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The autonomic nervous system is intimately involved in the genesis of cluster headache and it appears to be mediated by alterations in the hypothalamic area. This area and adjacent areas are believed to regulate both daily as well as yearly cycles that go on in the body.
Substances that cause blood vessel swelling can provoke an acute attack during a series period. Nitroglycerin or histamine, smoking or minimal amounts of alcohol can precipitate or increase the severity of the attacks as the sufferer’s blood vessels seem to change and become susceptible to the action of these substances. The blood vessels are not sensitive to these substances during headache-free periods. Hormonal influences in women do not appear to be a factor in cluster headaches.
The pain of cluster headache is generally intense and severe and often described as a burning or piercing sensation. It may be throbbing or constant, the scalp may be tender and the arteries often can be felt increasing their pulsation. The pain is so intense that most sufferers cannot sit still and will often pace during an acute attack.
-Pain almost always one-sided -Pain remains on the same side during a series -Pain can occur on the opposite side when a new series starts -Pain is localized behind the eye or in the eye region and may radiate to the forehead, temple, nose, cheek or upper gum on the affected side -The affected eyelid may become swollen or droop and the pupil may contract
The cluster headache sufferer has a considerable amount of pain-free intervals between series. Sufferers are generally affected in the spring or autumn, and, due to their seasonal nature, cluster headaches are often mistakenly associated with allergies or business stress. The seasonal relationship is individual for each sufferer.