HEADACHE, CLUSTER

General Information

DEFINITION--A very severe headache that typically causes pain on one side of the head, behind or around one eye. The headaches tend to recur at the same time each day for several days or weeks.

BODY PARTS INVOLVED--Central nervous system.

SEX OR AGE MOST AFFECTED-- Approximately 90% of those affected are males. Onset is around age 30 in men, later in women.

SIGNS & SYMPTOMS

• Sudden onset of headache often at night while sleeping.
• Headache reaches crescendo within 15 minutes and lasts about 2 hours
• Pain is unilateral around the eye.
• Severe, piercing or boring pain.
• Teary eyes.
• Infected conjunctiva.
• Swollen and droopy eyelid.
• Nasal congestion and runny nose.
• Slow heartbeat.
• Nausea.
• Perspiration.
• Restless, active, violent (sometimes).
• Episodes of headache occur at same time on consecutive days, with clusters of these days, separated by attack-free weeks or months.

CAUSES--Actual cause is unknown. Some indication that a neurological disturbance of the body's circadian rhythm (biologic clock) may contribute to cluster headache.

RISK INCREASES WITH

• Male, age over 30.
• Possible relationship to previous head injury or surgery.
• Significantly higher incidence of peptic ulcer, coronary artery disease (males).
• Prior history of migraine frequent (significant in females).

HOW TO PREVENT--Since the cause is unknown, no specific measures to prevent the first episode.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• Diagnosis is usually determined by the patient's history of the headache patterns and symptoms.

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment.
• Consider surgical treatments to trigeminal nerve if drug therapy is ineffective (rare).

POSSIBLE COMPLICATIONS

• Self-injury during attack.
• Side effects of drugs.

PROBABLE OUTCOME--

• No cure is available, but treatment can help control the pain and shorten the cluster period.
• Prolonged remissions.

How To Treat

GENERAL MEASURES--

• Therapy may involve medications and lifestyle changes.
• During cluster periods, avoid bright light or glare, alcohol, excessive anger, stressful activity or excitement. These will precipitate attacks.
• Avoid smoking; tobacco may make cluster unresponsive to drug treatment.
• See Resources for Additional Information.

MEDICATION--Your doctor may prescribe:

• Sumatriptan (the brand name is Imitrex) subcutaneous (self-injected under the skin) may help during an acute attack. Follow all prescription instructions carefully.
• Ergotamine aerosol to be used during an attack and also as a preventive. Follow prescription instructions carefully, especially if you take more than one medication.
• Oxygen therapy for at home use.
• Caffeine containing medications (oral and suppository) can help during acute attack.
• Local anesthetic, such as lidocaine.
• Phenylephrine for nasal stuffiness.
• Other medications that are available that can help suppress headaches during a cluster period (prednisone, lithium, ergotamine, verapamil, indomethacin and methysergide).

ACTIVITY--

• Avoid any activities that could cause you to injure yourself during attacks.
• Vigorous physical activity at first symptoms may abort attack.

DIET--

• During clusters, avoid alcohol as it can precipitate attack.
• Rarely, specific foods (chocolate, eggs, dairy products) trigger attacks.

Call Your Doctor If

• You have symptoms of cluster headache.
• Attacks continue after treatment is started.