Symptoms

Cluster headache causes and treatment

Cluster headache causes and treatment


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Cluster headaches are still a relatively unknown complaint even though they have received increasing media attention in recent years. This special form of headache disease is characterized by the most violent, relapsing, one-sided headache. By the time those affected receive a corresponding diagnosis, they have often already had a long medical odyssey. A time when many patients threaten to despair in the face of massive pain.

Definition

Cluster headache is a periodic headache that occurs repeatedly without any apparent connection to an existing disease. In contrast to this primary headache disease, secondary forms of headache have to be distinguished, which can be very similar to cluster headaches, but are a symptom of an existing disease. The term "cluster" refers to the periodic manifestation of the disease. After quite long, symptom-free periods, the cluster headache occurs in concentrated time intervals ("cluster": cluster, group, bundle). The acute, three-hour headache episodes can usually be observed over a period of several days before a symptom-free period follows. If this symptom-free period is longer than one month, the term episodic cluster headache is used, and shorter symptom-free periods are referred to as chronic cluster headache.

In addition to pain, according to the definition of the International Headache Society (IHS), at least one of the following accompanying symptoms of cluster headache can be observed: tears of the eye (lacrimation), reddening of the eyes, drooping eyes (ptosis), swelling of the eyelids (edema of the eyelids), narrowing of the pupil (miosis ), increased secretion of nasal secretions (rhinorrhea), nasal congestion, restlessness with urge to move and / or excessive sweating, especially in the area of ​​the forehead and face. According to the current medical classification, cluster headaches belong to the so-called trigeminal autonomous headache diseases. They are also known as erythroposopalgia, histamine headache and Bing-Horton headache.

Symptoms

Cluster headache is determined by very special pain symptoms, which - as already mentioned - are accompanied by various other symptoms. According to the German Migraine and Headache Society (DMKG), the pain attacks occur suddenly during the acute intervals and last for fifteen minutes to a maximum of 180 minutes. Afterwards, most patients show a symptom-free resting phase, which can last for different lengths of time (a few weeks to months or years) before the pain starts again.

The frequency of pain attacks in the acute phases can differ significantly from patient to patient. While some go through numerous attacks within a day (the DMGK reports up to eight attacks a day), others have one or two days of rest after a single occurrence. Typically there are longer symptom-free periods between the acute pain intervals, which can last for weeks and months. The patients are symptom-free for months or even years before the next acute phase begins. According to the information from the Pain Clinic Kiel, the complaints tend to be observed more frequently in the months of February, March, April and September, October, November.

Bing Horton neuralgia is most noticeable in the first few hours after falling asleep and early in the morning, but can theoretically occur at any time of the day. Sufferers suffer extreme, one-sided pain, which mostly focuses on the area around the eyes, cheekbones and temples. The majority of those affected always show the complaints on the same page. The pain is so intense that it is not uncommon for patients to feel faint. On a pain scale from zero (no pain) to ten (extreme pain, with suicidal thoughts), cluster headache patients often choose the 10 to describe the pain intensity. Migraine patients, for example, usually choose lower values ​​or a maximum of nine. This should not reduce the suffering of migraine patients, especially since the pain can last much longer. But it becomes clear how massive patients suffer.

The Pain Clinic Kiel, at whose center for rare headache diseases also cluster headache is an important topic, reports of a "devastating severity of pain that very often leads to suicide if the diagnosis and treatment are ineffective." According to the, the trigemino-autonomous headache diseases belong to the whole Pain clinic "one of the most malignant and at the same time the most disabling pain diseases in humans."

Accompanying the headache, those affected usually show extreme inner restlessness, bobbing back and forth with the upper body or continuously walking up and down. You also often start to sweat profusely during the pain attacks. Rather unspecific symptoms such as nausea or excessive sensitivity to noise and bright light can also be part of the symptoms. The appearance of other accompanying symptoms in the area of ​​the eye and / or the nose is characteristic of trigeminal autonomous headache disease. For example, the conjunctiva appears red in the patient, the eye begins to water, the pupil is narrowed, the eyelid hangs or is swollen. A stuffy or runny nose can also occur in connection with the cluster headache.

Since the pain often sets in during the night's rest, many sufferers suffer from lack of sleep or chronic fatigue during the acute phase. In addition, there are not seldom further psychological impairments, whereby the pain clinic Kiel names "social isolation, personality changes, fear, depression, discouragement, anger, grief, despair and abandonment of the will to live" as possible consequences of the cluster headache. The fact that patients often suffer for years without a correct diagnosis not only increases psychological stress, but also often results in incorrect therapies, which in turn can also have negative effects on health.

Causes and triggers

Although various causes of symptomatic cluster headaches can be identified, little is known about the development of primary cluster headaches. Secondary headache attacks can be observed, for example, in the context of brain tumors, injuries in the area of ​​the brain stem, inflammatory processes in the brain or as a result of a stroke. Trigeminal neuralgia (irritation of the trigeminal nerve) can also lead to one-sided pain attacks with accompanying symptoms such as watery eyes. However, the attacks do not usually last as long as with primary cluster headaches.

The Pain Clinic Kiel mentions the possible causes of the symptomatic cluster headache in particular as “upper cervical meningiomas, parasellar meningiomas, large arteriovenous malformations in the most diverse ipsilateral brain structures, ethmoidal cysts in the area of ​​the clivus and in the area of ​​the suprasellar cisterns, pituitary adenomas, calcifications in the area of ​​the third. Ventricles, ipsilateral aneurysms and aneurysms of the anterior communicating artery. ”Although the terms are difficult for laypersons to understand, it can be said that the diseases all occupy space in the area of ​​the midbrain line in the vicinity of the so-called cavernous sinus (enlarged vein space in the brain). Therefore, according to the Kiel Pain Clinic, the conclusion suggests that this anatomical structure is also of particular importance in the genesis of primary cluster headaches.

On the basis of this thesis, numerous investigations have been carried out in recent years, which allow a closer look at the processes in the brain during the cluster attacks. For example, examinations of the blood flow in the brains of those affected were carried out using so-called positron emission tomography (PET). These made it clear that changes in the area of ​​the cavernous sinus can actually be observed. Magnetic resonance imaging also shows that "during a cluster headache attack, the uptake of contrast medium in the area of ​​the cavernous sinus is increased," reports the Pain Clinic in Kiel. These are indications of inflammatory processes taking place here during the pain attacks.

Signs of inflammatory events could also be found in the affected persons in the cerebrospinal fluid and in the peripheral blood, and when “performing a phlebography (special X-ray examination procedure to assess the veins) there were indications of the presence of venous vasculitis in the area of ​​the cavernous sinus and the upper eye vein during the cluster period, ”explain the Kiel experts. In addition, vascular dilations (vasodilation) in the area of ​​the cavernous sinus, the arteria opthalmica, arteria cerebri anterior and the arteria media are to be observed. The changes were found on the same side of the body (ipsilateral) as the headache attacks.

Vascular dilation was initially considered to be the cause for a long time before the knowledge prevailed in the specialist world that it should rather be seen as a result of the disease. The activation in the area of ​​the hypothalamus, which can be demonstrated with the help of functional magnetic resonance tomography (fMRI), led to the presumption that the cause of the disease was to be found in this region of the brain. Especially since the sleep-wake rhythm is also regulated here and this has striking connections with the occurrence of pain attacks. If science initially started with purely functional changes in the brain as the cause, studies "using voxel-based morphometry have shown a significant structural change in the density of the gray matter compared to healthy controls", reports the Pain Clinic Kiel. The changes in the area of ​​the hypothalamic gray matter could therefore possibly play a role in the development of the cluster headache, even if a functional activation mechanism can still be assumed.

However, the structural changes in gray matter in recent studies could only be confirmed for the central pain-processing system, but not for the hypothalamus area. This suggests that "the morphological changes are the effects of acute pain and not the primary cause," explains the Kiel Pain Clinic.

The information found on inflammatory processes in the cavernous sinus and in the area of ​​the superior vena ophthalmica therefore moved into the focus of possible explanations for the occurrence of the headache attacks. In this region, a wide variety of nerve fibers that supply the face, the eye and eyelid, the eye socket (orbit) and the retroorbital (behind the eye socket) vessels are very close together. In addition, there are the internal carotid artery and venous vessels, which serve to drain the orbit and face. Inflammatory processes occurring here could affect the nerve fibers as well as the arterial and venous vessels, which is a possible explanation for the cluster pain and the accompanying symptoms, reports the Pain Clinic Kiel. These local inflammations lead to a regional protein leak in the venous blood vessels of the brain base, which can be detected with the help of modern imaging methods.

The inflammatory basic reaction in the cavernous sinus would therefore be the cause of impairments of the carotid artery, optic nerve, eye nerve and facial nerve, which are all affected during the pain attacks, explains the Kiel Pain Clinic. This would also explain why vasodilators such as alcohol, nitroglycerin or histamine can provoke the attacks during acute intervals and why vasoconstricting substances such as oxygen or sumatriptan end the cluster pain.

Furthermore, it is understandable why the attacks occur more while lying down or sleeping - the venous drainage of the cavernous sinus is reduced when lying down due to the poorer hydrostatic conditions. Getting up, walking around and the observed urge to move are conducive to the drainage of the cavernous sinus. Although plausible explanations for the occurrence of the pain attacks are provided here, a comprehensive, scientifically proven explanatory model has been lacking to date, which justifies the daily connections, the temporary concentration of the attacks, the one-sided localization, the sympathetic and parasympathetic activation as well as the accompanying symptoms that occur. Furthermore, the headache disease of science poses some riddles here. This also includes the possible initiation of the attacks by the different triggers, which only work during the acute intervals, but not in the remission phases.

Cluster headache trigger

In the acute periods, various triggers can trigger the pain attacks, whereby in addition to alcohol and nicotine, calcium antagonists such as nitroglycerin and a number of other substances such as the neurotransmitter histamine should be mentioned. In addition, those affected also report glaring, flickering light and heat or heat as possible trigger factors. Food additives such as glutamate or sodium nitrite are also increasingly being mentioned as possible triggers for cluster attacks. In addition, foods such as tomatoes, citrus fruits or chocolate are discussed as trigger factors.

The attacks are caused by particularly intense smells in some sufferers. Extreme physical stress as well as extreme psychological stress are also possible triggers for cluster headaches. Typically, the triggers only work during the acute periods and otherwise show no unusual effect in the remission phases. The relatively reliable trigger effect of nitroglycerin may also be used in the context of diagnosis, with sublingual (under the train) administration being used to specifically trigger a pain attack.

Diagnosis

The basis of the diagnosis is a detailed survey of the patients on the intensity and duration of the headache attacks as well as the accompanying symptoms, whereby the symptoms are classified according to the IHS classification ICHD-II. The symptoms are still the only clue to the diagnosis, since cluster headaches cannot be determined with medical procedures such as laboratory tests. However, it may be possible to initiate a pain attack with the sublingual administration of nitroglycerin during the acute phases, but this is not always possible reliably. Modern imaging methods such as computed tomography, magnetic resonance imaging, Doppler sonography or electroencephalography are primarily used to diagnose possibly underlying, serious diseases that can trigger symptomatic cluster pain.

Epidemiology

Fortunately, cluster attacks affect only a minimal fraction of the population. The German Society for Neurology (DGN) reports a one-year prevalence of 0.1 percent to a maximum of 0.9 percent of the population. Men are affected three times more often than women. The first attacks usually appear at the age of 28 to 30 years and "up to 80 percent of patients", according to the DGN, "still suffer from cluster episodes after 15 years." However, the intensity and frequency of the attacks in some patients remain higher Age after. On the other hand, up to 12 percent of those affected change from a primary episodic to a chronic form, reports the DGN. Although it is not yet possible to assume an inheritable disease, two to seven percent of the patients assume family stress.

Treatment

Cluster headaches are still not curable to this day, but acute pain attacks can be treated relatively reliably and there are a variety of preventive treatment options. Since the patients are usually under considerable suffering, detailed information about the disease and possible therapeutic measures are of particular importance. Those affected should also be informed about the known triggers so that they can avoid them in case of doubt. Furthermore, it makes sense to create a headache calendar or a headache diary in which the attacks are recorded.

Acute treatment

In its treatment recommendations for acute pain attacks, the German Society for Neurology mentions inhalation of 100 percent oxygen through a face mask in the first place. Since no systemic side effects are to be expected here, the treatment method should at least be tested in all patients, according to the DGN. However, the treatment usually only works after 15 to 20 minutes, which is why patients with short-term cluster attacks of just 15 minutes do not benefit here. According to DGN, oxygen inhalation also shows the desired effect in only 60 percent to 70 percent of those affected.

According to the DGN, sumatriptan, which is administered by subcutaneous (under the skin) injections in doses of six milligrams, is the drug of choice if oxygen inhalation has no effect. The patients can independently set the injections with the help of so-called auto-injectors. Devices that do without a needle are now also available here. The tolerance of sumatriptan in cluster patients is “generally very good, even with the described overdoses of up to 8 injections within 24 hours,” reports the Pain Clinic in Kiel. However, the general contraindications to the use of sumatriptan should be noted. In the case of particularly long attacks, sumatriptan can also be administered nasally in a 20 milligram dose, although here a delayed effect can be assumed.

Zolmitriptan nasal spray in a dosage of five to ten milligrams is known as another, relatively effective medicine against the cluster attacks. Here, however, the effect usually does not occur as quickly as with subcutaneous sumatriptan use. In addition, according to the DGN, “intranasal application of lidocaine” remains an option for the treatment of acute cluster attacks. The active ingredient is sprayed into the nostril in a four percent solution on the pain side. In the case of particularly long-lasting complaints that cannot be managed with the help of the methods mentioned, there is also the option of oral administration of triptans, the effects of which, however, only start to appear after a considerable delay.

Prophylactic therapy

Given the high number of pain attacks during an active cluster period, prophylactic drug therapy is recommended with the aim of preventing the occurrence of new cluster attacks. Here, the German Society for Neurology names the active ingredient verapamil in a dosage of three to four times 80 milligrams a day as the first choice. If the application does not show the desired success, it is possible to switch to higher dosages (maximum 960 milligrams per day). However, this requires an accompanying cardiac check (monitoring by means of an electrocardiogram; EKG) by experienced specialists.

If the patients are already in a cluster period and a renewed attack is to be expected due to the slow effect of the verapamil, according to the DGN, corticosteroids (prednisolone) are often used “in the sense of bridging therapy”. According to the DGN, the corticoids should be used in a dosage of at least one milligram per kilogram of the patient's body weight and can be administered for two to five days. In view of the risk of side effects, dosing is urgently recommended.

Ergotamine and long-acting triptans such as naratriptan can be used as part of the prophylactic cluster treatment, but here too, only a limited use is possible. For longer-term use, according to the DGN, in addition to verapamil, lithium in a dosage of 600 to 1,500 milligrams per day is recommended. Other active ingredients that can be used in cluster prophylaxis include topiramate, melatonin, methysergide, gabapentin, valproic acid, pizotifen, leuprorelin and capsaicin. According to the experience of the Pain Clinic Kiel, the administration of valproinate, topiramate and gabapentin in particular is not reliably effective. Although there are some positive case reports on these substances in the literature, "there may be a distorted picture due to unpublished negative reports."

Which medicines are best suited for prophylactic treatment depends primarily on the individual symptoms of the patient and their physical requirements. Experienced neurologists should reserve and select the medication, especially since combinations of the above medications often promise the greatest success in treatment, and some medications should never be used at the same time. The prophylaxis is maintained as long as the cluster periods of those affected normally last, which presupposes that their length can be traced, for example, using a headache diary. In the case of chronic pain, the breaks between the acute periods are often difficult to make out, so that, according to the German Society for Neurology, an attempt to reduce medication should be made every three to six months.

Surgical procedures for cluster treatment

If a symptomatic cluster headache is ruled out and all medication measures are unsuccessful, there is the possibility of a surgical intervention to eliminate the cluster headache. However, the success rates in relation to the treatment risks are relatively low, which is why the surgical procedures are usually only considered in patients with severe forms of chronic cluster headaches.

The Pain Clinic Kiel opens the following calculation example: Chronic cluster headaches suffer only 27 percent of cluster patients (in 240,000 cluster patients in Germany 64,800 have chronic cluster headaches) and in only one percent of them (648 patients) the development of "therapy-refractory situations" is due expect. If "an estimated 50 percent of these are suitable for invasive interventions, such procedures are likely to be relevant for around 300 people in Germany," reports the Pain Clinic in Kiel. This makes it clear that only a negligible proportion of those affected are even considered for the operative procedures.

In general, according to the Pain Clinic Kiel, three different invasive therapy strategies for the treatment of cluster headaches can be distinguished: "Destructive procedures, local blockages and neuromodulatory procedures." The chances of success are often extremely limited. For example, “destructive procedures such as the severing or decompression of the intermediate nerve or the petrosus superficialis major and direct interventions in the area of ​​the trigeminal nerve are only of historical importance due to unsatisfactory long-term results,” reports the Pain Clinic in Kiel.

Meanwhile, “neuromodulatory procedures have come to the fore because of the improved electronic stimulation options.” In the blockade of certain nerve pathways, the blockage of the occipital nerve by the injection of local anesthetics and corticosteroids is a possible therapeutic approach, the operative methods such as the radiation of the nerve entry zone trigeminal nerve (gamma knife), which is strongly recommended for resections of the major petrous superficial nerve or sphenopalatine ganglion

Possible neuromodulatory methods for cluster treatment are deep brain stimulation, occipital nerve stimulation and neurostimulation of the sphenopalatine ganglion. Deep brain stimulation concentrates on the area of ​​the posterior, inferior hypothalamus and, according to the studies to date, can bring about an improvement in around 50 percent of patients. However, the pain clinic in Kiel reported that massive side effects, such as fatal intracranial bleeding, had occurred in numerous patients. In addition, the procedure is associated with extremely high costs of over 30,000 euros and extensive post-operative treatment. "Based on the current data situation, neither a theoretically rational nor a practical reason for using deep brain stimulation in cluster headache can be understood," explains the Kiel Pain Clinic. The previous data would not justify deep brain stimulation in therapy.

Occipital nerve stimulation is usually achieved by inserting a stimulation electrode in the area of ​​the first cervical vertebra. Subsequently, a trial stimulation with an external pulse generator takes place over several weeks, "before a pulse generator is permanently implanted," reports the Pain Clinic in Kiel. The effectiveness of the method is roughly equated by the experts with deep brain stimulation, whereby the occipital nerve stimulation offers the advantage that it is "less invasive and less complicated than deep brain stimulation".

In 2011, neurostimulation of the sphenopalatine ganglion for the treatment of cluster headaches was also presented for the first time. This latest treatment method for cluster therapy is based on a tiny neurostimulator that is implanted in the gums without visible scars or cosmetic impairments and whose electrode tip attaches to the sphenopalatine ganglion (GSP) behind the cheekbones. An external remote control can be used to initiate stimuli that should alleviate the headache. So far, however, the method has only been little tested, so it is not possible to make a reliable statement about the effect and possible risks.

All in all, it can be said that the cluster headache is still not curable, but the intensity and frequency of the pain attacks can be reduced quite reliably on the basis of various medicines. Over-the-counter pain relievers such as aspirin, paracetamol, or ibuprofen have no effect and self-medication is strongly discouraged. Which active ingredients are ultimately used for treatment is essentially determined by the clinical course, possible comorbidities and the general constitution of those affected. Surgery should only be considered for a minimal fraction of those affected.

A problem with the drug treatment approaches mentioned is that the drugs are often not approved for treatment in Germany. If they are nevertheless prescribed as part of a so-called off-label therapy, this can lead to difficulties in billing the health insurance companies. In order to prevent possible recourse claims, the DMGK provides the treating physicians with "evidence-based guidelines" and "valid publication lists for the individual indications" as argumentation aids. However, according to the German Society of Neurology, some medicines such as pizotifen and methysergide also have a procurement problem because they are no longer authorized in Germany and can only be obtained as imported medicines.

Alternative treatments

While naturopathic treatment methods have promising approaches for other forms of headache, the options for cluster headaches are rather limited. Oxygen inhalation is a naturopathic approach, which is also considered the treatment option of choice for acute cluster attacks in conventional medicine. However, other methods that are often used in naturopathy for headaches, such as relaxation procedures, stress management techniques, biofeedback, magnetic therapy, acupuncture or dietary changes, have no effect on cluster headache. Although those affected often associate the appropriate measures with the sudden disappearance of the complaints, the timing here is purely coincidental.

There are also considerable doubts about the effect when using homeopathic remedies. Angesichts des geringen Nebenwirkungsrisikos und des enormen Leidensdrucks bei den Patienten kann ein Versuch der homöopathischen Behandlung dennoch in Betracht gezogen werden, wenn herkömmliche Therapieansätze nicht den gewünschten Erfolg bringen. Die Auswahl der geeigneten Mittel sollte dabei allerdings erfahrenen Therapeuten vorbehalten bleiben.

Bericht eines Betroffenen

Die individuelle Krankengeschichte der betroffenen Patienten ist oftmals geprägt durch eine lange Phase ohne exakte Diagnose, in der verschiedene therapeutische Maßnahmen ausprobiert werden und der Leidensdruck der Betroffenen deutlich zunimmt. Meine erste Cluster-Attacke erlitt ich vor rund 13 Jahren im Alter von 25 Jahren. Die Schmerzen betrafen meine linke Gesichtshälfte und waren unglaublich intensiv. Ich begann massiv zu schwitzen, meine Nase war verstopft und das Auge tränte leicht. Etwas länger als eine halbe Stunde lief ich unkontrolliert in der Wohnung umher und versuchte mir verzweifelt Linderung zu verschaffen. Zwischendurch hatte ich das Gefühl, angesichts der Schmerzen kurz vor der Ohnmacht zu stehen. Nach der Schmerzattacke, war ich zunächst wieder vollständig beschwerdefrei, bevor am nächsten Tag zwei weitere Schübe folgten.

Einen vergleichbaren Schmerz, hatte ich zuvor nur bei einer Wurzelentzündung erlebt, die viel zu lange unbehandelt blieb. Allerdings waren dort die Schmerzen lokal stark begrenzt, während der Clusterschmerz den Bereich um das Auge und den Kopf erfasste. Für mich lag die Vermutung nahe, dass möglicherweise ein Zusammenhang mit der erfolgten Wurzelbehandlung bestehen könnte. Auch dachte ich an einen möglichen erneuten Ausbruch einer zurückliegenden Nebenhöhlenentzündung. Da allerdings für einige Zeit keine weiteren Attacken folgten, tat ich die Beschwerden als einmaliges Phänomen ab. Ungewöhnliche Kopfschmerzattacken waren mir als Migränepatient durchaus bekannt. Richtige Sorgen hatte ich erst, nach dem erneuten Auftreten einer aktiven Cluster-Periode mit mehreren Schmerzattacken. Die Schmerzen waren schlichtweg unerträglich. Deutlich heftiger als bei einer Migräne-Attacke, allerdings glücklicherweise zeitlich stark begrenzt.

Migräne zeigt sich bei mir mit Aura-Symptomen wie Sehstörungen, einem Taubheitsgefühl in den Fingerspitzen und einer erhöhten Lichtempfindlichkeit. Diese sind bereits vor dem Einsetzen der Kopfschmerzen festzustellen und im weiteren Verlauf folgt in der Regel mehrfaches Erbrechen. Die Beschwerden können bei mir bis zu drei Tage anhalten, wobei nach dem Erbrechen meist nur noch ein extremer Kopfschmerz zurückbleibt und die Aura-Symptome abklingen. Die zeitliche Ausprägung der Migräne ist demnach deutlich unangenehmer als bei den Clusterschmerzen. Allerdings war die Intensität der Schmerzen sehr viel höher, was bei mir eine erhebliche Verunsicherung auslöste.

Es begann eine Odyssee zu verschiedensten Ärzten, auf der Suche nach den Ursachen der Beschwerden. Zunächst wandte ich mich an einen Hals-, Nasen-, Ohrenarzt, um festzustellen, ob möglicherweise eine Nebenhöhlenentzündung vorliegt. Die verstopfte Nase während der Schmerzattacken ließ mich in diese Richtung tendieren. Doch der HNO-Arzt konnte keinerlei pathologisches Geschehen feststellen. Für mich war zudem die Beschreibung der Symptome äußerst schwierig, da ich beim Arztbesuch ja keinerlei Beschwerden mehr hatte. Als nächstes erinnerte ich mich an die zurückliegende Wurzelbehandlung und suchte daher erneut den Zahnarzt auf. Eindeutige Anzeichen auf ein entzündliches Geschehen konnte dieser zwar nicht feststellen, doch vermutete er eine Entzündung im Bereich der behandelten Zahnwurzel als Ursache der Beschwerden.

Zwischenzeitig waren seit dem ersten Auftreten der Clusterkopfschmerzen gut zwei Jahre vergangen und ich hatte mit mehreren weiteren akuten Perioden zu kämpfen. Der Leidensdruck wuchs und ich unterzog mich auf Empfehlung meines Zahnarztes einer Wurzelspitzenresektion, in der Hoffnung, dass damit die Beschwerden vorüber wären. Tatsächlich dauerte es nach dem Eingriff einige Zeit, bevor die nächste akute Periode der Clusterkopfschmerzen auftrat, so dass ich zunächst an eine Heilung glaubte. Umso frustrierender war die erneute Schmerzattacke nach gut anderthalb Jahren. Ich wendete mich abermals an meinen Hausarzt, der mich anschließend an einen Neurologen verwies. Nachdem ich endlich einen Termin erhielt, erklärte dieser mir, dass er Clusterkopfschmerzen als Ursache vermute, allerdings zunächst eine Kernspintomographie durchgeführt werden müsse, um schwerere Erkrankungen des Gehirns auszuschließen. Auch hier wartete ich wieder einige Zeit auf einen Termin und meldete mich anschließend erneut bei dem Neurologen. Rund sechs Jahre nach der ersten Schmerzattacke stellte dieser mir dann die Diagnose und verschrieb mir eine Flasche Sauerstoff sowie zwei Nasensprays, mit denen ich die akuten Attacken behandeln sollte.

Erleichtert über die endgültige Diagnose, stellte sich für mich trotzdem die Frage, wie ich mit der Erkrankung künftig umgehen soll. Denn gelegentlich erwischten mich die Schmerzattacken auch tagsüber in durchaus ungünstigen Situationen. Der Sauerstoff zeigte bei mir leider nicht den gewünschten Effekt, die Nasensprays schon. Doch waren die mir verschriebenen Nasensprays zur Einmalanwendung gedacht, das heißt eine Attacke ließ sich mit ihrer Hilfe beenden, doch für die nächste Attacke brauchte ich ein neues Nasenspray. Somit hätten mir theoretisch deutlich mehr als zwei Nasensprays verordnet werden müssen, zumal die Anzahl der Schmerzattacke während der akuten Perioden mittlerweile auf mehr als vier pro Tag gestiegen war. Allerdings habe ich ohnehin eine gewisse Abneigung gegen Arzneien und Schmerzmittel, so dass ich mich nicht um weitere Verschreibungen bemühte. Mit der feststehenden Diagnose und der Sicherheit, dass keine schwerwiegendere Erkrankung vorliegt, waren die Schmerzattacken, welche bei mir im Vergleich zu anderen Cluster-Patienten eher kurz ausfielen, auch ohne Arzneien ertragbar.

Zudem hatte ich zwischenzeitig eigene Methoden entwickelt, um die Schmerzattacken in ihrer zeitlichen Ausprägung und Intensität zu begrenzen. Da bei mir Hitze als Auslöser feststand (länger als 25 Minuten in der warmen Badewanne führten mit hoher Wahrscheinlichkeit zu einer Attacke), lag der Schluss nahe, dass Kälte eine Linderung bewirken könnte. Beim ersten Anzeichen auf eine Cluster-Attacke begann ich meinen Mund mit eiskaltem Wasser zu spülen, gurgelt damit und zog vornübergebeugt Luft gegen den Widerstand des Wassers ein.

Ließen sich die Schmerzen hierdurch nicht lindern, legte ich mir ein Kühlkissen aus dem Eisfach auf die betroffene Gesichtshälfte. Bei extremen Cluster-Attacken nahm ich mir einen Eiswürfel und klemmte diesen zwischen Zahnfleisch und Wange ein. Durch die Kühlung reduzierte sich die gefühlte Schmerzintensität deutlich und sobald ich den Schmerz des Eises an den Zahnhälsen wahrnehmen konnte, war der Clusterkopfschmerz in der Regel vorüber. Heute erleide ich nur noch wenige Cluster-Attacken pro Jahr, die in ihrer Intensität nicht mit den anfänglichen Attacken vergleichbar sind und die maximal eine halbe Stunde dauern. Oftmals kann ich bei entsprechend frühzeitiger Reaktion beziehungsweise Kühlung die Entstehung der akuten Schmerzattacke vollständig verhindern – allerdings nur, wenn Eis oder sehr kaltes Wasser in Reichweite sind. Auch Schnee hat mir hier schon wertvolle Dienste erwiesen.

Ob die Kühlung bei anderen Patienten ebenfalls zur Linderung beitragen kann, vermag ich nicht zu sagen. Auch ist es sicher ein Unterschied, ob eine Attacke maximal 30 Minuten dauert oder 180 Minuten. Letztendlich bleibt für mich festzuhalten, dass die Clusterkopfschmerzen mich in seltenen Fällen zwar immer noch im Alltag behindern, doch kann ich heute insgesamt mit der Erkrankung gut leben. Zumal theoretisch auch noch die Option besteht, auf medikamentösem Weg gegen die Schmerzen anzugehen. Am schlimmsten war die Zeit ohne gesicherte Diagnose und mögliche Gegenmaßnamen.

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr. Fabian Peters

Swell:

  • Arne May: S1-Leitlinie Clusterkopfschmerz und trigeminoautonome Kopfschmerzen, Deutsche Gesellschaft für Neurologie (DGN), (Abruf 04.10.2019), DGN
  • Stephen D. Silberstein: Cluster-Kopfschmerz, MSD Manual, (Abruf 04.10.2019), MSD
  • Charly Gaul, Hans Christoph Diener: Kopfschmerzen: Pathophysiologie - Klinik - Diagnostik - Therapie, Thieme Verlag, 1. Auflage, 2016
  • Andreas Straube: Therapie des episodischen und chronischen Kopfschmerzes vom Spannungstyp und anderer chronischer täglicher Kopfschmerzen, Leitlinien für Diagnostik und Therapie in der Neurologie, Deutsche Gesellschaft für Neurologie, (Abruf 04.10.2019), AWMF
  • Deutsche Migräne- und Kopfschmerzgesellschaft: Cluster-Kopfschmerz, (Abruf 04.10.2019), DMKG
  • Hartmut Göbel: Clusterkopfschmerz-Wissen, Schmerzklinik Kiel, (Abruf 29.10.2019), schmerzklinik.de

ICD-Codes für diese Krankheit:G44.0ICD-Codes sind international gültige Verschlüsselungen für medizinische Diagnosen. You can find yourself e.g. in doctor's letters or on disability certificates.


Video: Oxygen, a quick, drug free and effective treatment for painful cluster headache (October 2022).