What is cluster headache?
Cluster headache is a rare but severe type of headache that comes in episodes ('clusters') and which used to be known as Horton's neuralgia.
The cause of cluster headache is unknown. It seems to involve hereditary factors. Attacks may possibly be triggered by drinking alcohol or by low air pressure (in an airplane).
Signs and symptoms
Cluster headache occurs mostly in men, in attacks lasting from half an hour up to three hours, which may happen a few times a day. The attacks often occur during certain periods, ranging from a few weeks to a few months (clusters). Outside these periods, patients have no complaints. Some patients do not have such periods, and their headaches can occur every day. This chronic type affects only about 15% of the cluster headache patients, and is thus rather rare. During an attack, the patient feels a severe, piercing pain around or behind one eye. The pain is often accompanied by signs like a watery eye, blocked or running nose, sweat appearing on the forehead, a narrowed pupil and a drooping or swollen eyelid. The headache may be so severe that the patient feels the urge to walk around; patients sometimes literally bang their head against a wall.
How is cluster headache diagnosed?
The pattern of complaints is usually so characteristic that it is enough for the diagnosis. Further examinations (like brain scans) are rarely necessary.
What are my treatment possibilities?
The treatment of cluster headache nearly always consists of a combination of drugs to prevent an attack (preventive medication) and drugs to treat an attack. They are usually prescribed by a neurologist.
Verapamil is one of the most effective preventive medicines. Others include methysergide, pizotifene, flunarizine, prednison and lithium.
Treating an attack
Attacks of cluster headache can be treated by having the patient inhale oxygen or by injecting them with sumatriptan (tablets do not work fast enough).
Interventional Pain Treatments
These are preferably used at the start of a period of attacks.