Page Updated on Jan 31, 2020 by Dr. Reyfman (Pain Management Specialist) of Pain Physicians NY

Cluster headaches are quite rare, but they are very strong and particularly stressful. The feelings that arise in some patients can go as far as the suicide impulse – which, luckily, happens very rarely.

Everything You Need to Know About Occipital NeuralgiaIt is estimated that the number of people affected is only about one in a thousand. Cluster headaches appear 4 to 5 times more often in men than in women and especially between the ages of 20 and 50. Women between the ages of 40 and 50 are the most affected.

Cluster headaches are similar to migraines but significantly more painful. The reasons are largely unknown. It seems that some brain malfunctions play a role. Nicotine and alcohol can worsen or even trigger the effects. Medications are often available for therapy.

What are the characteristics of cluster headaches?

There are a few things that make up this type of headache. This includes:

  • Cluster headaches usually reach their full strength quickly, within 5 or 10 minutes.
  • The pain in most of the cases is located only on one side of the head. In rare cases, when a new headache period begins, the pain can switch to the other side. The pain is usually felt behind or around the eye and spreads to the forehead, temple, nose, cheek or upper gums on the affected side.
  • Cluster headaches usually last no longer than 90 minutes on average, even though they can last anything between 15 minutes and up to 3 hours.
  • Cluster headache attacks appear to be linked to the circadian rhythm, which means that they tend to appear at the same time each day. This is especially true for those attacks occurring at night. Night attacks also seem to be more severe compared to day attacks.
  • Most people get a daily headache lasting up to 3 months. Between these periods they can have no pain at all. Pain-free periods can last up to 12 months or longer.

What are the causes of cluster headaches?

Some experts are convinced that cluster headaches are a result of an abnormality in the brain reactivity compared to external and internal stimuli that lead to excessive synthesis and secretion of the neurotransmitters norepinephrine and serotonin. The reverse leads to enlargement of the brain vessels and inflammatory reactions that are responsible for pain.

A genetic predisposition, combined with other factors, leads to attacks. The following trigger factors can trigger, aggravate or accelerate a cluster headache:

  • Mental or physical, chronic or acute stress
  • Muscle tension in the neck, shoulders, eyes or face
  • Climate change
  • Diseases such as infections, meningitis, migraines, brain tumors, etc.
  • Analgesics
  • Use of nicotine, alcohol
  • Lack of sleep
  • Hormonal changes in pregnancy
  • Excessive eye strain, etc.

How is a cluster headache diagnosed?

For the exact diagnosis of the type of headache, a very thorough medical history must be carried out, taking into account the personal and family history.

The medical history usually includes the following data:

  • Beginning, location, and duration of the pain
  • Attack frequency and pain intensity
  • Type of pain
  • Associated symptoms like dizziness, visual disturbances, loss of feeling, etc.
  • Pain triggering factors
  • Factors that increase or decrease pain
  • Circumstances of occurrence
  • Personal ability to cope with restrictions
  • Professional activity, leisure, social relationships
  • Family history
  • Treatments received and effectiveness
  • Taking medication
  • Expectation and motivation.

Other diagnostic options at Pain Physicians include physical and neurological examinations, laboratory analyzes, CT and MRI to rule out possible diseases, tumors, etc.

How is a cluster headache treated?

You have several options when it comes to treating your cluster headache.

Drugs – like Sumatriptan, Zolmitriptan, Dihydroergotamine, Lidocaine, etc., are commonly prescribed and effective for the treatment of headaches.

Preventive measures can often stop headaches before they even develop. In the cases of cluster headache, your doctor may prescribe medication to shorten the length of the cluster and reduce the severity of your attacks. These preventive medications include corticosteroids, ergotamine tartrate, gabapentin, carbonate, topiramate, verapamil, etc.

The occipital nerve block is another option when it comes to dealing with cluster headaches. In this case, the doctor will inject a mixture of anesthetic and steroid into these nerves. They are located at the base of the skull and are often the starting point for headaches. This is a temporary treatment until preventive treatment can start to work.

Nerve stimulation, like the stimulation of the occipital nerves, can also help. Your pain doctor will surgically implant a device that sends electrical impulses to this group of nerves at the base of the skull.

Operative interventions – if nothing else works, surgery can be an option for people who don’t get a break from cluster headaches. Deep brain stimulation, in which an electrode is inserted deep into the brain, loses importance compared to less invasive options. Most procedures involve blocking the trigeminal nerve, a major pathway for pain. It controls the area around the eye, but a misstep can cost weakness in the jaw and loss of feeling on the face and head.

Lifestyle changes – these measures can help you avoid cluster headaches:

  • Keep a regular sleep schedule
  • Avoid alcohol, nicotine, and caffeine
  • Reduce your stress level
  • Exercise 3-5 times per week
  • Eat healthy