Cluster Headaches: How to Alleviate Pain?

By Dr. Pallavi Sharma

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What causes headaches and how do you know if it’s a headache? There are many reasons why someone could be experiencing pain in their head.

  • Stress at work or in home life.
  • Hormonal changes (during pregnancy).
  • Side effects of medication
  • Overexertion (such as lifting heavy objects).
  • Sinusitis
  • Ear infections
  • Sleep deprivation
  • Alcohol consumption, etc.

The good news is that there are treatments available for these headaches that can help you feel better. With so many options for pain relief out there, how do you know which ones are right for you?

There are many different types of headaches, and each one is treated differently. The most common forms of headaches include tension headaches, migraine headaches, and cluster headaches. Cluster headaches are a rare but painful condition that affects 1 in 1,000 adults worldwide and it is not threatening and can be treated.

Patients on a proper cluster headache treatment plan often find their pain and cluster frequency significantly reduced. The pain can be so severe that it feels like someone is stabbing you in the head with a knife. Many people describe it as feeling like having a hot nail driven into their eyeball.

The pain usually lasts anywhere between 15 minutes and 3 hours, but it can last as long as 72 hours. The headache usually occurs every day for weeks or months at a time before going away again.

What is a cluster headache?

Cluster headaches are one of the most painful medical conditions you can have. They are characterized by severe pain on one side of your head and face, typically around the eye, temple, or cheek area.

These headaches can come in clusters, or clusters that occur on the same day, up to six to eight cycles, and can be debilitating. These clusters usually follow a cycle of pain-free intervals.

Two types of cluster headaches exist based on the duration of symptoms:

  • Episodic cluster headache

Cluster headaches that come and go periodically over the course of a year are referred to as “episodic cluster headaches. Here, the person will experience a pain-free interval of a month or longer.

  • Chronic cluster headaches 

Chronic headaches usually last for a year or longer and have a shorter duration between attacks.

Most cluster headaches happen when you’re sleeping.

If you’re awake, you might still experience a headache. The pain usually begins and stops abruptly, and is accompanied by a feeling of tightness around the eye.

A minority of people with cluster headaches has visual disturbances like flashing lights and auras before any pain manifests, but for the most part, cluster headaches strike suddenly without any prior warning.

Is Cluster Headache the Same as Migraine?

The cause of cluster headaches is unknown, but it is believed that the pain is caused by abnormal electrical activity in the brain.

This abnormal electrical activity may also be responsible for causing other types of headaches such as migraines too. If you’ve heard of migraines but not cluster headaches, you may be wondering what the difference is. Is the pain on one side of your head and the other side of your head? Are they both headaches?

The short answer is no.

Migraine headaches are characterized by either unilateral or bilateral pain of the head, which can last anywhere from a few hours to days, while cluster headaches are characterized by unilateral pain with severe excruciating pain on the same side. Both migraines and cluster headaches are severe headaches that can cause intense throbbing pain in one area of the head. However, there are some important differences between them.

Migraines tend to occur more often than cluster headaches, making them more common overall. Cluster headaches tend to recur more often than migraines.

A person experiencing a migraine attack may feel nausea, vomiting, or lightheaded before they actually experience any pain. But aura is rare in cluster headaches. The major difference between these two conditions is that migraines tend to last longer than 10 days, while cluster headaches typically last less than seven days.

Cluster headaches are characterized by two to 10 attacks within a 24-hour period. The pain is primarily on one side of the head and is accompanied by a burning or electrical sensation in the face, nose, and eyes.

Migraine pain typically lasts from one hour to 72 hours, with several phases with symptoms such as nausea and vomiting.

A cluster headache is evident by a tearing red eye with a unilateral headache, and the patient will rock back and forth with the pain. When suffering from a migraine, the patient typically avoids light and lies down day and night.

Symptoms of Cluster Headache

The pain in cluster headaches usually begins on one side of the head and can spread to the back of the head or around the eyes. It is a rare, chronic condition that can be debilitating and extremely painful.

The characteristic feature of alternating periods of pain and temporary relief, each lasting from a few minutes to several hours, will distinguish cluster headaches from other headaches.

Eye Symptoms

Most people with cluster headaches experience severe pain in and around the eyes, which is called ocular pain. This pain may be constant and intense, making it difficult to tolerate.

Other eye symptoms include eye pain, burning, redness, stinging, or irritating feelings in one eye that will make the patient unable to get any sleep.

The pupil on that side may become constricted, and the eyelid may swell and droop.

Vision changes

The patient may feel double vision, hazy vision, or trouble seeing light.

Facial pain

Moderate to severe facial pain and tightness across the forehead, over the eyes, or in the temples may make a hard day for the patient.

 Additionally, it may cause pain in the cheeks or jaw, which will get worse with chewing food (jaw claudication).

 Physical symptoms

Restlessness, malaise, and nausea are frequently seen in these patients. 

Causes of Cluster Headaches

Although the exact etiology of cluster headaches is unknown, many theories have been proposed so far.

The unbalanced electrical activity on one side of the brain is what is causing the intense headache.

Vasodilation is the main reason that is causing this abnormal electrical activity.

Pain in the face and neck is brought on by dilated veins that are pressing against the trigeminal nerve.

Hypothalamic abnormalities

Cluster headaches may result from hypothalamic abnormalities too. The hypothalamus regulates body temperature, sleep, and hormone signaling pathways.

Changes in these hormonal signaling pathways or responses of vessels to body heat may also cause headaches and vasodilation.

Chemical Discharge

Serotonin and histamine are linked to cluster headaches. Histamine can be released in the course of an allergic reaction, which might result in systemic vasodilation and headaches.

Serotonin is another endogenous hormone that causes pleasure and can also produce vasodilation.

Though there are no known triggers of cluster headaches that have been identified, unlike other headaches, avoiding inhalation of volatile drugs and abstaining from alcohol may lessen the clusters.

Diagnosis of Cluster Headaches

A cluster headache is an unpredictable, recurrent headache that is triggered by a sudden increase in intracranial pressure.

Cluster headaches are a type of complex regional pain syndrome. The diagnosis of cluster headaches can be made with history-taking alone. But yet, excluding other causes of similar pain is essential.

After taking your initial history, the doctor will perform a detailed neurologic examination on you. This brief neurological examination will be performed to detect vision problems, muscle weaknesses, sensory deficits, and mental status, which can be early signs of neurological disorders.

A neurological examination is usually painless and does not require any special preparation. If the doctor suspects cluster headaches, he will refer the patient to a neurologist for further evaluation and treatment.

A neurologist will ask about your medical history, including any current symptoms you may be experiencing. They may also ask about any medications you’re taking, including over-the-counter drugs and supplements.

Then, they’ll perform a physical exam to check your reflexes, motor skills, and muscle strength, as well as your posture and coordination.

The following tests will be performed to determine the cause of your cluster headache:

  • A CT scan of the head
  • MRI scan of the head
  • EEG (electroencephalogram)

An MRI or CT scan may be needed if there are neurological symptoms such as weakness in the arms or legs or changes in vision, speech patterns, or hearing to exclude other causes.

MRI scan

MRI scans are not painful and don’t use radiation. They can help your doctor check for tumors or other abnormalities that may be causing your cluster headache.

CT scan

The CT scan of the brain will use more radiation than a routine x-ray to detect masses in the brain.

EEG

A neurologist will likely perform an EEG, which measures electrical activity in the brain using electrodes placed on your scalp. It is a painless procedure.

Treatment

The main treatment for cluster headaches is medications that block the transmission of pain signals from the brain to the body.

There is no special cure for cluster headaches other than treating acute symptoms and preventing episodes.

Both medication and non-medication options are available to treat acute symptoms, and these work well on headaches!

If you feel an oncoming headache coming on, you should try taking one of the following treatments.

Home Remedies

These natural remedies may not be able to stop the onset of an attack altogether, but they can certainly help ease symptoms until you see a doctor.

Using over-the-counter analgesics like acetaminophen (Tylenol) or ibuprofen (Advil) often works wonders when taken 30 minutes before the bedtime.

-You can also try drinking more water and eating foods high in magnesium (like dark chocolate) at least 2 hours before bedtime to help reduce stress levels overall and allow your body to heal more quickly.

High-flow Nasal

High-flow oxygen therapy may be an effective treatment for cluster headaches. This increases the amount of oxygen that reaches your brain, which can reduce the severity of your pain and make it more manageable.

This treatment can be given by nasal prongs or a mask that delivers oxygen directly into your lungs. It’s a more effective way to deliver oxygen than using a continuous-flow nasal cannula, and it doesn’t require you to hold your breath while you’re getting treatment. Increasing oxygen levels in your brain will reduce vasospasms.

Cold Packs

The cold pack can be applied to the forehead and temples, but it is best to use a soft cloth instead of a plastic bag or ice.

The cold pack should be applied for 10 minutes at a time and removed briefly before reapplying. The key is to apply it more over the painful areas of the face and neck.

This will alleviate the delivery of pain signals from the nerve.

Ginger Tea

Ginger tea will alleviate cluster headache pain and the symptoms of the condition. It’s important to note that ginger tea is not a cure for cluster headaches, but it can help reduce the severity of symptoms and provide some relief.

Deep Breathing Exercises:

The goal is to slow down your breathing, which will help you relax and reduce stress levels. This can help prevent headaches from developing or lessen their severity.

To begin, take a deep breath in through your nose, hold it for about five seconds, and then exhale slowly through your mouth.

Repeat this exercise at least three times per day until the symptoms subside. It’s important to note that these techniques are not a cure for cluster headaches, but they can help reduce the severity of symptoms.

Relaxation Techniques

Relaxation techniques such as meditation and yoga can help to reduce stress and tension, which in turn will help to reduce headache frequency.

Supplements

Supplements such as vitamin B complex, magnesium sulfate, melatonin mixed syrups, and kudzu are proven to reduce cluster headache symptoms.

Medications for Acute Symptoms

If you’re experiencing cluster headaches, don’t suffer in silence. Reach out to your doctor for help managing your symptoms.

Unlike migraine headaches, cluster headaches don’t respond to most home remedies.

However, you should always consult with your doctor before taking any over-the-counter supplements.

Triptans

Triptans are a type of medication that constricts blood vessels to treat migraines. They are also used to help those who suffer from cluster headaches.

Triptans work by narrowing the blood vessels in the brain and decreasing the production of serotonin, which is a neurotransmitter that can cause migraines. They have been found to be more effective than other migraine medications because they can be taken as soon as symptoms arise, instead of waiting for an attack to start before taking medication.

The inhaler form or mist spray form of this drug is more effective in treating cluster headaches as it can act instantly once sprayed.

During pregnancy and breastfeeding, it is still not indicated as it can increase heart conditions.

Octreotide 

Octreotide (Sandostatin) is an injectable medication that inhibits somatostatin, a naturally produced chemical that slows the release of growth hormone It has serotonin effects. Thus, it is used to treat cluster headaches.

This can be administered in two ways: intramuscularly or subcutaneously. The injection can be given once every 1-2 weeks depending on the severity of the condition being treated.

Dihydroergotamine

(DHE) is a medication that may help relieve pain within five minutes. DHE is considered a safe and effective treatment for migraine headaches and cluster headaches too.

DHE can be given as a shot into a vein, or it can be swallowed in pill form.

It works by narrowing blood vessels in the head and reducing inflammation of nerves in the brain. It can take up to five minutes for this medicine to work, but it is considered a safe and effective treatment for cluster headaches. The professionals recommend not using DHE with triptans.

Intranasal Anesthesia

Lidocaine is an anesthetic that has been studied as a possible treatment for chronic pain, but there are still some unanswered questions about how well it works and how safe it is.

Intranasal lidocaine can be prescribed by a doctor to relieve cluster headaches and it is a possible treatment for cluster headaches.

Preventive Medications

The preventive medications for cluster headaches include antiseizure medications, verapamil, topiramate, and lithium. These medications are used to reduce the frequency of cluster headaches.

The preventive medication for cluster headaches is typically taken daily, as it has been shown to be effective in preventing future cycles of cluster headaches.

Topiramate and valproic acid are antiseizure medications, while verapamil is a vasoconstrictor.

Antiseizure Medications

Valproic acid is an anti-seizure medicine that is prescribed to people who suffer from migraines. 

Valproic acid is thought to be more effective for people who experience migraine-type symptoms such as nausea, vomiting, and photophobia.

Topiramate too has an effect on reducing the threshold of cluster headaches.

Calcite channel blocker

Verapamil prevents vasodilatation, which is the major cause of the onset of cluster headaches.

Lithium carbonate

Lithium is often used to treat bipolar disorder. It can control histamine and serotonin levels in the body. As these secretions are related to cluster headaches, lithium is prescribed as a preventive medication. Lithium can alter REM sleep in a person, the stage of sleep where most people develop headaches.

It is highly toxic and not indicated for pregnancy. So it is used often for refractory cluster headaches.

Steroids

As an anti-inflammatory agent, steroids can be used to reduce inflammation in vessels and pain.

Dexamethasone and prednisolone have been found to cause immune suppression and reduce the frequency of headaches.

The major aftereffects of prolonged use of steroids are Cushing’s syndrome, weight gain, high blood pressure, diabetes, vision loss, etc.,

Occipital nerve block

An occipital nerve block is a procedure that is used to treat headaches. It is performed by placing an injection of local anesthetic with a corticosteroid into the greater occipital nerve.

The greater occipital nerve transmits sensory signals to the pain in the face and the back of the head.

Occipital nerve blocks are done on an outpatient basis and can be done at any time of day. This procedure will take around 15 minutes.

It not only relieves cluster headaches, but migraines too.

Surgery

Cluster headaches are one of the most painful disorders known to medical science.

The surgery is a last resort for those who do not respond well to medications or other noninvasive therapies.

When noninvasive therapies are refractory to cluster headaches, the physician will refer you to invasive therapies like implanting an electrode or a neuro-stimulator in your brain.

The electrical signals that produced by these implants will stimulates nerve avoiding pain signals travelling.

This implant promotes nerve stimulation in the occipital nerve or the nerve cells that are linked to the trigeminal nerve where cluster headaches form.

In the years to come, nerve-stimulating implanters at the gums and autoantibody therapy are just a couple of the new cluster headache treatments that researchers are actively researching.

Bonus Tips to Prevent Cluster Headaches!

 In order to prevent these headaches from happening, it is important to understand what may trigger them and try to avoid those things when possible.

Cluster headaches are a type of headache that is often characterized by severe pain and by a pattern of periods of headache activity separated by pain-free intervals.

People with cluster headaches should avoid triggers such as smoking, alcohol, or other chemical substances that can trigger an attack.

They should also try to get plenty of sleep and reduce stress. Lifestyle changes, breathing exercises, and arranging sleep schedules are important tips to prevent cluster headaches.

Risk factors

  • Headaches are more common in men (5-6%) than in women.
  • Genetic
  • Smoking 
  • 20-40 years of age
  • Exposure to volatile gases

Cluster headaches are rare, affecting less than one in 1,000 people. Risk factors may make you more susceptible to cluster headaches.

The risk of developing a cluster headache is increased if you have a family history of the condition or if you are a male between the ages of 20 and 40 years old.

Other risk factors include smoking and being exposed to certain substances such as alcohol or nitroglycerin.

Cluster headaches are not fatal.

Visit your doctor!

Before you go see a doctor, there are some things you should do. The first thing is to keep a headache diary.

In this diary, you should write down the date of each headache, its duration, and the intensity of it. You can also write down your mood or any other symptoms that were present at the time.

Keeping a headache diary can help your doctor diagnose what’s causing your headaches.

It can also help them figure out how to treat them and when they’ll go away on their own.

The ideal time to visit a doctor is if the intensity of the headache is higher than normal, which will disturb your sleep, causing severe eye or facial pain and unexplainable.

Headaches are a common problem, but they can also be a symptom of more serious conditions. The below are considered red flag signs 

The headache that comes as a thunderclap flash may be the result of an intracranial hemorrhage.

A headache that develops after heavy work, exercise, or intercourse could be the result of abnormal brain pathology.

  • Some patients might experience weakness in their faces or limbs, with slurred speech and imbalanced gait that will indicate a stroke.

A headache with a high fever and neck stiffness will indicate meningitis.

  • If you are immunosuppressed or have cancer, a new onset of headache might need an urgent doctor’s opinion.

If you have any of these symptoms and they persist for more than one day, it is important to seek medical attention.

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TeleHealthDoc articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Dr. Pallavi Sharma

Dr. Pallavi Sharma is one of Melbourne’s best, well respected cosmetic doctors and aims to provide longstanding anti-aging benefits for her clients. With over 11 years experience in Performing cosmetic procedures, Dr. Sharma has lectured medical professionals regarding cosmetic treatments and is heavily involved in providing up to date cosmetic treatments to her clients and friends.
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