Today, March 21, is the International Cluster Headache Day. According to data from the Spanish Society of Neurology (SEN), nearly 50,000 people suffer from it in Spain. cluster headachea type of headache that is one of the most disabling in existence given the high intensity of the pain: 78% of patients suffer from significant restrictions in their daily lives.
“Cluster headache, although it is not the most common type of headache, it is the most common within the group of trigeminal autonomic headaches. It is characterized by the appearance of pain on only one side of the head and is generally accompanied by other ocular or nasal symptoms such as tearing, redness, congestion or nasal discharge”, explains the Dr. Pablo Irimia, Coordinator of the Headache Study Group of the Spanish Society of Neurology (SEN). “It is usually relatively short-lived, but the pain is experienced so intensely that many patients describe it as excruciating or unbearable. In addition, patients show great motor restlessness because they poorly tolerate being in a resting position”.
Another characteristic that defines this type of headache is that it is usually presents almost always at the same time, with an evening or nocturnal predominance in 73% of cases, and the crises frequently occur at certain times of the year, especially with the changes of season at the beginning of spring or at the end of autumn. And although the vast majority of patients experience it episodically -that is, quite long periods of remission are combined, together with symptomatic periods-, in up to 20% of patients, cluster headache can become chronic and, in these cases, periods of remission practically disappear.
Problems with the diagnosis of cluster headache
“Cluster headache is possibly one of the most underdiagnosed types of headache in Spain. In the first place, because if it does not become chronic, the periods of remission can be so long that there are few patients who, especially in the first years of their disease, do not go so far as to consult a specialist”, says Dr. Pablo. Irimia. “But it is also a type of headache in which, despite having such specific characteristics, as it is not a very common disease, more than 57% of patients receive previous erroneous diagnoses.”
Currently, in Spain, about 1,000 new cases of this disease are diagnosed. But still, there is a diagnostic delay which, in many patients, may be longer than 3 years. “The main consequence of not having a diagnosis is that, by not being able to access adequate control and treatment for this disease, headache crises will become more common and will tend to become chronic. And when patients already have a chronic cluster headache, their disease will not only be much more disabling, but they will also experience a reduced response to drugs. Because we also calculate that 10% of chronic forms are refractory to drugs”, says Dr. Pablo Irimia.
Cluster headache without diagnosis and treatment becomes chronic in 20% of cases
The SEN estimates that more than 50% of patients are not receiving the adequate preventive treatment and that more than 30% of patients do not have access to adequate symptomatic treatments, especially oxygen therapy, which is one of the main therapies of choice. “The usual treatment of patients is done with drugs, but resistant cases may benefit from surgical treatment,” says Dr. Pablo Irimia. “It is therefore necessary to emphasize not only the relevance for the population of becoming aware of the importance of consulting headaches, but also to call on all medical professionals to improve their clinical identification, to prevent this disease from becoming chronic.” .
The origin of cluster headaches is currently unknown, although it seems that certain alterations in a brain structure called the hypothalamus have been identified. On the other hand, and although there are cases of cluster headache in childhood, adolescence and in the elderly, it is a disease that especially affects young adults around 30 years of age. And above all it affects males, in a ratio of 4:1.