Cluster Headache

Authors

Affiliations

Nate Yomogida, PT, DPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, PT, DPT

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

• Stress reduction
• Vagal nerve stimulation (non invasive)
• C/s strength and mobility
• Consider the T/S as well

Vagal Nerve Stimulation

• vagal nerve stimulation was found to have pain relief within 15 minutes for ECH and not CCH¹.
• vagal nerve stimulation was found to significantly reduce CCH attacks when performed in addition to standard of care¹.
  • ECH was not tested

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