Cluster Headache: Meaning, Symptoms, Prevention, Treatment, Ayurveda understanding

Article by Dr Manasa. S

Cluster Headache

It is a type of headache which occurs in clusters or groups, before completely going away, for most individuals. For some others, it is a one-sided headache that may involve tearing of the eyes.  

The cluster headache feels like burning sensation, sharp and stabbing type of sensation. Episodes of headache last from 15 minutes to 3 hours, can occur daily or almost daily for weeks or months. There is a pain free time that may last for at least 1 month or longer. Cluster headaches are rare and it is estimated that it affects 0.1% of people around the world. It is more common in men than women.

Most commonly in cluster headaches there will not be any warning signs but some people experience slight discomfort or burning sensation on one side just before the actual episode of cluster pain.

Cluster headache is so fast in occurrence that people who are chronic sufferers don’t get enough time to be prepared for the episode.

Alternative names

Cluster Headache is also called by other names. They include –

• Histamine headache
• Headache – histamines
• Migrainous neuralgia
• Headache-cluster
• Horton’s headache
• Vascular headache-cluster
• Episodic cluster headache
• Chronic cluster headache

Causes

The exact cause for cluster headaches is not clearly understood but certain researchers have found that the release of histamine or serotonin near the trigeminal nerve that sends the signal between face and brain could be the common reason behind cluster headaches. Research also shows that cluster headaches can be genetic in up to 5% of people. Dysfunction in the area of the brain called as hypothalamus could also be the reason behind cluster headaches.

Symptoms of cluster headache

Symptoms of cluster headaches are –

Unilateral headache seen in one of the regions like behind eye or near the temples; above the eyes, near the forehead or side of the head behind the ear. Though it is one sided headache, in rare conditions it may switch the locations during the attack. The most common site of cluster headache is around one eye to the side of head at the hairline before the ear.

Sharp, severe and stabbing type of pain behind or around one eye. The pain sometimes may spread to other areas like face, head and neck.

Teary eyes

Redness of the eyes on the side that hurts

Drooping of the eyelid on the side that hurts

Restlessness

Flushing or sweating

Stuffy or running nose on the side that hurts

Swelling in the forehead or face

Change in the colour of the skin on the side of the face those hurts

What is cluster periods?

Cluster periods, a challenging phase for those experiencing cluster headaches, typically extend over a span of weeks to months, demonstrating a remarkable consistency in their onset and duration.

These recurring episodes often align with specific seasons, such as spring or fall, creating a predictable pattern.

For individuals grappling with cluster headaches, the cluster period usually persists for one week to a year, followed by a reprieve known as remission, lasting three months or more before the resurgence of another cluster headache. This cyclical nature characterizes what is termed episodic cluster headache.

However, in some cases, cluster periods may endure beyond a year, and the interluding pain-free intervals may contract to less than one month. When a cluster period perseveres for a year uninterrupted, it earns the classification of chronic cluster headache.

During the episode of a cluster period:

– Headaches manifest daily, often occurring multiple times throughout the day.

– A single attack can unfold over 15 minutes to three hours, with a more typical duration of 30 to 45 minutes.

– Attacks consistently transpire at the same time each day, often during the night, approximately 1 to 2 hours post-bedtime.

– The pain tends to terminate as abruptly as it initiates, leaving individuals mostly pain-free but understandably fatigued in the aftermath.

Triggering factors

The factors which trigger cluster headaches include –

• Consumption of cocaine
• Excessive intake of alcohol
• Excessive indulgence in cigarette smoking
• Trekking and air travel
• Exertion
• Hot weather or hot baths
• Bright lights
• Consuming foods which are high in nitrates
• Certain medications like sildenafil

Risk factors

Men are at higher risk of developing cluster headaches

Most people experience cluster headaches between the ages 20 and 40. But the condition may be seen at any age.

Frequent consumption of alcohol

Over indulgence in tobacco products

Cluster headaches runs in the family

Complications of cluster headache

It may interfere with day today activities

Might interfere with personal and professional commitments

Might feel helpless and hopeless

Very rarely, people with cluster headaches have a suicidal tendency because of depression caused due to headache. That’s the reason why some people refer cluster headaches to “Suicidal headache”.

Diagnosis

Physical examination – The healthcare provider or a neurologist would diagnose the case of cluster headache with the help of detailed case history and physical examination.

MRI – to rule out conditions with similar symptoms and for making differential diagnosis.

Treatment

Management of cluster headaches involves two approaches and they are as under –

Medicines to prevent headaches – Few medications used thoughtfully can shorten the headache cycle, such as medications used to treat allergies, depression, blood pressure and seizures.

Medications to manage headache during the attack – Certain medications like triptan medicines (sumatriptan), anti-inflammatory medicines (steroids like prednisolone) or dihydroergotamine injections and breathing 100% oxygen during the attack of headache helps to relieve the symptoms.

Alternative approaches to treat Cluster Headache

• Acupuncture
• Physiotherapy
• GammaCore
• Spinal manipulation

When to contact a health care worker / doctor urgently?

Reaching out to healthcare professional is needed urgently when the following symptoms are noticed –

• Headaches are becoming frequent or if there is any change in the frequency
• Change in the severity of headache
• Headache not getting reduced with medication
• Headache associated with stiff neck or fever
• Headache with speech, vision and movement problems, confusion, seizures, numbness or if there is trouble speaking.
• A headache after a head injury, especially if it gets worse

Prognosis

Though there is no permanent cure for cluster headaches, treatment options available makes it less painful and less frequent. One more good news is that cluster headaches become less frequent as the age progress and they are not life threatening in most of the cases.

Prevention

Cluster headaches cannot be prevented entirely. Below mentioned are few things which can be followed to keep the cluster headache at bay –

• Avoid triggering factors like excessive consumption of alcohol, tobacco
• If sleep apnoea is related to headaches, then healthcare worker should be consulted for prompt management of the underlying health concern

Ayurveda perspective of Cluster Headache

Cluster Headache appears as a mixture of conditions explained in Ayurveda treatises. By its nature of manifestation, unpredictable nature of having different ranges of appearance, stay, disappearance and recurrence (cluster period) in terms of days or months and its signs and symptoms, cluster headache falls closer in comparison to two conditions explained in Ayurveda i.e.

Vataja Shiroroga / shirashula – is a headache caused by predominant aggravation of vata.

Ardhavabhedaka – a type of headache marked by one sided headache and other symptoms, popularly correlated with migraine headache. Cluster Headache also has nature of migraine and is also called as ‘migranious neuralgia’.

Other conditions which occasionally fall in closer correlation with cluster headache are – tridoshaja or sannipataja shirashula (caused by simultaneous aggravation of all the three doshas) and adhimantha (closely correlated with glaucoma).

We can also appreciate a few of pitta and kapha symptoms, indicating their association in cluster headache.

The treatment of cluster headache too is done on the lines of treating the above said conditions, mainly vataja shiroroga and ardhavabhedaka.

Related Reading – ‘Ayurveda Understanding of Cluster Headache’