Mission of BHHI

The mission of BHHI is to deliver comprehensive, integrative and individualized healthcare to each patient in order to achieve freedom from headache. Our integrative and multidisciplinary approach is designed to attain optimum health of body, mind and spirit. 


Vision of BHHI


The vision of BHHI Center is to improve the quality of our patients’ lives by providing the highest quality of integrative medical treatment to create healthy people in healthy communities, living up to their full potential with vitality and passion.


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Cluster Migraine


  

   Cluster headache   is a type of severe, recurring pain that is located on one side of the head. It received its name from the clustering or  pattern of frequent headaches that usually occur.

      There are two main types of cluster headaches:

  •  Episodic cluster headaches : These occur one or more times
    daily for 4-8   weeks. The headaches then enter a period of
    remission and come back months or years later.
  •  Chronic cluster headaches : These occur almost daily with
    headache-free periods lasting less than one month. 
    Either type of headache may convert to the other type.
 

Causes :

The cause of cluster headaches is unknown. It is thought that there is abnormal activation of the area of the brain responsible for regulating temperature, blood pressure, hormone release, and sleep The pain is thought to be caused by a combination of widening of the blood vessels and inflammation of the nerves of the face.

Other possible causes include:

  •  Alcohol use
  •  Changes in barometric pressure
  •  Changes in sleep pattern
  •  Tobacco use
  •  Drugs, such as nitroglycerin
   Risk factors :

Factors that increases your chance of cluster headaches include:

  •  Sex: males
  •  Age: 20-50 years old
  •  Prior head surgery or head injury
  •  Positive family history of cluster headaches


    Symptoms : 
  •  Stabbing, penetrating, burning, or explosive head pain that:
  •  Has a rapid onset
  •  Is on one side of the head, but not both
  •  Often starts around the eye and spreads to the same side of the head
  •  Causes facial flushing
  •  Occurs daily or almost every day for 4-8 weeks
  •  Can occur 1-8 times per day
  •  Lasts 15 minutes to 3 hours
  •  Often occurs at about the same time each day
  •  Increases in intensity over time
  •  May start within two hours of going to sleep
  •  Can awaken you from sleep
  •  Aura—This can include visual disturbance, visual spots, or the inability to move one side of the body. This more often occurs with migraine. But, auras can also happen with cluster headaches in a minority of cases.
  •  Restlessness and agitation
  •  Nausea

    During the headache other symptoms may occur on the affected side, including:
  •  Stuffy or runny nose
  •  Redness or watering of the eye on one side
  •  Droopy eyelid
  •  Constriction of the pupil of the eye
  •  Facial swelling and flushing, sweating
  •  Sensitivity to light and noise

    Diagnosis :

The doctor will ask about your symptoms and medical history. A physical and neurological exam will be done. A neurological exam tests the following:

  •  Mental status
  •  Cranial nerve functioning
  •  Motor and sensory functioning
  •  Coordination
  •  Reflexes
  •  Gait (walking)

The doctor will ask about the frequency and pattern of your headaches. To help provide answers, keep a diary of :  

             When your headaches started and ended

             • What you were doing at the time

             • What you tried to relieve the pain

Tests are sometimes done to rule out other disorders. These tests may include:

     • MRI scan :     a test that uses magnetic waves to make pictures of structures inside the head

    • CT scan of the brain :     a type of x-ray that uses a computer to make pictures of structures
                                            inside the head .

    Treatment :

     Treatment aims to reduce the frequency of headaches and help relieve the pain.

1.   Lifestyle Changes and Self-care

  •    Maintain the same sleep routine. Avoid afternoon naps or sleeping in, which may bring on more           
       headaches.
  •    Do not drink alcoholic beverages. Even a small amount of alcohol can trigger a headache during
       a cluster period.
  •    Learn stress management techniques. Stress can bring on a headache.
  •    Do not smoke. Tobacco may interfere with medication to relieve the headache

2.    Medication

Drugs used to treat migraines often relieve acute attack of cluster headaches. These drugs must be taken at the first sign of a headache.

Drugs used to treat cluster headaches include:

  •  Sumatriptan or other triptans
  •  Dihydroergotamine (eg, Migranal)
  •  Lidocaine—nose drops or spray on the affected side
  •  Pain relievers with caffeine
  •  Prednisone (eg, PredniSONE Intensol)
  •  Ergotamine (eg, Ergomar)
  •  Octreotide (given as an injection)
  •  Glycerol (given as an injection into the nerve)—used when the other treatments are ineffective.

In some cases, the headache does not last long enough for drugs to be beneficial. Sometimes, the drugs just delay an attack, rather than stopping an attack.

Pain killers, especially narcotic drugs, should not be used during an acute attack.

Other medicines (usually used in combination) are given on a regular basis to prevent or reduce the frequency of headaches. These drugs include:

  •  Verapamil (eg, Calan, Isoptin)—to relax and dilate the blood vessels
  •  Lithium (eg, Eskalith)—blood levels of this drug must be monitored
  •  Methysergide (eg, Sansert)—most helpful in younger people in early stages of disease
  •  Prednisone—taken for a short period while other drugs are started
  •  Dihydroergotamine or a triptan (medications to treat migraines)—for people who suffer
     from cluster    headaches at predictable times, such as at night
  •  Topiramate (eg, Topamax)
  •  Baclofen (eg, Lioresal)
  •  Valproate (eg, Depakote) or gabapentin (eg, Neurontin)
  •  Beta-blockers
  •  Clonidine (eg, Catapres-TTS)
  •  Melatonin
  •  Amitriptyline (eg, Apo-Amitriptyline)
  •  Topical capsaicin cream
  •  Selective serotonin reuptake inhibitors (SSRIs)

3.   Oxygen Therapy :

Breathing 100% oxygen for 10-15 minutes often relieves cluster headache pain. The oxygen appears to decrease blood flow to the affected area of the brain. People under age 50 who have episodic cluster headaches seem to benefit most from oxygen therapy.

Oxygen therapy can be expensive, though, and there are risks with this therapy.

4.   Surgery :

As a last resort, some doctors may recommend cutting or destroying a facial nerve to eliminate the pain.

5.   Prevention  :

To prevent cluster headaches from getting worse, preventive medication may be given. In addition:

  •  Maintain a regular sleep routine.
  •  If you smoke, quit.
  •  Avoid alcohol, narcotic analgesics, bright sunlight, and emotional stress.
  •  Get moderate physical exercise.
  •  Practice relaxation techniques.