Pathophysiology and Current Treatment Options

Cluster Headache (CH): Pathophysiology and Current Treatment Options

From the case scenario that has been provided for Bob, he is most likely suffering from a diagnosis of cluster headache or CH. This type of headache is characterized by pain that is orbital, temporal, supraorbital, or all three. One important diagnostic detail is that the pain is strictly unilateral affecting only one side of the head and is quite severe. The headache typically lasts for between a quarter of an hour and three hours. It is also accompanied by tearing of the eye (lacrimation), a runny nose (rhinorrhea), nasal congestion, restlessness, and facial diaphoresis amongst others. Its effect on the quality of life can be so severe that it leads to suicidal ideation (Ljubisavljevic & Trajkovic, 2018; Hoffmann & May, 2017). Pathophysiology and Current Treatment Options

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Pathophysiology and Current Treatment Options

CH is a trigeminal autonomic cephalalgia (TAC) brought about by pain that is distributed in the facial areas supplied by the first division (ophthalmic) of the trigeminal nerve. Pathophysiologically, CH is neurovascular in origin with the severe unilateral pain resulting from the activation of the ophthalmic division of the trigeminal nerve. One of the signaling protein molecules for CH is the calcitonin gene-related peptide or CGRP whose plasma levels are elevated during an attack of severe headache. The autonomic symptoms that are characteristic of CH as stated in the introduction are the result of activation of the parasympathetic autonomic outflow from the facial nerve (7th cranial nerve). It is thought that hypothalamic disturbance is what leads to central autonomic dysregulation causing the witnessed autonomic symptoms of CH (Ljubisavljevic & Trajkovic, 2018; Hammer & McPhee, 2018; Hoffmann & May, 2017). Pathophysiology and Current Treatment Options

The aims of treatment are to abort an ongoing attack and to prevent future attacks of unilateral headache. Evidence-based therapy for CH includes (i) 100% oxygen by face mask at 12 L/min for 15 minutes (to abort an ongoing attack), and (ii) sumatriptan or zolmitriptan intranasally (Ljubisavljevic & Trajkovic, 2018; Hammer & McPhee, 2018; Hoffmann & May, 2017).

References

Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8th ed. McGraw-Hill Education.

Hoffmann, J., & May, A. (2017). Diagnosis, pathophysiology, and management of cluster headache. The Lancet Neurology, 17(1), 75-83. https://doi.org/10.1016/S1474-4422(17)30405-2

Ljubisavljevic, S., & Trajkovic, J.Z. (2018). Cluster headache: Pathophysiology, diagnosis and treatment. Journal of Neurology, 266(5), 1059-1066. http://dx.doi.org/10.1007/s00415-018-9007-4

Pathophysiology and Current Treatment Options