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Klasehodepine

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Definisjon:
Anfallsvis hodepine med ensidige smerter i eller rundt øyet med varighet 15-180 minutt, ledsages av autonome symptomer på samme side av ansiktet, samt rastløshet/uro. Anfallene kommer i perioder ("klaser"), fra 1-8 anfall daglig i uker til måneder. Episodisk form med symptomfrie intervall på mer enn 3 måneder mellom anfallene er vanligst, men ca. 10% har en kronisk form uten lengre opphør av anfall.
Forekomst:
Livstidsprevalensen anslås til i underkant av én promille av befolkningen, hyppigst blant menn
Symptomer:
Symptomene er anfallsvis hodepine med svært intens smerte lokalisert bak eller rundt ett øye og med utstråling til tinningen, ledsaget av rødt øye, tåreflod og tett og rennende nese på samme siden, og/eller rastløshet og uro. 
Funn:
Nevrologisk status vanligvis normal, men et lett Horner's syndrom kan forekomme også utenom anfall.
Diagnostikk:
Klinisk diagnose, ingen tilleggsundersøkelser nødvendig for å stille diagnosen.
Behandling:
Behandlingen er en kombinasjon av anfallsbehandling med oksygen eller medikamenter, forebyggende behandling med medikamenter og forebyggende atferdstiltak. 
  • Nasjonal kompetansetjeneste for hodepine - nettside 
  1. May A. Diagnosis and clinical features of trigemino-autonomic headaches. Headache. 2013; 53: 1470-8. pmid:24090530 PubMed  
  2. Tfelt-Hansen P, Højland Jensen R. Klyngehovedpine (Hortons hovedpine). Ugeskr Læger 2006; 168: 4417. PubMed  
  3. Weaver-Agostoni J. Cluster headache. Am Fam Physician 2013; 88: 122-8. American Family Physician  
  4. D'Amico D, Rigamonti A, Solari A et al. Health-related quality of life in patients with cluster headache during active periods. Cephalalgia 2002; 22: 818-21. PubMed  
  5. Horton BT, Maclean A, Craig W. A new syndrome of vascular headache: results of treatment with histamine. Mayo Clin Proc 1939; 14: 257-60. PubMed  
  6. Alstadhaug KB, Ofte HK. Cluster headache. Tidsskr Nor Legeforen 2015; 135: 1361-64 pmid: 26315237 PubMed  
  7. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan;38(1):1-211. PMID: 29368949 PubMed  
  8. Swanson JW, Yanagihara T, Stang PE, O'Fallon WM, Beard CM, Melton LJ 3d, et al. Incidence of cluster headaches: a population-based study in Olmsted County, Minnesota. Neurology 1994; 44: 433-7. Neurology  
  9. Fischera M, Marziniak M, Gralow I, Evers S. The incidence and prevalence of cluster headache: a meta-analysis of population-based studies. Cephalalgia. 2008;28(6):614–618.
  10. Rainero I, Rubino E, Valfrè W, et al. Association between the G1246A polymorphism of the hypocretin receptor 2 gene and cluster headache: a meta-analysis. J Headache Pain. 2007;8(3):152–156.
  11. Ekbom K, Hardebo JE. Cluster headache: aetiology, diagnosis and management. Drugs 2002; 62: 61-9. PubMed  
  12. Nobre ME, Filho PF, Dominici M. Cluster headache associated with sleep apnoea. Cephalalgia 2003; 23: 276-9. PubMed  
  13. May A, Bahra A, Buchel C, Frackowiak RS, Goadsby PJ. Hypothalamic activation in cluster headache attacks. Lancet 1998; 352: 275-8. PubMed  
  14. Hoffmann J, May A. Diagnosis, pathophysiology, and management of cluster headache. Lancet Neurol. 2018; 17: 75-83. PMID: 29174963 PubMed  
  15. Ran C, Alexanderson K, Belin AC, Almondo G, Steinberg A, Sjöstrand C. Multimorbidity and Sickness Absence/Disability Pension in Cluster Headache Patients and Matched References: A Swedish Register-Based Study published online ahead of print, 2022 Dec 14. Neurology. 2022;10.1212/WNL.0000000000201685. PMID: 36517237 PubMed  
  16. Rozen TD. Cluster headache as the result of secondhand cigarette smoke exposure during childhood. Headache. 2010;50(1):130–132.
  17. Matre C, Tronvik E, Ljøstad U, Mygland Å. Klasehodepine og andre trigeminal-autonome hodepiner. NevroNEL. Sist rev. nov. 2015. nevro.legehandboka.no  
  18. Bahra A, May A, Goadsby PJ. Cluster headache: a prospective clinical study with diagnostic implications. Neurology 2003; 58: 354-61. Neurology  
  19. Van Vliet JA, Eekers PJ, Haan J, Ferrari MD, Dutch RUSSH Study Group. Features involved in the diagnostic delay of cluster headache. J Neurol Neurosurg Psychiatry 2003; 74: 1123-5. PubMed  
  20. Francis GJ, Becker WJ, Pringsheim TM. Acute and preventive pharmacologic treatment of cluster headache. Neurology 2010; 75: 463-73. Neurology  
  21. Bahra A, May A, Goadsby PJ. Cluster headache: a prospective clinical study with diagnostic implications. Neurology 2002; 58: 354-61. Neurology  
  22. 3.May A, Leone M, Afra J, Linde M, Sándor PS, Evers S, Goadsby PJ; EFNS Task Force. EFNS guidelines on the treatment of cluster headache and other trigeminal-autonomic cephalalgias. Eur J Neurol 2006; 13: 1066-77. PMID: 16987158 PubMed  
  23. Tobin J, Flitman S. Occipital nerve blocks: when and what to inject? Headache 2009; 49:1521-33. PMID: 19674126 PubMed  
  24. Law S, Derry S, Moore RA. Triptans for acute cluster headache. Cochrane Database Syst Rev 2013 Jul 17;7:CD008042. PMID 24353996 The Cochrane Library  
  25. Van Vliet JA, Bahra A, Martin V, Ramadan N, Aurora SK, Mathew NT, et al. Intranasal sumatriptan in cluster headache: randomized placebo-controlled double-blind study. Neurology 2003; 60: 630-3. Neurology  
  26. Bennett MH, French C, Schnabel A, Wasiak J, Kranke P, Weibel S. Normobaric and hyperbaric oxygen therapy for the treatment and prevention of migraine and cluster headache. Cochrane Database of Systematic Reviews 2015, Issue 12. Art. No.: CD005219. DOI: 10.1002/14651858.CD005219.pub3 DOI  
  27. Cohen AS, Burns B, Goadsby PJ. High-flow oxygen for treatment of cluster headache. A randomized trial. JAMA 2009; 302: 2451-57. Journal of the American Medical Association  
  28. Obermann M, Nagel S, Ose C, et al. Safety and efficacy of prednisone versus placebo in short-term prevention of episodic cluster headache: a multicentre, double-blind, randomised controlled trial. Lancet Neurol. 2021; 20(1):29-37. PMID: 33245858 PubMed  
  29. Tyagi A, Matharu M. Evidence base for the medical treatments used in cluster headache. Curr Pain Headache Rep. 2009;13(2):168–178.
  30. Bratbak DF, Nordgård S, Stovner LJ, Linde M, Folvik M, Bugten V, Tronvik E. Pilot study of sphenopalatine injection of onabotulinumtoxinA for the treatment of intractable chronic cluster headache. Cephalalgia 2015. doi:10.1177/0333102415597891 DOI  
  31. Lovely TJ, Kotsiakis X, Jannetta PJ. The surgical management of chronic cluster headache. Headache 1998; 38: 590-4. PubMed  
  32. Wilbrink LA, de Coo IF, Doesborg PGG, et al. Safety and efficacy of occipital nerve stimulation for attack prevention in medically intractable chronic cluster headache (ICON): a randomised, double-blind, multicentre, phase 3, electrical dose-controlled trial. Lancet Neurology 2021; 20: 515-25. pmid:34146510 PubMed  
  33. Fontaine D, Lazorthes Y, Mertens P, et al. Safety and efficacy of deep brain stimulation in refractory cluster headache: a randomized placebo-controlled double-blind trial followed by a 1-year open extension. J Headache Pain. 2010;11(1):23–31.
  34. van Kleef M, Lataster A, Narouze S, Mekhail N, Geurts JW, van Zundert J. Evidence-based interventional pain medicine according to clinical diagnoses. 2. Cluster headache. Pain Pract. 2009;9(6):435–442.
  35. Ekbom K, Svensson DA, Traff H and Waldenlind E. Age at onset and sex ratio in cluster headache: observations over three decades. Cephalalgia 2002; 22: 94-100. PubMed  
  36. Duncan CW, Watson DPB, Stein A, et al. Diagnosis and management of headache in adults: summary of SIGN guideline. BMJ 2008; 337: a2329. BMJ (DOI)  
  • Lars Jacob Stovner, professor i nevrologi, Institutt for nevromedisin og bevegelsesvitenskap, NTNU. Leder av Nasjonal kompetansetjeneste for hodepine, St. Olavs hospital, Trondheim
  • Ingard Løge, spesialist allmennmedisin, redaktør NEL