Also known as histamine or noctural headaches, or red migraines, cluster headaches are more common in men than women, and usually affect people in their teens and middle years. Those who experience these headaches say they are severe and disabling, and describe their pain as burning, piercing, or throbbing. “The patient will characteristically pace around and feel agitated, as opposed to the person with a migraine, who gets relief by lying still,” says Dr. Drexler. Timing Is Everything With Cluster Headaches “The cluster headache period may last from a few weeks to a few months, and then they go away. The cluster periods often recur at the same time of year in subsequent years,” notes Drexler. These headaches may not come back for several months or even for several years. During the headache period, they tend to occur at the same time every day. Cluster headaches have sometimes been referred to as “alarm clock headaches” because they often wake up a person in the early morning or after the first few hours of sound sleep. “The cluster headache is very distinctive. It is always on the same side, usually centering on the eye. The pain is described as sharp or stabbing, and is of excruciating intensity, lasting from 15 minutes to 2 hours, and averaging 45 minutes,” says Drexler. Other characteristics of cluster headaches include:
Pain that can radiate from the area around the eye to the forehead, temple, ear, or neck on that side of the body.Headache pain that is accompanied by tearing and redness of the eye. The pupil of the eye may be constricted and the eyelid may droop, a condition called Horner’s syndrome.The nose may be congested and the face may appear flushed on the side of the pain.
One saving grace is that, unlike migraine headaches, cluster headaches are rarely accompanied by nausea, vomiting, or light sensitivity. Possible Causes of Cluster Headaches “The cause of cluster headaches is not completely understood, but the hypothalamus appears to be involved in their development,” says Drexler. The hypothalamus is the part of the brain that controls sleeping and waking cycles. Another theory is that cluster headaches are caused by a disorder of the internal carotid artery and the swelling of blood vessels inside the head. Sudden release of histamine and serotonin, substances released by the body that cause blood vessels to dilate, are also suspected. What is known is that cluster headaches are not inherited and they are not related to other diseases. Cluster headaches may be more common in smokers, and some people with cluster headaches find they can be triggered by certain foods. Consumption of alcohol will immediately trigger a cluster headache during a cluster period, although at other times alcohol may not act as a trigger. A study published in the November 2011 issue of Headache: The Journal of Head and Face Pain, which cited data from a survey of over 1100 people with cluster headaches, found that beer was the most common type of alcohol trigger, followed by red wine and hard liquor. Prevention and Treatment of Cluster Headaches There is no known cure for cluster headaches, so treatment is aimed at prevention and relieving symptoms. Lifestyle changes. If you get cluster headaches you should avoid:
SmokingAlcoholAny foods that seem to trigger your headachesStressChanges in sleep patterns
Pain relief. Once a cluster of headaches has started, pain medications are not very effective because they take too long to work. “Cluster headaches are treated symptomatically with the same types of medications that are used for migraine,” explains Drexler. One example is Imitrex (sumatriptan), a migraine medication approved by the U.S. Food and Drug Administration for cluster headache and most effective as an injection or nasal spray. Other treatments. At the onset of a headache, inhalation of 100 percent oxygen can be effective. Some people also get relief from the application of the topical anesthetic lidocaine inside the nose. When cluster headaches occur, some people can reduce the number of headaches by using the steroid medication prednisone and the drug verapamil, which relaxes blood vessels. Your doctor may recommend other medications or combinations. Then there is surgery. “Some patients with chronic cluster headache resistant to all medications have undergone a variety of surgical procedures with some success, most recently deep brain stimulation and occipital nerve stimulation with implanted electrical stimulators,” says Drexler. Although in some rare cases cluster headaches become chronic and continue without periods of remission, most often they run their course and don’t last longer than a few weeks. These headaches are debilitating, but they are not life-threatening. If you have symptoms of cluster headaches, see your doctor to find the treatment that works best for you.
