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These are a rare type of headache that affects about 1 to 2 people in every 1,000. Onset is normally between 20-40 years of age, and they are 3-4 times more common in men than women. Approximately 1 in 20 people with cluster headache have a family member who also has the condition. Unlike migraine, it is more common in men than women (by five to six times). It is also more common in heavy smokers. As with all forms of headache, cluster headache occurs in children but it is less common than in adults.
What are the Symptoms?
The symptoms of cluster headache are characterised by unilateral (one sided) pain, although the affected side may vary each cluster period. The pain is usually centered over one eye, temple or forehead, and can even be a combination of all or spread to other regions making diagnosis difficult. They usually last 15-180 minutes, and can occur from once every other day to up to 8 times a day. Pain is often characterised as excruciating.
Attacks can be associated with one or more of the following, on the same side of the face as the headache:
- conjunctival injection (redness of the white sclera of the eye)
- lacrimation (tears)
- nasal congestion
- rhinorrhoea (runny nose)
- forehead and facial sweating
- miosis (constricted pupil)
- ptosis (drooping eyelid)
- oedema (swelling)
During a bout of cluster headache the pain is often experienced at a similar time each day. The headache often starts at night, waking people one to two hours after they have gone to sleep. The pain usually reaches its full intensity within 5 to 10 minutes, and lasts at this agonising level for between 30 and 60 minutes.
Episodic cluster headache
80% of cluster headache attacks occur in periods lasting 7 days, to 1 year, separated by pain-free periods of 1 month or longer. The bouts (or “clusters”) often occur at the same time of year, and can then disappear for several months or even years. The reason for this seasonal timing is not completely known, although it is one of the key aspects of diagnosis, and may involve a brain area called the hypothalamus.
Chronic cluster headache
The remaining 20% of people do not have these pain free intervals, and are said to have “chronic cluster headaches”. Attacks occur for more than 1 year without remission or with remissions lasting less than 1 month.
There is no special test to diagnose cluster headache, diagnosis is based on your of all your symptoms, and you may be referred for an MRI scan to rule out other causes for the pain starting suddenly.
What Triggers a Cluster Headache?
- Alcohol is one well known trigger of cluster headache, often bringing on the pain within an hour of drinking. Avoid alcohol during a cluster period once the bout is over you will be to drink alcohol again.
- A significant number of people find that strong smelling substances such as petrol, paint fumes, perfume, bleach or solvents can trigger an attack. During an episode of cluster headaches you should try to avoid these things.
- Some people find exercise or becoming over heated will bring on an attack, so again avoiding these is the best advice during a bout.
- Research has showed that heavy smokers are at an increased risk of developing chronic cluster headache so giving up smoking or cutting down is worth considering.
Whilst there is currently no cure for cluster headache, the treatment has become much more effective in the last 10 years.
Quick treatment is key. Ordinary painkillers that you can buy over the counter are not usually effective, as they take too long to work. Oxygen is one of the safest ways to treat cluster headache. You need to breathe the oxygen in at a rate of between 7 and 12 litres per minute. The treatment usually starts to work within 15 to 20 minutes. For some people the attack is delayed rather than stopped altogether. Your GP will be able to order oxygen for you.
Sumatriptan injections have been found to reduce the pain within 10 minutes during an attack. Sumatriptan and zolmitriptan nasal sprays do help some people, although the onset of action maybe slower than the injection.
The most common preventative treatments are medication based. The migraine trust website gives further details of specific medications. Also avoid triggers as much as possible. The migraine trust gives further details on medications or see your GP.
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As with any new symptoms it is always important to visit your GP or Chiropractor to rule out any other disorders before reaching a diagnosis yourself.