Cluster headache is very painful type of headache that occurs in cyclic clusters of multiple headaches generally over the course of a week. The headaches are characterized by one-sided pain (especially localized to the eye), tearing or redness of the eye on the affected side, and stuffiness of the nostril on that side. However, cluster headaches can occur without those classic signs. The headaches are intense and come one suddenly but leave just as quickly. Periods with more frequent headaches are usually followed by periods that are headache-free called “remission periods” that can last months or even years. For most people, clusters of headaches will occur in clusters of one or more headaches during the course of roughly a week about once or twice annually. Most people have cluster headaches around the same time of day and especially during certain times of year. Attacks can last anywhere from 15 minutes to several hours. While nobody knows the exact cause of cluster headaches, part of the brain called the hypothalamus that regulates the wake/sleep cycle seems to play a role, which may be the reason the headaches tend to follow a 24 hour pattern. Other things that may play a role in cluster headaches include hormones and neurotransmitters (chemicals that act inside the brain). Medications are available both to treat acute headaches and to prevent the headaches from happening. While in a period of cluster headaches, alcohol tends to trigger very bad headaches. Factors that put you at higher risk of having cluster headaches include being male, being an adult, being black, having family members with cluster headaches, smoking, and drinking alcohol.
One-sided headache, very bad pain localized around the eye, sharp or burning pain in eye, restlessness, tearing of the eye on the affected side, redness of the eye on the affected side, fullness or stuffiness of the nostril on the affected side, pale or sweaty skin on the face, swelling of the face on the affected side, drooping eyelid on the affected side, increased pain with lying down, headaches that occur during specific seasons
Your doctor will begin by talking to you about your history and doing a physical exam. Your doctor will do specific exams including a neurologic exam to check your nerves. Your doctor may recommend taking a picture of the brain with a computerized tomography (CT) or magnetic resonance imaging (MRI) scan to make sure that nothing else is causing your headaches. Your doctor may recommend keeping a journal of your headaches including the type of pain, severity, how long it lasted and what time of day it happened as well as anything that might have triggered the headache like medications, activities or foods.
No cure exists for cluster headaches, so the goal of treatment is to decrease symptoms and frequency of headaches. Medications available over the counter like ibuprofen and Tylenol usually won’t work quickly enough for the symptoms of cluster headache. Medications that can be taken for acute attacks include oxygen (though carrying around a cylinder of oxygen can be bothersome), triptans (especially the injectable and nasal spray forms), dihydroergotamine (given intravenously through a vein, injectable or inhaler), octreotide (injectable), or lidocaine (when inhaled). If medications do not work, surgery is sometimes an option for treatment of cluster headache. All surgery involves intentionally injuring the trigeminal nerve which is responsible for pain sensation in the face. Conventional surgery is done by cutting the skin of the facing and cauterizing (burning) the nerve. This type of surgery is not favored anymore because better methods are available that are less invasive and have less chance of injury. Glycerol injection, which involves placing a small needle into the skin and injecting glycerol to damage the nerve, is also an available option. Medication is also available to prevent cluster headaches including corticosteroids, ergotamine, nerve block, calcium channel blockers (like verapamil), lithium, divalproex and topiramate. In order to help prevent cluster hedaches, you should maintain a regular sleeping schedule, avoid drinking alcohol, be careful when traveling to higher altitudes, not smoke or chew tobacco, and avoid nitrates (which are found in certain foods like recessed meats and in medications which are used to relieve chest pain). You should discuss your treatment options with your doctor.
