Cluster headaches, Its Causes, Symptoms, and Treatment

Cluster Headaches

Introduction

Cluster headaches are extremely painful headaches that you can get every day for weeks or months at a time. Pain from cluster headaches can be extreme and severe. Cluster headaches can occur at any age but are most common between adolescence and middle age. They are more common in males as compared to females.

What causes cluster headaches?

The cluster headaches are caused due to the vasodilatation, or widening of the blood vessels that supply blood to your brain and face. This vasodilatation puts pressure on the trigeminal nerve, which transmits sensations from the face to the brain. But it is unknown why this vasodilatation occurs. 

Some researchers believe that abnormalities in the hypothalamus, a small area of the brain that regulates the blood pressure, sleep, body temperature, and the release of hormones, may cause cluster headaches. 

Types of cluster headaches

There are mainly two types of cluster headaches:

Episodic cluster headaches occur regularly between 6 to 12 weeks that are followed by a headache-free period of around one month or more. 

Chronic cluster headaches occur regularly for more than one year, followed by a headache-free period that lasts for less than a month.

Symptoms of cluster headaches

 Cluster headache pain mainly occurs on one side of the head, but it can switch sides in some people. This one-sided pain is described as constant and deep burning or piercing pain. With time pain can spread to your forehead, temples, nose, teeth, or even maybe to your shoulders. Other symptoms of cluster headaches include:

1.) Nausea

2.) A runny nose

3.) Eye Redness

4.) A droopy eyelid

5.) Sensitivity to light

6.) Restlessness or agitation

Treatment for cluster headaches

Medication is a common treatment used to cure cluster headaches. In rare cases, if the pain doesn’t stop and increases with time, your doctor may recommend intervention.

Pain medication

Pain medication is used when the pain has just begun. This includes:

1.) Oxygen: If you’ll get 100% oxygen to breathe, it can help you overcome headache pain. 100% oxygen given by face mask at 12 liters/min for 15 mins is helpful. 

2.) Nasal Sphenopalatine ganglion block- This gives instant pain relief. A local anesthetic is applied over the inner aspect of lateral wall of the nose which blocks pain sensation from sphenopalatine ganglion.

3.) Triptan Medication: These nasal spray medications called sumatriptan, or other triptan medications help to constrict blood vessels, which can help you ease your pain.

4.) DHE: DHE (dihydroergotamine) is an injectable medicine that can often relieve cluster headache within five minutes of its use. Note: DHE cannot be used with sumatriptan.

5.) NSAID: Painkillers like Ibuprofen, Diclofenac help to relieve pain but the pain of cluster headache is very short-lived so the painkiller must be taken at the very onset of symptoms.

6.) Steroid- Prednisolone is helpful in cluster headache. It is started at a high dose and then tapered off. 

 

Preventive Medication

Preventive medications are used to stop headaches even before they start. These medications include:

1.) Beta-blockers – Propranolol

2.) Calcium channel blockers – Verapamil

3.) Muscle relaxants- baclofen.

4.) Lithium Carbonate – Lithium can cause organ damage so it is started only when most treatments are not working and the dose needs to be titrated.

5.) Anti-seizure medications, such as topiramate.

Interventional Pain Management

Patients not responding to preventive medication for cluster headache will benefit from intervention. Even patients having side effects of medication or non -compliant with medication can undergo intervention. This procedure will give remission from cluster headaches. Sphenopalatine ganglion is a bunch of nerves responsible for transmitting pain in cluster headache. The nerve plexus is ablated by radiofrequency using imaging guidance with Fluoroscopy. 

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