"Headaches" are real, and two ways can alleviate them

Source: Health Times Network

"I have a patient who said that when he had a headache attack, he really had a 'headache', he hurt so much that he hit the wall with his head and punched his head with his fist, and it really hurt so much that he couldn't stand it," said Professor Zhao Hongru, chief physician of the Department of Neurology at the First Affiliated Hospital of Soochow University.

Cluster headache attacks are intense

Cluster headache in English is "cluster headache", of which "cluster" means dense, one strain, and the Chinese called "cluster" is very graphic and accurate. "Unlike other occasional headaches, the cluster period of the general Chinese group is about 2-4 weeks, and the cluster period reported abroad is longer, such as 4 weeks to 8 weeks." Headaches recur during the cluster period, lasting from 15 minutes to 3 hours, and the patient is extremely painful. Professor Zhao Hongru introduced.

Although the pathogenesis of cluster headache is not yet fully understood, according to the data of clinical diagnosis and flow adjustment, Professor Zhao Hongru summarized several pathogenesis characteristics. First of all, 20-40 years old is a more common age of onset; this headache is more in men, male and female is about 4 to 7:1 ratio; the incidence has a certain periodicity, because it is related to hypothalamus activation, and the hypothalamus regulates the body's biological rhythm, so the onset of cluster headache has a certain periodicity, such as in winter and spring or autumn, the daily headache attack time is also relatively fixed; in addition, drinking alcohol, the use of nitroglycerin or weather changes are also the causes of cluster headache attacks.

Cluster headache is difficult to diagnose and treat

The first is the diagnosis of problems, some commonly used clinical tests such as laboratory tests, head CT or magnetic resonance and electroencephalogram have no special abnormalities. The diagnosis of cluster headache is mainly based on clinical manifestations: recurrent attacks; fixed headache sites, such as unilateral orbit, supraorbital or temporal parts; severe or very severe headache degree and characteristic concomitant symptoms, such as conjunctival congestion, tearing nasal congestion, etc.; combined with laboratory, imaging examination, etc. to fully exclude various other causes of headache similar to cluster headache-like manifestations, the diagnosis can be basically confirmed.

The clinical manifestations of cluster headache are very typical, but its diagnostic rate is not ideal, on the one hand, because the number of patients is relatively small, some doctors are not familiar with its clinical characteristics and diagnostic criteria; more importantly, the patient's awareness rate is also low, often because the headache is always fixed on one side, self-diagnosis as "migraine", when visiting the doctor will also mislead the receiving doctor, resulting in misdiagnosis and missed diagnosis. In addition, although painkillers can also relieve headaches in a small number of patients, there is no evidence that painkillers can relieve cluster headaches; some patients have "endured" through the cluster period, delaying diagnosis and treatment.

Inhalation of pure oxygen and medication can help with relief

Episodes of cluster headache are currently considered to be prodromal, acute, and late. The main current treatment recommendations for the acute phase are pure oxygen and the use of triptan-like drugs, which are effective in most episodes in most patients.

"Pure oxygen and mixed oxygen are different, pure oxygen or high-flow oxygen inhalation, generally inhale 10 to 15 minutes, the flow rate needs to reach 6 to 12 liters per minute, the need for special oxygen inhalation masks, can help patients quickly relieve pain." Professor Zhao Hongru said.

In terms of drugs, there are seven major categories of triptan abroad, and the domestic commonly used are zomitriptan, rizatriptan and sumatriptan. Cluster headache episodes require preventive treatment, and hormones, verapamil, lithium salts, dihydroergotamine, etc. can be used as treatment options. Also worth looking forward to is CGRP's monoclonal antibody, Galcanezumab. In addition, neuromodulation therapy can also be used for the treatment of cluster headaches.

(Editor-in-charge: Li Xuanzhang)