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Headaches - cluster - Highlights

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of cluster headaches.

Highlights:

What Are Cluster Headaches?

Cluster headaches are among the most painful types of headaches. They are marked by excruciating stabbing and penetrating pain, which is usually centered around the eye. Cluster headache attacks occur very suddenly and without warning, with the pain peaking within 15 minutes. During an attack, the patient is very restless and agitated while trying to cope with the severe pain.

Symptoms of Cluster Headache Attacks

In addition to pain, symptoms of cluster headaches may include:

Swollen or droopy eyelid
Watery, tearing eye
Stuffy or runny nose
Contracted eye pupil
Forehead and facial sweating
Intolerance to light and sound

Who Gets Cluster Headaches?

Cluster headaches are rare, affecting less than 1% of the population.
Men, usually in their 40s, are much more likely to suffer from cluster headaches than women.
Many people who have cluster headaches have a personal or family history of migraine headaches.

Treatment

Treatment of cluster headaches focuses on relieving pain when attacks occur, and on preventive strategies to reduce attack duration and frequency. Oxygen therapy and sumatriptan (Imitrex) injection are the most effective treatments for acute attacks. Verapamil (Calan), a high blood pressure drug, is typically the first choice of medication used for long-term prevention.

Behavioral treatments can be a helpful supplement to drug therapy. These treatments include relaxation therapy, biofeedback, cognitive-behavioral therapy, and stress management. Patients should also identify and avoid any triggers, such as alcohol use and cigarette smoking, which may provoke cluster headache attacks.

Resources

www.i-h-s.org -- International Headache Society
www.headaches.org -- National Headache Foundation
www.achenet.org -- American Headache Society
www.aan.com -- American Academy of Neurology
www.ninds.nih.gov -- National Institute of Neurological Disorders and Stroke
www.ouch-us.org -- Organization for Understanding Cluster Headaches
www.clusterheadaches.com -- Support group for people with cluster headaches

References

Beck E, Sieber WJ, Trejo R. Management of cluster headaches. Am Fam Physician. 2005; 71(4): 717-24.

Burns B, Watkins L, Goadsby PJ. Treatment of medically intractable cluster headache by occipital nerve stimulation: long-term follow-up of eight patients. Lancet. 2007 Mar 31;369(9567):1099-106.

Cittadini E, May A, Straube A, Evers S, Bussone G, Goadsby PJ. Effectiveness of intranasal zolmitriptan in acute cluster headache: a randomized, placebo-controlled, double-blind crossover study. Arch Neurol. November 2006. [Epub ahead of print 11 September 2006]

Magis D, Allena M, Bolla M, De Pasqua V, Remacle JM, Schoenen J. Occipital nerve stimulation for drug-resistant chronic cluster headache: a prospective pilot study. Lancet Neurol. 2007 Apr;6(4):314-21.

May A. Cluster headache: pathogenesis, diagnosis, and management. Lancet. 2005; 366(9488): 843-55.

Rapoport AM, Mathew NT, Silberstein SD, Dodick D, Tepper SJ, Sheftell FD, Bigal ME. Zolmitriptan nasal spray in the acute treatment of cluster headache: a double-blind study. Neurology. 2007 Aug 28;69(9):821-6.

Rose KM, Wong TY, Carson AP, Couper DJ, Klein R, Sharrett AR. Migraine and retinal microvascular abnormalities: the Atherosclerosis Risk in Communities Study. Neurology. 2007 May 15;68(20):1694-700.

Schurks M, Kurth T, de Jesus J, Jonjic M, Rosskopf D, Diener HC. Cluster headache: clinical presentation, lifestyle features, and medical treatment. Headache. 2006 Sep;46(8):1246-54.

Silberstein SD, Young WB. Headache and facial pain. In: Goetz CG, eds. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 53.

Sostak P, Krause P, Forderreuther S, Reinisch V, Straube A. Botulinum toxin type-A therapy in cluster headache: an open study. J Headache Pain. 2007 Sep 24; [Epub ahead of print]

Van Vliet JA, Eekers PJ, Haan J, Ferrari MD; Dutch RUSSH Study Group. Evaluating the IHS criteria for cluster headache -- a comparison between patients meeting all criteria and patients failing one criterion. Cephalalgia. 2006 Mar;26(3):241-5.

Reviewed last on: 9/9/2008
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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