By Dr. Abigail Chua
Headache and Facial Pain Fellowship Program Director
Hartford HealthCare Medical Group
Spring has turned to summer, flowers are in bloom and life takes a slower, more carefree pace. Until you suffer one of the worst headaches you’ve ever experienced, and it just won’t quit, causing excruciating pain, not just once, but again, and again and again. This scenario can be very typical for those who suffer from cluster headaches, which often strike at this time of year.
Cluster headache attacks are identified by severe, piercing pain on one side of the head or behind one eye. They often occur like clockwork at the same time of day or night, and can last for days or weeks. For people who suffer from cluster headaches, it can be the worst type of headache pain, with sharp, debilitating pain that can also be accompanied by red, watery eyes, a runny nose, or nasal congestion. Sufferers may also find themselves restless, finding no relief in lying down, sometimes anxiously pacing the floor to wait out the headache.
Cluster headaches come in cycles called cluster periods. These periods can occur once or twice a year. Some sufferers know that they are most prone to these headaches in the spring and fall. The episodes can strike several times a day and last for 15 minutes or up to three hours, with pain intensifying as it progresses. Some people report up to 8 episodes a day.
The causes of cluster headaches are unknown. In some patients it seems to be hereditary. Cluster headaches are more common in men than woman, and usually start between 20-40 years old. Some triggers are seasonal allergies, alcohol, inconsistencies in sleep patterns, and increased body temperature. Another trigger is nitrates, which are found in wine, cured meats, aged cheeses and some medication. Some individuals do not have any triggers.
While there may be little you can do to prevent cluster headaches, keeping a headache diary may be helpful to your doctor. Record when and how often the headaches occur, note the severity of each episode, along with any trigger that might have caused the headache. This information may be useful in creating a plan of treatment.
Although over the counter pain medications are not effective in relieving the pain of cluster headaches, there are several treatment options available. Certain blood pressure medications and anti-seizure medications may be helpful in preventing cluster headache attacks, and high-flow oxygen is a very effective acute treatment that can help alleviate the pain of a cluster headache as it starts.
While finding new remedies has been elusive, the FDA recently approved Emgality (galcanezumab-gnlm) for the treatment of cluster headaches. Emgality, a self-injected medication, reduces the frequency of cluster headache episodes. There is also a noninvasive medical device called gammacore nVNS that has been FDA-approved for the preventive and acute treatment of cluster headaches.
There is a little good news about this uncomfortable and unsettling condition. Despite the pain, cluster headaches do not cause any long-term harm. Many sufferers report the headaches taper off after the age of 40.
For more information on headaches and treatment options at the Hartford HealthCare Headache Center, click here.