Cluster headaches are often said to be the most painful of all headaches. They have been described as "boring," bearing, burning," "like a hot poker in the eye," and as "suicide headaches." The age of onset of cluster headaches is most often between the ages of 20 and 40, and they are more common in men than women at a ratio of 2.1. For many years, that ratio was stated to be 3:1. Researchers theorize that women have long been misdiagnosed because cluster headaches were thought to be so predominantly found in men.
有几个方面先前已用来指丛集性头痛：睫状神经痛，头赤melalgia，兵erythroprosopalgia，偏头痛angioparalytica，偏头痛neuralgiformis chronica，组织胺cephalalgia，霍顿的头痛，哈里斯 - 霍顿病，偏头痛性神经痛（哈里斯），岩神经痛（加德纳）。
Cluster headache symptoms:
Cluster headaches are attacks of severe pain lasting 15-180 minutes and occurring from once every other day up to eight times in one day.
The pain is:
severe
unilateral
轨道(t附近he orbit, the bone framing the eye), supraorbital (above the orbit), temporal (at the tempe), or a combination of those sites.
These attacks also include one or more of these symptoms ipsilaterally (on the same side as the pain):
conjunctival injection (forcing of fluid into the conjuctiva, the mucous membrane that lines the eyelids)
眼睑水肿（肿胀）
forehead and facial sweating
lacrimation (tearing)
瞳孔缩小（瞳孔的异常收缩）
鼻塞
rhinorrhea (runny nose)
上睑下垂(眼睑下垂)
Most cluster headache patients are restless or agitated during attacks and find it hard to be still. Cluster sufferers characteristically pace the floor during an attack.
Cluster headaches are diagnosed as "episodic" when the attacks occur in periods lasting 7 days to 1 year separated by pain-free periods lasting 1 month or longer. In "chronic" cluster headaches, attacks occur for more than 1 year without remission or with remissions lasting less than 1 month.
The term cluster headaches comes from the attacks usually occur in series (cluster periods) lasting for weeks or months separated by remission periods usually lasting months or years. However, about 10-15% of patients have chronic symptoms without remissions.
有没有诊断测试，以确认丛集性头痛。诊断是通过查看患者的个人和家族病史，研究他们的症状，并进行检查来完成。丛集性头痛，然后通过排除其他原因的症状诊断。
Treatment of cluster headaches:
Acute treatment:The most commonly used therapies to shorten or abort a cluster attack are:
• 100% oxygen administered by mask
•舒马曲坦（Imitrex, Imigran) nasal spray or subcutaneous injection
• DHE-45
The most commonly used preventive medications are:
• lithium
• divalproex sodium (Depakote, Depakote ER)
• topiramate (Topamax)
• melatonin
In the International Headache Society's International Classification of Headache Disorders, 2nd Edition (ICHD-II), cluster headache is described as,
"Attacks of 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 8 times a day. The attacks are associated with one or more of the following, all of which are ipsilateral: conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, forehead and facial sweating, miosis, ptosis, eyelid oedema. Most patients are restless or agitated during an attack."
The diagnostic criteria for cluster headaches under ICHD-II are:
- At least 5 attacks fulfilling criteria B-D
- Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 minutes if untreated
- Headache is accompanied by at least one of the following:
1.同侧结膜充血和/或流泪
- ipsilateral nasal congestion and/or rhinorrhoea
- ipsilateral eyelid oedema
- ipsilateral forehead and facial sweating
- 同侧瞳孔缩小和/或上睑下垂
- a sense of restlessness or agitation
- Attacks have a frequency from one every other day to 8 per day
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Resources:
"The International Classification of Headache Disorders, 2nd Edition."Cephalalgia24(s1). doi: 10.1111/j. 1468-2982.2003.00824.x
Stephen D. Silberstein, MD; Alan Stiles, DMD; William B Young, MD; Todd D. Rozen, MD. "An Atlas of Headache." Parthenon Publishing, 2002.
Randolph W. Evans, Nina T. Mathew. "Handbook of Headache, Second Edition." Philadelphia: Lipincott Williams & Wilkins. 2005.
Young, William B., MD; Silberstein, Stephen D., MD. "Migraine and Other Headaches." Ney York: AAN Press. 2004.
斯蒂芬D.斯坦博士理查德·利普顿B.，MD，和Donald J. Dalessio，MD。“沃尔夫的头痛等头痛，”第七版。牛津大学出版社，2001年。
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