Cluster headache is not a common headache. It is also referred to as histamine headache, and is classified as primary neurovascular headache disorder. It involves groups of headaches, occurring over a period of several weeks.
The headache occurs on one-side of the head which may involve tearing of the eyes, a droopy eyelid, and stuffy nose. The headaches are severe pain and occur as an episode for about 15-20 minutes.
The cluster headache is rare but not life-threatening. The attacks of cluster headache can be shorter and less severe with proper treatment. The headaches can last from weeks up to months. These are usually followed by remission periods during which the headaches stop. No headaches would occur for months or even sometimes even years during the remission period.
CAUSE OF CLUSTER HEADACHE
Cluster headaches are caused when a nerve pathway is triggered in the base of your brain. The signal comes from a deeper part of the brain referred to as the hypothalamus. Hypothalamus is the home of the “internal biological clock” responsible for controlling the sleep and wake cycles.
Trigeminal nerve is affected which is responsible for sensations like heat or pain in your face. Trigeminal nerve is located near the eye, and it branches up to the forehead moving across the cheek, down to the jaw, and above the ear on the same side.
Some characteristics of cluster headache that differentiates it from other headaches are:
Speed – Unlike other headaches, cluster headaches reach their full capacity quickly within 5-10 minutes.
Pain – Pain is usually on one side of the head during the time of the attack. The pain is described as burning or piercing which may be throbbing or constant. The pain may spread all across the forehead, temple, nose, cheek, or upper gum on that side of the headache, the scalp might be tender and you might feel the blood pulsating.
Short Duration – It typically lasts for around minimum 15 minutes or moderate to about 30 to 90 days to a maximum 3 hours before they disappear.
Predictable – The headaches are linked to the cardiac rhythm and occur the same time each day thus referred to as alarm clock headaches. The attacks can happen at night while you are sleeping and they are more severe at night than day.
requency – The frequency of the headaches is daily that ranges from 2 weeks to about 3 months. In between this period, you’ll be pain-free for at least 2 weeks.
Extreme temperature variations can trigger an episode during an attack. The temperature change is usually linked to a quick rise in body temperature. Narcotics like alcohol or smoking, strong smelling substances like petrol, paint fumes, perfume, bleach or solvents, certain medicines, hormonal changes, caffeine, some food or food additives can also trigger the cluster or bout.
SYMPTOMS OF CLUSTER HEADACHES
The headache strikes quickly, usually without warning signs or symptoms. First time it might have migraine-like symptoms, nausea and aura. The headache starts rapidly as intense pain, usually without warning.
Cluster headache is continuous rather than throbbing pain, usually described as stabbing, sharp, burning, and penetrating pain. The pain usually starts around the eye, radiating to other parts of the head that includes the face, neck, and shoulders. Other symptoms that you might notice are:
- Mild burning feeling or discomfort
- Swollen or drooping of the eye
- Pupil becomes small in the eye
- Redness or watering of the eyes
- Runny or congestion of nose on the side of pain
- Red and warm face
- Sweating on the face
- Sensitivity to light
- Pale skin
- Restlessness
- Tiredness after the episode
Each episode of cluster headache would last from 15 minutes up to several hours. The attack usually does not last more than an hour. There might be one to three clusters each day.
DIAGNOSIS OF CLUSTER HEADACHES :-
These headaches have a certain pattern of attack and a different characteristic of pain. The doctor would examine the characteristics of pain, its location and severity, and associated symptoms of the headache.
The doctor would get certain tests like MRI and CT scan to rule out other serious causes of pain like tumor or an aneurysm. They would get a neurological examination done to understand the brain function, including testing the senses, reflexes and nerves. These tests are usually normal in people suffering from cluster headaches.
TREATMENT OF CLUSTER HEADACHES :-
The treatment does not completely cure the headache. However, the main goal is to decrease the severity of pain, shorten the duration of headache and prevent the attacks from occurring frequently.
The bout of cluster headache is usually for a short duration which makes it difficult to evaluate and treat. A fast acting medication is required for the relief. The treatment regime might include medications and therapies as listed below:
Acute Treatment – These are the fast acting treatments prescribed by the doctors. These include:
Oxygen – Inhaling pure oxygen through a mask provides quick relief. The procedure is safe and inexpensive and provides relief within 15 minutes. The only drawback is the need to carry the small, portable oxygen unit.
Triptans – Triptans are the serotonin receptor antagonists and work on different mechanisms. Triptans work by stimulating serotonin (a neurotransmitter) which helps in reducing inflammation and constricts the blood vessels thereby reducing the headache. These provide quick relief in acute cluster headache episodes. Triptan is available in injectable form like sumatriptan (Imitrex) or as nasal spray like zolmitriptan (Zomig).
Octreotide – This acts as somatostatin hormone in the brain which acts like a neurotransmitter. This helps in reducing the inflammation and acute pain. Commonly used medicine is Sandostatin which is the synthetic injectable version of somatostatin.
Local anesthetics – Lidocaine, have a numbing effect on the area of pain and is usually taken through the nose (intranasal). It is effective against acute cluster pains.
Dihydroergotamine – These are injectable forms of dihydroergotamine (like D.H.E. 45) and are effective pain relievers for cluster headaches. This medication is available in an inhaled (intranasal) form.
Preventive Medicine – These help in suppressing the attacks on the onset of cluster episodes. The prescription of medicine depends on the length and regularity of the episodes.
Calcium channel blockers – The verapamil (Calan, Verelan, others) is used for preventing cluster headaches. The medicine is prescribed for longer term use to manage chronic cluster headache.
Corticosteroids – Prednisone Intensol or Rayos are Inflammation-suppressing drugs which are fast-acting and effective in curing cluster headaches.
Nerve Block – The occipital nerve block is useful for temporary relief until long-term preventive medications provide relief. It’s used in combination with verapamil for better results.
Surgery – This would be the last option when other treatments do not work effectively. Sphenopalatine ganglion stimulation involves implanting a neurostimulator providing quick pain relief as well as lowers the frequency of headaches. Noninvasive vagus nerve stimulation (VNS) delivers electrical stimulation through the skin to the vagus nerve which decreases the frequency of cluster headaches.
OUTLOOK
Cluster headaches can be very painful and you might want to opt for alternative or complementary therapies that would relieve your pain. Cluster headaches are not life-threatening but pain management helps in reducing the intensity of pain.
If you or anyone you know is suffering from cluster headaches, our expert providers at Specialty Care Clinics will take care of your health and help you recover.
Call us on (469) 545-9983 to book an appointment with Dr. Masel.