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THE CLUSTER HEADACHE
We have been using the term “vascular headaches” to refer to a group of headache conditions that share the common feature of having blood vessel widening as a major component in the production of painful symptoms. Migraine is the best-known headache disorder of this group. Another headache of this vascular headache group is a condition called cluster headache. This headache claims the notorious distinction of being one of the most painful conditions known to medical science. So ravaging is this headache that suicide has not only been contemplated but carried out as a means of escaping the agony of this affliction.
Cluster headaches are known by a variety of names. They are also called histamine headaches because this chemical is perhaps related to the sequence of events in this syndrome. Histamine, you may recall, is one of the amine substances that play an important role in causing the pain and inflammation associated with allergic conditions.
Sometimes cluster headaches are called Horton’s headaches, after the physician who first described this condition in the United States. Cluster headaches have also been referred to as “red headaches” because of the heat and flushing of the face that sometimes accompany the attacks. This coloring contrasts with the pallor that often accompanies a migraine headache.
Two other terms for this disorder are “episodic migrainous neuralgia” and “Harris’ neuralgia.” “Harris’ neuralgia” is the term used in some parts of Europe and refers to Dr. Wilfred Harris, an English neurologist who first described the disorder. We use the term “cluster headaches” because it emphasizes the characteristic grouping of attacks. Each cluster, or group, of headaches may last several weeks or even months at a time before either suddenly or gradually fading away for months or years.
Cluster headaches afflict more men than women. The reverse is true in migraine. Migraine frequently begins early in life; cluster headaches do not usually begin before the age of
twenty-five, and most commonly the onset of these painful headaches occurs after the age of thirty. The exact cause of cluster headache is not known, but this should not come as any great surprise since this is true with many other headache conditions as well. Although vasodilation and some other chemical changes do occur during a cluster attack, the reasons for the repetitive tendency of cluster headaches, for the excruciating intensity of pain, and for the periodic nature of the bouts remain medical mysteries.
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