Cluster headaches are one of the most painful kinds of headaches but are also quite rare. They begin suddenly and without warning, and typically occur in cycles or clusters. Frequent attacks, known as cluster periods, may last for weeks or months. Cluster periods are usually followed by remission, when the headaches stop completely. Cluster periods may occur only every one to two years.
Wellness & Prevention
While they may differ, symptoms of a cluster headache may include:
- Severe pain in or around one eye or on one side of the head. This pain can spread to other parts of the face, head, neck or shoulders.
- Redness or swelling of the affected eye
- Runny or stuffy nose on affected side of face
- Excessive tearing
- Sweaty, pale skin
- Drooping eyelid
Migraine-like symptoms may occur, although only on the affected side. These include sound and light sensitivity or the migraine aura. Sufferers describe cluster headache pain as sharp or burning, as if a hot poker is being pushed through their eye. People appear restless, as resting or lying flat may make the pain worsen. It’s not uncommon for people to rock, pace or even bang their heads against the wall during a pain episode.
A cluster period can last from four to 12 weeks, followed by a headache-free period that can last for months or years. Attacks tend to recur during the same time of year, commonly in the spring or fall.
Cluster headaches followed by a pain-free period of one month or more are episodic. Headaches followed by a remission of less than one month, or those that continue for at least 12 months without remission, are chronic cluster headaches.
About 10 to 20 percent of cluster headaches are chronic.
During a cluster period:
- Headaches occur every day, sometimes multiple times a day.
- A single attack can last from 15 minutes to three hours.
- Attacks often happen at the same time each day.
- The majority of attacks occur at night, usually one to two hours after going to bed.
- Pain usually ends suddenly, with rapidly decreasing intensity. Most people are completely exhausted following attacks.
Some people notice that certain things can trigger a cluster headache:
- Alcohol consumption
- Warm temperatures
- Strong smells or fumes
Cluster headaches are more common in men, although anyone of any age can have them. Other risk factors include:
- Age: Most people with cluster headaches first develop them between the ages of 20 and 50.
- Smoking: Many people who get cluster headache attacks are smokers.
- Alcohol use: Alcohol can trigger an attack for those at risk.
- Family history: Individuals with parents or siblings who have had cluster headaches have an increased risk.
People should consult with their doctor as soon as they begin to have what they think is a cluster headache. A doctor will ask about symptoms and run neurological exams. Imaging tests, such as CT scans or MRIs, may be done in order to rule out other disorders. If the brain scan comes back clean, a cluster headache diagnosis is usually made based upon symptoms.
Peoples can keep track of their headaches and other information in a diary to give their doctor more help with diagnosis and treatment. The diary can include a variety of information:
- Noting when any headaches happen and how long they last
- Rating the pain compared to the last headache cluster
- Any possible triggers that happened before headaches began, like eating certain foods
- Any medications taken, and whether they helped alleviate symptoms
Although not life-threatening, cluster headaches can greatly impact quality of life. There is no cure for them. Treatment is focused on shortening headache duration, making pain less severe, and reducing bouts. There are two methods of treatment: pain relief and prevention.
Over the counter painkillers are ineffective for cluster headaches. Specialized pain relief treatment is required:
- Oxygen therapy: People breathe pure oxygen through a mask. Pain is relieved within 15 minutes.
- Triptan: This prescription pain reliever can be injected or inhaled via nasal spray. It is fast-acting and can be self-administered.
- Local anesthetics: Lidocaine or similar anesthetics can be administered through the nose to help numb headache pain.
- Octreotide: This synthetic brain hormone can be self-injected for pain relief.
Preventive therapy is given when a cluster episode begins with the goal of suppressing attacks. Type of treatment depends on length and frequency of each person’s episodes.
- Calcium channel blockers: These are often the first choice for preventing cluster headache.
- Corticosteroids: These drugs reduce inflammation. They are fast-acting preventive medications that may be effective for people with cluster headaches.
- Lithium carbonate: This may be prescribed if other treatments have not been effective in preventing cluster headaches.
- Nerve block: A doctor may inject an anesthetic into the area around the occipital nerve. This may help improve chronic cluster headaches.
- Ergots: An oral tablet taken before bed to prevent nighttime attacks.
In rare cases where no other treatment works, surgery may be suggested. The surgical procedure for cluster headaches involves altering the nerve pathways where the pain is believed to begin. However, the long-term benefits of surgery are unknown and the risk of complications is high.
A series of follow up visits are routine to evaluate how well treatments are alleviating the cluster headaches.
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