Cluster Headache?
Cluster headache (CH) is a rare but a severe type of headache that affects 1 in 1,000 people. It is 3 x times more prevalent in men than women and usually begins in the late twenties or early thirties.
Contrary to migraineurs, those who suffer from CH cannot lie down quietly in a darkened room, they are often more agitated and active, rocking or pacing up and down. CH attacks typically begin in the middle of the night and consist of a severe stabbing pain that can last between 15 and 180 minutes affecting one side of the head. The side of the head on which the pain is felt can vary between attacks, but it almost never occurs on both sides at the same time. The pain is often described as a ‘hot poker’ penetrating one eye. Cluster headaches can occur several times a day. Attacks come in clusters that can last weeks or months. After each cluster, the attacks can disappear for months or even years.
Cluster Headache Symptoms
Several symptoms may also occur during an attack:
- Eyes get red and watery
- The nose can be blocked or runny
- Sweating from the forehead and face
- Constriction of the pupil
- Drooping or swelling of the eyelid
Cluster Headache can take two forms, episodic and chronic. With episodic CH, attacks occur daily over a period of weeks or months and then stop as suddenly as they start and go away for a period of weeks, months or even years, but they will return. With chronic CH, the attacks occur regularly with a pain-free remission of less than four weeks in any twelve-month period.
The exact cause of CH is unknown, although trigger factors include alcohol, tobacco, irregular sleeping patterns, stress, and decreased blood oxygen levels.
There is increasing evidence to suggest that most sufferers of Cluster Headache are also smokers.
There is a school of thought which suggests a peak in Cluster attacks is somehow linked to the seasonal changes occurring in March and September. Particularly around the time of equinoxes which is why the 21st of March was chosen as Cluster Headache Awareness Day.
What exactly are the Equinoxes and why do they affect my CH?
The word ‘equinox’ comes from ancient Latin ‘aequi noctium’ or more modern Latin ‘Equi-noxium’ and literally means ‘equal night’. For most days of the year, the Earth tilts 23.5 degrees on its axis giving us different periods of daylight and darkness because of where the sun’s rays hit us. On the equinoxes, the sun’s rays shine directly onto the equator, causing the hours of daylight to be almost equal to the hours of night.
In March this is known as the Vernal (spring) equinox in the Northern Hemisphere, and Autumnal (autumn) equinox in the Southern Hemisphere.
Credit: Seasonal Configuration of Earth and Sun – Encyclopædia Britannica Publisher https://www.britannica.com/science/vernal-equinox#/media/1/626277/112844
Incidentally, March was named after the Roman god of War, Mars, where in Ancient Rome wars would begin again after being suspended for the winter. Also Hares (as in tall bunnies) begin to breed and start their antics leading to the expression ‘Mad as a March Hare’, so it seems that the change to spring affects us much more than we realise.
So, all this aside, why is there an effect on my Cluster Headache?
No one really knows for sure, but there seems to be a noticeable change in the pattern of CH during these times of year.
Our brains are naturally attuned to seasonal changes as an evolutionary tool so that we will know when to plant, harvest and hibernate! The brains of primary headache sufferers can be more sensitive to small changes.
There is a small area of the brain called the hypothalamus that maintains what’s called ‘homeostasis’, basically it makes sure the body stays balanced. It looks after your body’s biological clock, hormones, and circadian rhythm.
During certain times of the year, changes occur to knock this balance out and with Cluster Headache it’s thought that this imbalance makes people more susceptible to attacks than at other times of the year. This is also more prevalent to episodic sufferers.
Of course, these are not the causes of CH and many people will suffer attacks throughout the year, regardless of season. More research is needed into all aspects of CH before a more definitive answer can be given surrounding seasonality.
What Treatments are Available for CH?
Treatments for Cluster Headache fall into two main categories, Acute and Preventative,
Acute Treatments
Triptans
- Sumatriptan (Imigran/Imitrex) is the most widely used Triptan for Cluster Headache. It is delivered via subcutaneous injection and has shown that it works very quickly in a high proportion of sufferers.
- Zolmitriptan (Zomig) may help with episodic Cluster Headache but may not be as fast-acting as either Sumatriptan or Oxygen therapy.
Some people may benefit from either sumatriptan or zolmitriptan in nasal spray format.
Oxygen Therapy
Breathing in pure oxygen (100%) at a rate of between 10 to 15 litres per minute is relatively fast at providing pain relief in most sufferers. It should be inhaled continuously for 15 – 20 minutes using a non-re-breathing mask (the one without the holes).
‘gammaCore’ Device**
The ‘gammaCore Sapphire’ device is a non-invasive handheld device that produces a mild electrical signal that is transmitted to the vagus nerve through the skin, which can relieve attacks. Some people also use it as a daily preventative treatment.
**’gammaCore’ is only available with a prescription and authorisation form signed by your physician.
Preventative Treatments
Short-term preventatives
- Corticosteroids
- DHE (Dihydroergotamine) infusion.
Long-term Preventatives
- Verapamil
- Lithium
Other Options
- Multiple Cranial Nerve Blocks
See this graphic with kind permission of Electrocore
To mark Cluster Headache Awareness Day this year, we are delighted to present Dr. Nick Silver, Consultant Neurologist and founder of the Headache Service in the Walton Centre in Liverpool. Dr. Silver will speak about Cluster Headache, what it is, how to treat it and will show how the ‘gammaCore Sapphire’ device works on the Vagus nerve.
Dr Silver’s interests are in the management of severe and refractory headache disorders, non-headache symptoms and presentations of headache disorders, chronic migraine and trigeminal autonomic cephalalgias, especially cluster headache and hemicrania continua. He has been a Principal and UK Chief Investigator for many clinical research studies in headache.
We will also be joined by Karly Hoggard – Director Global Commercial Development at ElectroCore, and is responsible for improving patient access to gammaCore therapy outside of the US and UK. Karly is a pharmacist and in a previous role worked in primary care with gammaCore over 7 years ago enabling access to some of the first UK patients. Karly will join us to support any questions around accessing gammaCore therapy from Ireland
To book a ticket for this event see here
https://www.eventbrite.ie/e/what-is-cluster-headache-tickets-261886889737
The information contained in this article is for information only and not intended nor suitable to replace medical advice or diagnosis
