosis (Wei et al., 2018). The pathophysiology of cluster headaches is complex and not fully understood. They are neurovascular headaches, rather than vascular headaches. Vascular cerebral changes that occur are driven by the effects of trigeminal-autonomic reflex activation (Wei et al., 2018). The cranial autonomic symptoms that arise during cluster headaches, come from the reflex activation of the trigeminal-autonomic reflex pathway through parasympathetic outflow which results in vasodilation and parasympathetic activation (Wei et al., 2018). Due to the clinical presentation of cluster headaches, some believe that the hypothalamus may be involved and that cluster headaches occur more often when the clocks change during daylight savings, which suggests and inability to synchronize internal circannual pacemaker with external environmental light cues (Wei et al., 2018). Since cluster headaches come on quickly and don’t last long, they require fast-acting treatment. The acute treatment drugs of choice are currently subcutaneous sumatriptan and/or high flow oxygen (Brandt et al., 2020). Sumatriptan is thought to be the most effective abortive treatment, with pain relief occurring in 75% of patients within 15 minutes (Brandt et al., 2020). There are also prophylactic treatments available, including verapamil, lithium, and topiramate (Brandt et al., 2020). These pharmacologic treatments require more research but have so far found to be effective in preventing cluster headache attacks.Brandt, R. B., Doesborg, P., Haan, J., Ferrari, M. D., & Fronczek, R. (2020). Pharmacotherapy for Cluster Headache. CNS drugs, 34(2), 171–184. https://doi.org/10.1007/s40263-019-00696-2Wei, D. Y., Yuan Ong, J. J., & Goadsby, P. J. (2018). Cluster Headache: Epidemiology, Pathophysiology, Clinical Features, and Diagnosis. Annals of Indian Academy of Neurology, 21(Suppl 1), S3–S8. https://doi.org/10.4103/aian.AIAN_349_17less1 UnreadUnread3 ViewsViews cluster headache essays
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Aina Oluwo posted Mar 31, 2021 11:20 AM
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Headaches are generally known to be benign but when it becomes more persistent it is associated with chronic conditions. Based on the few symptoms being experienced by this patient, a diagnosis to consider will be cluster headache (CH). According to Huether et al., (2017), cluster headaches occurs primarily in men between ages 20 and 50 years of age. It occurs in breaks throughout the day and lasts minutes to hours. It is also associated congestion of the mucosa, tearing of the eye and unilateral intense pain. All these symptoms are currently being experienced by Bob. CH is characterized by an alternation of excruciatingly painful attacks and pain‐free periods (Pohl et al., 2020). The recommended treatments are based on an update to the 2010 American Academy of Neurology (AAN) review. Robbins et al., (2016) illustrated the treatment plan for acute CH and maintenance. Acute treatment involves subcutaneous sumatriptan, zolmitriptan nasal spray, high flow oxygen and newly introduced sphenopalatine ganglion stimulation which is not currently practiced in the US. Lithium and verapamil are considered the best for maintenance and prophylactic management of CH.Barloese, M., Jürgens, T., May, A., Lainez, J., Schoenen, J., Gaul, C., Goodman, A., Caparso,stimulation: Experiences in chronic cluster headache patients through 24 months. JournalPohl, H., Gantenbein, A., Sandor, P., Schoenen, J., & Andrée, C. (2020). Interictal burden ofbased, cross-sectional study of people with cluster headache. Headache, 60(2), 360-369.Robbins, M., Starling, A., Pringsheim, T., Becker, W., & Schwedt, T. (2016). Treatment ofguidelines. Headache, 56(7), 1093-1106. https://doi.org/10.1111/head.12866 less1 UnreadUnread2 ViewsViews
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Last post April 4 at 9:14 PM by Hilary Szpara
cluster headache: The american headache society Evidence‐Based
https://doi.org/10.1111/head.13711
cluster headache: Results of the EUROLIGHT cluster headache project, an internet-
of Headache and Pain, 17(1), 1-8. https://doi.org/10.1186/s10194-016-0658-1
A., & Jensen, R. (2016). Cluster headache attack remission with sphenopalatine ganglion
References
The pathophysiology can be attributed to activation of a trigemino-autonomic reflex that is mediated through the sphenopalatine ganglion (SPG). The SPG connects directly and indirectly with the hypothalamus, superior salivatory nucleus (SSN), trigeminovascular system, meninges, and somatic and autonomic nerves innervating cranial structures (Barloese et al., 2016).
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Joanne Hogan posted Mar 30, 2021 4:37 PM
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Module 11Cluster headache is considered one of the more rare headache disorders, only affecting roughly 0.1% of the population and typically affects males more than females (Ljubisavljevic & Trajkovic, 2018). People who suffer from cluster headache typically have an increased level of calcitonin gene related peptide (CGRP) (Ljubisavljevic & Trajkovic, 2018). Not enough is known regarding the mechanism of CGRP to know the specifics regarding why this causes cluster headache, but this is generally what therapy is targeted to in treatment (Buture et al., 2019). Most research suggests that the parasympathetic nervous system goes into a type of overdrive and causes disturbances in the hypothalamus which leads to vasodilation (Ljubisavljevic & Trajkovic, 2018). Ljubisavljevic, S., & Trajkovic, J. Z. (2018). Cluster headache: Pathophysiology, diagnosis and treatment. Journal of Neurology, 266(5), 1059–1066. https://doi.org/10.1007/s00415-018-9007-4less1 UnreadUnread2 ViewsViews
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Last post April 4 at 7:42 PM by Tallona Boddy
Buture, A., Boland, J. W., Dikomitis, L., & Ahmed, F. (2019). Update on the pathophysiology of cluster headache: Imaging and neuropeptide studies. Journal of Pain Research, Volume 12, 269–281. https://doi.org/10.2147/jpr.s175312
References
High flow oxygen is typically used for patients who are in the midst of an attack and often times reduces the need for rescue medications as traditional rescue medications can be ineffective in providing comfort (Ljubisavlejevic & Trakjovic, 2018). Triptans can be useful in the midst of an attack if parentally administered but does not always work effectively so the main goal in treatment of cluster headaches lies with preventative treatment (Ljubisavelejevic & Trakjovik, 2018). Preventative treatment includes corticosteroids which has been proven effective in reducing the reoccurrence of the frequency of attacks and lithium or verapamil can be effective in reducing the frequency of attacks in patients who suffer from chronic cluster headaches (Ljubisavelejevic & Trakjovik, 2018).
Based on the information given in the case study this week, Bob appears to be suffering from cluster headaches. According to Ljubisavljevic & Trajkovic (2018), cluster headache is noted to be severe pain that occurs unilaterally to either the orbital, supraorbital, or temporal area. The duration of pain can last anywhere from 15 minutes to up to 3 hours and can occur up to 8 times a day in some cases (Buture et al., 2019). Cluster headache effects trigeminal nerve and is the most common type of trigeminal autonomic cephalgia headache disorders (Ljubisavljevic & Trajkovic, 2018). Like Bob, people who suffer from cluster headache can have rhinorrhea, nasal congestion, and ptosis alongside the severe unilateral pain (Buture et al., 2019). Additional symptoms include eyelid edema, agitation, and facial sweating (Buture et al., 2019) cluster headache essays.
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Tallona Boddy posted Mar 30, 2021 6:43 PM
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Bob most likely is experiencing a cluster headache. A cluster headache can occur unilaterally, it can last for 15 minutes to 3 hours. Runny nose, excessive tearing and restlessness are all signs and symptoms of a cluster headache. Episodes of recurrent headaches throughout the day can happen for days, weeks or months at time. Cluster headaches can have periods of no signs or symptoms, this can last for up to 12 months at a time. The cause of cluster headaches is not yet known, a current theory is a disruption in the body’s hypothalamus as a contributing factor (Mayo Clinic, 2019). ReferencesUniversity of Michigan Medicine. (4 August, 2020). Medicines for cluster headaches. https://www.uofmhealth.org/health-library/abk7653less2 UnreadUnread3 ViewsViews
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Mayo Clinic. (04 June, 2019). Cluster headaches. https://www.mayoclinic.org/diseases-conditions/cluster-headache/symptoms-causes/syc-20352080
High-flow oxygen has been shown to stop a cluster headache for seven out of 10 people, within 15 minutes. Triptans can be used via injection, oral, or nasal spray, for relief of the pain and pressure from a cluster headache. Lithium has been shown to help prevent cluster headaches. Ergotamine can be used at night to prevent cluster headaches. Opioids are not recommended for use to alleviate a cluster headache (University of Michigan Medicine, 2020). Understanding the person’s severity and pattern of their cluster headaches will help the provider determine the best medication regimen.
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Gisselle Mustiga posted Mar 30, 2021 8:05 PM
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The symptoms experienced by the patient are an indication of cluster headaches. The disease is associated with symptoms that include strictly unilateral headaches, excruciating pain precisely on one side of the head, commonly referred to as proximal hemicrania (Huether et al. 2020). The headaches are short-lasting, typically lasting from minutes up to one hour. There is also a recurrence of headaches during the day. A patient also may have redness of the face and nasal congestion. Other symptoms are autonomic, which entails lacrimation. Tearing and ptosis of the eye on the affected side is also another indication. The disease is prevalent in males. The descriptions in the case study match cluster headaches symptoms. As such, the client should be given urgent medical attention to counter its effects.ReferencesHuether, S. E., McCance, K. L. & Brashers, V. L. (2020). Understanding May, A., Schwedt, T. J., Magis, D., Pozo-Rosich, P., Evers, S., & Wang, S. J. (2018). Cluster headache. Nature Reviews Disease Primers, 4(1), 1-17.less1 UnreadUnread5 ViewsViews
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View profile card for Candice Russell
Last post April 4 at 6:18 PM by Candice Russell
Pathophysiology 7th ed. Elsevier Mosby.
Hoffmann, J., & May, A. (2018). Diagnosis, pathophysiology, and management of cluster headache. The Lancet Neurology, 17(1), 75-83.
Cluster headaches are associated with regions of the brain, specifically the hypothalamus. Abnormal activity of this region causes both pain and autonomic symptoms. The pain is also a result of the release of vasoactive substances and neurogenic inflammation formation (May et al., 2018). The other key player is the trigeminovascular system which induces episodic headaches. For the treatment, abortive drugs like triptans and sumatriptan are used since they are the most effective in countering the consequences of the symptoms (Hoffmann & May 2018). To prevent a recurrence, verapamil and lithium carbonate should be administered. However, the clinician should be worried about the side effects. In a case where the side effects are adverse, topiramate is considered the preventative drug. For transitional treatment, the acute attacks are managed with oxygen inhalation, and occipital nerve stimulation. Patients have an important role to play by adopting a regular sleep schedule and avoiding alcohol intake.
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Jennifer Bryant posted Mar 31, 2021 12:45 AM
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Bob’s symptoms meet the International Classification of Headache Disorders classification for cluster headaches. Diagnostic criteria include more than 5 attacks, severe unilateral pain, lacrimation, congestion and frequency occurring between one every other day and 8 per day (IHS, 2018). The duration of 10 years of episodic episodes would put Bob at 28 for age of onset. Typical age of onset is 20-40 and men are afflicted three times often than women (IHS, 2018).ReferencesInternational Classification of Headache Disorders, 3rd edition. Cephalalgia 38, 1–211.headache, The Lancet Neurology, 17(1) 75-83.May, A., Schwedt, T., Magis, D., Pozo-Rosich, P., Evers, S., Wang, S.J. (2018). Clusterless1 UnreadUnread3 ViewsViews
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headache. Nat Rev Dis Primers 4. https://doi.org/10.1038/nrdp.2018.6
https://doi.org/10.1016/S1474-4422(17)30405-2.
Hoffmann, J & May, A., (2018) Diagnosis, pathophysiology, and management of cluster
Headache Classification Committee of the International Headache Society (2018). The
The pathophysiology of cluster headache is not fully understood but includes alterations in both the central and peripheral nervous systems, including activation of the trigeminovascular system (May et al, 2018). Treatment options include management of acute attacks, prophylaxis and trigger avoidance. Triptans, oxygen and lidocaine are effective in aborting acute attacks (Hoffman & May, 2018). Prevention has been effective with verapamil and lithium (Hoffman & May, 2018). Future treatments include clinical trials for monoclonal antibodies and botulinum toxin and other medications suggest effectiveness in uncontrolled trials (Hoffman & May, 2018) cluster headache essays.
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Melissa Morgan posted Mar 27, 2021 9:46 PM
The patient in this case study, Bob, is experiencing cluster headaches. According to Huether, et al., this type of headache occurs primarily in men who are 20-50 years old, has a rapid onset, can last for minutes to hours and up to 8 attacks per day, and patients can experience lacrimation and rhinorrhea (2020). The patient who has cluster headaches can experience spontaneous remission, which Bob is noted in the case study to have also. Treatment. Cluster headaches affect only about 1% of the population, but it represents one of the most painful conditions (Kingston & Didick, 2018). Treatment for this disorder includes prophylactic drugs; avoidance of triggers; and managing acute attacks with oxygen inhalation, sumatriptan, or inhaled ergotamine administration, and nerve stimulation (Huether, et al., 2020). Delivering oxygen via a nonrebreather face mask has been shown to be an effective treatment (Kingston & Didick, 2018). A drawback to using oxygen is that it can be cumbersome for people to carry oxygen around all day. However, unlike triptans, there is no set limit of how many times a person can use oxygen, especially for those who experience multiple attacks per day. Preventative drugs used to treat cluster headaches are verapamil and lithium. They are the most widely used in first-line preventive treatment, and if they are not effective or contraindicated then topiramate can be used (Brandt, et al., 2020). Brandt, R. B., Doesborg, P., Haan, J., Ferrari, M. D., & Fronczek, R. (2020). Pharmacotherapy for Cluster Headache. CNS drugs, 34(2), 171–184. https://doi.org/10.1007/s40263-019-00696-2Kingston, W. S., & Dodick, D. W. (2018). Treatment of Cluster Headache. Annals of Indian Academy of Neurology, 21(Suppl 1), S9–S15. https://doi.org/10.4103/aian.AIAN_17_18less0 UnreadUnread
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View profile card for Gisselle Mustiga
Last post April 3 at 5:53 PM by Gisselle Mustiga
Huether, S., McCance, K., and Brashers, V. (2020). Understanding Pathophysiology (7th ed.). Elsevier
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Pathophysiology. Cluster headaches involve the autonomic division of the trigeminal nerve and are one of a group of disorders called trigeminal
