All headaches types can cause horrific pain. But in the pantheon of headache, only one type has been given the moniker, “suicide headache.” Cluster headaches are considered the most painful type of headache which a person can suffer. They occur in series of attacks that can last months and have been described by some as worse than childbirth.
Cluster headaches often begin to appear between ages 20 and 40 and affect twice as many men as women. Heavy smokers are also more likely to suffer from cluster headaches. When cluster headaches occur, the person affected often feels severe pain on one side of the head and can show other cranial autonomic symptoms on the same side as the pain such as tearing, facial sweating, red eye, swelling and drooping of the eyelid and drainage from one nostril. Patients suffering from cluster headaches are also often agitated and restless during their attacks as opposed to people suffering from migraine.
Cluster headaches can be triggered by multiple factors. Alcohol is a common trigger as pain may start about an hour after the onset of drinking. It should also be avoided during an attack. Strong smells can also trigger cluster headaches.
Cluster headache attacks can last for up to three hours and can happen as often as 8 times a day. Attacks occur on average twice a day over 1 to 2 months and can then disappear completely for the next few months. When the attacks are separated by pain free periods of at least one month, the cluster headaches are said to be episodic. This form of the disorder affects about 80% of patients suffering from cluster headaches. However, when attacks occur in intervals shorter than a month for more than a year, patients are diagnosed with chronic cluster headaches.
Diagnosis of cluster headaches is difficult as there is no specific test for it and many patients suffering from recurrent migraines are often misdiagnosed with cluster headaches. Cluster headaches usually do not last as long (less than four hours on average) as migraines. The error in diagnosis can also be attributed to the fact that both disorders can come with cranial autonomic symptoms. However they occur in 95% of patients suffering from cluster headaches as opposed to 56% of people with migraine. Another difference is that even though both disorders are typically one-sided, the location of the pain stays the same from headache to headache in cluster headaches. In migraines, even if there is a preferred side, the migraine affects the other side of the head from time to time as well. In addition, aura is rare in cluster headaches. Finally, the symptoms associated with the headache are on the same side of the headache in cluster headache but they are not in migraines. Diagnosing cluster headaches correctly is extremely important as treatment is different from migraine treatment.
While there is no cure for cluster headaches, a variety of treatments exists. Once the attack has already begun, acute treatment can be used to stop the pain. However since the pain can become excruciating in 10 minutes, the patient needs to act extremely fast. Inhaling 100% oxygen can be used to treat cluster headaches. It takes about 15 minutes to work and sometimes it only delays the attack. It is a safe treatment but can be inconvenient as patients need to carry oxygen cylinders with them. Sumatriptan injections are also an effective way to treat acute cluster headaches. Sumatriptan and Zolmitriptan nasal sprays can also be used but might take longer to act.
Preventive treatment is used to stop attacks from happening. For example, calcium channel blockers such as Verapamil can prevent the development of cluster headaches. Corticosteroids may be administered as well as they work to reduce inflammation. But they should not be used for a long time because they can lead to severe side effects such as hypertension and diabetes. Lithium, melatonin, Topamax and more can also be used to treat cluster headaches.
As cluster headaches are an extremely painful disease, it is important to talk to a headache specialist to establish the best treatment plan suited to each individual. Current research is also working on figuring out new techniques to treat cluster headaches and holds lots of promising opportunities for the future.