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Cluster Headache

Definition

Cluster headache is a type of severe, recurring pain that is located on one side of the head. It received its name from the clustering, or pattern, of frequent headaches that usually occur.
There are two main types of cluster headaches:
Either type of headache may switch to the other type.

Causes

The cause of cluster headaches is not known. It is thought that there is abnormal activation of the area of the brain that is responsible for regulating temperature, blood pressure, hormone release, and sleep. The pain is thought to be caused by a combination of widening of the blood vessels and inflammation of the nerves of the face.
Other possible causes include:

Risk Factors

Men aged 20-50 years are more likely to get cluster headaches. Other factors that may increase your chance of cluster headaches include:

Symptoms

Cluster headaches may cause:
During the headache, other symptoms may occur on the affected side, including:
Symptoms of a Cluster Headache
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Diagnosis

The doctor will ask about your symptoms and medical history. A physical and neurological exam will be done. A neurological exam may include examining:
The doctor will ask about the frequency and pattern of your headaches. To help provide answers, you may consider keeping a diary of:
Imaging tests to evaluate the brain include:

Treatment

Treatment aims to reduce the frequency of headaches and relieving pain.

Lifestyle Changes and Self-care

  • Maintain the same sleep routine. Avoid afternoon naps or sleeping in, which may bring on more headaches.
  • Do not drink alcoholic beverages. Even a small amount of alcohol can trigger a headache during a cluster period.
  • Learn stress management techniques. Stress can bring on a headache.
  • Do not smoke . Tobacco may interfere with medications.
  • Find out what your headache triggers are and take steps to avoid them.

Medication

Medications used to treat migraines often relieve sudden attacks of cluster headaches. These drugs must be taken at the first sign of a headache. Other medications may also be prescribed.
In some cases, the headache does not last long enough for medications to be helpful. Sometimes, the medications just delay an attack, rather than stop an attack.
Painkillers, especially opioids, may not be effective during an acute attack.
Other medications may be given to prevent or reduce the frequency of headaches.

Oxygen Therapy

Breathing 100% oxygen for 10-15 minutes often relieves cluster headache pain. This is often viewed as the front-line therapy for cluster headache. The oxygen appears to decrease blood flow to the affected area of the brain. People under age 50 who have episodic cluster headaches seem to benefit most from oxygen therapy.
Oxygen therapy can be expensive. There are also risks with this therapy.

Surgery

As a last resort, some doctors may recommend cutting or destroying a facial nerve to eliminate pain.

Prevention

Sometimes, cluster headaches can be prevented by doing the following:

RESOURCES

American Headache Society http://www.achenet.org

National Headache Foundation http://www.headaches.org

CANADIAN RESOURCES

Headache Network Canada http://www.headachenetwork.ca

Help for Headaches http://www.headache-help.org

References

Beck E, Sieber WJ, et al. Management of cluster headache. Am Fam Physician. 2005; 71:717-724.

Cittadini E, May A, et al. Effectiveness of intranasal zolmitriptan in acute cluster headache. Arch Neurol. 2006;63:1537-1542.

Cluster headache. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 17, 2013. Accessed November 16, 2013.

Finocchi C, Del Sette M, et al. Cluster headache and right-to-left shunt on contrast transcranial Doppler: a case-control study. Neurology. 2004;63:1309.

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

Headache: hope through research. National Institute Of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/headache/detail%5Fheadache.htm#193263138. Updated November 8, 2013. Accessed November 16, 2013.

Leone M, Bussone G. Pathophysiology of autonomic trigeminal neuralgias. Lancet Neurol. 2009;8(8):755-764.

Leroux E, Valade D, et al. Suboccipital steroid injections for transitional treatment of patients with more than two cluster headache attacks per day: a randomised, double-blind, placebo-controlled trial. Lancet Neurol. 2011;10(10):891-897.

May A, Leone M, et al. EFNS guidelines on the treatment of cluster headache and other trigeminal-autonomic cephalgias. Eur J Neurol. 2006;13(10):1066-1077.

Russell MB, Anderson PG, et al. Familial occurrence of cluster headache. J Neurol Neurosurg Psychiatry. 1995;58:341-343.

Van Vliet JA, Bahra A, et al. Intranasal sumatriptan in cluster headache: randomized placebo-controlled double-blind study. Neurology. 2003;60:630-633.

10/25/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Francis GJ, Becker WJ, et al. Acute and preventive pharmacologic treatment of cluster headache. Neurology. 2010;75(5):463-473.

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