Cluster headache attacks occur as severe headaches one side. Typically, a number of attacks occur for several weeks (a group of attacks). The headaches then usually go for weeks, months or years until the next series develops headaches. An injection of a drug called sumatriptan, or a nasal spray that contains a drug called zolmitriptan or 100% oxygen breathing, usually relieve headache. Some medications are also used to prevent headaches. In addition, it is recommended not to drink alcohol at all for the duration of an outbreak period.
On this page
- What are cluster headaches and what are the symptoms?
- Who gets cluster headaches?
- What causes cluster headaches?
- How to diagnose cluster headaches?
- What is the treatment for cluster headaches?
- More help and advice
What are cluster headaches and what are the symptoms?
Cluster headaches consist of attacks of severe on one side of the head. It is sometimes called migrainous neuralgia. Each attack develops suddenly, often without warning. It usually feels pain, mostly in or around the eye or temple. The pain may spread to other areas on the same side of the head. The pain is often described as burning or boring. Each attack lasts 15-180 minutes, but more commonly 45-90 minutes. Attacks can occur from once every two days, eight times a day.
The pain during an attack usually serious. It can be so severe that it is likely to become restless and do not lie. Some people even hit his head against the wall in frustration with the pain. The attacks often occur at night and wake up from sleep.
In each attack, one or more of the following symptoms also usually occur: redness and watering of the eyes covered and a runny nose, sweating of the face swollen eyelids, drooping eyelid, constriction of the pupil in the eye.
Attacks usually occur in groups (fights). That is, a series of attacks of pain for a period of time and then stops. In a cluster, each attack of pain usually occurs on the same side of the head. Each group of attacks usually last several weeks or months. Each group is then usually at intervals of months or years of remission (in which no attacks occur). However, it can vary greatly from person to person as to how frequently occurring clusters. For example:
- A typical case is enough for a cluster to last 6-12 weeks once a year or once every two years, and at the same time of year.
- Some people have more frequent groups, some less, than the previous.
- In a small number of cases a group of attacks only ever occurs.
- In about 1 in 10 cases, the attacks continue without periods of remission. (This is called chronic cluster headache.)
Who gets cluster headaches?
Cluster headaches affect about 1 in 1,000 people. They are four times more likely to occur in men than in women. Anyone can be affected. The first group usually develops between the ages of 20-40 years, but can start at any age.
What causes cluster headaches?
Research suggests that part of the brain called the hypothalamus becomes hyperactive during each attack. However, it is not known what causes hyperactivity. During an attack the hypothalamus is believed to release chemicals (neurotransmitters). These can stimulate nerve cells in the brain to cause pain and other symptoms. The nerve hyperactivity can also cause a widening (vasodilation) of the arteries (blood vessels) in the affected part of the brain. One theory is that the pain is caused by dilation of these vessels which in turn presses on nearby tissues in the brain, which may cause pain. However, this is only a theory and the exact cause of pain is unknown.
A feature of the hypothalamus is thought to be involved with circadian rhythms (body clock). Something to do with this biological clock function of the hypothalamus is possibly because in many cases the groups tend to occur at the same time each year. And besides, why in a cluster, each headache attack often occurs at approximately the same time each day. (This is often a couple of hours after going to sleep at night.)
There may be some genetic part, because in about 1 in 20 cases of the disease also occurs in close relatives.
Most cluster headaches occur for no apparent reason. However, some people find that something can trigger a headache. If you find that something triggers a headache, then it is best to avoid it for the duration of a cluster period (until it is in remission). For example:
- Alcohol. Some people find that a headache often occurs within an hour or so to have an alcoholic beverage. It is usually advised to stop drinking alcohol completely for the duration of a cluster period.
- Being hot can be a trigger as exercising in a hot room or taking a hot bath.
- Strong smelling substances such as solvents, fragrances, gasoline, etc.
Almost everyone with cluster headaches have any abnormalities in the brain that can be demonstrated by scans or tests. In a small minority of cases, cluster headaches seem to be triggered by a tumor in the pituitary gland (pituitary adenoma) or brain tumors. (The pituitary gland is a small gland at the base of the brain). Note that this is an uncommon cause of cluster headache.
How to diagnose cluster headaches?
The diagnosis is based on the typical symptoms. There is no test that can confirm the diagnosis. The tests are sometimes done if the diagnosis is not clear to rule out other causes of headache. Sometimes the tests and a brain scan may be performed to rule out a pituitary adenoma (as described above.)
What is the treatment for cluster headaches?
The treatment is divided into treatments to relieve (abort) each headache, and targeted therapies to prevent headaches.
Treatment of headache each
Common painkillers do not work. In general, if you take a common painkiller, it takes a long time to work, as the headache usually gone before the analgesic takes effect.
Sumatriptan Sumatriptan injection, administered by injection under the skin, the treatment is commonly used to settle a headache. Relieves pain in 15 minutes in 3 out of 4 people with cluster headaches. You can demonstrate how to use this injection. Use it as soon as you experience a headache. Sumatriptan is classified as a triptan medication used to treat migraine and cluster headaches. Not a painkiller. Triptans work by interfering with a brain chemical called 5HT. This chemical is thought to be involved in migraine and cluster headaches.
Some points about sumatriptan injection:
- Operates within 5 to 15 minutes to relieve headache in most affected individuals.
- The adult dosage is one injection of 6 mg per headache. The maximum dose in 24 hours is two 6 mg injections (12 mg) with a minimum interval of one hour between the two doses.
- Side effects sometimes occur, but if they do, they are usually mild and do not last long. These include nausea, dizziness, fatigue and dry mouth. A minority of people also develop a sense of warmth and heat, tightness, tingling, flushing and feeling of heaviness or pressure in the face, arms, legs, and sometimes the chest.
- Some people should not take sumatriptan. For example, some people with heart disease, cerebrovascular disease or peripheral vascular disease. Therefore, read the leaflet that comes with the package of medicine for a complete list of possible side effects and precautions.
Zolmitriptan nasal spray of zolmitriptan is also a medicine triptans. Zolmitriptan nasal spray is an alternative to the injection of sumatriptan. It often works well, but probably not as fast as the injection of sumatriptan.
This 100% oxygen therapy is an alternative treatment that may be recommended, especially if sumatriptan injections or zolmitriptan nasal spray can not be used, or do not work. It often works well to relieve pain within 15 minutes, but does not work on everyone. Its advantage, when it works, is that it can be used as often as needed. Oxygen has to be 100% and it has to be delivered through a special mask, from a cylinder of oxygen. Some people with cluster headaches have an oxygen cylinder and mask at home ready for an attack.
100% oxygen treatment may not be suitable for people who have chronic obstructive pulmonary disease (COPD).
Other treatments Sumatriptan injections, zolmitriptan nasal spray or oxygen are usually the first-line treatments. Other treatments that are sometimes used include sumatriptan nasal spray and injections of ergotamine. In general, these are often not as good as the first-line treatments.
Sometimes it is difficult for doctors to rule out other types of headache called paroxysmal hemicrania. This is a rare disease of unknown cause that results in a face similar headaches to cluster headaches. Sometimes the doctor will prescribe a trial of a week of a drug called indomethacin. This almost always remove the pain of paroxysmal hemicrania, but will have no effect on cluster headache.
The prevention of cluster headaches
Some medications are used which aim to prevent the cluster headaches. Most people with cluster headaches are prescribed one. It is hard to say exactly how well in reducing the frequency and / or severity of headaches. This is because there is a lack of research trials that are large have studied these treatments. However, little research has shown encouraging results and seems to work for many people with cluster headaches. In short:
- Verapamil is the treatment of choice. It is a drug commonly used to treat heart problems. It is unclear how to cluster headaches. The doses used are often higher than those used for heart problems, and you may need heart tests such as ECG before increasing at higher doses.
- A steroid medicine such as prednisolone can be administered at the beginning of a cluster. This can quickly help prevent headaches later. However, you should not take the long term due to side effects. In some cases, a steroid is started while another drug such as verapamil. But, the steroid is stopped after a week or so, when the effect of the other medicine has accumulated.
- Lithium is sometimes used. This drug is commonly used to treat bipolar disorder. Again, it is unclear how it can help cluster headaches. You need regular blood checks to measure the level of lithium in the blood to make sure the dose is correct.
- Methysergide is used to prevent migraine and cluster headaches. You should not take more than six months, you run the risk of serious side effects.
- Several other drugs are sometimes used. In addition, research continues to find better treatments for this painful condition.
Some Notes on preventive medicine for cluster headaches
- Intermittent preventive treatment is often taken – ie only for the duration of an outbreak period. The treatment is usually continued for a period of outbreak until headache free for 14 days. The exception to this are usually only prescribed steroids for a short time. Some people take preventive medication indefinitely. It depends on how often and for how long, their cluster periods occur. This can vary greatly among affected individuals. In particular, people with chronic cluster headache preventive medication can be taken indefinitely.
- It is often trial and error to determine what preventive treatment that works best for you. Many people start with verapamil and this is often successful. For most drugs, the dose is built as quickly as possible to the maximum tolerated dose. If this has not been found to help within a week, then you can be arrested and tried another. Treatment with a single drug is preferred, but a combination of drugs may sometimes be necessary.
- Once the effective preventive treatment found individually, this can be restarted as soon as possible after the start of the next period group.
- Preventive treatments that have worked previously and may not continue to work well during cluster periods in the future. When this occurs, alternative preventive treatment can be tried. For example, methysergide is believed to function in more than 7 out of 10 cases. However, some people become tolerant to the effects of this drug and therefore can not work after two or three cluster periods.
- All drugs used to prevent cluster headaches have potential side effects and may not be suitable for people with certain other conditions. So always read the leaflet that comes with the package of medicine. However, sometimes one has to be taken off. That is, accepting that some of the side effects may be the price to pay for the relief of headaches.
More help and advice
OUCH (UK) – Organization for Understanding Cluster Headaches
Pyramid House, 956 High Road, London N12 9RX
Helpline: 01646 651 979 Web: www.ouchuk.org