Cluster Headache – Diagnosis and Treatment
Diagnosis
Doctors diagnose cluster headaches by looking at a person’s symptoms and the pattern of pain. Neurologists check for intense, one-sided head pain, mostly near the eye or temple.
Other signs, such as tearing, nasal stuffiness, runny nose, eyelid swelling, eye redness, drooping eyelid, small pupil, and flushing on the same side as the pain, help confirm cluster headaches. These are called autonomic symptoms.
Doctors ask about headache history to tell cluster headaches apart from other conditions like migraines. They want to know if episodes are episodic (coming in cycles) or chronic (no long break between attacks).
Doctors may also ask about family history, since genetics can play a role. A physical and neurological check-up helps rule out other causes.
Sometimes, doctors order tests to rule out other issues.
| Test | Purpose |
|---|---|
| MRI scan | Looks for tumors, stroke, bleeding, infections, and other brain issues. |
| CT scan | Detects tumors, injury, infection, bleeding, or other structural brain problems. |
Doctors use these tests to make sure the pain is not from another cause.
Treatment
Quick Relief Approaches
Cluster headaches start suddenly and cause intense pain. People need immediate help. Some treatments act within minutes to ease symptoms.
Breathing in Pure Oxygen: People can inhale 100% oxygen through a fitted mask to stop or ease a headache rapidly. Most feel relief within 15 minutes. This method is safe for most, but people with certain lung conditions should avoid it.
Fast-Acting Triptans: Serotonin receptor agonists (shot or nasal spray), provide quick pain relief. The shot form works fastest and is best when relief is needed right away. People with heart or blood pressure problems may not be able to use these treatments.
- Somatostatin Analog Injection: If triptans do not work, a somatostatin analog injection may help stop the pain.
Nasal Anesthetics: Numbing medicine placed inside the nose, can give quick but short-term relief.
Dihydroergotamine: Doctors may give ergot alkaloid by injection into a vein for pain relief. There is also a nasal version, but it may not work as well for cluster headaches.
Ongoing Therapies to Reduce Attacks
Doctors use certain medicines regularly during headache periods to reduce how often cluster headaches strike and make them less severe. These are called preventive or maintenance therapies.
- Calcium Channel Blocker: Often the first choice to prevent future attacks. Sometimes, doctors combine it with other drugs, and people with frequent or chronic attacks may need it long-term. Side effects can include constipation, tiredness, or changes in heart rhythm.
- Steroids: Steroids work quickly to stop headaches but are for short-term use only. They can provide relief until other long-term medications start working. Using steroids for a long time can cause side effects like diabetes or bone loss, so doctors prescribe them for only a few days or weeks.
Calcitonin Gene-Related Peptide (CGRP) Antagonist: It is given as a monthly shot to help prevent episodic cluster headaches.
Mood Stabilizer: Doctors may use this medication for people with frequent or long-lasting headaches, especially if other medicines are not suitable. Side effects can include tremors or kidney problems, and regular blood tests are needed.
Noninvasive Vagus Nerve Stimulation (VNS): A device sends gentle electrical pulses through the skin to the vagus nerve in the neck. This can lower attack frequency for some people, but more research is needed.
Occipital Nerve Block: Doctors inject a pain-numbing solution, sometimes with a steroid, into the back of the head near the occipital nerve for short-term relief.ย
Other medications that doctors may use include anti-seizure drugs, melatonin, and sometimes, nonsteroidal anti-inflammatory drugs like indomethacin for certain headaches.
Surgical Options for Hard-to-Treat Cases
If medicines and other therapies do not stop chronic cluster headaches, doctors may consider surgery, but only rarely. The goal is to disrupt pain pathways in the head and face.
Types of surgical approaches include:
Nerve Pathway Modification: Surgeons target nerves that transmit cluster headache pain, either by damaging them or blocking their signals.
Electrical Nerve Stimulation: Doctors implant devices near certain nerves, such as the occipital nerve, to deliver gentle electrical stimulation and interfere with pain signals.
Surgery can have side effects, such as weakness in the jaw or numbness in areas of the head or face. Doctors consider surgery only when all other treatments fail.
New and Experimental Therapies
Researchers are studying new ways to control cluster headaches. These therapies use advanced technology and new medications.
Nerve Stimulation Devices: Devices stimulate areas like the sphenopalatine ganglion, occipital nerve, or deeper brain regions with electrical pulses. Doctors place small devices in these locations to enable nerve stimulation, which might reduce headache frequency or intensity for some people.
Emerging Medications: New medicines that target different parts of the headache process, including some migraine medications, are under study for cluster headaches.
Other Procedures: Researchers are also testing methods like intranasal capsaicin, newer triptan drugs, and improved nerve blocks.
These treatments are not yet standard. More studies are needed to confirm their safety and effectiveness.
Healthy Habits and Home Strategies
Keeping a regular sleep schedule helps reduce the chance of cluster headaches. Changes in sleep patterns can trigger attacks.
| Habit | Effect |
|---|---|
| Regular sleep | Reduces headache triggers |
| Avoid alcohol | Lowers attack risk |
| No smoking | Supports overall health |
Limiting or avoiding alcohol, especially during headache periods, can help. Staying away from smoking and quitting if possible may lower risk. Simple actions like these support better headache management.
Other Therapies
Some people try melatonin supplements, a hormone that helps control sleep, to ease cluster headaches.
Capsaicin cream, made from chili peppers, can be applied inside the nose and might help lessen headache attacks or make them less intense. Always check with a health care provider before starting these options.
Managing and Finding Help
Cluster headaches can cause stress and restlessness. Talking with a therapist or joining a headache support group can give emotional support and practical ideas.
Health care providers often know local options and can make referrals. Getting support can make daily life easier for people with cluster headaches.
Getting Ready for Your Visit
Steps You Can Take Before the Appointment
Being prepared helps you get the most out of your time with a healthcare provider or neurology specialist.
Here are some important actions to consider:
Check for Special Instructions: Ask if you need to follow any instructions, like fasting before certain tests.
Track Headaches in a Diary: Write down details each time a headache happens.
| Detail | What to Note |
| Date and Time | When the headache started |
| Length | How long it lasted |
| Severity | Pain level on a scale of 1โ10 |
| Triggers | Foods, smells, stress, sleep changes, or other possible causes |
| Symptoms | Warnings like aura or vision changes |
| Medications | All drugs, vitamins, or supplements and the doses |
| Relief | What helped or did not help |
Bring a Support Person: A friend or family member can help you remember what is discussed.
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Prepare Questions: Write down anything you want to ask, such as:
- What is causing these symptoms?
- Are there other possible causes?
- What tests may be needed?
- Will this problem go away or is it ongoing?
- What treatment does the provider suggest?
- Can you manage this with other health problems?
- Are there activities you should avoid?
- Should you see a neurology or neurosurgery specialist?
How Your Medical Team May Approach the Visit
During the appointment, the doctor or specialist will likely ask focused questions to better understand your condition.
They may want to know:
- When did your symptoms start?
- Do symptoms show up sometimes or all the time?
They may ask if headaches happen at certain times of day or year. They might want to know if alcohol makes the symptoms worse. They could ask how strong your symptoms are.
They may want to know what helps you feel better. They may also ask what makes things worse. The health team may discuss whether you need tests to rule out other causes.
They might talk about referring you to neurology or neurosurgery. Be ready to give clear answers. This will help the team make the best plan for your care.
