Cluster Headaches

cluster headache

Cluster headaches consist of attacks of severe one-sided pain in the head. It is sometimes called migrainous neuralgia. Each attack develops suddenly, usually without any warning. Typically, you feel the pain mainly in or around one eye or temple. The pain may spread to other areas on the same side of the head. The pain is sometimes described as burning or boring. Each attack lasts 15-180 minutes, but most commonly 45-90 minutes. Attacks may occur from once every two days to eight times a day.

The pain during an attack is usually severe. It can be so severe that you are likely to become agitated and unable to lie down.  During each attack, one or more of the following symptoms also usually occurs: redness and watering of the eye; a runny nose; sweating of the face; swelling of the eyelids; drooping of the eyelid; constriction of the pupil in the eye.

Attacks usually occur in clusters (bouts). That is, a number of attacks of pain occur over a period of time, which then stops. During a cluster, each attack of pain usually occurs on the same side of the head. Each cluster of attacks usually lasts for several weeks or months. Each cluster is then usually separated by months or years of remission (where no attacks occur).

What causes cluster headaches?

Research suggests that a part of the brain called the hypothalamus becomes overactive during each attack. However, it is not known what causes this over activity. During an attack, the hypothalamus is thought to release chemicals (neurotransmitters). These may stimulate nerve cells in the brain to cause the pain and other symptoms. There may be some genetic part, as in about 1 in 20 cases the condition also occurs in some other close relative.

  • Alcohol. Some people find that a headache often occurs within an hour or so of having an alcoholic drink.
  • Increased body heat may be a trigger, such as exercising in a hot room, or having a hot bath.
  • Strong-smelling substances, such as solvents, perfumes, petrol, etc.

How are cluster headaches diagnosed?

The diagnosis is based on the typical symptoms. There is no test that can prove the diagnosis.

What is the treatment for cluster headaches?

Treating each headache

Ordinary painkillers do not work. Generally, if you take an ordinary painkiller, it takes too long to work, as the headache will usually have gone before the painkiller takes effect.

Sumatriptan injection: sumatriptan, given by injection just under the skin, is the commonly used treatment to abort a headache. It relieves pain within 15 minutes in about 3 in 4 people with a cluster headache. Some points about sumatriptan injection:

  • It works within 5-15 minutes to ease the headache in most affected people.
  • The adult dose is a 6 mg injection for each headache. The maximum dose in 24 hours is two 6 mg injections (12 mg) with a minimum interval of one hour between the two doses.
  • Side-effects sometimes occur but, if they do, are generally mild and do not last long. They include feeling sick, dizziness, tiredness and dry mouth. A minority of people also develop a warm-hot sensation, tightness, tingling, flushing, and feelings of heaviness or pressure in the face, arms, legs, and occasionally the chest.

Zolmitriptan nasal spray: zolmitriptan is also a triptan medicine. Zolmitriptan nasal spray is an alternative to sumatriptan injection. It often works well but possibly not as quickly as sumatriptan injection.

100% oxygen therapy: this is an alternative treatment that may be advised, especially if sumatriptan injections or zolmitriptan nasal spray cannot be used, or do not work. It often works well to relieve pain within 15 minutes, but it does not work in everybody.

Preventing cluster headaches

Some medicines are used which aim to prevent cluster headaches. Most people with cluster headaches will be prescribed one. It is difficult to say exactly how well they work at reducing the frequency and/or severity of headaches.
Verapamil is the most commonly used treatment. It is a medicine that is normally used to treat heart problems. It is not clear how it works for cluster headaches.

Lithium is sometimes used. This medicine is commonly used to treat bipolar disorder. Again, it is not clear how it may help cluster headaches.

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