Cluster headaches, more commonly known as “cluster headaches”, result in very intense, excruciating unilateral pain in the face. Update on symptoms, causes, diagnosis and treatments with Dr Solène de Gaalon, neurologist at Nantes University Hospital.
Definition: what is a cluster headache?
Cluster headaches, or “suicidal headaches”, are extremely debilitating primary headaches. They are characterized by the recurrence of painful and very intense headaches, which occur very close together, hence the term “cluster”. This sharp pain is usually localized on one side of the face, most often at the level of the temple or the eye. “In the medical community, we speak rather cluster headache. This headache, which constitutes the illness in itself and does not reveal an underlying pathology, is considered one of the worst pains the human body can experience. Studies have shown that the pain from a cluster headache is worse than that from an open fracture or a childbirth without epidural“, shades Dr. Solène de Gaalon.
Is it different from a migraine?
Cluster headache attacks differ from migraine in thatthey are always on the same side in the vast majority of cases, while migraine most often changes sides from attack to attack. Attacks are short (15 minutes to 3 hours) and are characterized by extreme intensity. “Cluster headaches occur one or more times a day, often at fixed times, over given periods, mainly in spring and autumn. They stop spontaneously a few weeks later. Several months or even several years can pass before the next crisis. We think that 80% of forms are episodic and there is no remission in 20% of cases“, develops the neurologist.
What are the symptoms of a cluster headache?
A cluster headache results in a sharp pain in the temple or around the eye, on one side of the face only. This crisis is accompanied by dysautonomic signs (droopy eyelid, red and watery eye, stuffy or runny nose). “These symptoms are often associated with psychomotor agitation : the subject in crisis has difficulty staying still, he cannot find the right position to soothe his pain”adds the specialist.
85% of subjects who suffer from a vascular algia of the face are smokers
What are the possible causes of a cluster headache?
The causes of a cluster headache remain poorly understood. Outraged a genetic predispositionthis condition would be related to smoking since 85% of subjects who suffer from a vascular algia of the face are smokers. Cluster headaches are more common in men than in women and begin often between 30 and 40 years old.
The diagnosis is clinical. It is based on questioning the patient because he consults most often outside of crises. What he is going to describe is very evocative, especially on the chronology of the crises. brain imaging is carried out systematically to ensure that there is no anomaly in the brain that could mimic this pathology.
What treatment to treat a cluster headache?
No treatment can completely cure the pathology. There are two main drugs that are given at the time of attacks to reduce their duration and intensity:
► Triptan, an anti-migraine substance injectable subcutaneously which has a vasoconstrictor action, that is to say which will constrict the blood vessels. It is the first-line treatment in patients who do not have cardiovascular problems.
► Nasal oxygen therapy : the patient takes high flow oxygen with a high concentration mask for a period of 20 to 30 minutes.
In addition, background treatments can be administered to the patient during crises to try to reduce their frequency.
Thanks to Dr Solène de Gaalon, neurologist at Nantes University Hospital.