Getting Rid Of Cluster Headaches Symptoms And Treatment

What Is A Cluster Headache?

Cluster headaches involve an excruciating pain around/in the eye on one side of the head. As the name suggests, the attacks come in clusters. Cluster headaches are also quite rare, affecting only 0.1% of the population (the number will increase as it is getting more awareness). Many patients have experienced firsthand how painful and disabling cluster headaches are. The extreme pain of a cluster headache is characterized by weeks to months per attack period and a remission period that runs for months or years. 

What Are The Symptoms Of Cluster Headaches?

Some common cluster headache symptoms and signs include: 

• Severe, unilateral pain around or behind the eye
• Restlessness
• Excessive tearing
• Stuffy or runny nose on the affected side
• Redness or swelling of the eye
• Drooping eyelid on the affected side. 

How Long Do Cluster Headaches Last?

During a headache period, one cluster headache attack can last between 15 minutes to three hours, and these attacks usually occur every day or several times per day. Patients may wake up at night or experience a cluster headache one to two hours before sleep. These attacks end as suddenly as they started, but most patients feel exhausted after each flare-up. 

Cluster Headache Pain Scale

Many patients who have experienced cluster headaches mentioned that the cluster headache pain scale is a 10/10, compared to other painful conditions. This aligns closely with research, which has shown that the pain scale is approximately 9.6/10, with a standard deviation of +/- 0.6. This is even higher than labour pain, which averages approximately 7.2, with a standard deviation of +/- 2. Comparing the cluster headache pain scale with other conditions, researchers have shown that cluster headache had the most severe pain with a mean of 9.7, followed by child labor pain at 7.2, pancreatitis at 7.0, and nephrolithiasis at 6.9.

To see cluster headache on the top of the pain scale is one thing, but for it to exceed child labor is very telling. But what causes cluster headaches?

What Causes Cluster Headaches? 

The exact main cause of cluster headaches is still unknown. However, research shows how the hypothalamus and the cortical-hypothalamic-brainstem interconnection ignite the trigeminovascular system and the trigeminal autonomic reflexes, which explains the neuronal background of cluster headaches. Unlike migraine with trigger-induced attacks, cluster headache generally is not associated with triggers but possibly the sudden release of histamine or serotonin in the body.

Is Trigeminal Neuralgia The Same As Cluster Headaches?

Even though cluster headaches are often associated with pain in the trigeminal nerve area, cluster headaches are different from trigeminal neuralgia. While cluster headaches are episodic and can last for hours, trigeminal neuralgia only lasts for a few minutes.

Cluster Headaches Treatment

Treatment for cluster headaches involves acute and preventive treatments. Acute treatment for cluster headaches includes:

• Sumatriptan or zolmitriptan nasal spray
• Oxygen therapy
• Local anesthetic

Meanwhile, preventive treatments for cluster headaches include 

• Verapamil
• Lithium
• Steroids

Dosage Of Verapamil for Cluster Headaches

The recommended dosage of Verapamil for cluster headache is 360 to 480 mg of Verapamil. Experts recommend Verapamil as the drug choice of treatment for episodic and chronic cluster headache

Dosage Of Melatonin for Cluster Headaches

Using melatonin for cluster headaches is also an option for preventive treatmenT for episodic chronic cluster headaches. However,  its effectiveness on patients with chronic cluster headaches remains questionable compared to episodic patients. The recommended dosage of melatonin for cluster headaches is approximately 10 to 25 mg at night before bedtime.

Dosage of Emgality For Cluster Headaches

The FDA has also approved Emgality as a treatment for episodic cluster headache as Emgality reduces the weekly cluster headache cycles. The recommended dosage of Emgality for cluster headache is approximately 300 mg. Do note that Emgality isn’t a recommended treatment for chronic cluster headaches. Emgality is also known as an anti-CGRP or CGRP inhibitor migraine medication.

Anti-CGRP medication for migraine are known to be the fruit of migraine medication progress. Research has shown promising effects where other CGRP medications can potentially help treat chronic cluster headaches.

Cluster Headache Supportive Therapy

Cluster headache supportive therapy aims to provide relief and alleviate the symptoms of cluster headaches, which are intense and excruciating headaches that occur in clusters or cycles. Supportive therapy involves various strategies to manage pain, reduce the frequency and duration of cluster headache attacks, and improve overall quality of life. Common supportive measures include the use of oxygen therapy, where the affected individual inhales pure oxygen through a mask during an attack to help alleviate pain. Triptans, a class of medications commonly used for migraines, may also be prescribed to help relieve cluster headache symptoms. In addition, preventive medications such as calcium channel blockers, corticosteroids, or anti-seizure medications may be prescribed to reduce the frequency and intensity of cluster headache episodes. Lifestyle adjustments, including avoiding triggers like alcohol and certain foods, managing stress levels, and adhering to a regular sleep schedule, can also be part of the supportive therapy plan. A comprehensive approach that combines pharmacological interventions, lifestyle modifications, and patient education is crucial in effectively managing cluster headaches and improving the overall well-being of individuals affected by this condition.

Cluster Headache VS Migraine

Although cluster headaches and migraine attacks can be severe and disabling, there are differences between cluster headaches vs migraine attacks in their symptoms, frequency, sensation and characteristics. Here are the differences between migraine and cluster headaches:

• Frequency: Cluster headache tends to run in shorter, more frequent pain around one eye, whereas migraine attacks can feel more long-drawn.
• Migraine symptoms: Migraine attacks symptoms may begin with migraine prodrome symptoms such as aura or visual disturbances. It may even accompany light, sound or smell sensitivities, nausea and/or vomiting
• Sensation: Migraine attacks will have a pulsating or throbbing pain that lasts up to several hours
• Age: From the epidemiological perspective, cluster headache has a sooner and higher range of onset age (20-30 years old), while the onset age range for migraine is 23-25 years old. 
• Gender: Men are also more likely to suffer from cluster headaches, whereas women are more susceptible to suffering from migraine. We will explain later on who are most likely to suffer from cluster headaches

Cluster headache vs tension headache

The difference between cluster headache vs tension headache is that cluster headaches are usually excruciating and lasts for a shorter period of time. However, tension headaches may last a few hours, but the pain is usually manageable. The symptoms of tension headache differs from cluster headache symptoms too.

How To Get Rid Of A Cluster Headache?

Experts have recommended patients to get rid cluster headaches by considering changing their lifestyles, including avoiding alcohol and cigarettes. Another recommended cluster headache treatment at home involves sticking to a regular sleeping schedule. Sleep does help with cluster headache, so having an early night and restful sleep can be helpful. Some of the home remedies for cluster headaches include medication, like melatonin etc. Ultimately, make sure you find a cluster headache specialist to find out more.

Who Is Most Likely To Suffer From Cluster Headaches?

 From the epidemiological perspective, cluster headache has a sooner and higher range of onset age (20-30 years old), while the onset age range for migraine is 23-25 years old. Cluster headache affects 0.1% of the population and men are more likely to suffer from cluster headaches, whereas migraine is prevalent in approximately 15% of men.

Unsure how to start or whether you are experiencing cluster headaches or migraine? Download and use the Migraine Buddy app to track your flare-ups, even though you are not sure about the type of attack!

(The above article is contributed by Dorothea Tse, one of our amazing volunteers).