Cluster Headache and Confusing Headache Orofacial Pain Conditions

by Dr. James Fricton

Managing and preventing cluster headaches is a common issue for many individuals living in the United States. If you are seeking preventive therapy for yourself or patients with episodic cluster headache, this article will answer many questions for you.

What is a cluster headache?

Cluster headaches are a severe but rare pain condition that causes pain in, behind, or around one eye, that may radiate to other areas of your face, head and neck. These headaches are confusing because they often overlap or misdiagnosed as other facial pain conditions including migraine, tension headaches, myofascial referred pain, sinus headaches, arteritis, temporomandibular joint (TMJ) disorders, and even referred pain from painful teeth.

What is a “Headache Day”?

A headache day was recently defined as a day with 4 or more continuous hours of headache, according to the Headache Journal, The acronym NDPH stands for New Daily Persistent Headache.

A correct diagnosis is important. Pain specialists who diagnose and manage these conditions can be found at the American Academy of Orofacial Pain, or the American Academy of Pain Medicine, and MN Head and Neck Pain Clinics. This article reviews the characteristics of cluster headaches.

Are there Other Names for Cluster Headaches?

Yes. References to a cluster headache are often shortened by using CH. Cluster headaches are also called a “lower half headache” because of their physical location, or Horton’s syndrome. There is sometimes an aura associated with cluster headaches. A cluster headache strikes quickly, usually without warning, although some people have migraine-like nausea and visual auras such as lights flashing before the headache comes on.

People with cluster headaches, unlike those with migraines, may pace about while grasping the face or prefer to be alone to deal with pain away from distressed relatives who are unable to help. They may be restless and pace or sit and rock back and forth due to the severity of the pain. Some migraine-like symptoms — including sensitivity to light and sound — can occur with a cluster headache, though usually on one side.

How Painful is a Cluster Headache?

Cluster headaches are an excruciating pain often described with words such as agonizing, burning, and crippling. They call them “cluster” headaches because they occur in cyclical patterns of cluster periods. Cluster headaches can awaken you in the middle of the night with intense pain in or around one eye or one side of your head.

Bouts of frequent attacks or cluster periods can last from days to months, often followed by remission periods when the headaches stop. Remissions can occur for months and sometimes even years unless the next trigger hits. Fortunately, cluster headaches are rare and not life-threatening but can be very disabling. It is best to seek a specialist who treats chronic pain effectively.

Do Women suffer from cluster headaches of Longer Duration?

Yes, some studies indicate this is true due to women’s hormonal changes. The November 22, 2019, Gender Differences in the Clinical Presentation of Cluster Headache article states that “CH is a strictly unilateral headache occurring in attacks lasting 15–180 min and characterized by very severe pain commonly localized in the orbital or sovraorbital area.”

Marta Allena took data from observations of 163 males and 87 females suffering from CH and worked with the diagnostic criteria defined by the International Classification of Headache Disorders. She concluded that women have a longer mean CH attack (p = 0.004) duration than men. The onset of which often corresponded with moments of important changes in the levels of hormones (menarche, post-partum, menopause).

When a severe headache occurs, there is also a suicide tendency in many pain patients (55%). The personal burden of cluster headache is high and can be disabling.

What are the Symptoms of a Cluster Headache?

Here are typical symptoms that come with severe cluster headache pain:

• One-sided pain in and around the eye.
• Excessive tearing or redness of your eye on the affected side.
• Droopy eye or eye lid.
• 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.

How are Cluster Headaches Diagnosed?

Your pain specialist may conduct a neurological examination to detect physical signs of a neurological disorder. The exam is usually normal in patients with cluster headaches. Often a series of procedures are helpful to assess your brain function, including testing your senses, reflexes, and nerves.

Cluster headaches are typically diagnosed by evaluating the patient’s history for a pattern of recurrent bouts of near-daily headache attacks lasting for days, weeks, or even months.

The following questions assist in cluster headache diagnosis:

1. Is the pain isolated to one side around the eye or upper face?

2. Does the pain come on in clusters of days to weeks with months to years going by without one?

3. Do you make it more challenging for your system by smoking?

4. Do you struggle with teary eyes, facial flushing, droopy eye, a runny nose, excessive perspiration, and pupillary dilation that you can associate with the pain?

5. Do additional family members or relatives experience similar pain problem?

To make a diagnosis of cluster headache, severe head pain must be accompanied by sustained symptoms or signs of autonomic dysfunction. Also, Burxism can cause headaches.

What Conditions and Characteristics are Typical in a Cluster Period?

Cluster headache period characteristics include:

• A cluster period may stick around for several weeks to months. The beginning date and the length of each cluster period may or may not be consistent from period to period. Research finds that cluster periods may occur seasonally, such as every spring season or every fall.
• A lot of individuals have episodic cluster headaches. In these cases, the headaches occur for one week to a year, followed by a pain-free remission time frame that may last as long as 12 months before the next cluster headache develops.
• Chronic cluster periods are known to continue for over a year; pain-free intervals could last less than one month.
• Commonly, cluster headaches occur seasonally, typically in spring or in fall.
• A single attack can last from 15 minutes to three hours.
• DH attacks often occur at the same time each day.
• Most attacks occur at night, usually one to two hours after you go to bed. They usually occur just a few hours after people fall asleep as well, and you may miss getting enough sleep. Not only are they incredibly painful, but they also inhibit your natural sleep patterns.
• The pain usually ends as abruptly as it came on, with rapidly decreasing intensity. After attacks, most people are pain-free but exhausted.

What Causes Cluster Headaches?

Doctors do not know exactly what causes cluster headaches. They seem to relate to the body’s sudden release of histamine (a chemical in the body released during an allergic response) or serotonin (a chemical made by nerve cells). This happens in the area of a face nerve called the trigeminal nerve. Other studies suggest that chronic irritation of nose glands may trigger this headache type.

More men than women are impacted. CH can begin at any age but are most commonly occur in the 20s through middle age. They tend to run in families. Without a real understanding of what causes cluster headaches, it is hard for medical professionals to diagnose and treat them. As rare they are, this does not detract from how life-changing and debilitating they are to the small percentage of the world’s population who are unfortunate enough to suffer from them.

What can Trigger a Cluster Headache?

Many factors can trigger cluster headaches and help us understand what causes them. Symptoms can also resemble a stroke, so proper diagnosis is critical.

Cluster headaches may be triggered by:

• Beverages with alcohol such as beer.
• Smoking cigarettes and tobacco products.
• High altitudes (Examples: brought on by mountain climbing and air travel).
• Intensely bright light (Examples: sunlight and indoor UV light).
• Excess and sudden exertion (physical activity).
• Heat (hot weather or lengthy hot baths).
• Foods high in nitrites (Examples: bacon and preserved meats).
• Certain medications.
• Cocaine or other drug use.
• Certain strong scents or smells.

Are other Medical Conditions easy to Confuse with Cluster Headaches?

Yes. Cluster headaches are very rare but often confused with other head and facial pain conditions, making them seem more common. Other headache and facial pain conditions that are often confused with include myofascial pain, TMJ painful disorders, arthritis, dehydration, and alcohol hangovers are far more likely to be the cause of a new headache pain than cluster headaches are.

Diseases of the various organs and structures of the head, neck, and shoulders should be checked first in an orofacial pain condition.

Myofascial pain can cause similar symptoms to cluster headaches. It is a regional pain due to localized tender nodule in a taut band of muscle, tendon, or fascia that when palpated reproduces pain in local and distant referral sites. Sinusitis is also a common cause of dull constant pain in the head and neck. The location of this pain can vary; for example, between and behind the eyes. Dental problems may also cause referred pain in many areas and confuse practitioners.

Is there a cure for cluster headaches?

Currently, there is no cure for cluster headaches.

Treatment of acute cluster headache includes medications similar to a migraine, some sphenopalatine ganglion block with a local anesthetic, and control of triggers such as involves reducing alcohol and other triggers, eliminating smoking, stress management, calming practice to reduce strain, and adopting healthy habits.

Treatments can make cluster headache attacks shorter and less severe. In addition, medications can reduce the number of cluster headaches you have. Despite the confusion regarding the causes of cluster headaches, various research studies found that some treatments can be quite effective in treating the pain caused by cluster headaches.

Things, like using ice packs and over-the-counter medications to treat the pain can be helpful in the short term. There has been a nasal spray that has been developed specifically with cluster headaches in mind. This spray is designed to be used in the interloping period between one headache and another.

Although the timing of the dosage of this spray can prove difficult to get right, it has proven to be very effective in either delaying the onset of the next headache or in decreasing its ferociousness. The next task is to develop a treatment that can prevent the next headache from developing altogether.

When to seek a Pain Doctor about Cluster Headaches?

If you suspect that you have cluster headaches, you should definitely seek the advice of a doctor or a medical professional as soon as possible. While the doctor may not be able to offer an immediate solution, they will help with a correct diagnose and manage the pain to ease the severity. See your doctor if you’ve just started to have cluster headaches to rule out other disorders and to find the most effective treatment.

Seek emergency headache care have any of these signs and symptoms:

• A sudden, intense headache, similar to a thunderclap experience.
• A headache that is accompanied by a fever, unexplained nausea or vomiting, a stiff neck, mental confusion, seizures, numbness, or speaking challenges, which may be signals of a number of medical conditions, including a stroke, meningitis, encephalitis, or a brain tumor.
• A headache that follows a head injury, regardless if it seemed like a minor fall or bump, especially if it gets worse.
• The swift onset of a severe headache that’s unlike any you’ve previously experienced.
• A headache that is exacerbated over days and its pattern may change.

Headache pain, even if severe, most often isn’t the result of an underlying disease. Rather, headaches can point to a serious underlying medical condition. Examples might be a brain tumor or rupture of a weakened blood vessel (aneurysm). Additionally, if you have a prolonged history of tension headaches, see your doctor if the pattern changes or these headaches suddenly feel different.

Can most pain patients contine at work with cluster headaches?

Chronic pain caused by this type of headache can definitely impact a person’s ability to work. The February 7, 2020, Healthline article by Brian Krans says, “When workers took off of work claiming disability, people with cluster headaches had an average of 63 sick and disability days, while people without cluster headaches only took an average of 34 days off work.”

“A recent study suggests that the people who experience cluster headaches are likely to miss twice the amount of the work as people who don’t. According to experts, the research demonstrates that cluster headaches are a serious condition that can dramatically affect a person’s capacity for work.” – Cluster Headaches Can Cause People to Miss Twice as Much Work

Other studies also show that 20% of cluster headache patients have lost a job secondary to cluster headache while another 8% are out of work or on disability secondary to their headaches. Thus, it is best to understand, manage, and prevent cluster headaches.

Treatments can make cluster headache attacks shorter, less severe, and less frequent. We can help you to rule out other disorders and to find the most effective treatment.

SUMMARY

The pain specialists at the Minnesota Head & Neck Pain Clinic has extensive experience with many painful headache types. Our observations suggest that suffering from chronic headaches and pain may lead to an increase in self‐injurious behavior. A decrease in headache pain significantly reduces these behaviors. Do care for yourself and those that you love!

An unexpected benefit of cluster headache diagnosis and treatment is decreased distress felt by the patient and their caregivers. We offer both in-office visits and remote telehealth consultations. Check us out; we are available to offer solutions for many disorders and help you forgive the past..

Call the MN Head & Neck Clinic to Gain help for cluster headaches today: 763-577-2484

About the Author

James Fricton DDS, MS is a leading orofacial pain specialist at the Minnesota Head and Neck Pain Clinic, Chair of the Specialty Committee for the AAOP, and University of Minnesota Professor Emeritus.