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A cluster headache is one of the most painful types of headache. It's also distinctive in ways other than the severity of the pain. A striking feature of cluster headache is that the attacks occur in cyclical patterns, or clusters — which gives the condition its name.
Bouts of frequent attacks, in what's known as cluster periods, may last from weeks to months, followed by remission periods when the headache attacks stop completely. The pattern varies from one person to another, but most people have one cluster period a year. During remission, no Headaches occur for months, and sometimes even years.
Fortunately, cluster headache is rare. The condition is more common in men. Cluster headache can affect people at any age but is most common between ages 20 and 40.
Although cluster headache attacks are extremely painful, they're not life-threatening. Treatments can help make the attacks shorter and less severe. In addition, preventive medications can help reduce the number of headaches.
A cluster headache strikes quickly, usually without warning. Within minutes, excruciating pain develops. The pain typically develops on the same side of your head throughout a cluster period, and often the headaches remain on that side throughout your life. Less frequently, the pain may switch to the opposite side of your head in the next cluster period. Rarely, the pain switches sides from one attack to another.
The pain of a cluster headache is often described as sharp, penetrating or burning. People with this condition say that the pain feels like a hot poker being stuck in the eye or that the eye is being pushed out of its socket.
Restlessness
People with cluster headache appear restless, preferring to pace or sit and rock back and forth to soothe the attack. They may press a hand against the eye or scalp or apply ice or heat over the painful area. In contrast to people with Migraine, people with cluster headache usually avoid lying down during an attack because this position seems to only increase the pain.
Most people with a cluster headache prefer to be alone. They may remain outdoors, even in freezing weather, for the duration of an attack. They may scream, bang their heads against a wall or hurt themselves in some way as a distraction from the unbearable pain. Some may find relief by exercising, such as jogging in place or doing sit-ups or push-ups.
If cluster headache attacks regularly occur at night, some people try to remain awake for as long as possible to forestall the onset of a headache they know is coming. Unfortunately, doing so only speeds up the sleep cycle. The headache may occur within minutes of falling asleep in a compressed sleep cycle. In the worst cases, a vicious cycle of Head Pain and sleep deprivation develops. This can lead to Depression and thoughts of suicide.
Teary eye and stuffed Nose
Cluster headache always triggers a response from your autonomic Nervous system. This system controls many vital activities without your consciously having to think about them. For example, your autonomic nervous system regulates Blood pressure, heartbeat, sweating and body Temperature. The most common autonomic response to a cluster headache is excessive tearing and redness of the eye on the side of your head affected by the pain.
Other signs and symptoms that may accompany cluster headache include:
Most of the time, these signs and symptoms last only as long as the headache lasts. In some people, however, a drooping eyelid and reduced pupil size persist after long periods of attacks. Some migraine-like symptoms, including Nausea, sensitivity to light and sound, and aura, may occur with a cluster headache.
Cluster period characteristics
A cluster period generally lasts from two to 12 weeks. Chronic cluster periods may continue for more than a year. The starting date and the duration of each cluster period often are amazingly consistent from period to period. For many people, cluster periods occur seasonally, such as every spring or every fall. It's common for clusters to begin soon after one of the solstices — the longest and shortest days of the year. Over time, cluster periods may become more frequent, less predictable and longer lasting.
During a cluster period, headaches typically occur every day, sometimes several times a day. A single attack may last from 15 minutes to three hours. The attacks happen often at the same time within each 24-hour day. Nighttime attacks are more frequent than daytime attacks, often beginning during rapid eye movement (REM) sleep, the period of sleep during which most dreaming occurs. The majority of attacks occur between 9 p.m. and 9 a.m.
Cluster headache can be frightening to you and to your family and friends. The debilitating attacks may seem unbearable. But the pain usually ends as suddenly as it begins, with rapidly decreasing intensity. After attacks, most people are completely free from pain but exhausted. Temporary relief during a cluster period may be only a matter of hours or may last as long as a day before the next attack.
In most cases headache pain, even severe headache pain, isn't the result of an underlying disease. In fact, the vast majority of headaches are primary headaches — headaches not caused by a specific medical condition. These include Migraines, Tension Headaches and Cluster Headaches.
Based on the length of the cluster periods and the remission periods, the International Headache Society has classified cluster headache into two types:
About 10 percent to 15 percent of people with cluster headache have chronic symptoms with no periods of remission. Chronic cluster headache may develop after a period of episodic attacks, or it may develop spontaneously, without a prior history of headaches. Some people experience alternating episodic and chronic phases.
Researchers point to different mechanisms to explain the major characteristics of cluster headache. There may be a family history of cluster headache in some people with this condition, meaning a possible genetic component. Several factors may work together to produce cluster headache.
Cluster headache triggers
Unlike migraine and Tension headache, cluster headache generally isn't associated with triggers such as foods, hormonal changes or stress. But some people with cluster headache are heavy drinkers and cigarette smokers. Once a cluster period begins, consumption of alcohol can trigger a splitting headache within minutes. All it takes is one drink. For this reason, many people with cluster headache stay completely away from alcohol for the duration of a cluster period. Other possible triggers include the use of medications such as nitroglycerin, a drug used to treat Heart disease.
The beginning of a cluster period often follows occasions when normal sleep patterns are disrupted, such as during a vacation or when starting a new job or work shift. Some people with cluster headache also have Sleep Apnea, a condition in which the walls of a person's throat collapse momentarily, obstructing the sleeper's breathing repeatedly during the night.
Increased sensitivity of nerve pathways
The intense pain of a cluster headache is centered behind or around your eye, an area that's served by the trigeminal nerve, a major pathway for pain. Stimulation of this nerve results in abnormal reactions of the arteries that supply Blood to your head. These blood vessels enlarge (dilate) and become painful.
Some symptoms of cluster headache, such as teary eye, stuffy or runny nose and droopy eyelid, involve your autonomic nervous system. The nerves that are part of this system form a pathway at the base of your Brain. When the trigeminal nerve is activated, causing eye pain, autonomic nerves also are activated in What is called the trigeminal-autonomic reflex. Researchers believe that a still-unidentified process involving inflammation or abnormal blood vessel activity in this region also may be involved in the headache.
Abnormal function of the Hypothalamus
Cluster attacks typically occur with clock-like regularity during a 24-hour day. The cycle of cluster periods often follows the seasons of the year. These patterns suggest that the body's biological clock is involved. In humans, the biological clock is located in the hypothalamus, which lies deep in the center of your brain. Among the many functions of the hypothalamus is control of the sleep-wake cycle and other internal rhythms.
Abnormalities of the hypothalamus may explain the timing and cyclical nature of cluster headache. Studies have detected increased activity in the hypothalamus during the course of a cluster headache. This activity isn't seen in people with other headaches such as migraine.
Studies also indicate that people have abnormal levels of certain hormones, including Melatonin and Testosterone, during cluster periods. These hormonal changes are believed to be due to a problem with the hypothalamus. Other studies show activity in the hypothalamus during cluster attacks. But it remains unknown What causes these abnormalities in the first place.
Unlike migraine, which more often affects Women, cluster headache predominantly affects men. People ages 20 to 40 are most likely to be affected by cluster headache. Many people who get cluster headache attacks are heavy smokers. Alcohol can trigger an attack if you're at risk of cluster headache. Usually there's no family history of cluster headache.
Headache pain, even when severe, usually isn't the result of an underlying disease. Occasionally, however, headaches may indicate a serious underlying medical condition, such as a Brain tumor or rupture of a weakened blood vessel (Aneurysm). Be sure to tell your doctor about any headache that concerns you. If you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different.
In addition, see your doctor or go to the emergency room immediately if you have any of these signs and symptoms:
Call your doctor if your child has head pain that's severe or that causes him or her to miss school or other activities. Children who are too young to tell you what's wrong may cry and hold their heads to indicate severe pain.
Cluster headache has a characteristic type of pain and pattern of attacks. A diagnosis depends on your description of the attacks, including your pain, the location and severity of your headaches, and associated symptoms. The frequency and duration of your headaches also are important factors.
If you have chronic or recurrent headaches, your doctor may try to pinpoint the type and cause of your headache using certain approaches.
Examinations and tests
Headache tracking
One of the most helpful things you can do is keep a headache journal for at least two months. Each time you get a headache, jot down the following information:
A headache journal can offer valuable clues that may help your doctor diagnose your particular kind of headache and discover possible headache triggers.
There's no cure for cluster headaches. The goal of treatment is to help decrease the severity of pain and shorten the headache period.
Acute Medication
The purpose of acute treatment is to stop or reduce pain after a cluster headache starts. Because the headache peaks quickly, acute medications must be fast-acting and delivered quickly, using an injection or inhaler rather than oral tablets. You must be ready to take the medication as soon as an attack starts. And you may want to teach family members about your medications so that they'll be able to help you when you have an attack.
Because the pain of a cluster headache comes on suddenly and may subside within a short time, over-the-counter pain relievers such as aspirin or ibuprofen (Advil, Motrin, others) Aren't effective. The headache is usually gone before the drug starts working. Fortunately, other types of acute medication can provide some pain relief. Treatment of cluster headache is focused more on prevention, with more medication options available to choose from.
Acute treatments include:
Sumatriptan. The injectable form of sumatriptan (Imitrex), which is commonly used to treat migraine, is also an effective acute treatment for cluster headache. Some people may benefit from using sumatriptan in nasal spray form, but for most this is not as effective as an injection. Sumatriptan isn't recommended for people with uncontrolled high blood pressure or ischemic heart disease.
Another triptan medication, zolmitriptan (Zomig), can be taken orally for relief of cluster headache. Although oral zolmitriptan isn't as effective as injectable sumatriptan, it may be an option for People who can't tolerate other forms of acute treatment. Zolmitriptan also is available in nasal spray form.
Surgery
Rarely, surgery is recommended for people with chronic cluster headache who don't respond well to aggressive treatment or who can't tolerate the medications or their side effects. Candidates for surgery must have headaches only on one side of the head because the surgery can be performed only once. People with headaches that alternate sides of the head risk the chance that the procedure will be unsuccessful.
Several Types of Surgery have been used to treat cluster headache. These procedures attempt to damage the nerve pathways thought to be responsible for pain. However, residual muscle weakness in your jaw or sensory loss in certain areas of your face and head may result. The most common procedures are directed at the trigeminal nerve. They include:
Potential treatments
As scientists learn more about the causes of cluster headache, they're able to develop more selective treatments for the condition. One development that shows promise is the use of a device to stimulate the occipital nerve, which influences the trigeminal nerve. To treat people with frequent cluster headaches, researchers are testing a stimulator — a pacemaker-sized device that sends impulses via electrodes — that is implanted over the occipital nerve. A Mayo Clinic study of implanted occipital nerve stimulators found that the devices reduced chronic headache pain by an average of about half.
Similar research is under way using an implanted stimulator in the hypothalamus, the area of the brain associated with the timing of cluster periods. Stimulation of the hypothalamus in a small number of people with severe, chronic cluster headaches has produced complete and long-term pain relief with no significant side effects.
In addition, researchers are studying new medications for use in treating and preventing cluster headache.
Because the cause of cluster headache is unknown, you can't prevent a first occurrence. However, a preventive strategy is crucial for managing cluster headache because trying to treat it with acute drugs only can seem hopeless. Prevention can help reduce the frequency and severity of the attacks and the risk of Rebound headaches. Preventive medications can also increase the effectiveness of acute medications.
Preventive medications for cluster headache are generally used for either a short-term (transitional) strategy or a long-term (maintenance) strategy. The short-term medications work quickly but may have undesirable side effects. Long-term medications take effect more slowly but can be used safely throughout the cluster period.
Whenever a cluster period starts, you'll likely start taking a long-term medication, many times accompanied by a short-term medication. After a couple of weeks, you'll discontinue use of the short-term medication but continue with the long-term drug.
Short-term prevention
Short-term medications can prevent headache attacks during the period of time it takes for one of the long-term drugs to become effective. The main short-term preventive medications are corticosteroids and ergotamine. A nerve block also may be effective, particularly for some people who can't tolerate the other medications.
Long-term prevention
Long-term medications are taken during the entire cluster period. Some people with chronic cluster headache don't respond well to the use of one long-term medication. In this situation, your doctor may recommend that you take two or more long-term medications simultaneously.
Preventive medications under evaluation
Other preventive medications used for cluster headache include the hormone melatonin, Capsaicin (Zostrix) — a cream that affects nerves near the skin — and anti-seizure medications such as divalproex (Depakote) and topiramate (Topamax).
In addition, you may help reduce your risk of future attacks by avoiding alcohol and nicotine, which often precipitate cluster headaches.
The following measures may help you avoid a cluster attack:
Living with cluster headache can be difficult. In addition to the physical symptoms, the Chronic Pain that often accompanies cluster headache attacks can make you anxious or depressed. Ultimately, it may affect your interaction with friends and family, your productivity at work, and the overall quality of your life.
You may find that talking to a counselor or therapist can help you cope with the effects of cluster headache. Or you may find encouragement and understanding in a headache support group. Although support groups aren't for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences. If you're interested, your doctor may be able to recommend a group in your area.
Rebound headaches , Cluster Headaches , Tension Headaches , Bipolar Disorder , Types of Surgery , Muscle Weakness , Tension headache , Calcium channel
