Cluster Headache

Cluster Headache

Cluster headache is an overwhelmingly unilateral head pain typically centered around the eye and temporal regions. The pain is’ intense, frequently described as a stabbing sensation (i.e., as if an ice pick was being driven into the eye). Some component of parasympathetic overactivity
is present (commonly lacrimation, conjunctival injection, ptosis, or rhinorrhea). Headaches last 15 to 180 minutes and may occur once or multiple times per day, commonly with’ precise regularity (e.g., awakening the patient at the same time night after night), The headaches occur in “clusters” such that they may be present for some months and then remit’ for several months or even, years. Alcohol ingestion consistently triggers
headache but only during cluster episodes. As opposed to ‘most other chronic headaches, men are much more-like- Iy to suffer from cluster headache than women (Box 29-8). IHS criteria are listed in Box 29-9. Treatment, as in migraine, is either; preventive or symptomatic. Preventive
treatment is accomplished with verapamil, lithium salts, anticonvulsants, corticosteroids, and certain ergot com- ,pounds, Symptomatic treatment is with “triptans,” ergots, and analgesics. Oxygen inhalation at 7 to “to
min may be an effective abortive treatment.

BOX 28-9

Common Cluster Headache Features

Sex: Mainly male
Frequency: Up to 8 per day
Quality: Throbbing/stabbing
Intensity: Severe

BOX 29-9

IHS Criteria for Cluster Headache

A. Severe unilateral orbital, supraorbital, or temporal
pain (or a combination) lasting 15 to 180 minutes
(Note: Frequently in posterior maxillary dentoalveolar
region as well) –
B. At least one of the following on the headache side:
• Conjunctival injection
• Facial sweating
-. Lacrimation
• Miosis
• Nasal congestion
• Ptosis
• Rhinorrhea
• Eyelid edema
C. No evidence of organic disease

Dentists must be aware that frequently cluster headache produces pain in the posterior maxilla, mimicking severe dentoalveolar pain in the posterior maxillary teeth. The pain is frequently stabbing and intense,although background aching may occur. Unnecessary dental therapy is, unfortunately, common. Common features can distinguish a toothache secondary to cluster headache from a toothache produced by a dental problem  Rapid emergence and discontinuation of symptoms unlike typical toothache  Toothache precipitated by alcohol ingestion .

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