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Cluster Headache

Also indexed as: Horton’s Headache

Illustration

A sharp, recurring pain around the eye or upper face may mean more than your average headache. According to research or other evidence, the following self-care steps may help you control cluster headaches:

What you need to know

  • Manage pain with melatonin
  • Take 10 mg of this natural hormone before bedtime to decrease the frequency of cluster headaches
  • Consider capsaicin
  • Consult a healthcare provider experienced with intranasal capsaicin treatment, which may ease the pain and reduce recurrences
  • Experiment with oxygen therapy
  • See a healthcare provider experienced with oxygen therapy to find out if it reduces the pain of cluster headache attacks

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full cluster headaches article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About cluster headaches

Cluster headaches are very painful one-sided headaches that tend to occur in clusters of several headaches in a short period of time, after which there may be no headaches for weeks or months. Cluster headaches that continue for more than one year without remission, or with remissions lasting less than 14 days, are considered to be chronic and are very difficult to treat.

Product ratings for a cluster headache

Science Ratings Nutritional Supplements Herbs
2Stars

Melatonin

Cayenne
1Star

Magnesium (intravenous)

  
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

Cluster headaches involve pain in the eye or upper face, tearing, runny nose with nasal congestion, and facial sweating.1

Medical options

The prescription drugs most commonly used to treat cluster headaches are the serotonin 5-HT 1 receptor agonists, such as sumatriptan (Imitrex), frovatriptan (Frova), eletriptan (Relpax), rizatriptan (Maxalt), naratriptan (Amerge), zolmitriptan (Zomig), and almotriptan (Axert). Injections of dihydroergotamine (D.H.E. 45 Injection) might also provide pain relief for some people. The calcium channel blocker verapamil (Calan, Verelan) may be prescribed to prevent cluster headaches. Other agents that might be useful include corticosteroids, experimental topiramate (Topamax), and imethandocin (Indocin).

Oxygen inhalation is especially beneficial when symptoms occur at night.

Dietary changes that may be helpful

Some doctors report that food sensitivities may trigger cluster headaches in some people.2 3 While the connection between diet and migraine headache is well established, no controlled research has investigated the role of diet in cluster headache.

Many people with cluster headaches are heavy consumers of alcohol, and alcohol consumption has been reported to bring on cluster headache attacks.4 5 However, no research has investigated the effects of avoiding alcohol on cluster headache recurrences.

Lifestyle changes that may be helpful

Many people with cluster headaches are smokers.6 7 8 9 10 While this does not necessarily mean quitting smoking will reduce cluster headache attacks, smoking should be avoided for many reasons.

Vitamins that may be helpful

People who suffer from cluster headaches often have low blood levels of magnesium, and preliminary trials11 12 show that intravenous magnesium injections may relieve a cluster headache episode. However, no trials have investigated the effects of oral magnesium supplementation on cluster headaches.

Researchers have found low levels of the hormone melatonin in cluster headache patients.13 14 15 16 In a small double-blind trial, a group of cluster headache sufferers took a 10 mg evening dose of melatonin for 14 days. About half of the group saw a significant decrease in the frequency of their headaches within three to five days, after which no further headaches occurred until melatonin was discontinued.17 Melatonin appears to be effective against both types of cluster headache (e.g., episodic and chronic). 18 More research is needed to establish the long-term effects of melatonin supplementation on cluster headache.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

Substance P is a nerve chemical involved in pain transmission that may cause some of the symptoms of cluster headache.19 20 Capsaicin, a constituent of cayenne pepper can reduce the levels of substance P in nerves.21 Preliminary clinical trials investigating the use of intranasal capsaicin for the prevention and treatment of cluster headaches report significant decreases in the number of cluster episodes in some of the participants.22 The decreases usually lasted no more than 40 days after the end of treatment,23 although a few patients have experienced relief for up to two years.24 In a double-blind study, patients who received capsaicin intranasally twice daily for seven days during a cluster episode had a significant reduction in pain for the following 15 days.25 As capsaicin can cause burning and irritation, this treatment should be utilized only under the supervision of a qualified doctor.

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

Holistic approaches that may be helpful

Oxygen therapy has been found to be useful in treating cluster headaches. A double-blind trial compared breathing 100% oxygen with breathing air (nitrogen and oxygen) through a mask for 15 minutes or less during six headache episodes per person. The 100% oxygen significantly reduced the pain of acute cluster attacks in all subjects.26 A controlled trial found that during acute episodes of cluster headaches, breathing 100% oxygen through a mask for 15 minutes significantly decreased pain in most of the people with episodic cluster headache and in over half of those with chronic cluster headache.27 However, one-fourth of the study participants experienced cluster attacks soon after the treatment was stopped. While oxygen inhalation therapy is now considered a standard treatment,28 treatments may need to be repeated, and they have not been shown to help prevent recurrences.

In controlled studies,29 30 a single treatment of hyperbaric oxygen therapy, in which the patient is placed in a chamber with highly concentrated oxygen, has been found to help decrease pain and prevent recurrence of cluster episodes in some patients for several days. Two studies have investigated the use of multiple treatments of hyperbaric oxygen in chronic cluster headache patients. In one small, preliminary trial,31 ten 70-minute treatments over two weeks brought relief in most of the participants; headaches did not recur for 1 to 31 days after the end of treatment in those who responded. In another preliminary trial, chronic cluster headache patients received 15 hyperbaric oxygen treatment sessions (every other day for 30 minutes each); results showed a gradual decrease in episodes in some patients, which lasted for up to two weeks after treatment ended.32

References:

1. Mendizabal JE, Umana E, Zweifler R. Cluster Headache: Horton’s Cephalalgia Revisited. South Med J 1998;91:606–17 [review].

2. Mendizabal JE, Umana E, Zweifler R. Cluster Headache: Horton’s Cephalalgia Revisited. South Med J 1998;91:606–17 [review].

3. Trotsky MB. Neurogenic vascular headaches, food and chemical triggers. Ear Nose Throat J 1994;73:228–30.

4. Levi R, Edman GV, Ekbom K, Waldenlind E. Episodic cluster headache. II: High tobacco and alcohol consumption in males. Headache 1992;32:184–7.

5. Manzoni GC. Cluster headache and lifestyle: remarks on a population of 374 male patients. Cephalalgia 1999;19:88–94.

6. Manzoni GC. Cluster headache and lifestyle: remarks on a population of 374 male patients. Cephalalgia 1999;19:88–94.

7. Levi R, Edman GV, Ekbom K, Waldenlind E. Episodic cluster headache. II: High tobacco and alcohol consumption in males. Headache 1992;32:184–7.

8. Hannerz J. Symptoms and diseases and smoking habits in female episodic cluster headache and migraine patients. Cephalalgia 1997;17:499–500.

9. Anonymous. Case-control study on the epidemiology of cluster headache. I: Etiological factors and associated conditions. Italian Cooperative study Group on the Epidemiology of Cluster Headache (ICECH). Neuroepidemiology 1995;14:123–7.

10. Swanson JW, Yanagihara T, Stang PE, et al. Incidence of cluster headaches: a population-based study in Olmsted County, Minnesota. Neurology 1994;44:433–7.

11. Mauskop A, Altura BT, Cracco RQ, Altura BM. Intravenous magnesium sulfate relieves cluster headaches in patients with low serum ionized magnesium levels. Headache 1995;35:597–600.

12. Mauskop A, Altura BT, Cracco RQ, Altura BM. Intravenous magnesium sulfate rapidly alleviates headaches of various types. Headache 1996;36:154–60.

13. Chazot G, Claustrat B, Brun J, et al. A chronobiological study of melatonin, cortisol, growth hormone, and prolactin secretion in cluster headache. Cephalalgia 1984;4:213–20.

14. Waldenlind E, Gustafsson SA, Ekbom KA, Wetterberg L. Circadian secretion of cortisol and melatonin during active cluster periods and remission. J Neurol Neurosurg Psychiatry 1987;50:207–13.

15. Leone M, Lucini V, D’Amico D, et al. Twenty-four-hour melatonin and cortisol plasma levels in relation to timing of cluster headache. Cephalalgia 1995;15:224–9.

16. Leone M, Lucini V, D’Amico D, et al. Abnormal 24-hour urinary excretory pattern of 6-sulphatoxymelatonin in both phases of cluster headache. Cephalalgia 1998;18:664–7.

17. Leone M, D’Amico D, Moschiano F, et al. Melatonin versus placebo in the prophylaxis of cluster headache: a double-blind pilot study with parallel groups. Cephalalgia 1996;16:494–6.

18. Peres MFP, Rozen TD. Melatonin in the preventive treatment of chronic cluster headache. Cephalalgia 2001;21:993–5.

19. Sicuteri F, Renzi D, Geppetti P. Substance P and enkephalins: a creditable tandem in the pathophysiology of cluster headache and migraine. Adv Exp Med Biol 1986;198B:145–52.

20. Sicuteri F, Fanciullacci M, Nicolodi M, et al. Substance P theory: a unique focus on the painful and painless phenomena of cluster headache. Headache 1990;30:69–79 [review].

21. Lynn B. Capsaicin. Actions on nociceptive C-fibers and therapeutic potential. Pain 1990;41:61–9.

22. Sicuteri F, Fusco BM, Marabini S, et al. Beneficial effect of capsaicin application to the nasal mucosa in cluster headache. Clin J Pain 1989;5:49–53.

23. Fusco BM, Marabini S, Maggi C, et al. Preventative effect of repeated nasal applications of capsaicin in cluster headache. Pain 1994;59:321–5.

24. Fusco BM, Fiore G, Gallo F, et al. “Capsaicin-sensitive” sensory neurons in cluster headache: pathophysiological aspects and therapeutic indication. Headache 1994;34:132–7.

25. Marks DR, Papoport A, Padla D, et al. A double-blind placebo-controlled trial of intranasal capsaicin for cluster headache. Cephalalgia 1993;13:114–6.

26. Fogan L. Treatment of cluster headache. A double-blind comparison of oxygen v air inhalation. Arch Neurol 1985;43:362–3.

27. Kudrow L. Response of cluster headache attacks to oxygen inhalation. Headache 1981;21:1–4.

28. Mendizabal JE, Umana E, Zweifler RM. Cluster Headache: Horton’s Cephalalgia Revisited. South Med J 1998;91:606–17 [review].

29. DiSabato F, Fusco BM, Pelaia P, Giacovazzo M. Hyperbaric oxygen therapy in cluster headache. Pain 1993;52:243–5.

30. DiSabato F, Giacovazzo M, Cristalli G, et al. Effect of hyperbaric oxygen on the immunoreactivity to substance P in the nasal mucosa of cluster headache patients. Headache 1996;36:221–3.

31. Pascual J, Peralta G, Sanchez U. Preventive effects of hyperbaric oxygen in cluster headache. Headache 1995;35:260–1.

32. DiSabato F, Rocco M, Martelletti P, Giacovazzo M. Hyperbaric oxygen in chronic cluster headaches: influence on serotonergic pathways. Undersea Hyperb Med 1997;24:117–22.
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