Sharp headaches that occur in cyclical patterns, and are located around the eye are called Cluster headaches. Cluster headache has acquired this name from the pattern of the attacks, multiple attacks occur during one period of time (weeks-months) followed by a period of remission (weeks, months or even years). Although Cluster headache is very painul, it is not life-threatening.
A cluster headache attack occurs and progresses very quickly, usually without any warning. Excruciating pain, located around one eye, sometimes associated with eye redness, excessive tearing, and runny nose on the affected side of the face. Other symptoms that are sometimes associated with the attack are sweating, pallor on the face, and swelling around the eye.
A period of pain attacks usually lasts up to 12 weeks. Often the periods of cluster attacks have a consistent in patterns for example they may always happen at the evening or in winter. The single attack time varies from 10 minutes to few hours.
It is important that you visit your general practitioner when you experience cluster headache for the first time. This headache is not dangerous but it is important to rule out other causes of severe headache such as strokes or ruptured aneurysm both of which rarely cause of headache.
Doctors depend on the description of the attacks to diagnose Cluster headache severity, pattern, location, and associated symptoms are very important clues.
Neurological physical examination is also important to rule out underlying serious conditions.
If an abnormal neurological examination, or an unusual presentation of headache doctor will recommend brain imaging such as computerized tomography (CT) or Magnetic resonance imaging (MRI).
For now there's no cure for cluster headaches. Treatment is available to decrease the duration, severity and frequency of cluster headache.
The most common medications that are used to treat and abort the acute pain attack are:
- Oxygen. 100 percent oxygen through a mask has shown a dramatic relief of the acute attack. The biggest issue of this treatment is the need to have an oxygen cylinder with you, which makes the treatment inaccessible all the time.
- Triptans. Injectable triptans are effective in many patients. Nasal spray triptans are not as effective.
- Other less commonly used medication are Octreotide, Local anesthetics and Dihydroergotamine.
The goal here is to suppress attacks and decrease duration and frequency. Preventive treatment often starts at the onset of the attack. The most common medications that are used:
- Calcium channel blockers. Such as Calan and Verelan are often the best medications to start with.
- Corticosteroids. such as Prednisone, are also very effective and fast-acting medications. Steroids are usually used for short term treatment due to the many side effects associated with long term use.
- Lithium carbonate. Less commonly used.
- Nerve block. Might help improve chronic persistent cluster headache. Also short term treatment until other medications kick in.
- Ergots and Melatonin can also be used
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