Mr. Joginder Singh
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Cluster headaches, which occur in cyclical patterns or cluster periods, are one of the most painful types of headache. A cluster headache commonly awakens you in the middle of the night with intense pain in or around one eye on one side of your head.
Bouts of frequent attacks, known as cluster periods, can last from weeks to months, usually followed by remission periods when the headaches stop. During remission, no headaches occur for months and sometimes even years.
Fortunately, cluster headache is rare and not life-threatening. Treatments can make cluster headache attacks shorter and less severe. In addition, medications can reduce the number of cluster headaches you have.
Common signs and symptoms
A cluster period generally lasts for several weeks to months. The starting date and the duration of each cluster period might be consistent from period to period. For example, cluster periods can occur seasonally, such as every spring or every fall.
Most people have episodic cluster headaches. In episodic cluster headaches, the headaches occur for one week to a year, followed by a pain-free remission period that can last as long as 12 months before another cluster headache develops.
Chronic cluster periods might continue for more than a year, or pain-free periods might last less than one month.
See your doctor if you've just started to have cluster headaches to rule out other disorders and to find the most effective treatment.
The exact cause of cluster headaches is unknown, but cluster headache patterns suggest that abnormalities in the body's biological clock (hypothalamus) play a role. Unlike migraine and tension headache, cluster headache generally isn't associated with triggers, such as foods, hormonal changes or stress.
Once a cluster period begins, however, drinking alcohol may quickly trigger a splitting headache. For this reason, many people with cluster headache avoid alcohol during a cluster period.
Other possible triggers include the use of medications such as nitroglycerin, a drug used to treat heart disease.
Risk factors for cluster headaches include:
Cluster headache has a characteristic type of pain and pattern of attacks. A diagnosis depends on your description of the attacks, including your pain, the location and severity of your headaches, and associated symptoms.
How often your headaches occur and how long they last also are important factors.
Your doctor will likely try to pinpoint the type and cause of your headache using certain approaches.
A neurological examination may help your doctor detect physical signs of a neurological disorder. The exam is usually normal in patients with cluster headaches. Your doctor will use a series of procedures to assess your brain function, including testing your senses, reflexes and nerves.
If you have unusual or complicated headaches or an abnormal neurological examination, your doctor might recommend other tests to rule out other serious causes of head pain, such as a tumor or an aneurysm. Common brain imaging tests include:
MRI. This uses a powerful magnetic field and radio waves to produce detailed images of your brain and blood vessels.
CT scan. This uses a series of X-rays to create detailed cross-sectional images of your brain.
There's no cure for cluster headaches. The goal of treatment is to decrease the severity of pain, shorten the headache period and prevent the attacks.
Because the pain of a cluster headache comes on suddenly and might subside within a short time, cluster headache can be difficult to evaluate and treat, as it requires fast-acting medications.
Some types of acute medication can provide some pain relief quickly. The therapies listed below have proved to be most effective for acute and preventive treatment of cluster headache.
Acute treatments
Fast-acting treatments available from your doctor include:
1. Oxygen. Briefly inhaling pure oxygen through a mask provides dramatic relief for most who use it. The effects of this safe, inexpensive procedure can be felt within 15 minutes.
Oxygen is generally safe and without side effects. The major drawback of oxygen is the need to carry an oxygen cylinder and regulator with you, which can make the treatment inconvenient and inaccessible at times. Small, portable units are available, but some people still find them impractical.
2. Triptans. The injectable form of sumatriptan (Imitrex), which is commonly used to treat migraine, is also an effective treatment for acute cluster headache.
The first injection may be given while under medical observation. Some people may benefit from using sumatriptan in nasal spray form, but for most people this isn't as effective as an injection and it may take longer to work. Sumatriptan isn't recommended if you have uncontrolled high blood pressure or heart disease.
3. Another triptan medication, zolmitriptan (Zomig), can be taken in nasal spray form for relief of cluster headache. This medication may be an option if you can't tolerate other forms of fast-acting treatments.
Oral medications are relatively slow to act and are often not useful for acute treatment of cluster headaches.
4.Octreotide.
5. Local anesthetics.
6. Dihydroergotamine.
Preventive therapy starts at the onset of the cluster episode with the goal of suppressing attacks. Determining which medicine to use often depends on the length and regularity of your episodes. Under the guidance of your doctor, you can taper off the drugs once the expected length of the cluster episode ends.
Calcium channel blockers.
Side effects may include constipation, nausea, fatigue, swelling of the ankles and low blood pressure.
Researchers are studying several potential treatments for cluster headache.
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