What are cluster headaches?
Symptoms of a cluster headache include severe pain and headaches occurring in clusters. There may be periods of headache freedom in between attacks.
You may suffer from headaches once every few days to several headaches a day during these cycles. Headaches caused by clusters can be extraordinarily painful.
Adolescence and middle age are the most common times to experience cluster headaches, but they can happen at any age.
Earlier studies have shown that men reported cluster headaches six times more often than women before 1960, as evidenced by a 1998 study published in Cephalagia. This difference has narrowed over time, with cluster headache seen only twice as often in women as men by the 1990s.
Read: Chronic Migraine
How it works
Whenever your brain’s base nerve pathways are triggered, you get a cluster headache. The “internal biological clock” that controls how you sleep and wake comes from the hypothalamus, a deeper part of the brain.
Symptoms of the affected nerve, the trigeminal nerve, include facial pain or heat. It is near your eye on the same side, extending across your forehead, your cheek, and down your jaw.
There are no neurological conditions that cause headaches like these, such as tumors or aneurysms.
Types of cluster headaches
The two types of cluster headaches are episodic and chronic.
Episodic cluster headaches: There is an interval of up to one year between headaches occurring, followed by a week or more without headaches.
Chronic cluster headaches: The condition last for at least one year before a period of freedom from headaches lasts less than one month.
Cluster headaches can develop into chronic headache from episodic cluster headaches, and the reverse is also true.
Read: Hemicrania Continua
Differentiating between a cluster headache and other types of headaches
Cluster headaches tend to occur suddenly. Occasionally, people who experience headaches experience visual disturbances similar to an aura, such as flashes of light.
The pain from a headache usually begins a few hours after you fall asleep and can wake you up, though some headaches occur during the day.
It usually gets worse a few minutes after it begins. Headaches typically last from 30 minutes to two hours, and the most intense ones last up to two hours.
Cluster headaches generally affect one side of the head and are located behind or around an eye, although some people can experience pain on both sides of the head. Pain that is constant, deep, and piercing is described as constant migraines.
Many people who experience this pain describe it as being like being poked with a hot poker. Depending on the side, discomfort may be felt in the forehead, temples, teeth, nose, neck or shoulders.
Cluster headaches symptoms
There is usually a sudden onset of pain around or behind the eye. Here are some symptoms you might notice:
- Mild discomfort or a burning sensation
- Swollen or drooping eyelids
- Reduced pupil size
- Redness or watering of the eyes
- Congested or runny nose
- Warm, red face
- Excessive pacing or restlessness
It is more common for smokers or heavy drinkers to get cluster headaches. The effects of nicotine and alcohol are more pronounced during cluster periods. It takes just a little bit of alcohol to cause a headache. However, drinking during headache-free periods won’t trigger one.
Read: Thunderclap Headaches
What causes cluster headaches?
It is believed that cluster headaches are caused by a dilation, or enlargement, of the blood vessels supplying blood to the brain and face. An increase in the dilation of the pupil exerts pressure on the trigeminal nerve, which transmits sensations from the face to the brain. However, the cause of this dilation remains unknown.
The hypothesis is that cluster headache may be the result of abnormalities in the hypothalamus, a small region of the brain that regulates body temperature, blood pressure, sleep, and hormone release.
It is also possible that cluster headaches are the result of a sudden release of chemicals such as histamine, which fights allergens, or serotonin, which regulates moods.
Your doctor will examine you physically and neurologically and ask you questions about your symptoms. To rule out other causes of your headaches, such as brain tumors, an MRI or CT scan of your brain may be required.
Treatment for cluster headaches
Prescription medications can reduce your headache symptoms and prevent them from returning. Occasionally, your doctor may recommend surgery when pain relief and preventive measures do not work.
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Once you have headache pain, your doctor prescribes pain medication to relieve it. Treatment options include:
- Oxygen: It can help to breathe 100 percent pure oxygen when headaches begin.
- Triptan medications: Tripitan medications, such as sumatriptan (Imitrex), constrict blood vessels in the head, so they can ease headaches.
- DHE: Cluster headache pain can usually be controlled within five minutes with an injected medication called dihydroergotamine (DHE). It is not safe to take DHE with sumatriptan.
- Capsaicin cream: Applied topically, capsaicin cream is effective in treating pain.
Preventative medications prevent headaches from occurring. There is no guarantee that these medications will eliminate headaches completely, but they can reduce your headache frequency. Examples of such medications include:
- Medication that relaxes blood vessels, such as propranolol (Inderal) or verapamil (Calan, Covera, Isoptin, Verelan)
- Prednisone is a steroid medication that reduces nerve inflammation
- Ergotamine prevents blood vessels from dilation
- Antidepressant medications
- Valproic acid, topiramate (Topamax) and other antiseizure medications
- Lithium carbonate
- Baclofen, a muscle relaxant
Surgery can permanently disable the trigeminal nerve in the last resort. Patients may experience permanent relief of their pain with the surgery, but they can also experience serious side effects, such as permanent facial numbness.
Read: Tension Headache
Tips to prevent cluster headaches
The following actions may prevent cluster headaches:
- Hot baths
- High altitudes
- Strenuous activities
- Hot weather
- Products that contain a lot of nitrates, such as:
- Hot dogs
- Preserved meats
Cluster headaches do not pose a threat to life, but there is no proven way to treat them. These tips and treatments can help reduce your headache frequency and pain over time, or they could make them completely disappear.