Cluster headaches

Alternative names:

headache - cluster; headache - histamine; histamine headache; migrainous neuralgia

Treatment:

Treatment does not cure cluster headaches. The goal of treatment is to relieve symptoms. Spontaneous remission may occur, or treatment may be required to prevent headaches.

Smoking, alcohol use, specific foods, and other factors that trigger cluster headaches should be avoided.

A headache diary may be helpful to identify factors that trigger cluster headaches. When a headache occurs, record the date, the time, and list any activities, substances used or consumed within the previous 24 hours, and any other factors that seem significant.

Analgesic medications do not usually relieve the pain from cluster headaches (they take too long to work--the headache is usually gone before they take effect).

Inhalation of 100% oxygen often relieves cluster headache for some people, particularly for frequent cluster headaches that occur mostly at night.

Combination or multiple medications may be required to control symptoms of cluster headache. Because response to medications varies, several medications may be tried before a suitable medication combination is found. Response can vary over time, so a previously taken effective medication or combination of medications may not have the same effect.

Ergot preparations (containing ergotamine tartrate alone or in combination with other medications) are effective for some people, and may help prevent attacks. The side effects, however, may be severe. Methysergide maleate may be helpful for some persons to relieve pain and prevent attacks. It may have severe side effects. Other medications may be used to treat or prevent symptoms. These include antihistamines, lithium carbonate, calcium channel blockers, propranolol, amitriptyline, verapamil, methysergide, cyproheptadine, and others. All preventive medications should be tapered off slowly during periods of remission (no headache).

Corticosteroid medications such as prednisone may provide short-term relief of cluster headaches in some people. They are not advised for long-term use because of side effects.

Surgery on certain nerve cells near the brain may rarely be recommended if medications are ineffective.

Expectations (prognosis):

Cluster headaches are not life threatening and usually cause no permanent structural changes. However, they are chronic and may be painful enough to be debilitating during an attack, which may interfere with work or lifestyle. Occasionally, the pain may be severe enough to drive some individuals to suicide. Side effects of medications or surgery may be severe.

Complications:

• interference with lifestyle
• side effects of medications (see the specific medication)
• permanent muscle weakness in parts of the face and or head after surgery
• decreased sensation in parts of the face or head after surgery
• chronic Horner's syndrome (not really a problem, but can be noticeable)

Calling your health care provider:

Call for an appointment with your health care provider if cluster headaches do not respond to treatment, headaches disturb sleep, are caused whenever the person is active, other concerns or questions develop, or if cluster headaches are accompanied by other symptoms.

Emergency symptoms include drowsiness, vision changes, changes in movement or sensation, seizures, changes in alertness, and nausea/vomiting.