What is Cluster Headaches

A specific trait to Cluster Headaches are that they occur in “clusters”, hence the name, meaning they affect the same location of the head, around the same time of day, during the same time of year (Mayo 2007). Patients may also experience tearing from the eye on the same side of the head as the pain as well as nasal discharge or stuffiness, or neurological complications (Horner’s syndrome). In contrast with the other two types of primary HA, emotion and food are NOT triggers in Cluster Headaches.

Cluster Headaches are considered to be from vasodilatation of the blood vessels in the brain likely from the release of Serotonin and histamines (Silberstein 2007). This causes the acute and severe pain by compressing and irritating Cranial Nerve V (Trigeminal), which innervates the sensory and some motor function of the face.
Some of the known risk factors/ inciting events of Cluster Headaches are:
  • Alcohol and cigarette smoking
  • High altitudes
  • Bright light
  • Physical Exertion
  • Heat
  • Certain medications (vasodilators)
  • Cocaine and other illicit drugs


Treatment for Cluster Headaches

Typical over the counter medications have no use for Cluster headaches. Some commonly used therapies are (Beck 2005):

  • Oxygen – First line treatment.
  • Triptans – First line in conjunction with oxygen.
  • Ergots
  • Capsaicin (intranasal)
  • Verapamil – Prophylactic
Medications and techniques that are considered preventive therapies are directed at reducing the frequency and severity of the attacks. Unfortunately, most of these medications are not able to terminate an acute episode so they are typically used in conjunction with the abortive therapies during an attack.  Verapamil is first line for prophylaxis of Cluster Headaches however; alternatives for prophylaxis include prednisone and antiepileptic drugs.  However these medications should only be used if verapamil is not tolerated or not effective (Beck 2005).
A number of surgical treatments have been performed in cases of Cluster Headaches because of their high resistance pharmacologic therapy.  Of these minimally invasive procedures, sphenopalatine ganglion (SPG) blockade has been shown to have the most successful results (2006 Felisati).  SPG blocks have are a safe, low-cost, therapy that, if effective, oftentimes can be self-administered for pain relief.” (2006 Obah).

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