Cluster headache
Cluster headaches – the most painful headache in the world, otherwise known as suicide headaches.
Cluster headache is a rare but extremely intense primary headache; this means there is no structural cause of brain damage or other treatable pain at the heart of this pain. They are often described as “the strongest pain a person can experience.” This type of headache has a significant impact on quality of life and requires a specific treatment approach.
How common are cluster headaches?
- They affect only 0.1%-0.3% of the population, but mostly men (up to 3-4 times more likely than women)
- Usually starts at 20-40
- Seasonality – outbreaks often occur in spring or autumn, but these headaches can also be permanent
What causes a cluster headache?
The exact mechanism is not fully known, but what matters is:
- hypothalamic dysfunction, which regulates circadian rhythms and hormonal balance;
- activation of the trigeminal nerve and extension of blood vessels;
- genetic predisposition (low risk in families with similar cases);
- provokes: alcohol, inflammation (histamine), changes in sleep patterns, smoking.
Characteristics of the cluster headache:
- very intense, burning or sharp pain on one side of the head, most often around the eye or temples;
- the attack lasts 15-180 minutes, can occur several times a day (up to 8 times);
- characteristic period of aggravation (cluster): for several weeks or months, seizures occur up to 8x daily or every few days, followed by a remission period (months or years without symptoms).
One-sided symptoms during a pain attack:
- tearing and redness in the eye;
- nasal congestion or discharge on the same side;
- dropping of the eyelid (ptosis);
- sweating of the forehead;
- anxiety – patients often walk or move during pain (as opposed to migraines when looking for peace, quiet and darkness).
Classification of the cluster headache:
- episodic cluster headache – pain attacks lasting 1 week to 1 year, followed by remission for at least 3 months;
- chronic cluster headache – seizures occur for more than a year without remission or remission is shorter than 3 months.
Diagnosis at NeiroMed ASTRA clinic
The diagnosis is determined by an experienced neurologist based on a description of typical symptoms and a pattern of pain. Additional exams may be required to exclude other causes:
- magnetic resonance of the brain with or without angiography or computed tomography (CT) (excluding tumours or vascular damage, etc.) in cooperation with twinning clinics and experienced radiologists;
- blood tests, hormonal examinations (uncommon);
- headache diary for assessing the frequency and duration of pain attacks.
Treatment
Acute treatment during pain attack
In cases of cluster headache, standard analgesics (such as ibuprofen) may be insufficiently effective, however, they may provide relief for some patients.
Specific acute therapy:
- pure oxygen: high flow inhalation (100%) through the mask for at least 15-20 minutes;
- triptanes (sumatriptan, rizatriptan, almotriptan, eletriptan, zolmitriptan, etc.) in the form of injections, nasal spray or tablets;
- lidocaine nasal drops or other specialized analgesics are also rarely used.
Prophylactic treatment during aggravation
Objective: to reduce the frequency of seizures and to prevent the cluster period:
- verapamil (first optional);
- corticosteroids (short-term course at the beginning of the outbreak);
- lithium preparations (in certain cases);
- if treatment is not helpful, specialised procedures (e.g. neural blockades or intravenous infusions).
Lifestyle and self-help:
- avoid drinking alcohol, especially during an outbreak of pain (may provoke seizures);
- regular sleep;
- maintaining a headache diary (helps your doctor evaluate the effectiveness of treatment)
- control of possible triggers.
NeiroMed ASTRA clinic approach to Cluster headaches:
- thorough diagnosis, considering international guidelines for the diagnosis of headaches;
- accurate and effective acute treatment during aggravation;
- individualised prevention and lifestyle recommendations;
- long-term monitoring of patients to reduce recurrence of disease and improve quality of life.
