About Cluster Headaches

Cluster headache is a neurological condition featuring stabbing, excruciating pain that usually occurs somewhere near the eye or temple. Episodes usually continue off and on for several weeks at a time. Then the headaches may disappear for months or years. Cluster headache is more common in men than in women, and sometimes first generation relatives suffer from it.

Cluster headache has been identified as one of the most painful medical conditions possible, and has been nicknamed "suicide headache" for this reason. The cause of the pain is dilation of blood vessels pressing on the trigeminal nerve. However, why this occurs in some individuals is still unknown. Two suspected reasons are low testosterone and abnormalities in the hypothalamus or metabolism.

There can be "triggers" for cluster headaches in some patients, including ingesting chocolate or alcohol or becoming overheated. Some individuals experience the headache after exercising. But the reasons for the triggering are not yet understood.

Symptoms

The overwhelming unilateral pain is the main symptom of a cluster headache. However, there are other possible symptoms such as runny nose or a feeling a nostril is "stopped up," dropping eyelid, pupil constriction, stiff neck or aversion to bright light. Some patients experience excessive sweating, facial swelling or reddening or rash, or eye redness.

If the pain is untreated, it can go on for anywhere from fifteen minutes to two or three hours.

Diagnosis

Besides reporting history and symptoms, physical and neurological examinations will be performed. Imaging of the brain will be performed, such as magnetic resonance imaging and computerized tomography scan.

Treatment

Many medications and treatments have been developed for the treatment of cluster headache as well as to prevent future cluster headache attacks.

In an acute attack, inhaling pure oxygen through a mask can relieve severe pain. Lidocaine, a local anesthetic, may be provided in the form of nasal drops. Oral ergotamine may be taken, or an intravenous drug, dihydroergotamine, can be given. An injectable brain hormone called somatostatin is sometimes provided.

Other effective medications for the pain of cluster headache are triptans. These are either inhaled or in injectable form.

There are some medications that can be given as preventive therapy. Corticosteroids, which suppress inflammation, are sometimes effective, but they can only be given for short periods and should be alternated with other treatments. Anti-seizure medications, ergotamines, and even lithium or calcium channel blockers may be used as preventive measures.

An occipital nerve procedure may be done, which involves injecting an anesthetic in the area at the back of the head around the occipital nerve.

Surgery is rarely done for cluster headache, due to the accompanying risk. The surgery requires cutting or making small burns in part of the trigeminal nerve. This is a dangerous procedure which most doctors do not recommend.

Researches continue to study cluster headache, and it is hoped more effective treatment and prevention of this debilitating condition will be developed as causes become known.

Sources:

Mayo Clinic

Signet/Mosby Medical Encyclopedia

National Institute of Health