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Alternative names Return to top
Histamine headache; Headache - histamine; Migrainous neuralgia; Headache - clusterDefinition Return to top
Cluster headaches affect one side of the head (unilateral) and may be associated with tearing of the eyes and nasal congestion. They occurs in clusters, happening repeatedly every day at the same time for several weeks and then remitting.Causes, incidence, and risk factors Return to top
Cluster headaches are a fairly common form of chronic, recurrent headache. Unlike migraines, they affect men more often than women. They can affect people of any age but are most common between adolescence and middle age. There does not seem to be a pattern among families in the development of cluster headaches.
A cluster headache begins as a severe, sudden headache. No specific cause has been found for the disorder, but it appears to be related to a sudden release of histamine or serotonin by body tissues.
The onset is sudden, and it happens most commonly during the dreaming (REM) phase of sleep. Cluster headaches may occur daily for months, alternating with periods without headaches (episodic), or they can recur for a year or more without stopping (chronic). A person may experience alternating chronic and episodic phases.
Some people who experience cluster headaches are heavy smokers. Alcohol use may trigger attacks. Glare, stress, or certain foods may trigger an attack.
Symptoms Return to top
Signs and tests Return to top
Cluster headaches may be diagnosed by your health care provider based on the symptoms and a physical examination. Tests may be required to rule out other causes of the symptoms. Examination usually shows no specific neurologic effects except for Horner's syndrome (one-sided eyelid drooping or small pupil) during an attack that is not present between episodes. This can evolve into persistent Horner's syndrome.
An MRI of the head may be done to rule out other pathology.
Treatment Return to top
Treatment does not cure cluster headaches. The goal of treatment is to relieve symptoms. Spontaneous remission may occur, or treatment may be required to prevent headaches.
Smoking, alcohol use, specific foods, and other factors that seem to trigger cluster headaches should be avoided.
A headache diary may be helpful to identify such triggers. When a headache occurs, record the date and the time, list any activities, substances used or consumed within the previous 24 hours, and any other factors that seem significant.
Analgesic medications do not usually relieve the pain from cluster headaches. Generally, they take too long to work -- the headache is usually gone before they take effect.
Inhalation of 100% oxygen often relieves cluster headache for some people, particularly for frequent cluster headaches that occur at night.
Combination or multiple medications may be required to control symptoms of cluster headache. Because response to medications varies, several medications may be tried before a suitable treatment is found. Response can vary over time, so a previously taken effective medication or combination of medications may not have the same effect.
Ergot preparations (containing ergotamine tartrate alone or in combination with other medications) help prevent attacks for some people. The side effects, however, may be severe.
Methysergide maleate may be helpful to relieve pain and prevent attacks. It may also have severe side effects.
Other medications may be used to treat or prevent symptoms. These include the following:
All preventive medications should be tapered off slowly during periods of remission (no headache).
Corticosteroid medications such as prednisone may provide short-term relief of cluster headaches in some people. They are not advised for long-term use because of side effects.
Surgery on certain nerve cells near the brain may rarely be recommended if medications are ineffective.
Expectations (prognosis) Return to top
Cluster headaches are not life-threatening and usually cause no permanent structural changes. However, they are chronic and may be painful enough to be debilitating as they are happening, and this may interfere with work or lifestyle. Occasionally, the pain may be severe enough to drive some individuals to attempt suicide. Side effects of medications or surgery may be severe.Complications Return to top
Calling your health care provider Return to top
Call for an appointment with your health care provider if cluster headaches do not respond to treatment, if headaches disturb sleep, if they happen whenever you are active, or are accompanied by other symptoms.Prevention Return to top
If prone to cluster headache, stop smoking. Alcohol use and any foods that are associated with cluster headache may need to be avoided. Medications may prevent cluster headaches in some cases. Update Date: 8/1/2004 Updated by: Joseph V. Campellone, M.D., Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network.
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Page last updated: 28 October 2004 |