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Article | Cluster
Headache . . . .
The most common headache type seen in the general population
is tension-type headache. However, the headache that most
frequently brings a patient to consult a physician is migraine.
There is another type of headache which is less widespread
and not well-recognized, yet is described as the worst pain
a human may possibly experience. This type – cluster
headache – is most frequently seen in males.
For many years, cluster headache was called by a variety
of names, such as migrainous neuralgia, histaminic headache,
red migraine, and Horton’s headache. In 1952, the term,
cluster headache, was coined and has been used since that
time. The occurrence of cluster headache is about 1:1000 persons.
The male-to-female ratio in cluster headache ranges from 4:1
to 7:1. It primarily occurs between the ages of 20 to 50 years.
Cluster headache is characterized by cycles or series of
painful attacks that occur daily for periods lasting 2 to
3 months. The acute attacks are relatively brief – lasting,
on average, from a few minutes to one hour. The headaches
begin suddenly, without any warning, and are described as
sharp, boring, burning pain, like a "hot poker,"
and are extremely severe. In many cases the headache awakens
its victim from a sound sleep. These headaches are almost
always localized on one side, do not cross the midline of
the head, and – most commonly – are felt behind
or around one eye. Another distinguishing feature of cluster
headaches are the associated symptoms that occur on the same
side as the pain. The most common of these accompanying symptoms
include redness of the conjunctiva of the eye, tearing, runny
nose, forehead sweating, or a droopy eyelid. Unlike migraine,
the patient does not complain of a visual warning (aura),
and will not experience vomiting. Frequently, patients with
cluster headache are tall men, with ruddy complexions, who
smoke. During the attack, the cluster headache victim is unable
to remain still and will pace the floor, may become agitated,
and possibly aggressive.
An interesting feature of cluster headache is the periodicity
associated with the cycles. During a headache series, the
attacks will usually occur at the same time each day. The
cluster cycles most often occur during the spring or fall.
Only 10% of cluster patients suffer from the chronic form
in which there is no remission of headaches which can continue
every day for several months. The headache attacks of the
chronic form may be less intense but can continue longer,
or occur more than once a day. Patients with the chronic form
may also suffer from other types of headaches.
Therapy
Treatment for both the episodic and chronic forms are similar,
consisting of both reversal and preventive therapy. Because
of the brief nature of the acute cluster attacks, any medication
to be used must have a rapid onset of action – within
30 minutes of the headache onset. The most effective and safest
treatment method is the administration of 100 percent oxygen
by facial mask. Dramatic termination of an acute attack is
achieved within 10 to 15 minutes in 80% of patients using
oxygen inhalation. Injectable and intranasal sumatriptan (Imitrex®)
are also effective in aborting an attack.
Preventive therapy must be initiated at the very onset of
a cluster cycle, and continued for at least 2 to 4 weeks after
the last cluster episode. Verapamil, lithium, methysergide,
and divalproex sodium have all been found effective in reducing
and preventing cluster attacks during a cycle, whether episodic
or chronic. Intractable cluster headaches have been successfully
treated with intravenous histamine desensitization. This form
of therapy should only be administered in an inpatient setting,
such as the Diamond Inpatient Headache Unit at Saint Joseph
Hospital.
The Diamond Headache Clinic has extensive experience in treating
intractable cluster headache patients. If you think you are
suffering from this debilitating headache disorder, or your
present treatment is not effective, please contact the Diamond
Headache Clinic.
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