(LifeWire) - Cluster headaches are so named due to their frequent occurrence in clustered time periods lasting weeks or months, often striking with such regularity that they can be predicted with pinpoint accuracy by those who endure them.
Sinisterly dubbed "suicide headaches," cluster headaches are quite rare, affecting less than 1% of the population. But for these few individuals, the potent pain caused by these headaches can be debilitating, significantly affecting their quality of life.
Depression, for example, is higher among those who suffer severe headaches, and affects well over a quarter of headache patients referred to specialists. In contrast, only approximately 8% of adults among the general population suffer depression. However, due to the brevity of the attacks--they can last anywhere from 15 minutes to three hours--actual suicides are infrequent.
Symptoms of Cluster Headaches
Though cluster headaches frequently wake sufferers from deep, rapid eye-movement (REM) sleep that is crucial for rest, these headaches can also strike during the day. Headache symptoms include severe pain on one side of the face, in addition to a drooping or swollen eyelid, red and watery eye, and runny nose on only the affected side. Individuals who suffer from these headaches say they often wish they could crawl out of their own skin, comparing the sensation experienced to an ice pick or poker being jabbed repeatedly into the eye, with burning and pressure also common. Pain can also spread to the upper teeth, neck or jaw.
If they occur each day for weeks or months and then stop inexplicably for a month or more, the cluster headaches are termed episodic. For a particularly unlucky 10 to 15% of patients, these headaches are chronic--occurring daily for more than one year, or with remissions lasting less than one month.
Men Get Them More Often
Men outnumber women 2 to 1 among cluster headache sufferers, and the condition can arise at any age, though the peak period is between the ages of 20 and 40.
David Rothner, MD, a headache expert at the Cleveland Clinic, says the throbbing of cluster headaches can easily be differentiated from migraines - which affect mostly women - by the ways in which sufferers of such episodes react.
"If a person has a migraine, they're pale, they're grouchy, and they typically want to lie down in the dark and quiet and be left alone," says Rothner, a pediatric neurologist. "With cluster headaches, it's just the opposite. They're in severe pain, but they can't lie down. They pace, they hit their head against the wall - they cannot rest."
The head-banging, while extreme, is by no means rare as a coping mechanism for these patients. Other cluster headache sufferers may scream or hurt themselves, exercise, or go outdoors in cold temperatures, in an effort to distract themselves from the overwhelming pain of an attack.
Do Circadian Rhythms Play a Role?
"These headaches can occur three, four or six times a day," Rothner adds, "and may awaken the patient at the exact time every night, almost like an alarm clock."
Though scientists are unsure what causes cluster headaches, they do know that the excruciating pain is centered behind the eye because of its proximity to the trigeminal nerve, a primary nerve pathway for pain. When this nerve is stimulated, arteries in the brain react abnormally and enlarge, causing a steady, sharp pain.
Cluster headaches, like migraines, are classified as vascular headaches, which involve irregular reactions of blood vessels in the brain. Other headache types include inflammatory headaches, such as those in the sinuses, and tension headaches, which result from muscle contractions.
Researchers believe the circadian rhythm - our inner biological clock that regulates sleep, wakefulness and other cycles every 24 hours - may play a role in triggering cluster headaches. But there are other catalysts as well, some of which are controllable, including smoking, alcohol, specific foods, stress, and sun glare.
Treatment Options
While there is no cure for cluster headaches, numerous medications can be prescribed, either alone or in combination, to prevent cluster headaches or treat the excruciating pain associated with these episodes. These medications are either injected, inhaled, or placed under the tongue -- instead of being swallowed -- to allow them work faster. Over-the-counter pain relievers, such as aspirin, Advil and Motrin (ibuprofen), or Tylenol (acetaminophen), are not among this list of medications, however, as they take far too long to provide relief.
"We can do a lot more for cluster headaches than we could do years ago," says Rothner, whose initial remedies for his patients include briefly inhaling 100% oxygen or corticosteroids.
It may take time to determine the best combination of medications for each patient due to differing individual reactions, and some of the substances may cause significant side effects, including osteoporosis and tremors. Surgery is rarely recommended as a treatment option because of the possibility of lingering muscle weakness or nerve damage.
Anyone with cluster headache symptoms would be advised - and likely very motivated - to see a doctor. A neurological exam may be performed, and other diagnostic tests may include CT or MRI brain imaging scans.
Sources:
Rothner, David. Pediatric neurologist, Cleveland Clinic. Telephone interview. 25 Mar. 2008.
"Cluster Headache." MayoClinic.com. 8 Feb. 2007. Mayo Foundation for Medical Education and Research. 20 Mar. 2008. <http://www.mayoclinic.com/health/cluster-headache/DS00487>.
Kantor, Daniel. "Medical Encyclopedia: Cluster Headaches" Medline Plus. 10 Sept. 2006. National Institutes of Health. 19 Mar. 2008. <http://www.nlm.nih.gov/medlineplus/print/ency/article/000786.htm>.
Beck, Ellen, et. al. "Management of Cluster Headache." American Family Physician. 71.15 Feb. 2005. 717-24; 728. 19 Mar. 2008. <http://www.aafp.org/afp/20050215/717.html>.
Loder, Elizabeth W., and Vincent T. Martin. Headache: A Guide for the Primary Care Physician. 2004.
Jelinski PhD, Susan E, et. al.. "Factors Associated with Depression in Patients Referred to Headache Specialists." Neurology. 68. 20 Oct. 2006. 489-495. 28 Mar. 2008. http://www.neurology.org/cgi/content/abstract/68/7/489. (subscription)
