Cluster Headaches are repetitive headaches that cause a very intense sharp pain that is described by the patients to be the most intense pain they ever experienced. Even women who have cluster headaches describe them to be more painful than giving birth. That is why the pain resulting from cluster headaches is considered the most intensive pain a human may experience.
The sever intensity of the pain associated with cluster headaches had led some patients to commit suicide, especially in long term cases with the absence of hope for a treatment. And this is the reason why cluster headaches are given the name “Suicide Headaches”.
Cluster Headaches may occur several times a day, and every day during the cluster period. They usually occur without a sign or a warning and the attack can be as short as few minutes and it can extend to 3 hours or more. The short periods of cluster headaches attacks cause convenient over the counter pain relievers to not be effective relieving the associated pain. Conventional pain relievers start working after few minutes of consumption which can happen after or at the end of a cluster headache attack.
Cluster headaches causes are still unknown, and because of that, cluster headaches have no cure. However, since the pain associated with cluster headaches is extremely intensive and severe in a way it may lead to suicide, researches never stopped to find effective ways to relief or even reduce the pain level associated with them.
Cluster headache treatments are divided into abortive and preventive treatments.
Abortive treatments interrupt the headache attack after it starts in to reduce the attack period before it reaches the peak by aborting it. Abortive treatments include:
Inhaling %100 Oxygen at 12 to 15 litres per minute has shown very good results with many cluster headaches patients. The relief can occur as short as 1 minute up to few minutes depending on how soon after the attack the treatment is started and the severity of the case. If the Oxygen Treatment is applied too late, the pain level would be already high and the treatment will not be effective. Studies show that results can be even better with some patients when the inhalation rate increases to 25 litres per minute.
Since the Oxygen treatment needs to be done as soon as the attack starts, patients find it an inconvenient type of treatment because they will be required to carry an oxygen cylinder around.
Triptans are a family of drugs that were first introduced to the market in the early 1990s for migraine attacks abortive treatments. From the Triptans family, both Sumatriptan and Zolmitriptan can abort the cluster headache attacks or at least reduce the attacks’ associated pain. Triptans bind the serotonin receptors in cranial blood vessels and nerve endings to inhibit the release of the molecules that signal the brain with the painful feelings. Triptans cannot be prescribed for patients with a history of Heart Attacks, Strokes, Transient Ischemic Attack, and High Blood Pressure.
Dihydroergotamine or DHE does the same function of Triptans as an agonist to the serotonin receptors, but eventually, it also interact with dopamine and adrenergic receptors. Dihydroegotamine is also used to abort migraines attacks, but Nausea is a common side effect of its intravenous form dosages (IV). DHE is also available as a nasal spray, but the nasal dose doesn’t work as fast as the IV. DHE cannot be taken with Triptans and there should be 24 hours period separating them.
Lidocaine is a topical anesthetic that can be sprayed in the nasal cavity to relieve the pain associated with cluster headaches attacks. Long-term usage of Lidocaine may cause a damage to the nasal cavities as a side effect.
Preventive or Prophylactic treatments are used to avoid the cluster headaches attacks before they occur. Preventive treatments include:
Calcium Channel Blocker Verapamil
Calcium Channel Blocker Verapamil function is to block the voltage dependent calcium channels to dilate the blood vessels and increase the oxygen and blood supply to the heart. Verapamil is used in migraine preventive treatment as well. Verapamil is also used to treat Hypertension, Cardiac Arrhythmia, and Angina Pectoris. Side effects include dizziness, nausea, fatigue, swelling, and constipation.
Even the side effects of Verapamil, it is widely used to prevent cluster headaches attacks because it is a familiar player in preventive migraine treatments and its effectiveness in preventing the cluster headaches attacks even with chronic cases.
Corticosteroids such like prednisone and prednisolone are hormones that are produced naturally by the adrenal cortex, they are immunosuppressive agents that treat and reduce inflammation by reducing the production of white blood cells that cause it. They are very effective in short term preventive treatment of the cluster headaches attacks, but they do have several serious side effects that make them unsuitable for long term treatments.
There are other several treatment procedures, but many of them are not widely used or they are not tested widely enough to show proven results and researches are continuing to provide newer and more effective methods. As of now Oxygen treatment is the most effective in terms of results even that it doesn’t prevent the attack, but its complexity is affordable by many patients compared to the other methods.