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Cluster headache


Definition:

A cluster headache is one-sided head pain that may involve tearing of the eyes and a stuffy nose. Attacks occur regularly for 1 week to 1 year, separated by long pain-free periods that last at least 1 month, possibly longer.

Other common types of headaches include migraine headache and tension headache .

Alternative Names:

Histamine headache; Headache - histamine; Migrainous neuralgia; Headache - cluster; Horton's headache

Signs and tests:

Your health care provider can diagnose this type of headache by performing a physical exam and asking questions about your symptoms and medical history.

If a physical exam is done during an attack, the exam will usually reveal Horner syndrome (one-sided eyelid drooping or a small pupil). These symptoms will not be present at other times. No other nervous system (neurological) changes will be seen.

Tests, such as an MRI of the head, may be needed to rule out other causes of the headaches.

Treatment:

Treatment for cluster headaches involves:

  • Medicines to treat the pain when it happens
  • Medicines to prevent the headaches

TREATING CLUSTER HEADACHES WHEN THEY OCCUR

Your doctor may recommend the following treatments for when the headaches occurs:

  • Triptans, such as sumatriptan (Imitrex)
  • Anti-inflammatory (steroid) medicines such as prednisone -- starting with a high dose, then slowly decreasing it over 2-3 weeks
  • Breathing in 100% (pure) oxygen
  • Injections of dihydroergotamine (DHE), which can stop cluster attacks within 5 minutes (Warning: this drug can be dangerous if taken with sumatriptan)

You may need more than one of these treatments to control headache symptoms. Your doctor may have you try several medications before deciding which works best for you.

Painkillers and narcotics do not usually relieve the pain from cluster headaches. Generally, they take too long to work.

PREVENTING CLUSTER HEADACHES

Avoid smoking, alcohol use, certain foods, and other factors that seem to trigger your cluster headaches. A headache diary can help you identify your headache triggers. When you get a headache, write down the day and time the pain began. The diary should include notes about:

  • What you ate and drank in the last 24 hours, how much you slept and when, and what was going on in your life right before the pain started. For example, were you under any unusual stress?
  • About how long the headache lasted, and what made it stop.

The headaches may go away on their own, or you may need treatment to prevent them. The following medications may also be used to treat or prevent headache symptoms:

  • Blood pressure medicines, such as beta-blockers (propanolol) or calcium channel blockers such as verapamil
  • Cyproheptadine
  • Drugs used to treat seizures, such as topiramate and valproic acid
  • Lithium carbonate
  • Medicines used to treat depression, such as amitriptyline

In rare cases, a device that delivers tiny electrical signals to a certain nerve near the brain may be placed. This device is called a neurostimulator. However, it is not yet an established therapy for cluster headaches.

Expectations (prognosis):

Cluster headaches are not life threatening and usually cause no permanent changes to the brain. However, they are chronic and often painful enough to interfere with work or lifestyle. Rarely, the pain may be so severe that some people may consider harming themselves.

Calling your health care provider:

Call for an appointment with your health care provider if:

  • Cluster headaches do not respond to treatment
  • Headaches disturb your sleep
  • You get headaches whenever you are active
  • Headaches occur with other symptoms

Danger symptoms require immediate medical care. Some of these symptoms include:

  • Changes in alertness
  • Changes in movement or sensation
  • Drowsiness
  • Nausea or vomiting
  • Seizures
  • Vision changes
 
Prevention:

If prone to cluster headache, stop smoking. Alcohol use and any foods that are associated with cluster headache may need to be avoided. Medications may prevent cluster headaches in some cases.

References:

Francis GJ, Becker WJ, Pringsheim TM. Acute and preventive pharmacologic treatment of cluster headache. Neurology. 2010;75(5):463-473.

Law S, Derry S, Moore RA. Triptans for acute cluster headache. Cochrane Database Syst Rev. 2010;(4)::CD008042.

Silberstein SD, Young WB. Headache and facial pain. In: Goetz CG. Textbook of Clinical Neurology. 3rd ed. St. Louis, Mo: WB Saunders; 2007:chap 53.


Review Date: 11/2/2012
Reviewed By: Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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