How to Get Rid of Cluster Headaches
The treatment of cluster headache can be divided into two distinct categories.
- Relief of the acute headache, and
- Prevention of future headaches.
What are the different types of headaches?
How do I relieve a headache?
What could headaches be a sign of?
The treatment of cluster headache can be divided into two distinct categories.
Headache is defined as pain arising from the head or upper neck of the body. The pain originates from the tissues and structures that surround the skull or the brain because the brain itself has no nerves that give rise to the sensation of pain (pain fibers). The thin layer of tissue (periosteum) that surrounds bones, muscles that encase the skull, sinuses, eyes, and ears, as well as thin tissues that cover the surface of the brain and spinal cord (meninges), arteries, veins, and nerves, all can become inflamed or irritated and cause a headache. The pain may be a dull ache, sharp, throbbing, constant, intermittent, mild, or intense.
In 2013, the International Headache Society released its latest classification system for headache. Because so many people suffer from headaches, and because treatment is difficult sometimes, the Headache Society hoped that the new classification system would help health care professionals make a more specific diagnosis as to the type of headache a patient has, and allow better and more effective options for treatment.
The guidelines are extensive, and the Headache Society recommends that health care professionals consult the guidelines frequently to make certain of the diagnosis.
There are three major categories of headache based upon the source of the pain.
The guidelines also note that a patient may have symptoms that are consistent with more than one type of headache, and that more than one type of headache may be present at the same time.
Primary headaches include migraine, tension, and cluster headaches, as well as a variety of other less common types of headaches.
Primary headaches can affect the quality of life. Some people have occasional headaches that resolve quickly while others are debilitating. While these headaches are not life-threatening, they may be associated with symptoms that can mimic strokes.
Many patients equate severe headache with migraine, but the amount of pain does not determine the diagnosis of migraine. Read our Migraine Headache article for more information about the symptoms, causes, and treatment of migraines.
Secondary headaches are those that are due to an underlying structural or infectious problem in the head or neck. This is a very broad group of medical conditions ranging from dental pain from infected teeth or pain from an infected sinus, to life-threatening conditions like bleeding in the brain or infections like encephalitis or meningitis.
Traumatic headaches fall into this category including post-concussion headaches.
This group of headaches also includes those headaches associated with substance abuse and excess use of medications used to treat headaches (medication overuse headaches). "Hangover" headaches fall into this category as well. People who drink too much alcohol may waken with a well-established headache due to the effects of alcohol and dehydration.
Neuralgia means nerve pain (neur=nerve + algia=pain). Cranial neuralgia describes inflammation of one of the 12 cranial nerves coming from the brain that control the muscles and carry sensory signals (such as pain) to and from the head and neck. Perhaps the most commonly recognized example is trigeminal neuralgia, which affects cranial nerve V (the trigeminal nerve), the sensory nerve that supplies the face and can cause intense facial pain when irritated or inflamed.
The different types of headaches depend upon the class to which they belong. Some common types include:
Migraine headache is caused by inflammation or irritation of structures that surround the brain or affect its function. While the brain itself has no pain nerve fibers, everything else above the shoulders, from the neck, skull, and face, can cause a person to have head pain. Systemic illnesses, including infection or dehydration, can have associated headache. These are known as toxic headache. Changes in circulation and blood flow or trauma can also cause headache.
Changes in brain chemistry may also be associated with headache: Medication reactions, drug abuse and drug withdrawal can all cause pain.
Every person is different so the history of the headache is important. Recognizing patterns or precipitating (foods eaten, stress, etc.) factors, in combination with the physical examination and associated symptoms, can help identify the cause for each individual's specific headache.
While tension headaches are the most frequently occurring type of headache, their cause is not known. The most likely cause is contraction of the muscles that cover the skull. When the muscles covering the skull are stressed, they may become inflamed, go into spasm, and cause pain. Common sites include the base of the skull where the trapezius muscles of the neck insert, the temples where muscles that move the jaw are located, and the forehead.
There is little research to confirm the exact cause of tension headaches. Some believe that tension headaches occur because of physical stress on the muscles of the head. For example, these stressors can cause the muscles surrounding the skull to clench the teeth and go into spasm. Physical stressors include difficult and prolonged manual labor, or sitting at a desk or computer concentrating for long periods. Emotional stress also might cause tension headaches by causing the muscles surrounding the skull to contract.
Common signs and symptoms of tension headaches include:
The key to making the diagnosis of any headache is the history given by the patient. The health care professional will ask questions about the headache to try to help make the diagnosis. Those questions will try to define the quality, quantity, and duration of the pain, as well as any associated symptoms. The person with a tension headache will usually complain of mild-to-moderate pain that is located on both sides of the head. People with tension headaches describe the pain as a non-throbbing tightness, that is not made worse with activity. There usually are no associated symptoms like nausea, vomiting, or light sensitivity.
The physical examination, particularly the neurologic portion of the examination, is important in tension headaches because to make the diagnosis, it should be normal. However, there may be some tenderness of the scalp or neck muscles. If the health care professional finds an abnormality on neurologic exam, then the diagnosis of tension headache should be put on hold until the potential for other causes of headaches has been investigated.
Tension headaches are painful, and patients may be upset that the diagnosis is "only" a tension headache. Even though it is not life threatening, a tension headache can make daily activities more difficult to accomplish. Most people successfully treat themselves with over-the-counter (OTC) pain medications to control tension headaches. The following work well for most people:
If these fail, other supportive treatments are available. Recurrent headaches should be a signal to seek medical help. Physical therapy, massage, biofeedback, and stress management can all be used as adjuncts to help control tension headaches.
It is important to remember that OTC medications, while safe, are medications and may have side effects and potential interactions with prescription medications. It always is wise to ask a health care professional or pharmacist if one has questions about OTC medications and their use. This is especially important with OTC pain medications, because they are used so frequently.
It is important to read the listing of ingredients in OTC pain medications. Often an OTC medication is a combination of ingredients, and the second or third listed ingredient may have the potential of interfering with the action of other drugs based upon a patient's other medical issues. For example:
Other examples where caution should be used include the following:
Cluster headaches are so named because they tend to occur daily for periods of a week or more followed by long periods of time -- months to years -- with no headaches. They occur at the same time of day, often waking the patient in the middle of the night.
The cause of cluster headaches is uncertain but may be due to a sudden release of the chemicals histamine and serotonin in the brain. The hypothalamus, an area located at the base of the brain, is responsible for the body's biologic clock and may be the source for this type of headache. When brain scans are performed on patients who are in the midst of a cluster headache, abnormal activity has been found in the hypothalamus.
Cluster headaches also:
If an individual is in a susceptible period for cluster headache, cigarette smoking, alcohol, and some foods (for example, chocolate, and foods high in nitrites like smoked meats) also are potential causes for headache.
Cluster headaches are headaches that come in groups (clusters) separated by pain-free periods of months or years. A patient may experience a headache on a daily basis for weeks or months and then be pain-free for years. This type of headache affects men more frequently. They often begin in adolescence but can extend into middle age.
Unlike people with migraine headaches, those with cluster headaches tend to be restless. They often pace the floor and/or bang their heads against a wall. People with cluster headaches can be driven to desperate measures, including suicidal thoughts.
The diagnosis of cluster headache is made by taking the patient's history. The description of the pain and its clock-like recurrence is usually enough to make the diagnosis.
If examined in the midst of an attack, the patient usually is in a painful crisis and may have the eye and nose watering as described previously. If the patient is seen when the pain is not present, the physical examination is normal and the diagnosis will depend upon the history.
Cluster headaches may be very difficult to treat, and it may take trial and error to find the specific treatment regimen that will work for each patient. Since the headache recurs daily, there are two treatment needs. The pain of the first episode needs to be controlled, and the headaches that follow need to be prevented.
Initial treatment options may include one or more of the following:
Prevention of the next cluster headache may include
Since cluster headache episodes may be spaced years apart, and since the first headache of a new cluster episode can't be predicted, daily medication may not be warranted.
Lifestyle changes may help minimize the risk of a cluster headache flare. Stopping smoking and minimizing alcohol may prevent future episodes of cluster headache.
Headache is a symptom associated with many illnesses. While head pain itself is the issue with primary headaches, secondary headaches are due to an underlying disease or injury that needs to be diagnosed and treated. Controlling the headache symptom will need to occur at the same time that diagnostic testing is performed to identify the underlying disease. Some of the causes of secondary headache may be potentially life threatening and deadly. Early diagnosis and treatment is essential if damage is to be limited.
The International Headache Society lists eight categories of secondary headache. A few examples in each category are noted (This is not a complete list.).
Oral contraceptives, medications used to treat erectile dysfunction, blood pressure or other cardiac medications can all lead to or cause headaches. Medication overuse headache, occurring when pain medications are taken too frequently, can be caused by acetaminophen (Tylenol and others), aspirin, ibuprofen (Advil and others), OTC analgesics with caffeine (Excedrin and others), as well as narcotic analgesics and other prescription pain medications.
If there is time, the diagnosis of secondary headache begins with a complete patient history followed by a physical examination and laboratory and radiology tests as appropriate.
However, some patients present in crisis with a decreased level of consciousness or unstable vital signs due to the underlying cause of the headache. In these situations, the health care professional may decide to treat a specific cause without waiting for tests to confirm the diagnosis.
For example, a patient with headache, fever, stiff neck, and confusion may have meningitis. Since meningitis can be rapidly fatal, antibiotic therapy may be started before blood tests and a lumbar puncture are performed to confirm the diagnosis. It may be that another diagnosis ultimately is found, for example, a brain tumor or subarachnoid hemorrhage, but the benefit of early antibiotics outweighs the risk of not giving them promptly.
The patient history and physical examination provide the initial direction for determining the cause of secondary headaches. Therefore, it is extremely important that patients with a new, severe headache seek medical care and give their health care professional an opportunity to assess their condition. Tests that may be useful in making the diagnosis of the underlying disease causing the headaches will depend upon the doctor's evaluation and what specific disease, illness, or injury is being considered as the cause of the headaches (the differential diagnosis). Common tests that are considered include the following:
Specific tests will depend upon what potential issues the health care professional and patient want to address.
Blood tests provide helpful information in association with the history and physical examination in pursuing a diagnosis. For example, an infection or inflammation in the body may cause a rise in the white blood cell count, the erythrocyte sedimentation rate (ESR), or C-reactive protein (CRP). These two tests are very nonspecific; that is, they may be abnormal with any infection or inflammation, and abnormalities do not point to a specific diagnosis of the cause of the infection or inflammation. The ESR is often used to make the tentative diagnosis of temporal arteritis, a condition that affects an older patient, usually over the age of 65, who presents with a sharp, stabbing temporal headache, due to inflammation of the arteries on one side of the head.
Blood tests may be used to assess electrolyte imbalance, and a variety of other potential problems involving organs like the liver, kidney, and thyroid.
Toxicology tests may be helpful if the patient is suspected of abusing alcohol, or prescription or other drugs of abuse.
Computerized tomography of the head
Computerized tomography (CT scan) is able to detect bleeding, swelling, and some tumors within the skull and brain. It also can show evidence of a previous stroke. With intravenous contrast injection (angiogram), it may also be used to look at the arteries of the brain for aneurysms.
Magnetic resonance imaging (MRI) of the head
MRI is able to show the anatomy of the brain and the layers that cover the brain and the spinal cord (meninges). It is more precise than computerized tomography. This type of scan is not available at all hospitals. Moreover, it takes much longer to perform, requires the patient to cooperate by holding still, and requires that the patients have no metal in their body (for example, a heart pacemaker or metal foreign objects in the eye).
Cerebrospinal fluid, the fluid that surrounds the brain and spinal cord, can be obtained with a needle that is inserted into the spine in the lower back. Examination of the fluid looks for infection (such as meningitis due to bacteria, virus, fungus, or tuberculosis) or blood from hemorrhage. In almost all cases, computerized tomography is done prior to lumbar puncture to make certain there is no bleeding, swelling, or tumor within the brain. Pressure within the space can be measured when the lumbar puncture needle is inserted. Elevated pressures may make the diagnosis of idiopathic intracranial hypertension (previously known as pseudotumor cerebri) in combination with the appropriate history and physical examination.
Seek medical care if the headache is:
It is important to consider that an unusual headache may need to be evaluated by a health care professional, but in most instances, primary tension headaches may be initially treated at home.
Those with migraine headaches often have a treatment plan that will allow treatment at home. Prescription medications are available to abort or stop the headache. Other medications are available to treat the nausea and vomiting. Most patients with migraine headaches get much relief after resting in a dark room and falling asleep.
Patients who have secondary headaches will often need to seek medical care.
Thyroid blood tests determine the adequacy of the levels of thyroid hormones in in a patient. The blood tests can determine if the thyroid gland's hormone production is normal, overactive, or underactive. The level of thyroid hormones may help to diagnose hypothyroidism or hyperthyroidism. The test may also point to other diseases of conditions of the thyroid gland.