The Cluster Headache: Just Like Clockwork
If you have cluster headaches, you know that timing is everything. These headaches are called cluster because of their pattern of striking in groups or clusters. They hit at the same time of day for a period of weeks or months. They then vanish as suddenly and as mysteriously as they appeared.
The pain of cluster headaches can be very intense. Most people can't sit still and will often pace during an acute attack. The pain is often described as having a burning or piercing quality. It may be throbbing or constant. The scalp may be tender. Cluster headaches occur more often in men than in women.
Cluster headaches generally reach their full force within 5 to 10 minutes after onset. The attacks are usually very similar. They vary only slightly from one attack to another.
Malfunction is the trigger
Researchers now believe that cluster headaches, as well as migraines, are set off by a malfunction of neurotransmitters, in particular, serotonin. They control the action of the blood vessels in the head and neck.
Although the pain of a cluster headache starts suddenly. Even so, people usually have a bit of warning that one is on the way. That warning is often a feeling of discomfort or a mild, one-sided burning sensation. Most cluster headaches last only 30 to 45 minutes. Some range from a few minutes to several hours. The headache will disappear only to happen again later that day. Most people get 1 to 4 headaches per day during a cluster period.
They generally happen at the same time each day. Because occur so regularly, they have been dubbed "alarm clock headaches."
The headache periods can last weeks or months. They can then disappear completely for months or years. The person who has cluster headaches has pain-free intervals between episodes. Many cluster headaches occur in the spring or autumn. Because of this, cluster headaches are often mistakenly associated with allergies or business stress. The seasonal relationship is unique for each person. The attacks may be chronic in about 1 in 5 people who have cluster headaches. They are present throughout the year and don't occur in groups. This makes the control of these headaches more difficult.
The pain of cluster headaches is almost always on one side only. During a series, the pain remains on the same side. When a new series starts, it can occur on the opposite side. The pain is found behind the eye or in the eye region. It may radiate to the forehead, temple, nose, cheek, or upper gum on the affected side. The affected eye may become swollen or droop. The pupil of the eye may contract. The nostril on the affected side of the head is often congested. Excessive sweating also may occur., And the face may become flushed on the affected side. Unlike migraines, cluster headaches are not associated with gastrointestinal disturbances or sensitivity to light.
During a series, even small amounts of alcohol can bring on an attack. Smoking can increase the severity of cluster headaches during a cluster period. During these series, the blood vessels seem to change. They may become more susceptible to the action of these substances. The blood vessels are not as sensitive to these substances during headache-free periods.
For some people, cluster headaches never disappear. These are known as chronic cluster headaches. People who have this form of cluster headaches don't respond to usual forms of cluster therapy.
A two-pronged approach is used for treatment of cluster headaches:
To stop or at least control an attack in progress, you may be given high-dose oxygen therapy through a face mask for 15 to 20 minutes. Your healthcare provider may also prescribe an injection or nasal spray called sumatriptan to ease the severe pain of a cluster headache. Sumatriptan is a selective serotonin receptor agonist. This medicine causes blood vessels in the brain to constrict, easing pain. Other choices include intravenous dihydroergotamine and intranasal lidocaine.
The second part of cluster headache treatment is to prevent recurrent attacks by using daily medicine. Several medicines are used to prevent cluster headache attacks:
Verapamil. A medicine that relaxes blood vessels.
Prednisone. A steroid that reduces inflammation and swelling.
Lithium carbonate. A medicine that restores the balance of certain brain chemicals.
Antiseizure medicines. Medicines that may help reduce the number of cluster headaches.
Galcanezumab is an antibody to calcitonin gene-related peptide receptors shown to reduce cluster headache frequency.