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Cluster headache is a type of primary headache disorder. These headaches are caused by an electrical or chemical problem in the brain as opposed to an underlying medical problem such as a brain tumour that might occur in secondary headaches. People often describe the headaches as stabbing or burning headaches of excruciating pain.

 

Cluster headache is also known as “suicide headaches” as patients report suicidal thoughts due to the pain. The age of onset is usually 20-40 years, affecting men 4 times more than women. Less than 1% of the population suffers from this type of headache. Cluster headache is not a strongly genetic disease, even if some families have been reported.

Cluster headaches are short attacks of severe pain lasting 15 minutes to 3 hours, occurring every other day up to 8 times a day. The headaches occur 1 to 8 times daily and often at the same time of day or night, over a period of 4-6 weeks, then disappearing sometimes for up to 6-12 months. This is why they are called cluster headaches, because they tend to cluster for weeks or months separated by pain free periods usually lasting months or years. The pain is severe, one sided, located around the eye. The headaches are associated with red eye, eyelid swelling, forehead or face swelling, tearing of the eye, differences in pupil size, nasal congestion or drooping eyelid. These symptoms are always on the same side as the headache. People tend to be restless and agitated, and usually do not like to lie down, unlike migraine patients. Like any other headache disorder, they can occur episodically, as in they tend to come and go, or it can be a chronic problem where the attacks occur for more than a year without remission.

The cause of the disease is unknown. Some researchers believe that a part of the brain known as the hypothalamus becomes activated. This area of the brain is involved in the sleep-wake cycles and controls your biological clock.

The diagnosis, like most primary headache disorders, is clinical, based on the patient’s history. However, given that this type of headache can mimic other causes, which are more serious, an MRI is usually recommended. It is likely to be completely normal in patients with cluster headache.

To treat the pain, most people require an injection of sumatriptan, which is an abortive medication. This medication works fast to stop the pain from getting worse. Oxygen by facemask has also been found to help with the pain.  Oral triptan are often too slow to break the attack. Nasal sprays (such as zolmitriptan or sumatriptan) may be used.

Preventative medications, which prevent the headache attacks from occurring are also necessary during a cluster. Verapamil and lithium have been used with good success. Oral prednisone (cortisone) or injections of cortisone in the occipital area are also options to break a bout.

Important Points:
1.    Cluster headaches affect more men than women, unlike migraine.
2.    Cluster headaches are short lasting headaches on one side of the head with red eye, tearing, runny nose and/or other symptoms which occur on one side of the head over a period of weeks before subsiding. The pain is very severe.
3.    Control requires both acute and preventative treatments. Oxygen by mask or injectable sumatriptan in combination with daily verapamil are most effective.

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