Overview
These are very severe headaches, otherwise known as ‘suicide headaches’. They are very rare, approximately 1 in 1000 people and is more prevalent in males. They can occur in clusters normally around spring or autumn. It is suggested that cluster headaches are linked to increased activity in an area of the brain called the hypothalamus. The hypothalamus is the part of the brain that is responsible for a range of bodily functions including body temperature and sleep cycles. In some people there may be a family link. They can be triggered by drinking alcohol during an active headache period; increase in body temperature; using nitroglycerin (used in for angina) and strong odours e.g. chemicals/paint for example. Cluster headache are either episodic or chronic. In episodic cluster headache, bouts last from 7 days to one year separated by pain free periods lasting at least 3 months. Most cluster bouts usually last between 2 weeks and 3 months. In chronic cluster headache, people experience persistent attacks for more than a year without remission, or remission which lasts less than three months. Up to 2 in 10 people with cluster headache have chronic cluster headache.
Symptoms & Diagnosis
They can experience one to eight attacks a day during a period which can last weeks to months. The attacks often wake people up about one to two hours after they go to bed, at the same time each night or in the early hours of the morning. The pain tends to start suddenly with no warning. The pain is stabbing or burning, located behind one of the eyes and is associated with strikingly characteristic features. These including watering and redness of the eye and restlessness. The headache usually lasts 45-90 minutes but can range from 15 minutes to 3 hours. It is probably one of the most painful conditions known to mankind with female patients describing each attack as being worse than childbirth. The pain is so intense that most sufferers cannot sit still; they become restless, preferring to move about and looking for a movement or posture that may relieve the pain.
In the vast majority of patients the headache bout or period lasts several weeks or months (usually 1-3 months), then disappears completely for 3 months or years leaving considerable amounts of pain-free intervals between bouts. These patients are said to have episodic cluster headache. About 20% of patients will note that they don’t have any pain-free intervals. These patients are said to have chronic cluster headache. Investigations may include imaging of the head as well as specialised blood tests. Occasionally indomethacin trials to exclude similar disorders may be carried out.
Treatments, Key Areas We Specialise In & Prognosis
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