| Cluster headaches are so named because they typically occur in clusters over a period of weeks or months. This is followed by a headache-free period until another cluster of headaches begins. The headache is usually sudden and severe, lasting a few minutes up to 2 hours, and mostly affects the temple or the area around one eye, and on one side of the head (unilateral). It is often associated with involvement of the autonomic nervous system that controls involuntary bodily functions with symptoms such as forehead sweating, tearing, or runny nose, all occurring on the same side as the headache.
No specific cause has been found for the disorder but it appears related to a release of histamine, serotonin, or similar substances from body tissues that cause painful widening (dilatation) of blood vessels.Risk: Individuals with a history of heavy smoking and drinking are at higher risk ("How Headaches Differ"). Alcohol consumption is likely to provoke headache recurrence.
The condition is more common in men; the male-to-female ratio is 5:1. Middle-aged individuals are the most susceptible to cluster headaches (Mendizabal). Incidence and Prevalence: Cluster headaches are not common and affect an estimated 1% of the US population ("How Headaches Differ"). |
Source: Medical Disability Advisor
| History: Cluster headaches often occur daily over many days or weeks and commonly begin 2 or 3 hours after falling asleep. Once the cluster of headaches is over, individuals may be headache-free for periods of 2 months to 20 years. Episodes of pain come on suddenly and peak in about 10 to 15 minutes. Generally, peak pain lasts from a half hour to 2 hours, but it may persist for several hours. The headaches occur on one side of the head, usually centering around the eye and may be described as a boring pain as if the eye is being pushed out. Most cluster headaches involve the forehead or cheek region, but up to one-fifth may result in pain in other areas such as the back of the neck or on the side of the neck along the carotid artery. Physical exam: If the individual is examined while experiencing a headache, the exam may reveal a blocked or runny nose, eye redness, and excessive tearing. The pupil on the same side as the pain may be smaller than in the other eye and the eyelid on the same side may be drooping (Horner's syndrome). There may also be nausea and sweating on the same side of the forehead. Tenderness may occur on the scalp, face, and carotid artery. Tests: There is no known technical diagnostic test that will confirm a diagnosis of cluster headache. Diagnosis is based on history and presenting signs and symptoms. |
Source: Medical Disability Advisor
| Cluster headaches cannot be cured and must be treated symptomatically. Medications that constrict blood vessels (vasoconstrictors) including ergot alkaloids given by inhalation may help in acute episodes by relieving pain and preventing attacks. A new type of vasoconstrictor, triptanes, useful in the treatment of migraine headaches may also be effective for cluster headaches when given by mouth or injection under the skin (subcutaneous). Inhalation of pure oxygen often relieves cluster headaches. Anti-emetics and sedatives may be useful in treating the accompanying nausea and agitation. For prevention, various drugs have been generally effective including ergot alkaloids, antihistamines, beta-blockers, tricyclic antidepressants, corticosteroids, lithium carbonate, verapamil, ciproheptadine, indomethacin, and calcium channel blockers.
Surgery or radio wave-induced damage (radiofrequency thermocoagulation) that interrupts the nerve supplying sensation to the face (trigeminal nerve) or to the autonomic pathways may be considered if medications are ineffective and if the headache is always on the same side. |
Source: Medical Disability Advisor
| The outcome is variable and quite individualized. Headaches may be well managed medically or resist treatment. There are no known predictors of positive (or negative) outcomes. Remissions may be prolonged for 20 years or more. Episodic cluster headache may be transformed to chronic cluster headache. |
Source: Medical Disability Advisor
| Overuse of pain medicines may render them ineffective and increase the risk of drug addiction. Inability to avoid smoking, alcohol, stress, and foods that trigger the attack may also aggravate the condition. Impaired judgment because of severe pain during attacks may lead to self-injury or even suicide attempts.
If surgery is performed, there may be permanent muscle weakness in parts of the face and/or head afterwards. |
Source: Medical Disability Advisor
| The flexibility to go to a quiet, dark location at the onset of a headache may be useful. Depending on the type of medication taken and its effects, the individual may need to leave work or come in late the morning after an attack. Strenuous physical activity, glare, and undue stress may trigger attacks and should be avoided. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Did a severe, sudden headache develop without warning? Was headache on one side of the head? Did it center around the eye?
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While individual was experiencing a headache, did physical exam reveal a blocked or runny nose, eye redness, and tearing? Is pupil on the same side as the pain smaller than in the other eye? Does eyelid on same side droop (Horner's syndrome)?
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Does individual have nausea and sweating on the same side of the forehead?
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Was headache trigger such as smoking, alcohol, stress, or certain foods identified?
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Were conditions with similar symptoms ruled out?
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Was diagnosis of cluster headaches confirmed?
Regarding treatment:
- Is individual taking medication as prescribed? How long after onset of symptoms did individual wait to seek treatment?
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If medications are ineffective or if the headache is always on the same side, is individual a candidate for more aggressive treatment such as surgery or radiofrequency thermocoagulation?
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Does individual understand the concept of headache triggers? Is individual capable of and diligent in avoiding factors (alcohol, specific foods, insufficient sleep, strong emotions, excessive physical activity, tobacco) that might trigger an attack?
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Does individual understand that overuse of pain medicines can result in them becoming ineffective and creates a risk of drug addiction? Is individual showing evidence of addiction to pain medication?
Regarding prognosis:
- Is headache medically managed or does it resist treatment?
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Is individual aware of and able to avoid smoking, stress, alcohol, and foods that could trigger an attack?
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Are there factors at work such as strenuous physical activity, glare, or undue stress that may also trigger attacks?
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Has impaired judgment during attacks of severe pain led to self-injury or suicide attempts?
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Do work accommodations allow individual to go to a quiet, dark location at the onset of a headache and leave work or come in late the morning after an attack? Would these accommodations help decrease disability and allow individual to remain in present occupational duties?
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Does individual have an underlying condition that may impact recovery such as substance abuse, stress, or other types of headaches including migraine?
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Source: Medical Disability Advisor
| "How Headaches Differ." ACHE. 16 Jan. 2004. American Council for Headache Education. 18 Oct. 2004 <http://www.achenet.org/understanding/differ.php>.Mendizabal, Jorge. "Cluster Headache." eMedicine. Eds. Joseph R. Carcione, et al. 13 Oct. 2004. Medscape. 18 Oct. 2004 <http://emedicine.com/neuro/topic70.htm>. |
Source: Medical Disability Advisor
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