Headache, Cluster
What is it?
Cluster headaches are characterized by sudden, intense, stabbing pain occurring on one side of the head, centering around one eye. They tend to occur repeatedly, night after night, in periods or "clusters" of several weeks or months at a time. Pain can appear one to three hours after falling asleep, during the phase of sleep characterized by rapid eye movement (REM).
Clusters may be separated by symptom-free months or years. Rarely, cluster headaches may be chronic, lasting for several years. This disorder is four times more common in men than women and most commonly strikes between the ages of 20 and 40. Although cluster headaches may produce severe pain, they do not cause permanent harm (such as brain damage) and do not lead to other disorders.
What Causes It?
- The cause of cluster headaches is unknown.
- Substances that may trigger headaches include alcohol, nicotine, and nitroglycerin (used in the treatment of angina).
- Certain foods have been implicated, specifically those containing tyramine. Such foods include pepperoni, red wine, chicken livers, active yeast preparations, and Camembert, cheddar, and other aged cheeses.
- Heavy smokers and drinkers are at greater risk for cluster headaches.
- Stress, overwork, or emotional duress may promote cluster headaches.
Prevention
- Avoid substances that appear to trigger headaches. Keep a detailed headache diary to help identify possible culprits. Keep a daily record of food and drink intake, activities, and the duration and severity of headaches.
- Avoid cigarettes and excessive alcohol consumption.
Diagnosis
- Patient history and physical examination are needed.
- Tests may be performed to rule out sinusitis, glaucoma, cerebral aneurysm, or other disorders that may produce symptoms similar to those of cluster headaches.
How to Treat It
- Do not lie down during an episode—this often worsens the pain.
- Over-the-counter pain relievers often work too slowly to relieve the pain of a cluster headache.
- Your doctor may prescribe inhalation of 100 percent oxygen for five to 15 minutes at the beginning of an episode to relieve pain.
- Your doctor may prescribe one of the new "trip-tan" medications, such as simatriptan, which may relieve pain at the first sign of a headache. The injectable forms of these medications may be the most effective. A more effective approach is to prevent headaches by taking one of a number of different medications (steroids, anti-inflammatories, antidepressants, and antihypertensive drugs) throughout the duration of a cluster.
- Surgery to sever certain nerves near the site of the headaches may be recommended in severe cases that do not respond to other therapy. Surgery provides relief about two-thirds of the time but may have serious side effects, including muscle weakness and loss of sensation in some areas of the face.
When to Call a Doctor
- Call a doctor immediately if you have never had a cluster headache, and you develop a sudden, intense headache centered on one eye. Other, more severe disorders may produce similar symptoms.
- Make an appointment with a doctor if your headaches are not responding to treatment.
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Copyright © 2008 Medletter Associates, LLC
Content excerpted from Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference.