Cluster Headache Essays

Cluster Headache Essays

Module 11: Discussion

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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.

  1. 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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    • Mod 11Subscribe
    • 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., M., & Michl, G. M. (2017). headaches. Der Internist (Berlin), 58(9), 892.      less1 UnreadUnread4 ViewsViews
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    • View profile card for Amandeep Kaur
    • Last post April 4 at 11:29 PM by Amandeep Kaur
    • Wei, D. Y., Yuan Ong, J. J., & Goadsby, P. J. (2018). Cluster Headache: Epidemiology, Pathophysiology, Clinical Features, and Diagnosis. Annals of Indian Academy of Neurology21(Suppl 1), S3–S8.
    • 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.
    • Mayo Foundation for Medical Education and Research. (2019, April 9). Chronic daily headaches. Mayo Clinic. cluster headache essays.
    • Hoffmann, J., & May, A. (2018). Diagnosis, pathophysiology, and management of cluster headache. The Lancet Neurology, 17(1), 75-83. 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)
    • Module 11Subscribe
    • 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 drugs34(2), 171–184., D. Y., Yuan Ong, J. J., & Goadsby, P. J. (2018). Cluster Headache: Epidemiology, Pathophysiology, Clinical Features, and Diagnosis. Annals of Indian Academy of Neurology21(Suppl 1), S3–S8. UnreadUnread3 ViewsViews cluster headache essays
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    • Last post April 4 at 10:17 PM by Steven Bartos
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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. less1 UnreadUnread2 ViewsViews
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    • View profile card for Hilary Szpara
    • Last post April 4 at 9:14 PM by Hilary Szpara
    • cluster headache: The american headache society Evidence‐Based
    • cluster headache: Results of the EUROLIGHT cluster headache project, an internet-
    • of Headache and Pain, 17(1), 1-8.
    • 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 Neurology266(5), 1059–1066. UnreadUnread2 ViewsViews
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    • View profile card for Tallona Boddy
    • 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 ResearchVolume 12, 269–281.
  • 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.
    • BobSubscribe
    • 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 UnreadUnread3 ViewsViews
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    • View profile card for Dennies Jones
    • Last post April 4 at 6:50 PM by Dennies Jones
    • Mayo Clinic. (04 June, 2019). Cluster headaches
    • 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 Primers4(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 Neurology17(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.
    • Bob’s cluster headaches Subscribe
    • 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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    • View profile card for Eleany Yasein
    • Last post April 4 at 1:01 PM by Eleany Yasein
    • headache. Nat Rev Dis Primers 4.
    • 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 drugs34(2), 171–184., W. S., & Dodick, D. W. (2018). Treatment of Cluster Headache. Annals of Indian Academy of Neurology21(Suppl 1), S9–S15. 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
    • References
    • Pathophysiology. Cluster headaches involve the autonomic division of the trigeminal nerve and are one of a group of disorders called trigeminal autonomic cephalalgias (Huether, et al., 2020). The mechanism for trigeminal activation is unknown, but “The pathogenic mechanism for pain is related to the release of vasoactive substances and the formation of neurogenic inflammation” (Huether, et al., 2020, p. 401). This disorder is characterized by sympathetic underactivity and parasympathetic activation with unilateral trigeminal distribution and ipsilateral autonomic manifestations (Huether, et al., 2020).
    • Module 11, Eleany YaseinSubscribe
    • Eleany Yasein posted Mar 31, 2021 12:17 PM
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    •           Based on the symptoms that are described, Bob is experiencing cluster headaches. Cluster headaches are rare, but are considered one of the most severe types of headache (Kandel & Mandiga, 2020). Cluster headaches are described as a unilateral headache that can happen anywhere from every other day, to eight times a day. Although they occur mainly during night time, they also occur around the same time during the day as well. There is not a clear understanding of cluster headaches, but there are different research studies suggesting the root of this headache. Trigeminovascular system and the parasympathetic nerve fibers are involved. There is a defect in the central pathway that controls pain and dysregulation in the autonomic nervous system. The supraspinal control of pain does not function normally and cognitive processing is affected. Studies also state that there is a dysfunction of intracellular signaling pathways of neurotransmitters, ion channels, and inflammation related molecules (Kandel & Mandiga, 2020).ReferenceWei, Y. D., Yuan Ong, J. J., & Goadsby, J. P. (2018, April). Cluster Headache: Epidemiology, Pathophysiology, Clinical Features, and Diagnosis. Annals of Indian Academy of Neurology21(1), S3–S8. UnreadUnread2 ViewsViews
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    • View profile card for Jazmin Jerez-Rivera
    • Last post April 3 at 4:44 PM by Jazmin Jerez-Rivera
    • Kandel, A. S., & Mandiga, P. (2020, June 30). Cluster Headache. StatPearls.
    • Moreover, there is activation of the posterior hypothalamus during cluster headache attacks (Wei et al., 2018). The involvement of the hypothalamus provides support for clinical presentation and treatments (Wei et al., 2018). Acute treatment for cluster headaches includes 100% oxygen therapy, triptans, intranasal lidocaine, octreotide and ergotamine (Kandel & Mandiga, 2020). Preventative treatments include verapamil, lithium, valproic acid and oral steroids (Kandel & Mandiga, 2020).  Electrical stimulation including deep brain stimulation of the hypothalamus has also been effective (Wei et al., 2018).
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    • Amandeep Kaur posted Mar 29, 2021 12:19 PM
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    • Based on the case scenario one can infer that Bob’s symptoms are consistent with cluster headaches. Cluster headaches have a clinical manifestation of severe unilateral pain, with agitation and restlessness (Wei et al., 2018) cluster headache essays. These attacks can last anywhere from 15 minutes to a couple of hours, up to eight times a day. These headaches can also cause eye redness, tearing and discomfort, nasal congestion, aural fullness, throat swelling, and flushing. These types of headaches occur predominantly in males, age of onset being 20-49 years old. The pathophysiology of these headaches is not fully understood. The symptoms and imaging lead to the theorization that the hypothalamus may be involved (Blanda, 2021). This is due to the nature of the attacks being intermittent and the hypothalamus controls circadian rhythm (biologic clock). There is also involved with central disinhibition of the nociceptive and autonomic pathways, specifically the trigeminal nociceptive pathways. Vascular dilation is also cited as possible causation for these headaches; however, studies show inconsistent results. The extracranial blood flow is increased but only after the initiation of pain. These cluster headaches also seem to initiate after the release of histamines, antihistamines have no effect in stopping these headaches. There are two forms of treatment for these headaches, symptomatic and prophylactic. Symptomatic treatments can include administration of oxygen, anesthetics, etc. NSAIDs have proven to give some pain relief in these headaches. Galcanezumab is one drug that has gotten FDA approval for prophylactic usage. It is cited to decrease the frequency of these headaches. Depending on the individual there are procedures that can be performed on the trigeminal nerve or the autonomic pathways. These include alcohol injections or even avulsion of nerves for chronic refractory cases.Wei, D. Y., Yuan Ong, J. J., & Goadsby, P. J. (2018). Cluster Headache: Epidemiology, Pathophysiology, Clinical Features, and Diagnosis. Annals of Indian Academy of Neurology21(Suppl 1), S3–S8. less1 UnreadUnread3 ViewsViews
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    • View profile card for Joanne Hogan
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    • Blanda, M. (2021, March 01). Cluster headache. Retrieved March 29, 2021, from
    • References
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    • Caroline Otto posted Apr 1, 2021 7:44 AM
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    • Pathophysiology of the Cluster Headache.They occur in one side of the head, and men between the ages of 20 and 50 years old are mostly affected. The source may alternate sides with each headache episode, and they are commonly described as stabbing and throbbing (Huether, S. E., McCance, K.L. & Brashers, V.L. 2020).The triggers are like those that cause migraine headaches, and these involve triggers that decrease the threshold for a migraine. They may be genetic, or associated with fatigue, oversleeping, missed meals, overexertion, weather change, stress or relaxation from stress, hormonal changes, or over stimulation from either bright lights, strong smells, and chemicals such as alcohol or nitrates.Current Treatment options for Patients who present with Cluster headaches.The medical treatment relies on prophylactic drugs.According to the American Headache Society evidenced based guidelines; Sumatriptan subcutaneous, zolmitriptan nasal spray, and high flow oxygen remain the treatments with a level A recommendation. For prophylactic therapy suboccipital steroid injections have emerged as the only treatment to received Level A recommendation. Notably what did receive a Level C recommendation – meaning a positive study was warfarin, I would personally not want to take warfarin ever, unless I absolutely had to.There has been some success noted with Zolmitriptan 5mg and 10mg, however it has been identified that these patients remain undertreated if treated at all. The main goal and focus should adhere to evidence based practice guidelines, as in all other areas of Medicine.References:7th ed. Elsevier MosbyRobbins, M. S., Starling, A. J., Pringsheim, T. M., Becker, W. J., & Schwedt, T. J. (2016). Treatment of Cluster Headache: The American Headache Society Evidence-Based Guidelines. Headache56(7), 1093–1106. UnreadUnread5 ViewsViews
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    • View profile card for Sheryl Dixon
    • Last post April 2 at 8:53 PM by Sheryl Dixon
    • Kingston, W. S., & Dodick, D. W. (2018). Treatment of Cluster Headache. Annals of Indian Academy of Neurology21(Suppl 1), S9–S15.
    • Huether, S. E., McCance, K.L. & Brashers, V.L. (2020). Understanding Pathophysiology.
    • According to another source, Oxygen at 6-15 L/min by a nonrebreather face mask has been shown to improve headaches in these clients. This continues to be the mainstay of treatment with much debate surrounding other options.
    • Acute Cluster headache attacks are treated with oxygen inhalation, sumatriptan or inhaled ergotamine administration and nerve stimulation.
    • Overall, the patient’s main goal should be to identify and become aware of what triggers these attacks and avoiding those triggers, such as caffeine, tyramine, fluorescent lighting, and alcohol.
    • When a Cluster headache develops there is trigeminal activation, but the mechanism of action is unclear. The pathogenic mechanism for pain is related to the release of vasoactive substances and the formation of neurogenic inflammation. Autonomic dysfunction is characterized by sympathetic underactivity and parasympathetic activation. There is unilateral trigeminal distribution of severe with ipsilateral autonomic manifestations, including tearing and ptosis of the eye on the affected side, and congestion of the nasal passages.
    • These headaches occur in clusters, thereby getting its name, and individuals may have up to 8 attacks per day, and they often last for minutes to hours for a period of days, followed by a long period of spontaneous cessation. These headaches are episodic and chronic varying between extreme pain intensity and short duration. If these headaches present without spontaneous cessation, they are referred to as; chronic cluster headaches which involve 10% to 20% of cases.
    • Cluster headaches are commonly referred to as trigeminal autonomic cephalalgias, meaning headaches that involve the autonomic division of the trigeminal nerve.
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    • Jazmin Jerez-Rivera posted Mar 30, 2021 9:55 PM
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    • After analyzing the patient’s symptoms further, it looks like Bob is suffering from Cluster Headaches. The pathophysiology can be complex and underlying causes are not fully clarified. The headache is neurovascular in nature and it stems from the trigeminal-autonomic reflex activation. This pathway “consists of a brainstem connection between the trigeminal nerve and facial cranial nerve parasympathetic outflow” (Wei et. al., 2018, p. 4). It is triggered by the stimulation of the trigeminovascular pathways. Pain afferents cross the ophthalmic division and receive signals from cranial vessels and dura mater. These synapse in the Trigeminocervical complex (TCC) and projects to brain structures that trigger pain, including the thalamus, cortex and hypothalamus (Wei et. al., 2018). The hypothalamus is connected to the ipsilateral trigeminal system which causes associated symptoms of tearing, ptosis of the eye, and nasal congestion (Huether et. al. 2020). Treatments for cluster headaches include oxygen therapy, and sumatriptan (Imitrex) injectable and nasal spray, which is frequently used for migraines. Another fast-acting nasal spray used is zolmitriptan (Zomig). Other injectables prescribed are ocreotide and dihydroergotamine (MFMER, 2019).ReferencesMayo Foundation for Medical Education and Research. (2019). Cluster headache. Retrieved from UnreadUnread1 ViewsViews
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    • View profile card for Jennifer Bryant
    • Last post April 2 at 1:34 AM by Jennifer Bryant
    • Wei, D. Y., Yuan Ong, J. J., & Goadsby, P. J. (2018). Cluster Headache: Epidemiology, Pathophysiology, Clinical Features, and Diagnosis. Annals of Indian Academy of Neurology21(Suppl 1), S3–S8.
    • Huether, S. E., McCance, K. L., Brashers, V. L. (2020). Understanding Pathophysiology (7 Ed.).  Elsevier.
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    • Sheryl Dixon posted Mar 31, 2021 6:13 PM
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    • A cluster headache is an uncommon type of headache “Cluster” is a descriptive term that refers to the way the attacks occur in groups, bursts or clusters, which can last from days to months and then go into remission, often for years at a time. The clusters occur with some seasonal regularity, most often in the spring or fall. During a cluster period, a patient may have one or several headaches in a day. The attacks frequently occur at night, waking the patient from a sound sleep. The pain is of short duration, lasting from a few minutes to several hours, though most often for 30 to 45 minutes. The pain is rarely present longer than four hours (Phelps, 2008).Cluster headaches may be triggered by alcohol and cigarette smoking, high altitudes (trekking and air travel), bright light (including sunlight), exertion (physical activity), heat (hot weather or hot baths), foods high in nitrites (bacon and preserved meats), certain medicines and cocaine (Medlineplus, 2020).Medications to improve quality of life. Prescription medications can shorten a headache cycle. They can also make the headaches less severe. Calcium channel blockers, verapamil, lithium carbonate, divalproex sodium, melatonin or topiramate may help. There is a new preventive therapy that is a calcitonin gene-related peptide (CGRP) monoclonal antibody.                                                                                                           ReferencesMedlineplus, (2020).Cluster headache. Retrieved from UnreadUnread6 ViewsViews
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    • View profile card for Cassie Fritzinger
    • Last post April 1 at 11:04 AM by Cassie Fritzinger
    • Phelps. P. (2008), Case Studies in Headache: Cluster Headache. Retrieved from
    • Clevelandclinic, (2018).Cluster Headaches. Retrieved from
    • Other options when needed Surgeons have tried operations for cluster headaches. But they haven’t had much success preventing them. Researchers are now testing newer therapies to see if they can work. One option uses mild electrical stimulation on the neck. Another creates electrical stimulation by placing a medical device through the upper gums (Clevelandclinic, 2018).
    • Unfortunately, there is no cure for cluster headaches. But you do have treatment options that can make them a little less painful. Treatment options include Abortive treatment to stop attacks: Often, a headache will stop before you have a chance to see a healthcare provider. But if you get there in time, there are several effective ways to stop a cluster headache. A healthcare provider may give you injected medications or a nasal spray. These include sumatriptan, dihydroergotamine and zolmitriptan. The provider may also give you oxygen through a mask.
    • Doctors do not know exactly what causes cluster headaches. They seem to be related to the body’s sudden release of histamine (chemical in the body released during an allergic response) or serotonin (chemical made by nerve cells) in the area of a nerve in the face called the trigeminal nerve. A problem in a small area at the base of the brain called the hypothalamus may be involved. More men than women are affected. The headaches can occur at any age, but are most common in the 20s through middle age cluster headache essays. They tend to run in families.
    • Dennies JonesSubscribe
    • Dennies Jones posted Mar 31, 2021 6:38 PM
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    • Bob is suffering from clustered headaches. According to Huether et al. (2020), “cluster headaches are part of a group of disorders known as trigeminal autonomic cephalalgias, headaches involving the autonomic division of the trigeminal nerve. CH headache is usually felt on one side of the head and is seen primarily in males between the age of 20 and 50” (p. 970. The headaches occur in clusters and can last from minutes to hours for several days, followed by months of nonrecurrence (Huether et al., 2020). Signs and symptoms are lacrimation, nasal congestion, rhinorrhea, forehead and facial sweating miosis, ptosis, eyelid edema, and restlessness or agitation.       less1 UnreadUnread6 ViewsViews
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    • View profile card for Cassie Fritzinger
    • Last post April 1 at 10:44 AM by Cassie Fritzinger
    • Ljubisavljevic, S., & Zidverc Trajkovic, J. (2019). Cluster headache: pathophysiology, diagnosis, and treatment. Journal of neurology, 266(5), 1059–1066.
    • Huether, S., McCance, K., & Brashers, V. (2020). Understanding Pathophysiology (7th ed.). Elsevier.
    • Guo, X. N., Lu, J. J., Ni, J. Q., Lu, H. F., Zhao, H. R., & Chen, G. (2019). The role of oxygen in cluster headache. Medical gas research, 9(4), 229–231.
    • References
    •             According to (Huether et al., 2020), “prophylactic drugs are used to treat CH. Avoiding things that trigger headaches is essential; acute attacks are treated with oxygen inhalation, sumatriptan, or inhaled ergotamine administration and nerve stimulation” (p. 971). High flow oxygen has been recommended for alleviating acute attacks of CH and is one of the first-line acute treatments. Oxygen is better when compared to other acute medications, such as sumatriptan and zolmitriptan; oxygen causes very few side effects or long-term harm (Guo et al., 2019).
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    • Steven Bartos posted Mar 31, 2021 11:02 PM
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    • Based on this week’s scenario, I would provide a diagnosis of Cluster Headaches. Bob met the following diagnostic criteria for cluster headaches, which includes having severe unilateral orbital, supraorbital, and/or temporal pain lasting 15 – 180 min, up to eight times a day, if left untreated. Furthermore, Bob had at least one of the following: conjunctival injection and/or lacrimation, nasal congestion and/or rhinorrhea, eyelid edema, forehead and facial sweating, and miosis and/or ptosis (Ljubisavljevic & Trajkovic, 2019).            Acute cluster headaches are typically treated with inhaled oxygen, recommended at 12 – 15 L/min for 15 – 20 min through a non-rebreathing facemask. Parenteral treiptans have also been shown to be effective, however, oral triptans have not. Sumatriptan subcutaneously is the most effective triptan. Sumatriptan and Zolmitriptan nasal spray have both been proven to be effective. If these interventions are ineffective or contraindicated, Lidocaine has been effective in approximately one third of patients (Hoffmann & May, 2018). Preventative options include verapamil 360 mg and lithium 900 mg doses have been shown effective in research. Research into neurostimulation of the hypothalamus and occipital nerve also shows promise for treating cluster headaches (Ljubisavljevic & Trajkovic, 2019).Hoffmann, J., & May, A. (2018) cluster headache essays. Diagnosis, pathophysiology, and management of cluster headache. Lancet Neurology, 17(1), 75 – 83. less1 UnreadUnread6 ViewsViews
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  • View profile card for Caroline Otto
  • Last post April 1 at 8:15 AM by Caroline Otto
  • Ljubisavljevic, S., & Trajkovic, J.Z. (2019). Cluster headache: Pathophysiology, diagnosis and treatment. Journal of Neurology, 266(5), 1059 – 1066.
  • References
  • Cluster headaches involve the autonomic division of the trigeminal nerve. The exact mechanism in the pathophysiology of cluster headaches remains unclear, but it is believed to involve several structures of the peripheral nervous system and central nervous system. When the trigeminovascular system is activated, and the pain associated with cluster headaches is related to the release of CGRP, a vasodilator that regulates the nociceptive trigeminal neurons. Furthermore, the parasympathetic system is connected to the trigeminal nerve through the superior salivatory nucleus, via the facial nerve; this regulates conjunctival injection, lacrimation and rhinorrhea, and cranial and extracranial vasodilation. Recently, research with MRI’s and animal studies has also shown that the hypothalamus may be involved as well, possibly related to melatonin, the GABAergic, and the glutamatergic receptor systems (Hoffmann & May, 2018).
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  • Cassie Fritzinger posted Mar 28, 2021 11:41 PM
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  • Based on Bob’s presentation I would diagnosis him with Cluster Headaches. According to Heuther, McCance & Brasher (2020), cluster headaches are also known as trigeminal autonomic cephalalgias. The usual presentation of these types of headaches includes pain on one side of the head such as stabbing and throbbing (which can alternate sides with each episode), unilateral tearing of the eye, ptosis, as well as nasal congestion. Cluster headaches typically present in males between the ages of 20 and 50 (Heuther, McCance, Brasher, 2020). Bob is exhibiting typical signs/symptoms of cluster headaches and does have periods of remission when he is headache free for several months thus he does not have chronic cluster headaches which occurs in a small percentage of cases (Heuther, McCance, & Brasher, 2020).Cluster headaches have also been seen to be related to abnormal melatonin levels. These patients have a low nocturnal melatonin level, thus have had some success with supplementation. However, Wei & Jensen (2018) report that those with chronic cluster headaches did not have relief with the melatonin treatments, and those with episodic cluster headaches had minimal relief. Although with the low potential adverse effects one may suggest adding melatonin to other treatments as an adjunctive therapy (Wei & Jensen, 2018). ReferencesChrisholm-Burns, M. A., Schwinghammer, T.L., Malone, P.M., Kolesar, J.M., Lee, K.C., Bookstaver, P.B. (2019). Pharmacotherapy: Principles and practices (5th ed.) McGraw-Hill Education.Wei, D. & Jensen, R. (2018) Therapeutic Approaches for the Management of Trigeminal Autonomic Cephalalgias. Neurotherapeutics. 15(2): 346-360. 10.1007/s13311-018-0618-3
  • Heuther, S. E., McCance, K. L., & Brashers, V. L. (2020). Understanding Pathophysiology (7th ed.). Elsevier.
  • Barloese, M.C.J. (2018) cluster headache essays. The pathophysiology of the trigeminal autonomic cephalalgias, with clinical implications. Clin Autonomic Research 28, 315–324.
  • While there are different views on the treatments of headaches, it would be important for the patient to evaluate their headaches and start a headache journal to document any triggers. Knowing triggers will assist the patient in attempting to avoid these triggers potentially lessening the frequency of their headaches. Chrisholm-Burns, Schwinghammer, Malone, Kolesar, Lee & Bookstaver (2019), recommend the treatment for cluster headaches begin with the administration of 100% oxygen via a high glow nonrebreather mask at 12-15L/min for a time of 15 minutes. This is suggested secondary to the reported increased amount of cluster headaches with high-altitude exposure suggesting hypoxemia as a cause of cluster headaches (Chrisholm-Burns, Schwinghammer, Malone, Kolesar, Lee & Bookstaver, 2019). Should the administration of oxygen be ineffective to the treatment of these cluster headaches, another suggestion would be to begin adjunctive therapy using triptan class medications. For the acute cluster headache, it is suggested to use intranasal or subcutaneous sumatriptan for a more rapid onset of relief of symptoms. The oral use of triptans may play a better role in the limiting of recurrence cluster attacks secondary to their delayed onset. A caution with triptans is the vasoconstrictive property which should be avoided in patients with underlying ischemic vascular disease. For these patients, octreotide a somatostatin analogue administered subcutaneously, can be used. Octreotide does not have the vasoconstrictive properties (Chrisholm-Burns, Schwinghammer, Malone, Kolesar, Lee & Bookstaver, 2019).
  • Cluster headaches or trigeminal autonomic cephalalgias are poorly understood in means of pathology. The presentation of these headaches is only a portion of the complex symptoms associated with the pathophysiology of this type cephalalgia. There is an activation of the trigeminal-autonomic reflex, this reflex which is controlled by higher centers in an important part of the wide range of symptoms likely indicating a homeostatic disturbance. It has been suggested that the hypothalamus plays a key role in these headaches (Barloese, 2018). Unique symptomology of cluster headaches is the “circannual and circadian tendency, as well the neurohormonal changes in testosterone, cortisol, and melatonin”, supporting the hypothalamus as being a part of these symptoms (Wei & Jensen, 2018) cluster headache essays. Wei & Jensen (2018), also report that Nitric oxide also plays a part in cluster headaches, and it was found that patients with cluster headaches have a higher level of nitric oxide in their plasma. Because of this the use of nitroglycerin has been found to trigger cluster headaches. While indomethacin is classified as a nonsteroidal anti-inflammatory drug (NSAIDs) it is not equal to all other NSAIDs and has been found to affect the Nitric Oxide mechanism associated with cluster headaches. This treatment is part of a Nitric Oxide-cyclic guanosine monophosphate (NO-cGMP) cascade which is a therapeutic target for treatment cluster headache essays.
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