Bob Case Response Discussion
Based on the information provided I feel that the patient is suffering from cluster headaches. It is one-sided head pain that could involve tearing of the eyes, a droopy eyelid, and a stuffy nose. The occurrences can last from 15 minutes to 3 hours, occur daily or almost daily for weeks or months. The headaches are then separated by pain-free periods that last at least one month or longer. Cluster headaches are one of the most painful types of headaches, but are rare on not life threatening. The pathophysiology of the headaches is complex and not entirely known. A cluster headache is a neurovascular rather than a vascular headache, with vascular cerebral changes being driven by the effects of trigeminal-autonomic reflex activation. The trigeminal-autonomic reflex is a pathway which consists of a brainstem connection between the trigeminal nerve and facial cranial nerve parasympathetic outflow and is activated with the stimulation of the trigeminovascular pathways. The related cranial autonomic symptoms characteristic of cluster headache arises from the reflex activation of the trigeminal-autonomic reflex pathway through parasympathetic outflow from the superior salivatory nucleus, the cranial facial nerve, through the sphenopalatine ganglion, resulting in vasodilatation and parasympathetic activation. Clinically, this presents as tearing, conjunctival injection, and nasal congestion (Goadsby et al., 2018).
Treatment for cluster headaches include calcium channel blockers such as verapamil is often the first choice for preventing cluster headaches and can be used in conjunction with other medication. Occasionally, longer term use is needed to manage chronic cluster headache. Corticosteroids and are fast-such as prednisone are used for preventive medications that may be effective for many people with cluster headaches. The provider may prescribe corticosteroids if the cluster headache condition has started recently or if they have a pattern of brief cluster periods and long remissions. Lithium carbonate which is used to treat bipolar disorder, and may be effective in preventing chronic cluster headaches if other medications haven’t been effective. A nerve block could also be utilized which involves injecting an anesthetic and a corticosteroid into the area around the occipital nerve which might help improve chronic cluster headaches. An occipital nerve block may be useful for temporary relief until long-term preventive medications take effect, and is often used in combination with verapamil (Robbins et al., 2016).
Goadsby, P., Wei, D.-T., & Yuan Ong, J. (2018). Cluster headache: Epidemiology, pathophysiology, clinical features, and diagnosis. Annals of Indian Academy of Neurology, 21(5), 3. https://doi.org/10.4103/aian.aian_349_17
Robbins, M. S., Starling, A. J., Pringsheim, T. M., Becker, W. J., & Schwedt, T. J. (2016). Treatment of cluster headache: The american headache society evidence-based guidelines. Headache: The Journal of Head and Face Pain, 56(7), 1093–1106. https://doi.org/10.1111/head.12866