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Cluster Headache

Definition:
Cluster headache is a type of severe, recurring pain that is located on one side of the head. It received its name from the clustering or pattern of frequent headaches that usually occur.

There are two main types of cluster headaches:

Episodic Cluster Headaches–occur one or more times daily for several months. The headaches then enter a period of remission and come back months or years later.

Chronic Cluster Headaches–occur almost daily with headache-free periods lasting less than two weeks.

Either type of headache may convert to the other type.

Causes:
The cause of cluster headaches is unknown. The pain is caused by a combination of dilation (widening) of the blood vessels and inflammation of the nerves of the face.

Possible causes may include:

  • Genetic factors
  • Alcohol, changes in barometric pressure and sleep pattern
  • Tobacco use
  • Drugs such as nitroglycerin
Risk Factors:
A risk factor is something that increases your chance of getting a disease or condition.
  • Sex: Male to female ratio: 6:1
  • Age: 25-50 years old
  • Prior head surgery or head injury
Symptoms:
Symptoms of a cluster headache include:
  • Stabbing, penetrating, burning, or explosive head pain that:
    • Is on one side of the head, but not both
    • Often starts around the eye and spreads to the same side of the head
    • Causes facial flushing
    • Occurs daily or almost everyday for 4-8 weeks
    • Can occur 1-6 times per day
    • Often occurs at about the same time each day
    • Increases in intensity over time
    • May start within two hours of going to sleep
    • Can awaken you from sleep
    • Usually lasts less than 60 minutes, but may last up to three hours
  • Restlessness and agitation
  • Nausea

During the headache other symptoms may occur on the affected side, including:

  • Stuffy or runny nose
  • Redness or watering of the eye on one side
  • Droopy eyelid
  • Constriction of the pupil of the eye
  • Facial swelling and flushing, sweating

Diagnosis:
The doctor will ask about your symptoms and medical history, and perform a physical and neurological exam. A neurological exam tests the following:

  • Muscle strength
  • Coordination
  • Reflexes
  • Response to stimuli
  • Alertness

The doctor will ask about the frequency and pattern of your headaches. To help provide answers, keep a diary of:

  • When your headaches started and ended
  • What you were doing at the time
  • What you tried to relieve the pain

Tests are sometimes done to rule out other disorders.

Treatment:
Treatment aims to reduce the frequency of headaches and help relieve the pain.Lifestyle Changes and Self-care
  • Maintain the same sleep routine. Avoid afternoon naps or sleeping in, which may bring on more headaches.
  • Do not drink alcoholic beverages. Even a small amount of alcohol can trigger a headache during a cluster period.
  • Learn stress-management techniques, because stress can bring on a headache.
  • Do not smoke. Tobacco may interfere with medication to relieve the headache.
Medication
Drugs used to treat migraines often relieve acute attack of cluster headaches. These drugs must be taken at the first sign of a headache. Some patients' headaches do not last long enough for drugs to be beneficial. Sometimes the drugs delay, but do not stop, an attack. Pain killers especially narcotic drugs should not be used during an acute attack.These drugs may include:
  • Sumatriptan or other triptans
  • Dihydroergotamine
  • Lidocaine–nose drops or spray on the affected side
  • Analgesics with caffeine
  • Prednisone
  • Ergotamine
  • Glycerol injection into the trigeminal ganglion for those individuals resistant to other treatments

Other medications (usually used in combination of the 2-3 drugs) are administered on a regular basis to prevent or reduce the frequency of headaches. These drugs include:

  • Verapamil (Calan, Isoptin)–to relax and dilate the blood vessels
  • Lithium (Eskalith)–blood levels of this drug must be monitored
  • Methysergide (Sansert)–most helpful in younger people in early stages of disease
  • Prednisone–taken for a short period while other drugs are started
  • Dihydroergotamine or a triptan–for people who suffer from cluster headaches at predictable times such as at night
  • Valproate (Depakote) or gabapentin (Neurontin)
  • Beta blockers
  • Clonidine
  • Melatonin
  • Amitriptyline
  • Selective serotonin reuptake inhibitors (SSRIs)
Oxygen Therapy
Breathing 100% oxygen for 10-15 minutes often helps relieve cluster headache pain. The oxygen appears to decrease blood flow to the affected area of the brain. People under age 50 who have episodic cluster headaches seem to benefit most from oxygen therapy.

Note: Oxygen therapy is expensive and has associated health risks.

Surgery
As a last resort, some doctors may recommend cutting or destroying a facial nerve to eliminate the pain.

Prevention:
To prevent cluster headaches from getting worse, preventive medication may be given. In addition:
  • Maintain a regular sleep routine.
  • Do not smoke.
  • Avoid alcohol, and narcotic analgesics, bright sunlight, emotional stress.
  • Get moderate physical exercise.
  • Practice stress-management techniques.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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