The Truth About Cluster Headaches

Cluster headaches (also used in singular: headache), also nicknamed suicide headaches, occur several times a day, they come on unexpectedly, do not last long, and are generally very painful. The pain is usually intense, and sometimes only on one side of the head. Frequently, the sufferer also feels pain around the eye.

A cluster-headache sufferer can wake up during the night because of the pain. Often, this occurs at the same time each night. The eye on the painful side of the head may be reddened and watery. The individual’s nose may be runny or blocked on the side of the nose where the pain is.

In northern countries cluster headaches tend to occur more frequently during the autumn (fall) and spring. Alcohol or extreme variations in temperature can trigger an episode during a cluster period – generally, the change in temperature refers to a rapid rise in body temperature.

Cluster headache attacks occur cyclically, hence the name. A bout of regular attacks – cluster periods – can last from a few days, weeks, to even months. This is followed by remission periods during which no headaches are felt.

Cluster headaches are not very common – they are said to affect about 1 in every 1,000 people. Unlike migraines, they affect men more often than women; about 80% of sufferers are men, most of them smokers. Fortunately, they generally have no long-term effects on the sufferer’s physical health. There are therapies, such as oxygen therapy, available which can significantly reduce the number and intensities of headaches.

Each cluster can last from 15 minutes up to several hours – the majority of cases do not last more than an hour. Typically, a patient will suffer from one to three clusters each day.

According to Medilexicon’s medical dictionary:
Cluster headache is “possibly due to a hypersensitivity to histamine; characterized by recurrent, severe, unilateral orbitotemporal headaches associated with ipsilateral photophobia, lacrimation, and nasal congestion.”
What are the signs and symptoms of cluster headaches?
A symptom is something the patient feels and reports, while a sign is something other people, including a doctor or a nurse may detect. For example, pain may be a symptom while a rash may be a sign.

Symptoms come on rapidly, generally without any warning, and they may include:
Intense pain, some describe it as excruciating. The pain is continuous, rather than throbbing. The pain often starts around the eye, and may then radiate to other parts of the head, including the face, and down to the neck and even the shoulders. Many patients feel pain in a temple or cheek.

• The pain remains on one side of the head
• The patient becomes restless.
• The eye on the side of the pain is watery and tearful
• The eye on the side of the pain reddens
• There may be swelling around the eye on the pain side
• Stuffy, blocked, or runny nose on the pain side
• Pallor – skin of the face is pale
• Face is sometimes sweaty
• Pupil size may shrink
• Eyelid on the pain side may droop

Patients often describe their pain as stabbing, sharp, burning and penetrating; as if a hot poker had been plunged into one of their eyes. The individual will usually pace around during the episodes of pain, unable to stay still for long. When they sit many may rock back and forth in an attempt to sooth the discomfort (sometimes this helps).

While migraine sufferers prefer to lie down during an attack, most people with a cluster headaches say that lying down worsens the pain.
Chronology of cluster headaches (time patterns)

A cluster period typically lasts from 1 to 12 weeks. They often start at similar calendar moments – perhaps during springtime or at some time in the fall (autumn).
Episodic cluster headaches – patients experience a series of searing headaches for about one week. Then nothing for six to twelve months. Then the week repeats itself.

Chronic cluster headaches – in this case the cluster periods can persist for several months, even for a year or longer. While periods of remission (periods with no pain) are short; perhaps just a month long.
A cluster period may consist of:
Daily occurrences, with symptoms appearing several times each day.
Just one attack, lasting from 15 minutes to up to three hours.
Attacks occur each day at approximately the same time.
Most attacks occur between 9pm and 9am (source: The Mayo Clinic, USA)
The pain will suddenly go as quickly as it appeared. Sufferers will be pain-free afterwards, and are often worn out.

If you start getting headaches, it is advisable to see your doctor. Usually, headaches do not have an underlying cause (some illness or condition). However, sometimes they do. It is important for the doctor to rule out any possible underlying causes.
What are the risk factors for cluster headaches?

In medicine, a risk factor is a condition, illness, situation or environment which raises the risk of developing a disease or condition. For example, obese people are more likely to develop diabetes type 2 compared to people of normal weight. Therefore, obesity is a risk factor for diabetes type 2.

For cluster headaches, the risk factors include:
Being male – approximately 8 in every 10 sufferers are male.
Being an adult – nearly all suffers say their cluster headaches started after they were 20 years old.
Ethnic ancestry – people of African ancestry are twice as likely to suffer from cluster headaches, compared to Caucasian people.
Smoking - the majority of male sufferers are smokers.
Alcohol consumption – a significant proportion of sufferers claim that alcohol is a key trigger during a cluster period (not during remission periods).
Genetics – if you have a close relative (parent or sibling) who has (had) cluster headaches, your risk of having them yourself is greater.

What are the causes of cluster headaches?

Experts are unsure why cluster headaches occur. Some researcher neurologists have found that during an attack there is a great deal more activity in the hypothalamus – an area of the brain that controls body temperature, hunger, and thirst. It is suggested that perhaps that area of the brain releases chemicals that cause blood vessels to widen, resulting in a greater bloodflow to the brain, and subsequent headaches.

If the hypothalamus does act in this way, nobody knows why. We do know that such things as alcohol or a sudden rise in temperature, or exercising in hot weather may trigger attacks.

Biology – The cyclical nature of cluster headaches suggests there it may be linked to our biological clock, which is located in the hypothalamus.

Hormones - researchers have found that many people who suffer from cluster headaches have unusual levels of melatonin and cortisol during their attacks.

Apart from alcohol, cluster headaches are not linked to the consumption of any foods.  Even with alcohol, it is only a trigger when the sufferer is in the middle of a cluster period.   Some association has been found between cluster headaches and mental stress or anxiety.

Experts say there may be a link between cluster headaches and some medications, such as nitroglycerin, which is used for the treatment of heart disease.
What are the treatment options for cluster headaches?

Currently, public opinion states that there is no treatment that can get rid of cluster headaches completely. Modern therapy aims to alleviate some of the symptoms, shorten the periods of headaches, and reduce their frequency.

OTC (over-the-counter, no prescription required) painkillers, such as aspirin or ibuprofen are not effective for cluster headaches; because the pain comes on rapidly and goes away quickly too. By the time the medication has started to work the headache has probably gone. Therefore, many medications and treatments for cluster headaches are either aimed more at prevention, or fast action.

Fast-acting treatments (acute treatments)
Inhaling 100% oxygen – most patients find that if they breathe in oxygen through a mask at 7 to 10 liters per minute they experience significant relief of symptoms within 15 minutes. The only problem with this therapy is that the patient has to have an oxygen cylinder and regulator close at hand – carrying them around can be cumbersome. There are some small units on the market. In some cases this kind of therapy only postpones symptoms, rather than alleviating them.

Local anesthetic nasal drops. It is very effective for the treatment of cluster headaches.

Surgery – if patients do not respond adequately to aggressive treatments, or cannot tolerate some medications, surgery may be recommended – even so, surgery is very rare. Surgery can only be performed once, and is only suitable for sufferers who have pain on just one side of the head. Surgical procedures include:

Conventional surgery – the surgeon cuts part of the trigeminal nerve, which serves the area behind and around the eye. This is not a procedure of first choice as there are risks to the patient’s eye.

Glycerol injection – glycerol is injected into the facial nerves. This effective treatment is safer than other surgical procedures.

Stimulator (still being tested) – a small device is implanted over the occipital nerve and sends impulses via electrodes. According to researchers from the Mayo Clinic, USA, a significant number of patients experienced reduced chronic headache pain. The device appears to be well tolerated and safe to use. Another study is looking into implanting a stimulator in the hypothalamus. The National Institute for Health and Clinical Excellence (NICE), the UK body that approves drugs and therapies for National Health Service (NHS) use, has not yet assessed either treatment.

Prevention of cluster headaches

As the medical experts are not yet sure what the causes of cluster headaches are, it is not possible to recommend proven measures for prevention. A comprehensive preventive strategy is vital for managing the cluster headaches – simply using acute therapies is not enough.

The following may help reduce the risk of future attacks:

Alcohol – during a period when headaches occur alcohol may trigger attacks. Abstaining from alcohol during these periods will help reduce the number of headaches. Alcohol does not appear to be a trigger during periods of remission.

Inhaled nitroglycerin – this medication causes blood vessels to dilate (enlarge) and can cause headache cluster attacks. The NHS (National Health Service), UK, recommends that cluster headache sufferers avoid this medication.

Exercising in hot weather – this is a well known trigger for cluster headache. Sufferers should avoid doing anything which may cause their body’s temperature to rise rapidly.

Smoking – a significantly higher percentage of cluster headache sufferers are smokers, compared to the rest of the population. Although not proven, some suggest that giving up smoking may help.

Can Magnets Relieve Migraines?

New animal research suggests that a noninvasive therapy called transcranial magnetic stimulation (TMS) may help treat chronic migraines. The hair dryer-size device triggers activity in the brain’s nerve cells and is already being tested as a way to treat depression.

What happens during TMS is this: the electrical activity in the brain is influenced by a pulsed magnetic field generated through coils of wire. The wires are wrapped in plastic and held close to the scalp. The location of the device allows for stimulation of specific areas of the brain.

In earlier human research, TMS relieved pain more effectively than placebo in patients who had migraines with auras, which are visual sensations (such as flashes of light) that occur before or during the pain of a migraine.

In this latest study, presented at the annual American Academy of Neurology scientific meeting in Seattle, researchers aimed to learn exactly how TMS may affect the brain to improve pain symptoms.

The authors found that the magnetic pulses of TMS may disrupt abnormal brain waves that have been linked to migraines. However, the authors state that more research in humans is needed to fully understand how TMS affects chronic migraines.

“I think for migraine, it’s extremely likely that this [device] will become part of the therapeutic armamentarium,” said Dr. Richard Lipton, director of the Montefiore Headache Center in New York. “I think for some people who don’t like taking prescription medications … or for people who have side effects to these drugs, this will prove to be a very useful option.”

TMS has also been studied as a potential therapy for chronic or treatment-resistant depression. Some research suggests that therapy may down regulate beta-adrenergic receptors and subsequently increase the levels of dopamine and serotonin in the brain.

Instructions:

Step 1
Use magnets and magnetic therapy under the care and guidance of a doctor or expert. An expert can place the magnets correctly at the right strength in order to best treat migraine pain.

Step 2
Adhere magnets in place as soon the migraine warning signs begin and leave them on until the symptoms pass. You can also use certain magnets to prevent headaches on a daily basis.

Step 3
Place stick magnets on either side of the spine, between the shoulder blade and spine. Magnets should adhere to the areas of the spine 1 to 2 inches above the bottom of your shoulder blade, 1 inch from the top of the shoulder blade and on the back of the shoulder above the shoulder blade.

Step 4
Wear a magnetic necklace, bracelet, earrings or headband and sleep with a magnetic pillow to reduce migraine pain daily. Start with a lower strength, as your body generally responds better to a lower strength magnet when relieving migraine pain.

Step 5
Find products at alternative medicine facilities, through your health care provider or online at websites such as Magnetic Products or Magnetic Therapy Magnets (or see my picks on right hand side).

Step 6
Use other pain treatment methods in conjunction with magnetic therapy, as they won’t interfere with magnetic therapy. For example, take a hot bath or shower and then apply magnets once completely dry.

Step 7
Use high quality magnets with the correct strength for your degree of migraine pain. Consult a book such as “Magnetic Therapy” by Gloria Vegari or ask an expert for assistance. If you use the wrong strength your symptoms could worsen, and if you use the wrong placement you might not get all the benefits that correct placement gives you.

Types of Migraines – Complicated, Abdominal, Hemiplegic and More

Most people have heard of migraine headaches, but most don’t realize that there are many different types of migraines, each with its own unique symptoms and need to be understood before we can look at natural relief. Let’s have a look at them in detail.

An abdominal migraine is also called periodic syndrome. It occurs usually in children, and usually ones with a prior family history of migraine attacks. Abdominal migraines are characterized by bouts of pain in the abdomen lasting for around two hours. Other symptoms can include nausea, vomiting, flushing and pallor. Standard natural migraine treatments usually work for abdominal migraines.

A basilar migraine is one affecting the circulation in the back of the neck or brain. This usually occurs in young women and can cause dizziness, loss of balance, double vision, confusion, fainting, slurred speech and disorientation. Some people will even lose consciousness during an acute headache. Often people are mistakenly believed to be suffering from some other condition.

A complicated migraine is a type which is accompanied by one or more neurologic deficits, for instance, paralysis. It sometimes features an aura that lasts for hours or days, as opposed to the half hour or hour which is the usual. There are a few different forms of complicated migraine headaches. One is the ophthalmoplegic migraine, in which the patient develops some paralysis of the nerves required for eye movement. In a retinal migraine, the visual symptoms occur from the person’s retina rather than from the part of the brain used for vision. Another form of complicated migraine is the hemiplegic migraine, which is often inherited and is linked to one of a few different chromosomes.

Cyclic Migraine Syndrome refers to patience who experience more than 10 migraine attacks a month.These are typically long-lasting and not associated with typical cluster headache symptoms. Studies have shown that cyclic migraine syndrome can be helped by lithium carbonate, as long as the patient’s medication level and thyroid functioning are both monitored.

A hemiplegic migraine is a rare type considered to be a severe variety. During an attack, the sufferer might experience temporary motor paralysis and some sensory disturbances on a single side of his or her body.These symptoms precede the headache itself. The symptoms will fade as the headache appears.

Nocturnal headaches refer to attacks experienced in the early hours of the morning, usually around 4:00 a.m. The person is often awakened by the pain. According to recent studies, these attacks are linked with changes in the person’s adrenaline and similar substances. As the levels reach their peak, the headache is experienced.

An occular migraine refers to a migraine in which the person experiences visual hints of an oncoming attack, usually the “aura” which produces flashing lights or spots or something related.

Ophthalmoplegic migraines are considered rare forms of migraine. In this variety, the pain surrounds the person’s eyeball and can last as long s several months. It’s caused by a weakness of muscles which surround the eye. A person should get a doctor to confirm the diagnosis, as similar symptoms might also be produced by a pressure on the nerves directly behind the eye.

Stratus migraines are attacks that persist for over 72 hours. One of the factors that might prolong a migraine attack is a sterile an inflammatory response to the migraine, which sometimes develops around the walls surrounding the affected blood vessels.

If there are other kinds of migraines that I haven’t mentioned, I’d be very interested to hear about them. What are the symptoms and when and where do they occur?

This Ingredient can Drastically Reduce Migraines

A new animal study presented at the International Headache Society’s 14th International Congress provided evidence that Theobroma cacao may be an appropriate dietary supplement for those suffering with migraine headaches. The ingredient is thought to repress inflammatory responses in the brain that are associated with pain.

Approximately 30 million Americans suffer with migraine headaches. A migraine is a severe, painful headache that can last for hours or even days. During the headache, the temporal artery enlarges, producing a release of chemicals that cause inflammation and pain.

Theobroma cacoa is the botanical name for the cocoa plant, and it has long been used in folk medicine as an antiseptic and diuretic. The seeds are used to make chocolate – which is often indicted as a trigger food for migraine headaches because of its caffeine and tyramine content, ingredients thought to restrict blood flow.

Pure cocoa alone has been shown in some studies to have other positive effects on health, including improving hypertension and glucose metabolism. Cocoa also contains phenylethylamine, which has anti-depressant properties and can cause the brain to release chemicals that fight pain.

Dietary intervention is one of the methods of treatment for migraine headaches, as some foods are thought to be trigger foods for attacks. The foods thought to exacerbate symptoms are cheese, chocolate, citrus fruits, meats with high nitrate content (ie: hot dogs), MSG, aspartame, and alcoholic beverages. Unfortunately, avoiding these trigger foods does not always prevent migraine headaches from occurring.

According to WebMD, food triggers often act in combination with other factors such as stress and hormonal changes. The amount of food eaten that can trigger an attack is also a consideration. Small amounts may not cause a migraine, but eating large quantities can induce symptoms.

Another natural treatment for migraine headaches is exercise. A study published in Headache: The Journal of Head and Face Pain, researchers found that the frequency of headaches decreased with a regular aerobic exercise program. Headache intensity and amount of medications taken also decreased. Exercise reduces stress, which is often a factor in migraine headaches.

Medical experts will not likely soon promote eating chocolate as a method to reduce the pain of headaches, as most chocolate products are low in actual cocoa and the processing of cocoa into chocolate reduces its beneficial phytochemical properties. However, there are currently manufacturers of cocoa extract dietary supplements, which are often not regulated and may not be as beneficial to health.

Sources: Medical News Today and WebMD.

Migraines: what really triggers them and how research is bringing relief

The specialist: Dr. Alan Carver on migraines

http://www.nydailynews.com

An assistant professor in the department of neurology at Mount Sinai, Alan Carver has spent the past 10 years helping patients with problems of the nervous system – the brain, spinal cord and nerves throughout the body.

Each week, he sees about 60 patients with migraines.

Who’s at risk

Migraine headaches affect 28 million Americans, almost 10% of the general population. “Migraine is a severe, episodic headache that is characterized by light sensitivity, noise sensitivity, nausea and vomiting,” says Carver. “You don’t have to have all the characteristics, but you have to have at least one to put your headache under the migraine umbrella.”

Migraines are often associated with women, who make up two-thirds of migraine sufferers. But millions of men have symptoms, too. Most patients are diagnosed in their 20s and 30s. “This is a younger adults’ disorder, though there are children with migraine, and elderly people with migraine as well,” says Carver.

Twenty years ago, doctors thought migraines were due to too much blood flow in the brain. Now, they believe that migraines are a brain disorder. “The blood-flow problems are secondary to neuronal inflammation, a problem at the level of the brain cell itself,” says Carver. “Neurons are brain cells, and they are releasing a lot of inflammatory peptides, brain molecules that are linked together – and they are what drives the pain of the problem.”

The majority of migraine patients are genetically predisposed. “It’s a hereditary disorder of the brain,” says Carver. “When I see someone with a migraine, 70% of the time they have a first-degree relative with migraine – a mother, father or sibling.”

Signs and symptoms

The primary symptom is the headache itself. “People describe the pain as pounding, screaming, awful,” says Carver. “And there’s a huge variation in debility.” Some people have one or two migraines a year; as long as they take their medicine, it’s not a big deal. For other patients, migraines can be incredibly disabling; they might miss three days of work and major events. Because some headaches are quite benign, sufferers often meet with skepticism and lack of sympathy. “Sometimes, there is discrimination involved,” says Carver. “‘Oh, it’s just a headache, get back to work.’ So the patient can end up suffering in more ways than one.”

Research suggests patients with migraines have a nervous system that is set differently than the general population. “The nerves are firing at a somewhat increased rate,” says Carver. “People with migraines have been found to have a hypersensitivity in general.” This sensitivity can manifest in many ways: wearing sunglasses a lot, finding rock concerts uncomfortably loud, being bothered by things like video games and computer screens. “That’s a common trigger,” says Carver, “They’re more likely to have a migraine when presented with a lot of stimuli.”

“People with migraines have trouble with irregularity,” adds Carver. Common triggers include: a change in sleep patterns, either too little or too much; changing eating patterns, either allowing yourself to get too hungry or thirsty; a change in exercise routine, not exercising at all, or way more than normal; weather changes; certain foods and alcohol, especially red wine, aged cheeses, and the MSG in Chinese food; having difficulty with smells like perfumes; for women, menstruation, and for everyone, emotional stress.

Migraine pain can be located anywhere in the head: the right or left side, the cheeks, the back of the head. “It’s important that patients not be fooled into thinking it’s a sinus infection just because of the location,” says Carver. “Patients often mistakenly start treating themselves.”

Traditional treatment:

In the past, the only treatment available was nonspecific pain medication. “This medicine was as good for a headache as for a sprained ankle,” says Carver. “It was okay, and it took the edge off – but it wasn’t migraine-specific.” Then, in the mid-’90s, Triptans were developed. “These meds specifically go after the neurovascular elements: causing overly dilated blood vessels to shrink, and stopping the neurons from releasing the peptides that cause pain.” Patients take Triptan after the onset of a migraine to control its symptoms.

Somewhere between 65%-75% of patients respond “beautifully” to Triptans, says Carver. But that leaves out about 30% of patients or 28 million who are still symptomatic.

For patients who get debilitating migraines several times a month, doctors often prescribe preventative therapy. “Many patients are on Triptan every time they get a migraine, and on a daily medication to make these incidents more rare,” says Carver.

Some have found relief in alternative therapies like acupuncture and vitamin therapy. Carver always recommends migraine-specific therapy first; for patients who fall into the 30% who don’t respond, he recommends trying alternative approaches, taking them on a case-by- case basis.

Research breakthroughs:

Migraine research has been revolutionized in the past 15 years. “Triptan is certainly the most important breakthrough we’ve had,” says Carver. “The second most important was discovering the role of time in managing migraines.” Researchers found that the brain in migraine becomes activated in stages. Patients often told doctors that Triptan worked great – as long as they took it within the first 20-30 minutes of getting the migraine. “We found that if they wait, many more brain cells have gotten into the act, and that’s bad,” says Carver. “When they finally take the pill, you’re asking that one little pill to reverse the process, which has grown much bigger.” So early treatment is key to good care. Another new discovery is that migraines are a stroke risk factor. “Women with migraine with aura [visual symptoms] or a lot of headaches are more likely to have strokes than the general population,” says Carver.

A question for your doctor:

If you’ve been suffering from what you thought was sinus pain, ask your doctor, “Could this be migraine?”

And don’t avoid sharing severe headache symptoms out of fear of a brain tumor diagnosis.

It’s helpful for patients to know that headaches are not necessarily a sign of brain tumors, says Carver.

Know your family history

70% of migraine cases are hereditary, so ask your relatives to see if anyone suffers from debilitating headaches accompanied by the characteristic symptoms.

Get informed

The National Headache Foundation has helpful information, including a physician finder and patient surveys, at their Web site, www.headaches.org.

My note: there are ways to cure migraines forever and not have to turn to medecine for treatment.