NOTE: iHeadache Online and the iHeadache mobile app do not classify headaches as "Cluster Headaches." You can still use iHeadache to track the number of headaches, duration, medications & other treatments and notes.
Cluster headaches are, by far, the most severe type of primary headache. These headaches are called "cluster" because the patient experiences a group or series of headaches over a period of time and then the headaches disappear for several months. The pain can be so severe that some cluster patients have been known to commit suicide because of the attacks. Cluster headaches are more common among men. When a patient is having near daily headaches or daily headaches - they are said to be in a cluster cycle. Cluster headaches can be triggered by wine and nitroglycerin during a cycle.
A typical cluster headache may feel like being stabbed in the eye and is typically a relatively short headache. They tend to occur at night and may wake patients from their sleep. There may be redness of the eye, tearing, and pupil changes.
Very little is known about the source of cluster headaches. The best data available suggests that cluster headaches are somehow regulated by the region of the brain responsible for circadian rhythms and biologic functions such as appetite and temperature regulation. It is believed that a defect in this region occurs in patients who get cluster headaches and this is why they occur principally at night. The mechanism that triggers a series of cluster headaches and then eventually stops the series is unknown.
Oxygen is the long-standing treatment for an acute cluster attack. Unfortunately, many patients do not respond to this therapy. Also, the opportunity to try oxygen therapy can be somewhat difficult for patients. Since headaches are quite short and commonly happen at night, it may be difficult for patients to get to oxygen fast enough to try it. However, if oxygen is effective, it is economical and essentially free of side effects.
If oxygen therapy is not successful then sumatriptan injections are usually the next treatment of choice because the injections typically work faster than tablets. Triptan tablets are commonly used to prevent additional cluster attacks in close proximity to the first cluster attack of the night to allow for better patient sleep.
Less commonly used are DHE (dihydroergotamine) injections. These injections are more painful than sumatriptan injections but the benefits last longer. An inhaled version of DHE will hopefully be available soon.
An electronic device, Gammacore® is currently under study for acute cluster treatment.
WARNING: Patients with ischemic heart disease should not take triptan medications or DHE. This can be problematic when treating older patients.
Once a cluster cycle has started, the key is to start therapy to help bring an end to the cycle. There are no FDA approved medications for stopping cluster cycles. Commonly used medications include prednisone, verapamil, lithium, valproic acid, and topiramate. iHeadache does not currently support cluster headaches but one can use the iHeadache features to track the number of headaches, medications used, and preventative therapies.
This educational content was written by Brian D. Loftus, MD, a neurologist, headache specialist and a developer of iHeadache. The science and study of headaces is changing rapidly. If there is information on this page that is incorrect or needs revision, please contact us.
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