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Understanding Cluster Headaches

Treatment for Cluster Headaches

According to the International Headache Society, a Cluster Headache is a rare type of severe headache that affects around 0.1% of the population. While they are quite rare compared to other types of primary headaches, they affect males about 5 times more than females. Even though Cluster Headaches are uncommon, they are regarded as being the most severe and debilitating type of headache. Research has shown out of all 300 different types of headaches and migraines, cluster headaches were described as having the highest pain levels.

Cluster Headache attacks occur in cycles throughout regular times during the day and will often wake sufferers during the night. Attacks generally last between 15 minutes to 3 hours, and can repeat multiple times per day, or once every couple of days.

Cluster headache patients will generally experience periods of attacks that can last weeks to months, known as a “cluster period”. These periods are then followed by periods of remission lasting weeks, months or even years without symptoms. If a cluster period lasts for over a year without letting up, the condition is called chronic cluster headache.

Once our headache clinicians offer a cluster headache treatment and expect a significant improvement to occur rapidly in 90% of our patients within the first 6 treatment consultations.

Our Cluster Headaches treatment does not require the use of medication or any surgery, it is non-invasive and is completely safe.

Cluster Headache Symptoms

What Does A Cluster Headache Feel Like?

Cluster Headaches are often so severe that a sufferer cannot keep still during an attack. They may pace back and forth or have to take a shower but often have difficulty reducing the pain.

Cluster headache pain is extreme and is commonly described as a sharp, burning or piercing feeling on one side of the head. Pain is frequently experienced around the eye or temple and generally impacts the same side of the head during each episode. 

Associated symptoms of cluster headaches can include the following: 

  • Stabbing pain on one side of the head
  • Severe pain around one eye, that can refer further around the face or neck
  • Watery/teary eyes or eye redness
  • Restlessness
  • Shortness of breath and/or a sweaty face
  • Droopy and swollen eyelids
  • Congested or runny nose
  • Flushed or pale skin

How are cluster headaches diagnosed?

Cluster headaches are typically diagnosed through a thorough assessment that involves your medical history, symptoms, and a physical examination. When you visit the healthcare professional, they’ll ask about the nature, frequency, and intensity of your headaches, as well as any family history of similar issues. They may also conduct a physical and neurological examination to check for signs of neurological problems. Keeping a headache diary can help track your symptoms, including any triggers or relieving factors. 

While imaging tests like MRI or CT scans aren’t usually necessary, they may be ordered to rule out other potential causes. Treatment response can also aid in confirming the diagnosis; if medications like triptans or oxygen therapy prove effective, it supports the likelihood of cluster headaches. If you’re experiencing persistent or severe headaches, seeking prompt medical attention is vital for proper diagnosis and management.

Organise Your Initial Assessment

Chronic Daily Headache - Sydney Headache & Migraine Clinic

Can cluster headaches be prevented?

What Triggers Cluster Headaches?

Historically it was believed that cluster headaches, as well as migraines, were caused by the dilation of blood vessels in the brain, leading to headache symptoms. This led to the belief that medications, like triptans, are effective at relieving the pain as it prevents vessel dilation. However, research has now shown that blood vessel dilation occurs in both for headache and migraine sufferers as well as those that don’t experience headaches.  This means that we have been treating the wrong physiological structure.

Current research has shown that Cluster Headaches and migraines arise from increased sensitivity in the central nervous system, more specifically, a sensitised brainstem which is located in the upper cervical spine C1-3 in the neck. Dysfunction in the upper cervical can lead to this sensitised brainstem, which then can refer severe pain and associated symptoms into the head, face and eye. Furthermore, Triptan medication have also recently been shown to desensitise the brainstem. This would explain the true mechanism behind cluster headaches being a sensitised brainstem.

This information now indicates cluster headaches and migraines to be a direct result of a neck issue, accompanied by a sensitised brainstem.

 

Diagnosis– Cluster Headache

How are cluster headaches diagnosed?

Cluster headaches are typically diagnosed through a thorough assessment that involves your medical history, symptoms, and a physical examination. When you visit the healthcare professional, they’ll ask about the nature, frequency, and intensity of your headaches, as well as any family history of similar issues. They may also conduct a physical examination to check for signs of neurological problems. Keeping a headache diary can help track your symptoms, including any triggers or relieving factors. 

While imaging tests like MRI or CT scans aren’t usually necessary, they may be ordered to rule out other potential causes. Treatment response can also aid in confirming the diagnosis; if medications like triptans or oxygen therapy prove effective, it supports the likelihood of cluster headaches. If you’re experiencing persistent or severe headaches, seeking prompt medical attention is vital for proper diagnosis and management.

About The Assessment Stage

What To Expect During The Assessment


1. Comprehensive and in-depth examination

We instigate an in-depth assessment to identify all possible related factors that could be causing your headaches or migraines. The upper cervical spine, in particular, is thoroughly examined to identify possible issues.



2. Ligamental stability and vertebral arterial tests

We undertake careful examination of neck ligaments and vertebral arteries, ensuring only the highest standards of patient safety and comfort.


3. Temporarily reproduce your headache and migraine symptoms

As a part of the treatment process, we apply gentle and selective stress to the upper cervical spine in order to reproduce headache symptoms, which subside after 20-30 seconds. This helps to identify and treat the cause of your headaches.

More Information on Cluster Headaches

Episodic Cluster Headache

Episodic Cluster Headaches account for up to 80% of all Cluster Headache cases, making it the most common type of Cluster Headache. Episodic symptoms are when patients experience bouts of “cluster periods” that can last for weeks or months. They can occur seasonally or at set times each year. This is normally followed by an extended pain free period of remission that can last for months or even years.

Chronic Cluster Headache

Chronic Cluster Headaches occur without a prolonged period of remission and account for roughly 20% of cluster headaches. Sufferers will often have “cluster periods” that will last over a year. Some sufferers may experience headache-free days however, remission periods generally last less than one month.

What Are The Risk Factors for Cluster Headaches

– Men are 3-4 times more likely to experience cluster headaches
– Patients are generally heavy smokers
– High alcohol consumption may trigger cluster headaches
– Cluster Headaches most commonly affect people aged 20-50
– Patients with family members who are sufferers may be at a higher risk

What causes Cluster Headaches?

As with many forms of headache, the cause of cluster headache was previously unknown. Medical professionals have been prescribing medications such as Triptans, which have been effective at relieving the pain, if taken early enough to ‘catch’ the headache. The effect of Triptans, as most doctors originally thought, was that it predominantly works on migraines as it helps prevent dilatation of the blood vessels in the head to stop migraines.

However, recent studies have shown that dilatation and expansion of the blood vessels are no different to those suffering from a migraine and those who are migraine-free. More importantly, the physiology of blood vessels in the head during a cluster headache do not expand, yet patients still benefit from medications such as Triptans.

This has led researchers to reconsider the mechanisms behind how Triptans work in the context of cluster headaches. Emerging insights suggest their benefit may be linked to their effect on serotonin within the central nervous system. Serotonin plays a role in how the brain processes pain, particularly in areas like the brainstem, which is thought to be closely involved in cluster headache generation. By enhancing serotonin activity, Triptans may help regulate increased sensitivity in these regions, potentially reducing both the intensity and duration of headache episodes. This evolving understanding suggests that Triptans may act primarily through neurological pathways rather than by altering vascular tone.

Common Treatment Strategies for Cluster Headaches

Conventional Approaches

Managing and treating cluster headaches often involves a combination of acute treatments to relieve pain during an attack and preventive therapies aimed at reducing the frequency and severity of future episodes.

Acute Treatments

  • Oxygen Therapy: Inhaling 100% oxygen through a non-rebreather mask at a flow rate of 12–15 litres per minute for 15–20 minutes can provide rapid relief during an attack. Approximately 70% of patients experience improvement within 15 minutes.
  • Triptans: Medications such as sumatriptan, administered subcutaneously or intranasally, are commonly used to treat acute cluster headache attacks. Subcutaneous administration provides faster relief for many patients.

Preventive Treatments

  • Verapamil: A calcium channel blocker often prescribed to reduce the frequency of cluster headaches. Improvement may be seen within 1.7 weeks for episodic cluster headache and 5 weeks for chronic cluster headache at doses between 160 and 720 mg daily.
  • Corticosteroids: Short-term use of steroids like prednisone can help reduce the occurrence of cluster periods but is generally avoided long-term due to potential adverse effects.
  • Occipital Nerve Blocks: Injecting anaesthetics or steroids near the occipital nerve can provide temporary relief, particularly for patients who do not respond well to other preventive options.

Neuromodulation and Surgical Considerations

For patients with chronic cluster headaches unresponsive to conventional treatment, neuromodulation techniques may be considered:

  • Occipital Nerve Stimulation (ONS): This procedure involves stimulating the occipital nerves with implanted electrodes to reduce headache intensity and frequency. ONS has shown potential in providing relief for some patients with refractory cluster headaches.
  • Deep Brain Stimulation (DBS): In severe cases, DBS targets specific brain regions involved in pain processing. While still considered a last-resort option, DBS has demonstrated significant reductions in headache frequency and severity in select patients with chronic cluster headaches.

Considerations 

While these treatments may offer relief, some come with risks, side effects, or limited long-term effectiveness. It’s important to work with experienced healthcare professionals to develop a personalised treatment plan that balances immediate symptom relief with long-term management.

At Sydney Headache and Migraine Clinic™, our approach focuses on identifying and addressing the root cause of cluster headaches – aiming for effective, medication-free results through evidence-based, non-invasive techniques.

How are cluster headaches treated?

Our Unique Treatment for Cluster Headaches

At Sydney Headache and Migraine Clinic™, we focus on identifying and addressing the root causes of cluster headaches. Our approach includes:​

  • Comprehensive Assessments: We conduct thorough evaluations in order to understand each patient’s unique condition.​
  • Non-Invasive Treatments: Our therapies are designed to be safe and effective without relying on medications or surgical interventions.​
  • Personalised Care: We tailor our treatment plans to meet the specific needs of each patient, aiming for rapid and lasting relief.​
  • Patient Education and Empowerment: We believe in empowering our patients through education, providing them with the knowledge and tools to actively participate in their treatment journey. This collaborative approach enhances self-management and supports long-term well-being.

By focusing on the individual and employing evidence-based practices, we strive to provide effective solutions for those suffering from cluster headaches.​

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