Headaches can have many causes, some of which are innocuous. But sometimes, they need to be taken seriously. Dr (Lt Gen) C S Narayanan, VSM, head of department of neurology at Manipal Hospitals, New Delhi, says some of the red flags that would mandate detailed investigations are the onset of headache after 50 years of age, new onset of headache in those with an underlying medical condition or when the treating doctor finds abnormalities on clinical examination.
“Those who have these so-called primary headache syndromes can have frequent, severe, and debilitating headaches that adversely impact quality of life. The most common headache that falls into this category is migraine,” he explains.
What are cluster headaches?
According to the doctor, people are more familiar with migraine than cluster headaches because “migraine is much more prevalent”. “One characteristic feature of migraine headache is it often affects one side of the head. Cluster headache, another common primary headache, shares this feature with migraine. While both are unilateral, cluster headache is side-locked, meaning it involves the same side in each attack, whereas migraine headache can shift sides,” says Dr Narayanan.
Since the treatments for the two conditions are different, it is crucial to make the correct diagnosis.
Signs and symptoms of cluster headaches
A cluster headache strikes quickly, usually without warning, although you may first have migraine-like nausea. Common signs and symptoms include:
– Excruciating pain that is generally situated in, behind or around one eye, but may radiate to other areas of your face, head, and neck.
– One-sided pain
– Excessive tearing
– Redness of your eye on the affected side
– Stuffy or runny nose on the affected side
– Forehead or facial sweating on the affected side
– Pale skin (pallor) or flushing on your face
– Swelling around your eye on the affected side
– Drooping eyelid on the affected side
Cluster headaches versus migraine
The doctor says unlike migraine, cluster headache is significantly more common in men than women.
“Hereditary factors play a limited role in the causation of cluster headache as against migraine. Migraine may start very early in childhood with peak prevalence in the 20–40-year age group. Cluster headache begins around this time and lingers on for several decades thereafter. Migraine headaches have well-defined triggers like sunlight, fasting, strong odours, certain types of food, stress and the hormonal changes that occur during the menstrual period. The most potent trigger for cluster headache is consumption of alcohol. People with a migraine attack may experience nausea, sensitivity to light, and vomiting, whereas those with a cluster headache experience watery eyes and runny noses.”
Did you know?
Cluster headaches are often confused with sinus headaches, and unlike migraine attacks these headaches can start abruptly.
“Headache in migraine is usually described as throbbing, while cluster headache is piercing and intense. Migraineurs find relief by resting in a quiet, dark room, but people with cluster headaches become agitated and restless, pacing up and down in quest of relief. A migraine attack typically lasts between 4 and 72 hours and a cluster headache lasts between 15 minutes and three hours,” the doctor says.
Dr Narayanan says treating both cluster and migraine involves the use of “rescue medications” taken at the onset of symptoms, as well as “preventive therapy”.
“A class of medications called triptans is often used to abort a migraine headache. The most effective acute treatment for cluster headache is high flow oxygen administered for about 20 minutes. Cluster headaches may be prevented by daily doses of verapamil, with or without a short course of steroids.”