PEDIATRICS

Cluster Type Headaches

Cluster headaches develop in clusters over a course of several weeks and are a severe form of headache. Cluster headaches are painful enough to wake someone who is asleep. The pain is usually on one side of the head, in and around the eye. Frequent attacks occur in the cluster period followed by remission which can last for weeks, months and even years.

Cluster headaches are rare and not life threatening. They are severe headaches which can have a seriously adverse impact on the quality of life. Effective treatment can shorten the attacks while reducing pain to more manageable levels. Additionally, medication can reduce the frequency and duration of cluster headaches.

Symptoms

Cluster headaches generally occur without any advance warning. The most commonly observed symptoms are: drooping eyelids, swelling around the eyes, paleness or redness, one-sided pain and a blocked nose on the side of the pain, a runny nose, a feeling of anxiety, and severe pain which may affect the face, head, neck and shoulders.

  • Unbearable, severe pain, commonly stemming from around the eye. The pain can radiate towards the face, head, neck, shoulders and other areas.
  • One-sided pain
  • A feeling of anxiety
  • A red eye on the affected side of the head, tearing
  • A blocked or runny nose on the affected side of the head
  • Sweating on the forehead or face
  • Paleness or redness
  • Swelling around the eye on the affected side of the head
  • Drooping eyelid

In contrast with migraine sufferers, people who suffer cluster headaches are likely to rock back and forth due to the pain or walk around as opposed to lying or sitting down.

Characteristics of the cluster period

A cluster period generally lasts for 6-12 weeks. The duration of each cluster period and the starting date is usually consistent from period to period and can occur seasonally. Most people experience episodic cluster headaches. Episodic cluster headaches can have remission phases between attacks of more than one month in a year before the onset of a new cluster period. Chronic cluster headaches have remission phases lasting less than one month in a year. Patients suffer tremendously with these types of headaches.

During a cluster period:

  • Headaches generally occur daily, or a few times per day.
  • A single attack can last between 15 minutes and three hours.
  • Attacks usually occur at the same time each day.
  • Most attacks occur while asleep during the night. The attacks are severe enough to wake a sleeping person.
  • The onset of pain is sudden and its intensity decreases until it suddenly ends. Most people are pain-free after an attack but will most likely feel exhausted.

When should you consult a neurologist?

If you are experiencing cluster headaches, it is advisable to consult a neurologist in order to eliminate other causes of the pain and to find the most effective treatment. Although cluster headaches are extremely painful, they are not considered to have any underlying causes. However, sometimes severely painful headaches can be the result of more serious medical conditions such as the tearing of a blood vessel (aneurysm rupture) or a brain tumor.

If you suffer from headaches that begin suddenly and which you cannot identify then you must consult a neurologist.

Seek emergency care if you have any of the following signs or symptoms:

  • A sudden, severe headache (like a thunderclap),
  • A headache which is accompanied by a high temperature, nausea or vomiting, a stiff neck, confusion, seizures, numbness or difficulty talking, which can indicate a number of conditions including strokes, meningitis, encephalitis or a brain tumor,
  • If the headache worsens, especially if it has developed following a fall or a head trauma,

What causes a cluster headache?

The exact cause of cluster headaches is not known, however, it is though that abnormalities in the body’s biological clock (hypothalamus) plays a role. In contrast with migraines or tension type headaches, cluster headaches are not usually associated with triggers such as food, hormonal changes or stress.

Consuming alcohol can trigger a headache once a cluster phase begins. This is why many people who suffer from cluster headaches avoid alcohol during the cluster phase. Another possible trigger is medication containing nitroglycerin which is used to treat cardiovascular conditions.

Risk factors

The risk factors for cluster headaches include:

  • Gender: Cluster headaches occur more frequently in men.
  • Age: Cluster headaches can develop at any age but occur more frequently between 20 and 50 years of age.
  • Smoking: Many cluster headache sufferers smoke. However, quitting smoking is generally ineffective to combat headache pain.
  • Drinking alcohol: Alcohol can trigger attacks.
  • Family history: Having a parent or sibling who suffers cluster headaches may increase the risk of suffering cluster attacks.

Diagnosis

Cluster headaches and attacks have certain characteristics. Information regarding the location of the pain, its intensity, associated symptoms, the frequency and duration of your headaches will all be required in order to be able to make a diagnosis. Your neurologist will usually make a diagnosis during your consultation.

Neurological examination

Your neurologist may ask for further tests after your neurological examination depending on whether or not your cluster headache is primary or secondary.

Imaging tests

When necessary, your neurologist may recommend the following tests in order to be able to rule out other serious causes of your headaches including tumors or aneurysms.

CT scan: This method uses a series of X-rays to create detailed images of your brain.

MRI: This uses a powerful magnetic field to create detailed images of the brain and blood vessels.