Definition
Synonyms: Bing-Horton syndrome, Bing-Horton neuralgia, erythroposopalgia, lightning headache: cluster headache. Cluster headache is a form of recurrent headache. It occurs unilaterally, usually in the eye-forehead- sleep area, and has some features that are different from other forms of headache:
Symptoms
Cluster headache is characterised by an accumulation of very severe painful episodes over 1-2 months, alternating with symptom-free periods of 6 months to 2 years. A pain episode usually lasts 15 minutes to 2 hours and can occur up to 10 times a day, accompanied by reddening and watering of the eyes, a drooping eyelid on the affected side or runny nose. The pain occurs particularly at night and in the morning hours, with a seasonal accumulation in spring and autumn. In some cases the pain is caused by alcohol (even small amounts), bright light or certain drugs. The great intensity of the pain and the frequency of the episodes can mean immense suffering for those affected!
Cause
The cause of recurrent headache episodes is ultimately unclear. While some explanations are based on the assumption that the inflammation is not caused by the pathogen in the area of the brain‘s vessels, others see the cause in disorders of the regulation of vascular width there. Episodic headache can also be symptomatic of another underlying disorder.
This may be due to aneurysms or tumours. To find the cause of cluster headaches, documentation in a headache diary is also suitable, in which one writes down over a certain period of time when, where and to what extent the complaints occur. The neurologist can then use the evaluation for diagnosis and therapy planning.
What are typical triggers?
Most cluster headaches have no identifiable trigger. However, it has been found that many of the patients have inflamed veins behind the eye, which probably irritate the nerves at this point. This could be an explanation for the cluster headaches.
Within a period in which pain attacks occur more frequently, it has been observed that alcohol is often a trigger for such attacks. In addition, the stay at high altitude, such as in the Alps, is observed as a trigger for the attacks within a cluster period. Other triggers can be the drug nitroglycerine, which is used to dilate blood vessels around the heart.
The hormone histamine can also lead to vasodilation. This hormone is released by the body in the case of allergies and inflammations in order to increase the blood flow. All these triggers are handled as primary triggers of cluster headache.
The secondary triggers are tumours and vascular malformations that irritate the nerves and thus cause the pain. Histamine plays a role as a trigger factor or trigger of cluster headache attacks. This effect is primarily only observed during an existing cluster period. Histamine is an endogenous hormone that is released by the body in connection with allergies and inflammations. It causes a dilation of the blood vessels, which increases the blood circulation.
