Cluster Headache

Cluster headaches are a relatively uncommon form of headache. They are characterized by sudden sharp pain that involves one side of the head, usually the forehead and eye. The headaches last for anywhere from a few minutes to an hour and a half. There are two types of cluster headaches, episodic and chronic. The episodic type is much more common, occurring in about 90 percent of cases. Cluster headaches occur much more frequently in men.

Cluster Headache Causes

The cause of cluster headache is unknown. There are a number of possible precipitating factors but the exact physiology (as with most headaches) is unknown.

Cluster Headache Symptoms

The symptoms of the two types of cluster headaches, episodic and chronic are similar in a number of ways. They both exhibit sudden, sharp, stabbing pain in the forehead and eye. There is one or more of the following: stuffy or runny nose, redness of the eye, tearing, flushed appearance of the face, small pupil or drooping eyelid. These symptoms all occur on the same side as the headache. The headaches tend to occur at the same time of day, and last for a standard amount of time.

Cluster Headache Diagnosis

As always, a careful history and physical examination are the first steps in diagnosis. In the case of episodic cluster headaches, the headache tends to go away for many months. In the case of chronic cluster headache, the headaches do not go away or if they do, it is for a short period of time. Imaging studies such as CT scans and MRI scans are usually not needed if the diagnosis is straightforward. However, if there are unusual aspects to the diagnosis or presentation, then scanning may be warranted. Some things that may lead to scanning include increasing headache frequency, dizziness or coordination changes, numbness or tingling, weakness, headaches that wake the patient from sleep and new onset of headaches in older patients.

Cluster Headache Treatment

The most common treatments for cluster headaches are various medications. These include lithium, methysergide, prednisone and calcium channel blockers. Inhaled oxygen may be used to abort an attack. In certain cases that fail medical treatment, surgical options may be tried. These include radiofrequency lesioning of the trigeminal nerve and stereotactic radiosurgery with the gamma knife.