FAQs on Cluster Headache Treatment in Nashville

Cluster headache, often called histamine headache, red migraine, and Horton’s headache, is an uncommon type of head pain. The pain of the headache can last for several weeks or even months, before it disappears completely for months or years. The 1-year prevalence rate of cluster headache is 53 per 100,000 persons. Additionally, cluster headache occurs more often in men, with a ratio of 4:3.

What causes cluster headache?

The pain of cluster headache is vascular in nature, caused by blood vessel swelling in the head region. Experts believe the autonomic nervous system is involved in the onset of cluster headache, occurring from alterations in the hypothalamic region of the brain.

What are the symptoms of cluster headache?

Cluster headaches comes on suddenly with few or no warning signs. However, the headache be preceded with a feeling of discomfort or a mild burning sensation on one side of the head. The pain of this type of headache is of short duration, which is 30-45 minutes, but it can last for several hours and reoccur within hours or days. Many patients report clusters of 2-5 headaches in a 24-hour period. Common symptoms of cluster headache include:

  • Severe, intense pain on one side of the head, usually the same side in a series of clusters.
  • Pain localized behind the eye or in the eye region that can radiate to the temple, forehead, nose, upper gum, or cheek on the affected side.
  • Nostril congestion or drainage on the affected side.
  • A swollen or droopy eyelid on the affected side
  • Scleral redness on the affected side.

What can trigger a cluster headache?

Certain substances can cause blood vessel swelling and provoke an attack of several cluster headaches. These include:

  • Nitroglycerine
  • Histamine
  • Smoking
  • Alcohol
  • Seasons (more common in Spring and Autumn)

What are the treatment options for cluster headache?

Various treatment modalities are used for cluster headaches, such as:

  • Preventive medications – There are several medications useful for preventing the onset of cluster headache. These include corticosteroids, calcium channel blockers, lithium carbonate, ergotamine, and melatonin.
  • Injectable medications – When used as soon as the headache starts, injectable sumatriptan (Imitrex) and octreotide (Sandostatin) are useful for aborting cluster headaches.
  • Sphenopalatine ganglion block (SGB) – This block involves instilling an anesthetic onto the sphenopalantine ganglion (mass of nerves in the back of the throat at the base of the brain). The doctor first numbs the inside of the nostril or cheek with an anesthetic gel. After several minutes, a catheter is passed through the nostril or orally to deliver the medication. A recent research study found that 66% of patients reported significant pain relief within 7 days of the procedure, and half of the participants had pain relief on the 30-day follow-up visit.
  • Occipital nerve block (ONB) – This block is a minimally invasive procedure where the doctor injects a long-acting anesthetic agent near the occipital nerve at the posterior region of the head. According to recent research, ONB was 100% effective for patients with occipital neuralgia and 75% effective for other types of head pain.
  • Oxygen – For acute, severe cluster headache, inhalation of 100% oxygen by mask is used with good results.

Resources

Felisati G, Arnone F, Lozza P, et al. (2006). Sphenopalatine endoscopic ganglion block: A revision of a traditional technique for cluster headache. Laryngoscope,116, 1447-1450.

Fischera M, Marziniak M, Gralow I, & Evers S (2008). The incidence and prevalence of cluster headache: a meta-analysis of population-based studies. Cephalalgia, 28:614.

Jurgens, TP, Muller, P, Seedorf, H et al. (2012). Occipital nerve block is effective in craniofacial neuralgias but not in idiopathic persistent facial pain. Journal of Headache Pain, 13(3), 199-213. doi:  10.1007/s10194-012-0417-x

Rozen TD & Fishman RS (2012). Cluster headache in the United States of America: demographics, clinical characteristics, triggers, suicidality, and personal burden. Headache, 52(1), 99-113. doi: 10.1111/j.1526-4610.2011.02028.x.