Cluster headache

Cluster headache

Fig.3.22.

Definition

Cluster headaches are characterized by an intense one-sided pain centered by the eye or temple. The pain lasts for one to two hours on average and may recur several times in a day.

(Fig 3.22.)
The primary cluster headache symptom is excruciating one-sided head pain located behind an eye or near the temple. Secondary symptoms include eye tearing, nasal congestion, and a runny nose.



Description

Cluster headaches have been known as histamine headaches, red migraines, and Horton's disease, among others. The constant factor is the pain, which transcends by far the distress of the more common tension-type headache or even that of a migraine headache.

Cluster headaches afflict less than 0.5% of the population and predominantly affect men; approximately 80% of sufferers are male. Onset typically occurs in the late 20s, but there is no absolute age restriction. Approximately 80% of cluster headaches are classified as episodic; the remaining 20% are considered chronic. Both display the same symptoms. However, episodic cluster headaches occur during one- to five-month periods followed by 6- to 24-month attack-free, or remission, periods. There is no such reprieve for chronic cluster headache sufferers.



Causes and symptoms

Biochemical, hormonal, and vascular changes induce cluster headaches, but why these changes occur remains unclear. Episodic cluster headaches seem to be linked to changes in day length, possibly signaling a connection to the so-called biological clock. Alcohol, tobacco, histamine, or stress can trigger cluster headaches. Decreased blood oxygen levels (hypoxemia) can also act as a trigger, particularly during the night when an individual is sleeping. Interestingly, the triggers do not cause cluster headaches during remission periods.

The primary cluster headache symptom is excruciating one-sided head pain centered behind an eye or near the temple. This pain may radiate outward from the initial focus and encompass the mouth and teeth. For this reason, some cluster headache sufferers may mistakenly attribute their pain to a dental problem. Secondary symptoms, occurring on the same side as the pain, include eye tearing, nasal congestion followed by a runny nose, pupil contraction, and facial drooping or flushing.

Diagnosis

Cluster headache symptoms guide the diagnosis. A medical examination includes recording headache details, such as frequency and duration, when it occurs, pain intensity and location, possible triggers, and any prior symptoms. This history allows other potential problems to be discounted.

Treatment

Treatment for cluster headaches is composed of induction, maintenance, and symptomatic therapies. The first two therapies are prophylactic treatments, geared toward preventing headaches. Symptomatic therapy is meant to stop or shorten a headache.

Induction and maintenance therapies begin together. Induction therapy is intended to break the headache cycle with drugs such as corticosteroids (for example, prednisone) or dihydroergotamine. These drugs are not meant for long-term therapy, but rather as a jump-start for maintenance therapy. Maintenance therapy drugs include verapamil, lithium carbonate, ergotamine, and methysergide. These drugs have longterm effectiveness, but must be taken for at least a week before a response is observed. With long-term treatment, methysergide must be stopped for one month each year to avoid dangerous side effects (formation of fibrous tissue inside the abdominal artery, lungs, and heart valves).

Despite prophylactic treatment, headaches may still occur. Symptomatic therapy includes oxygen inhalation, sumatriptan injection, and application of local anesthetics inside the nose. Surgery is a last resort for chronic cluster headaches that fail to respond to therapy.

Alternative treatment

Since some cluster headaches are triggered by stress, stress reduction techniques, such as yoga, meditation, and regular exercise, may be effective. Some cluster headaches may be an allergic response triggered by food or environmental substances, therefore identifying and removing the allergen(s) may be key to resolution of the problem. Histamine is another suspected trigger of cluster headaches, and this response may be controlled with vitamin C and the bioflavonoids quercetin and bromelain (pineapple enzyme). Supplementation with essential fatty acids (EFA) will help decrease any inflammatory response.

Physical medicine therapies such as adjustments of the spine, craniosacral treatment, and massage at the temporomandibular joint (TMJ) can clear blockages, as can traditional Chinese medical therapies including acupuncture. Homeopathic treatment can also be beneficial. Nervous system relaxant herbs, used singly or in combination, can allow the central nervous system to relax as well as assist in peripheral nerve response. A few herbs to consider for relaxation are valerian (Valeriana officinalis), chamomile (Matricaria recutita), rosemary (Rosemarinus officinalis), and skullcap (Scutellaria baicalensis).

Prognosis

In general, drug therapy offers effective treatment.

Prevention

Avoiding triggers, adhering to medical treatment, and controlling stress can help ward off some cluster headaches.