Cluster Headaches Cluster Headaches

Cluster Headaches

Cluster headaches are intense, searing headaches that are so named because they come in a cluster — one or two a day for a few weeks or even months. The headaches themselves come on suddenly, and can last anywhere from 15 minutes to three hours. Since the clusters tend to occur in spring and fall, they are sometimes mistakenly associated with allergy symptoms.

This type of headache is rarer than most, with fewer than one in 1000 people experiencing them. Of that number, men are much more likely (90 percent of cluster headaches occur in men) to experience this syndrome.

Symptoms

You may feel a burning or piercing sensation right before the headache starts, or experience a migraine-like aura or nausea. Cluster headaches may cause red, teary eyes, (especially on the side of the pain) a runny or stuffed nostril, and nausea. Unlike during a migraine, when movement makes you feel worse, you will feel restless, and experience the need to walk or move.

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Causes

Though the cause has not yet been determined, the hypothalamus — in charge of the body’s biological clock — is thought to be related. These headaches are sometimes known as “alarm clock” headaches because they tend to occur at the same time each day, often an hour or two after you fall asleep.

It is the trigeminal nerve that is affected and causing the pain. This is the largest of the cranial nerves, with branches that extend from inside your head to run up and down each side of your face, reaching your forehead, eyes, and jaw; in a cluster headache, only one side of the nerve is generally affected.

Prevention

Though there are no proven non-medical ways to prevent cluster headaches, not smoking is a basic rule for good health. It is one important to follow for those who experience cluster headaches, because the risk of these painful episodes is higher for smokers. Those who have sleep apnea are also more likely to develop this condition, as are those who have had a head injury.

There are several medical treatments that can help decrease the severity of these cluster headaches once they start, and there are also treatments available that may help reduce the number of headaches that occur in a cycle.

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Living Better

There are no known cures for cluster headaches. These suggestions, however, may set you on a path to feeling better.

  • If you smoke, stop. That also means that if you are around those who smoke frequently, be wary; you are breathing in that smoke as well, and it may contribute to this debilitating condition. Stopping smoking may not stop your headaches, but your general health will improve, enabling you to more quickly recover.
  • Ask your doctor if you can be tested for sleep apnea, if sleeping is fitful or interrupted. The special equipment that is worn by those with sleep apnea may prevent that condition — and reduce the number of cluster headaches you get as well.
  • If you have had a head injury, consult with your doctor about any lasting effects you may be experiencing. Events that seem unrelated to your injury may actually be both connected and treatable.
  • Avoid alcohol, particularly red wine, during a cluster phase. Alcohol has been shown to intensify symptoms or provoke an attack.
  • Another trigger might be nitroglycerin, which is a medicine sometimes given for heart conditions. If you are taking medication, discuss it with your physician to make sure that there is not a relationship between your medicine and your headaches.

There are medical treatments available that can help you manage your headaches during the times that they occur.

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Exams and Tests

Although the symptoms of cluster headaches are not usually similar to those of a tumor or an aneurysm, the range of effects is large enough that a physician may want to perform imaging tests, such as a CT scan or an MRI, to rule these out. Once the expert physicians at the St. Luke’s Headache Center have performed a physical and taken your medical history, they will know if further tests are indicated.

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Treatment

Treatments for cluster headaches include those that lessen the impact of the headaches when they occur, and those that control the number of actual occurrences. It may take time to find the medicine or medicines that work best for you, including weighing any possible side effects.

One of the fast-acting treatments that can be used for cluster headaches sounds simple: oxygen. At the onset of one of these headaches, breathing 100% oxygen at a certain rate over a short amount of time can provide dramatic relief. The downside to this treatment is that you need to have an oxygen tank, calibration regulator, and a mask available. The up side is that if your attacks generally occur at night, you can keep this equipment bedside.

Another treatment is called non-invasive vagus nerve stimulation. Here, a handheld device held to a certain point on the neck provides electrical stimulation to the vagus nerve — the longest cranial nerve, which also passes through the neck and thorax to the abdomen — through the skin. Unlike the stimulators that are used for migraines, this device is not implanted under the skin, but is administered externally instead.

More invasive, but also fast-acting, are triptans. These injectables are generally used for migraines, but can be effective for cluster headaches. The first injection is given under medical supervision.

Additionally, there are several types of preventive treatments available for cluster headaches, including a few classes of medication: anti-psychotics; calcium-channel blockers; and anticonvulsants. These types of medicines are generally administered at the start of a cluster cycle; you continue to take them during the length of time that the cycle generally occurs. Each of these types of medicines has its own benefits and risks; your physician at the St. Luke’s Headache Center will advise you as to which course of action is best for you.

Alternative medicines are being looked at for their effectiveness in controlling cluster headaches as well. Of these, melatonin — which is a sleep regulator — has shown promise in small studies. Capsaicin — an extract of chili peppers — has also shown effectiveness when administered through the nose.

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