Cluster headache is a synonym to erythroprosopalgia and Bing-Horton's neuralgia (although it is of no neuralgic origin). It is not to be confounded with Horton's temporal arteritis which is an inflammation of the temporal and other cranial arteries and which can lead to arterial obstruction (eventually with blindness), the pain caused by it, however, is similarly located mostly in the temporal and orbicular region.
In contrast to the other forms of headache cluster headache "belongs" to the masculine gender. The patients are frequently from their thirties to their fifties. The pains come in clusters, that is in periods of time when the patient suffers pain, whereas else he doesn't have a headache at all. The painful attacks are as if having been stroked by a hatchet into the forehead, the temple and behind the eye, and they practically never change the side. They often occur every day or preferably night at the same time. On the side of the headache frequently the following occurs: The eye and the pupil gets smaller, the eye becomes red and tears, the nose becomes congested or runs, the forehead is sweating (as can be the whole head or the upper part of the body) and may become red. The pain is so strong that the patient cannot tolerate lying in the bed but has to get up and run about, banging his head. The pain lasts from ten minutes to two hours. After a certain time (one ore two months) the period of pain fades away and may recur a few months or even years later. Because of the very acute beginning and the relatively short endurance cluster headache is often confounded with trigeminal neuralgia. Cluster headache is rare. It may become chronic.
A rare form of chronic unilateral temporal headache similar to chronic cluster headache but occurring mostly with females is probably of spondylogetic origin. It responds specifically to non steroid antirheumaticals, especially Indomethacine.
The interview in typical cluster headache is so specific that you can diagnose it through the telephone (or via Internet) - providing that you know the disease and think of it.
There is no known technical diagnostic tool that will allow the positive diagnosis of a cluster headache. However, you might be happy with a normal blood sedimentation rate to distinguish it from a Horton's arteritis. I tried to find changes in the sympathic skin reaction of the forehead but I have failed so far.
In most cases of cluster headache there is an effective therapy. In the painfree interval no measures whatsoever can or should be taken. However since red wine is a powerful trigger for the pain (as are sometimes also nuts, cheese and seafood) it should be avoided. Because of the very specific medication cluster headache should be treated only under close medical supervision.
The standard therapy is Methysergide. Vasoconstrictive or psychic side effects can occur. The medicament should not be given longer than three months, perhaps with a pause, because of the possibility of endovascular or retroperitoneal fibrosis.
If Methysergide can not be given because of its side effects or because the cluster headache has become chronic, steroids in relatively high dosage can be given. Lithium carbonate is a good alternative and possibly also Valproate or Verapamil.
Since the pain in cluster headache builds up very fast and the duration of the pain itself is mostly as short as less than half hour an oral application of any drug doesn't make sense at all. Instead the medicament should be taken subcutaneously or should be inhaled. Both ways are applicable by the patients himself.
Sumatriptane is very effective. So is Ergotamine if inhaled (e.g. Ergotamine Medihaler Riker©). The vasoconstrictive effect should be taken into consideration when using a prophylactic medication with Methysergide. A good alternative measure is the inhalation af pure oxygen (6-8 liters per minute).
Please do not use peripheral or central analgesics like Metamizole or Morphine related drugs because they have no specific effect.
The other Horton's disease, namely the cranial arteriitis, is to be treated with steroids. Sometimes the simple excision of a piece of the inflicted artery (which is necessary anyhow to make the correct diagnosis) has a therapeutic effect.
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