What are cluster headaches?

Veröffentlicht am: October 08, 2024
Irina  Fink
Irina Fink

Naturopath

Cluster headaches are one of the most painful complaints we humans can suffer from. Sufferers describe cluster headaches like a dagger being stabbed through their eyes. Women repeatedly compare cluster headaches to the pain of childbirth; men report that it is the worst pain they have ever experienced.

Contents

What are cluster headaches? 

Cluster headaches are intense, unrelenting pain in and around the eye, almost always on one side of the head. Sometimes the symptoms are confused with migraines, but there is a crucial difference. This type of headache occurs in a pattern, clustered together over a period of time - frequent attacks that generally last between six and twelve weeks - see Cluster headache vs migraine. A cluster period ends with a remission - a period in which there are no more symptoms for months or even years. 

The pain is very intense. However, only a few people are affected by cluster headaches. The symptoms can be treated with a combination of conventional and natural headache remedies.

 

How long does a cluster headache last?

The duration of cluster headaches varies from person to person: 80 to 90 percent of those affected suffer from cluster periods that last several weeks, followed by a remission of around one year during which no symptoms occur. Chronic cluster periods occur in around 20 percent of those affected. They sometimes last longer than a year with only a brief remission. 

A single cluster attack lasts between 15 minutes and three hours. During a cluster period, the headache always occurs at the same time, usually in the middle of the night a few hours after going to bed.

Lying down seems to make the pain worse during an attack. As a result, many sufferers wake through the night and appear restless, moving back and forth or remaining seated. Some sufferers experience pathological restlessness or changes in heart rate and blood pressure as well as sensitivity to light, sounds or smells. Attacks can also occur during the day, in some cases up to three attacks a day. These are usually not as severe as at night.

An attack usually lasts 15 to 180 minutes and ends as suddenly as it came. Even if the pain ends suddenly, the sufferer feels drained and weak.

What are the symptoms of a cluster headache?

The most common symptoms of cluster headaches are

  • Excruciating pain almost always only on one side behind or in the area of the eyes; radiating from there to the forehead, temples, nose, cheeks or upper jaw of the corresponding side
  • continuous pain during the seizure, described as burning, throbbing or stabbing
  • Pain lasting between 15 minutes and three hours - attacks usually occur one to three times a day, generally always at the same time, which is why cluster headaches are sometimes referred to as "alarm clock headaches"

Who is affected by cluster headaches?

Few people are affected by cluster headaches, usually less than one in 1000, and population studies suggest that there is a delay of seven years before the condition is diagnosed. Cluster headaches occur mainly in men; only one in ten sufferers is a woman. Most are between 20 and 50 years old when the pain first occurs. However, outbreaks can occur at any age. Smokers are more prone to cluster headaches than non-smokers.

What is the cause of cluster headaches?

The headache occurs when the nerve pathway in the brain stem - the so-called trigeminal nerve - is activated. This main nerve is responsible for sensations in the face. When it is activated, it causes pain in the eye - a common symptom of cluster headaches. An activated trigeminal nerve also stimulates a group of nerves, which in turn cause symptoms: Watery eyes and redness, a blocked nose and secretions.

Cluster headaches are not caused by a tumor, aneurysm or the like. However, they appear to originate from the hypothalamus, an area of the brain responsible for the body's physiological functions, such as temperature regulation, thirst, hunger, sleep, mood, sex drive and the release of hormones within the body. Recent studies confirm stimulation of the hypothalamus during a cluster seizure.

In 2013, a Chinese study came to the following conclusion: the scientists noticed a significant increase in the functional correlation of the right hypothalamus in cluster patients during cluster periods compared to phases without seizures. They concluded that cluster patients suffer from a dysfunction in the connectivity of brain functions, which is mainly concentrated in the areas responsible for pain processing.

Cluster headaches are often confused with allergies, as they often occur in spring or fall. This also suggests that the hypothalamus is involved in the development of the pain. Some scientists also assume that genetic predisposition plays a role, as cluster headaches occur more frequently in some families.

Let's take a closer look at the best natural treatment methods.

How you can combat cluster headaches with lifestyle changes and a change in diet:

Natural treatment methods for cluster headaches

  • Food supplements and natural remedies
  • Change of lifestyle

Many people rely on natural supplements. In addition, a lifestyle change can help you to get cluster headaches under control.

Food supplements and natural remedies

1. magnesium

People who suffer from cluster headaches often have low blood magnesium levels and can only benefit from taking magnesium or receiving injections. Preliminary studies show that intravenous magnesium injections can relieve a cluster headache attack and that magnesium deficiency can exacerbate symptoms.

To relieve the symptoms of cluster headaches and related attacks, take 400 mg of magnesium three times a day . You should take one capsule directly before going to bed, as the attacks often occur in the middle of the night. You should also eat magnesium-rich foods such as spinach, Swiss chard, pumpkin seeds, yogurt, almonds, black beans, avocado and bananas frequently.

2. vitamin B2

Vitamin B2 can reduce the severity and frequency of cluster headaches. The important vitamin also acts as an antioxidant in the body, ensures healthy blood cells and increases energy levels.

vitamin B2 deficiency can lead to nerve damage and inflammation - two factors that can increase the intensity of cluster headaches. In 2004, scientists published a study in the European "Journal of Neurology". They reported that patients who took a capsule containing 400 mg of vitamin B2 every day suffered fewer headache attacks than before they started taking the supplement.

3. kudzu extract

Kudzu extract is obtained from a woody, perennial, legume-bearing vine native to Southeast Asia. Kudzu has been used for more than two thousand years as a herbal remedy for fever, acute dysentery, diarrhea, diabetes and cardiovascular diseases. Scientists have identified more than 70 phytochemicals and phytonutrients in the root, mainly isoflavonoids and triterpenoids.

In 2009, patients suffering from cluster headaches were asked to answer questions about the use of various alternative remedies . Out of 235 patients, 16 had used kudzu. These 16 agreed to answer further questions and provide their medical records for analysis. Eleven (69 percent) of them experienced a reduction in the severity of attacks, nine (56 percent) experienced a reduction in the frequency of attacks and five (31 percent) experienced a reduction in the duration of attacks - all with minimal side effects.

4. melatonin

Melatonin is used as an adjunctive therapy for patients with cluster headaches where conventional methods do not fully relieve the pain. Scientists have found that patients with cluster headaches have low melatonin levels. Impaired melatonin secretion makes sufferers particularly susceptible to headache attacks.

In some studies, taking melatonin brought about rapid relief from cluster pain - but only in patients suffering from periodic cluster headaches. In some studies, treatment with melatonin did not work. Scientists recommend that patients start taking melatonin before the pain period begins in order to increase the chances of success.

5. capsaicin cream

Apply a small amount of capsaicin cream to the inside of the nostril (the side affected by the pain). The main ingredient in capsaicin cream is cayenne pepper, which suppresses the pain signals from the nerves.

According to a study published in the "Clinical Journal of Pain", capsaicin can reduce the number of headache attacks up to 60 days after the end of treatment. Some people experience brief pain inside the nostril or sneezing and nasal discharge after applying the cream. However, study results show that capsaicin cream can help with cluster headaches.

6. mushrooms containing psilocybin

Mushrooms containing psilocybin are banned in our country and at first glance seem a little strange for treating unimaginably intense cluster headaches. However, there are sufferers who use them to relieve their pain after they have exhausted all other options. Psilocybin is a classic hallucinogen. Case studies suggest that it is suitable for the treatment of cluster headaches. 

Scientists at Harvard Medical School evaluated various studies that looked at the effect of psilocybin-containing mushrooms on headache patients. Of 26 patients, 22 reported that the mushrooms led to a cessation of the attack; 25 of 48 confirmed that the mushrooms ended the cluster period and 18 and 19 patients respectively reported that remission was prolonged after taking the mushrooms. These reports show that further research into the mode of action and recommended dose is more than justified or needed.

Change of lifestyle

1. go out into the fresh air

People with cluster headaches report that their symptoms were alleviated during an attack after being given oxygen. You can easily try this yourself: Go out into the fresh air and take a few deep breaths in and out.

2. sport

Daily physical exercise reduces stress and improves blood circulation. Walk, do yoga or interval training between attacks and during periods of remission. Scientists confirm that exercise relieves headache symptoms, adding cluster headaches to the long list of benefits of exercise.

3. breathing exercises

Deep, rhythmic breaths lead to a better oxygen supply to the brain, relieve pain during headache attacks and provide relaxation. This is why yoga is so suitable for people who suffer from headaches. The combination of physical movement and breathing exercises alleviates headache symptoms.

4. stick to a fixed sleep rhythm

It is essential for people who suffer from cluster headaches to stick to a fixed sleep rhythm. Cluster periods often occur after deviations from the normal sleep rhythm. You should therefore stick to fixed times. Even if you are unable to sleep, this can trigger cluster headaches. You should therefore leave no stone unturned to get a good night's sleep on a regular basis.

5. use peppermint essential oil

Peppermint oil is known to relieve headaches, provide a boost of energy, relax tense muscles and improve mental concentration. Apply two to three drops of peppermint oil to your temples, the back of your neck and the soles of your feet before and during a cluster headache attack.

6. drink ginger tea

Ginger contains bioactive gingerol, which has therapeutic benefits. The compound is a powerful antioxidant and has an anti-inflammatory effect. It relieves pain by acting on the vanilloid receptors, as well as nausea, which often occurs during intense cluster headache attacks. Drink a cup of ginger tea once or twice a day to relieve the symptoms of cluster headaches.

7. avoid alcohol and tobacco

Alcohol and tobacco can increase the frequency of cluster headache attacks and intensify the pain. If you suffer from cluster headaches, you should avoid alcohol and tobacco, especially during a cluster period.

Conventional treatment methods for cluster headaches

There is no cure for cluster headaches. All forms of treatment are aimed at relieving the symptoms and preventing future attacks. The following is a brief list of the most common conventional treatments for cluster headaches:

1. deep brain stimulation of the hypothalamus

Tests have shown that the posterior hypothalamus is activated during a cluster attack. Stimulation of the ipsilateral posterior hypothalamus should therefore counteract hyperactivity and prevent persistent cluster headaches.

"Stimulation of the hypothalamus was successful in more than 60 percent of the 58 hypothalamic-implanted, treatment-resistant patients with chronic cluster headaches." The scientists published their study in the journal "Therapeutic Advances in Neurological Disorders" and went on to report that the implantation process is generally safe, even if there is a small risk of cerebral hemorrhage.

2. verapamil

In a clinical study, the administration of 360 mg verapamil daily proved to be superior to a placebo. In everyday clinical practice, doses of 480 to 720 mg daily are usually administered, i.e. roughly twice the amount used in cardiology. Although verapamil is prescribed most frequently, methysergide, lithium and divalproex sodium are also used to treat cluster headaches.

3. corticosteroids

Corticosteroids are known to many as steroids. The anti-inflammatory drugs are prescribed for a variety of different diseases, such as painful inflammation of the joints, inflammatory bowel disease, Crohn's disease and COPD (chronic obstructive pulmonary disease). Corticosteroids are intended to replace certain hormones that the body does not produce itself. They have been used for 50 years to treat cluster headaches.

Scientists believe that corticosteroids are an effective treatment method as they act on inflammation, the hypothalamic-pituitary-adrenal system and the histamine and opioid systems. The disadvantage, however, is that very high doses are required to treat cluster headaches, which can trigger severe side effects. Corticosteroids should therefore only ever be taken for a period of four weeks.

The possible side effects include

  • Thin skin with a tendency to bruise
  • Increased risk of infection
  • Mood swings
  • Diabetes
  • High blood pressure
  • Osteoporosis
  • Withdrawal symptoms

4. blockage of the occipital nerves

The occipital nerves, which are located at the back of the head near the neck, are blocked using an injection of steroids. These nerves are responsible for sensations, including pain, at the back and top of the head.

The injected steroids are intended to relieve inflammation and swelling of the tissue around the nerves so that the headache also subsides. The injection must be given in a doctor's office or outpatient clinic. The effect usually sets in three to five hours later and lasts for several days to a few months.

The most common side effect:

  • Pain in the area of the puncture site

Rather rare side effects are infections, bleeding and worsening of symptoms.

There are conflicting statements about the effectiveness of the treatment. A German study from 2005 came to the conclusion that the injections showed no effect in the treatment of patients with chronic cluster headaches. An evaluation of other studies showed that positive effects could be achieved in some studies, but only a few were controlled blind studies. The report was published in the specialist journal "Current Pain and Headache Reports". The scientists call for further studies.

5. sumatriptan

Sumatriptan is usually used to treat migraines. The drug belongs to the group of selective serotonin receptor agonists. Sumatriptan constricts blood vessels that lead to the brain and interrupts pain signals that are sent to the brain. The drug also blocks the release of substances that trigger headache symptoms.

Sumatriptan cannot prevent headache attacks or reduce the number of attacks; it only relieves the symptoms.

The side effects include:

  • Drowsiness
  • Weakness
  • Dizziness
  • Stomach ache
  • Diarrhea
  • Nausea
  • Muscle cramps

Most studies suggest that sumatriptan is effective for treating a single acute headache attack or migraine attack. To treat cluster headaches, the medication would need to be taken with each attack. Up to eight attacks per day can occur.

Cluster headache compared to migraine

In terms of the intensity of the pain, cluster headaches and migraines are sometimes difficult to distinguish. However, there are considerable differences between the two types of headache:

  • Severity of pain: Cluster headaches are usually even more severe than migraine pain, but do not last as long.
  • Number of attacks: Most sufferers experience one to eight cluster attacks per day, while migraine attacks occur one to ten times per month.
  • Duration of an attack: A cluster attack lasts between 15 and 180 minutes, a migraine attack up to 72 hours.
  • Location of the pain: Cluster headaches always occur on one side and around one eye. Migraine pain can occur on one or both sides and is accompanied by nausea and impaired vision.
  • People affected: Cluster headaches mainly affect men, while migraines mostly affect women.
  • Behavior: People with cluster headaches appear restless during the attack. During a migraine attack, most people retreat to a dark room and rest until the attack is over. 

 

Sources (in English):

Peres, M. F. & Rozen, T. D. (2001, December). Melatonin in the preventive treatment of chronic cluster headache. Cephalalgia : an International Journal of Headache, 21(10):993-5, doi: 10.1046/j.1468-2982.2001.00307.x   

Dodick, D. W. & Capobianco, D. J. (2001, February). Treatment and Management of Cluster Headache. Current Pain and Headache Reports, 5(1):83-91   

Qiu, E., Wang, Y., Ma, L., Tian, L., Liu, R., Dong, Z., Xu, X. et al. (2013, February). Abnormal Brain Functional Connectivity of the Hypothalamus in Cluster Headaches. PLoS One, 8(2): e57896, doi: 10.1371/journal.pone.0057896   

May, A. (2005, September). Cluster headache: pathogenesis, diagnosis, and management. Lancet, 366(9488):843-55, doi: 10.1016/S0140-6736(05)67217-0

Govare, A. & Leroux, E. (2014, May). Licit and illicit drug use in cluster headache. Current Pain and Headache Reports, 18(5):413, doi: 10.1007/s11916-014-0413-8   

Tfelt-Hansen, P. C. & Jensen, R. H. (2012, July). Management of cluster headache. CNS Drugs, 26(7):571-80, doi: 10.2165/11632850-000000000-00000   

Shapiro, R. E. (2005, April). Corticosteroid treatment in cluster headache: evidence, rationale, and practice. Current Pain and Headache Reports, 9(2):126-31 

Sicuteri, F., Fusco, B. M., Marabini, S., Campagnolo, V., Maggi, C. A., Geppetti, P. et al. (1989). Beneficial effect of capsaicin application to the nasal mucosa in cluster headache. The Clinical Journal of Pain, 5(1):49-53   

Lodi, R., Kemp, G. J., Montagna, P., Pierangeli, G., Cortelli, P., Iotti, S. et al. (1997, February). Quantitative analysis of skeletal muscle bioenergetics and proton efflux in migraine and cluster headache. Journal of the Neurological Sciences, 146(1):73-80 

Leone, M. (2010, May). Hypothalamic deep brain stimulation in the treatment of chronic cluster headache. Therapeutic Advances in Neurological Disorders, 3(3): 187–195, doi: 10.1177/1756285610370722   

McCrory, D. C. & Gray, R. N. (2003). Oral sumatriptan for acute migraine. The Cochrane Database of Systematic Reviews, (3):CD002915, doi: 10.1002/14651858.CD002915   

Leinisch-Dahlke, E., Jürgens, T., Bogdahn, U., Jakob, W. & May, A. (2005, September). Greater occipital nerve block is ineffective in chronic tension type headache. Cephalalgia: an International Journal of Headache, 25(9):704-8, doi: 10.1111/j.1468-2982.2004.00941.x   

Ashkenazi, A. & Levin, M. (2007, June). Greater occipital nerve block for migraine and other headaches: is it useful?. Current Pain and Headache Reports, 11(3):231-5   

Göbel, H., Schmidt, G. & Soyka, D. (1994, June). Effect of peppermint and eucalyptus oil preparations on neurophysiological and experimental algesimetric headache parameters. Cephalalgia: an International Journal of Headache, 14(3):228-34; discussion 182, doi: 10.1046/j.1468-2982.1994.014003228.x  

Barloese, M., Lund, N., Petersen, A., Rasmussen, M., Jennum, P. & Jensen, R. (2015, October). Sleep and chronobiology in cluster headache. Cephalalgia: an International Journal of Headache, 35(11):969-78, doi: 10.1177/0333102414564892   

Kim, S. D. (2015, July). Effects of yoga exercises for headaches: a systematic review of randomized controlled trials. Journal of Physical Therapy Science, 27(7): 2377–2380, doi: 10.1589/jpts.27.2377 

Mauskop, A., Altura, B. T., Cracco, R. Q. & Altura, B. M. (1995, November-December). Intravenous magnesium sulfate relieves cluster headaches in patients with low serum ionized magnesium levels. Headache, 35(10):597-600  

Boehnke, C., Reuter, U., Flach, U., Schuh-Hofer, S., Einhäupl, K. M. & Arnold, G. (2004, July). High-dose riboflavin treatment is efficacious in migraine prophylaxis: an open study in a tertiary care centre. European Journal of Neurology, 11(7):475-7, doi: 10.1111/j.1468-1331.2004.00813.x  

Sewell, R., A., Halpern, J. H. & Pope, H. G. Jr. (2006, June). Response of cluster headache to psilocybin and LSD. Neurology, 66(12):1920-2, doi: 10.1212/01.wnl.0000219761.05466.43

Sewell, R. A. (2009, January). Response of cluster headache to kudzu. Headache, 49(1):98-105, doi: 10.1111/j.1526-4610.2008.01268.x