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 headaches:
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 headache-free periods lasting less than two weeks.
Either type of headache may convert to the other type.
Causes
The cause of cluster headaches is unknown. The pain is caused by a combination of dilation (widening) of the blood vessels and inflammation of the nerves of the face.
Possible causes may include:
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Symptoms
Symptoms of a cluster headache include:
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Stabbing, penetrating, burning, or explosive head pain that:
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Restlessness and agitation
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Nausea
During the headache other symptoms may occur on the affected side, including:
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Stuffy or runny nose
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Redness or watering of the eye on one side
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Droopy eyelid
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Constriction of the pupil of the eye
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Facial swelling and flushing, sweating
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical and neurological exam. A neurological exam tests the following:
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Muscle strength
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Coordination
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Reflexes
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Response to stimuli
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Alertness
The doctor will ask about the frequency and pattern of your headaches. To help provide answers, keep a diary of:
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When your headaches started and ended
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What you were doing at the time
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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
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Maintain the same sleep routine. Avoid afternoon naps or sleeping in, which may bring on more headaches.
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Do not drink alcoholic beverages. Even a small amount of alcohol can trigger a headache during a cluster period.
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Learn stress-management techniques, because stress can bring on a headache.
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Do not smoke. Tobacco may interfere with medication to relieve the headache.
Medication
Drugs used to treat migraines often relieve acute attack of 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. Pain killers especially narcotic drugs should not be used during an acute attack.These drugs may include:
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Sumatriptan or other triptans
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Dihydroergotamine
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Lidocaine–nose drops or spray on the affected side
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Analgesics with caffeine
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Prednisone
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Ergotamine
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Glycerol injection into the trigeminal ganglion for those individuals resistant to other treatments
Other medications (usually used in combination of the 2-3 drugs) are administered on a regular basis to prevent or reduce the frequency of headaches. These drugs include:
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Verapamil (Calan, Isoptin)–to relax and dilate the blood vessels
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Lithium (Eskalith)–blood levels of this drug must be monitored
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Methysergide (Sansert)–most helpful in younger people in early stages of disease
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Prednisone–taken for a short period while other drugs are started
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Dihydroergotamine or a triptan–for people who suffer from cluster headaches at predictable times such as at night
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Valproate (Depakote) or gabapentin (Neurontin)
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Beta blockers
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Clonidine
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Melatonin
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Amitriptyline
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Selective serotonin reuptake inhibitors (SSRIs)
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:
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Maintain a regular sleep routine.
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Do not smoke.
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Avoid alcohol, and narcotic analgesics, bright sunlight, emotional stress.
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Get moderate physical exercise.
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Practice stress-management techniques.
RESOURCES:
American Council for Headache Education
http://www.achenet.org
National Headache Foundation
http://www.headaches.org
References:
American Academy of Family Physicians website. Available at: http://www.aap.org.
American Medical Association website. Available at: http://www.ama-assn.org/.
Beck E, Sieber WJ, Trejo R. Management of cluster headache. Am Fam Physician. 2005; 71:717-24.
Cecil Textbook of Medicine, 21st ed. WB Saunders Company; 2000.
Conn's Current Therapy 2001, 53rd ed. WB Saunders Company; 2001.
Emergency Medicine: Concepts and Clinical Practice, 4th ed. Mosby-Year Book Inc; 1998.
Griffith's 5-Minute Clinical Consult, 2001 ed. Lippincott Williams & Wilkins; 2001.
The International Classification of Headache Disorders: 2nd edition. Cephalagia. 2004: 24(Suppl 1) 9-160.
Primary Care Medicine, 4th ed. Lippincott Williams & Wilkins; 2000.
Textbook of Clinical Neurology, 1st ed. WB Saunders Company; 1999.
VanVliet JA, Bahra A, Martin V, et al. Intranasual sumatriptan in cluster headache: randomized placebo-controlled double-blind study. Neurology. 2003; 60: 630-3.
