Cluster Headaches - The Basics

The term cluster headaches comes from the attacks usually occur in series (cluster periods) lasting for weeks or months separated by remission periods usually lasting months or years. However, about 10–15% of patients have chronic symptoms without remissions.

There are no diagnostic tests to confirm cluster headaches. Diagnosis is accomplished by reviewing the patient's personal and family medical history, studying their symptoms, and conducting an examination. Cluster headache is then diagnosed by ruling out other causes for the symptoms.
   

Treatment of cluster headaches:

Acute treatment:
The most commonly used therapies to shorten or abort a cluster attack are:

• 100% oxygen administered by mask

• sumatriptan (Imitrex, Imigran) nasal spray or subcutaneous injection

• DHE-45

The most commonly used preventive medications are:

• verapamil

• lithium

• divalproex sodium (Depakote, Depakote ER)

• topiramate (Topamax)

• melatonin
 

In the International Headache Society's International Classification of Headache Disorders, 2nd Edition (ICHD-II), cluster headache is described as,

"Attacks of severe, strictly unilateral pain which is orbital, supraorbital, temporal or in any combination of these sites, lasting 15–180 minutes and occurring from once every other day to 8 times a day. The attacks are associated with one or more of the following, all of which are ipsilateral: conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, forehead and facial sweating, miosis, ptosis, eyelid oedema. Most patients are restless or agitated during an attack."
  

The diagnostic criteria for cluster headaches under ICHD-II are:

1. At least 5 attacks fulfilling criteria B-D

2. Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15–180 minutes if untreated

3. Headache is accompanied by at least one of the following:

   1. ipsilateral conjunctival injection and/or lacrimation

   2. ipsilateral nasal congestion and/or rhinorrhoea

   3. ipsilateral eyelid oedema

   4. ipsilateral forehead and facial sweating

   5. ipsilateral miosis and/or ptosis

   6. a sense of restlessness or agitation

4. Attacks have a frequency from one every other day to 8 per day