Characteristics of a Cluster Headache

Cluster headaches cause more severe pain than a normal headache or migraine and are classified as a primary headache. Primary headaches are a response to its own neurological problem and not part of a bigger health issue, while secondary headaches are the result of a completely different health problem like a sinus congestion or a tumor. The pain caused by cluster headaches onsets rapidly, reaching its full pain potential within a 5 – 10 min window but usually only lasts for between 15 minutes to 3 hours. Some individuals experience attacks up to eight times a day while others have cluster headaches every other day. It is suggested that attacks are somehow linked to a body’s circadian rhythm which causes predictable attacks at regular intervals at the same time every day. The pain is often described as a “burning” or “stabbing” sensation that can throb or be persistent throughout the duration of the headache. The pain is often on one side of an individual’s head centralized around or behind the eye. Once the onset of pain starts, the pain can spread to the temple, surrounding sinuses, forehead, nose, cheek, upper mouth, and scalp. The problem with cluster headaches beyond the extreme pain is that individuals have been known to have debilitating headache attacks for several months at a time before a remission period starts.

Types of Cluster Headaches

There are 2 primary types of cluster headaches that most individuals deal with:

• Episodic Cluster Headaches: This type of cluster headache occurs when there are periods of remission between cluster headache attacks that last longer than a month.
• Chronic Cluster Headaches: This type of cluster headache occurs when cluster headaches are not interrupted by a long remission period that lasts longer than a month.

It is important to note that episodic cluster headaches can evolve into a chronic cluster headache and that chronic cluster headaches can improve and become episodic.

Cluster Headache Symptoms

The most common signs of cluster headaches include:

• Severe head pain that onsets quickly
• Mild to extreme burning or piercing sensation behind one eye
• Pain centralized around one eye before spreading to other areas of your face
• Pain on one side of the head
• Eye with pain tearing up or watering
• Redness in the eye suffering from pain
• Congestion or swelling on the side of the face with pain
• Sweating and flushing of the face
• Runny nose
• Drooping eyelid
• Sensitivity to light and sound
• Smaller pupil on the affected side of the face
• Restlessness or pacing
• Agitation

Cluster Headache Causes

The specific cause of cluster headaches has yet to be discovered and remains a mystery. That said, the patterned timing of cluster headaches suggests that cluster headaches are linked to the circadian rhythm and irregularities in a body’s biological clock (hypothalamus). When cluster headaches occur, there is usually a neural pathway that is being triggered by a signal from the hypothalamus. That nerve, the trigeminal nerve, is responsible for pain sensation and is near your eye and spreads to areas in the forehead, cheek, and jaw. Cluster headaches are not typically triggered by the same things that may cause normal headaches or migraines, like stress, hormonal changes, or excessive noise or pollution. That said, there are things that can potentially exacerbate symptoms, like drinking and certain medications or drugs.

Cluster Headache Triggers & Risk Factors

While the exact cause of cluster headaches is still being researched, there are several things that have been identified as triggers and potential risk factors that play into the likelihood of cluster headaches occurring.

Cluster Headache Triggers

• Smoking cigarettes or otherwise ingesting nicotine
• Drinking alcoholic beverages
• Exposure to strong smells like paint, gasoline, or certain chemicals
• Staying at elevated altitudes for extended periods
• Heavy exercise or lasting exertion
• Extended time in hot environments
• Sustained exposure to bright or strobing lights
• Consumption of foods rich in nitrates
• Use of certain narcotics like cocaine

Cluster Headache Risk Factors

• Those that have family members that also experience cluster headaches
• Cluster headaches attack more men than women
• Cluster headaches present themselves in people between the ages of 20 – 50 years

When to See a Doctor for Cluster Headaches

While cluster headaches are not life threatening, it is important to go see a doctor when cluster headache symptoms start to ensure that there isn’t a more severe problem at play. Getting a proper diagnosis will rule out other disorders and identify an appropriate treatment option. Headache pain that isn’t the result of cluster headaches can indicate a serious underlying medical condition like aneurysm, stroke, or growth. It is also important to note that getting a diagnosis is critical when the severity or pattern of headache pain changes from what is consistent with a normal headache. Seek professional medical care when a headache:

• Onsets immediately which could be the sign of aneurysm
• Other symptoms occur like fever, nausea or vomiting, confusion, seizures, numbness, difficulty speaking or slurring words, or a stiff neck
• Associated with recent head trauma
• Causes pain more severe than any other headache previously experienced
• Increases in pain or changes drastically in pattern
• Persists for several days
• Causes changes in vision
• Causes drowsiness or inability to focus / stay alert

How to Diagnose Cluster Headaches

Diagnosis of cluster headaches will require you to answer questions about symptoms followed by a physical examination performed by your primary care physician followed by a neurological examination by a neurologist. Some cases will require additional tests to ensure that other underlying problems are not the cause of the headache pain. These tests can include brain scans, MRIs, or CT scans to ensure that the headache pain is not being caused by something like a tumor, aneurysm, or stroke.

Cluster Headache Treatments

There are several treatment options available to individuals that suffer from cluster headaches.

Medications

There are several acute attack treatments that can help alleviate the symptoms of cluster headaches:

• Triptans that include sumatriptan, rizatriptan, zolmitriptan, fravotriptan, almotriptan, naratriptan, and eletriptan which can be ingested, injected, and inhaled via nasal spray.
• Dihydroergotamine is an injected for most effective cluster headache relief.
• Octreotide is an injectable synthetic version of a brain hormone called somatostatin.
• Lidocaine is a local anesthetic that can be inhaled nasally to relieve cluster headache symptoms.

Surgery

When medications fail to curb severe cluster headache symptoms, more invasive measures like surgery may be warranted.

• Occipital nerve block is an injection of anesthetic and steroids that are released into the occipital nerve. They are designed to provide temporary relief until other medications can take effect.
• Nerve stimulations like occipital nerve stimulation, transcutaneous vagus nerve stimulation, and neuromodulation use implanted devices to send electrical impulses to stimulate the group of nerves that cause cluster headaches.

Therapy

• Oxygen therapy increases the concentration of oxygen being breathed through a facemask which has shown to help provide relief from cluster headaches in a short time.

How to Prevent Cluster Headaches

The best way to prevent cluster headaches is to avoid any triggers that may cause cluster headaches to emerge. This means that individuals that are likely to experience cluster headaches should avoid alcohol, nicotine, and drugs in addition to other environmental triggers like loud music, strong smelling chemicals, and bright lights. They should also do their best to get adequate and regular rest while also not overexerting themselves during a series of episodic attacks. In addition to avoiding triggers, there are other medications and lifestyle changes that can drastically help prevent cluster headache symptoms.

Medications

There are several preventative medications that can help stop a cluster headache before it starts keeping patients pain free. Additionally, these medications can also help reduce the severity of cluster headache attacks:

• Corticosteroids act as anti-inflammatories which have shown to be effective in preventing cluster headaches
• Divalproex sodium is an effective ingestible prophylactic drug used to prevent cluster headaches and migraines.
• Galcanezumab is administered regularly subcutaneously to help reduce the frequency of episodic cluster headaches.
• Gabapentin has been shown to be effective in preventing cluster headaches when consumed orally at regular intervals.
• Lithium carbonate is taken orally to help prevent and reduce the symptoms of cluster headaches.
• Topiramate is another drug that can be consumed orally to help prevent cluster headaches.
• Verapamil is an extended-release medication that should be taken with food to prevent cluster headaches.

Lifestyle Changes

• Getting regular sleep to prevent triggering a headache
• Avoid alcohol, cigarettes, and drugs to prevent headaches
• Breathing exercises and other stress reducing activities that help calm and control cortisol levels