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SYMPTOMS OF CLUSTER HEADACHE
Cluster headaches usually develop without warning. There is a tendency for the attacks to occur at specific times of the day or night, often with such regularity that some of our patients claim that they can actually set their watches by the onset of the pain. The repetitive episodes are quite uniform and vary only slightly from attack to attack. Typically, the attacks recur one to six times each twenty-four hours, frequently awakening their victims from a sound sleep a few hours after retiring.
The pain of a cluster headache can be overwhelming. It almost always begins on one side of the upper face or head, often near one eye, the forehead, or the temple. The pain then spreads to other areas on the same side of the face or head. As the intensity of the pain grows, it usually localizes around or in an eye or over one temple. The pain is present on only one side of the face and neck at a time but may alternate, affecting the other side in separate attacks.
During an attack, the nose on the painful side of the face often becomes stuffy or runny. The eye on the affected side may become bloodshot and tears may run copiously down the side of the face. Occasionally, the eyelid will droop, the pupil on the affected side will narrow, and the skin of the involved side of the face may become warm and flushed. Despite the severity of the pain, nausea and vomiting do not regularly occur.
The intensity of the pain of a cluster headache deserves special mention. It has been described as
burning,
throbbing,
boring,
piercing,
tearing, or
stabbing.
It usually begins as a mild but distinct discomfort, then quickly, over a period of minutes, relentlessly gathers intensity. The pain can be incredibly cruel and merciless, and those who suffer from it vividly attest to its excruciating torture.
Cluster headaches have been described as the most painful event imaginable. One of our patients described each attack as feeling as though a red-hot iron were being pressed into his forehead and eye until it had burned its way through his skull. Another said of his attacks that they felt as though the skin of his face and his eyes were being clawed from his skull and acid poured into the open wound. Another victim described the attacks as a burning metal spike being pounded into his eye and pushed through the skull, deep into his brain. One patient likened his attacks to the flame of a blowtorch being applied to his eye for fifteen to twenty minutes. It is not unusual for people who are normally stoic to scream out in anguish during an attack.
During a migraine attack, darkness and quiet are often sought, but individuals who suffer with cluster headaches often desperately pace, sometimes banging their heads against walls or
inflicting painful bodily injury to themselves in order to alter the feeling of head pain.
Not long ago, the wife of a patient with cluster headaches phoned at five o’clock in the morning. She was sobbing and panic-stricken. In the background could be heard her husband’s loud and agonized screaming. The woman was crying and asking whether she should take her husband to the hospital. As she spoke, a loud banging sound became audible over the telephone, and the woman said that it was her husband banging his head on a tabletop; he threatened to commit suicide unless he could escape from the searing pain.
Each attack of cluster headache lasts from fifteen minutes to an hour, averaging about thirty minutes. To most victims the period seems forever. The attack can subside suddenly or gradually, but a dull ache may last for a while afterward. The individual is then well until another attack strikes.
Drinking alcoholic beverages is likely to provoke some migraine attacks, but alcohol’s ability to initiate a cluster episode is dramatic. Most people with cluster headaches are exquisitely
sensitive to alcohol, particularly during a bout of headaches. Strangely, however, alcohol may not trigger an attack during the headache-free months. One of our patients said that during his cluster attacks even the smell of a strong alcoholic drink would make him sick with a headache, but he could drink without restraint during his headache-free intervals.
Cluster headaches occur more commonly during the spring and fall, but can develop during any season. With some patients, years will pass between attacks. Every so often a victim will experience attacks that do not cluster but will continue year after year without remission. In other words, the cluster headaches just do not cluster. (What’s in a name anyway!)
Pain Relief/Muscle Relaxant One of our patients came to us after ten years of at least five attacks a day. He claimed that throughout the entire period he had enjoyed only two months during which he did not suffer from his headaches. He told us that if he could not find relief soon he was going to end his life. We are still working with this patient, and although he is dramatically improved, he still endures an occasional headache every few months.
While cluster attacks usually bear a striking similarity from one patient to another, some people do have attacks that deviate from the classical pattern. Instead of being localized mainly around an eye or temple, the pain may center around the lower part of the face, the upper or lower cheek, the jaw, and even the neck. This variation has been called a “lower-half headache” and may be easily confused with the pain of dental origin. There is some difference of opinion among medical experts about these lower-face attacks with respect to whether they are related to typical cluster headaches or not.
*49/88/2*
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