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Posted by Bob P ( on February 07, 2002 at 19:16:06:

In Reply to: Clusters are Unmistakeable posted by Jack on February 07, 2002 at 18:09:51:

Cluster headache (CH) is a strictly unilateral headache that occurs in association with cranial autonomic features and, in most patients, has a striking circannual and circadian periodicity. It is an excruciating syndrome and is probably one of the most painful conditions known to mankind, with one female patient describing each attack as being worse than childbirth.

The Cluster attack

The attacks are strictly unilateral, although the headache may alternate sides. The pain is excruciatingly severe. It is located mainly around the orbital and temporal regions, although any part of the head can be affected. The headache usually lasts 45 to 90 minutes but can range from 15 minutes to three hours. It has an abrupt onset and cessation.

The significant feature of CH is its association with autonomic symptoms, and it is extremely unusual for these to be reported. The International Headache Society classification diagnostic criteria require the cluster attacks to be accompanied by at least one of the following, which have to be present on the pain side: conjunctival injection, lacrimation, miosis, ptosis, eyelid oedema, rhinorrhoea, nasal blockage, and forehead or facial sweating. The autonomic features are transient, lasting only for the duration of the attack.

Premonitory symptoms of tiredness and yawning, and associated features of nausea, vomiting, photophobia, phonophobia and aura symptoms have all been described in relationship to cluster attacks. However, in contrast to migraine, CH sufferers are usually restless and irritable, preferring to move about, looking for movement or posture that may relieve the pain.

Cluster attack frequency varies between one on alternate days to three a day, although some have up to eight a day.

Alcohol, nitroglycerine, exercise and elevated environmental temperature are recognised precipitants of acute cluster attacks.

The cluster bout

CH is classified according to the duration of the bout. About 80 to 90 per cent of patients have episodic cluster headache (ECH), which is diagnosed when they experience recurrent bouts, each with a duration of more than a week and separated by remissions lasting more than two weeks. The remaining ten to 20 per cent of patients have chronic cluster headache (CCH) in which either no remission occurs within a year or the remissions last less than 14 days.

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