Cluster Headaches

Signs and Symptoms

Cluster headaches are recurring attacks of excruciating, stabbing pain on one side your head, usually behind an eye. Men experience cluster headaches eight times more often than women. Attacks occur nearly every day or several times a day for weeks or months and may disappear for several months or even years. Attacks may last from 15 minutes to three hours, and often occur during the night.

There are two kinds of cluster headaches -- episodic and chronic. In episodic cluster headaches, there are long, pain-free remissions. In chronic cluster headaches, there are no long remissions. If during the past year or longer, you experience periods of only a week or less of relief between headache attacks, you may be diagnosed with chronic cluster headaches. About 10 percent of cluster headache sufferers have the chronic condition.

Other symptoms usually occur on the side of the head where burning or penetrating pain is felt in or around an eye. Occasionally the pain extends to your forehead, nose, cheek or upper jaw. Other symptoms include:

• Red or teary eyes
• Runny or stuffy nose
• Facial swelling

Cluster headaches usually don't run in families and don't appear to be hereditary.

Diagnosis

Cluster headaches are characterized by a specific type of pain and pattern of attacks. Keeping a headache journal is a great way to track the location and severity of the pain, the duration of the pain, any medications taken and any possible headache triggers.

A physical exam also may help your doctor detect signs of a cluster headache. One of your pupils may appear smaller than the other or your eyelid may droop.

If your doctor suspects a tumor or aneurysm, he or she may order one or more of the following tests:

• Computerized Tomography (CT) Scan -- A CT scan uses a thin X-ray beam that rotates around the area being examined. A computer processes data to construct a three-dimensional, cross-sectional image.

• Magnetic Resonance Imaging (MRI) -- An MRI uses magnetism, radio waves and computer technology, rather than X-rays, to produce images of your brain.

Treatment

Most doctors believe that taking medications to prevent cluster headaches before they occur is the most effective treatment. These medications include:

• Lithium -- This is useful for both episodic and especially chronic cluster headaches.

• Corticosteroids -- Prednisone is an example of these inflammation suppressing drugs that may provide relief.

• Calcium Channel Blockers -- Calcium channel blockers, which relax the muscles in the walls of your blood vessels, may help prevent cluster headaches. The medication Verapamil is one of the drugs in this group that has been effective.

• Anti-seizure Medications -- Medications used to control seizures in conditions such as epilepsy may be prescribed to help control cluster headaches. These medications include divalproex topiramate and gabapentin.

• How often the medication should be taken
• If the medication should be taken with meals or on an empty stomach
• What to do if pain or other symptoms persist