According to the International Headache Society (IHS), cluster headache attacks can be described as severe, strictly unilateral pain which is orbital, supraorbital, temporal or in any combination of these sites, lasting 15-180 minutes and occurring from once every other day to eight times a day (1)
- pain
- is unilateral in at least 97% of people with episodic disease
- usually experienced behind the eye (88-92%), over the temple (69-70%), or over the maxilla (50-53% . Sometimes it may extend to other areas of the head and neck.
- pain may shift sides between bouts of attacks and less commonly during a bout (never during the attack itself)
- patients usually describe pain as a sharp, piercing, burning, or pulsating sensation like “having a red hot poker forced through my eye,
- a cluster attack is an individual episode of pain.
- may last between 15 and 180 minutes (on rare occasions they may last longer)
- rapid build-up of pain, may increase from serious discomfort to excruciating pain over the course of a few minutes
- intensity of the pain remains at maximum throughout the duration of the attack
- in some patients, pain may wax and wane slightly, or be punctuated by super-intense stabs of pain
- ends abruptly
- frequency of attacks may vary from one attack every 48 hours to eight separate attacks in 24 hours (2)
Other concomitant symptoms seen during attacks include:
- activation of the cranial autonomic pathways – usually transient and resolve with cessation of pain
- ipsilateral lacrimation (91%)
- ipsilateral conjunctival injection (77%)
- ipsilateral nasal congestion or rhinorrhoea (75%/72%)
- ipsilateral ptosis (74%)
- ipsilateral oedema of the eyelid or the face (or both) (74%)
- ipsilateral sweating of the forehead or the face (or both) (38%)
- ipsilateral miosis (29%)
- sense of restlessness and agitation, patients often pace, rock back and forth, and bang their heads
- nausea - 28% and 50%
- vomiting – around 23%
- photophobia, often limited to the same side as the pain - 54-64%
- an aversion to loud noise (43%) or strong smells (26%) (2)
Note
- a cluster bout refers to the time period where a number of attacks re-occur, usually lasting some weeks or months.
- local damage to occulosympathetic fibres caused by repeated attacks may result in persistence of partial Horner’s syndrome or isolated ptosis between attacks or even bouts
- consider a secondary cause if they progressively worsen (2)
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