Are there specific risk factors for cluster headaches?Cluster headaches seem to occur more often in men, and more often in smokers. There is some thought that the dilation of blood vessels may be related to cluster headache pain as certain vasodialator drugs such as nitroglycerine and histamine can cause attacks in some patients. It is this blood vessel dilation that may cause pressure on the peripheral nerves of the head and neck to trigger headache episodes. There also seems to be some genetic predisposition to these headaches as patterns within families have been seen.
What causes cluster headaches?While the cause of cluster headaches is not completely understood, the periodic nature of these headaches has indicated that they might be related to triggers in the hypothalamus which is a control center of the brain. It is this portion of the brain that controls circadian rhythms which help with sleep patterns. Special studies that look at metabolic activity in the brain have localized the hypothalamus as an area of enhanced activity during cluster headaches.
How are peripheral nerves related to cluster headaches?Alterations in the hypothalamus seem to have a relationship to changes seen in the trigeminal regions of the brain which control activity from the peripheral sensory nerves of the head and neck. These peripheral nerves that are addressed during headache surgery seem to have a role in the triggering of cluster headaches.
How can headache surgery really help cluster headaches?While there does seem to be some periodic susceptibility to having a headaches in cluster headache patients, a secondary trigger seems to be additionally related to these episodes. In many patients the irritation of the peripheral nerves that are addressed during headache surgery can be a major trigger of headache pain. During the workup for headache surgery, these nerve triggers are identified through a series of specific nerve blocks which can indicate that a patient is a good candidate for headache surgery- one that can find relief from release or division of these affected nerves.
How common are cluster headaches?Little research has been done on cluster headaches, so there aren’t great numbers of how common the condition is. It’s estimated that between 200,000 and 1 million people are living with cluster headaches in the U.S. Onset for those unfortunate enough to have them usually comes between the ages of 20 and 40. Men are somewhat more likely to have cluster headaches, and there appears to be a genetic component, although it does not always pass down through subsequent generations.
What are the signs and symptoms of cluster headaches?This headache disorder gets its name from the fact that these attacks occur in groups, or “clusters.” During a cluster cycle, brief, excruciatingly severe headache attacks recur between one and eight times per day. Pain severity is identified as being 10 out of 10. These headaches occur on one side of the head. Symptoms occur on the same side of the head that the pain is taking place on. These can include red or teary eye, runny or stuffy nostrils, and flushing or sweating of the face. During attacks, some people develop a smaller pupil or a drooping eyelid on the headache side. Most cluster headache patients are agitated; this differs from migraine patients who try and stay as still as possible. The pain of a cluster headache comes as searing, stabbing pain that usually occurs behind one eye or at the temple near the forehead. The headaches are shorter than with migraines, lasting between 15 minutes and three hours. They come in cycles that often occur once or twice over the course of a year. Timing can be unpredictable. But then the headaches can go away for years before returning.
Can you prevent a cluster headache from starting?Many doctors don’t understand cluster headaches and they lump treatment in with migraine headaches. But these are two very different conditions. Dr. Lowenstein understands the difference and can help patients with cluster headaches. Cluster headaches can sometimes be prevented with drug treatment. Corticosteroids injected into the back of the head are often the first preventive treatment. From there, various drugs can shorten attacks and make them less severe, including: divalproex sodium, ergotamine tartrate, gabapentin, lithium carbonate, topiramate, and verapamil. The occipital nerve is located at the base of the skull and seems to be the starting point for cluster headaches. An occipital nerve block can be an effective temporary prevention measure.
When should I consider surgery to address my cluster headaches?Surgery is usually considered the last recourse. It is only recommended for patients who don’t find any relief with aggressive treatment or who can’t tolerate the medications or their side effects. If an occipital nerve block has been helpful in the past, you can be very confident that surgery is a good option for you. If occipital nerve blocks have not worked, Dr. Lowenstein can administer one himself to make certain it was done correctly. Many patients that have not had success with other nerve blocks respond well when the block is performed by Dr. Lowenstein.