About cluster headaches

What is cluster headaches?

Cluster headache is pain that occurs along one side of the head. It's frequently described as pain that occurs around, behind, or above the eye and along the temple in cyclic patterns or clusters. The pain of a cluster headache is very severe. Many patients describe a “drilling” type of sensation. For classification as a true cluster headache, associated autonomic features such as tearing/watering of the eye, redness of the conjunctiva, rhinorrhea or nasal stuffiness, eyelid drooping, sweating on one side of the face, or changes in pupil size (with the pupil on the affected side becoming notably smaller) are usually present. The headache lasts from 15 minutes to a maximum duration of about 3 hours. However, the headache can recur up to eight times daily. Cluster headache was originally described in the 17th century, but it wasn't until the mid- 20th century that it became known by this name.

What are the symptoms for cluster headaches?

Nasal stuffiness symptom was found in the cluster headaches condition

Cluster Headaches usually occur in cyclical patterns called cluster periods . Possible symptoms include severe Pain in or around one eye or on one side of your head. There may be tearing, Nasal stuffiness and a runny nostril on the affected side of the head.

A cluster Headache strikes quickly, usually without warning, although you might first have migraine-like Nausea and aura. Common signs and symptoms during a Headache include:

  • Excruciating Pain that is generally situated in, behind or around one eye, but may radiate to other areas of your face, head and neck
  • One-sided pain
  • Restlessness
  • Excessive tearing
  • Redness of your eye on the affected side
  • Stuffy or runny nose on the affected side
  • Forehead or facial Sweating on the affected side
  • Pale skin (pallor) or flushing on your face
  • Swelling around your eye on the affected side
  • Drooping eyelid on the affected side

People with cluster headache, unlike those with migraine, are likely to pace or sit and rock back and forth. Some migraine-like symptoms — including sensitivity to light and sound — can occur with a cluster headache, though usually on one side.

Cluster period characteristics

A cluster period generally lasts for several weeks to months. The starting date and the duration of each cluster period might be consistent from period to period. For example, cluster periods can occur seasonally, such as every spring or every fall.

Most people have episodic cluster headaches. In episodic cluster headaches, the Headaches occur for one week to a year, followed by a pain-free remission period that can last as long as 12 months before another cluster Headache develops.

Chronic cluster periods might continue for more than a year, or pain-free periods might last less than one month.

During a cluster period:

  • Headaches usually occur every day, sometimes several times a day
  • A single attack can last from 15 minutes to three hours
  • The attacks often occur at the same time each day
  • Most attacks occur at night, usually 1 to 2 hours after you go to bed

The Pain usually ends as suddenly as it began, with rapidly decreasing intensity. After attacks, most people are pain-free but exhausted.

What are the causes for cluster headaches?

The exact cause of cluster headaches is unknown, but cluster headache patterns suggest that abnormalities in the body's biological clock (hypothalamus) play a role.

Unlike migraine and tension headache, cluster headache generally isn't associated with triggers, such as foods, hormonal changes or stress.

Once a cluster period begins, however, drinking alcohol may quickly trigger a splitting headache. For this reason, many people with cluster headache avoid alcohol during a cluster period.

Other possible triggers include the use of medications such as nitroglycerin, a drug used to treat heart disease.

What are the treatments for cluster headaches?

The treatment of cluster headache can be divided into two distinct categories -- relief of the acute headache and prevention of future headaches. Oxygen delivered by face mask has been shown to help a majority of patients within a short period of time. However, this can be unwieldy, and most patients are unable or unwilling to transport oxygen canisters if they need to travel. Injectable sumatriptan has been shown to be beneficial in many of patients with cluster headache. This treatment is contraindicated in patients with cardiac disease or untreated hypertension. Nasal spray or oral versions of this medication have been less effective than the injectable. Dihydroergotamine, given intravenously, can be extremely effective in treating a cluster headache, but can be difficult to administer acutely and cannot be used if a patient has used sumatriptan in the preceding 24 hours. Intranasal lidocaine has been suggested as a treatment option, but must be administered in a specific manner and is ineffective if not given correctly.

Steroids can be extremely effective to decrease a headache cycle; these can be used infrequently and are for short-term use only as long-term use can lead to significant complications. Verapamil, lithium, valproic acid, topiramate, and melatonin can all be of benefit in reducing the frequency and severity of cluster cycles. In intractable cases, surgery has been suggested. Radiofrequency lesioning of the trigeminal ganglion can decrease cluster headache frequency, but is associated with significant side effects and nerve loss; gamma knife lesioning and deep brain stimulation are being studied as possible options with less risk of permanent nerve change.

What are the risk factors for cluster headaches?

  • Sex. Men are more likely to have cluster headaches.
  • Age. Most people who develop cluster headaches are between ages 20 and 50, although the condition can develop at any age.
  • Smoking. Many people who get cluster headache attacks are smokers. However, quitting smoking usually has no effect on the headaches.
  • Alcohol use. If you have cluster headaches, drinking alcohol during a cluster period may increase your risk of an attack.
  • A family history. Having a parent or sibling who has had cluster headache might increase your risk.

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