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Wednesday, 27 November 2013

Cluster Headache - Misdiagnosis and Diagnosis

Cluster Headache
Cluster Headache also known as suicide headache, is defined as an uncommon distinctive neurovascular syndrome occurring in either episodic or chronic patterns of that occur periodically over a long period of time. The diseases affects over 0.1% of the population, occurring at 45-to 60-day intervals with one to three headaches a day lasting 45 min to 2 h(a), if untreated it, can cause increased frequency of the attacks.
A. Misdiagnosis
In a study conducted of Vast Majority of Cluster Headache Patients Are Initially Misdiagnosed, Dutch Researchers Report of a total of 1163 participants completed and returned the second questionnaire (913 men, 250 women). Only 22% said they were initially diagnosed with CH. Twenty-one per cent were initially diagnosed with sinusitis, 17% migraine, and 11% with a dental related condition. Sixteen percent had made the CH diagnosis themselves after reading about the symptoms. Sixteen percent had undergone tooth extraction and 12% an ears, nose and throat operation as treatment for their headaches
Your health care provider can diagnose this type of headache by performing a physical exam and asking questions about your symptoms and medical history, In their report, published in the Journal of Neurology Neurosurgery and Psychiatry in August 2003, Dr. van Vliet and colleagues say that clinical symptoms such as sensitivity to light, nausea and vomiting most likely lead physicians to diagnose migraine even though they are also common CH symptoms (23)

B. Diagnosis
Diagnosis depending to the symptoms of the diseases, including medical history, physical exam, pattern of recurrent attacks, and by cardinal symptoms (swollen eyelid, watery eye, runny nose). Keeping a headache attacks diary, etc. will help a physician to rule out other types of headaches. As The attacks are stereotypic--they are of extreme intensity and short duration, occur unilaterally, and are associated with robust signs and symptoms of autonomic dysfunction. Although the pathophysiology of cluster headache remains to be fully understood, there have been a number of recent seminal observation(24)
If a physical exam is done within 48h of last attack, patients who had pain episodes mimicking cluster headache attacks, and who experienced a total or partial Horner's syndrome ipsilaterally to pain (25)

C. Types of diagnosis
The aim of the diagnosis is to rule other causes of the diseases
1. CT scan
CT scan can dive your doctor a three-dimensional view of your blood vessels of the brain to look for masses and other abnormalities  that cause migraine headache

2. Magnetic resonance imaging (MRI)
By using radio waves and magnetic fields to take pictures, MRI scan provides very high quality of a cross-sectional slice and lengthwise slices of the brain and thus providing the better and detail image of location of tumor and the surrounding structures. It is one of most likely early test ordered by a doctor to diagnose tumors, strokes, aneurysms, neurological diseases and other brain abnormalities and the blood vessels around the brain.

3. Spinal tap (lumbar puncture)
A spinal tap is a procedure performed when a doctor needs to look at the cerebrospinal fluid (also known as spinal fluid), by inserting a thin needle between two vertebrae in your lower back to extract a sample. If your doctor suspects the onset of migraine headache is caused by inflammation of the membranes and cerebrospinal fluid surrounding your brain and spinal cord

4. Etc.

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Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/18047865
(23) http://web.archive.org/web/20060925093857/http://www.w-h-a.org/wha2/Newsite/resultsnav.asp?color=C2D9F2&idContentNews=595
(24) http://www.ncbi.nlm.nih.gov/pubmed/20352587
(25) http://www.ncbi.nlm.nih.gov/pubmed/17508178