People who suffer from cluster headaches often have repeated, severe headaches for weeks or months at a time. Other people have continuous headaches, occurring at different times during the day. Although cluster headaches are painful, there are many ways to deal with the condition. There are two main types of cluster headaches. One type, called episodic cluster headache, occurs every day and lasts from a week to a year.
The trigeminal autonomic reflex causes cluster headaches.
Cluster headaches, paroxysmal hemicrania, and hemicrania continua are a subset of trigeminal autonomic cephalalgias. They are characterized by a pronounced headache, conjunctival injection, cranial autonomic symptoms, and nasal congestion. Men are 2.5 to seven times more likely to develop TAC headaches than women.
These headaches are typically very short-lived and usually occur unilaterally. Some patients experience conjunctival injection and tearing. While the exact cause of this disorder is unclear, recent neuroimaging studies have revealed structural and functional neuromatrix activation. This further supports the idea that the TAC in the trigeminal ganglia may play a role in the development of cluster headaches.
The pain people experience from cluster headaches is caused by trigeminal nerve stimulation, a branching of the brainstem behind the eye. This nerve is responsible for sending impulses throughout the face and skull. As a result, the pain often causes blood vessels to dilate. This dilation is part of the brain’s response to pain. The pain can be so severe that it’s nearly unbearable. However, as people age, the pain gradually disappears.
Early studies of trigeminal autonomic headaches used positron emission tomography (PET). However, new imaging methods were developed and are now widely used in headache research. A structural method of study called voxel-based morphometry has also been used to study trigeminal autonomic headaches.
Verapamil is the primary treatment for cluster headaches.
One of the main treatment options for cluster headaches is the drug verapamil, which is taken in a tablet form several times a day. However, it has a risk of causing heart problems in some people, so the drug must be used under close monitoring. If verapamil fails to relieve the symptoms, other treatments may be tried. They may include lithium medicine, corticosteroids, or local anesthetic injections into the back of the head. The best treatment for cluster headaches is a combination of different treatments, as there is no single treatment for everyone.
Verapamil is an anticonvulsant that acts on two different pathways in the brain. First, it acts by blocking the CGRP-induced hyperresponsive state by inhibiting the release of presynaptic calcium channels. This blockade also inhibits the expression of specific genes in the central nervous system.
Other treatment options for cluster headaches include transitional treatments and fast-acting abortive medications. The fast-acting treatments last for just a few weeks and are used to bridge the gap between prophylactic medication and drug titration. The primary aim of cluster headache treatment is to decrease the severity of the headache, shorten the duration of the attack, and prevent a recurrence. Because cluster headache symptoms usually come on suddenly, the treatment must be quick and effective. Fortunately, several fast-acting medications for cluster headaches are widely available.
While these drugs are not proven to eliminate cluster headaches, they reduce the number of attacks during a cluster headache episode. However, the number of patients who can be treated with these drugs for cluster headaches is limited. In such a case, high-flow oxygen is the preferred treatment for cluster headaches.
Other treatments may be considered if verapamil is not adequate.
If verapamil fails to control cluster headaches in most patients, other treatments may be considered. Current treatments include corticosteroids and verapamil, but the former can harm the patient if used for an extended period. Verapamil is considered a first-line treatment for CH, and it works by blocking a canonical L-type calcium channel. It also blocks sodium and potassium channels. In addition, it also inhibits p-glycoprotein, which is necessary for transport across the blood-brain barrier.
Verapamil takes up to two weeks to reduce the frequency of cluster headaches. It can also be used as a preventive treatment, but other treatments may be used if inadequate verapamil. Some other drugs, such as lithium and corticosteroids, are also used to treat cluster headaches.
Another drug that may be considered for cluster headaches is botulinum toxin A injections. These injections are often used for other purposes, such as to reduce abnormal muscle contractions or smooth wrinkles. However, there is little evidence supporting the effectiveness of botulinum toxin A injection in treating cluster headaches.
Other treatments for cluster headaches include fast-acting, abortive, and preventive treatments. The best-known preventive therapies are inhaled oxygen, subcutaneous sumatriptan, and verapamil. While most of these treatments are not backed by robust clinical evidence, a growing list of potential adjunctive therapies and lifestyle modifications may help cluster headache sufferers.