A headache can strike anywhere and at any time, be it at work, at home or on the go. The pain can be dull and throbbing, or sharp and pinpointed. No matter when or where a headache comes on, you just want the pain to stop. But what if you experience a throbbing pain in the head that occurs at frequent intervals? Well, it becomes a real challenge as most of us are still not clear about this type of headache. One of the most annoying and bothersome types of headache — this type of headache is known as a cluster headache. In this article, we will be discussing what is a cluster headache and explaining in detail about its causes, symptoms, and treatment.
What Is A Cluster Headache?
A cluster headache is one of the most debilitating headache disorders that affect around 0.1% of the population worldwide[1]. Although it is quite rare, the condition is known to be one of the worst pains known to man. A cluster headache is one-sided head pain that may involve tearing of the eyes and a stuffy nose. The word “cluster” refers to a specific time (which can range from weeks to months) during which a person can experience recurrent attacks or bouts of pain.
The attacks can occur at regular intervals for 1 week to a month, separated by long pain-free periods that may last at least a month or possibly longer. The pain occurs on one side of the head and may be described as burning, sharp and continuous pain. The pain may occur in, behind, and around one eye and may also involve one side of the face from neck to temples. It quickly gets worse, peaking within 5 to 10 minutes. The strongest pain may last 30 minutes to 2 hours.
Cluster headaches are broadly classified into two forms based on clinical factors[2]. These are:
Episodic cluster headache: It is the most common form in which a person can experience an attack or bout around one to eight per day. These may include with or without pain-free days and the period of remission might last for more than 30 days. This form of cluster headache affects around 80-90% of people with cluster headache.
Chronic cluster headache: In this form of headache, the patient may experience one or more attacks per year and mostly at the same time of the year. So if a person suffers from headache without remission for a year or pain with a remission period of less than a month, he/she is diagnosed as suffering from chronic cluster headache. Around 15% of people suffer from this form of cluster headache[3].
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What Are The Possible Causes?
No one knows exactly what causes cluster headaches. However, many experts believe that a cluster headache and migraine headache share a common cause that begins in the nerve that carries sensation from your head to your brain (trigeminal nerve) and ends with the blood vessels that surround your brain. The pain arises in the deep vascular channels in your head (for example, the cavernous sinus) and does not involve the trigeminal system[4].
Cluster headache is often misdiagnosed as migraine or sinusitis. But unlike migraine, a person suffering from cluster headache can become agitated during the attack and may not find respite on lying down, sitting or sleeping. Moreover, the intensity of the pain peaks within minutes and may drop quickly which is not the case with a migraine attack.
Are There Any Triggers Of Cluster Headache?
There are certain lifestyle triggers that may lead to cluster headache attacks. These include:
-Alcohol and smoking
-High altitudes (trekking, air travel)
-Bright light (including sunlight)
-Exertion
-Heat (hot weather, hot baths)
-Foods high in nitrites (such as preserved meats)
– Season changes
– Strong smelling substances (petrol, paints, perfumes, etc)
What Are The Symptoms Of Cluster Headache?
The key symptom of a cluster headache is an attack which causes severe stabbing pain that rapidly peaks at an unbearable intensity. Additionally, there are certain other symptoms which may occur along with pain during an attack. These are[2]:
-Swelling under or around the eye (may affect both eyes)
-Excessive tearing
-Redness in the eyes
-A runny nose or one-sided stuffy nose (same side as the head pain)
-Red, flushed face
-Drooping of the eyelid
-Constriction of the pupil
– Agitation
– Not able to stand or sit in one place
What Are The Treatment Options?
There is no specific test to diagnose cluster headache. As a result, your doctor depends on your medical history to make the right diagnosis. Also, you may be asked to get an MRI or a CT scan done to rule out any other possible causes of headache before starting the treatment.
Depending upon the clinical requirements, your doctor may recommend drugs like triptans, such as sumatriptan, or anti-inflammatory (steroid) medicines such as prednisone — starting with a high dose, and then slowly decreasing it over 2-3 weeks or injections of dihydroergotamine to treat it instantly[3]. Painkillers which are available over the counter may not be effective in relieving the high-intensity of pain seen in these cases. In certain cases, applying cold water or ice pack on the aching region was found to provide relief. Certain lifestyle tricks can help you to prevent an attack such as staying away from the triggers and maintaining a diary to identify the trigger.
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When To See A Doctor?
You should see a doctor if:
-Headaches do not respond to analgesics
-Headaches disturb your sleep
-You get headaches whenever you are active
-Headaches occur with other danger symptoms, like changes in alertness, changes in movement or sensation, drowsiness, nausea or vomiting, seizures and vision changes.
Cluster headaches can cause severe pain which is unbearable and hence, it is important to consult a doctor without a second thought. Knowing about the triggers and maintaining a diary can help you to manage the condition. But remember that treatment for cluster headache is a must to get rid of the debilitating pain.
(The article is reviewed by Dr. Lalit Kanodia, General Physician)
Recommended Reads:
Types Of Headache And When To Go To A Doctor
6 Practical Ways To Manage Headache
References:
1. Kingston WS, Dodick DW. Treatment of Cluster Headache. Ann Indian Acad Neurol. 2018 Apr;21(Suppl 1):S9-S15.
2. Rossi P, Whelan J, Craven A, Ruiz De La Torre E. What is cluster headache? Fact sheet for patients and their families. A publication to mark Cluster Headache Day 2016. Funct Neurol. 2016 Jul-Sep;31(3):181-3.
3. Gaul C, Diener HC, Müller OM. Cluster headache: clinical features and therapeutic options. Dtsch Arztebl Int. 2011 Aug;108(33):543-9.
4. Wei DY, Yuan Ong JJ, Goadsby PJ. Cluster Headache: Epidemiology, Pathophysiology, Clinical Features, and Diagnosis. Ann Indian Acad Neurol. 2018 Apr;21(Suppl 1):S3-S8.