Cluster Headaches Cause Years Of Needless Pain
The first time I experienced a cluster headache, I thought I was dying. I thought it was an aneurysm or stroke, because surely this amount of pain would kill me. But then, after around 90 minutes, it was gone, leaving my body drained and my mind full of fear.
Cluster headache is one of the most painful conditions people can experience. Those who have felt it rate the pain as considerably worse than that from childbirth, kidney stones and gunshot wounds. It is not like any other kind of head pain it is a different beast entirely. However, when people like myself head to the hospital or to our physicians, we rarely get the help we need. Medical professionals commonly chalk up the pain as a migraine attack a misdiagnosis that can take years or even decades to correct, meaning a long wait before effective treatment can finally be prescribed.
I was told for six years that I couldnt have cluster headaches because I am a woman, and cluster headache is most common in men. My symptoms were dismissed by several clinicians. I relied on sumatriptan for relief. The drug helped to stop attacks in progress, but it cost US$215 for just two injections and came with severe side effects that I would not understand fully until my early 30s, when tests revealed evidence of a possible heart attack. Had I been offered other forms of treatment sooner, such as oxygen therapy, I could have avoided some of these injections.
What Triggers Cluster Headaches
Many patients report their headaches to begin while sleeping. Additionally, alcohol can trigger cluster headaches in patients who are in the midst of a cycle. Histamines and nitroglycerin can trigger cluster headaches in patients. Seasonal variation has been described, although this is inconsistent for many patients. Some patients have clusters precipitated by environmental changes or changes in stress or activity levels. Hormonal factors, or menstruation, do not seem to trigger cluster headaches. Other risk factors include smoking and a family history of the problem.
Cluster headache is always unilateral, or one-sided. However, some people may experience some variability of the side on which their headache occurs. Most people with cluster headaches describe their pain as occurring around or behind the eye. Pain may radiate along the forehead, into the jaw or along the gum line and into the teeth, or across the cheek of the affected side. Infrequently, pain may extend into the ear, neck, or shoulder.
In addition to head pain, many people with cluster headaches have symptoms and signs that may include:
Rescue Treatments For Quick Relief
Migraine rescue medications that have been used for years include a class of drugs called triptans, as well as nonsteroidal anti-inflammatory drugs .
Two newer classes of medications approved to treat acute migraine are gepants and ditans. Gepants are unique in that they are not associated with medication-overuse headache, a kind of headache that can occur when people overuse acute migraine medications, according to the American Migraine Foundation.
For cluster headaches, standard treatments include injectable triptans and high-flow oxygen, says Lipton.
Fast treatment is advisable for cluster headaches, Diamond says, because the pain is so severe. Injectables or nasal sprays work quicker than pills, the fastest treatment for a cluster headache is high-flow oxygen through a mask for about 10 minutes, she says.
Nerve blocks can also be used to treat cluster headaches, says Rajneesh. These in-office procedures, in which a numbing agent, or anesthetic, is injected into the scalp near particular nerves, can improve cluster headaches for a few weeks to a few months, he adds.
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How To Manage Weather
June is Awareness Month, and many people with migraines say that weather changes trigger headachesespecially extreme heat.
“Migraine is a prime example of a neurologic condition with environmental triggers,” says Orrin Devinsky, M.D., a neurologist at New York University and a Fellow of the American Academy of Neurology. “Foods are often considered the main trigger, but weather may be an underappreciated factor. For many people with migraine, recognizing their own triggerssuch as food or sleep deprivationcan be one of the most effective forms of prevention,” he says.
According to a recent survey by the National Foundation, specific weather triggers may include:
- Temperature changes
- Bright lights and sun glare
- Barometric pressure changes
Some experts suggest that people with frequent headaches, including migraine, have a lower threshold for pain or are more sensitive to changes in the environment, including weather. On the other hand, several objective studies do not show a consistent association between weather changes and migraine. : 941-52)
Why Are They Called Cluster Headaches
Cluster headaches get their name from how they affect you. They come on in clusters, or groups, before temporarily going away for most people.
Each headache tends to last 30 to 45 minutes, though some are shorter and some longer. You may experience up to eight of these headaches within 24 hours. And this may happen for weeks or several months.
Then the clusters usually pause, for reasons that arent yet understood. The headaches go into remission for months or years before returning. Some people never get much of a break, though. They experience chronic cluster headaches. This happens to about one in five people who get cluster headaches.
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Finding The Right Treatment Options For Cluster Headache
Dr. Tepper has one important piece of advice for patients living with cluster headache: Get to a headache specialist. Most cluster patients we can treat, he says. A headache specialist can help you determine the best course of treatment for your symptoms and your lifestyle.
While cluster headache experiences can vary, in most cases it can be successfully treated by individualizing acute and preventive drug treatment. A full treatment plan might include a temporary medication bridge to provide initial relief with steroids, as well as daily preventive medication to help avoid attacks during these weeks-long cycles.
Its important to note that only sumatriptan and dihydroergotamine injections are FDA-approved for acute treatment of CH, while galcanezumab is approved for the prevention of episodic cluster. The FDA has approved a portable device without significant side effectsthe non-invasive vagal nerve stimulatorfor the acute headache attacks and preventative treatment of episodic cluster headache attacks. This device is now commercially available with a prescription.
It is important to work with your doctor to arrive at the treatment plan thats right for you. Read on to see some of the available treatment options that you might find in your plan.
Managing Migraines In General
Whatever your specific triggers, the following steps will help you manage your migraines.
Practice good sleep hygiene. Make sure you get enough sleep and try to fall asleep around the same time each night. Interruptions in your sleep schedulesuch as getting too much or too little sleepcan trigger migraines in some people.
Drink plenty of water. Eating regular meals and drinking enough water can help prevent migraines caused by a drop in blood sugar or dehydration. A common recommendation is to drink six or eight 8-ounce glasses of water every day. However, some adults may need more, depending on how much they exercise, for example.
Be careful with coffee. Although caffeine can provide migraine relief , too much can cause migraines. Caffeine can be found in chocolate and cocoa beverages such as coffee, tea and colas and certain medications.
Limit alcohol. Blood flow to your brain increases when you drink alcohol. Red wine in particular triggers migraines in many people.
Watch what you eat. Many foods can trigger migraines. A few of the more common ones include peanuts, peanut butter, other nuts and seeds, chocolate, and foods containing tyramine, such as aged cheeses and cured meats.
Exercise regularly. Research has shown that regular, moderate aerobic exercise may reduce the severity, duration, and number of migraines in many people. Regular exercise also helps control stress, another migraine trigger.
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Essential Oil To Relieve Headache
Some oils are meant to relieve the symptoms of headaches. Lavender oil is very essential to reduce the headache, only inhaling it for 1 minute will show the results. It is known as the best oil to get rid of a headache.
There are some other essential oils such as peppermint oil, rosemary oil, and chamomile oil. Applying a few drops of these oils in the affected area reduces the intensity of tension, stress, and headache.
Boise Neurologist Doctors And Specialists For Cluster Headaches
Type of Physician: Neurologist
What is a Neurologist? A certification by the Board of Psychiatry & Neurology practitioners focus on the diagnosis and treatment of all categories of disease or impaired function of the brain, spinal cord, muscles and nervous system, as well as the blood vessels that relate to these structures. The neurologist is often the primary physician but also serves as a consultant to other physicians and may render all levels of care, including the continuing care of outpatients and/or inpatients. The neurologist will often perform and interpret tests that relate to the nervous system or muscles.
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Causes Of Migraines Or Cluster Headaches
The cause of migraine appears to be linked to hormones, genetics or environmental factors, while the cause of cluster headaches is not fully understood. Research has linked cluster headaches to a nerve in the face that causes intense pressure around one of the eyes.
Triggers for migraines
Cluster headaches typically recur in certain seasons, so they are often mistaken for seasonal allergies.
Do Migraine Attacks Last Longer Or Happen More Frequently Than Cluster Headaches
A migraine attack typically lasts between 4 and 72 hours, says Rajneesh. Thats longer than a cluster headache lasts, which is between 15 minutes and three hours.
Most people with migraine have one or two migraine attacks per month, but some people have them much more frequently. About 1 percent of the population has chronic migraine, which is defined as having at least 15 migraine days per month, according to American Migraine Foundation.
Cluster headaches come in bouts, or cluster periods. These periods last for weeks or months, according to the International Headache Society, and are separated by remissions lasting months or years.
During a cluster period, the frequency of headaches ranges from one every other day to as many as eight per day.
How Do Cluster Headaches Happen
- The discomfort of cluster headaches is due to the dilation or enlargement of the blood vessels which provide blood to your face and brain. The dilation causes pressure on the trigeminal nerve, transmitting pain signals from your face into the brain. It is not known what causes this dilation.
- Researchers suspect that abnormalities in the hypothalamus region, a small brain area that regulates body temperature, sleep, blood pressure, and hormone release, could cause Cluster Headaches.
- Cluster Headaches can be caused due to the rapid release from the chemical called histamine. Cluster headaches could also be called histamine headaches.
- Smokers seem to be at a greater risk of suffering from cluster headaches. The attacks of cluster headaches can be caused by drinking alcohol or strong odors like paint, perfume, or petrol.
- A few people who experience cluster headaches also have relatives who suffer from these headaches, suggesting a genetic connection.
Types Of Cluster Headache
- Episodic Cluster Headache:
Episodic cluster headaches frequently occur between one week to one year. Then a period of headache-free time for a month or more.
- Chronic Cluster Headache:
Chronic cluster headaches can be seen frequently for more than a year. They are then followed by a period of headache-free lasting less than a month.
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Symptoms Of A Cluster Headache
Cluster headaches begin quickly and without warning. The pain is very severe and is often described as a sharp, burning or piercing sensation on one side of the head.
It’s often felt around the eye, temple and sometimes face. It tends to affect the same side for each attack.
People often feel restless and agitated during an attack because the pain is so intense, and they may react by rocking, pacing or banging their head against the wall.
You may also get 1 or more of the following symptoms:
- a red and watering eye
- drooping and swelling of 1 eyelid
- a smaller pupil in 1 eye
- a sweaty face
- a blocked or runny nostril
The attacks generally last between 15 minutes and 3 hours, and typically occur between 1 and 8 times a day.
Remove Anything Resting Tight On Your Head
Some migraine sufferers say that this simple step may provide relief. Remove tight items like a hat, goggles, headband or ponytail holder before they cause an external compression headache. External compressions headaches can lead to a migraine in people who suffer from them, if the item causing the compression is worn for a prolonged time.
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What Are The Causes Of A Migraine
Migraines arent the same as other types of headaches. Migraine is a genetic neurological disease in which there is an interplay between the pain neurons in the brain and the blood vessels.
Migraines can be set off by different stimuli, foods, and conditions. These triggers vary from person to person, with the most common including:
How Often Cluster Attacks Can Occur
About 1 in 250 men and 1 in 700 women experience cluster headaches, according to Lawrence Robbins, MD, of the Robbins Headache Clinic in Riverwoods, Illinois, and the author of the book, Advanced Headache Therapy: Outpatient Strategies.
While migraine is more common in women, cluster headache is more common in men, he says. About 10 to 15% of people get chronic clusters where you dont get a break for one or two months, but most people have episodic clusters where you get a break. The headache comes and then goes away. If you are lucky, you can have years between the cluster cycles.
Cluster headaches are characterized by very severe pain that can last from 15 to 90 minutes, sometimes longer, and typically is located around or through one eye or on the temple. A series of cluster headaches can last from several weeks to several months and occur once or twice a year. In addition to pain, individuals may experience symptoms of nasal congestion, forehead and facial sweating, nausea, and tearing of the eyes.
Cluster headaches are much less common than migraine headaches, says Noah Rosen, MD, director of Northwell Healths Headache Center in Great Neck, New York. It is more common in younger people and, while there is not a strong family component, about 1% of people with cluster headache have a family member with it, he says.
While cluster headache is rare, living with the condition is a daily struggle.
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Both Migraine And Cluster Headache Can Get Better With Age
Puberty is often the time when girls first have migraine attacks, and theyre most common between ages 18 and 44, according to Migraine Research Foundation.
About 2 out of 3 women with migraine will have significant improvement in their migraine attack frequency when they go through natural menopause, especially for women who have migraine with aura, according to American Migraine Foundation.
The average age of onset of cluster headache is between 20 and 40, according to American Migraine Foundation. People may not age out of cluster headaches entirely, but the amount of time between bouts of cluster headaches usually increases, leading to fewer headaches, according to the Migraine Trust.
Keep A Migraine Diary
If you feel that weather might be one of your migraine triggers, what can you do? The first step is to keep a migraine diary. Share this information with your neurologist. Below are several factors to include in your diary each time you experience a migraine:
- The date and time. When did the migraine begin, and when did it end?
- Where you feel the pain. For example, is the pain shifting from one side of the head to the other, or does it affect the whole head?
- Changes in the weather. Was it especially hot or humid before your migraine started? Or especially cold and dry?
- What the pain feels like. Is it pounding or throbbing? On a scale of one to 10 , how painful is the headache?
- Whether or not physical activity is a factor. Were you running around outside when the migraine began, for example?
- The presence of any unusual symptoms before the pain starts. Some people experience unusual symptoms up to 48 hours before a migraine starts. These may include nausea drowsiness irritability sensitivity to light, sounds, or motion visual disturbances such as seeing zigzag patterns or flashing lights and others.
- What treatments you have tried in the past. Don’t forget to include whether the treatment helped.
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Clinical Features And Classification
In 2004, the International Headache Society published new criteria for diagnosing cluster headache. To fulfill criteria for diagnosis, patients must have had at least five attacks occurring from one every other day to eight per day and attributable to no other disorder.5 In addition, headaches must cause severe or very severe unilateral orbital, supraorbital, or temporal pain lasting 15 to 180 minutes if untreated, and be accompanied by one or more of the following: ipsilateral conjunctival injection or lacrimation, ipsilateral nasal congestion or rhinorrhea, ipsilateral eyelid edema, ipsilateral forehead and facial sweating, ipsilateral miosis or ptosis, or a sense of restlessness or agitation.5 Episodic cluster headache is defined as at least two cluster periods lasting seven to 365 days and separated by pain-free remission periods of one month or longer. Chronic attacks recur over more than one year without remission or with remission lasting less than one month.5
Cluster headache is diagnosed by history, and the key feature is a pattern of recurrent bouts of near-daily attacks lasting for days, weeks, or months. Patients fearing an attack may be afraid to go to sleep. Precipitants of cluster headache include hypoxia, which may occur with sleep apnea. Vasodilators such as nitroglycerin, alcohol, and carbon dioxide may trigger a headache during a cluster period.10