Headaches are an extremely common complaint, most of us have experienced headaches at some point in our lives. For the majority of people, headaches are an inconvenience and may cause difficulty performing tasks for a short amount of time but are easily controlled with some over the counter medicines and a good nights sleep. There are however a number of headache conditions that cause significant levels of pain, the most common being migraines. For those unlucky enough to suffer with chronic migraines they can be extremely debilitating, often causing nausea and vomiting and leaving the sufferer shut in a dark room for hours or days at a time. The condition I want to talk about today is called cluster headaches.
Cluster headaches are classified as rare but they are about as common as MS. They can occur in women but are more common in men and although they can begin at any age the most common age of onset is from the early 30s to mid 40s. The main characteristic of cluster headaches is a severe pain in and around the eye which is sudden onset and not relieved by normal pain medicines. The pain comes in “groups” or clusters, often reoccurring multiple times in the same day for weeks or months at a time followed by a period with no headache. This is called episodic cluster headaches. For some people the cluster headaches happen every day with no period of remission (no headache for weeks or months) this is known as chronic cluster headaches. The exact cause of cluster headaches is currently unknown but it is thought that the blood vessels around the occipital nerve dilate (widen) and put pressure on the nerve causing extreme pain.
Along with the very severe pain, other characteristics of cluster headaches include –
* Swelling around the eye on the painful side
*A blocked or runny nose
*A red and watering eye
* A smaller pupil in one eye
*Drooping of one eyelid
*Pain lasting from 15 minutes to 3 hours and reoccurring throughout the day
* A sweaty and flushed face
Unlike some other types of headaches, normal pain medicines are not effective in managing cluster headaches. Treating cluster headaches is difficult because many medications take too long to begin working and once a cluster headache is in full swing it’s usually too late to stop it.
Therefore, treating cluster headaches involves a mixture of “Abortives” that stop an acute headache and “preventatives” that try to stop clusters long term. Treatments include
* Sumatriptan nasal sprays or injections – Sumatriptan is an abortive that is used at the onset of pain. It’s also available as a tablet but these are not effective in cluster headaches. Nasal sprays work for some but injections are the best option for most people. Injections work quickly and for some people reduce the pain within 10-20 minutes. The downside is that you have to inject yourself and the side effects can include dizziness, tiredness and nausea.
*High flow oxygen – The exact way that oxygen helps is uncertain but one of the theories is that it causes constriction of the veins in the head, relieving pressure and inflammation. High flow oxygen works for a lot of cluster headache patients and its a good option because its very low risk.
*High dose steroids – Steroids reduce inflammation and can be prescribed at a high dose for a short amount of time to try and give patients a break from the cluster headaches. They carry a lot of side effects so can’t be used all of the time, but they are a really useful tool in the fight against clusters.
* Verapamil – Verapamil is the drug of choice for preventing cluster headaches, it reduces dilation of the blood vessels therefore preventing the debilitating headaches. The downside of this treatment is that it can cause complications with the heart and breathing, so ECGs are very important before and during treatment, especially when doses are increased.
*Occipital nerve blocks – During an occipital nerve block high dose steroids and local anaesthetic are injected around the occipital nerve in the hope of stopping the pain associated with cluster headaches. When they work, nerve blocks can relieve symptoms completely for weeks or even a couple of months at a time. Unfortunately the success rate is only around 50% and there are risks including infection so they are often reserved for patients who haven’t had success with other treatments.
So far I have tried all of these treatments but still suffer daily with multiple severe headaches. At the moment my best treatment is high flow oxygen which greatly reduces the pain of attacks. Unfortunately my situation isn’t that uncommon among cluster headache patients so we really need more awareness and funding to help with finding more consistently effective relief.
For more information on cluster headaches or if you’d like to help find the cure, please visit Ouchuk.org.
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