Headache: Tension And Cluster

Introduction

• Description: Tension headache, now called tension-type headache, is the most common form of headache and is caused by abnormal neuronal sensitivity and pain facilitation and/or contracted muscles of the neck and scalp. Cluster headaches are a type of recurrent headache that are characterized as unilateral and “stabbing” and are associated with symptoms of histamine release such as nasal stuffiness, lacrimation, facial sweating, or eyelid edema. These occur in episodic waves of frequent headaches separated by days, weeks, or years of remission.

• Prevalence: 90% of women experience tension headaches; 60% within the previous year. The male-to-female ratio is 1:1.27. Approximately 10% of tension headache sufferers also have migraine headaches. Cluster headaches occur in 4/100,000 women per year; most cluster headaches occur in men in a ratio of 4.3:1.

• Predominant Age: Tensions headaches—any age; 60% begin after the age of 20 years. Rarely do tension headaches start after the age of 50 years. Cluster headaches—ages 20–30 years.

• Genetics: Women are more often affected by tension headaches than men (88% vs. 69%); 40% have a family history of headache. Cluster headaches are four times more common in women than in men. There is suggestive evidence for an autosomal dominant gene involved in cluster headache inheritance in some families; a family history of cluster headache is present in 5%–20% of patients

Etiology and Pathogenesis

• Causes: Tension headache—abnormal neuronal sensitivity and pain facilitation; no correlation to muscle contraction. They generally build in intensity in relation to stress. Cluster headache—incompletely understood; postulated: disorders of histamine release or sensitivity, serotonin metabolism or transmission, hypothalamic circadian rhythm, or cerebral artery autoregulation. The most generally accepted mechanism is one of hypothalamic activation causing activation of the trigeminal-autonomic reflex through a trigeminal-hypothalamic pathway.

• Risk Factors: Tension headache—physical or emotional stress, poor posture, depression, obstructive sleep apnea, excess caffeine. Cluster headache—allergies, alcohol, tobacco, nitroglycerin, high altitudes, sleep-cycle disruption, stress. One study found an association between a history of head trauma and cluster headache.

Signs and Symptoms