Clinical Features And Classifications
Because of the location and associated symptoms, cluster headache is classified as a trigeminal autonomic cephalgia in the most recent diagnostic criteria from the International Headache Society .2 Cluster headache is divided into chronic and episodic categories based on the duration and frequency of episodes. Patients with the chronic form have at least one cluster period lasting at least one year, with no remission or remission of less than one month. Those with the episodic form have at least two cluster periods of at least one week but less than one year, with remission for at least one month. In addition to severe unilateral headache, associated diagnostic symptoms can include ipsilateral conjunctival injection, lacrimation, nasal congestion, rhinorrhea, eyelid edema, forehead and facial swelling, miosis, or ptosis. Patients who fulfill all but one of the diagnostic criteria are considered to have probable cluster headache. In one study, 64% of patients in the probable cluster headache group reported episodes exceeding three hours, or less often than every two days.4 A questionnaire combining headache duration of less than 180 minutes and conjunctival injection or lacrimation showed a sensitivity of 81.1% and a specificity of 100% for cluster headache diagnosis, and has been suggested as an effective screening tool.5
NOTE: At least five episodes are required for diagnosis. Symptoms cannot be attributed to another condition.
Information from reference 2.
Navigating The Symptoms & Treatments For Cluster Headaches
Cluster headache is a primary headache disorder and the most common of the group of headache disorders called trigeminal autonomic cephalalgias. The term cluster headache comes from the fact that these attacks occur in groups, or clusters. During a cluster cycle, brief, excruciatingly severe headache attacks recur between 1-8 times per day. Cluster cycles can last for weeks or months and are usually separated by remission periods, or periods of headache freedom, which usually last months or years. People who experience chronic cluster headache have no remission periods, or the remissions last less than a month at a time.
Cluster headache is often said to be the most painful of all headaches; it has been described as boring, burning, like a hot poker in the eye and as suicide headache.
Cluster pain is described as being at least 10/10 in severity, and typically there is an inability to lie still, says Dr. Deborah E. Tepper, MD, of Dartmouth University. People with migraine tend to lie down in a dark, quiet room, while, in contrast, those with cluster will pace, rock in one place, or sometimes even bang their head to distract themselves from the pain. People almost never lie down during a cluster attack.
What Treatment Guidelines And Pain Relief Options Are Available For Cluster Headache
There have not been a lot of randomized controlled trials of treatments for cluster headache. One of the treatments that has been formally studied is oxygen. High-flow oxygen inhaled through a mask has been shown to be effective as an acute treatment for cluster headache in a very well-designed study.
Other treatments that are used routinely are the triptans and those can be highly effective. Part of the issue with the triptans is that it takes 20 to 30 minutes for the concentration of the medication to reach levels that are therapeutic and by that time it may be too late to treat an attack. There are some individuals with very reliable timing of their cluster attack, who may treat before the attack begins. Alternatively, subcutaneous injection or nasal spray triptan formulations can rise in the bloodstream much faster than an oral triptan and, based on studies, are more effective for acute treatment of cluster attacks once the attack has begun. Ergotamines may also be helpful but are not as commonly used as triptans at this point.
Headache specialists don’t yet know whether the gepants are effective in cluster attacks. Presumably, they might have similar benefits as triptans although, again, with the issue of taking a while before they reach their therapeutic concentration.
In addition to oral steroids, injection of a steroid into the occipital region has been shown to be effective as a transitional therapy to break a cluster episode.
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Treatment For Migraines Or Cluster Headaches
Because there is not a cure for migraines or cluster headaches, the goal of treatment is to prevent the attacks as well as decrease the severity of symptoms. Specific treatments will vary based on the type of headache.
Migraine treatments include:
Medications that relieve painPain relief medications should be taken when an attack comes on to reduce the pain associated with the migraine. Mild migraines may be handled with OTC aspirin or ibuprofen, while severe migraines may need prescription medication. Other medications that may be used to relieve pain include Triptans, Ergots, Anti-nausea medication, pain medication and glucocorticoids.
Medications that prevent future attacksPreventive medications are taken daily and can reduce the number or severity of migraines. Not all patients are candidates for prevention medication. Preventive medication is best for patients who are not finding symptoms relief on pain relief medications, who have four or more migraines a month, and have attacks that last longer than 12 hours. Common medications that are used to prevent migraine attacks include cardiovascular drugs, antidepressants, anti-seizure drugs, pain relievers or Botox.
Your doctor will determine the most appropriate medication for your case, taking into consideration your symptom severity, overall health and other medical conditions.
Cluster headache treatment needs to be fast-acting. Treatments include:
- Pure oxygen treatment
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.
What Is A Cluster Headache
Cluster headaches are rare when compared to other types of headaches. The pain they produce is severe and tends to recur in the same way each time. They occur in groups, or clusters, and each attack lasts about 1 to 3 hours on average. The frequency of occurrence may range from every other day to multiple times a day. Cluster periods are followed by remissions that may last months or years.
Males are affected by cluster headaches more than females and they typically start around age 30.
Migraine Attacks That Group Together
Yes, migraine attacks can group together in time. In fact, research is increasingly showing that migraine frequency tends to be cyclical for many patients. Someone can go six months without a migraine attack, then have five in one month, then have a break before another spate of attacks. This is different from cluster headache. It doesnt mean a person has cluster migrainethey simply have migraine attacks that tend to group together in time.
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Exhalation Filters For Oxygen Masks
Filtered oxygen masks have the ability to prevent exhaled, potentially infectious particles from being released into the surrounding environment. These masks are normally of a closed design such that leaks are minimized and breathing of room air is controlled through a series of one-way valves. Filtration of exhaled breaths is accomplished either by placing a filter on the exhalation port or through an integral filter that is part of the mask itself. These masks first became popular in the Toronto healthcare community during the 2003 SARS Crisis. SARS was identified as being respiratory based and it was determined that conventional oxygen therapy devices were not designed for the containment of exhaled particles. Common practices of having suspected people wear a surgical mask was confounded by the use of standard oxygen therapy equipment. In 2003, the HiOx80 oxygen mask was released for sale. The HiOx80 mask is a closed design mask that allows a filter to be placed on the exhalation port. Several new designs have emerged in the global healthcare community for the containment and filtration of potentially infectious particles. Other designs include the ISO-O2 oxygen mask, the Flo2Max oxygen mask, and the O-Mask. The use of oxygen masks that are capable of filtering exhaled particles is gradually becoming a recommended practice for pandemic preparation in many jurisdictions.
Migraine And Cluster Headache Can Overlap
Yes is the answer to the first three questions. Both migraine and cluster headache involve the same nerves. This doesnt mean they are necessarily intertwined, but some symptoms overlap. Key differences are:
- Cluster attacks tend to last 15 minutes to three hours and can come many times in a day
- During a cluster attack, a person becomes restless and agitated
- Cluster headaches usually come on suddenly and disappear rapidly
To learn more, check out this excellent article from Tammy Rome explaining what cluster headache is and how it is treated. Tammy has both migraine and cluster headache, so she’s well-versed in both.
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The Difference Between Cluster Headaches And Migraines
Migraines have become so well;known that many people simply categorize any severe headache as a migraine. This isnt accurate, however, and there are a number of differences between migraines and other types of debilitating headaches. Cluster headaches, in particular, are very painful and have actually caused patients to commit suicide on occasion. How do you know whether that blinding pain in your head is a migraine or cluster headache? These comparisons will help you to determine what youre suffering from:
What Are Some Tips For Living With Cluster Headache
The first is to seek an accurate diagnosis and aggressive therapy with an effective acute and preventive regimen. Cluster headache is not something that one can live with untreated. It is helpful to understand that multiple different treatment approaches can be used. It is a disease that necessitates an aggressive strategy for management.
One other point is that for those with episodic cluster headache, a headache specialist‘s approach is often to use multiple treatments at once and then withdraw those approaches after one comes out of an episode. So, unlike migraine, where the different kinds of medications are minimized and treatment is as efficient as possible, cluster episodes are so disabling that multiple different approaches are used, sometimes simultaneously, to try to break someone out of an episode.
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Pain And Cluster Headache
Cluster headache is cyclic, the head pain occurs in groups, and can be short or long term. People experience the same type of severe, unilateral pain from a head pain that develops 1 to 4 times a day. People often describe this as a stabbing pain in one eye or behind their eye. These pain symptoms can last from 15 minutes to 2-3 hours, with the average lasting around half an hour.1-3
What Are Cluster Headache Symptoms
Cluster headaches tend to have very recognizable symptoms. When symptoms set in, it usually only takes 5 to 10 minutes for them to reach their worst. Common symptoms include one sided head pain and other symptoms involving the eye, nose and skin on the same side as the pain.
Pain from cluster headaches
Pain from cluster headaches has a few notable features:
- Often described as a burning or piercing feeling.
- Lasts 15 minutes to 3 hours at a time.
- Typically felt on the same side of the head in the current cycle rarely may switch in the future.
- Always centered behind one eye but can spread over the affected sides forehead, temple, nose and gums.
- Can make you feel like you cant sit still and need to pace, unlike the relief lying down provides for migraines.
Other cluster headache symptoms
Cluster headaches may also cause:
- Congestion: Your nose may run or become stuffy only on the side of the headache
- Eye problems: You may experience a drooping eyelid, eye pain or a watering eye. Your pupil may also look smaller. These symptoms appear on the same side of the head as headache pain.
- Face changes: You may start sweating and your face may become flushed on the side of the headache.
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What Are The Treatments To Manage Cluster Headache Episodes
Patients have to be aware that research on cluster headache is difficult as it is not common, unpredictable, and so severe that patients may be reluctant to engage in placebo studies. Here are options to break a bout frequently used in practice:;
- Occipital nerve blocks with steroids;
- Oral prednisone;
Other options with limited scientific evidence include topiramate, lithium, valproate, DHE IV , gabapentin.;
There is a very long list of options tried on a few patients only.;
What Is Migraine Or A Cluster Headache
Although migraines and cluster headaches both cause severe pain in the head around the forehead, temples or sinuses, they typically feel and act differently.
A migraine is severe pain or throbbing, typically on one side of the head.
Cluster headaches are painful headaches that are shorter in duration but recur over a period of a few months and are followed by a period of remission up to a few years. People who suffer from cluster headaches tend to get them during the same season each year.
A migraine is a common condition that affects more than 37 million Americans, while cluster headaches are rarer and only affect approximately 1 million people.
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What Are Cluster Headaches
- Primary headaches: Start because of a response from the part of the brain that communicates pain. A primary headache is its own health challenge, not part of a larger issue.
- Secondary headaches: Start because of another health condition. Several things can cause these headaches, including ear infections, nasal congestion and dehydration.
Cluster headaches can disrupt your life for weeks or even months at a time. They tend to follow a pattern, often showing up at the same time each day. They can also wake you up an hour or two after going to bed. These nighttime headaches may feel more severe than those during the day.
How Often Do Cluster Headaches Occur
Characterized by periods of daily painful headaches, cluster headache typically occurs at the same time each day with intense pain coming on quickly and often stopping as suddenly as it starts. Cluster headache can happen numerous times in a day where the pain experienced is severe and the symptoms produced are similar each time they develop.1-5 Cluster headache can be exhausting but when each headache ends typically there are no ongoing or residual symptoms. They end as suddenly as they come on.1
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What Are The Symptoms Of Cluster Headaches
Each attack occurs suddenly, often without any warning. Pain is typically in or around one eye or temple, and may spread to other regions on the same side of the head.
Episodes of cluster headaches often involve eye watering , nasal congestion or runny nose, a bloodshot eye , swelling around the eye, a droopy eye, constricted pupil, and facial sweating.
As suggested by their name, cluster headaches typically occur in clusters over several days or weeks, and then disappear for a variable period of time. Each attack usually lasts 45-90 minutes. Attacks may occur from once every couple of days, up to eight times per day. They usually occur at the same time of the day, and patients frequently say they could set their clock by the onset of the headache. It is quite common for a cluster to last 1-3 months once every year or two, and for them to occur at about the same time of the year.
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.
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What Is The Difference Between Cluster Headaches And Migraine
Almost everyone has suffered severe pain sometime in their life, whether it was pain from a broken bone, child birth or a painful, throbbing headache. You understand when someone says their pain was excruciating. Unfortunately, there are currently over 30 million people suffering from excruciatingly painful headaches, that occur over and over, due to migraine and cluster headaches. Both types of headaches incur debilitating pain, both are considered vascular headaches , and both tend to run in families. If you have a first degree relative with either type of headache you are much more likely to be diagnosed with that type of headache yourself. Cluster headaches often go undiagnosed for years as they are confused with migraine. So how do you know if you are suffering from frequent migraines or if you have cluster headaches?
There are differences between the two. Migraine is fairly common and sufferers are most often female whereas cluster headache sufferers are rare and predominantly male. Migraine headaches are most common in people between the ages of 25 to 55 although children and teens also are diagnosed with it. The migraines often start in childhood, adolescence or young adulthood. The onset of cluster headaches typically begins in the late 20s although there are exceptions. There are many similarities as well as differences, so lets look at a quick review of both types of severe headache and then compare the two.