The mother of all headaches: cluster headaches!
This is the third blog in our headache series; this week let's talk about cluster headaches – ‘the mother of all headaches’!
“Imagine having the worst brain freeze you have ever had with two abscessed toothaches and a migraine headache all at the same time. And that is why they are named Suicide Headaches!” Cluster headaches, which occur in cyclical patterns or clusters, are one of the most painful types of headache. They have been described as “the mother of all headaches”, “drilling,” “burning,” “piercing,” “like a hot poker in the eye” and have often been compared to the pain of childbirth.
What are cluster headaches?
Cluster headaches are a series of relatively short but extremely painful headache attacks every day for weeks or even months at a time. This period of intense brutal headaches is known as a cluster period and generally lasts from six to twelve weeks; it is then followed by remission periods, which are pain-free. These headaches can be divided into two types: episodic and chronic.
They are diagnosed as episodic when the attacks occur in periods lasting seven days to one year separated by pain-free periods lasting one month or longer. In chronic cluster headaches, attacks generally continue for more than a year, or pain-free periods might last less than one month. Most people have episodic cluster headaches.
Cluster headaches: when do they strike and how long do they last?
During a cluster period, the headache strikes quickly, usually without warning, although you might first have migraine-like nausea and aura. Attacks appear to be linked to your body's 24-hour clock. They generally strike at the same time each day and with such regularity that they've been called "alarm clock headaches." A cluster headache will often wake you up an hour or two after you go to bed. These nighttime attacks can be more severe than the daytime ones.
A typical cluster headache lasts a short time; it starts suddenly and usually lasts for a limited time with the pain ending as suddenly as it began, with rapidly decreasing intensity and after attacks most people are pain-free, but exhausted. As one suffer described it: ” Once the pain fades, I feel like I’ve run a marathon. My body is exhausted.” You may suffer from one to three of these headaches a day.
The signs and symptoms
There are a variety of signs and symptoms that are characteristic of a cluster headache and the majority of these can be indicators of the onset of the headache. These include:
Excruciating pain, which is generally one-sided and situated in or around one eye, but may spread to other areas of your face, head, neck and shoulders.
Watering eyes as well as swelling and redness in the eye on the affected side.
Stuffy or runny nose on the affected side.
Forehead or facial sweating.
Changes in skin tone such as extremely pale skin or flushing on your face.
Restlessness. It may be so bad that many people can't sit still and will often pace during an attack.
Some migraine-like symptoms, such as increased sensitivity to light and sound, can be present in a cluster headache but these headaches don't make you queasy or throw up. It is also possible for someone with cluster headaches to get migraines, which can have those symptoms. Generally, cluster headaches can be more severe than a migraine, but they usually don't last as long.
Unlike migraine and tension headache, cluster headaches generally aren’t associated with triggers, such as foods, hormonal changes or stress. Possible triggers include the use of medications such as nitroglycerin, a drug used to treat heart disease.
Eight common denominators amongst sufferers of cluster headaches
The following is a list of eight factors which are a common denominator amongst people who suffer from cluster headaches.
Men are more likely to have cluster headaches than women.
Most people who develop cluster headaches are between ages 20 and 50, although the condition can develop at any age.
Many people who get cluster headache attacks are smokers.
Oxygen deprivation to muscle cells can cause cluster headaches.
Alcohol can trigger an attack if you're at risk of cluster headaches.
Having a parent or sibling who has had cluster headache might increase your risk.
A significant number of people find that strong smelling substances such as petrol, paint fumes, perfume, bleach or solvents can trigger an attack. During an episode of cluster headaches you should try to avoid these.
Some people find exercise or becoming over heated will bring on an attack, so again avoiding them is the best advice during a bout.
What causes cluster headaches?
While the exact cause for these vicious attacks has not been established, it is known that the cluster headache syndrome is a neurological disorder in which the trigeminal nerve in the face plays a part. This nerve is situated near the eye, and branches up to the forehead, across the cheek, down the jaw line and above the ear. It can create intense pain around one of the eyes.
One of the key muscles associated with cluster and tension headaches is the trapezius muscle. The muscle itself gets its nerve supply from the brain itself (the XI cranial nerve) and is very sensitive to physical and emotional overload as well.
Symptoms of trapezius muscle dysfunction include neck pain, stiffness, deep pain in the back of the eye, jaw pain and cluster and chronic daily headaches. This muscle can be treated quickly and easily by an osteopath. Research has also been conducted to try to establish whether these headache patterns could be as a result of abnormalities in the body's biological clock.
Currently, there is no cure for cluster headache but treatment options have become much more effective in recent years. They aim to relieve some of the symptoms, shorten the duration of headaches and reduce their frequency. Most people with cluster headaches take short- and long-term medications. When each period of clusters is over, the short-term treatments stop, but the long-term ones may continue.
Acute treatment is used to stop the pain once it has started. Treating cluster headaches can be tricky because the pain becomes extremely severe very quickly – usually within 10 minutes. Thus the key to treating cluster headache during an attack is speed in an attempt to reduce the agonizing pain as fast as possible.
For treatment to shorten attacks, effective acute treatment must be used just as rapidly. Unfortunately, Over-the-Counter (OTC) painkillers, such as aspirin or ibuprofen, are generally not effective, because the pain starts and finishes so rapidly and is so intense that by the time the medication starts to work, the headache has probably gone. However, drugs, such as sumatriptan, and other treatments, including oxygen therapy, can help reduce the incidence and severity of attacks.
Preventative treatment is used to try and stop the attack from starting in the first place. If attacks occur frequently, or if one lasts over three weeks, preventive treatments are recommended, the most common of which are:
Corticosteroids are given because they are fast acting. They can be used in a short burst for two to three weeks in decreasing amounts as a first step to break the cycle. They are often used alongside other treatments which take longer to work. Corticosteroids are more effective for chronic cluster headache to break the cycle. If used for episodic cluster headache, when the medication is reduced the headaches come back.
Calcium channel blockers. These are taken during the cluster period and then gradually tapered off, although some people may need to use them long term.
When nothing else has worked, surgery may be an option for people who don't get a break from cluster headaches. Most of the procedures involve blocking the trigeminal nerve.
Sufferers maintain that cluster headaches are the work of the devil and that the only option is “to put an ‘out of order’ sticker on my forehead and call it a day” until they pass. As painful as it is, the best option is to be aware of the various treatment options and to remember that ….. this too will pass.
Miriam Lipshitz is the Back into Shape team IDD technician, clinical receptionist and blogger. She is a South African qualified and experienced teacher by profession with wide ranging experience in research and writing.