Cluster Headache
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Cluster Headache

En Español (Spanish Version)

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—These occur one or more times daily for 4-8 weeks. The headaches then enter a period of remission and come back months or years later.
  • Chronic cluster headaches—These 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:

  • 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. Risk factors include:

  • Sex: male to female ratio: 7-8:1
  • Age: 20-50 years old
  • Prior head surgery or head injury
  • Positive family history of cluster headaches
  • History of a small hole in the heart (called patent foramen ovale)

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 every day for 4-8 weeks
    • Can occur 1-6 times per day
    • Lasts 15 minutes to 3 hours
    • 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
  • 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
  • Sensitivity to light and noise

Symptoms of a Cluster Headache

© 2008 Nucleus Medical Art, Inc.

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. These tests may include MRI or CT scan of the brain .

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.

Drugs used to treat cluster headaches include:

  • Sumatriptan or other triptans
  • Dihydroergotamine
  • Lidocaine—nose drops or spray on the affected side
  • Analgesics with caffeine
  • Prednisone
  • Ergotamine
  • Octreotide injection given subcutaneously
  • Glycerol injection into the trigeminal ganglion for those individuals resistant to other treatments

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.

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
  • Topiramate
  • Baclofen
  • Valproate (Depakote) or gabapentin (Neurontin)
  • Beta-blockers
  • Clonidine
  • Melatonin
  • Amitriptyline
  • Topical capsaicin cream
  • Selective serotonin reuptake inhibitors (SSRIs)

Oxygen Therapy

Breathing 100% oxygen for 10-15 minutes often relieves 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.

Oxygen therapy, though, 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:

RESOURCES:

American Council for Headache Education
http://www.achenet.org

National Headache Foundation
http://www.headaches.org

CANADIAN RESOURCES:

Headache Network
http://www.headachenetwork.ca/

Help for Headaches
http://www.headache-help.org/index.html

References:

American Academy of Family Physicians website. Available at: http://www.aap.org .

American Medical Association website. Available at: http://www.ama-assn.org/ .

Beck E, Sieber WJ, Trejo R. Management of cluster headache. Am Fam Physician . 2005; 71:717-24.

Cecil Textbook of Medicine . 21st ed. WB Saunders Company; 2000.

Cittadini E, May A, Straube A, et al. Effectiveness of intranasal zolmitriptan in acute cluster headache. Arch Neurol . 2006;63:1537-1542.

Cluster headache. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Accessed April 12, 2008

Conn's Current Therapy 2001 . 53rd ed. WB Saunders Company; 2001.

Emergency Medicine: Concepts and Clinical Practice . 4th ed. Mosby-Year Book Inc; 1998.

Evans RW. Headache: cluster headaches. ACP Medicine Online, 2002. Available at: http://www.medscape.com/viewarticle/534617 . Accessed on March 16, 2007.

Finocchi C, Del Sette M, Angeli S, Rizzi D, Gandolfo C. Cluster headache and right-to-left shunt on contrast transcranial Doppler: a case-control study. Neurology. 2004;63:1309.

Griffith's 5-Minute Clinical Consult . Lippincott Williams & Wilkins; 2001.

The International Classification of Headache Disorders. 2nd ed. Cephalagia . 2004:24(suppl)9-160.

Primary Care Medicine . 4th ed. Lippincott Williams & Wilkins; 2000.

Raskin NH. Cluster headache. Harrison’s Internal Medicine website. Available at: Harrison’s Online at: http://www.accessmedicine.com/content.aspx?aID=51915 . Accessed on March 15, 2007.

Russell MB, Andersson PG, Thomsen LL. Familial occurrence of cluster headache. J Neurol Neurosurg Psychiatry. 1995;58:341-343.

Textbook of Clinical Neurology . WB Saunders Company; 1999.

VanVliet JA, Bahra A, Martin V, et al. Intranasual sumatriptan in cluster headache: randomized placebo-controlled double-blind study. Neurology . 2003;60:630-633.



Last reviewed March 2008 by J. Thomas Megerian, MD, PhD, FAAP

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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