Cluster Headache

Cluster Headache is a type of severe, recurring pain that is located on one side of the head. It received its name from the clustering or pattern of frequent headaches that usually occur.

There are two main types of Cluster Headache:

Episodic Cluster Headaches – occur one or more times daily for several months. The headaches then enter a period of remission and come back months or years later.

Chronic Cluster Headaches – occur almost daily with, at most, one headache-free week during a year.

Either type of headache may convert to the other type.

Causes

The cause of Cluster Headaches is unknown. Possible causes may include:
  • Decreased blood supply to the brain in the area of the headache
  • Disturbance in normal body rhythms
  • Imbalance of brain chemicals

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.
  • Sex: Male
  • Age: 20-50 years old
  • Prior head surgery or head injury

Symptoms

Symptoms of a Cluster Headache include:
  • Stabbing, penetrating, burning or explosive head pain that:
    • Is on one side of the head, but not both
    • Often starts around the eye and spreads to the same side of the head
    • Occurs daily or almost every day for 4-8 weeks
    • Can occur 1-6 times per day
    • Often occurs at about the same time each day
    • Increases in intensity over time
    • May start within two hours of going to sleep
    • Can awaken you from sleep
    • Usually lasts 30-45 minutes, but may last up to three hours
  • Restlessness and agitation
  • Nausea
During the headache other symptoms may occur on the affected side, including:
  • Stuffy or runny nose
  • Redness or watering of the eye
  • Droopy eyelid
  • Constriction of the pupil of the eye
  • Facial swelling

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical and neurological exam. A neurological exam tests:
  • Muscle strength
  • Coordination
  • Reflexes
  • Response to stimuli
  • Alertness
The doctor will ask about the frequency and pattern of your headaches. To help provide answers, keep a diary of:
  • When your headaches started and ended
  • What you were doing at the time
  • What you tried to relieve the pain
Tests are sometimes done to rule out other disorders.

Treatment

Treatment aims to reduce the frequency of headaches and help relieve the pain.

Lifestyle Changes and Self-Care
  • Maintain the same sleep routine. Avoid afternoon naps or sleeping in, which may bring on more headaches.
  • Do not drink alcoholic beverages. Even a small amount of alcohol can trigger a headache during a cluster period.
  • Learn stress-management techniques, because stress can bring on a headache.
  • Do not smoke. Tobacco may interfere with medication to relieve the headache.
  • Do not take narcotic pain medicine. Narcotics may cause episodic cluster headaches to become chronic.
  • Do moderate physical exercise on a regular basis. Excessively strenuous exercise may trigger cluster headaches. Vigorous physical activity at the first symptoms may stop the headache in some people. Caution: Take care not to injure yourself.
  • During cluster periods avoid:
    • Bright lights and glare
    • Heights and high altitudes
    • Hazardous activities
Medication

Drugs used to treat migraines often relieve cluster headaches. These drugs must be taken at the first sign of a headache. Some patients' headaches do not last long enough for drugs to be beneficial. Sometimes the drugs delay, but do not stop, an attack. These drugs may include:
  • Sumatriptan
  • Dihydroergotamine
  • Lidocaine – nose drops on the affected side
Other medications are used on a regular basis to prevent or reduce the frequency of headaches. These drugs include:
  • Calcium channel blockers – to relax and dilate the blood vessels
  • Lithium (blood levels of this drug must be monitored)
  • Methysergide – most helpful in younger people in early stages of disease
  • Prednisone – taken for a short period while other drugs are started
  • Ergotamine – for people who suffer from cluster headaches at predictable times such as at night
Oxygen Therapy

Breathing 100% oxygen for 10-15 minutes often helps relieve cluster headache pain. The oxygen appears to decrease blood flow to the affected area of the brain. People under age 50 who have episodic cluster headaches seem to benefit most from oxygen therapy. Note: Oxygen therapy is expensive and has associated health risks. Surgery

As a last resort, some doctors may recommend cutting or destroying a facial nerve to eliminate the pain.

Prevention

To prevent Cluster Headaches from getting worse, preventive medication may be given. In addition:
  • Maintain a regular sleep routine.
  • Do not smoke.
  • Avoid alcohol.
  • Get moderate physical exercise.
  • Practice stress management techniques.