Cluster Headaches and Atypical Migraines

What are they and how are they treated?

Almost everyone has a headache occasionally. But if you have frequent, severe headaches, you could be experiencing neurological disorders such as cluster headaches or migraines. 

Cluster headaches are rare — affecting only 1-2 people per 1000. Migraines, on the other hand, are more prevalent, affecting around 12% of Americans.

If you experience severe or frequent headaches that prevent you from working or fulfilling your other responsibilities, you should make an appointment with an experienced neurologist for diagnosis and treatment. 

While headaches are common, you shouldn’t accept disruptive headaches as a normal part of life.

Understanding Cluster Headaches

A cluster headache, clinically referred to as a type of trigeminal autonomic cephalalgia, is one of the most painful experiences a human can have. 

These attacks don’t last long — 15-30 minutes — but occur in clusters or groups. You may have between one and eight episodes a day for several weeks or even months. 

Most patients have remission periods between clusters. The onset of cluster headaches is typically between the ages of 20-40.

The causes of cluster headaches aren’t fully understood. Some research indicates that abnormal activity in the hypothalamus causes blood vessel dilation and increased circulation in your brain. 

Some other triggers for cluster headaches include sudden increases in temperature, exercising in hot weather, and alcohol.

Symptoms of Cluster Headaches

A cluster headache is typically unilateral, which means it affects one side of the head. 

Patients describe the excruciating pain as boring, burning, or like stabbing a hot poker into their eye. 

In addition to severe pain, some patients have additional symptoms on the same side of their head as the pain, including:

  • Red or teary eye
  • Nasal congestion
  • Runny nose
  • Facial flushing
  • Sweating
  • Drooping eyelid
  • Smaller pupil

Unlike migraines, cluster headache patients rarely lie still. They’re often agitated or restless, pacing or rocking in place.

Diagnosis of Cluster Headaches

There isn’t a specific test to identify cluster headaches. 

Your physician will take a detailed medical history to learn about your symptoms, frequency, and identifiable patterns for an accurate diagnosis. 

You might need an MRI to rule out other potential causes of sudden head pain or headache disorders.

Treatment of Cluster Headaches

Treatment for cluster headaches includes preventive and acute therapies. 

Acute treatment stops your attack. Timing is critical as your head pain can become excruciating very rapidly, sometimes within 10 minutes. 

Oxygen therapy is one of the safest ways to treat cluster headaches. 

Your physician may also recommend subcutaneous sumatriptan or sumatriptan and zolmitriptan nasal sprays. 

Unfortunately, over-the-counter pain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), aren’t usually effective for cluster headache attacks.

Understanding Migraines

Migraines are a neurological disorder that causes incapacitating symptoms that last between 4-72 hours. 

Women are more likely to experience migraines than men, although anyone can have a migraine. Migraine attacks are most common between the ages of 18-44.

There are two main types of migraines: migraines with aura and migraines without aura. Migraines also occur in phases:

  • Prodrome
  • Aura
  • Headache
  • Postdrome

Knowing the phases and warning signs of migraine headaches can help you start treatment to prevent or weaken your migraine pain and other symptoms.

Symptoms of Migraines

Each migraine phase has different symptoms.

The prodrome phase begins a few days to a few hours before the peak of a migraine attack. 

Almost like a warning, you may experience irritability, depression, food cravings, or frequent urination during a prodrome.

If you have a migraine with aura, the aura phase lasts for between 5-60 minutes. It includes visual disturbances, temporary loss of vision, and numbness or tingling sensations on your face or another part of your body.

When the headache phase hits, other classic migraine symptoms also emerge, including:

  • Head pain
  • Facial pain
  • Neck pain and stiffness
  • Nausea and vomiting
  • Sensitivity to light, sound, and smell
  • Nasal congestion
  • Anxiety

Migraine headaches are often unilateral, although around a third of migraine patients have pain on both sides of their heads. 

Migraine headaches are often described as throbbing, drilling, or burning. Migraine symptoms are often so debilitating that all you can do is lie down in a cool, quiet, or dark room.

The postdrome phase can last 24-48 hours after the attack. It can affect your concentration and comprehension. You may feel fatigued or have an abnormally depressed or euphoric mood.

Migraine Causes

Medical researchers haven’t identified the specific cause of migraines. However, they know that abnormalities in your hormones, brain chemistry, and nerve signals contribute to the disease. 

Irregular trigeminal nerve activity is known to contribute to migraines.

Some known migraine triggers include hormonal fluctuations, stress, flickering or bright lights, strong smells, and temperature changes. 

Some medications such as birth control and sleeping pills can also contribute to migraines.

Diagnosis of Migraines

Your physician will collect a detailed medical history and details about your migraines, including attack frequency, symptoms, and how your attacks affect your life. 

They may order other diagnostic tests to rule out other conditions that can cause similar symptoms.

Treatment of Migraines

Most patients experience significant improvement with a combination of preventive therapy and medicine to relieve migraine attacks. 

Your physician will tailor your treatment options to meet your needs and may suggest:

  • Over-the-counter pain relievers
  • Antiepileptic drugs
  • Electrical stimulation
  • Botox®
  • Sumatriptan
  • Antiemetics
  • Gepants
  • Ditans

Your physician will also discuss lifestyle adjustments to your diet and sleep habits to enhance your health and reduce the frequency of your migraine attacks.

Call your primary care physician for a referral to an OrthoNeuro Neurologist if you have chronic cluster headaches or migraines with debilitating symptoms.

Make an Appointment with an OrthoNeuro Specialist Today! 

  • If you are suffering from chronic cluster headaches or migraines, schedule an appointment with one of our Board Certified Orthopedic Neurologists at one of our 7 convenient locations throughout Greater Columbus.
  • We will evaluate your unique lifestyle and goals to determine which type of treatment is best for you.
  • Best of all, most patients can be seen within 24 hours of making an appointment.

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