Cluster Headaches: The "Other" Bad Headache
As Americans, I feel that we brand things too easily. We ask for a Kleenex when we want a tissue and any brand will do. Viagra has become synonymous with medications to help with... you know - even though there are a number of others available. When it comes to headaches, the term migraine has similarly become applied to a "really bad headache." To me, however, it is important to label things appropriately, especially for headaches. Therefore, I'd like to address the topic of cluster headaches, a lesser-known type of headache distinctly different from migraines.
Symptoms of the Cluster Headache
First off, cluster headaches are severe. They have been referred to as "suicide" or "ice pick" headaches. Indeed, it is common for people to describe the pain graphically as a knife or ice pick being thrust though the eye socket and into the brain.
Classically, the headaches are only present on one side of the head (as is often true with migraines). Most often, the epicenter involves the area around the eye or the temple. Occasionally, the pain can extend to the nose or the face. Often, people report feeling restless or agitated due to the pain.
If untreated, the headache can last for a matter of minutes to a few hours. In contrast, migraines can last for days. Other symptoms can develop with the cluster headache, including tearing, eye redness, nose congestion, eyelid swelling, or eyelid droop. As the name implies, cluster headaches are often grouped together and then disappear for a spell.
It is not fully understood what causes cluster headaches. Varied theories exist involving dilation of blood vessels, release of histamines, stimulation of a nerve in the face called the trigeminal, disturbed sleep cycles, or genetics. Cluster headaches can run in the family; 1 in 20 with cluster headaches will also have a parent who also suffers from them. In the general population, the rate of those experiencing cluster headaches is around 1 in 1000.
Cluster headaches can be triggered by different factors. Allergies, which trigger histamine release, can bring on a cluster headache. Exposure to tobacco smoke, either inhaled or second hand, can trigger these headaches. Alcohol is also a known causal agent. The only medication known to be a factor in bringing on cluster headaches is nitroglycerine, which is used to alleviate heart-related chest pain.
There is no "slam dunk" effective treatment for cluster headaches. Often, multiple strategies are incorporated. Oxygen therapy delivered via tank and mask has been shown to be effective. Success has also been found using lidocaine, a numbing agent applied to the membranes up and inside the nose. As far as medications, the triptan medications used primarily for migraine such as Imitrex have been commonly used with marginal success. Ergotamine, which has been used since the 16th century as a derivative of a fungus, has also shown some benefit. Both of these drugs work to constrict the blood vessels in the head, which may be dilated, causing the headache. A blood pressure medication, verapamil, is used if the cluster headaches become chronic warranting daily, preventative therapy. A review of the literature provided no reports of the use of alternative therapies specifically for cluster headaches, such as chiropractic manipulation, herbal remedies, homeopathic medications, acupuncture, or biofeedback.
Cluster headaches should be a consideration for anyone experiencing severe, recurring headaches. They are often mistaken for migraine headaches. The distinction is important as treatment options are somewhat different. While a number of treatment options are available, none shines as the best option. Further research is needed for better success in standard and alternative options.