When it comes to headaches, most people think that migraine headaches are the worst type of headache a person can have. While this is true for some, imagine a headache that is described by some as a pain worse than childbirth. Cluster headaches can be excruciatingly painful, debilitating, and challenging to treat. Here’s what you should know about these severe headaches.
What is a cluster headache?
Cluster headaches are a thankfully rare type of headache that occurs in just one or two people per thousand. Their official designation as trigeminal autonomic cephalalgia (TAC) breaks down into the following.
- Trigeminal refers to the fifth cranial nerve that enervates the face (including the area behind the eyes)
- Autonomic is a classification of symptoms that includes runny eyes and a stuffy nose
- Cephalagia means it is a headache
More men than women experience cluster headaches (at a ratio of approximately three to one), and the most common age of onset is between 20 and 40 years old.
What’s the difference between cluster headaches vs migraines?
Many people, doctors included, misdiagnose cluster headaches as migraines. Migraine sufferers may experience pain that comes with periods of relief (see below), labeling these migraines as clusters. The main difference between the two is duration. Migraine headaches typically last much longer than cluster headaches.
Location is another big difference between the two. While some migraine sufferers do experience pain on just one side of the head, unilateral pain behind the eyes is a unique characteristic of cluster headaches. This unilateral pain also generally stays consistent, while migraines may move around the head.
The symptoms that accompany cluster headache are much different than those that come with migraine. Some migraine sufferers report runny or stuffy noses, but the majority of them experience other symptoms (e.g., sensitivity to light and sounds, nausea, dizziness, etc.).
A final important difference is the emotional state of those suffering from cluster headache pain and those with migraines. Most migraine sufferers prefer quiet and stillness in a dark room, but cluster headache patients are often very agitated, pacing the floor and unable to be still.
What are the most common cluster headache symptoms?
As mentioned above, cluster headaches symptoms are characterized by pain that is described by many as burning and like a hot poker in the eye. They usually occur on just one side of the head and also come with the following symptoms:
- Headache behind the eyes
- Red eyes
- Teary eyes
- Runny nose
- Stuffy nose
- Flushed or red face
- Restlessness
- Irritation
The affected side of the face may also have a swollen or drooping eyelid.
These symptoms occur in clusters that usually begin at night. Severe pain can last between 15 minutes to over an hour, reoccurring from once every few days to eight times a day. The average cluster headache sufferer experiences two episodes of pain every day for four to six weeks, with pain-free periods that can last between six or twelve months.
While approximately 80% of sufferers experience episodic cluster headaches with periods of relief, the other 20% have headaches that last for over a year without relief.
Diagnosing cluster headaches
Diagnosis of cluster headaches is very challenging. Patients first discuss their symptoms with their doctor. An MRI is a part of the diagnosis to rule out any conditions that mimic cluster headache symptoms, including:
- Migraine with prominent autonomic features
- Trigeminal neuralgia
- Paroxysmal hemicranias
- Short lasting unilateral neuralgiform headaches with red eye and tearing (SUNCT/SUNA)
- Hemicrania continua
Rarely, blood vessel disorders can also mimic cluster headache symptoms.
How to get rid of cluster headaches
Cluster headache treatments work best in a combination with preventative therapies and quick action during the acute phase of symptoms.
How to prevent cluster headaches
Unlike migraines, cluster headaches are not usually brought on by triggers. Because of this, preventative measures include some drug therapies. These include the following.
- Calcium channel blockers: Verapamil (Calan, Verelan) is one of the most common choices to prevent cluster headaches. These do come with side effects such as constipation, nausea, fatigue, and low blood pressure.
- Corticosteroids: These inflammation-fighting medications can be injected into the base of the skull (as a nerve block with a numbing agent) or taken as a pill (prednisone). This type of prevention is best for patients who have long pain-free periods or who only recently began to experience cluster headaches.
- Lithium carbonate: If nothing else has worked, lithium carbonate may be the answer. This does come with significant side effects, including the risk of liver damage.
- Melatonin: Melatonin is a natural supplement that helps promote restful sleep and has been shown to reduce the incidence of cluster headaches.
At-home or over the counter treatments
There are not many over the counter treatments that are effective because the onset of pain is swift and the attacks are generally fleeting. By the time your ibuprofen kicks in, the pain is already gone.
In some cases, just trying to relax with deep breathing or placing a compress over the eyes can help. Supplements of magnesium and B-2 can help as preventative measures.
During an attack, swabbing essential oils like eucalyptus and peppermint onto your forehead and temples may help ease symptoms.
Acute phase treatments and interventional approaches
During the acute phase of your headache, one of the most powerful approaches to cluster headache treatment is to administer 100% oxygen. Your doctor may recommend this to ease symptoms quickly.
Medications such as injectable sumatriptan (Imitrex), dihydroergotamine, and octreotide are fast-acting and offer swift pain relief. Lidocaine delivered via nasal drops also helps to ease pain during the acute phase.
More interventional approaches include surgery. There are two main types of surgery. The first is deep brain stimulation, an approach that is still in its infancy. Electrodes placed in the brain near the hypothalamus show some promise for patients who have not found relief from other more conservative measures. Less invasive procedures with fewer side effects include placing electrodes on either side of the occipital nerve at the back of the head. This can block pain signals from the nerves, reducing or eliminating pain during an attack.
Blocking pain signals from the trigeminal nerve is another interventional approach. Your doctor surgically damages the nerve to interrupt the signal. But, again, doctors reserve surgical techniques for those patients who experience unrelenting pain that has not been relieved by other more conservative treatments.
Did you know that your Phoenix area family dentist can work with your doctor to treat cluster headaches? Give us a call today to find out how.