Cluster Headache

Overview

Cluster headache is a type of headache that causes extreme, sharp, or stabbing pain on one side of the head, often near or around one eye. This pain can spread to other areas of the face, head, and neck. Cluster headaches typically occur in frequent attacks known as clusters, which can last for several weeks to months. The headaches may wake people from sleep and can be accompanied by other symptoms such as restlessness, tears, redness of the eye, facial sweating, and skin color changes. Cluster headache attacks can be triggered by factors such as alcohol consumption and weather changes. The exact cause of cluster headaches is unknown, but experts believe there may be a link to the body's biological clock. Treatments can help shorten cluster headache attacks and reduce pain.

Understanding the disease

Symptoms

Cluster headache is a very painful type of headache that typically occurs in periods of frequent attacks known as clusters. The pain is intense and usually affects one side of the head, around or behind one eye. Common symptoms of a cluster headache include:

• Extreme sharp or stabbing pain in or around one eye, which can spread to other areas of the face, head, and neck
• Pain on one side of the head during a single cluster period, with the possibility of switching to the other side in another cluster
• Restlessness
• Tears
• Redness of the eye on the affected side
• Stuffy or runny nose on the affected side
• Forehead or facial sweating
• Skin color changes on the affected side of the face
• Swelling around the affected eye
• Drooping eyelid on the affected side If you experience any of these symptoms, it is recommended to see a healthcare provider for proper evaluation and treatment. Seek emergency care if you have a severe headache that comes on suddenly, a headache with a fever, nausea, vomiting, stiff neck, confusion, seizures, numbness, or trouble speaking.

Risk Factors

The risk factors for developing cluster headache include:

1. Sex: Men are more likely to have cluster headaches than women.
2. Age: Most people who develop cluster headaches are between ages 20 and 50. However, the condition can start at any age.
3. Smoking: Many people who get cluster headaches are smokers, but quitting smoking usually doesn't stop the headaches.
4. Alcohol use: If you have cluster headaches, drinking alcohol during a cluster period may increase the risk of an attack.
5. Family history: Having a parent, brother, or sister who has cluster headache might increase the risk.

Development

During a cluster headache, various symptoms can develop due to the intense pain. These symptoms may include:

1. Extreme sharp or stabbing pain, usually in, behind, or around one eye. The pain can spread to other areas of the face, head, and neck.
2. Pain on one side of the head in a single cluster. Pain can switch to the other side in another cluster.
3. Restlessness.
4. A lot of tears.
5. Redness of the eye on the side that hurts.
6. Stuffy or runny nose on the side that hurts.
7. Forehead or facial sweating.
8. Skin color changes on the side of the face that hurts.
9. Swelling around the eye on the side that hurts.
10. Drooping eyelid on the side that hurts. Cluster periods typically last for several weeks to months. Each cluster period may start at about the same time of year and last about the same length of time. For example, cluster periods can come during certain seasons, such as every spring or every fall. However, the exact cause of cluster headaches is not known, and experts believe that it might be related to the body's biological clock, specifically the hypothalamus. Common triggers include alcohol consumption, weather changes, and certain medications.

Assessment and Diagnosis

Triage

You should see a health care provider if you've just started to have cluster headaches or if there's a change in how your headaches feel or how often they occur. Additionally, seek emergency care if you experience a severe headache that comes on suddenly, a headache with fever, nausea or vomiting, a stiff neck, confusion, seizures, numbness, or trouble speaking, as these symptoms may indicate a more serious medical condition such as a stroke, meningitis, encephalitis, a brain tumor, or other problems.

Diagnosis

To diagnose cluster headache, a specialist trained in treating headaches, such as a neurologist, will make a diagnosis based on your medical history, symptoms, and a physical and neurological examination. In some cases, tests may be performed to rule out other causes for the pain, such as an MRI scan or a CT scan. It's important to keep a headache diary, noting the date, duration, intensity, triggers, and any symptoms you experienced prior to the headache.

Management and Treatment

Prevention

Preventing cluster headaches can be challenging, as the exact cause is not well understood. However, there are some potential strategies that may help reduce the frequency and severity of cluster headaches for some individuals:

1. Avoid Triggers: Identify and avoid potential triggers such as alcohol, tobacco smoke, and certain foods. Keeping a headache diary may help in identifying specific triggers.
2. Medications: Speak with a healthcare professional about medications that can help prevent or reduce the severity of cluster headaches, such as anti-inflammatory drugs, calcium channel blockers, or steroids.
3. Oxygen Therapy: Inhaling pure oxygen through a mask may help relieve symptoms during an attack. This can be done at home with a portable oxygen tank or with the help of a healthcare professional in a medical setting.
4. Lifestyle Changes: Maintaining a regular sleep schedule, reducing stress through relaxation techniques, and practicing good posture can help in managing cluster headaches.
5. Biofeedback: This technique involves learning how to control bodily functions, such as heart rate and blood pressure, to help manage pain.
6. Remission Period: During periods without headaches, it's essential to maintain a healthy lifestyle and avoid potential triggers to reduce the likelihood of future cluster headaches. It's important to consult with a healthcare professional for personalized advice and treatment options, as prevention methods may vary from person to person.

Treatment

Treatments for cluster headache can help shorten the duration of attacks, lessen the pain, and reduce the frequency of cluster headaches. Some treatments include:

1. Oxygen therapy: Breathing pure oxygen through a mask can help relieve symptoms within 15 minutes in some cases.
2. Medications: Prescription medications, such as sumatriptan (Imitrex) and dihydroergotamine (D.H.E. 45), are effective in treating cluster headaches. These medications work by narrowing blood vessels and reducing inflammation.
3. Preventive treatments: If you have frequent or chronic cluster headaches, your doctor may prescribe preventive medications to reduce the number of attacks. These can include anti-seizure medications, such as topiramate (Topamax) and lithium, as well as corticosteroids.
4. Nerve blocks: Injecting a local anesthetic and corticosteroid into the affected nerve can provide relief from pain.
5. Lifestyle modifications: Avoiding known triggers, such as alcohol, can help reduce the frequency and severity of cluster headaches. It's important to work closely with your healthcare provider to find the most effective treatment plan for your specific needs.

Preparing for medical consultation

To prepare for an appointment for cluster headache, you should:

1. Make the appointment: Contact your primary care provider or a neurologist to schedule a consultation.
2. Keep a headache diary: Before the appointment, keep a record of your headache symptoms, including the date, duration, intensity, and any triggers. Note any aura or visual disturbances you experience.
3. List questions: Prepare a list of questions to ask your doctor, such as the cause of your symptoms, recommended tests, treatment options, and how to manage other health conditions.
4. Gather personal information: Write down any major stresses, recent life changes, or other relevant personal information to share with your doctor.
5. Be ready to discuss your medical history: Be prepared to share details about any previous headaches, other health conditions, and medications you are taking.
6. Bring a family member or friend: Consider bringing a family member or friend to the appointment to help you remember the information discussed and to provide support. Remember to be open and honest with your doctor about your symptoms and any concerns you have. This information will help your doctor make an accurate diagnosis and recommend the best course of treatment.