Cluster Headache - Why they are also called suicide headache
Cluster Headache definition
Cluster headaches occur in cyclical patterns or clusters — which gives the condition its name. Cluster headache is one of the most painful types of headache. Cluster headache is sometimes called the "alarm clock headache" because it commonly awakens you in the middle of the night with intense pain in or around the eye on one side of your head.
Bouts of frequent attacks — known as cluster periods — may last from weeks to months, usually followed by remission periods when the headache attacks stop completely. During remission, no headaches occur for months and sometimes even years.
Fortunately, cluster headache is rare and not life-threatening. Treatments can help make cluster headache attacks shorter and less severe. In addition, preventive medications can help reduce the number of cluster headaches.
Symptoms of Cluster Headaches
Cluster headaches usually strike suddenly and without warning, although some people experience a migraine-type aura before the attack. The pain is deep, constant, boring, piercing, or burning in nature, and located in, behind, or around the eye. The pain then spreads to the forehead, jaw, upper teeth, temples, nostrils, shoulder or neck. The pain and other symptoms usually remain on one side of the head.
The pain generally reaches very severe levels within 15 minutes. Patients may feel agitated or restless during an attack and often want to isolate themselves and then move around. Gastrointestinal symptoms are not very common.
Other typical symptoms include:
Swollen or droopy eyelid
Watery, tearing eye
Contraction of the eye pupil
Stuffy or runny nose
Forehead and facial sweating
Restlessness and agitation
Nausea and vomiting
Intolerance to light and sound
The symptoms of a cluster headache include stabbing severe pain behind or above one eye or in the temple. Tearing of the eye, congestion in the associated nostril, and pupil changes and eyelid drooping may also occur.
You can get 2 types of cluster headache:
Episodic: This type is more common. You may have 2 or 3 headaches a day for about 2 months and not experience another headache for a year. The pattern then will repeat itself.
Chronic: The chronic type behaves similarly but, unfortunately, you get no period of untreated sustained relief.
Causes of Cluster Headaches
The exact cause of cluster headaches is unknown, but abnormalities in the hypothalamus likely play a role. Cluster attacks typically occur with clocklike regularity during a 24-hour day, and the cycle of cluster periods often follows the seasons of the year. These patterns suggest that the body's biological clock is involved. In humans, the biological clock is located in the hypothalamus, which lies deep in the center of your brain. Abnormalities of the hypothalamus may explain the timing and cyclical nature of cluster headache. Studies have detected increased activity in the hypothalamus during the course of a cluster headache.Unlike migraine and tension headache, cluster headache generally isn't associated with triggers, such as foods, hormonal changes or stress. But once a cluster period begins, consumption of any alcohol can quickly trigger a splitting headache. For this reason, many people with cluster headache avoid alcohol for the duration of a cluster period. Other possible triggers include the use of medications such as nitroglycerin, a drug used to treat heart disease.
Typical Cluster Headache Cycles
Timing of an Attack. Headache attacks tend to occur with great regularity at the same time of day. (For this reason, cluster headaches are sometimes referred to as "alarm clock" headaches.) About 75% of attacks occur between 9 p.m. - 10 a.m. Attacks may also peak between 1 - 3 p.m.
Duration of an Attack. A single cluster attack is usually brief but extremely painful, lasting about 15 minutes - 1.5 hours if left untreated.
Number of Attacks per Day. During an active cycle, people can experience as few as 1 attack every other day to as many as 8 attacks a day.
Duration of Cycles. Attack cycles cycles typically last 6 - 12 weeks with remissions lasting up to 1 year. In the chronic form, attacks are ongoing and there is little remission. Attacks cycles tend to occur seasonally, most often in the spring and autumn.
Risk Factor of Cluster Headaches
Gender. Men are more likely to have cluster headaches.Age. Most people with cluster headaches first develop the disorder in their late 20s, although the condition can develop at any age.
Smoking. Many people who get cluster headache attacks are smokers.
Alcohol use. Alcohol can trigger an attack if you're at risk of cluster headache.
A family history. If a parent or sibling has ever had a cluster headache, you may have an increased risk of cluster headaches.
More: Severe Headaches tied to Suicide Attempt
Test and Diagnosis of Suicide Headache
Cluster headache has a characteristic type of pain and pattern of attacks. A diagnosis depends on your description of the attacks, including your pain, the location and severity of your headaches, and associated symptoms. The frequency and duration of your headaches also are important factors.
If you have chronic or recurrent headaches, your doctor may try to pinpoint the type and cause of your headache using certain approaches.
Neurological examination
A neurological examination may help your doctor detect physical signs of a cluster headache. Sometimes the pupil of your eye may appear smaller, or your eyelid may droop, even between attacks.
Imaging tests
If you have unusual or complicated headaches or an abnormal neurological exam, you may undergo other diagnostic testing to rule out other serious causes of head pain, such as a tumor or aneurysm. Common brain-imaging tests include:
Computerized tomography (CT) scan. A CT scan uses a series of computer-directed X-rays to provide a comprehensive view of your brain.
Magnetic resonance imaging (MRI). An MRI doesn't use X-rays. Instead, it combines magnetism, radio waves and computer technology to produce clear images of your brain.
Treatments and drugs of Cluster Headache
There's no cure for cluster headaches. The goal of treatment is to help decrease the severity of pain, shorten the headache period and prevent the attacks.
Because the pain of a cluster headache comes on suddenly and may subside within a short time, over-the-counter pain relievers such as aspirin or ibuprofen (Advil, Motrin, others) aren't effective. The headache is usually gone before the drug starts working. Fortunately, other types of acute medication can provide some pain relief. Based on the latest studies, the therapies listed below have proved to be most effective for acute and preventive treatment of cluster headache.
Acute treatments
Fast-acting treatments available from your doctor include:
Oxygen. Briefly inhaling 100 percent oxygen through a mask at a minimum rate of 7 liters a minute provides dramatic relief for most who use it. The effects of this safe, inexpensive procedure can be felt within 15 minutes. The major drawback of oxygen is the need to carry an oxygen cylinder and regulator with you, which can make the treatment inconvenient and inaccessible at times. Small, portable units are available, but some people still find them impractical. Be careful not to smoke or be near an open flame if you're using oxygen, due to the risk of explosion.
Triptans. The injectable form of sumatriptan (Imitrex), which is commonly used to treat migraine, is also an effective acute treatment for cluster headache. The first use is often done while under medical observation. Some people may benefit from using sumatriptan in nasal spray form, but for most people this isn't as effective as an injection. Sumatriptan isn't recommended if you have uncontrolled high blood pressure or ischemic heart disease.
Another triptan medication, zolmitriptan (Zomig), can be taken in nasal spray or tablet form for relief of cluster headache. This medication may be an option if you can't tolerate other forms of fast-acting treatments.
Octreotide (Sandostatin, Octreotide Acetate). This drug, an injectable synthetic version of the brain hormone somatostatin, is an effective treatment for cluster headache and is safe if you have high blood pressure and ischemic heart disease.
Local anesthetics. The numbing effect of local anesthetics, such as lidocaine (Xylocaine), may be effective against cluster headache pain when used intranasally.
Dihydroergotamine. This medication derivative is available in intravenous, injectable and inhaler forms. Dihydroergotamine (D.H.E. 45, Migranal) is an effective pain reliever for some people with cluster headache. When administered intravenously, you'll need to go to a hospital or doctor's office to have an intravenous (IV) line placed in a vein. The inhaler form of the drug works more slowly.
More on Treatment of Cluster Headache
Sources:
www.mayoclinic.com
http://www.umm.edu/patiented/articles/what_a_cluster_headache_000099_2.htm
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