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Microsoft word - cluster headaches.doc
Cluster headache is a type of severe, recurring pain that is located on one side of the head. It
received its name from the clustering or pattern of frequent headaches that usually occur.
There are two main types of cluster headaches:
Episodic cluster headaches—These occur one or more times daily for 4-8 weeks. The
headaches then enter a period of remission and come back months or years later.
Chronic cluster headaches—These occur almost daily with headache-free periods lasting
Either type of headache may convert to the other type.
The cause of cluster headaches is unknown. It is thought that there is abnormal activation of the
area of the brain responsible for regulating temperature, blood pressure, hormone release, and
sleep The pain is thought to be caused by a combination of widening of the blood vessels and
Alcohol use Changes in barometric pressure Changes in sleep pattern Tobacco use Drugs, such as nitroglycerin
Factors that increases your chance of cluster headaches include:
Sex: males Age: 20-50 years old Prior head surgery or head injury
Positive family history of cluster headaches
Stabbing, penetrating, burning, or explosive head pain that:
Is on one side of the head, but not both
Often starts around the eye and spreads to the same side of the head
Occurs daily or almost every day for 4-8 weeks
Often occurs at about the same time each day
May start within two hours of going to sleep
Aura—This can include visual disturbance, visual spots, or the inability to move
one side of the body. This more often occurs with migraine. But, auras can also happen with cluster headaches in a minority of cases.
During the headache other symptoms may occur on the affected side, including:
Stuffy or runny nose Redness or watering of the eye on one side Droopy eyelid Constriction of the pupil of the eye Facial swelling and flushing, sweating Sensitivity to light and noise
The doctor will ask about your symptoms and medical history. A physical and neurological
exam will be done. A neurological exam tests the following:
Mental status Cranial nerve functioning Motor and sensory functioning Coordination Reflexes Gait (walking)
The doctor will ask about the frequency and pattern of your headaches. To help provide
When your headaches started and ended What you were doing at the time What you tried to relieve the pain
Tests are sometimes done to rule out other disorders. These tests may include:
MRI scan —a test that uses magnetic waves to make pictures of structures inside the
CT scan of the brain —a type of x-ray that uses a computer to make pictures of
Treatment aims to reduce the frequency of headaches and help relieve the pain.
Maintain the same sleep routine. Avoid afternoon naps or sleeping in, which may bring on
Do not drink alcoholic beverages. Even a small amount of alcohol can trigger a headache
Learn stress management techniques. Stress can bring on a headache. Do not smoke. Tobacco may interfere with medication to relieve the headache.
Drugs used to treat migraines often relieve acute attack of cluster headaches. These drugs
must be taken at the first sign of a headache.
Drugs used to treat cluster headaches include:
Sumatriptan or other triptans Dihydroergotamine (eg, Migranal) Lidocaine—nose drops or spray on the affected side Pain relievers with caffeine Prednisone (eg, PredniSONE Intensol) Ergotamine (eg, Ergomar)
Octreotide (given as an injection) Glycerol (given as an injection into the nerve)—used when the other treatments are
In some cases, the headache does not last long enough for drugs to be beneficial. Sometimes,
the drugs just delay an attack, rather than stopping an attack.
Pain killers, especially narcotic drugs, should not be used during an acute attack.
Other medicines (usually used in combination) are given on a regular basis to prevent or reduce
the frequency of headaches. These drugs include:
Verapamil (eg, Calan, Isoptin)—to relax and dilate the blood vessels Lithium (eg, Eskalith)—blood levels of this drug must be monitored Methysergide (eg, Sansert)—most helpful in younger people in early stages of disease Prednisone—taken for a short period while other drugs are started Dihydroergotamine or a triptan (medications to treat migraines)—for people who suffer
from cluster headaches at predictable times, such as at night
Topiramate (eg, Topamax) Baclofen (eg, Lioresal) Valproate (eg, Depakote) or gabapentin (eg, Neurontin) Beta-blockers Clonidine (eg, Catapres-TTS) Melatonin Amitriptyline (eg, Apo-Amitriptyline) Topical capsaicin cream Selective serotonin reuptake inhibitors (SSRIs)
Breathing 100% oxygen for 10-15 minutes often relieves cluster headache pain. The oxygen
appears to decrease blood flow to the affected area of the brain. People under age 50 who
have episodic cluster headaches seem to benefit most from oxygen therapy.
Oxygen therapy can be expensive, though, and there are risks with this therapy.
As a last resort, some doctors may recommend cutting or destroying a facial nerve to eliminate
To prevent cluster headaches from getting worse, preventive medication may be given. In
Maintain a regular sleep routine. If you smoke, quit. Avoid alcohol, narcotic analgesics, bright sunlight, and emotional stress. Get moderate physical exercise. Practice relaxation techniques.
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