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What are cluster headaches?

Cluster headaches have been called the "demon of headaches." They are extraordinarily severe headaches that usually develop around or behind one eye.

They are called "cluster headaches" because they occur in groups, recurring for days, weeks, or months at a time and then disappearing for a year or longer. During an episode, a person may experience up to 10 headaches in a single day.

What causes cluster headaches?

Cluster headaches are a form of "vascular" headaches. They occur when blood vessels in the scalp contract and expand to produce a throbbing pain. They are related to migraine headaches, but they are distinctly different in their duration and frequency. Cluster headaches are believed to have neurological origins. However, there is some evidence that excessive smoking and/or alcohol consumption triggers them.

How are cluster headaches diagnosed and treated?

A diagnosis usually can be deduced from the symptoms, but a doctor may want to do tests to rule out other causes. These examinations may include x-rays and a CT (computed tomography) or MRI (magnetic resonance imaging) scans of the head. Treatment is aimed at prevention, since conventional painkillers are of little help.

What can I do myself?
Keep a careful record of when headaches occur, as well as food and drink intake and other activities in the hours preceding their onset. Although foods rarely play a significant role in precipitating attacks, some victims do find that particular foods (such as chocolate or cheese) may be a factor.

Avoid cigarette smoking and consuming alcohol, which dilate

Cluster headaches typically occur on one side of the head and are more common in men than in women.

blood vessels. Finally, a balanced diet, regular exercise, and regular sleeping habits may help control cluster headaches.

When should I see my doctor?
Any severe pain centered primarily in or around one eye should be reported to a physician immediately, because it could be a symptom of acute glaucoma. If a person has suffered cluster headaches in the past, any change in their pattern should be investigated.

What will the doctor do?
Simple painkilling medicines rarely help cluster headaches because, by the time the drugs enter the bloodstream, the pain may be ending.

Swollen blood vessels account for the pain of cluster headaches

Thus, preventive therapy is the key to controlling cluster headaches. When an initial attack signals the onset of a cluster, the physician usually prescribes a series of medications, to be taken prophylactically for a period of weeks or months, depending on the individual's history. These may include drugs such as ergot derivatives or methysergide. Drugs that constrict blood vessels (vasoconstrictors) or that affect blood circulation in other ways may be helpful. Steroid medications also may be prescribed.

The course of cluster headaches

Although cluster headaches can occur at any age, they most often begin during the 20s or 30s and are more common in men than in women. Most often, cluster headaches waken their victims in the middle of the night. The pain is usually so excruciating that the individual cannot find any comfortable position. Some patients are so driven by the pain that they resort to headbanging — a tactic that does not help.

The pain is usually excruciating but brief — an attack usually disappears in 30 to 60 minutes. Typically, attacks occur for 6 to 10 weeks and then disappear for periods of months or years. However, a minority of victims — less than 15 percent — suffer chronically, with attacks occurring almost daily.

Clusters are most likely to occur in the spring and fall, although no direct links to weather, allergies, or pollen have been established.

Are cluster headaches dangerous?
Although they are extraordinarily painful, the headaches themselves are not dangerous. However, some physicians believe that cluster headaches may be part of a more generalized disease process because they are linked to an increased incidence of hypertension, coronary artery disease, stomach ulcers, and diabetes.