Headache, Cluster -
Cluster headache, also known as histamine headache,
is a specific vascular headache syndrome. Attacks
usually are severe and unilateral and typically are
located at the temple and periorbital region. Each
headache is brief in duration, typically lasting a
few moments to 2 hours. Cluster refers to a grouping
of headaches, usually over a period of several
weeks.
At one time or another, almost everyone has had a
headache. Some headaches are only moderately
painful, while others are severe and disabling. No
matter what kind of headache you have, you'd rather
be without it.
In most cases headache pain, even severe headache
pain, is not the result of any underlying disease.
In fact, the vast majority of headaches are primary
headaches - headaches that aren't caused by a
specific medical condition. These include
migraines,
tension-type headaches and cluster headaches.
Treatment
Unfortunately, there's no treatment to stop cluster headaches. The goal
of treatment is to help decrease the severity of pain and shorten the
headache period.
Medications
Over-the-counter pain medications generally are ineffective, often
taking longer to work than the headache lasts. However, some
prescription drugs may provide relief. These include:
-
Ergotamine (Ergomar).
This drug works by constricting swollen blood vessels in the outer
area of your brain and in your scalp. Ergotamine is an effective
pain reliever for some people. Doctors also prescribe it to prevent
attacks for short periods of time. However, the dosage must be
limited to avoid side effects, especially nausea.
-
Calcium channel
blockers.
Many people find calcium channel blocking agents, such as verapamil
(Calan, Verelan), effective in preventing cluster headaches. These
drugs help relax the muscles in the walls of your blood vessels.
-
Lithium (Lithobid).
This drug is effective during a chronic phase of cluster headaches.
Your doctor can adjust the dosage to avoid side effects such as
tremor and drowsiness.
-
Corticosteroids.
Doctors commonly prescribe inflammation-suppressing drugs called
corticosteroids, such as prednisone (Deltasone, Prednisone Intensol),
to stop a cluster headache.
-
Oxygen.
Inhaling 100-percent oxygen for a few minutes often provides relief
and may relieve frequent cluster headaches that occur primarily at
night.
-
Antimigraine
medication.
If injected at the first sign of an attack, sumatriptan (Imitrex),
which is commonly used to treat migraines, may lessen the pain of a
cluster headache.
-
Local
anesthetics.
The use of local anesthetics, such as lidocaine (Xylocaine), may be
effective against cluster headache pain when used in nasal spray
form.
-
Botulinum toxin
(Botox).
Injections of Botox, the wrinkle-smoothing toxin, into the scalp may
provide relief for some people with cluster headaches who don't
respond to conventional treatment. Larger studies are needed to
confirm research to date.
Nausea
Chronic cluster headaches may require you to use two or more
medications.
Surgery and radiation
Surgery, while rarely needed, provides relief in about two-thirds of
people with chronic cluster headaches. However, residual muscle weakness
in your jaw or sensory loss in certain areas of your face and head can
occur. Surgical procedures for cluster headaches include:
-
Conventional
surgery.
For relief of pain from chronic cluster headaches, your doctor may
surgically cut or destroy certain nerves in your face. The
trigeminal nerve — the large nerve that provides sensation to most
of your face — can be surgically damaged in an effort to relieve
cluster headaches. This procedure has had limited success.
-
Radiation.
An intensely focused beam of radiation aimed at the trigeminal nerve
may be successful in people who don't respond to other treatment.
Radiation isn't a common treatment for cluster headaches, and
further research is needed to determine its effectiveness.
