Cluster Headache
Symptoms and Synopsis
Cluster headaches are extremely painful headaches that occur on a regular basis (in clusters) on one side of the head. These painful, piercing headaches last anywhere from 15 minutes to three hours. The term “cluster” is derived from the extreme frequency in which the headaches occur (usually at the same time of day for weeks or months) and the same time of year (often near seasonal changes or the equinoxes).
Pain
The pain is often described as an unrelenting piercing pain that begins as a dull burning sensation, and very quickly ramps up into the most unimaginable pain possible — like ice pick or red hot poker stabbed into one eye. The headaches have been dubbed “ice pick headaches” and “suicide headaches” because of the severity of the pain. Women who suffer from them compare the pain to be more severe than childbirth. (Imagine experiencing the pain of delivering a child every day for weeks or months — or for the most unlucky, several times a day for years.)
Other Symptoms
Most sufferers describe the pain as primarily focussed behind one eye and radiating out into the temple, cheek and sinus — some experience radiating pain in the ear, base of the neck, shoulders, and on the carotid artery in the front of the neck. Symptoms can also include: droopy eyelid (on the effected side), or red eye, tearing, runny nose, facial redness, swelling or sweating. Usually the pain is so severe that the sufferer is unable to sit still or lie down during the attack, and will often pace aimlessly to escape the pain. Rarely is sensitivity to light or sound reported, unlike migraine headaches, and usually is not associated with nausea or vomiting, though cases have been reported of each of these.
Frequency
Most sufferers (80-90%) are episodic sufferers. Like the name suggests, these headaches occur in clusters of time. Generally each headache occurs around the same time each day during a cycle, and each cycle usually occurs around the same time of year (usually around the season changes or solar equinoxes). Episodic cluster headaches are followed by a period of remission which can last weeks, months or years.
The few unfortunate souls who are in the 10-20% range suffer chronic cluster headaches which can occur several times per day for years without relief.
Demographics
Cluster headache sufferers number somewhere around 60 cases per 100,000 people (less than 0.1 percent of the population). And although more common in men, cluster headaches do affect women; the ratio is around 6:1. Sufferers age at onset is between 20 and 50 years, however has been documented to begin much sooner and much later.
Pathophysiology
Technically they are classified as vascular headaches (similar to migraine headache) which develop due to swelling and dilation of blood vessels which in turn put pressure on the trigeminal nerve. The underlying cause for cluster headaches is not clearly understood, but believed to be caused by physical abnormalities in the hypothalamus. The hypothalamus is an area of the brain that controls circadian rhythms in humans (the internal clock).
Triggers
Unlike migraine headaches, it is not believed that there are direct external triggers for a cluster headache cycle, other than the season changes and variation in daylight length. However, during a cycle it has been widely experienced that alcohol will bring on a nearly immediate attack in most sufferers, as will nitroglycerin (taken by some heart patients) and some petrochemicals like gasoline, solvents, and perfume. Some patients find that becoming overheated may trigger an attack (not an episode).
Psychology
Since cluster headaches occur in such a small fraction of the population, and the term “headache” has such a common and benign definition in society, it is common for cluster headache sufferers to not feel understood. Many are told by their peers to simply “take an aspirin” — which would be about as effective as telling that to someone who has just experienced an amputation without anesthesia (cluster headaches have been compared to such pain).
Many sufferers will get very depressed during an episode. Partly due to the knowledge that each day brings a new, excruciating attack; and partly because the effects of such pain usually leave the sufferer unable to live a normal life. Work is often affected, as is family life and activities. Every aspect of life can be strained because of the lasting mental effects of the attacks.
Treatment
Over-the-counter medications typically have no effect on cluster headache pain, and unlike other headaches like migraine and tension headaches, cluster headaches cannot be altered using biofeedback techniques.
The typical method of treatment is two-fold: First, a prophylactic is generally prescribed to attempt to deal with the headaches long-term. Usually this involves at least one of the following: A calcium channel blocker (such as verapamil), corticosteroids (such as prednisone), lithium, methysergide, topiramate, or anti-psychotic medications. Second, these may be prescribed to attempt to abort an attack once it has begun: oxygen, imitrex, sumatriptan, or ergot compounds.
Some people find relief during the early stages of an attack with hot showers, ice packs, aggressive massages (particularly of the shoulders and neck), strong coffee (caffeine), cold air, large amounts of water, or vigorous exercise.