Cluster headaches

Posted on 4 July 2013

One of the leading causes of short-term work absenteeism is headaches, as anyone who suffers from them will know. Dr Peter Haug, a neurologist at Mediclinic Milnerton in Cape Town, explains what a cluster headache is.

What is it and how does it feel? ?
Some describe a cluster headache as a short, stabbing pain on one side of the head, like an ‘ice pick in the eye’. It often presents with visible symptoms like small pupils, the drooping of an eyelid, runny nose, and a bloodshot and teary eye on the same side as the pain. There are usually several episodes at predictable time(s) of the day. Individual attacks can last between 15 minutes to three hours. A cluster of daily pain attacks can last weeks to months.

Who gets it?
Cluster headaches are not that common, and 90% of patients are men. This may be genetic and associated with smoking.

What triggers it?
They can be seasonal every year, disappearing for a while and recurring at the same time the next year.

What treatment is available?
Rapid-onset painkillers – preferably injectable ones – are prescribed for individual pain attacks. Inhalation of pure oxygen can help, too. There is medicine that will shorten the pain episode’s length and prevent the recurrence of cluster headaches the following year.

When should I seek medical attention?
In the case of a cluster headache, there’s usually nothing structurally wrong with your brain or body, so the episode will pass, but an underlying structural cause needs to be ruled out in someone with new onset cluster headaches.

I always pop (or two) a pill when I have a headache. Is this ok?
Dr Marinda McDonald, an allergy specialist at Mediclinic Sandton in Johannesburg says, ‘It’s very easy to get addicted in the pill/headache cycle, especially if the over-the-counter (OTC) medication you’re taking contains caffeine or codeine as main ingredients. They can actually cause head pain, called “rebound headaches” if taken too often. If you suffer from chronic recurring headaches, it’s vital you seek clear diagnosis.’

‘If you’re popping large doses of OTC pain medication six- to eight-hourly, it’s too much,’ she advises, and cautions that ‘you should never take more than four pain pills in a day. Long-term over dosage can lead to systemic problems like becoming allergic to the tablets you’re taking. It’s also vital to know that taking different types of OTC pain pills in combination can be lethal. Long-term use can result in renal failure,’ she continues, ‘and, worst-case scenario, liver failure if you exceed the dose.’

You can read more about migraines and tension headaches, too. And here’s what you need to know about when headaches signal trouble.

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Published in Neurology

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