HEADACHE, CLUSTER

 Basic information

description

A cluster headache typically causes severe pain on one side of the head, behind the head, or around one eye. The headaches occur in groups or clusters usually over weeks or months. Cluster headaches usually affect adults over age 30, and men more than women.

FREQUENT SIGNS & SYMPTOMS

• Sudden onset of headache. It often occurs at night while sleeping.
• Headache reaches a peak within 15 minutes and lasts about 2 to 3 hours.
• Pain around the eye.
• Severe, piercing, or boring pain.
• Teary eyes.
• Swollen and droopy eyelid.
• Stuffy or runny nose.
• Sweating.
• Feeling agitated and restless during an attack.
• Episodic cluster headaches tend to recur at the same time each day for several days or weeks, separated by attack-free weeks or months.
• The more rare, chronic type occur almost daily with headache-free periods lasting about 2 weeks.

causes

The cause is unknown. It may be a combination of factors, such as dilating blood vessels in the head, disturbance of the trigeminal nerve, or abnormal activity in part of the brain (hypothalamus).

risk increases with

• Male, age over 30.
• Previous head injury.
• Possibly a genetic factor (unproven as yet).
• Other possible factors include smoking, alcohol abuse, sleep disturbances or sleep apnea (periods of not breathing at night), stressful job, or history of migraines.

PREVENTIVE MEASURES

Since the cause is unknown, there are no specific measures to prevent the first episode.

expected outcomes

There is no cure. The cluster headache attacks may come and go, or be ongoing. Many people are headache-free for a year or more, but then they may start up again. Various therapies are available that can help prevent and treat the headache attacks.

possible complications

Cluster headaches do not cause complications or lead to other disorders. They are debilitating and can interfere with daily activities.

 diagnosis & treatment

general measures

• Your health care provider can usually diagnose the disorder based on the history of the headache patterns and symptoms. Medical tests are normally not required.
• Treatment goals are to treat the symptoms and prevent or abort future attacks. It may involve drug therapy, use of oxygen, and lifestyle changes.
• During cluster periods, avoid bright light or glare, alcohol, excessive anger, stressful activity, or excitement. These can trigger attacks. Keeping a headache diary may be useful to help identify other triggers.
• Don't smoke. It may interfere with drug therapy.
• Some patients also have sleep apnea. Treating the apnea (with a mechanical device) may help headaches.
• Surgical treatments may be considered when drug therapy is not helpful. Surgery has limited effectiveness.
• To learn more: National Headache Foundation, 820 N. Orleans, Suite 217, Chicago, IL 60610; (888) 643-5552; website: www.headaches.org.

medications

• Your health care provider may prescribe one or more drugs to treat the headache and for prevention:
  • Drugs called triptans (by mouth or by injection).
  • Dihydroergotamine (Migranal) by injection.
  • Ergotamine tartrate, in a tablet, suppository, aerosol, or injection form.
  • Verapamil or prednisone by mouth.
  • Oxygen therapy for home use.
  • Lidocaine nasal spray or nasal drops.
  • Other drugs to help treat/prevent cluster headaches.

activity

Physical exercise may help bring relief in some patients.

diet

Avoid alcohol and foods containing nitrates (such as smoked meat).

 notify our office if

• You or a family member has symptoms of cluster headache.
• Attacks continue after treatment is started.

Special Notes: