Cluster headache

An Overview

Cluster headaches, which occur in cyclical patterns or cluster periods, are one of the most painful types of headache. A cluster headache commonly awakens you in the middle of the night with intense pain in or around one eye on one side of your head. Cluster headache are a series of relatively short but very painful headaches every day for weeks or months at a time. You tend to get them at the same time each year, such as in the spring or fall.

Bouts of frequent attacks, known as cluster periods, can last from weeks to months, usually followed by remission periods when the headaches stop. During remission, no headaches occur for months and sometimes even years. It’s so bad that most people can’t sit still and will often pace during an attack. Cluster headaches can be more severe than a migraine but they usually don’t last as long. Cluster headache can start at any age but most commonly starts in your 20’s or older. You are not likely to grow out of cluster headache, although as you get older it is likely that the pain free periods between bouts of cluster headache will get longer.

Approximately 1 in 20 people with cluster headache have a family member who also has the condition. Unlike migraine, it is more common in men than women (by five to six times). It is also more common in heavy smokers. The nerve that’s affected, the trigeminal nerve, is responsible for sensations such as heat or pain in your face. It’s near your eye, and it branches up to your forehead, across your cheek, down your jaw, and above your ear on the same side. These are the least common type of headaches, affecting fewer than one in 1,000 people.

Types of headace

There are two types of cluster headaches: episodic and chronic.
Episodic cluster headaches occur regularly between one week and one year, followed by a headache-free period of one month or more.
Chronic cluster headaches occur regularly for longer than one year, followed by a headache-free period that lasts for less than one month.
A person who has episodic cluster headaches may develop chronic cluster headaches, and vice versa.

A cluster headache strikes quickly, usually without warning, although you might first have migraine-like nausea and aura. The symptoms of cluster headache are characterised by unilateral (one sided) pain, although for some people the side can vary from time to time. The pain is usually centred over one eye, one temple or the forehead. It can spread to a larger area making diagnosis harder.Common signs and symptoms during a headache include:

• Excruciating pain that is generally situated in, behind or around one eye, but may radiate to other areas of your face, head and neck
• One-sided pain
• Restlessness
• Excessive tearing
• Pale skin (pallor) or flushing on your face
• Redness of your eye on the affected side
• Stuffy or runny nose on the affected side
• Forehead or facial sweating on the affected side
• Pale skin (pallor) or flushing on your face
• Swelling around your eye on the affected side
• Drooping eyelid on the affected side.

Causes of Cluster headache

The exact cause of cluster headaches is unknown, but cluster headache patterns suggest that abnormalities in the body’s biological clock (hypothalamus) play a role. Unlike migraine and tension headache, cluster headache generally isn’t associated with triggers, such as foods, hormonal changes or stress.
Once a cluster period begins, however, drinking alcohol may quickly trigger a splitting headache. For this reason, many people with cluster headache avoid alcohol during a cluster period.

• The pain from cluster headaches is caused by the dilation, or widening, of the blood vessels that supply blood to your brain and face. This dilation applies pressure to the trigeminal nerve, which transmits sensations from the face to the brain. It is unknown why this dilation occurs.
• While alcohol hasn’t been proved to cause cluster headaches on its own, it has been suggested that alcohol can trigger cluster headaches in those who are already known to have the problem.
• Researchers believe that abnormalities in the hypothalamus, a small area of the brain that regulates body temperature, blood pressure, sleep, and the release of hormones, may be responsible for cluster headaches.
• Cluster headaches may also be cause

Diagnosis

There is no special test to diagnose cluster headache and so your doctor will need to take a very detailed history of all your symptoms in order to make the correct diagnosis. You may be referred for an MRI scan to rule out other causes for the pain starting suddenly. Your doctor will ask you questions about your symptoms and give you a physical and neurological exam. This may include an MRI or CT scan of your brain to rule out other causes of the headaches, such as a brain tumor. You are likely to be referred to a headache specialist in a hospital or headache clinic. This is because this is a rare condition which GP or family doctors do not often treat, not because it is dangerous or life threatening.

Treatment

Whilst there is currently no cure for cluster headache, the treatment has become much more effective in the last 10 years.
Acute treatment
Acute treatment is used to stop the pain once it has started. Treating cluster headache can be tricky because the pain becomes extremely severe very quickly – usually within 10 minutes.
• Sumatriptan injections have been found to reduce the pain within 10 minutes during an attack. In general tablets are less effective if you have cluster headache because of the time they take to work.
• Sumatriptan and zolmitriptan nasal sprays do help some people although the onset of action maybe slower than the injection.
Breathing exercises: One of the first-line clinical treatments for cluster headache is the application of oxygen, 1 which is known to reduce the severity of an attack. With this in mind, some sufferers have found deep breathing exercises to be effective in managing symptoms.

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