Suddenly it stabs you in the eye like a knife - cluster headaches are severe, one-sided headaches mainly in the eye and temple area.
Cluster headaches are extremely severe, strictly unilateral headaches. The pain comes in attacks several times a day, often at night. They are accompanied by symptoms such as a watery and red eye, a swollen eyelid and a runny nose. Those affected feel a so-called restlessness. They walk around and tend to rock their upper bodies.
The term “cluster” comes from the English language and characterizes the peculiarity that cluster headaches occur in episodes lasting several weeks to months, while they can be absent for months or even years. This episodic occurrence plagues nine out of ten sufferers, one out of ten even has constant headaches.
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| Cluster headaches |
Causes and risk factor
The causes of cluster headache are not clear. Experts now suspect that several factors are responsible for the severe pain. On the one hand, the sleep-wake cycle in the brain seems to be disturbed, which is suggested by the frequency of cluster attacks at certain times of the day or night, as well as the frequency in spring and autumn. As a further cause, the researchers consider a kind of network disruption in areas of the brain that process pain.
Risk factors
Exact factors of inheritance are not yet known, but familial clusters seem to occur. In various studies, between 5 and 7 out of 100 people affected by cluster headaches stated that close relatives also suffered from the headache attacks.
Attacks are often caused by triggers. The triggers to which those affected react vary greatly from person to person. There are also cluster headache sufferers who don't respond to any triggers.
Some known triggers of cluster headaches:
- Foods containing histamine (hard cheese, preserves, convenience products, salami, etc.), histamine-releasing foods (tomatoes, chocolate, nuts, etc.), food additives such as glutamate
- Alcohol (beer, wine)
- Nicotine
- Flickering and flickering light (TV, cinema), harsh light
- Altitude changes, stays at high altitude
- Physical exertion
- Emotional excitement
- Smell of perfume, metal, nicotine etc.
Symptoms
Do you keep having severe pain on just one side of your head while your eyes are watering and your nose is running?
Do you sweat on your head and do you walk around restlessly?
These symptoms are among the typical symptoms associated with cluster headaches. They always occur on one side and are limited to the area around the eyes and temples. Classically, the eye waters, a lid swells and the pupil narrows. The nose also reacts: it starts running on the side of pain and feels congested. Sweat breaks out on the head and forehead, the affected person becomes restless and begins to walk around or rock his upper body.
It is also characteristic of cluster headaches that they occur frequently over days and weeks several times a day. Cluster headaches tend to stick to a precise daily schedule and always occur at the same time, often an hour or two after falling asleep, in the early hours of the morning or at noon. An attack of pain lasts between 15 minutes and three hours and is extremely severe in its intensity. Patients often give the pain the highest level on a pain scale from 0 to 10.
The main symptoms in detail:
- One-sided, very severe headache, generally always on the same side of the head
- The complaints can often be localized (eyes, forehead, bridge of the nose)
- The symptoms appear suddenly and in attacks
- Marked circadian rhythm, seizures most commonly occur one to two hours after falling asleep, in the early morning hours and after midday
- Frequency between every other day and eight times a day
- Duration between 15 and 180 minutes
- The complaints come in series (cluster period) with symptom-free phases of months or years
- Preferred in spring and autumn
The accompanying symptoms in detail:
- Watery and red eyes, runny nose and perspiration on the face and forehead
- Horner syndrome: constricted pupil (miosis), drooping upper eyelid (ptosis), sunken eyeball
- Agitation with pacing and rocking of upper body
- Associated headache (unilaterally accentuated)
- Rare but possible are migraine-like symptoms such as aura, nausea, and sensitivity to noise and light
Depending on the course, two types of cluster headaches can be distinguished. Eight to nine out of ten sufferers suffer from occasional, i.e. episodic, cluster headaches. One to two in ten is plagued by chronic cluster headaches:
- Episodic cluster headache: The symptoms last from a week to a few months and are repeatedly interrupted by pain-free phases (the definition of the International Headache Society IHS is: at least two cluster periods with a duration of 7 to 365 days, which are accompanied by remission phases of separated by more than one month).
- Chronic cluster headache: The symptoms last for more than a year without a pain-free phase or are only interrupted by pauses shorter than four weeks.
Differentiation between cluster headaches and migraines
Those affected by migraines also suffer from one-sided headaches. But unlike migraines, in which those affected prefer to retire to bed, cluster headache sufferers have an urge to move and run around. In addition, they usually show at least one of the symptoms such as watery eyes, runny nose or Horner's syndrome.
However, 3 to 5 out of 100 people affected do not appear to get any of the accompanying symptoms, which can make it difficult to differentiate. Likewise, cluster headaches can also have atypical symptoms such as nausea, insensitivity to noise and light, which are more likely to be attributed to migraines.
Psychological accompanying complaints
Cluster headaches are not only extremely painful, they also come in attacks, which is extremely stressful for those affected. This stress can have a strong impact on private and professional life and therefore lead to mental problems such as depression.
Treatment
The treatment of cluster headaches is difficult for those affected, since common painkillers such as paracetamol, acetylsalicylic acid (ASA) and ibuprofen are usually completely ineffective. Therefore, it is advisable to see a doctor if you experience symptoms of cluster headaches. The right medical contacts for cluster headaches are either the family doctor or a specialized neurologist. He will ask the person concerned about their medical history (anamnesis) and will want to know where and at what time of day the headache occurs, how long it lasts, whether it is accompanied by other symptoms and how often the attacks recur. If the person concerned has kept a headache diary, this can make the diagnosis easier for the doctor.
In addition, the doctor will distinguish the possible cluster headache from other headaches such as migraine or the very rare paroxysmal hemicrania (also a chronic headache with usually shorter and more frequent attacks) as well as from the painful trigeminal neuralgia (facial pain in the area supplied by the trigeminal nerve). He will also rule out that the headache is symptomatic, i.e. that the pain is due to another illness such as tooth or sinus infections, but also to tumors, heart attacks or infections. This may require examination methods such as computed tomography of the head (CCT) or magnetic resonance imaging (MRI). A cluster headache attack – like a migraine attack – can be provoked with a nitroglycerin test and a symptomatic headache can thus be ruled out.
The disease is not curable in the sense that a cluster headache attack will never occur again. Nevertheless, there are active ingredients for acute treatment that directly combat the pain, as well as medical measures that preventively reduce the intensity of the attacks and their frequency (cluster headache prophylaxis).