Cluster headache

Definition

Cluster headaches are a form of headache notable for their extreme pain and their pattern of occurring in "clusters", usually at the same time(s) of the day for several weeks.

Cause

• Scientists aren't sure what causes cluster headaches, although there are currently several theories.
• The tendency of cluster headaches to occur during the same time(s) from day to day, and more often at night than during the daylight hours, suggests they could be caused by irregularities in the body’s circadian rhythms, which are controlled by the brain and a family of hormones that regulate the sleep-wake cycle.
• The development of cluster headaches may additionally be related to the body's release of histamine (chemical released in the body during an allergic response) or serotonin (chemical made by nerve cells).
• It is also possible that a problem in a part of the brain called the hypothalamus may be involved.
• Alcohol (especially red wine) provokes attacks in more than half of those with cluster headaches, but has no effect once the cluster period ends.
• Cluster headaches are also strongly associated with cigarette smoking.
• Glare, stress, or certain foods may also trigger an attack.
• An increased familial risk of these headaches suggests that there may be a genetic cause, though more studies are needed to confirm this suspicion and identify specific genetic changes associated.

Onset

• Cluster headaches usually begin between the ages of 20 and 50, although they can start at any age.
• Males are more commonly affected than females.

Signs and symptoms

• A cluster headache begins with severe pain strictly on one side of the head, often behind or around one eye.
• In some people, it may be preceded by a migraine-like "aura."
• The pain usually peaks over the next 5 to 10 minutes, and then continues at that intensity for up to three hours before going away.
• Typical attacks may strike up to eight times a day and are relatively short-lived.
• On average, a cluster period lasts 6 to 12 weeks.
• Autonomic symptoms may include: conjunctival injection (bloodshot eyes), swelling under or around the eye, excessive tearing of the eyes, drooping of the eyelid, runny nose and/or nasal congestion, and forehead and facial sweating.
• These symptoms generally occur only during the pain attack and are on the same side as the headache pain.

Cluster headache pain is usually:

• Burning, sharp, stabbing, or steady
• Felt on one side of the face from neck to temple, often involving the eye
• At its worst within 5 to 10 minutes, with the strongest pain lasting 30 minutes to 2 hours

When the eye and nose on the same side as the head pain are affected, symptoms can include:

• Swelling under or around the eye (may affect both eyes)
• Excessive tearing
• Red eye
• Droopy eyelid
• Runny nose or stuffy nose on the same side as the head pain
• Red, flushed face, with extreme sweating

Diagnosis

• Your health care provider can diagnose this type of headache by performing a physical exam and asking about your symptoms and medical history.
• If a physical exam is done during an attack, the exam will usually reveal Horner syndrome (one-sided eyelid drooping or a small pupil).
• These symptoms will not be present at other times.
• No other nervous system (neurologic) changes will be seen.
• Tests, such as an MRI of the head, may be needed to rule out other causes of the headaches.

Treatment

• Treatment does not cure cluster headaches.
• The goal of treatment is to relieve symptoms.
• Spontaneous remission may occur, or treatment may be required to prevent headaches.
• There are medications available to lessen the pain of a cluster headache and suppress future attacks.
• Oxygen inhalation and triptan drugs (such as those used to treat migraine) administered as a tablet, nasal spray, or injection can provide quick relief from acute cluster headache pain.
• Lidocaine nasal spray, which numbs the nose and nostrils, may also be effective.
• Ergotamine and corticosteroids such as prednisone and dexamethasone may be prescribed to break the cluster cycle and then tapered off once headaches end.
• Verapamil may be used preventively to decrease the frequency and pain level of attacks.
• Lithium, valproic acid, and topiramate are sometimes also used preventively.

NIH genetic and rare disease info

• NIH info on Cluster headache

Cluster headache is a rare disease.

Cluster headache Resources
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