Cluster headache is a type of headache that affects 2 in a thousand people. Although it
is not very common, it is considered the most severe form of headache
and one of the most painful conditions known to humankind. Women who experience cluster headaches
say it is worse than giving birth to a child. Not many doctors know how to diagnose cluster
headaches, and many patients go many years without a proper diagnosis and treatment.
Today, I will explain what cluster headache is,
how it is different from migraines, and how to treat it.
This video is the second in a series about headaches. My previous video was about
migraines. Stay tuned to the end, and I’ll tell you about my upcoming videos.
So, let’s talk about cluster headaches today.
In cluster headaches, the pain is usually localized around the eye,
on one side of the head. It can spread to the ear, jaw, forehead, and neck. During an attack,
the person will also have symptoms related to the trigeminal autonomic system,
which means red and watering eyes, runny or blocked nose, swollen and drooping eyelid,
facial flushing, and agitation. The headaches have some interesting patterns.
The episodic form is the most common. The headaches happen every day for a few weeks or
months. They start at the same time of the year and occur at the same time of the day or night.
Then they stop for many months and return the following year around the same month.
In chronic cluster headaches, the attacks occur more frequently, and they
have a pain-free period of less than a month. The duration of the headache attacks is usually
between 15 minutes to 3 hours, and they may range between 1 to 8 per day. The person may also have
nausea and sensitivity to light during an attack. Before I continue, let me remind you that this
video is not intended to replace medical advice. It is for educational purposes
only. Please talk to your doctor about the diagnosis and treatment plan for you.
In case of emergency, please go to the nearest emergency department or call an ambulance.
So, how is cluster headache different from migraines?
Cluster headache affects more men than women, which is the opposite of migraine.
The pain in cluster headache remains on one side,
usually around the eye and the temple. In migraine, the localization of the pain is
more variable, and even if it often starts on one side it often diffuses to the whole head.
In cluster headache the person is agitated. They cannot rest. The person with migraine likes to be
quiet, in the dark, and away from the noise. In cluster headache the attacks last
less than 3 hours without treatment. Migraine usually lasts more than 4 hours without treatment.
Cluster headache comes with particular symptoms like tearing of the eye, running of the nose, a
droopy eyelid, all on the side of the pain, during the attack. These are called «autonomic symptoms».
In cluster headaches, oral triptans are not effective in aborting the attack,
but triptan sprays and injections may help.
I made this video series in collaboration with Migraine Canada.
If you want to learn more about headaches and migraines, visit their website. They
have a lot of resources, events, and education materials for you to learn more about migraines.
There are some triggers to cluster headaches. In general, drinking alcohol,
sleeping, and some positions of the neck trigger the attacks. Also, some medications that cause
dilatation of blood vessels like nitroglycerine and medications for sexual impotence.
How is cluster headache treated? The first thing is to educate the
patient about what it is and let them know that the intensity of pain does not mean that there
is something to be fixed in the brain, the eye or even the sinuses and teeth.
Patients may become very anxious about the disease and think they need some surgery or have a brain
tumour. Once these fears are addressed, they have less anxiety about the condition.
It is also crucial to ask the patient about any intention to commit suicide,
as the pain can be very intense and debilitating. If the person acknowledges they have been
thinking of suicide, especially in between attacks, they need to be referred to a mental
health specialist to address this concern. The treatments during a cluster headache
attack involve the following: - Triptans are given either
by injection or intranasal. - Oral triptans do not help
because they take too long to start the effect. - Inhaled oxygen at 100% for 10-15 liters per
minute with a non-rebreathing mask - Opioids should not be given
because they may lead to addiction and rebound.
Preventive treatments include:
- Verapamil, a drug for hypertension - Injections of steroids in
the occipital area - CGRP antibody is
effective to treat episodic cluster headache and approved by Health Canada for this disease
Because cluster headache is not so common and not correctly diagnosed,
there are not a lot of research studies published to treat this condition.
You may use a Headache diary to track your symptoms, and Migraine Canada has a version
that you can download and an App version. This diary is designed for migraine.
You can use the 1-2-3 scale to document the frequency of cluster attacks on any given day.
A paper version fitting your needs can also be used.
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In the next weeks, I will release videos about trigeminal neuralgia,
tension-type headache, and cervicogenic headache.
Thank you for watching. Goodbye!