Cluster headache is a type of headache that predominates in men, attacks of variable pain that occur between 1 every two days up to 8 attacks a day and which appear during weeks or months a year. The most frequent trigger factors in some patients are: onset of sleep.
There are certain consensuated diagnostic criteria:
- Severe orbital, supraorbital and/or temporal pain lasting 15-180 minutes without treatment.
- The headache is associated, at least, with one of the following signs, which should be homolateral to the pain: conjunctival injection, tearing, nasal congestion, rhinorrhea, sweating of the forehead and face, myosis, ptosis, palpebral oedema
- At least 5 attacks with the characteristics described and which oscillate between one every two days to eight a day.
They may be episodic or chronic (absence of remission for one year or more, with remissions that last less than fourteen days)
When pharmacological treatment does not improve the situation, and the headache is chronic, the following surgical techniques are available:
RADIOFREQUENCY OF THE PTERYGOPALATINE GANGLION
This is a simple technique performed under local anaesthesia and minimum sedation, with ablation of the pterygopalatine ganglion, the ganglion involved in cluster headache. The patient is discharged 2 hours after completing the procedure. Complications are very infrequent, and only mild.
The probability of improvement with this technique is 60%.
OCCIPITAL NERVE STIMULATION
This technique is somewhat more complex than radiofrequency of the pterygopalatine ganglion. It is usually indicated when radiofrequency of the pterygopalatine ganglion has not been sufficient to reduce the pain. It is extracranial surgery, and so there are no severe complications. The probability of improvement for this headache is 70%.
This is a complex technique, and only indicated for severe cases that do not respond to any other surgical technique. It is a technique with a probability of improvement of 50%. Complications are infrequent but may be severe as it is brain surgery.