Cluster Headache

Authors
Affiliations

Nathaniel Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

Epidemiology

  • Men > women
  • May be associate w Horners syndrome (myosis, ptosis, anhidrosis)
Note

Cluster is greater in men than women, which is unlike the other headache types

Etiology

  • Unknown
  • No Genetic factors
Note

Lack of familial history or genetic factors is different from other headache types

Types

  • Episodic Cluster Headache (ECH)1
  • Chronic Cluster Headache (CCH)1

Pathophysiology

  • Trigeminal autonomic reflex
  • Hypothalamus? Unclear

Clinical Presentation

Precipitating factors

  • Neck mvmts may trigger them or may not

Onset

  • No warning signs
    • No aura

Time

  • Headaches can last from 15 min to 3 h1

Symptoms

Area of Symptoms

  • Unilateral
    • May change sides
  • Trigeminal nerve distribution1

Quality

  • Burning
  • Piercing
  • Severe

Associated Symptoms

  • Nausea, vomiting, bradycardia
  • Photophobia
  • Nasal congestion, flush face
  • Possible mild neck symptoms
  • Autonomic response (lacrimation, ptosis)

Diagnosis

  • Need at least 5 attacks unilaterally
  • Attacks must last 15min-3 hours
    • Probs to sympathetic nerves of face

Treatment

from PT School

Vagal Nerve Stimulation

Patient education

  • Stress reduction techniques1

Bloodflow improvement

  • Cardiovascular could help to improve bloodflow through the brain, resulting in reduction in symptoms

References

1.
Wei DY, Goadsby PJ. Cluster headache pathophysiology — insights from current and emerging treatments. Nature Reviews Neurology. 2021;17(5):308-324. doi:10.1038/s41582-021-00477-w

Citation

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