Headache, Cluster Headache

Medically Refractory Headache (new page)

Cluster headache is a series of bouts of headache that may strike several times a day for weeks or months, followed by a pain-free period. Another bout may return weeks or months later, or, for some patients, attacks continue in a chronic fashion without a break.

Also known as histamine headache, cluster headache occurs at any age, particularly in adolescence and middle age, and tends to run in families. Cluster headache is so excruciating, it is sometimes referred to as suicide headache. This type of neurovascular headache is less common than migraine, affecting an estimated 0.1-0.3% of the population, with men affected more than woman by a factor of 6:1.

What Happens in a Cluster Headache?

An attack begins quickly, often a couple of hours after falling asleep. The pain strikes one side of the head and reaches a peak within 2 to 15 minutes. The pain burns or stabs, spreading out from the temple and eye. The sufferer may pace, rock back and forth, bang the head, and cry out. The eye may become red, watery, or puffy; the eyelid may droop; and the nostril may become runny or stuffy.

Are There Triggers?

A variety of triggers have been associated with cluster headache attacks:

• Alcohol, cocaine, cigarette smoking
• Certain medications
• Various foods, such as bacon and preserved meats, chocolate, eggs or diary products
• Hay fever attacks
• High altitudes
• Bright light or sunlight
• Exertion, stress or relaxation
• Exposure to heat or cold

What Can Be Done for Cluster Headaches?

In time, bouts may stop by themselves. Meanwhile, patients may need a combination of medicines to control headache symptoms. Also, breathing 100% pure oxygen during an attack, especially at night, relieves symptoms for many people. For patients whose cluster headaches are not relieved by medication, electrical neurostimulation has been explored. The least invasive target is the sphenopalatine ganglion nerve bundle that can be reached through the gum. Another approach is to stimulate the occipital nerve at the base of the neck. About 60 percent of the time, patients experience relief through neurostimulation of the hypothalamus, located just above the brainstem, which is active in controlling daily rhythms (the circadian clock). Brain imaging has shown the hypothalamus is activated during a cluster headache attack. (1)

References:

1. Schoenen, J. Jensen, RH. Lantéri-Minet, MJA. Láinez, M. Gaul, C. Goodman, AM. Caparso, A. May, A. Stimulation of the sphenopalatine ganglion (SPG) for cluster headache treatment. Pathway CH-1: A randomized, sham-controlled study. Cephalalgia. Jan. 11, 2013. doi: 10.1177/0333102412473667. Accessed Feb. 6, 2013.

Reviewed April 2, 2012
Jaimie M. Henderson, MD
Director-at-Large, International Neuromodulation Society, 2011 - 2014
Associate Professor of Neurosurgery, and, By Courtesy, of Neurology and Neurological Sciences; Robert and Ruth Halperin Faculty Scholar; Director, Stereotactic and Functional Neurosurgery; Co-Director, Neural Prosthetics Translational Laboratory; Stanford University School of Medicine, Stanford, California, USA

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