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Alternative namesHistamine headache; Headache - histamine; Migrainous neuralgia; Headache - cluster
DefinitionCluster headaches affect one side of the head (unilateral) and may be associated with tearing of the eyes and nasal congestion. They occurs in clusters, happening repeatedly every day at the same time for several weeks and then remitting.
Causes, incidence, and risk factors
Cluster headaches are a fairly common form of chronic , recurrent headache . Unlike migraines , they affect men more often than women. They can affect people of any age but are most common between adolescence and middle age. There does not seem to be a pattern among families in the development of cluster headaches.
The onset is sudden, and it occurs most commonly during the dreaming (REM) phase of sleep. Cluster headaches may occur daily for months, alternating with periods without headaches (episodic), or they can occur for a year or more without stopping (chronic). A person may experience alternating chronic and episodic phases.
Signs and tests
Cluster headaches may be diagnosed by your health care provider based on the symptoms and a physical examination . Tests may be required to rule out other causes of the symptoms. Examination usually shows no specific neurologic effects except for Horner's syndrome (one-sided eyelid drooping or small pupil) during an attack that is not present between episodes. (This can evolve into persistent Horner's syndrome.)
An MRI of the head may be done to rule out other pathology.
Treatment does not cure cluster headaches. The goal of treatment is to relieve symptoms. Spontaneous remission may occur, or treatment may be required to prevent headaches .
Methysergide maleate may be helpful to relieve pain and prevent attacks. It may also have severe side effects.
Other medications may be used to treat or prevent symptoms. These include the following:
All preventive medications should be tapered off slowly during periods of remission (no headache).
Expectations (prognosis)Cluster headaches are not life-threatening and usually cause no permanent structural changes. However, they are chronic and may be painful enough to be debilitating during an attack, which may interfere with work or lifestyle. Occasionally, the pain may be severe enough to drive some individuals to suicide . Side effects of medications or surgery may be severe.
Calling your health care providerCall for an appointment with your health care provider if cluster headaches do not respond to treatment or if headaches disturb sleep, are caused whenever you are active, or are accompanied by other symptoms.
Emergency symptoms include drowsiness , vision changes, changes in movement or sensation, seizures , changes in alertness, and nausea/vomiting .
PreventionIf prone to cluster headache, stop smoking. Alcohol use and any foods that are associated with cluster headache may need to be avoided. Medications may prevent cluster headaches in some cases.
Update Date: 7/28/2002Elaine T. Kiriakopoulos, M.D., MSc, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT