Cluster headaches: a painful reality

“Pain so severe you just want to die” –and yet affecting approximately as many people in the UK as the widely known condition multiple sclerosis (MS) (1),  any mention of cluster headaches will likely draw blank looks from most of the general population. Given this, it’s hardly surprising that many sufferers feel alone in their battle with the condition. (1)

What are cluster headaches?

Cluster headaches (CH) differ vastly from a regular (tension) headache. Attacks (individual headaches) come on very suddenly. During an attack, sufferers experience a sharp, burning pain of excruciating intensity on one side of the head. (2) In fact, women who have both given birth and have CH have branded the latter as worse. (3) The pain is typically centred around the eye, but may affect other parts of the head or neck. The side affected may change between attacks, or less commonly, in the same attack. (4) Other symptoms occurring alongside the headache can include a red, watering eye, a congested or runny nostril, facial sweating, a droopy eyelid and a constricted pupil. (2)

Unlike migraine sufferers who usually want to lie down and rest during an attack, those with CH may pace around, rock their head or even resort to banging their head against a wall due to the severity of the pain. (2)

Attacks normally take place in bouts, or ‘clusters’, which persist on average for a period of four to twelve weeks. Within a cluster, attacks normally happen every day at the same time of day, and may occur multiple times a day, beyond eight in some cases. (2)

The period in between clusters is known as remission, which may last years before attacks return. However, many sufferers find they experience clusters around the same time every year.

In some particularly unfortunate instances, sufferers experience attacks on a chronic (ongoing) basis. This means they have experienced attacks every day for a year or more with no remission period, or a very short one. (3)

The excruciating pain of CH, along with the relentless nature, has led to the condition being dubbed “suicide headache”. (5)

What is the cause?

As of yet, there is no known definitive cause of CH, however, it is believed that malfunctioning of the hypothalamus, a part of the brain responsible for many vital bodily functions and processes, is the most likely basis. Additionally, CH is sometimes found to run in families, indicating a genetic link. (6)

How is it treated?

There are treatments available both to stop an attack from progressing and to prevent attacks from happening in the first place.

The following are abortive medications, used to treat individual attacks:

• Sumatriptan, when used at the beginning of an attack, can bring the headache to a halt. It comes in either injection form, which can be self-administered once or twice a day, or as nasal spray if preferred.

• Zolmitriptan is a similar medicine to sumatriptan and is available in a nasal spray form.

• Pure oxygen can be breathed through a mask to provide relief from an attack.

• Lignocaine is an anaesthetic administered in nasal drop or spray form. It is usually not sufficient to stop an attack completely, but can be helpful when used alongside other medicines.

• A gammacore device is a handheld appliance that can be held to the neck to generate a pulse which stimulates the vagal nerve, which is believed to play a role in CH. This can stop an attack in its tracks. (2, 7)

The following medications are preventative:

• Verapamil is the most common medicine used to prevent attacks. It may cause heart problems, so it is important to have regular electrocardiogram (ECG) tests during treatment.

• Local anaesthetic injections to the back of the head, corticosteroids or lithium are alternatives if verapamil is ineffective or unsuitable. (2)

It is thought that certain triggers can bring on attacks in some people. The smell of pungent chemicals, such as perfume or petrol, has been known to be a trigger. Also, avoidance of alcohol and smoking cessation is recommended. (2)

If these symptoms sound all too familiar and you think you may have cluster headaches, make an appointment with your GP as soon as you can. They will rule out other causes and assess your condition. Once you have a formal diagnosis, you should then be referred to a specialist who will discuss a treatment plan with you and help you to regain control over your life! (2)

For further support and information, visit ouchuk.org.

References

1. OUCH UK. Organisation for the Understanding of Cluster Headache [cited 3 September 2017]. Available from: https://ouchuk.org/

2. National Health Service. Cluster headaches [cited 3 September 2017]. Available from: http://www.nhs.uk/conditions/cluster-headaches/Pages/Introduction.aspx

3. OUCH UK. What is Cluster Headache? [cited 3 September 2017]. Available from: https://ouchuk.org/what-is-cluster-headache

4. OUCH UK. Cluster Attack [cited 3 September 2017]. Available from: https://ouchuk.org/cluster-attack

5. Medscape (2015). Hope for 'Suicide Headache'. [online] Available from: http://www.medscape.com/viewarticle/844217 [Accessed 3 Sep. 2017].

6. OUCH UK. Causes [cited 3 September 2017]. Available from: https://ouchuk.org/causes

7. OUCH UK. Abortive Medication [cited 3 September 2017]. Available from: https://ouchuk.org/abortive-medication

   Author: Gabby Gallagher MPharm

   Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 04/09/17