The symptoms of a cluster headache include stabbing severe pain
behind or above one eye or in the temple. Tearing of the eye, congestion in the associated
nostril, and pupil changes and eyelid drooping may also occur.
The pain of a cluster headache commences quickly, without warning, and
reaches a crescendo within 2 to 15 minutes. It is often excruciating in intensity,
and is deep, nonfluctuating, and explosive in quality; only occasionally is it pulsatile.
In addition, 10 to 20 percent of patients report superimposed paroxysms of
stabbing, icepick-like pains in the periorbital region that last for a few seconds and may
occur once or several times in rapid succession; this paroxysmal pain usually heralds the
end of an attack. The symptoms resolve in 1 to 2 minutes.
The pain usually begins in, around, or above the eye or the temple
occasionally the face, neck, ear, or hemicranium may be affected (Sutherland and
Eadie, 1972). It is always unilateral, and generally affects the same side in
subsequent bouts. However, it may shift to the corresponding region of the opposite
side in 15 percent of patients (Manzoni et al, 1983b), usually for the duration
of a bout, less often switching sides within a bout. Many patients prefer to be
upright and active when an attack is in progress, but this is reported with a frequency
that is not high enough to be useful diagnostically.
Description of Cluster Headach
Cluster headaches have been known as histamine headaches, red migraines, and Horton's
disease, among others. The constant factor is the pain, which transcends by far the
distress of the more common tension-type headache or even that of a migraine headache.
Cluster headaches afflict less than 0.5% of the population and predominantly affect
men; approximately 80% of sufferers are male. Onset typically occurs in the late 20s, but
there is no absolute age restriction. Approximately 80% of cluster headaches are
classified as episodic; the remaining 20% are considered chronic. Both display the same
symptoms. However, episodic cluster headaches occur during 1- to 5-month periods followed
by 6- to 24-month attack-free, or remission, periods. There is no such reprieve for
chronic cluster headache sufferers.
Causes & symptoms of Cluster Headache
Biochemical, hormonal, and vascular changes induce cluster headaches, but why these
changes occur remains unclear. Episodic cluster headaches seem to be linked to changes in
day length, possibly signaling a connection to the so-called biological clock. Alcohol,
tobacco, histamine, or stress can trigger cluster headaches. Decreased blood oxygen levels
(hypoxemia) can also act as a trigger, particularly during the night when an individual is
sleeping. Interestingly, the triggers do not cause cluster headaches during remission
The primary cluster headache symptom is excruciating one-sided head pain centered
behind an eye or near the temple. This pain may radiate outward from the initial focus and
encompass the mouth and teeth. For this reason, some cluster headache sufferers may
mistakenly attribute their pain to a dental problem. Secondary symptoms, occurring on the
same side as the pain, include eye tearing, nasal congestion followed by a runny nose,
pupil contraction, and facial drooping or flushing.
Diagnosis of Cluster Headache
Cluster headache symptoms guide the diagnosis. A medical examination includes recording
headache details, such as frequency and duration, when it occurs, pain intensity and
location, possible triggers, and any prior symptoms. This history allows other potential
problems to be discounted.
Treatment of Cluster Headache
Treatment for cluster headaches is composed of induction, maintenance, and symptomatic
therapies. The first two therapies are prophylactic treatments, geared toward preventing
headaches. Symptomatic therapy is meant to stop or shorten a headache.
Induction and maintenance therapies begin together. Induction therapy is intended to
break the headache cycle with drugs such as corticosteroids (for example, prednisone) or
dihydroergotamine. These drugs are not meant for long-term therapy, but rather as a
jump-start formaintenance therapy. Maintenance therapy drugs include verapamil, lithium
carbonate, ergotamine, and methysergide. These drugs have long-term effectiveness, but
must be taken for at least a week before a response is observed. With long-tern treatment,
methysergide must be stopped for one month each year to avoid dangerous side effects
(formation of fibrous tissue inside the abdominal artery, lungs, and heart valves).
Despite prophylactic treatment, headaches may still occur. Symptomatic therapy includes
oxygen inhalation, sumatriptan injection, and application of local anesthetics inside the
nose. Surgery is a last resort for chronic cluster headaches that fail to respond to
Alternative treatment of Cluster Headache
Since some cluster headaches are triggered by stress, stress reduction techniques, such
as yoga, meditation, and regular exercise, may be effective. Some cluster headaches may be
an allergic response triggered by food or environmental substances, therefore identifying
and removing the allergen(s) may be key to resolution of the problem. Histamine is another
suspected trigger of cluster headaches, and this response may be controlled with vitamin C
and the bioflavonoids quercetin and bromelain (pineapple enzyme). Supplementation with
essential fatty acids (EFA) will help decrease any inflammatory response.
Physical medicine therapies such as adjustments of the spine, craniosacral treatment,
and massage at the temporomandibular joint (TMJ) can clear blockages, as can traditional
Chinese medical therapies including acupuncture. Homeopathic treatment can also be
beneficial. Nervous system relaxant herbs, used singly or in combination, can allow the
central nervous system to relax as well as assist in peripheral nerve response. A few
herbs to consider for relaxation are valerian (Valeriana officinalis), chamomile (Matricaria
recutita), rosemary (Rosemarinus officinalis), and skullcap (Scutellaria