Categories: Neurology

Cluster Headaches: Everything You Need to Know

What Are Cluster Headaches?

Cluster headaches affect about one in a thousand people and affect men more than women. People suffering from a cluster headache have been described as one of the most painful types of headaches. These aches are usually one-sided and are centered around one eye or the temple. They appear suddenly, last for hours and disappear spontaneously. Though these headaches are not life-threatening, they can be quite debilitating and have no cure.

What are the Types of Cluster Headaches?

Cluster headaches are of two types: episodic and chronic. People suffering from one type may switch to the other at any point in their lifetime.

  • Episodic cluster headaches occur at regular intervals between a week or a year, and are followed by a head-ache free interval that lasts at least for a month,
  • Chronic cluster headaches occur continuously for periods as long as a year followed by a headache-free period lasting less than a month.

These headaches usually become severe within 5-10 minutes of onset and can last for several hours.

What Are the Symptoms of Cluster Headache?

During an episode of a cluster headache, pain occurs at a fixed time of the day. People have even reported being woken up a couple of hours after they sleep due to the headache. The pain can be agonising within five minutes and last for upto an hour at this intensity. The pain can then stop just as abruptly as it started. Some bad episodes can even mean 8-10 bouts of headaches a day.

Most people experience these headaches during one season of the year, often spring or autumn.

People with cluster headaches often pace about to relieve their pain, or even bang their heads to distract themselves from the pain until it subsides.

Other symptoms that accompany a cluster headache include:

  • Drooping of the eye on the affected side
  • A runny or stuffy nose
  • Watering or redness of the eyes
  • Sweating or a flushed face

Cluster Headache vs Other Types of Headaches

A cluster headache is easy to differentiate from other causes by its severity,  its regularly recurring nature, and the symptoms:

Cluster headaches start all of a sudden and can be accompanied by aura-like visual symptoms such as bright flashes of light. Cluster headaches are usually felt on one side of the head and are located behind the eye. It is a constant and deep burning or stinging sensation.

The pain has even been described as a hot rod piercing the eye and can radiate to the teeth, nose, forehead, temples or the neck on the same side.

Symptoms accompanying cluster headaches include restlessness, a constricting pupil, sensitivity to light or a droopy eyelid.

What are Causes Cluster Headaches?

Although the exact reason for cluster headaches is still unclear, research has shown that there is increased activity in the hypothalamus during an episode. The hypothalamus is that part of the brain that controls temperature, thirst and hunger. It has been theorised that chemicals released from the hypothalamus may cause the blood vessels that supply the brain to dilate, causing cluster headaches.

Higher levels of melatonin and cortisol were identified in the blood during an attack, suggesting a possible relationship between these hormones and cluster headaches.

External factors have also been identified as triggers for a cluster headache. These include:

  • Alcohol consumption. People typically complain of the onset of a cluster headache within an hour of drinking. It is advised to avoid drinking during a bout of cluster headaches if you are prone to them.
  • Strong odours. Smelling strong solvents like petrol, bleach, paints, or some perfumes can trigger a cluster headache.
  • Strenuous activities or your body heating up can be a trigger for some.
  • Heavy smokers have been a victim of cluster headaches. Cessation can prevent these headaches once and for all.

Various Types of Treatment for Cluster Headaches

There is no cure for cluster headaches as their etiology is still unclear. If you are wondering how to get rid of cluster headaches, treatment mostly focuses on medications to prevent them from occurring and pain relief once it has occurred.

Acute treatment:

Acute treatment comprises relieving the pain once it has started. The excruciating pain needs to be relieved quickly and is hence a challenging task. Over the counter pain-killers are not effective for these severe headaches:

  • Inhaling oxygen at the rate of 7-12 litres a minute has shown to be effective in most people. People with frequent cluster headaches even keep oxygen cylinders at their homes to use when they have an episode.
  • Sumatriptan injections. Injections are more quick and effective in pain relief than tablets.
  • Sumatriptan and zolmitriptan nasal sprays.

Preventive treatment:

Recent advances in medicine have aided in the development of a lot of drugs that can prevent the onset of cluster headaches. However, remember that these drugs are not without side effects, and must be prescribed by your treating physician. These include:

Long term medicines for a cluster headache:

  • Calcium channel blockers such as Verapamil. A daily dose of verapamil has shown to prevent the occurrence of cluster headaches. However, this drug requires frequent cardiac monitoring and should be prescribed by a doctor.
  • This drug is effective in episodic cluster headaches. However, this drug should not be used for a period of longer than 6 months.
  • A drug that is advised for bipolar disorder, is sometimes prescribed in the prevention of chronic headaches.
  • Topiramate and other anti-seizure medications have shown promising results in preventing cluster headaches.

Short-term medications:

  • Steroids like prednisolone are fast-acting and suppress inflammation.
  • Anaesthetic on the occipital nerve. Numbing this nerve can provide instant relief.
  • This drug temporarily narrows the blood vessels, thus relieving symptoms.

Natural treatment options

Here are some home remedies for cluster headaches:

  • Avoiding alcohol. Abstaining from alcohol may reduce the number of episodes.
  • Avoiding some medications. Drugs like nitroglycerine that cause dilation of blood vessels can trigger a cluster headache.
  • Avoiding exercising in hot weather.
  • Quitting smoking.
  • Maintain a regular sleep pattern. Cluster headaches have been associated with irregular sleep schedules.

Despite cluster headaches being a long-term problem and a debilitating condition, medical advancements in recent times have made it possible to reduce the occurrence and severity of symptoms. If you are suffering from chronic or episodic headaches, visit our specialists at NH for an accurate diagnosis and effective pain management.

Dr. Human Prasad Sinha, Consultant – Neurology, MMI Narayana Superspeciality Hospital, Raipur

Narayana Health

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