Cluster Headaches

Cluster headaches have been called histamine cephalalgia, Horton neuralgia, and erythromelalgia. The causes of cluster headaches are not known with certainty. The mechanisms by which the body produces cluster headache pain and other symptoms are also not known for sure.

Cluster Headaches, Prevalence

Cluster headaches are rare. (Less than 1% of the population experience them.) People who do have such headaches usually start to have them when aged 20-40 years. Males get them more often than females (by a ratio of 5-8:1). Usually, no family history of cluster headaches is noted.

Cluster Headaches, Clinical features

Typically, cluster headaches come on with no warning. The signs and symptoms may include intense burning or penetrating pain, often described as a stabbing or hot poker sensation, in or around one eye or temple, occasionally spreading to the forehead, nose, cheek, or upper gum and jaw.

Cluster headaches usually occur on one side of the head. Pain is often penetrating and lasts from 15 minutes to 4 hours. Cluster headaches often cause people to awaken in the middle of the night. During a cluster headache, people are restless and may find relief in pacing or crying. Cluster headaches start rapidly over a few minutes. Periodicity (occurring at regular intervals) is characteristic of cluster headaches. Clusters of headaches are experienced, each cluster lasting as long as several months, once or twice a year. Using alcohol, histamines, or nitroglycerine during a cluster headache may worsen the attack.

Certain personality and physical characteristics have been associated with cluster headaches. A leonine (lionlike) appearance is one of them. Strong associations with smoking, alcohol use, and previous head and face trauma have been noted.

Cluster Headaches, Abortive treatment

Most of the headache-stopping drugs (abortive drugs) effective in treating migraine headaches are also effective in stopping cluster headaches, suggesting that the two types are related.

• Oxygen therapy: This is the treatment of choice and is very safe and effective. Early in an attack, oxygen delivered through a face mask has been known to either stop an attack or diminish its intensity. Why this works is unknown.
  
  
• Occipital nerve steroid injection (methylprednisolone acetate [Depo-Medrol]): An injection of this drug may stop a cluster headache attack.

Cluster Headaches, Preventive therapy

As with the abortive drugs, most of the preventive drugs effective in treating migraine headaches are also effective in preventing cluster headaches, again suggesting that the two types are related.