Cluster headache falls under the idiopathic headache entities characterized by severe headache attacks accompanied by autonomic symptoms. Though there exist several theories explain the condition, one theory suggests that cluster headache arises from activation of hypothalamic and secondary triggering of the trigeminal-autonomic reflex via the trigeminal-hypothalamic pathway.
Fischera et al. (2008) who examined 16 population-based studies on cluster headache prevalence, found that the 1-year prevalence varied greatly between the studies and ranged from 3 to 150 per 100,000. The study found that their pooled lifetime prevalence was 0.12 percent. Goadsby et al. (2018) noted that Norway had a prevalence rate of 381 per 100,000 while Ethiopia had a prevalence rate of 87 per 100,000.
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Richard will be subjected to therapy. The goal of the therapy will be to reduce the headache period, prevent attacks and lessen the severity of pain. To reduce pain, the therapy will utilize anesthetics. Anesthetics such as lidocaine. are effective against cluster headache pain when given through the nose due to their numbing effect. The injectable form of dihydroergotamine or octreotide can also relieve pain. To shorten the headache period, oxygen therapy would be the best option. Ward (2017) argued that breathing 7 to 10 liters per minute may significantly lessen the headache to 15 minutes. Oxygen has no side effects and can be administered at an emergency department setting o at home using an oxygen cylinder and regulator. The cluster headache is accompanied by attacks that are defined as a pulsating sensation in the brain. To prevent episodic cluster headache Richard will be administered with melatonin. Overall, the therapy will utilize medication and oxygen to achieve therapy goals.
References
Fischera, M., Marziniak, M., Gralow, I., & Evers, S. (2008). The Incidence and Prevalence of Cluster Headache: A Meta-Analysis of Population-Based Studies. Cephalalgia , 28 (6), 614-618. https://doi.org/10.1111/j.1468-2982.2008.01592.x
Goadsby, P., Wei, D., & 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
Ward, T. N. (2017). The Use of Oxygen for Acute Treatment of Cluster Headache Attacks. Headache: The Journal of Head and Face Pain , 57 (9), 1339-1339. https://doi.org/10.1111/head.13196
