Cluster headaches

Cluster headaches have been a recognized medical condition for over a hundred years, but it wasn’t until 1956 that this disorder was truly brought to the attention of the medical establishment. There was often confusion in medical research about cluster headaches because they went by several different names and the disorder itself presents different symptoms in different people. In contemporary medicine, however, cluster headache is firmly established as a serious disorder.

There are two kinds of cluster headaches. One is the episodic kind, which is expressed in one or more severe headaches a day over a period of one to two months. In this kind of cluster headache, the patient may be free of pain for as long as a year. About eighty-five to ninety percent of people with cluster headaches experience the episodic kind. There are also chronic cluster headaches, which do not have the pain-free interim as episodic ones do; they simply suffer attacks with no respite for years. About ten to fifteen percent of patients suffer with this type of cluster headaches. The headaches can change back and forth from being one kind or the other; if a patient has chronic headaches, they may become episodic, giving the patient some relief, or vice-versa.

Men begin having cluster headaches at an average age of thirty years, and are more likely than women to suffer from them, while women more often start getting them after age fifty, although anyone can begin having them at any age. It is also believed that geographical latitude plays an important role in the frequency and intensity of cluster headaches; the farther from the equator you go, the more likely you are to experience these headaches.

The chief symptom of cluster headaches is an extreme pain that begins without warning and reaches its peak in two to fifteen minutes. This pain has been described as “deep, non-fluctuating, and explosive,” and “the most severe pain condition known to human kind.” It is usually continuous, rather than pulsing. Up to twenty percent of patients also report the additional sensation of a sharp stabbing pain, which exacerbates the agony, but often signals that the attack will subside within a minute or two. This pain usually begins near or above the eye or in the temple, and remains on the same side throughout the attack.

Other symptoms of cluster headaches include a drooping eyelid, redness of the eyes, tearing up of the eyes, runny nose, and other less common symptoms such as redness of the face, sweating, and swelling. Cluster headaches also produce restlessness, causing the patient to pace back and forth or to rock in place while the attack is going on. Sometimes there is an aversion to lights or noise, as well.

Attacks usually average from half an hour to two hours, though sometimes, if an attack is mild, it can be shorter, or if it is especially serious, can last several hours. They can vary in frequency from six a day or one a week, and usually occur at around the same time every day. Statistically, about three-quarters of cluster headaches happen between nine at night and ten in the morning, often waking patients up in their intensity. This usually happens at about the same time every night during an episode; for this reason, they have been called “alarm clock headaches.”

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In many patients, these headaches are triggered by alcohol consumption, at least part of the time. Others have reported that their headaches or headache episodes are triggered by stress, exposure to heat or cold, glare, allergies, and less commonly, reactions to specific foods, chemicals, or perfumes. Some studies suggest that cluster headaches can be precipitated by head trauma; over forty percent of patients reported the onset of headaches after a head injury in which they lost consciousness.

One of the most widely accepted theories about the cause of cluster headaches says that they result from an abnormality in the hypothalmus. The hypothalamus regulates the biological clock—the internal mechanism that regulates our bodies’ rhythms—and if there is something wrong with it, it would explain why cluster headaches strike during the same hours and the same seasons. If it is responding to certain stimuli, such as bright light, heat, cold, stress or relaxation, the defective hypothalamus might trigger dilation of the blood vessels, which in turn put pressure on the trigeminal nerve, the source of cluster headache pain.

There are drugs which can be effective in relieving the intense pain of a cluster headache attack. The problem is, many drugs, especially those which come in any sort of oral form, work too slowly to help a person in the throes of a quick-moving cluster attack. For this reason, many doctors prescribe inhalants or injections rather than tablets. Inhaling oxygen has also been effective for many cluster headache sufferers, but may be less practical than portable inhalers for pain relief. Another method of pain relief is through the use of lidocaine, administered as nose drops or nasal spray. Some doctors also use the class of drugs known as triptans, which are also used for migraines, injected under the skin at the onset of an attack.

The drugs which are most often used to prevent cluster headaches are prednisone (a corticosteroid), lithium, methysergide, and ergotamine (a drug also used for migraines). Ergotamine is a caffeine-based medication; consistent with the long-standing self-medicating practice of sufferers drinking several cups of coffee at the onset of a headache. Lithium is thought to be the most effective preventative, and can sometimes be coupled with ergotamine for maximum effectiveness, but has side effects that may make it less desirable. These include tremor, nausea, diarrhea, low blood pressure, and convulsions. For all the above medications, smoking can lead to the medicine being ineffective, so the patient should stop smoking while they are taking the drug. After anecdotal reports that ingesting “magic mushrooms” eased the pain of cluster headaches, a research team launched an investigation into the properties of psilocybin, the mushrooms’ main ingredient, but the results have not yet been published. These doctors caution that psilocybin and other hallucinogenic drugs are illegal in the Untied States and should not be used as self-medication.