What are cluster headaches?
Cluster headaches are part of a family of primary headaches referred to as Autonomic Cephalalgias. It is a devastating and painful affliction and primarily affects men, with the onset typically between the ages of 20 and 40. Cluster headaches are characterized by a periodic attack of severe, sharp, piercing or burning pain that is localized primarily to the eye, temple, forehead or cheek region. About 50% of patients report having tenderness at the base of the skull and upper neck on the same side as the headache. Each attack of a cluster headache is typically accompanied by some combination of the following symptoms on the same side as the headache: eye watering, nasal drainage, eye lid dropping, small pupil and swelling around the eye. Unlike patients with migraine who prefer to rest in a dark and quiet room, those with cluster frequently feel agitated and the need to move.
The term “cluster” is used to describe the nature of the attacks. Each attack typically lasts between 30-90 minutes, with sufferers experiencing between 1 and 6 attacks per day. Cluster headaches typically follow a pattern, start at the same time each day during the cluster period and often awaken the sufferer from sleep. Cluster periods can last from weeks to months and then spontaneously disappear. Most of those with these headaches have cluster periods 1 to 2 times per year, although this can vary widely. The period between cluster cycles is known as an “interim.” It has been observed that as patients get older, the interim periods become longer and at times, the headache resolves. Cluster headaches run in families. Although the exact cause is unknown, the hypothalamic region in the brain and the sphenopalatine ganglion are important and related to the cause of this disorder. The sphenopalatine ganglion is of particular importance, as there are procedures which target this structure and often provide long term relief from this potentially debilitating condition.
What triggers cluster headaches?
Researchers do not know the exact cause of cluster headaches; however, a correlation can be made to the sudden release of histamine or serotonin in the body. Provocation with alcohol is considered a reliable feature. The following are common triggers for cluster headaches:
- Alcohol and/or smoking
- Change to high altitude
- Bright light
- Change in sleep routine
- Heat to include weather or bathing
- Foods that include nitrates such as bacon or lunch meat
How are cluster headaches diagnosed?
There are no blood or imaging studies that will provide a diagnosis of cluster headache. It is a clinical diagnosis based upon a careful history, a detailed neurologic examination and appropriate imaging studies to exclude an underlying condition which could mimic a cluster headache.
How are cluster headaches treated?
Cluster headaches are treated with abortive medications to stop the headache and prophylactic agents to prevent them from occurring. At the onset of an attack, common treatments include high flow oxygen and/or Imitrex injections. The latter relieves the headache by blocking vascular inflammation. Prevention is important, in that overuse of the abortive agents can lead to a chronic form of the headache. Verapamil is but one of the more commonly prescribed preventative medications. Occipital nerve blocks with cortisone can interrupt a cluster cycle long enough to initiate preventative medications.
Can Interventional Headache Management help with cluster headaches?
If you have had a neurological examination, made life style changes to limit triggers, tried and failed an appropriate medication regimen and continue to have debilitating cluster headaches, then Interventional Headache Treatment may be for you. There are specific interventional procedures which can effectively lessen the cluster frequency and intensity. One such procedure involves radiofrequency lesioning of the sphenopalatine ganglion. There are additional interventional procedures to treat cluster headaches, which will be discussed as part of your initial consultation.