N90 Cluster headache (ICD-10:G44.0)

Introduction

Cluster headaches are a type of primary headache disorder characterized by severe, unilateral pain that occurs in clusters or cycles^[1]. They are often referred to as “suicide headaches” due to the intensity of the pain^[2]. The aim of this guide is to provide an overview of cluster headaches, including their symptoms, causes, diagnostic steps, possible interventions, and lifestyle interventions.

Codes

• ICPC-2 Code: N90 Cluster headache
• ICD-10 Code: G44.0 Cluster headache syndrome

Symptoms

• Severe, unilateral pain around the eye or temple^[3]
• Pain that is described as sharp, stabbing, or burning^[4]
• Pain that lasts for 15 minutes to 3 hours^[5]
• Pain that occurs in clusters or cycles, typically lasting weeks to months^[6]
• Red or watery eyes on the affected side^[7]
• Nasal congestion or runny nose on the affected side^[8]
• Drooping eyelid or swelling around the eye on the affected side^[9]

Causes

The exact cause of cluster headaches is unknown, but several factors may contribute to their development:

• Abnormalities in the hypothalamus, a region of the brain that regulates the body’s internal clock and circadian rhythms^[10]
• Changes in serotonin levels
• Genetic predisposition
• Triggers such as alcohol, smoking, certain foods, and strong odors

Diagnostic Steps

Medical History

• Obtain a detailed medical history, including the frequency, duration, and characteristics of the headaches
• Ask about any triggers or factors that may worsen or alleviate the headaches
• Inquire about any family history of cluster headaches or other headache disorders
• Assess for any comorbid conditions, such as sleep disorders or psychiatric disorders

Physical Examination

• Perform a thorough physical examination, including a neurological examination
• Look for signs of autonomic symptoms, such as red or watery eyes, nasal congestion, or drooping eyelid
• Assess for any other signs or symptoms that may suggest an underlying cause or comorbid condition

Laboratory Tests

• There are no specific laboratory tests to diagnose cluster headaches
• Blood tests may be done to rule out other causes of headache, such as infections or metabolic disorders

Diagnostic Imaging

• Imaging studies, such as MRI or CT scans, are not typically necessary for diagnosing cluster headaches
• These studies may be ordered if there are atypical features or if an underlying cause is suspected

Other Tests

• Other diagnostic tests, such as a sleep study or a lumbar puncture, may be considered if there are atypical features or if an underlying cause is suspected

Follow-up and Patient Education

• Schedule regular follow-up appointments to monitor the effectiveness of interventions and adjust treatment as needed
• Provide education to the patient about cluster headaches, including triggers to avoid, lifestyle modifications, and the importance of adhering to the treatment plan

Possible Interventions

Traditional Interventions

Medications:

Top 5 drugs for Cluster headache:

1. Sumatriptan:
   • Cost: $10-$50 per dose.
   • Contraindications: Ischemic heart disease, uncontrolled hypertension.
   • Side effects: Nausea, dizziness, injection site reactions.
   • Severe side effects: Chest pain, heart attack, stroke.
   • Drug interactions: Ergotamine, MAO inhibitors.
   • Warning: Limit use to 2 doses per day.
2. Oxygen therapy:
   • Cost: $100-$200 per month for equipment rental.
   • Contraindications: None.
   • Side effects: None.
   • Severe side effects: None.
   • Drug interactions: None.
   • Warning: Use a high-flow rate of 100% oxygen for 15-20 minutes at the onset of a headache.
3. Verapamil:
   • Cost: $10-$50 per month.
   • Contraindications: Severe hypotension, heart block.
   • Side effects: Constipation, dizziness, fatigue.
   • Severe side effects: Heart failure, bradycardia.
   • Drug interactions: Beta-blockers, digoxin.
   • Warning: Monitor blood pressure and heart rate regularly.
4. Prednisone:
   • Cost: $10-$50 per month.
   • Contraindications: Active infections, uncontrolled diabetes.
   • Side effects: Increased appetite, weight gain, mood changes.
   • Severe side effects: Adrenal suppression, osteoporosis.
   • Drug interactions: NSAIDs, anticoagulants.
   • Warning: Taper the dose gradually to avoid adrenal insufficiency.
5. Lithium:
   • Cost: $10-$50 per month.
   • Contraindications: Severe renal impairment, dehydration.
   • Side effects: Hand tremor, increased thirst, weight gain.
   • Severe side effects: Kidney damage, thyroid dysfunction.
   • Drug interactions: Diuretics, ACE inhibitors.
   • Warning: Monitor serum lithium levels regularly.

Alternative Drugs:

• Melatonin: May help regulate sleep-wake cycles and reduce the frequency of cluster headaches. Cost: $10-$20 per month.
• Topiramate: An antiepileptic drug that may be effective in preventing cluster headaches. Cost: $10-$50 per month.
• Valproic acid: Another antiepileptic drug that may be used for prevention of cluster headaches. Cost: $10-$50 per month.
• Botox: Injections of botulinum toxin may be considered for chronic cluster headaches. Cost: $500-$1000 per treatment.

Surgical Procedures:

• Occipital nerve stimulation: Involves implanting a device that delivers electrical impulses to the occipital nerves. Cost: $20,000-$30,000.
• Deep brain stimulation: Involves implanting electrodes in the brain to modulate abnormal electrical activity. Cost: $50,000-$100,000.

Alternative Interventions

• Acupuncture: May help reduce the frequency and intensity of cluster headaches. Cost: $60-$120 per session.
• Chiropractic care: Spinal adjustments and other manual therapies may provide relief for some individuals. Cost: $50-$200 per session.
• Herbal supplements: Some herbs, such as feverfew and butterbur, may have potential benefits for preventing cluster headaches. Cost: Varies depending on the specific supplement.
• Biofeedback: Teaches individuals to control bodily functions, such as heart rate and muscle tension, to reduce the frequency and intensity of headaches. Cost: $50-$150 per session.
• Mind-body techniques: Practices such as meditation, yoga, and tai chi may help manage stress and reduce the frequency of cluster headaches. Cost: Varies depending on the specific program or class.

Lifestyle Interventions

• Avoid triggers: Identify and avoid triggers that may precipitate cluster headaches, such as alcohol, smoking, certain foods, and strong odors.
• Maintain a regular sleep schedule: Establish a consistent sleep routine and ensure an adequate amount of sleep each night.
• Manage stress: Practice stress management techniques, such as deep breathing exercises, meditation, or relaxation techniques.
• Stay hydrated: Drink plenty of water throughout the day to maintain hydration.
• Exercise regularly: Engage in regular physical activity to promote overall health and reduce the frequency of cluster headaches.

It is important to note that the cost ranges provided are approximate and may vary depending on the location and availability of the interventions.

Mirari Cold Plasma Alternative Intervention

Understanding Mirari Cold Plasma

• Safe and Non-Invasive Treatment: Mirari Cold Plasma is a safe and non-invasive treatment option for various skin conditions. It does not require incisions, minimizing the risk of scarring, bleeding, or tissue damage.
• Efficient Extraction of Foreign Bodies: Mirari Cold Plasma facilitates the removal of foreign bodies from the skin by degrading and dissociating organic matter, allowing easier access and extraction.
• Pain Reduction and Comfort: Mirari Cold Plasma has a local analgesic effect, providing pain relief during the treatment, making it more comfortable for the patient.
• Reduced Risk of Infection: Mirari Cold Plasma has antimicrobial properties, effectively killing bacteria and reducing the risk of infection.
• Accelerated Healing and Minimal Scarring: Mirari Cold Plasma stimulates wound healing and tissue regeneration, reducing healing time and minimizing the formation of scars.

Mirari Cold Plasma Prescription

Video instructions for using Mirari Cold Plasma Device – N90 Cluster headache (ICD-10:G44.0)

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Use the Mirari Cold Plasma device to treat Cluster headache effectively.

WARNING: MIRARI COLD PLASMA IS DESIGNED FOR THE HUMAN BODY WITHOUT ANY ARTIFICIAL OR THIRD PARTY PRODUCTS. USE OF OTHER PRODUCTS IN COMBINATION WITH MIRARI COLD PLASMA MAY CAUSE UNPREDICTABLE EFFECTS, HARM OR INJURY. PLEASE CONSULT A MEDICAL PROFESSIONAL BEFORE COMBINING ANY OTHER PRODUCTS WITH USE OF MIRARI.

Step 1: Cleanse the Skin

• Start by cleaning the affected area of the skin with a gentle cleanser or mild soap and water. Gently pat the area dry with a clean towel.

Step 2: Prepare the Mirari Cold Plasma device

• Ensure that the Mirari Cold Plasma device is fully charged or has fresh batteries as per the manufacturer’s instructions. Make sure the device is clean and in good working condition.
• Switch on the Mirari device using the power button or by following the specific instructions provided with the device.
• Some Mirari devices may have adjustable settings for intensity or treatment duration. Follow the manufacturer’s instructions to select the appropriate settings based on your needs and the recommended guidelines.

Step 3: Apply the Device

• Place the Mirari device in direct contact with the affected area of the skin. Gently glide or hold the device over the skin surface, ensuring even coverage of the area experiencing.
• Slowly move the Mirari device in a circular motion or follow a specific pattern as indicated in the user manual. This helps ensure thorough treatment coverage.

Step 4: Monitor and Assess:

• Keep track of your progress and evaluate the effectiveness of the Mirari device in managing your Cluster headache. If you have any concerns or notice any adverse reactions, consult with your health care professional.

Note

This guide is for informational purposes only and should not replace the advice of a medical professional. Always consult with your healthcare provider or a qualified medical professional for personal advice, diagnosis, or treatment. Do not solely rely on the information presented here for decisions about your health. Use of this information is at your own risk. The authors of this guide, nor any associated entities or platforms, are not responsible for any potential adverse effects or outcomes based on the content.

Mirari Cold Plasma System Disclaimer

• Purpose: The Mirari Cold Plasma System is a Class 2 medical device designed for use by trained healthcare professionals. It is registered for use in Thailand and Vietnam. It is not intended for use outside of these locations.
• Informational Use: The content and information provided with the device are for educational and informational purposes only. They are not a substitute for professional medical advice or care.
• Variable Outcomes: While the device is approved for specific uses, individual outcomes can differ. We do not assert or guarantee specific medical outcomes.
• Consultation: Prior to utilizing the device or making decisions based on its content, it is essential to consult with a Certified Mirari Tele-Therapist and your medical healthcare provider regarding specific protocols.
• Liability: By using this device, users are acknowledging and accepting all potential risks. Neither the manufacturer nor the distributor will be held accountable for any adverse reactions, injuries, or damages stemming from its use.
• Geographical Availability: This device has received approval for designated purposes by the Thai and Vietnam FDA. As of now, outside of Thailand and Vietnam, the Mirari Cold Plasma System is not available for purchase or use.

References

1. Wei DY, Yuan Ong JJ, Goadsby PJ. Cluster Headache: Epidemiology, Pathophysiology, Clinical Features, and Diagnosis. Ann Indian Acad Neurol. 2018;21(Suppl 1):S3-S8. doi:10.4103/aian.AIAN_349_17
2. Rozen TD, Fishman RS. Cluster headache in the United States of America: demographics, clinical characteristics, triggers, suicidality, and personal burden. Headache. 2012;52(1):99-113. doi:10.1111/j.1526-4610.2011.02028.x
3. May A. Cluster headache: pathogenesis, diagnosis, and management. Lancet. 2005;366(9488):843-855. doi:10.1016/S0140-6736(05)67217-0
4. Hoffmann J, May A. Diagnosis, pathophysiology, and management of cluster headache. Lancet Neurol. 2018;17(1):75-83. doi:10.1016/S1474-4422(17)30405-2
5. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211. doi:10.1177/0333102417738202
6. Dodick DW. Cluster Headache. Continuum (Minneap Minn). 2018;24(4, Headache):1093-1109. doi:10.1212/CON.0000000000000634
7. Buture A, Boland JW, Dikomitis L, Ahmed F. Update on the pathophysiology of cluster headache: imaging and neuropeptide studies. J Pain Res. 2019;12:269-281. Published 2019 Jan 21. doi:10.2147/JPR.S175312
8. Nesbitt AD, Goadsby PJ. Cluster headache. BMJ. 2012;344:e2407. Published 2012 Apr 11. doi:10.1136/bmj.e2407
9. Robbins MS. The Psychiatric Comorbidities of Cluster Headache. Curr Pain Headache Rep. 2013;17(2):313. doi:10.1007/s11916-012-0313-8
10. Steinberg A, Fourier C, Ran C, Waldenlind E, Sjöstrand C, Belin AC. Cluster headache – clinical pattern and a new severity scale in a Swedish cohort. Cephalalgia. 2018;38(7):1286-1295. doi:10.1177/0333102417731773