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A cluster headache is actually a series of headaches that occurs with patterns or clusters. Typically patients experience bouts of frequent attacks, also known as cluster periods, that last from weeks to months. Here we aim to give you key information on cluster headache, its management, and treatment.
The symptoms of this headache type are characterized by unilateral (one-sided) pain. However, for some the side can vary from time to time. The pain is usually centered over one eye, one temple or the forehead. It can also spread to a larger area making diagnosis harder.
During a bout of a cluster headache, the pain is often experienced at a similar time each day. A headache often starts at night waking people one to two hours after they have gone to sleep. The pain usually reaches its full intensity within 5 to 10 minutes and can last for 30 to 60 minutes. You may experience the head pain every other day during a “bout”, or up to eight times per day during a bad cluster. In 80 percent of people with cluster headaches, the bouts (or “clusters”) of head pain can last for 4 to 12 weeks. In some people, headaches can happen once a year during the Spring or Autumn.
If your headache comes and disappears for several months or years, you may have an episodic cluster headache. The reason for this seasonal timing is not fully known, although it’s one of the key aspects of diagnosis and may involve a brain area called the hypothalamus.
The remaining 20 percent of people do not have these pain free intervals and are said to have “chronic cluster headaches.” People with a cluster headache are usually unable to keep still during an attack and often try to relieve the excruciating pain by pacing the room or walking outside, and sometimes banging their heads against a wall until the pain stops.
The other symptoms typically associated with this specific headache type include a stopped up or runny nose–typically on the same side as the pain. Patients also experience droopy eyelids, watery eyes, or redness in one eye. Many patients also complain of a flushed face or their face feeling “sweaty”.
These headaches can start at any age, but most commonly starts in your 20’s or older. You are not likely to grow out of the susceptibility of this unfortunate cycle. However, as you get older, it is likely that the pain-free periods between bouts will get longer. Approximately 1 in 20 people with a cluster headache have a family member who also has the condition. Unlike a migraine, it is more common in men than women (by five to six times). It is also more common in heavy smokers.
Alcohol is one well-known trigger of a cluster headache, often bringing on the pain within an hour of drinking. If you have a cluster headache you should not drink any alcohol during a cluster period. Some people find that certain exercises or becoming overheated will bring on an attack, so again avoiding these is the best advice during a bout.
There is no special test to diagnose a cluster headache and so your doctor will need to take a very detailed history of all your symptoms in order to make the correct diagnosis. You may be referred for an MRI scan to rule out other causes for the pain starting suddenly.
While there is currently no cure for a cluster headache, the treatment has become much more effective in the last 10 years. Acute treatment is used to stop the pain once it has started. Treating this type of headache can be tricky because the pain becomes extremely severe very quickly – usually within 10 minutes. Thus the key to treating cluster headache during an attack is speed to reduce the excruciating pain as fast as possible.
Sumatriptan injections have been found to reduce the pain within 10 minutes during an attack. In general, tablets are less effective if you have a cluster headache because of the time they take to work.
Sumatriptan and zolmitriptan nasal sprays do help some people although the onset of action may be slower than the injection.
Preventative treatment is used to try and stop the attack from starting in the first place. There is a far wider range of preventative treatments available now than in the recent past. You will need to take the preventative treatment when the cluster period starts and continue for about two weeks after the bout has ended. You will need to stop the drugs gradually and restart them if a new bout begins. The most common preventative treatments are:
Verapamil has shown that a daily dose can be effective in both episodic and chronic cluster headache.
Methysergide is effective in episodic (short-term bouts) of a cluster headache but needs caution in the treatment of chronic cluster headache, as you should not take this for more than six months at a time.
Lithium at a low dose can be effective although again this will need careful monitoring. It is more effective in treating chronic cluster headache than episodic.
Corticosteroids are given because they are fast acting. They can be used in a short burst for 2 to 3 weeks in decreasing amounts as a first step to break the cycle.
Ergotamine is infrequently prescribed. It can be helpful in reducing attacks at night if you take it at bedtime.
Topiramate has recently been reported to be useful.
As with any drug treatment you may need to work with your doctor to determine what works best for you. You may need to try several treatment regimes before you discover the best one for you. The Pain Relief Center has an institute dedicated specifically to those patients who suffer with chronic headaches and migraines. To schedule an appointment, call 214-709-1904 or fill out our online form.
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