Cluster Headaches (Horton's Headache)

Cluster headaches are caused by abnormalities in the blood vessels of the head. Nicknamed "suicide headaches" because of their severity, they appear in clusters just as their name implies. These headaches generally occur daily, sometimes several times a day, for weeks or months at a time and then suddenly disappear, only to recur weeks, months, or even years later.

The excruciating pain is usually localized to one side of the head, commonly around the eye. During an attack, the eye on the affected side often tears and may become quite red. the nostril may become congested or runny, and the face may flush. The headaches start and end abruptly, usually without warning, often beginning during sleep. Most last for less than an hour.

While the causes of cluster headaches are not well understood, a few potential triggers have been identified. Alcohol and tobacco both appear to precipitate attacks in some people, as do certain foods. Stress and other psychological factors sometimes trigger cluster headaches, but not to the same extent as in other types. For many people, cluster attacks are seasonal and occur at arise from tumors and other potentially dangerous medical conditions.

When consulting a doctor, be prepared to describe the frequency and duration of the headaches, possible precipitating factors, and the nature of the pain and what alleviates it. To identify triggers and accurately report the frequency and duration of symptoms, it may help to keep a log or journal for a few months (see Self-Treatment).

A complete physical examination, including a neurologic workup, should be performed, along with blood tests to exclude other diagnoses. In some cases, imaging studies such as a CT brain scan or MRI may be necessary.

Medical Treatments

There are several drugs that can prevent cluster headaches, but they must be taken regularly and are ineffective if taken once an attack begins. Lithium carbonate, more commonly prescribed to treat manic-depression, provides relief in up to 90 percent of patients.

Other possible medications include corticosteroids; methysergide (Sansert), a migraine drug; cyproheptadine (Periactin), an antihistimine; indomethacin (Indocin), a common arthritis drug; and calcium channel blockers such as verapamil (Calan and others). The last are vasodilators normally used to lower blood pressure.
The drugs containing ergot that are frequently used to treat migraines are also useful in preventing cluster headaches but caution must be exercised to avoid ergot toxicity.

During an acute attack, the two most effective treatments appear to be ergot drugs and inhaled oxygen, which seem to work by constricting the blood vessels in the head.

Alternative Therapies

There are few alternatives to medical therapy that are effective in relieving cluster headaches; approaches that focus on preventing them are generally the most successful.

Acupressure. Pressing the webbed area between the thumb and forefinger is said to relieve headaches.

Biofeedback. Some patients are helped by biofeedback training to learn how to divert blood flow from the scalp vessels to other parts of the body.

Herbal Medicine. Herbalists recommend one to three capsules of feverfew daily to prevent migraines, and some also advocate taking this herb to prevent cluster headaches.

Meditation and Visualization. Patients whose headaches are triggered by stress may benefit from these relaxation techniques. Meditation can also help with pain management during an attack.

Self-Treatment

Self-treatment starts with prevention. Identify those things that set off your headaches and try to avoid them. Document your headaches in a journal, making note of anything that could possibly have caused them. See if any patterns emerge and, if they do, try to eliminate the potential trigger.

When a cluster does develop, using a portable oxygen inhaler helps about 80 percent of patients. Talk to your physician about obtaining one.

Individuals who suffer from cluster headaches usually have their own coping routines. For example, some people sit quietly in a darkened room, while others feel better if they stand or pace. Some even bang their heads against a padded surface, but it is doubtful that this can alleviate the pain.

Other Causes of Headaches

Cluster headaches can be confused with other forms of headache, particularly vascular types such as migraines. Conditions that may mimic cluster headaches include sinusitis, congestion or infection of the sinus cavities in the forehead and cheekbones; trigeminal neuralgia, a disorder affecting one of the facial nerves; aneurysms, abnormalities of the blood vessels in the head or neck; and brain tumors.