Cluster Headache
Introduction
Cluster headaches are the least common and most severe type of primary headache. Sufferers agree that cluster headaches are horrendously painful. They are medically defined as one-sided headaches that recur in groups, or "clusters," over a period of weeks to months.
They are not life threatening and usually cause no permanent structural changes to the brain. The pain can peak in five minutes and remain severe for 30 to 180 minutes. Cluster headaches tend to occur frequently, making them particularly distressing for sufferers.
Symptoms
The symptoms of cluster headaches include
- deep, stabbing pain around the temple or the eye
- a stuffy or runny nose
- tearing and redness in one eye
- a droopy eyelid
- Flushing and redness in the face
Cluster headaches are either episodic or chronic. If they occur daily for months, alternating with periods without headaches they are episodic. On the other hand headaches recurring for a year or more without stopping are chronic. Whichever type occurs is to some extent immaterial as the pain, distress and disruption they cause are exactly the same.
Cluster headaches are one of the few types of headaches that affect men more often than women, unlike migraine for example. The condition can occur and then go into remission only for the headaches to return months or years later.
Causes
There is much uncertainty around the causes of cluster headaches.One theory is they are related to the brain suddenly releasing histamine or serotonin. They are not caused by an underlying condition such as a tumour or an aneurysm. Cluster headaches seem to be associated with alcohol and tobacco use, which of course men tend to consume to a greater extent.
Diagnosis
Cluster headaches are diagnosed from the history combined with physical examination. Tests such as an MRI scan (magnetic resonance imaging) are occasionally done if there is reason to think there may be other causes of the pain.
Treatment
Medications to prevent cluster headaches (prophylactic headache medications) include muscle relaxants, steroids, anti seizure medications and calcium channel blockers such as verapamil. Magnesium supplements have been helpful to a minority of patients.
All prophylactic drugs taken daily may help reduce the frequency or severity of cluster headaches although response is very variable. All these medications should be tapered off slowly during periods of remission.
Medications to stop a headache include sumatriptan, ergot compounds and pure oxygen. Pure oxygen has been shown to stop the pain within 5-15 minutes in the majority of patients. However the oxygen needs to be breathed at the start of the attack to get best results.
The medications and oxygen may stop a cycle of headaches or prevent them from getting worse once it starts. However there is no guarantee of success and no treatment works well for everyone. Combination or multiple medications may be required to control symptoms.
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