Cluster headache sufferers typically experience very severe headaches of a piercing quality near one eye or temple that last for between 15 minutes and three hours. The headaches are unilateral and occasionally change sides.

Cluster headaches are frequently associated with drooping eyelids, conjunctival injection (which results in red, watery eyes), tearing, constricted pupil, eyelid edema, nasal congestion, runny nose, and sweating on the affected side of the face. The neck is often stiff or tender in association with cluster headaches, and jaw and teeth pain is sometimes reported.

During an attack, the person often is unable to be still and may pace. Sensitivity to light is more typical of a migraine, as is vomiting, but they can be present in some sufferers of cluster headache.

In episodic cluster headache, these attacks occur once or more daily, often at the same times each day, for a period of several weeks, followed by a headache-free period lasting weeks, months, or even years. Approximately 10-15% of cluster headache sufferers are chronic; they can experience multiple headaches every day for years.

Cluster headaches are occasionally referred to as "alarm clock headaches", as they can occur at night and wake a person from sleep at the same time each night or at a certain period after falling asleep. Other synonyms for cluster headache include Horton's syndrome and "suicide headaches" (a reference to the excruciating pain and resulting desperation).

The location and type of pain has been compared to a "brain-freeze" headache from rapidly eating ice cream; this analogy is limited, but may offer some insight into the cluster headache experience. Persons who have experienced both cluster headaches and other painful conditions (childbirth, migraines) report that the pain of cluster headaches is far worse. One analogy is that of a burning ice pick being repeatedly stabbed through the eye into the brain.

Incidence

Whereas other headaches, such as migraines are diagnosed more often in women, cluster headaches are diagnosed in men at a rate 2.5 to 3 times greater than in women. Between 1 and 4 people per thousand experience cluster headaches in the U.S. and Western Europe; statistics for other parts of the world are fragmentary. Latitude plays a role in the occurrence of cluster headaches, which are more common as one moves away from the equator towards the poles. It is believed that greater changes in day length are responsible for the increase.

Pathology

While the immediate cause of pain is in the trigeminal nerve, the true cause(s) of cluster headache is complex and not fully understood. Cluster headaches are a type of vascular headache and the intense pain of an attack is also associated with the dilation of blood vessels.

Definition

A headache involves pain in the head which can arise from many disorders or may be a disorder in and of itself.

Description

There are three types of primary headaches: tension-type, migraine, and cluster. Although everyone experiences headaches at some point, approximately 40-45 million people in the United States suffer from chronic headaches. An estimated 18% of American women suffer migraines, compared to 6% of men. Cluster headaches affect fewer than 0.5% of the population, and men account for approximately 80% of all cases. Headaches caused by illness are secondary headaches and are not included in these numbers.

Causes & symptoms

Tension-type headaches are caused by muscle contraction, and migraine and cluster headaches are caused by blood vessel dilation (swelling). Although brain tissue itself has no sensitivity to pain, headaches may result from contraction of the muscles of the scalp, face or neck, dilation of the blood vessels in the head, or brain swelling that stretches the brain's coverings. Sinus inflammation is a common cause of headache. A headache diary may link headaches to stressful occurrences, menstrual phases, food triggers, or medication.

Tension-type headaches are often brought on by stress, overexertion, loud noise, and other external factors. The typical tension-type headache is described as a tightening around the head and neck accompanied by a dull ache.

Migraines are intense throbbing headaches generally occurring on one side of the head that may be accompanied by nausea, vomiting, blurred vision, and aversion to light, sound, and movement. Migraines are often triggered by food items, such as red wine, chocolate, and aged cheeses. For women, a hormonal connection is likely, because headaches occur at specific points in the menstrual cycle, with use of oral contraceptives, or the use of hormone replacement therapy after menopause.

Cluster headaches cause severe, stabbing pain that centers around one eye, with eye tearing and nasal congestion on the same side. The headache lasts from 15 minutes to four hours and may recur several times in a day. Heavy smoking and alcohol consumption put one at risk for cluster headaches.

Diagnosis

Because headaches arise from many causes, a physical exam assesses general health and a neurologic exam evaluates the possibility of neurologic disease that is causing the headache. A detailed headache history includes: its frequency and duration, when it occurs, pain intensity and location, possible triggers, and any prior symptoms.

The following warning signs indicate the need for prompt medical attention:

Headache accompanied by one-sided weakness, numbness, visual loss, speech difficulty, or other signs.
Headache that becomes worse over a period of six months, especially if most prominent in the morning or if accompanied by neurological symptoms.
Sudden onset of headache accompanied by fever and stiff neck.

Headache diagnosis may include computed tomography scan (CT scan) or magnetic resonance imaging (MRI).

Treatment

Alternative remedies can lessen the frequency and severity of headaches. Common treatments include:

Acupressure. The stomach 3 and large intestine 4 points relieve sinus headaches.
Acupuncture. A National Institutes of Health (NIH) panel concluded that acupuncture may be a useful treatment for headache.
Aerobic exercise. Regular aerobic exercise reduces the frequency and intensity of headaches
Aromatherapy. Massage using the essential oils of lavender, rosemary, or peppermint relieves headache.
Autogenic therapy. Headache may be relieved by attaining a semihypnotic state.
Chiropractic. Cervical manipulation may relieve tension headaches.
Heat and/or cold. A hot shower or bath can ease tension headaches; an ice pack on the forehead or head can ease vascular headache, or the feet in hot water and a cold pack on the forehead (hydrotherapy treatment).
Herbals. Use feverfew (Chrysanthemum parthenium) for migraine; goldenseal (Hydrastis canadensis) for sinus headache; valerian (Valeriana officinalis), skullcap (Scutellaria lateriflora), or passionflower (Passiflora incarnata) for tension headache; and cayenne (in nostrils) for cluster headache.
Holistic medicine. Headaches are caused by constipation and liver malfunction. Apple-spinach juice relieves constipation and a blend of carrot, beet, celery, and parsley juices treats the liver.
Homeopathy. Remedies are chosen for each patient and may include belladonna (throbbing headache), bryonia (splitting headache), kali bichromicum (sinus headache), and nux vomica (tension headache with nausea and vomiting).
Massage. Firm massage of the forehead, neck, and scalp may relieve headache.
Osteopathy. Headache is treated with neuromuscular manipulation and massage of head, neck, and upper back.
Pressure. A headband tied tightly around the head can relieve migraines.
Reflexology. Headache is treated using the solar plexus, ear, eye, and head points.
Relaxation techniques. Meditation, biofeedback, and yoga can relieve headache.
Supplements. Vitamins B₂ and B₁₂, magnesium, and niacin may help treat or prevent headache.
Transcutaneous electrical nerve stimulation (TENS). An effective headache treatment which electrically stimulates nerves and blocks pain transmission.
Visualization.

Allopathic treatment

Tension-type and migraine headaches can be treated with aspirin, acetaminophen, ibuprofen, or naproxen. Extra-strength Excedrin is indicated for mild to moderate migraines. Antidepressants and muscle relaxants can treat tension-type headaches, and ergotamine tartrate or sumatriptan can relieve migraines and cluster headaches. Cluster headaches may also be treated by inhaling pure oxygen.

Expected results

Headaches are typically resolved through the use of analgesics and other treatments.

Prevention

Some headaches may be prevented by avoiding triggering substances and situations, or by employing alternative therapies, such as yoga and regular exercise. Eyestrain is a common cause of headache, so proper lighting may prevent headache. Because food allergies are often linked with headaches, especially cluster headaches and migraines, identification and elimination of the allergy-causing food(s) from the diet can be an important preventive measure. Prophylactic treatments include prednisone, calcium channel blockers, and methysergide.

Key Terms

Analgesics: A class of pain-relieving medicines, including aspirin and Tylenol.
Biofeedback: A technique in which a person is taught to consciously control the body's response to a stimulus.
Chronic: A condition that occurs frequently or continuously.
Prophylactic: Treatment which prevents symptoms of a disorder from appearing.
Transcutaneous electrical nerve stimulation (TENS): A treatment where a mild electrical current is passed through electrodes on the skin to stimulate nerves and block pain signals.

Headache therapies
Description Type

Acupressure Press pointer fingers beneath cheekbones and parallel to pupils (Stomach 3) for one minute. Squeeze fleshy area between thumb and pointer finger (Large Intestine 4) for one minute. Sinus

Aromatherapy Massage mixture of lavender oil and sunflower oil in temples, sides of eyes, behind ears, and on the neck. Do same using eucalyptus. Migraine, tension, and sinus

Chiropractic Spinal or cervical manipulation to realign posture. Tension

Diet and exercise Avoid chocolate, cheeses, citrus, red wine, and foods containing sodium nitrates or MSG. Exercise regularly. Migraine

Herbal remedies Feverfew, hawthorn, skullcap, ginger, goldenseal, valerian, passionflower, and cayenne. Migraine and tension

Homeopathy Belladonna, bryonia, kali bichromicum, and nux vomica. Sinus and tension

Home remedies Simultaneous ice pack/warm foot soak; drink three cold glasses of water; inhale pure oxygen. Migraine and cluster

Massage Scalp massage All

Mind/body Meditation and relaxation and biofeedback. Migraine

Osteopathy Neuromuscular manipulation and massage of head, neck, and shoulders. All

Gale Encyclopedia of Alternative Medicine. Gale Group, 2001.

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