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What are Cluster Headaches?

Headache, also termed as cephalgia, is pain or a feeling of discomfort in the head, scalp, or neck region.

Cluster headaches are a rare type of headache characterized by intense pain from the neck to the temple and around the eye, on one side of the face, occurring mostly at night. It usually occurs in a cyclical pattern or cluster period and is one of the most painful types of headache. The cluster often occurs suddenly, lasts around an hour, then disappears suddenly.

The bouts (or “clusters”) of headaches can last from weeks to months, typically followed by a remission phase when the headaches cease. During the remission phase, no headaches occur for months and sometimes even years. Cluster headaches normally appear once a year often at the same time, such as in the fall or spring season. They affect around one to two in a thousand people, and men are more likely to be affected than women.

Causes of Cluster Headaches

It is still unknown what exactly causes cluster headaches. However, doctors and experts believe that a nerve in the facial region is involved, producing extreme pain around one of your eyes. Some women who have lived with cluster headaches describe the severity of pain as worse than childbirth. Cluster headaches are more acute than a migraine, but they generally do not last as long.

Risk Factor for Cluster Headaches

Some of the risk factors that can trigger cluster headaches include:

  • Alcohol consumption
  • Smoking
  • Strong smelling substances such as perfume, paint fumes, bleach, or solvents
  • Gender (Men more likely than women)
  • Family history
  • Age factor (Mostly occurring between ages 20 and 50)

Signs and Symptoms of Cluster Headaches

Some of the common signs and symptoms of cluster headaches include:

  • One-sided pain
  • Excruciating pain around or behind one eye that may radiate to your head, face, and neck region
  • Excessive tearing
  • Restlessness
  • Runny or stuffy nose on the affected side
  • Eye redness on the affected side
  • Eye swelling on the affected side
  • Flushing or pallor (pale skin) of the face
  • Eyelid drooping on the affected side
  • Facial or forehead sweating on the affected side
  • Sensitivity to light

Diagnosis of Cluster Headaches

In order to diagnose cluster headaches, your physician will conduct a detailed physical and neurological examination and ask questions about your symptoms and lifestyle to identify any triggers or underlying disease. Your physician may also order a CT or MRI scan of your brain to exclude other causes of the condition, such as a brain tumor.

Treatment for Cluster Headaches

Currently, there is no cure for cluster headaches. Hence, treatment basically focuses on decreasing the severity of headaches, reducing the headache period, and preventing the headache symptoms using conservative treatment. Surgery may only be recommended in rare instances when pain relief and preventive treatment have failed to provide desired results.

The treatment modalities involved in the management of cluster headaches include:

Pain Medication

  • Triptans: A class of drugs regarded as the best option to manage cluster headaches. Some of these drugs may include:
    • Zolmitriptan (Zomig)
    • Sumatriptan (administered as an injection or as inhaled medication)
    • Rizatriptan (Maxalt)
    • Naratriptan (Amerge)
    • Frovatriptan (Frova)
    • Eletriptan (Relpax)
  • Oxygen: Inhaling 100% pure oxygen during headaches can help reduce symptoms.
  • Lidocaine: Inhaling lidocaine in the form of a nasal spray can help relieve symptoms.
  • Dihydroergotamine (DHE): This injected medication can typically alleviate cluster headache within five minutes of use.
  • Capsaicin cream: This is a topical analgesic applied to the painful area to mitigate painful symptoms.

Preventive Medication

These medications are able to avert headaches before they start. Preventative medications can reduce the frequency of headaches, make attacks less severe, and make a cluster shorter in duration. These include:

  • Steroid medications, such as prednisone, which alleviate nerve inflammation
  • Antidepressant medications
  • Muscle relaxants, such as baclofen
  • Anti-seizure medications, such as valproic acid and topiramate
  • Lithium carbonate
  • A medication known as ergotamine prevents dilation of your blood vessels in the head

Nerve Block

In this treatment method, a numbing agent (anesthetic) and corticosteroid are injected into the region around the occipital nerve, located behind your head, to improve episodes of cluster headaches.

Nerve Stimulation

Occipital nerve stimulation: During this procedure, your surgeon surgically places a device at the base of the skull where the occipital nerve originates. The device sends electrical signals to target one or more of the occipital nerves transmitting the pain.

Surgery

Surgery is employed when nothing else has worked for cluster headaches. The surgery involves cutting a section of the trigeminal nerve, the principal pathway for pain, to block pain signals from reaching the brain. The surgery can provide permanent pain relief for some patients, but can also cause significant side effects, such as permanent facial numbness.

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