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SALEM COMMUNITY HOSPITAL...Explaining and dealing with cluster headaches

October 16, 2011
By CATHY BROWNFIELD - Family Recovery Center , Salem News

Most people have headaches from time to time. But if you have a headache on more days than not, you may be experiencing cluster headaches.

"Cluster headaches usually occur in cycles, known as cluster periods," explained Board certified Neurologist Chaohua Yan, M.D., Ph.D.

"These headache episodes may last from weeks to months, and are usually followed by periods when the headaches stop entirely."

Common Symptoms

A cluster headache usually strikes without warning. Typical symptoms include:

-Excruciating pain, generally located in or around the eye, but which may radiate to other areas of the face, head, neck or shoulders, usually on one side of the body

-Excessive tearing, swelling around the eye and/or redness in the eye of the affected side

-Reduced pupil size and/or drooping eyelid

-Stuffy or runny nasal passage in the nostril on the affected side of the face

-Sweaty, pale skin


This type of headache is one of the most painful and is sometimes called the "alarm clock headache," because it can awaken a person in the middle of the night with intense pain in or around the eye on one side of the head.

"The pain of a cluster headache is often described as sharp, penetrating or burning," Dr. Yan said. "Some migraine-like symptoms, such as nausea, sensitivity to light and sound, and aura, may occur with a cluster headache, although usually only on the affected side of the body. In contrast to migraine sufferers, those with cluster headache may avoid lying down during an attack because this position seems to increase the pain."

Cluster Periods

"A cluster headache period generally lasts from six to twelve weeks," Dr. Yan continued. "However, the approximate starting date and the duration of each headache episode may be the same from time to time. For example, cluster periods may occur seasonally, such as in the spring or fall. These cluster periods are usually followed by a pain-free time that may last as long as six to twelve months before another cluster headache develops."

During a cluster period:

-Headaches typically occur every day, sometimes several times a day.

-A single attack may last from 15 minutes to two hours.

-The attacks happen often at the same time within each 24-hour day.

-The majority of attacks occur at night, usually one to two hours after going to bed.

-The pain usually ends as suddenly as it begins, with rapidly decreasing intensity. After these attacks, most people are free from pain, but exhausted.


"The goal of treatment is to help decrease the severity of pain, shorten the headache period and prevent the attacks," Dr. Yan advised. "Because the pain of a cluster headache comes on suddenly and may subside within a short time, over-the-counter pain relievers such as aspirin or ibuprofen aren't usually effective."

Fortunately, other types of medications can help in the treatment, such as:

-Oxygen: Briefly inhaling 100 percent oxygen through a mask at a minimum rate of 7 liters a minute may provide relief that can be felt within 15 minutes.

-Triptans: The injectable form of sumatriptan (Imitrex), which is commonly used to treat migraine, may be an effective acute treatment for cluster headache. Another triptan medication, zolmitriptan (Zomig), can be taken in nasal spray or tablet form.

-Octreotide: This drug is an injectable synthetic version of the brain hormone somatostatin.

- Local anesthetics: The numbing effect of anesthetics may be effective against cluster headache pain when used intranasally.

- Dihydroergotamine: This medication derivative is available in intravenous, injectable and inhaler forms.


"Preventive medications can sometimes increase the effectiveness of acute medications, and may be used at the beginning of the cluster episode with the goal of suppressing the attacks," Dr. Yan advised. "Medications like calcium channel blockers, corticosteroids, lithium carbonate, nerve blocks, melatonin or anti-seizure drugs may be prescribed as preventative tools, based on the length and frequency of the episodes."

Other lifestyle measures can help reduce the frequency and severity of the attacks and reduce the risk of rebound headaches, such as:

- Sticking to a regular sleep schedule. Cluster periods may begin when there are changes in a person's normal sleep schedule.

- Avoid alcohol consumption, which almost always triggers a headache during a cluster period. This can happen quickly, even before finishing one drink.

"If you've just started to experience cluster headaches, check with your physician to rule out other disorders and to find the most effective treatment," Dr. Yan concluded. "Headache pain, even when severe, usually isn't the result of an underlying disease, but it may occasionally indicate a serious underlying medical condition. In addition, if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different."

Seek emergency care if you have a sudden, severe headache unlike any other that you have experienced; a headache accompanied by a fever, nausea or vomiting, stiff neck, mental confusion, seizures, numbness, or speaking difficulties, which may indicate another problem, such as stroke, meningitis, encephalitis or a brain tumor; or a headache after a head injury, especially if the headache gets worse.

For more information, contact board certified neurologist Chaohua Yan, M.D., Ph.D., at The Neurology Center of Salem, Inc., 2235 East Pershing Street, next to Salem Home Medical. Appointments with Dr. Yan may be scheduled by calling 330-337-4940.



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