Cluster Headache

What Is It?

A cluster headache is a rare type of headache which can be quite severe and debilitating. It is quite distinct from other types of headaches because it has very specific symptoms that set it apart. The pain from cluster headaches can be quite severe and have even been described as "suicide headaches" because the recurring headaches can be so hard to deal with that a patient may not wish to go on suffering from them. However, despite the severity of the pain, the headaches themselves are not life-threatening.

These are called "cluster" headaches because they tend to occur in clusters in a cyclical pattern. These periods of recurring attacks can last as long as weeks or months. These periods are then usually followed by a remission period, without attacks, that are variable in time but can last months or even years.

The cause of these rare headaches are not well understood. Because of the symptoms that accompany the headache and their cyclical nature, it appears that they are related to an underlying problem with the autonomic nervous system, particularly a part of the brain called the hypothalamus. Although it is not known what sets off a cluster attack, there appears to be some association with certain hormones and neurotransmitters. During a cluster period, alcohol is a common trigger which sets of headaches.

Although the exact cause of cluster headache is not known, there are some known risk factors that increase one's risk of having this condition:

  • Adult age: Although cluster headaches can develop at any age, it is most common to affect adults from their late 20's on.
  • Male Gender: Men are much more likely than women to develop cluster HAs.
  • Ethnicity (African American): African Americans are more likely than caucasians to experience these headaches.
  • Family History: People with first degree relatives (sibling or parent) with these headaches are at a higher risk of developing them themselves.
  • Smoking and Drinking: Many cluster headache sufferers are smokers and in people who have a history of these headaches alcohol can trigger attacks.

What Types of Symptoms Are Typical?

The headache associated with this condition is usually sudden in onset and is typically described as a severe pain located in, around or behind the eye. This specific type of headache is quite different from most other types of headache. The pain is usually only on one side and several other symptoms can accompany it, including tearing of the eye, redness in the eye on that side, stuffy or runny nose on the affected side, sweaty, pale skin, swelling around the eye on the same side, small pupil on that size and drooping eyelid on that side.

These other symptoms (tearing, swelling, pupil changes, stuffy nose, etc.) all suggest an autonomic nervous system source for the symptoms.

How Is The Diagnosis Typically Made?

The very unique and characteristic pattern of headache clusters as well as symptoms that accompany cluster headaches makes their diagnosis relatively easy. A physician will usually take a very careful history of your headaches, their characteristics and their pattern. They will also examine for any outward signs of cluster HAs. While imaging studies like MRI and CT do not show anything in a patient with cluster HAs, they may be ordered to rule-out other serious cause of headache, such as aneurysms or tumors.

Because the pattern of the headaches is so characteristic, doctors will often ask sufferers to make a diary or journal of their headaches, to look back and see if they fit a typical pattern of clusters. For example, the patient is asked to write down every time they have a headache and to describe the pain, the severity, the location, the duration, any inciting factors (alcohol, medications, etc.), the time and date, etc. This type of journal alone can go a long way to helping make the diagnosis.

What Are Some Common Treatments?

While there are no cures for these headaches there are many treatments that may be used to reduce pain and reduce the frequency of attacks. Some treatments are used acutely to try to treat the symptoms of an attack once it starts. Most slow acting medications like ibuprofen and others do not work because they take time to take effect.

Some examples of acute treatments that are given once an attack starts:

  • Oxygen: When at home, inhaling 100% oxygen from an oxygen tank often helps alleviate the symptoms of an attack. This is obviously more difficult to use away from the home because the large oxygen tank and mask must be with you.
  • Triptan medications: There is a class of drugs called triptans (all the names end in -triptan) that are most commonly used to treat migraine headaches. These drugs also help some people control cluster headaches. The fastest acting form are the injectable forms of sumatriptan (Imitrex) although nasal spray forms can also be used. There is also a nasal spray form of zolmitriptan (Zomig).
  • Dihydroergotamine: Another medication used for migraine, this medication can also be prescribed in injectable, IV and inhalation forms.

  • Octreotide: Sandostatin or octreotide is a hormone and neurotransmitter which is effective as an injection for many patients with cluster HAs.
  • Local Anesthetics: Local anesthetics are numbing medications such as lidocaine and can be effective as nasal drops.

Other treatments are rarely suggested for patients who don't respond well to the medications mentioned above. They can attempt to control the ocurrence of headaches in the first place. For example, surgical treatments, either open surgical or injections can be used to treat the nerves at the base of the brain which appear to be associated with the headaches. Likewise, some preventative medicines may be prescribed during cluster periods to help reduce the severity and frequency of headaches. Examples include short courses of corticosteroid medications (such as prednisone), ergotamine or nerve blocks. Other longer-term medications may be prescribed, such as calcium channel blockers (such as verapamil) or lithium. Less commonly, anti-seizure medications such as divalproex and topiramate may be used.

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Important Note: This site is not intended to offer medical advice. Every patient is different, and only your personal physician can help to counsel you about what is best for your situation. What we offer is general reference information about various disorders and treatments for your education.

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