Cluster headache - causes, symptoms, and treatments

Cluster headache causes and pathophysiology

It is unknown what causes this debilitating condition. However, some body systems can be involved in the occurrence.

The hypothalamus, a small region of the brain that controls the body's circadian rhythms, is thought to be involved in the onset of cluster headaches. Imaging studies have shown that during a cluster headache attack, there is increased activity in the hypothalamus.

The trigeminal nerve, which is responsible for sensation in the face, is also thought to be involved. During a headache attack, there is often increased activity in the trigeminal nerve. This nerve can become activated by various triggers, such as alcohol, nitroglycerin, or a sudden increase in body temperature.

When the trigeminal nerve is activated, it releases substances that cause inflammation and swelling in the blood vessels in the brain. This inflammation and swelling are thought to cause the severe pain of a cluster headache.

In addition, there may be involvement of the autonomic nervous system, which controls functions such as heart rate and sweating. During a cluster headache, symptoms such as tearing, nasal congestion, and pupil changes can occur, which are thought to be due to activation of the autonomic nervous system.

Alterations in the levels of certain chemicals in the brain, such as serotonin and melatonin, have also been suggested to play a role in cluster headaches, but their exact role is not clear.

Cluster headache triggers list

According to hopkinsmedicine.org, the following may trigger cluster headaches:

1. Alcohol

   During a cluster period, alcohol can quickly trigger a splitting headache. This is not usually the case outside of a cluster period.

2. Cigarette smoke

   Many people with cluster headaches are smokers. However, quitting smoking does not appear to stop the headaches.

3. High altitudes

   Flying or hiking can trigger a cluster headache.

4. Bright light

   Bright sunlight or any other type of bright light can set off a cluster headache.

5. Exertion

   High levels of physical activity can prompt a cluster headache.

6. Heat

   Hot weather or hot baths can cause a cluster headache.

7. Certain medications

   Some drugs, like nitroglycerin, a medication used to treat heart disease, can provoke cluster headaches.

8. Specific foods

   Certain foods that contain nitrates might trigger cluster headaches in some people.

9. Use of cocaine

These headaches are more common in people who have a family history of the condition, indicating that there may be a genetic component. They are also more prevalent in males and typically start after the age of 20.

Cluster headache symptoms

1. Severe, intense pain usually on one side of the head, behind the eye, eyebrow, or temples. It is often described as a sharp, burning, or piercing sensation

2. Red, swollen, or tearing eyes on the affected side of the head

3. Runny or congested nose on the affected side of the head

4. Swelling, redness, sweating, or flushing of the face on the affected side

5. Restlessness or agitation

6. Sensitivity to light or sound

7. Stiffness or discomfort in the neck or shoulders

8. Drooping eyelid or pupil constriction on the affected side of the head

9. Nausea or vomiting

10. Rapid heart rate

11. Difficulty speaking or swallowing

12. Attacks often occur at the same time each day, typically during night hours

13. The pain of a cluster headache peaks in just a few minutes and can last for several hours.

14. Ptosis (droopy eyelid)

Cluster headache prevention

Although the cause of this illness is unknown, there are some things people can do if they have a history of cluster headaches in the family or just want to lower the chance of another attack.

1. Medications

   A variety of medications can be used to prevent cluster headaches, including calcium channel blockers, corticosteroids, lithium carbonate, and melatonin. Some anti-seizure medications, such as topiramate, may also be helpful.

2. Lifestyle changes

   Some people find that certain triggers can cause their cluster headaches. These can include alcohol, cigarettes, high altitudes, certain foods, excessive heat, and strenuous physical activity. Avoiding these triggers may help to prevent cluster headaches.

3. Nerve block

   In some cases, an anesthetic can be injected into the area around the occipital nerve, which can help to prevent cluster headaches.

4. Physical therapy

   Some people find that physical therapy exercises that strengthen the neck and shoulder muscles can help to prevent cluster headaches.

5. Maintain a regular sleep schedule

   Cluster headaches have been associated with irregular sleep patterns. Maintaining a regular sleep schedule can potentially help in preventing cluster headaches.

6. Calcium channel blockers

   Verapamil (Calan, Verelan) is often used to prevent cluster headaches.

7. Lithium carbonate

   This is often used for chronic cluster headache prevention.

Treatments to stop cluster headache cycle

If an attack still occurs, you will want to find a way to stop the pain cycle. Here are some treatments to alleviate cluster headache discomfort.

1. Oxygen therapy

   Breathing in pure oxygen through a mask can often help to reduce symptoms within 15 minutes of treatment.

2. Triptans

   Medications like sumatriptan (Imitrex) can help to stop the headache cycle. They can be taken as a nasal spray, injection, or orally.

3. Octreotide

   This is a synthetic version of the brain hormone somatostatin and is often used as an injectable treatment for cluster headaches.

4. Lidocaine

   A local anesthetic that is applied in the nostrils can sometimes relieve cluster headache pain.

5. Ergots

   A medication called dihydroergotamine (D.H.E. 45, Migranal) can be taken as a nasal spray or injection to alleviate the symptoms of a cluster headache.

6. Corticosteroids

   Prednisone is sometimes used as a short-term treatment to break a cluster cycle.

7. Greater occipital nerve block

   This involves injecting a local anesthetic and steroid medication around the occipital nerve at the back of the head. This can provide temporary relief for some people.

8. Deep brain stimulation

   In severe cases, a surgical procedure can be done to implant an electrode in the brain. This electrode can be used to block the pain signals that cause cluster headaches.

Treatments you can do at home

1. Relief massage: massage can help with any headache and many other pains. It relaxes muscles, relieves tension, and increases blood flow. Also, massage reduces stress and helps you relax. If you suffer from cluster headaches, try massaging your neck, temples, shoulders, or bridge of nose.

2. Relief pressure points: acupressure is another form of pain relief. Applying pressure to temples, nose bridge just below the forehead, top of the muscle that runs from the back of the head to shoulders, inner wrist three fingers from the palm and point where index finger and thumb join together.

3. Deep breaths: oxygenating your body helps prevent or relieve pain from cluster headaches.

4. Get enough sleep, relax, and drink a lot of water.

5. Supportive therapy: it is a type of psychotherapy that aims to help patients manage their mental health issues and improve their quality of life. It is a normal procedure to talk with a psychotherapist about your condition and he can help you go through cluster headache cycles.

Mushrooms and Kudzu Extract in treating cluster headache

Although it is not clinically approved or even statistically significant, some studies show that small amounts of psilocybin can help relieve pain from headaches.

The same stands for kudzu extract from kudzu vine.

Both studies were conducted on a small number of participants and are not relevant but show some promising courses of natural treatment.

New treatments and drugs for cluster headache

Besides usual treatments, there are lots of new drugs that can help ease the pain or even prevent attacks.

Emgality (generic name: galcanezumab) is a medication that is used for the preventive treatment of migraine in adults. In addition to its use for migraines, Emgality has also been approved by the Food and Drug Administration (FDA) for the treatment of episodic cluster headaches in adults. This makes it the first FDA-approved drug that reduces the frequency of attacks.

Sumatriptan (Imitrex) belongs to a class of medications known as triptans, which work by narrowing blood vessels in the brain to relieve headaches. Sumatriptan can also reduce substances in the body that can trigger headache pain, nausea, sensitivity to light and sound, and other migraine symptoms.

It is usually taken at the first sign of a cluster headache, or as soon as possible after the headache has already started. It should not be used to prevent cluster headaches.

Prednisone is often used as a transitional treatment to stop a cluster period. It is typically given in a high dose (50-100 mg daily) for a week, then tapered off over the next 3-5 weeks. This treatment can provide rapid relief from the pain and can be a very effective short-term solution.

However, prednisone is not a long-term solution for cluster headaches due to its side effects, which can include weight gain, insomnia, mood changes, increased blood sugar levels, and a weakened immune system among others. Therefore, it is typically used in conjunction with other treatments to manage the condition.

Can you die from cluster headaches?

No. The cluster headache does not cause death. However, it is a dangerous condition and may cause some other complications that can lead to death. Also, excruciating and unbearable pain can lead people with mental health problems to suicide.

Cluster headache vs. migraine

Cluster headaches are typically characterized by severe, burning, and piercing pain that's concentrated on one side of your head, often around your eye. Symptoms may also include red or teary eyes, runny or stuffy nose on the affected side, sweating, or flushing of the face.

Migraines, on the other hand, are often characterized by a moderate to severe throbbing pain that can affect the whole head.

Cluster headaches often occur in groups, or clusters, for several weeks or months, followed by a remission period during which the headaches stop. Each headache within a cluster can last from 15 minutes to three hours.

Migraines, on the other hand, typically last from four hours to three days if untreated, and the frequency of occurrence can vary from person to person, from several times a week to once a year.

Cluster vs. tension headache

Tension headaches are the most common type of headache. They cause a constant ache or pressure around the head, especially at the temples or back of the head and neck. This type of headache is often described as feeling like a tight band around your forehead.

The difference between these two conditions is in the severity of pain and its location.

Cluster headache vs. trigeminal neuralgia

Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain. The pain is usually felt on one side of the face and is described as sudden, severe, electric shock-like, or stabbing.

Paroxysmal hemicrania vs. cluster headache

Paroxysmal hemicrania and cluster headaches are very similar, but there are some differences.

1. Frequency and Duration

   Paroxysmal hemicrania typically occurs more frequently and lasts for a shorter duration than cluster headaches. A person with paroxysmal hemicrania may have attacks 5-40 times per day, each lasting 2-30 minutes. Cluster headaches generally occur 1-8 times per day and can last between 15 minutes to 3 hours.

2. Pain Location

   Both types of headaches are usually one-sided. However, paroxysmal hemicrania is typically described as being localized around or behind the eye, while cluster headaches may also involve pain in the temple or forehead.

3. Symptoms

   Both types of headaches can be associated with symptoms like tearing, nasal congestion, and eyelid drooping on the side of the headache. However, in paroxysmal hemicrania, these symptoms are always present during attacks, while for cluster headaches, they may not always be present.

4. Timing

   Cluster headaches are known for their clock-like regularity - they often occur at the same time each day, and can be seasonal, often occurring in the spring or fall. Paroxysmal hemicrania does not have this same regularity.

Famous cluster headache sufferers

Actors: Peter Mayhew, Ben Affleck, Brooke Shields, Michelle Stafford, Emilia Clarke, Michael Palin and the director Tim Burton

Musicians: Elvis Presley, Carly Simon, Johnny Cash, Jonathan Davies, Joe Strummer, Bob Dylan, Ben Folds, Eric Clapton and Leonard Bernstein

Athletes: Terrel Davies and Frank Bruno

Please note that some of these celebrities may not have publicly confirmed they have cluster headaches, and their inclusion in this list is based on speculation or unconfirmed reports.

What to do when a headache occurs?

Try to ease the pain with some home treatments. Then, book an appointment with EUDoctor. Our experts can help you, give you advice, assess your condition, and prescribe medications if needed.