Cluster headaches are one of the most mysterious types of headache. Very little is known about this type of headache. Also known as suicide headaches due to the intense pain, cluster headaches come on quickly and intensely and have few definitive causes or triggers. So, what are cluster headaches?
What are cluster headaches?
Brian M. Grosberg, M.D., director, Montefiore Headache Center and associate professor, Clinical Neurology, Albert Einstein College of Medicine of Yeshiva University believes that cluster headache pain is even more debilitating than migraine pain, noting:
“Cluster headache, also known as ‘suicide headache,’ is a neurological disorder characterized by severe pain behind or around one’s eye. It is one of the most painful conditions a person can experience, even more incapacitating than a migraine. When patients come in with a cluster headache, they often share how it impacts their personal and professional lives and how the sensation is so severe they feel at the end of their rope.”
As Dr. Grosberg noted, cluster headaches are intense, recurring cycles of pain usually clustered around one eye. Attacks can last from 15 minutes to three hours, with pain so debilitating that the sufferer is unable to function normally.
These periods of attack are known as cluster periods. Cluster periods are usually followed by weeks or months of remission. During a cluster period, patients may experience several headaches a day, with pain most often occurring at night. Patients may experience one or more headaches in each attack, one right after the other.
Other symptoms that may occur during a cluster period are:
- Droopy eyelid
- Eye watering
- Agitation (pain so severe that patients cannot sit still)
Of all headache types, cluster headaches are among the most rare. In a change of pace, men are more likely to suffer from cluster headaches than women.
What are cluster headaches causes?
What causes cluster headaches is a complicated question with few answers. Researchers theorize that the cause is related to the hypothalamus. Cluster headaches seem to be related to the seasons, with a rise in cluster periods during the summer. The hypothalamus is the area of the brain that controls the body’s circadian rhythm. Circadian rhythms tell us when to sleep and wake up and are closely linked to the amount of daylight.
The pain of cluster headaches is linked to the trigeminal-autonomic reflex pathway, a major nerve pathway. The hypothalamus triggers activity along this pathway. Thus, the hypothesis is that cluster headaches are closely tied to seasonal changes and their effect on the hypothalamus.
In addition to the extra light in the summer that may trigger cluster headaches, a rise in barometric pressure during the summer may also be part of what causes cluster headaches. A study of over 7,000 headache sufferers found strong links to changes in temperature and barometric pressure.
Kenneth Mukamal, MD, MPH, the study’s first author and a physician in the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center noted that previous studies were unable to verify what he called “clinical folklore” – the idea that environmental change might be what causes cluster headaches. The study found that higher air temperature and changes in barometric pressure did correlate with an onset of headache.
Mukamal noted that what causes cluster headaches may not always be internal, saying:
“Certainly our results are consistent with the idea that severe headaches can be triggered by external factors. These findings help tell us that the environment around us does affect our health and, in terms of headaches, may be impacting many, many people on a daily basis.”
What are cluster headaches treatments?
As with most types of headache, prevention is important, but because what causes cluster headaches is out of our control (weather), this can be challenging. In the case of cluster headaches, the best prophylactic treatments are those that deal directly with the effects of warmer weather.
- Drink water: As the temperature begins to warm, dehydration becomes even more of a risk factor for cluster headaches. Our bodies lose moisture even as we sleep. In the summer, it is especially important to start each day with a large glass of water and continue to drink clear fluids throughout the day.
- Get plenty of rest: Longer days and shorter, hotter nights may make deep, restful sleep difficult. Over-the-counter supplements like melatonin may help the body rest. Patients who experience cluster headaches should also consider a sleep mask and ear plugs to maintain a sleep schedule.
- Quit smoking and limit alcohol: Nicotine and caffeine can exacerbate cluster headaches and serve as triggers. Alcohol is also very dehydrating. While a cold beer may seem like a great idea on a hot day, it can lead to intense pain later that night. Skip the alcoholic beverages and sip sparkling water instead.
When cluster headaches begin, most treatments focus on easing the pain as quickly as possible. Patients have described the pain of a cluster headaches as a burning pain that feels like their eye is being pried out with a hot poker.
Some treatments that can help ease this pain include:
- Breathing pure oxygen for 10 to 15 minutes
- Injections of botulinum toxin to stop nerve activity
- Subcutaneous sumatriptan
- Intra-nasal sumatriptan or zolmitriptan
- Occipital nerve blocks (local anesthetic mixed with a corticosteroid)
Alternative therapies may include massage, physiotherapy, and chiropractic. There is very little research on the efficacy of these treatments, but they have no side effects and can be utilized if patients find relief.
In very rare cases, surgery to limit nerve activity may be recommended. This is only for patients who have cluster headaches that are not responding to treatment or who are unable to tolerate treatment.
What triggers your cluster headaches, and what provides relief?