One of the most painful headaches known to occur in some people is known as a cluster headache. The most typical feature of this headache is that it presents in a cyclical fashion or in clusters. In most cases, the cluster headache lasts anywhere from a few weeks to a few months. This pattern is quite variable in each individual but most individuals will have a set of cluster headaches in any give 12-month period. Fortunately, cluster headaches are rare.
These headaches are more common in men and often start around the 2nd- 4th decade of life. It is very rare for children or women to develop cluster headaches. After the 3rd decade of life, it is extremely rare to develop new onset cluster headaches. It is believed that hormonal differences may account for this. Even among men, cluster headaches seem to occur more often in certain races and in specific age groups. Of all cultures, ethnic groups and races, black individuals seem to be more prone to cluster headaches. This is only true of African Americans. There are not enough data on blacks living in Africa. When cluster headaches start, they usually persist for several decades. In some individuals, the headaches do suddenly disappear in the 6-7th decade of life.
What are features of a cluster headache?
While the headaches are agonizingly painful, they are not a threat to life. Cluster headaches typically strike without any warning signs or symptoms. Within a few minutes, the headaches increase in intensity and become excruciating. The headache typically beings on one side of the head and always occurs on that particular side for the rest of your life.
In very rare cases does the side of the cluster headache shift position. Most individuals affected with a cluster headache describe it as burning and intense in nature. Others describe it as a being struck in the head with a hot flaming rod.
Cluster headaches usually last anywhere from 2-10 weeks. During remission, one is fine; however, some unfortunate individual can develop chronic cluster headaches that may go on for 10-12 months. An amazing fact is that the intensity, start time and duration of a cluster headache is consistent during each attack.
What triggers a cluster headache?
What precipitates a cluster headache is not always known but there are some risk factors.
- Some individuals develop cluster headaches that can be triggered by seasonal changes, allergens, or excessive stress. In others, medications like nitroglycerin can precipitate a cluster headache.
- One of the biggest risk factors for developing cluster headaches is heavy smoking or having started smoking at an early age. Once the headaches have started, discontinuation of smoking does not do much to decrease the intensity of headaches but does reduce the number of episodes.
- Another factor strongly associated with cluster headaches is heavy alcohol consumption on a regular basis. There are exceptions to this and some people who only drink less than a bottle of beer a day and still develop cluster headaches. For the individual who develops cluster headaches, discontinuation of alcohol has been shown to decrease both the frequency and intensity of the headaches.
- An additional risk factor for developing cluster headaches is family history. Individuals who have a parent or a sibling with a prior diagnosis of cluster headaches are also more prone to developing the same disorder.
- Some individuals develop cluster attacks seasonally; others get it during certain natural anniversaries (new moon, the shortest day, seasonal rainfalls, etc). In any case, with time the cluster headaches generally tend to last longer, become less predictable and remain just as painful.
For the most part, no one really knows why cluster headaches develop. Bad luck more than anything is the best explanation for the majority of individuals afflicted with this dreadful disorder.
What are symptoms of a cluster headache?
The headache that occurs during a cluster period may occur every day or even several times a day. The duration of a headache may be a few minutes to several hours. The headaches do tend to occur at the same time each day but unlike other headaches, cluster headaches do occur more commonly at night.
Research has shown that these headaches often occur during sleep when people start to dream. Most people wake up from a deep sleep with a headache, which is severe in intensity. The headaches are agonizing and may indicate that something is seriously wrong. The pain usually subsides as suddenly as it started. After the attack, most individuals are exhausted but are pain-free. In some unlucky individual this pain-free period may only be several hours and in others, it may be days.
Agitation: The headache is so severe that most people are restlessness, anxious and simply can’t lay still. Most individuals will hold the head and pace the floors. Others often apply ice packs, heating pads or some even massage the scalp. This is in complete contrast to the individuals who get migraines. Individuals who develop a migraine will usually be quiet and prefer to lie down. Cluster headaches, on the other hand, are generally worse in the sleeping position.
Because the headaches are so severe, most individuals do develop a certain personality during the attack. Some may go outside the house, cry, scream, exercise, swim, bang their head against the wall, or even induce self-inflicted wounds to the head. This is not an indication of any psychotic behavior- the individual is simply trying to find a way to ease the headache.
Since cluster headaches are nocturnal, many of these individuals will be hesitant to go to bed during the cluster period- because they are quite aware that the headaches come on during sleep.
In most cases, the headache will also affect the eye on the same side. The eye may become red, may develop sensitivity to light and excessive tearing is quite common. Occasionally the eyelid on the affected side may start to droop. The eye pain may feel like a hot metal being pierced into the face.
Occasionally some individuals may develop pain along the neck or jaw on the same side.
In many individuals, complaints of nasal stuffiness are also common on the affected side. Rarely both nostrils may appear congested. Associated with nasal congestion may be a runny nose.
On examination, there is nothing spectacular about a cluster headache. A few individuals may have a teary eye or a runny nose. The face may be flushed and the scalp and facial area may also be tender to touch. Often the patients are in distress, frequently crying or screaming for help. Many patients threaten to commit suicide because the pain is so agonizing.
How is the diagnosis of a cluster headache made?
The diagnosis of a cluster headache is based on the history and clinical presentations. The key is the rhythmicity and periodicity of attacks. X-ray or laboratory studies are not needed to make a diagnosis of a cluster headache. However, CT scans are occasionally done to rule out other more serious disorders of the brain.
Any patient who has a headache needs to write down a few things to tell the physician so that the diagnosis can be made with ease. This includes a description of pain, severity, location, time it occurs, any associated symptoms and how long it lasts. A competent physician can make the diagnosis just based on the history.
What is the treatment for a cluster headache?
Unfortunately, there is no cure for cluster headaches. In each case, the aim of treatment is to decrease the severity of symptoms and prolong the headache-free time period between attacks.
Today, there are a variety of treatments that can help not only help reduce the pain but also diminish the duration of headaches. Further, those individuals who have many cluster attacks may be helped by taking prophylactic medications.
NSAIDs: Over the counter pain medications are not effective for the treatment of cluster headaches. At most, they may work for a few minutes but the majority of individuals find no relief from these agents. In most cases, the headache has long gone before the medications start to work
The other treatment widely used to treat cluster headaches is oxygen.
Oxygen: It has been shown in a number of studies that briefly inhaling oxygen (60%-100%) either through a mask or a nasal cannula can rapidly relieve cluster headaches. Oxygen treatment is deemed safe, relatively cheap and works immediately. The only drawback is that one has to have a container of oxygen around when the attack happens. It is also highly recommended that the individual not smoke during this therapy. Today, many companies market portable oxygen units that can be transported in backpack. These lightweight canisters can easily be carried almost anywhere.
Some individuals find that that oxygen only decreases the intensity and not the duration of the headache. Others find that with time, oxygen fails to work for acute headaches but does help prevent further attacks from coming on.
Once oxygen is inhaled, the relief from pain occurs in a few minutes. The majority of individuals who have used oxygen indicate that it does help initially. However, with recurrent attacks oxygen often fails to reduce the intensity of headaches. Nevertheless, oxygen should always be the first therapy for cluster headaches. Current studies indicate that oxygen can abort at least 70-85 percent of cluster headaches.