Cluster Headaches
Cluster headaches are a series of relatively short but extremely painful headaches experienced daily for weeks or months at a given time.
Cluster headache sufferers tend to report their pain as being the worst imaginable, and these are often considered the nastiest of the primary headache disorders. Although not a very common type of headache, approximately 1 in 1000 people suffer from them, they are severe, and the pain is enough to make some cluster headache sufferers feel suicidal. They tend to happen at the same time each year. Traditionally they were far more common in men, a ratio of males to females of 8:1, however there has been an increase in women with the ratio dropping to 2.5:1. Cluster headaches may disappear completely (go into ‘remission’) for months or years, but they can come back without any warning.
The team at Auckland's new Headache & Migraine Clinic have specific training in treating cluster headaches, and are here to help you.
What are the symptoms?
The series of Cluster headaches usually last several weeks to several months, once to twice per year. They may occur every other year or less frequently. Clusters are most common in spring or autumn. Attacks appear to be linked to the circadian rhythm, your body’s 24-hour clock. They happen so regularly, generally at the same time each day, that they’ve been called “alarm clock headaches.” Approximately half of the patients will be woken from sleep with an attack. Another common time is between 9pm and 10pm.
Rapid onset of pain without aura or warning, reaching full force within 5 or 10 minutes
Excruciating Normally short-lived 15 – 90 minutes, the average being 45 minutes
Sharp, stabbing pain, sometimes throbbing
Pain is felt around or through one eye, in the forehead and temple, and may involve the face and neck.
One to two headaches per day, in some up to 8 headaches in 24 hours
Usually one-sided, but in 10-15% of patients, can change sides within the cluster or between clusters
Living with cluster headaches can be frightening and difficult. The attacks can seem unbearable and make you feel anxious and depressed. Ultimately, they can affect your relationships, your work and the quality of your life.
Other symptoms that accompany the pain?
Although the pain starts suddenly, you may experience a few associated symptoms:
Swollen or drooping eye
Smaller pupil in the eye
Eye watering
Runny or congested nose
Nausea
Forehead and facial sweating and general perspiration
How are they Diagnosed?
There is no specific test that identifies cluster headaches. Your diagnosis will be made based on the interpretation of your symptoms and how you respond to different treatments. You may be referred to a neurologist who will clarify your diagnosis and prescribe medication.
What causes a cluster headache?
Cluster headache, like other headache and migraine types is caused by a sensitised brainstem. We know that the upper cervical spine when problematic, is capable of sensitising the brainstem. If you experience pain or stiffness in your neck, it is possible that your upper cervical spine is playing a role in sensitising your brainstem and triggering cluster headaches.
Medication for cluster headaches
Due to the severity of the pain from the very beginning of the attack, patients are usually treated with fast acting, abortive medications like inhaled oxygen, sumatriptan injections or nasal spray. Sumatriptan medication by way of a nasal spray or injection is commonly prescribed to patients with cluster headaches. The sumatriptan acts on the brainstem to ‘desensitise’ it, at that moment in time.
Our approach
It makes sense that if neck pain or stiffness is a symptom you experience in association with cluster headaches, have your upper cervical spine assessed by a skilled practitioner to ‘rule in’ or ‘rule out’ your neck as a cause of your cluster headaches.
We know that cluster headache like other primary headaches are the result of a ‘sensitised’ brainstem, normal nerve messages are amplified by the sensitised brainstem resulting in the generation of severe head pain by the brain. Our approach involves finding the neck segments responsible, treating them, and desensitising the brain stem for long term results.