Cluster Headaches
Cluster headaches are reoccurring headaches that happen over a certain period of time, usually around the same time of day. Because of this, they are believed to be linked to a person’s biological clock or their circadian rhythm (sleep and wake cycles). Cluster headaches tend to occur at night, one to two hours after a person has fallen asleep, but may occur up to three times each day. People typically experience cluster headaches anywhere from two weeks to three months at a time, referred to as the cluster period. This often occurs at the same time of year, often in the spring or fall, although this is not true for all patients. The cluster period is usually followed by a remission period where no headaches occur for at least 14 days. However, while some people may experience a remission period that lasts for years, about 20% of people who suffer from chronic cluster headaches experience less than 14 days without a headache during a 12 month period. Fortunately, with time, most patients experience less cluster headaches.
Cluster headaches can be more painful, but last for a shorter amount of time, than migraine headaches; usually 30-90 minutes, with some people experiencing them for up to three hours. The severity of the pain peaks within 5 to 10 minutes. The headaches occur on one side of the head, almost always the same side, and are very intense, with a burning or piercing sensation. Pain is typically experienced behind the eye or in the eye region, but may also be felt in other regions on the same side of the head, such as the temple, forehead, jaw, cheek, or gum-line. Other symptoms that may occur include watery eyes, eye redness, eyelid drooping, decrease in pupil size, runny or stuffy nose, sweating on the affected side of the face, and sensitivity to lights and sounds. Many people report a feeling of restlessness during their headache, with the pain being so severe that they may pace.
Cluster headaches are more common in men, and sufferers usually start to experience them before the age of 30. However, these types of headaches are fairly uncommon; they affect less than 1 in 1,000 people. They are also more common in people who smoke or drink; nicotine and alcohol can also trigger headaches during a person’s cluster period.
Although the exact cause of cluster headaches is unknown, it appears to involve a nerve pathway called the trigeminal-autonomic reflex pathway. Since the trigeminal nerve is responsible for sensations such as heat or pain in the face, when it is activated it causes the eye pain that occurs with cluster headaches. Some evidence suggests that this activation is triggered by a part of the brain called the hypothalamus, which regulates sleep and wake cycles. Activation of the hypothalamus may also be responsible for the seasonal nature of the cluster period.
Diagnosis is usually made by taking a history from the patient and performing a physical exam. Tests such as an MRI or CT scan may be done to rule out other causes, and an ophthalmological exam may be done to make sure there are no problems in the eyes. Treatments for cluster headaches include abortive medications, preventative medications, and surgery. Abortive medications are taken after a headache has begun and include Imitrex (sumatriptan) or other triptans, ergotamine drugs and intranasal lidocaine, as well as breathing oxygen through a face mask. Preventative medications, such as verapamil, lithium, divalproex sodium, prednisone, and ergotamine tartrate, can be used to decrease the cluster period and the severity of the headaches. For more chronic cases, surgery to block the trigeminal nerve may be an option; however, this has significant side effects.
We offer biofeedback, massage, chiropractic, acupuncture and auricular acupuncture for those who suffer from cluster headaches.
Sources:
http://www.webmd.com/migraines-headaches/guide/cluster-headaches
http://www.medicinenet.com/cluster_headaches/article.htm
http://www.emedicinehealth.com/cluster_headache/article_em.htm
http://www.nlm.nih.gov/medlineplus/ency/article/000786.htm