Cluster headaches

2021-08-19 12:01 PM

Each time the pain came quickly, without warning. Pain in or around the eyes, facial pain, stuffy nose, runny nose, drooping eyelids.


Cluster headaches are one of the most common types of headaches. The distinguishing feature of pain is that the pain occurs cyclically or intermittently.

Frequent episodes of pain are called periods of pain, which can last from a few weeks to several months, often followed by a period of remission when the headaches stop completely. The pattern varies from person to person, but most people have one or two episodes of pain a year. During remission, there is no headache for months and sometimes even years.

Fortunately, cluster headaches are rare and not life-threatening. Treatments can help make the pain shorter and less severe. In addition, preventive medications can help reduce the number of headaches.


A headache comes on quickly, usually without warning. Typical signs and symptoms include:

Pain is usually in or around the eyes but can radiate to other areas of the face, head, neck, and shoulders.

Face pain.

Red-eye on the side of the headache.

Nasal congestion, watery discharge on the affected side.

Sweaty, pale skin.

Swelling around the eye on the affected side.

All eyelids.

The pain of a headache is often described as sharp, penetrating or hot. People who have had this experience say it feels like a hot rod stuck in the eye or being pushed out of the socket. People with headaches appear restless, preferring speed or sitting and rocking to ease the pain. In contrast to migraine sufferers, people with cluster headaches often avoid lying in pain because this position seems to increase pain.

Some migraine-like symptoms include nausea, sensitivity to light, sound, and aura.

Pain period characteristics. An episode of pain usually lasts from 1 to 12 weeks. The onset and duration of each pain episode can unify the pain period with the cycle. For example, periods of pain occur seasonally, such as each spring or fall every year.

Most people have multiple headaches, which means headaches that occur for a week to a year, followed by a period of remission that can last as long as six to 12 months before another attack. develop. Chronic pain episodes may continue for more than a year, or pain episodes may last for less than a month.

A headache:

Headaches usually occur every day, sometimes several times a day.

A single pain can last from 15 minutes to 3 hours.

The pain usually occurs at the same time every day for 24 hours.

Most attacks occur from 9:00 to 21:00.

The pain usually ends as suddenly as it began, with the intensity decreasing rapidly. After the pain, most people find it completely pain free.

If you are just beginning to experience headaches, see your doctor to rule out other disorders and to find the most effective treatment. Headaches, even when severe, are not usually the result of an underlying disease, but occasional headaches can indicate a serious underlying medical problem, such as a brain tumor or rupture of a blood vessel. weakened (aneurysm). Also, if you have a history of headaches, see your doctor if the pattern of pain or headaches suddenly feels different.

See your doctor or go to the emergency room right away if you have any of these signs and symptoms:

Sudden severe headache, often like a thunderclap.

Headaches with fever, stiff neck, mental confusion, seizures, numbness, or difficulty speaking may indicate a number of problems, including stroke, meningitis, encephalitis, or a brain tumor.

Headache after a head injury, even if it's a minor injury or bump, especially if it's worse.

A sudden severe headache, unlike any other headache that one has experienced.


The exact cause of cluster headaches is unknown, but abnormalities in the hypothalamus may play a role. The pain usually occurs at regular intervals in a 24-hour day, and the pain cycle often follows the seasons of the year. These models suggest that the body's biological clock is involved. In humans, the circadian clock is located in the hypothalamus, deep in the center of the brain. Abnormalities in the hypothalamus may explain the duration and cyclical nature of cluster headaches. Studies have found increased activity in the hypothalamus during pain.

Other factors that may be involved in the development of cluster headaches include:

Hormone. People with migraine headaches have abnormal levels of certain hormones, such as melatonin and cortisol during pain.

Nerve conduction. Changes in the levels of certain brain chemicals (neurotransmitters), such as serotonin, may play a role in the development of headaches.

Unlike migraines and tension headaches, cluster headaches are usually unrelated to triggers such as: Food, hormonal changes, or stress. But when it comes time to start drinking can quickly trigger headaches. For this reason, many people with migraine headaches avoid drinking alcohol around the time of the attack. Other possible triggers include the use of medications such as nitroglycerin.

Risk factors

Risk factors for migraine headaches include:

Man. Men are more likely than women to have cluster headaches.

Adults. Most people with cluster headaches develop their first disturbances in their late 20s, although it can develop at any age.

Skin color. Blacks are more likely than whites.

Smoke. Many people who suffer from headaches are smokers.

Drink alcohol. Alcohol can trigger a headache if you're at risk for a headache.

Family history. If a parent or sibling has had a headache, there may be an increased risk.

Tests and diagnostics

Cluster headache has a characteristic pain and pattern of pain. Diagnosis depends on the description of the pain, including pain, location and severity, and associated symptoms. The frequency and duration of pain are also important factors.

If you have chronic or recurrent headaches, your doctor may try to determine the type and cause of the headache using certain approaches.

Neurological examination. A neurological exam can help your doctor detect the physical signs of a cluster headache.

Check pictures. If there is an unusual or complex headache or a neurological exam is abnormal, another testing may be done to rule out other causes of the severe headache, such as a tumor or aneurysm. circuit. Two common images are computed tomography (CT) and magnetic resonance imaging (MRI). CT scans use a series of images to provide a comprehensive view of the brain. MRI does not use X-rays. Instead, it combines magnetism, sound waves, and computers to create clear images of the brain.

Monitor headache

One of the most helpful things you can do is keep a headache diary for at least two months. For each headache, record the following:

Description of pain.

The severity of pain.

Location of pain.

Duration of pain.

Any medications you are taking.


Things have been doing, eating, drinking.

A headache diary can provide valuable clues that can help your doctor diagnose the specific type of headache and discover possible causes of the headache.

Treatments and drugs

There is no cure for migraine headaches. The goal of treatment is to help reduce pain and shorten the duration of the headache.

Because the pain of a cluster headache comes on suddenly and can subside over a short period of time, over-the-counter pain relievers, such as aspirin or ibuprofen, are not effective. Headaches are often before the medication begins to work. Fortunately, acute medications can relieve pain. Treatment of cluster headaches is more focused on prevention, with more medication options available to choose from.

Acute treatments

Oxygen. Inhaling 100 percent oxygen briefly through a mask at 7-10 liters a minute provides powerful relief for most people who use it. The effects of this safe, inexpensive procedure can be felt within 15 minutes. The major limitation of oxygen is the need to have a convenient and regulated source of oxygen, which can make treatment inconvenient and inaccessible. Small hand-held units are available, but some people still find them impractical. Sometimes, oxygen can only delay, not stop, pain, and pain can return.

Triptans. Injections of sumatriptan, commonly used to treat migraines, are also an effective treatment for acute cluster headaches. Some people may benefit from using sumatriptan in nasal spray form, but for most people, this is not as effective as an injection. Sumatriptan is not recommended if uncontrolled hypertension or ischemic heart disease.

The triptan, zolmitriptan, can be used as a nasal spray to relieve headache pain. This medication may be an option if other forms of rapid treatment cannot be tolerated.

Dihydroergotamine. Syringes and other forms. Dihydroergotamine is an effective pain reliever for some people with cluster headaches. When administered intravenously, a visit to the hospital or doctor's office is required.

Octreotide. This medication, a synthetic version of the brain hormone somatostatin, is an effective treatment for migraine headaches and is safe for high blood pressure and ischemic heart disease.

Anesthetic. Regional anesthetics, such as lidocaine (Xylocaine), can be effective against migraine headaches when used as nasal drops.


Rarely, surgery is recommended for people with chronic cluster headaches, who have not responded well to aggressive treatment, or who cannot tolerate medications or their side effects. Candidates for surgery must have headaches on only one side of the head because the surgery can be done only once.

Several types of surgery have been used to treat migraine headaches. These procedures attempt to remove the nerve pathways thought to be responsible for pain. However, jaw weakness or loss of sensation in certain areas of the face may begin.

Surgical options include:

Conventional surgery. Using a conventionally invasive procedure, the surgeon cuts part of the trigeminal nerve - the nerve that serves the area behind and around the eye with a scalpel or uses heat to destroy part of the nerve. This form of surgery can provide relief, but there are serious risks to the eye. This is a procedure that is no longer the first choice.

Glycerol injection. Injecting glycerol into the facial nerve can provide immediate relief of symptoms with less risk than other surgery.

Newer treatments

As scientists learn more about the causes of migraine headaches, it may be possible to develop a multi-selective treatment for this condition. One development that shows promise is the use of a post-acupuncture neurostimulator, which affects the trigeminal nerve. To treat people with frequent migraine headaches, researchers are testing a stimulus - a pacemaker device that sends electrical impulses - implanted on nerves belonging to post-acupuncture. Several small, post-acupuncture studies have found that devices relieve chronic headaches in some people, and the devices have been well-tolerated and appear to be very safe.

Similar research is being done using stimulators implanted in the hypothalamus, areas of the brain involved in pain episodes. Stimulation deep in the brain of the hypothalamus can provide relief for people with severe chronic headaches.

Preventive medicine

Whenever possible, start long-term medication, often with a short-term medication. Once the headache is under control, it is likely that short-term medications will be discontinued but continued with long-term medications.

Short-term medications can help prevent headaches during the time it takes for one of the long-term medications to become effective.

Corticosteroids. Corticosteroids, such as prednisone as a prophylactic. It belongs to a class of drugs called steroids. Your doctor may prescribe corticosteroids if a headache has started only recently or if there is a pattern of short pain and long remission. It is a corticosteroid, the side effects making it unsuitable for long-term use.

Ergotamine. Ergotamine, available as a sublingual medication or available as a rectal suppository, can be used at bedtime to prevent nighttime attacks. The drug is effective but cannot be combined with triptans.

Nerve blockade. Injecting anesthetics and corticosteroids into the area around the post-acupuncture nerves at the back of the head can block pain signals from traveling along those nerve pathways. Post-acupuncture nerves converge with the trigeminal nerve, which connects to all pain-sensitive structures in the skull. A post-neuraxial blockade may be beneficial for temporary relief until long-term preventive medication takes effect.

Long-term medication is taken for the entire period of pain. Some people with chronic migraine headaches may need to take two or more medications together long-term.

Calcium channel blockers. The calcium channel blocker - verapamil is usually the first choice to prevent migraine attacks. Sometimes after the pain period ends, the use of these drugs is gradually reduced and discontinued as directed by the doctor. Occasionally, long-term use is necessary to manage chronic cluster headaches. Constipation is a common side effect of this medication, as are dizziness, nausea, fatigue, swollen ankles, and low blood pressure.

Lithium carbonate. Lithium, used to treat bipolar disorder, is also effective in preventing chronic headaches. Side effects include tremors, increased urination, and diarrhea. Your doctor may adjust the dosage to minimize side effects. While you are taking this medicine, blood tests check for the development of more serious side effects, such as kidney damage.

Other preventive medications used for cluster headaches include antiepileptic drugs such as Divalproex and topiramate.

Lifestyle and remedies

The following measures can help avoid an attack during a cluster cycle:

Regular sleep schedule. The pain may begin when there is a change in the normal sleep schedule.

Avoid drinking alcohol. Alcohol, including beer and wine, almost always causes headaches over a period of time. This can happen quickly, even before finishing the first meal.

Limit exposure to volatile substances. Prolonged exposure to substances such as solvents, gasoline, and oil paints can trigger pain.

Be cautious at high altitudes. Around the time of the pain, the reduced oxygen at a high altitude can cause a headache.

Avoid tobacco products. Nicotine can trigger headaches around the time of the pain. If you're prone to headaches, it's best to stop smoking and avoid other tobacco products.

Avoid nitrates. During pain, nitrates can trigger headaches for some people. Foods that contain nitrates include smoked and processed meats. Some medications, such as nitroglycerin, may also contain nitrates.

Alternative medicine

Because cluster headaches can be painful, it may be tempting to try alternative or complementary therapies to relieve the pain. However, a recent survey of headache sufferers who have tried several alternative therapies including acupuncture, touch therapy, chiropractic, and homeopathy found that less than 10 percent found these effective therapies.

Since prescriptions became available, some people have turned to dietary supplements to try to relieve headaches. One of these supplements is melatonin which has been found to be used in people with migraine headaches. But melatonin therapy has not been proven to be an effective way to get rid of headaches. Check with your doctor before trying any type of supplement because it may interact with prescribed medications.

Coping and supporting

Living with a headache can be very difficult. Headaches can be scary. The pain caused can seem uncomfortable. In addition to physical symptoms, chronic pain is often accompanied by episodes of pain that can cause anxiety or depression. Ultimately, it can affect interactions with other people and families, productivity at work, and overall quality of life.

Talking to a therapist can help you cope with the effects of headaches. Or maybe find encouragement and understanding in a headache support group. Although support groups are not for everyone, they can be good sources of information. Group members are often aware of the latest therapies and tend to share their own experiences. If interested, your doctor can recommend a group in your area.


Since the cause of a cluster headache is unknown, it is not possible to prevent an occurrence. However, a preventive strategy is important for headache management because trying to treat it with only acute medication can seem hopeless. Prevention can help reduce the frequency and severity of attacks and the risk of rebound headaches. Prophylactic drugs may also increase the effectiveness of acute medications.

In addition, it is possible to help reduce the risk of future pain by avoiding alcohol and nicotine.