Cluster Headache (cont.)
Cluster Headache Symptoms and Signs
The pain of cluster headache is its defining and most dramatic symptom (feature). This pain comes on without warning (no forewarning symptoms such as the aura in classic migraine) and may begin as a burning sensation on the side of the patient's nose or deep in the eye.
The pain peaks in just a few minutes. Patients describe the feeling as having an ice pick driven through
their eye. They use words such as "excruciating," "explosive," and "deep." This stabbing eye pain carries with it a rapid electrical-shock like element, which may last for a few seconds, and a deeper element that continues for a half-hour or longer. The pain almost always begins in your eye and always on 1 side of your face. Interestingly, for most patients the pain stays on the same side of the face from cluster to cluster, while in a small minority the pain switches to the opposite side during the next cluster.
In addition to its one-sidedness, other characteristics, symptoms, and signs that separate cluster headaches from other headaches include:
- The headaches commonly come on just after you go to sleep.
- Often the eye on your affected side will tear.
- Your eyelid on the affected side will droop.
- You will experience one-sided nasal stuffiness and runny nose.
- Cluster headaches have seasonal variations. Most attacks occur in January and July, where the days are in turn the shortest and longest.
When Should I Call a Doctor or Other Health Care Professional for Treatment?
Notify your doctor or other medical health care professional in these situations.
- You and the doctor will work out a plan so you will know which types of pain you can deal with safely at home, which require a medical professional, and which require an immediate trip to a hospital's emergency department.
- You should always bear in mind, however, that these headaches can be excruciating, and your doctor always will be there to help you.
- Notify the doctor when you get a severe headache that is not of the same type as the ones you are used to experiencing.
- Call your doctor if you develop a new side effect from the medications you are taking.
- If you have not ever had headaches, or have never seen a doctor for headaches, and have a sudden, severe headache, you should call your doctor or go to a hospital's emergency department.
Seek immediate medical attention or go to a hospital's emergency department under the following circumstances:
- When your current medication does not control the pain and you need immediate relief
- When your pain prevents eating and drinking and you become at significant risk of malnutrition or dehydration
- When you experience profound side effects from your medication such as severe drowsiness, sedation, and nausea and vomiting
- When a doctor advises you to seek evaluation and treatment for any of these problems
- When you have a change in the severity or increased frequency of headaches, or a headache that feels different from any previous headaches
Are There Tests To Diagnose This Type of Headache?
- Your doctor must rule out a variety of other causes of facial pain besides cluster headache to make the diagnosis, including the following unusual forms of headache and facial pain.
- The patient's first experience of a severe explosive headache may be a warning of subarachnoid hemorrhage or bleeding in the head or brain. This is a neurological emergency that needs to be treated immediately by a medical doctor.
- A severe headache also can be a warning of a brain tumor or infection in the head. Both these conditions are rare, but because they are life threatening, the doctor will want to rule these out first.
- Physical examination of your head will help define other possible causes of this painful syndrome. Physical findings in people with cluster headache between attacks are usually normal. During headache attacks, these symptoms may occur:
- Eye tearing
- Pupil of the eye narrows
- Lack of sweating over one-half of the face
- Nasal stuffiness
- Facial and eye redness
- A doctor or other medical professional should complete an initial examination of the patient's nerve response. Doctors reserve more extensive testing, such as a CT scan or MRI, for patients in whom they suspect a more serious condition; for example:
- Skull or brain tumor
- Neurological condition
The doctor or other medical health care professional also may order a lumbar puncture ("spinal tap"). This may help to establish if the cause of the headache is from an infection, or from bleeding in or around the patient's brain.
Medically Reviewed by a Doctor on 9/11/2017
Joseph Carcione Jr, DO, MBA
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