WHAT IS IT?
Cluster headaches are so named because they typically occur in clusters over a period of time, usually one to two months. This is followed by a headache-free period of several months until another cluster of headaches begins. Cluster headaches are more common in men, usually beginning between the ages of 15 to 40. They may represent a variation of migraine headache. In some individuals, episodes occur at regular intervals without let-up. This is referred to as chronic cluster headache.
HOW IS IT DIAGNOSED?
History is of a severe headache that begins without warning, which is one-sided and usually centers from the eye. Episodes of pain last one to two hours, occur daily over many days or weeks, and often at the same time every day. The episodes may occur at night, waking the individual from sleep. Many individuals report that their episodes are triggered by stress, glare, alcohol, or specific foods.
Physical exam, if done during a headache, will reveal a blocked or runny nose, eye redness, tearing, and the pupil on the same side as the pain will be smaller than the other eye.
Tests are not available to confirm this diagnosis.
HOW IS IT TREATED?
Medications that constrict blood vessels (vasoconstrictors), including ergot alkaloids given by inhalation, may help relieve an acute episode. A new type of vasoconstrictor, useful in the treatment of
migraine headaches, may also be effective for cluster headache when given orally or by subcutaneous (under the skin) injection. Oxygen inhalation is also used. For prevention, various drugs have been generally effective. These include ergot alkaloids, beta blockers, tricyclic antidepressants, corticosteroids, lithium carbonate, and calcium channel blockers.
WHAT MIGHT COMPLICATE IT?
Overuse of pain medicines can result in their becoming ineffective. There is a risk of drug addition.
PREDICTED OUTCOME
The outcome is variable. Headaches may be well managed medically, or they may resist treatment. Headaches may come and go in cycles.
ALTERNATIVES
Migraine headache, rebound headache, and temporal arteritis are other possibilities.
APPROPRIATE SPECIALISTS
Neurologist.
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