(3) CLUSTER HEADACHES
Cluster headaches refer to a type of headache that reoccurs over a period of time in cyclical pattern. Individuals who have cluster headaches experience an episode one to to three times per day during a period of time (usually referred to as the cluster period), which may last from two weeks to three months.
A cluster headache typically awakens a person from sleep one to two hours after going to bed. Night time attacks such as these can be more severe than daytime attacks. Cluster headaches are excruciatingly painful, causing intense pain around one eye, and often occur with other symptoms, such as eye watering or red eye and a blocked runny nose. They can be more intense than migraine headaches but do not last as long as migraines do.
The cause of cluster headaches is unknown. Cluster headaches however, do occur when a nerve pathway at the base of the brain ( the trigeminal autonomic reflex pathway) is stimulated. The trigeminal nerve coursing through this pathway is the main nerve of the face responsible for sensations such as heat and pain.
Manage Your Cluster Headaches
There are no known cures to cluster headaches neither can they be treated with over the counter painkillers like paracetamol.
Good management of cluster headaches involve the use of one or more specialist treatments along with certain lifestyle changes to help prevent attacks.
The following may trigger attacks of cluster headaches so you do well to avoid them:
- Alcohol and cigarette smoking
- High altitudes (Air travel)
- Bright light
- Exertion
- Food rich in nitrates (e.g bacon and preserved meats)
- Cocaine
- Certain types of medication.
Maintaining a regular sleep schedule is helpful in preventing attacks of cluster headaches as cluster headaches may begin when there are changes in normal sleep pattern.
Cluster Headaches Non-Drug Treatment
Recent studies conducted at the New England center for headache showed that patients who applied capsaicin,cream (the active ingredient capsaicin is found in the cayenne pepper) in their nostrils during a cluster headache experienced a decrease in cluster headache intensity. Capsaicin acts as a pain reliever by stimulating the pain sensing C nerve fibres and rapidly depletes the substance these fibres use in conducting pain signals to the brain.
The capsaicin causes a burning sensation for approximately 10 minutes which must occur for treatment to be effective. The burning sensation will decrease on subsequent applications. Use the capsaicin cream on the same side as the headache for maximum effect.
Melatonin has also been shown to reduce severity and frequency of cluster headaches when used once a day at bedtime for greater than 14 days. This is because cluster headache sufferers often have a lower than average level of melatonin during a cluster headache period.
Vitamin B2 has also been shown to reduce the severity and frequency of cluster headaches. Administered once daily, 3 months daily supplementation is required to produce such beneficial effect.
The Kudzu plant (Puereria lobata) gotten from Asia has also shown promise in the treatment of cluster headaches. Case studies has shown a decrease in intensity, frequency and duration of cluster headache attacks. The Kudzu plant contains anti-oxidants, has anaesthetic effects, dilates blood vessels in the brain, increases cerebral blood flow and also improves brain acetylcholine levels.
Cluster Headache Drug Treatment
Treatment for cluster headaches follows 2 therapeutic goals:
- Medicines to treat Cluster headaches when it happens
- Medicines to prevent Cluster headaches.
The therapeutic goal of treating cluster headaches when they do occur makes use of the following drug therapies:
(a) Triptans such as sumatriptan to relieve the headache. This can be given as an intramuscular injection administered twice daily or as a nasal spray.
(b) Steroidal anti-inflammatory medicines such as prednisolone. Your doctor may start you on a high dose and then slowly decrease dosage over 2 to 3 weeks.
(c) Dihydroergotamine can be given through Intramuscular injections to provide quick relief from a cluster headache attack.
(d) Inhalation of 100% pure oxygen.
To prevent Cluster headaches, the following drug treatment therapy would prove useful:
(e) Blood pressure medicines such as beta-blockers(propranolol) or calcium channel blockers such as verapamil.
(f) Drugs used to treat seizures such as topiramate and valproic acid.
(g) Lithium carbonate
(h) Drugs used in treating depression such as amitryptilline.
NEXT ARTICLE (PART 3) WILL DISCUSS: MANAGING HEADACHES OF SECONDARY ORIGIN.