Прекластерные симптомы и особенности патофизиологических механизмов пучковой (кластерной) головной боли

Abstract

The prevalence of cluster headaches is about 0.4–1% in the general population and is more common than epilepsy and parkinsonism. This work examines several pathophysiologically significant ways for the disease development: the trigeminovascular pathway, the trigeminal-autonomic reflex with the release of several neuropeptides, and the involvement of the hypothalamus and its suprachiasmatic nucleus as the main circadian pacemaker in cluster headaches. The authors present data on the clinical manifestations of the attack and pre-cluster symptoms that occur in some patients several days before the onset of cluster headache. An average of 6 years may pass from the disease onset to the diagnosis and prescription of effective therapy. Awareness of pre-cluster symptoms allows for the preventive treatment of a cluster headache attack to reduce the duration and intensity of clinical manifestations and, as a result, reduce the negative impact of the disease on various aspects of the patient’s life. The heterogeneity of clinical manifestations of cluster headaches, and consequently, the difficulties in making a timely diagnosis, as well as the clinically significant role of concomitant diseases on the disease course and the treatment effectiveness, require further study of this problem and the application of the results obtained in clinical practice.