Cluster Headaches:
Cause not known, treatments exist Question: I get cluster headaches. I have had them for several years, and when they come, they last for several weeks. Can you tell me more about them? What causes them, how can I get rid of them, and can they be prevented?
Answer: Cluster headaches, so-named because they occur in clusters – or patterns – are extremely painful, as you know. When the series of headaches start, they may occur anywhere from a week to several months to a year. Then they cease. This remission can last for a few weeks or for many years. While the headaches are very painful, they are not life-threatening.
Cluster headaches occur without warning, and are located on one side of the head, with the pain primarily in the face, around the eye. Sometimes the eye on the affected side waters and becomes red, and the surrounding skin may swell. Frequently, nasal congestion also occurs.
Unlike a migraine headache where a person becomes very still to minimize the pain, a person with a cluster headache is usually restless, sometimes rocking back and forth or pacing.
For many people, the clusters come almost on schedule and last the same amount of time, both in terms of time of day and time of year. Sometimes, they seem to be related to the season. Cluster headaches are classified as episodic or chronic. They seem to be more common at night. Each headache in the cluster can last for a few minutes up to several hours. However, when the headache is gone, there is complete relief, and the sufferer is usually very tired.
While several theories exist, no one is quite sure what causes these headaches. Because the headaches tend to appear at the same times each day, it is believed that they are related to abnormalities of the hypothalamus, which controls the body’s internal clock. There also is evidence suggesting that abnormal levels of neurotransmitters or hormones play a role in the condition.
Very few environmental triggers have been identified, though nitroglycerin, which is often used for heart problems, does appear to be a trigger.
Cluster headaches are more common in adult men, smokers, African Americans and those with a family history of cluster headaches.
Treatment usually begins after more serious causes of headaches have been ruled out with CT scans or magnetic resonance imaging. With treatment, the pain of cluster headaches can become less severe and the duration and frequency of attacks can be reduced. Prescription medications can be used at the onset of a headache to help alleviate the attack.
There also are some medications that have shown promise in decreasing the frequency of headache clusters in the long-term. Nerve blocks help some people with the condition. Glycerol injections have replaced conventional surgery as the recommended surgical treatment for cluster headaches.
Finally, lifestyle choices such as avoiding alcohol, tobacco, and nitrate medication, as well as making sure you get consistent and adequate sleep, can help to decrease the frequency and severity of cluster headaches.
Family Medicine is a weekly column. General medical questions can be sent to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, Communication Office, Athens, Ohio 45701, familymedicine@oucom.ohiou.edu. Please do not ask Dr. Simpson to diagnose a condition or provide personal medical advise. Medical information in Family Medicine® is provided as an educational service only and does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.