A cluster headache is described as a neurological disorder with severe recurrent headaches that are experienced on one side of the head mostly around the eye area. Cluster headaches are typically accompanied by autonomic symptoms such as nasal congestion, swelling around the eye and eye watering. All the symptoms occur on the side that is affected by the headache.
A cluster headache is placed in a larger primary headache disorders group classified as TACs or trigeminal autonomic cephalalgias. The name of the headache emanates from the fact that the attacks occur together or in a cluster. A person with a cluster headache will experience excruciating pain which is severe and unilateral. The attacks will mostly occur in a periodic manner, with spontaneous remissions interrupting the pain periods. About 10% to 15% of chronic cluster headaches do not remit.
Signs and Symptoms of Cluster Headaches
A cluster headache has been described as having excruciating bouts of unilateral pain attacks which are recurrent and have extreme intensity. Duration of a typical cluster headache attack will last for 15 to 180 minutes. Most of the untreated cases, which account for about 75%, last for a period under 60 minutes.
The attacks are rapid and in most cases, they lack the preliminary signs that exist in migraines. Shadows or preliminary pain sensations in the attack area might be a sign of an imminent cluster headache. These symptoms might also linger after an attack is over, or during the remission periods. Cluster headaches are unilateral, but there are rare cases where the pain might shift between cluster periods.
The typical symptoms of a cluster headache are recurrent attacks or severe unilateral orbital temporal or supraorbital pain. When not treated, the attack frequency ranges from an attack once every two days to 8 in a day. The attacks are accompanied by one or more of the following symptoms: pupil constriction, drooping eyelid, conjunctiva redness, runny nose, tearing and in some cases sweating, swelling, facial blushing and the symptoms all occurring in the side affected by the headache.
Some of the other symptoms include relentlessness, aversion to light known as photophobia, photosensitivity, photophobia or sensitivity to noise. Though rare, nausea has been reported to accompany a cluster headache. A cluster headache patient may experience secondary effects such as physical exhaustion, agitation, inability to plan and organize thoughts, depression, anxiety, and aggressiveness.
Individuals with cluster headaches might develop fear of another attack and make adjustments for their social and physical activities. They might ask for assistance in tasks that are otherwise easy and will hesitate to make any future plans based on the regularity and the unpredictability of the attacks. All these factors combined will lead to panic disorders, anxiety disorders, isolation, social withdrawal and depressive disorders.
Cluster Headache Pain
Cluster headache pain occurs on one side of the head around the eye orbital particularly on the supraorbital or above the eye. Pain may also occur in the temporal or in the temple and in some cases, the pain occurs in both the orbital/supraorbital and in the temple. The cluster head ache pain has been found to be greater than the pain experienced in most of the other types of headaches.
Some medical experts have stated that ‘headache’ is a term that does not seem to show the intensity of the headache and have placed it as the most painful condition in medical science. The pain has been described as boring, squeezing, stabbing or burning and appears behind or near the eye. Due to the intensity and the severity of the pain some cluster headache patients might experience suicidal thoughts.
Causes of Custer Headaches
There are no known causes of cluster headaches.
Genetics – A cluster headache might, but on rare cases run in some families. This happens in autosomal inheritance patterns. A person with a first degree relative with a cluster headache is between 14 and 48 times more likely to have the condition. Though genetic elements are important the number and type of genes associated with the condition is unclear.
Smoking – About 65% of the individual with cluster headaches have been or are still tobacco smokers. Cluster headaches will occur to people who have never smoked and stopping smoking will not improve the condition. This makes smoking an unlikely cause but it is believed that people with cluster headaches might be predisposed to lifestyle habits such as smoking.
Hypothalamus – There are theories placing the dysfunction of the hypothalamus as a probable cause of cluster headaches. These theories are supported by the occurrence of the cluster headaches during a particular season and the attack happening during the same time of the day.
For decades, cluster headaches have been described as vascular headaches with the pain being proposed to be as a result of blood vessels dilation which leads to increased pressure on the trigeminal nerve. This theory was initially believed to be the cause of the pain, the underlying cause of this headache type are not known and cluster headache pathogenesis has remained an ongoing debate in medical science. The investigations and studies of headache disorders vascular theories are assisting in the identification of possible causes of cluster headaches.
In most cases, cluster headaches are often undiagnosed, misdiagnosed or mismanaged. These headaches are often confused with migraines because of the cluster like mimics of the condition. There is no confirmatory test for cluster headaches and thus the oral history is used in correct differential diagnosis. The correct diagnosis remains a major challenge for most medical practitioners especially those not trained in detecting rare or complex headache disorders.
Cluster Headache Prevention
There are preventive treatments which are used in eliminating or reducing headache attacks and are used in combination with transitional and abortive techniques. Some of the preventive treatments include; verapamil, steroids and surgery, among others.
Cluster Headache Management
The treatment for cluster headaches is categorized into three groups: abortive, transitional and preventative. Acute cluster headaches can be treated using primary treatments which are triptans and oxygen. These two treatments are underused because of the misdiagnosis of the syndrome. Triggers such as nitroglycerine, alcohol and day naps should be avoided during bouts of headaches.