Cluster Headache - Incidence and Its Association with Age, Gender and Triggers

BACKGROUND Cluster headache is an unusual but particularly painful and crippling primary headache disorder with a prevalence of 1 in 1000 making study of the disease process a difficult task to master. These headaches are always unilateral characterised by recurrent short-lasting attacks of 15 - 180 minutes associated with ipsilateral autonomic signs. The diagnosis is mainly clinical, and it continues to be managed sub optimally as the chance of coming across such a condition is few and far between. This study was conducted to determine the incidence of cluster headache in a hospital population and study its association with age, gender and triggers. METHODS This is a cross sectional study of a total of 100 patients attending our Otorhinolaryngology department from June 2017 to June 2018 at Sri Muthukumaran Medical College Hospital & Research Centre with primary complaints of headache. Prior ethical committee clearance was obtained. Patients with chronic debilitating illness, chronic rhino sinusitis, headache following trauma or the presence of fever or any other acute illness were excluded from this study. The results were interpreted using Statistical Package for Social Sciences (SPSS) version 17. RESULTS Out of the total number of 100 patients with headache, only one patient, a 40-yearold male was diagnosed with cluster headache. CONCLUSIONS Hence, we conclude that the incidence of cluster headache in the total of 100 patients is only 1 % which makes it a quite rare condition. Diagnosis is clinical, hence effective history taking is mandatory. KEY WORDS Cluster Headache, Primary Headache, Trigeminal Autonomic Cephalgia, Cluster Attacks

Dynamic Pressure Pain Hypersensitivity as Assessed by Roller Pressure Algometry in Episodic Cluster Headache

Background: A method for assessing dynamic muscle hyperalgesia (dynamic pressure algometry) has been developed and applied in tension-type and migraine headaches. Objectives: To investigate differences in dynamic pressure pain assessment over the trigeminal area between men with cluster headache (CH) and headache-free controls, and the association between dynamic and static pressure pain sensitivity. Study Design: A case-control study. Setting: Tertiary urban hospital. Methods: Forty men with episodic CH and 40 matched controls participated. Dynamic pressure pain sensitivity was assessed with a dynamic pressure algometry set consisting of 8 rollers with different fixed levels (500, 700, 850, 1,350, 1,550, 2,200, 3,850, and 5,300 g). Each roller was moved at a speed of 0.5 cm/sec over a diagonal line covering the temporalis muscle from an anterior to posterior direction. The dynamic pressure threshold (DPT; load level of the first painful roller) and the pain intensity perceived at the DPT level (roller-evoked pain) were assessed. Static pressure pain thresholds (PPT) were also assessed with a digital pressure algometer applied statically over the mid-muscle belly of the temporalis. Patients were assessed in a remission phase, at least 3 months from the last cluster attack, and without preventive medication. Results: Side-to-side consistency between DPTs (r = 0.781, P < 0.001), roller-evoked pain on DPT (r = 0.586; P < 0.001), and PPTs (r = 0.874; P < 0.001) were found in men with CH. DPT was moderately, bilaterally, and side-to-side associated with PPTs (0.663 > r > 0.793, all P < 0.001). Men with CH had bilateral lower DPT and PPT and reported higher levels of rollerevoked pain (all P < 0.001) than headache-free controls. Limitations: Only men with episodic CH were included. Conclusions: This study supports that a dynamic pressure algometry is as valid as a static pressure algometry for assessing pressure pain sensitivity in patients with CH. Assessing both dynamic and static pain sensitivity may provide new opportunities for differentiated diagnostics. Key words: Cluster headache, dynamic pressure pain, pressure pain threshold

Low-temperature plasma radiofrequency ablation of Sphenopalatine ganglion in Cluster headache: a case report

Background： Herpes zoster is a common disease mainly affect sensory nerves, but in this report sphenopalatine ganglion (SPG), mainly a parasympathetic ganglion was infected by the vesicular-zoster virus, with the performance of cluster headache. Case presentation: The patient underwent headache on left side orbit, supraorbital and temporal regions after infection of herpes zoster for 8 months, with lacrimation, conjunctival injection and nasal discharge. Pulsed radiofrequency of the SPG under ultrasound guidance was performed, we applied 2 cycles of PRF at 42℃for 120 seconds each time. Partial response lasted 1 month and the pain had recover to its baseline level. Low-temperature plasma radiofrequency ablation (coblation) technology is a relatively new technology that has shown promise in treating neuropathic pain. Then a CT-guided coblation of SPG was performed, used three of intensity for coblation (lasting for 30s, repeat twice) and six of intensity for coagulation (lasting for 30s, once). After coblation, the patient reported completed pain relief and autonomic symptoms disappeared without any side effects. The patient was satisfied with the effect on post-operative telephone follow-up performed on day 7, month 1 and month 3, pain VAS score remained on 0/10. Conclusions: Our report demonstrates that coblation technology is succeseful treatment for cluster headache in this case, but this finding still needs additional studies for confirmation. Key words: cluster headache, coblation, herpes zoster

Chronic Bilateral Sphenopalatine Ganglion Stimulation for Intractable Bilateral Chronic Cluster Headache: A Case Reportlkmjn

A cluster headache (CH) is an excruciating pain centered on the periorbital region and is accompanied by autonomic symptoms. Despite the best currently available medical therapy, many patients still suffer from these headaches. Some patients also experience CH with side shift of attacks, which makes treatment more difficult. In light of the pathophysiological mechanism of CH, the sphenopalatine ganglion (SPG) is a promising therapeutic target for its management. SPG ablation and non-ablation techniques have been the preferred treatment for CH in recent decades. However, few articles have reported the effectiveness of acute SPG stimulation for CH, and no studies have demonstrated the safety and efficacy of bilateral continuous SPG stimulation for CH. In this article, we report on a 59-year-old chronic cluster headache (CCH) patient who had side shifts of attacks and was treated with bilateral continuous SPG stimulation. The patient suffered from CCH for 9 years, and the intensity of pain and the frequency of attacks had gradually increased over time. At the time of admission, he experienced daily attacks. Medical therapy and SPG blocks were offered, but he only achieved transient pain relief. After a careful preoperative examination and discussion with the patient, we provided bilateral SPG stimulation. The electrode was implanted under C-arm fluoroscopic guidance. After continuous stimulation, the patient experienced significant reductions in headache severity. The frequency of attacks was reduced from daily to less than once per week. He also discontinued all of the related drugs that he was taking. This is the first report of bilateral continuous SPG stimulation for CCH. This report indicates that continuous SPG stimulation is a feasible therapeutic option for CCH. However, large-scale and long-term studies are required to elucidate the efficacy of SPG stimulation. Key words: Cluster headache, sphenopalatine ganglion, SPG, neuromodulation, side shift, stimulation