Cluster headache is diagnosed from its typical symptoms. The pain is around the orbital region, is very severe, has the same time of onset during the day and year and almost always presents unilaterally on the same side of the head during subsequent attacks.
Treatment is symptomatic (to stop the symptoms). There is no permanent cure for cluster headaches.
Diagnosis of Cluster Headache from Symptoms
Cluster headache has to be differentiated from other types of headaches namely migraine and tension headaches. The type of pain and its cyclical occurrence as described by the patient is enough to tell the doctor that the headache is of cluster type. There may be associated symptoms such as a
- Teary eye (lacrimation)
- Nasal congestion and nasal stuffiness
- Drooping eyelid, which may be present even during the remission period.
- A history, which shows that an immediate relative of the patient has cluster headache will go in favor of diagnosing this headache.
There are no tests to specifically diagnose a cluster headache. Certain tests may be done to rule out other causes of the headaches such as a brain tumor, meningitis, etc to diagnose the cluster headache by the elimination method.
These tests are
- CT scan of the brain
- MRI of the brain
- Eye tests to rule out glaucoma
- A dental check-up is done to rule out a dental cause for the headache
- X-ray of the cervical spine to rule out cervical spondylosis, which can also cause a headache.
- Lumbar puncture is done to test the CSF fluid for meningitis
These investigations are done to make sure they do not have a different primary headache or secondary disorder that can imitate a cluster headache.
Treatment for cluster headache does not give permanent relief. In other words, there is no permanent cure for cluster headaches.
Treatment is given only to provide relief from the headache pain and minimize future attacks.
As explained in the post of its symptoms, the pain of cluster headache can be the worst pain that is experienced and a remedy to get relief from it becomes necessary in view of the tendency of the sufferer to commit suicide.
Treatment of cluster headache aims at the following:
- Acute treatment: To treat the acute cluster headache pain
- Preventive treatment: To prevent or minimize further attacks. This is explained in the subsequent post.
The pain of cluster headache reaches its peak within five to ten minutes of its onset and at times, it may subside within a short time of 15 minutes or may stay up to three hours without treatment.
At such times, analgesics like aspirin or Ibuprofen will not be effective as the pain may stop even before these analgesics start to take effect. You need, therefore, a line of treatment which works fast to get relief from the headache pain.
Research has indicated some specific treatments and remedies, which help to stop these headache pains. Some people may require a combination of medicines to treat their cluster headaches.
Acute Treatment for Cluster Headache
High flow oxygen therapy
Inhaling pure 100% oxygen is probably the most effective cluster headache remedy that can give quick relief from cluster headache pain. This is useful especially when the pain occurs at night, which it usually does.
When oxygen is given immediately at the onset of pain, relief is obtained within one minute or in as long as ten minutes.
70% of the cluster sufferers get relief within 15 minutes. However, if oxygen is administered during the peak of the pain, oxygen therapy has little effect.
How oxygen therapy acts: Breathing in pure oxygen increases the oxygen levels in the blood thereby relaxing the constricted blood vessels. This provides relief from headache pain.
The advantage is that this treatment is not expensive, is free of drug use and has no side effects.
However, there is a drawback of dealing with heavy equipment consisting of an oxygen cylinder and regulator.
Small portable units can solve this problem and people with chronic cluster headaches usually can keep this equipment in their house. Keep the equipment away from fire, as oxygen is highly inflammable.
Triptans have been explained in details in the treatment of migraine, as they are also used in treating migraine headaches.
Triptans are available as orals, injectables, and nasal sprays. Sumatriptan (Imitrex) is the most commonly used triptan in the subcutaneous injectable form and gives relief from headache pain.
6 mg of Sumatriptan is given as a one-shot subcutaneous injection and has been known to give relief in 15 minutes. However, it should be used immediately at the onset of the headache pain.
Zolmitriptan (Zomig) is also used and is given in the nasal form. However, this drug is contraindicated in patients with cardiac disease.
This derivative of ergotamine is available as intramuscular, subcutaneous, intravenous injectable and in inhaler forms. It acts by constricting the blood vessels in the brain thereby giving relief from headache pain.
Subcutaneous injection of dihydroergotamine is effective when administered early at the onset of pain. If necessary, the dose may be repeated after one hour but not in the intravenous form. Its use is restricted due to its side effects especially nausea and vomiting
This drug should not be used with other medications such as antibiotics, protease inhibitors, azole antifungals, and sumatriptan, due to its ischemic effect on brain and peripheral areas (hands and feet).
4% Lidocaine solution when used in intranasal form (as nasal drops) gives some relief from headache pain but rarely stops the pain completely
The patient lies supine with the head tilted backward and turned to the side of the headache. The nasal drops are used in the nostril on the same side of the headache pain and can be repeated after 15 minutes if necessary.
Side effects include a burning sensation or numbness in the nostril. It is a prescription drug and is reserved for use when other medicines have failed to give relief and is strictly to be used under medical advice only.
This is a synthesized derivative of the brain hormone, somatostatin. Subcutaneous octreotide in the dose of 100 mcg is found to give relief from headache pain even of moderate or severe intensity. It is safe for use in patients of high blood pressure and cardiovascular disease.