MIGRAINE: CLUSTER HEADACHE
Cluster headache is a one-sided pain centred on one eye. As well as pain there is redness of the affected eye with weeping, a running or stuffed-up nose, sweating of the face and forehead, and sometimes a drooping eyelid with-a constricted pupil on the affected side. The headache lasts for between fifteen minutes and three hours and can occur as often as eight times a day.
Cluster headache occurs in groups (called the cluster period) of about six to twelve weeks in duration. This is then followed by a long period of remission, which on average lasts about twelve months. Although the headache is one-sided, the similarity with migraine ends there. In cluster headache it is always the same eye that is affected, while in migraine, although one side may dominate, headaches can occur on either side in individual attacks. Cluster headache affects predominantly men, by a ratio of four to one. The pain of cluster headache is constant; the pain of migraine is throbbing. For some reason cluster headache is more prevalent in smokers and alcoholics. At the moment we don’t know what causes cluster headache but it shares a number of features with the neuralgias, so irritability of the nerves supplying the area may be at the heart of the problem.
The treatment for cluster headache falls into two sections: aborting the existing attack, and preventing further attacks. Prevention of future attacks is by using drugs such as amitriptyline, propranolol, ergotamine, methysergide, calcium channel-blockers and lithium. An injection of sumatriptan will abort an existing attack. Some patients can prevent an attack by breathing pure oxygen (this is not appropriate for those with chronic bronchitis or respiratory failure, as it stops them breathing). Other methods include inhaling ergotamine.
Type of headache
Constant, sharp excrutiating pain centred behind or around one eye.
What else could it be?
Migraine shares some features, but principally the redness and watering of the eye provides easy distinction between the two. Migraine isn’t always on the same side of the face, as cluster headaches are.
Acute glaucoma is similar in that the pain of both is sharp and very strong, but with glaucoma the pupil is wide, and the central part of the eye greenish-grey and misty-looking. In glaucoma, the eye is tender to the touch, and just before an attack haloes might appear around bright lights. A family history of glaucoma, or known raised pressure inside the eye may also point to the diagnosis. Finally, acute glaucoma usually gives rise to vomiting, while cluster headaches do not.
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