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For a small segment of the population, cluster headaches can be a debilitating condition that strikes without warning. Cluster headaches attack at seemingly random intervals, for which they gain their name. Patients can go years without a single cluster headache, and suddenly suffer them for a period of weeks on end. The exact cause of cluster headaches is not known, although it is thought that stress, alcohol, and drugs can all play a role in promoting an attack. Even without these factors, however, a series of cluster headaches can befall a patient at any time in their life. A cluster headache is easy to differentiate from a normal headache because of its severity and distinct symptoms.

A sufferer of a cluster headache will often have a runny nose or eyes. The pain tends to focus behind one eye, and is often described as feeling like an icepick. This extremely uncomfortable sensation can become very intense, often times triggering a pain crisis in the patient. The pain is often intense enough to cause irrational behavior and extreme reactions. Immediate treatment is very important. Sedatives and pain killers can do a great deal to mitigate the devastating pain frequently associated with a cluster headache.

Cluster headache treatment is a difficult process because of the seemingly random nature of their attacks. Instead of a lifelong regimen of medication, cluster headache treatment is typically limited to lifestyle choices. Avoiding drugs and alcohol is an important first step in avoiding a triggering of cluster headaches. Although prevention is difficult, cluster headache treatment measures such as powerful pain killers can be necessary to have on hand.

Frequent cluster headaches are a definite sign that a visit to the doctor is in order. Although cluster headaches can occur without any discernable cause, they may sometimes be a sign of a deeper neurological issue. If this is the case, it is important that treatment be sought as soon as possible. Some forms of stress management may also be considered effective cluster headache treatment. Although the role of stress in cluster headache treatment is not certain, it is known to play a role in other headaches, and could potentially have an effect on the cluster variety of headaches. Significant emotional stress is known to cause a variety of physiological symptoms, and could play an important role in cluster headaches as well.

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There are many different types of headaches. Although not all headaches are the same, they all share at least one thing in common - they cause pain. But many headaches also cause other unwanted symptoms, including nausea and vomiting. This article addresses the most common headache symptoms associated with the different types of headaches.

Tension Headaches

People with tension headaches commonly report these symptoms:

Episodic Tension Headaches (occurs less than 15 days per month)

* Pain is mild to moderate, constant band-like pain, pressure or throbbing
* Pain affects the front, top or sides of the head.
* Pain usually begins gradually, and often occurs in the middle of the day
* Pain may last from 30 minutes to several days

Chronic Tension Headaches (occurs more than 15 days per month)

* Pain may vary in intensity throughout the day, but the pain is almost always present
* Pain affects the front, top or sides of the head
* Pain comes and goes over a prolonged period of time

Associated Symptoms of Tension Headaches include:

* Headache upon awakening
* Difficulty falling asleep and staying asleep
* Chronic fatigue
* Irritability
* Disturbed concentration
* Mild sensitivity to light or noise
* General muscle aching

Migraines

The symptoms of migraine headaches can occur in various combinations and include:

* Moderate to severe pain (often described as pounding, throbbing pain) that can affect whole head, or can shift from one side of the head to the other
* Sensitivity to light, noise or odors
* Blurred vision
* Nausea or vomiting, stomach upset, abdominal pain
* Loss of appetite
* Sensations of being very warm or cold
* Paleness
* Fatigue
* Dizziness
* Fever (rare)
* Bright flashing dots or lights, blind spots, wavy or jagged lines (aura)

Cluster Headaches

* Intense one-sided pain described as having a burning or piercing quality that is throbbing or constant
* Pain is located behind one eye or in the eye region, without changing sides
* Pain lasts a short time, generally 30 to 90 minutes. But, it can last from 15 minutes to three hours. The headache will disappear only to recur later that day (most sufferers get one to three headaches per day during a cluster period).
* Headaches occur very regularly, generally at the same time each day, and they often awaken the person at the same time during the night.

Sinus Headaches

* Deep and constant pain in the cheekbones, forehead or bridge of the nose
* The pain usually intensifies with sudden head movement or straining and usually occurs with other sinus symptoms, such as nasal discharge, feeling of fullness in the ears, fever, and facial swelling.

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The medical profession classifies headaches into two broad categories – primary and secondary. Primary headaches are those, which are not caused by another illness. Headaches, which are associated with an illness, are called secondary headaches. The accompanying illness can be minor or major and can even be life threatening.

Primary headaches include tension headaches, migraines and cluster headaches. The most common primary headache is the tension headache. There are two types of tension headaches – episodic and chronic. The difference between these two lies in the frequency with which they occur and the intensity of the pain. Episodic headaches occur at random intervals and usually don’t last more than a few hours.

As with all headaches, there are many different causes of episodic. Often just alleviating the cause will cure the headache. For example, if the headache is due to hunger, dehydration or disturbed sleep patterns; it can be cured by eating, drinking water or resuming normal sleep routines. Other causes of episodic headaches are stress, emotions, such as sadness, grief or anger, and environmental conditions.

Women who wear hairdos such as ponytails, in which the hair is pulled back, often experience headaches if the hair is pulled too tightly. In this case, merely loosening the hair will eliminate the headache.

When a headache occurs repeatedly or more than fifteen days in a month, it is said to be chronic. Chronic headaches are also triggered by emotional conditions such as repressing sadness, anger or grief, anxiety and depression. In addition, chronic headaches can be due to certain physical symptoms. These include: poor posture, arthritis, eyestrain, misaligned vertebrae and abnormalities in discs, bones or neck muscles.

Tension headaches are usually bilateral. That is they occur on both sides of the head. If the headache occurs only on one side of the head, it may well be caused by a physical abnormality on that side of the body.

Constant exposure to environmental factors such as inadequate lighting, excessive noise, close work, working with the body in a strained position, unpleasant odors and insufficient ventilation will also trigger chronic tension headaches.

The use of certain artificial sweeteners such as sorbitol, xylitol, mannitol and sucrose can also cause or worsen a headache.

Tension headaches are normally treated with over the counter medications taken with a glass of water as prescribed on the package. However, if you follow the glass of water with a cup of coffee, your pain reliever will work faster since caffeine improves the effectiveness of the pill.

The most painful headaches are cluster headaches. Fortunately these are very rare occurring in less than one percent of the population. Unlike many other types of headaches, cluster headaches affect men more often than women. Only fifteen percent of cluster headaches occur in women.

Cluster headaches are unilateral. They occur on one side of the head and always on that side. They begin in the area around the eye and spread to the forehead, temple and cheek. Sometimes they are accompanied by a runny nose or bloodshot eye on the affected side of the head.

Chronic smokers and heavy users of alcohol are most susceptible to cluster headaches. The pain is excruciating making it impossible for the person to sit or lie still.

Regardless of the type of headache, if the pain interferes with one’s lifestyle it is advisable to seek medical help.

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Q. I seem to be getting a lot of headaches lately. I’m pretty sure it’s been caused by stress, but I was wondering if I should have it checked by a doctor.

A: You should definitely see your doctor. Most headaches are harmless, but they can be a symptom of a serious condition.

The American Council for Headache Education urges people to see a doctor if there are any of the following symptoms with headache:

Headaches that began after age 50; three or more headaches per week; taking a pain reliever almost daily; taking more than the recommended doses of over-the-counter pain relievers; stiff neck; fever; shortness of breath; unexpected symptoms that affect your eyes, ears, nose, or throat; dizziness; slurred speech; weakness; numbness; a tingling sensation; confusion; drowsiness; headaches that begin and persist after a head injury; a headache triggered by exertion, coughing, bending, or sexual activity; a headache that intensifies and persists; headaches that change character; persistent or severe vomiting; a headache that is your “first or worst.”

More than 45 million Americans suffer from recurring headaches. About 70% of headache sufferers are women.

There are primary headaches that are not related to another condition, and secondary headaches, which are. Primary headaches include tension, migraine, mixed headache syndrome and cluster headaches.

About 90 percent of primary headaches are caused by tension. These muscle-contraction headaches cause mild-to-moderate pain and come and go. Tension headaches are called chronic if you have them more than 15 days per month. They are episodic if you get them less than 15 days per month.

Most tension headaches can be treated with over-the-counter pain relievers such as acetaminophen, aspirin and ibuprofen.

The precise cause of migraines is unknown. However, research has demonstrated that migraines involve the actions of nerves and blood vessels. The pain from migraines is moderate to severe. They can last from hours to days and be combined with stomach distress. Prescription medications are often needed to treat migraines.

Another subcategory of primary headache is mixed headache syndrome, which is the combination of migraine and tension headaches.

Cluster headaches, which come in groups, are the worst type of primary headache. The pain hits behind one eye and is severe. Cluster headaches occur one to three times per day during a cluster period, which may last two weeks to three months.

Preventive medications are prescribed for cluster headaches. During a cluster headache, injecting medication or inhaling 100 percent oxygen may help. About 85 percent of cluster-headache sufferers are male.

Secondary headaches include chronic progressive, sinus and hormone headaches.

Chronic progressive headaches worsen and become more frequent. These headaches may be caused by a brain or skull illness such as encephalitis, inflammation of the brain. If diseases are ruled out, doctors will try to focus on preventing the pain from striking. Preventive medication may include antidepressants, muscle relaxants or other drugs.

Sinus headaches cause pain in the head and face and sometimes can fool you into thinking you have a dental problem. These headaches coincide with other sinusitis symptoms such as nasal discharge. Over-the-counter pain relievers and decongestants work well with this type of headache.

Hormone headaches come with changing hormone levels during menstruation, pregnancy, and menopause. These are treated with non-steroidal anti-inflammatory drugs such as ibuprofen, and other drugs.

Another type of headache is caused by taking too much pain medication. This type is called a rebound headache.

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Since the brain itself feels no pain, headache pain comes from the tissues around the brain, the attaching structures at the base of the brain, and the muscles and blood vessels of the scalp, face and neck. Cluster headache pain may be related specifically to blood vessel dilation or to inflammation of nerves behind the eye.

The pattern of cluster headache attacks earn their name: episodic cluster headaches consist of active periods that may last days or even months, during which headaches occur in “clusters” every other day or as frequently as eight times per day. Headache-free remissions can last months or years.

During active periods, factors that may trigger attacks include alcohol, high altitude, air travel, bright sunlight, exertion or foods, especially foods high in nitrites. Drugs that dilate the blood vessels, such as nitroglycerine and various blood pressure medications, can also set off an attack. When the cycle is inactive, these triggers usually have no effect.

Cluster headache pain generally resides on one side, behind or around the eye or in the temples, and may be accompanied by hyperactivity, congestion, swelling and eyelid drooping or swelling. The pain may fluctuate before it subsides. Care focuses on controlling pain in acute attacks, preventing recurrences and minimizing the impact on daily functioning. Treatment usually consists of pain relief and headache prevention medications, but may include nerve injection, radio-frequency therapy or oxygen therapy.

Cluster Headaches most commonly occur in men from 20 to 40. People with cluster headaches tend to be sociable, active and responsible, so cluster headaches are sometimes called “the executive headache.” Because these headaches can be very disruptive, patient education and support groups are often helpful and comforting.

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Identify The Pain in Your Head. The type of pain you are experiencing determines the treatment you need.

It’s critical to identify which type of headache you suffer from—tension, cluster, sinus, rebound, or migraine—so that the correct treatment can be prescribed. In one 2004 study, 80% of patients with a recent history of self-described or doctor-diagnosed sinus headache—but none of the signs of sinus infection—actually met the criteria for migraine. And two-thirds of those patients expressed dissatisfaction with the medications they were using to treat their headaches. Here’s a cheat sheet to help you put a name to your pain.

Tension headaches

Tension headaches, the most common type, feel like a constant ache or pressure around the head, especially at the temples or back of the head and neck. Not as severe as migraines, they are not usually accompanied by nausea and vomiting, and they rarely stop someone from continuing their regular activities. Over-the-counter treatments, such as aspirin, ibuprofen, or acetaminophen (Tylenol), are usually sufficient to treat tension headaches, which experts believe may be caused by contraction of neck and scalp muscles (including in response to stress), and possibly changes in brain chemicals.

Cluster headaches

Cluster headaches, which affect men more often than women, are recurring headaches that occur in groups or cycles. The headaches appear suddenly and are characterized by severe, debilitating pain on one side of the head often accompanied by a watery eye and nasal congestion or a runny nose on the same side of the face. During an attack, sufferers are often restless and unable to get comfortable and not likely to lay down the way someone with a migraine usually does. The cause of cluster headaches is unknown, but they may have some genetic component. There is no cure, but medications can reduce the frequency and duration of attacks.

Sinus headaches

When a sinus becomes inflamed, usually through an infection, it can cause pain. It usually comes with a fever, and can—if necessary—be diagnosed by MRI or CT scan (which can both detect changes in fluid levels), or by the presence of pus viewed through a fiber-optic scope. Headaches due to sinus infection can be treated with antibiotics, as well as antihistamines or decongestants.

Rebound headaches

Overuse of painkillers for headaches can, ironically, lead to rebound headaches. Culprits include over-the-counter medications like aspirin, acetaminophen (Tylenol), or ibuprofen (Motrin, Advil), as well as prescription drugs.”Most of the patients we see in a headache center with daily headache have medication-overuse, or rebound, headaches,” says Stewart Tepper, MD, director of research at the Center for Headache and Pain at the Cleveland Clinic Neurological Institute.

“They are on a merry-go-round and they can’t get off,” says Dr. Tepper. “They keep taking more medicine, they keep having more headaches, and so the patient becomes more and more desperate. That’s when they end up coming to headache specialists to kind of reset the whole system.”One theory is that too much medication can cause the brain to shift into an excited state, triggering more headaches. Another is that the headaches are a symptom of withdrawal as the level of medicine drops in the bloodstream.

Migraine headaches

Migraine headaches come from a neurological disorder that can run in families and are defined by certain criteria.

* Having at least two out of four of these features: one-sided pain, throbbing pain, moderate-to-severe pain, and pain that interferes with, is worsened by, or prohibits routine activity.
* Having at least one associated feature: nausea and/or vomiting, or, if those are not present, then sensitivity to light and sound An oncoming migraine attack may, for some, be foreshadowed by an aura, which can include visual distortions (such as wavy lines or blind spots) or numbness of a hand. It’s estimated, though, that only 15% to 20% of migraineurs experience this.

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What is headache?

Headache is a term used to describe aching or pain that occurs in one or more areas of the head, face, mouth, or neck. Headache involves the network of nerve fibers in the tissues, muscles, and blood vessels located in the head and at the base of the skull.

Almost everyone has occasional headaches, especially when they are sick, tired or otherwise under stress. Headache is the result of pain signals caused by interactions between the brain, blood vessels, and surrounding nerves. During a headache, the pain comes not from the brain. It comes from specific nerves surrounding the skull, head muscles, and blood vessels that are activated and send pain signals, interpreted by the brain as a headache. The reasons why these nerves are activated are not clearly understood. Most headaches go away on their own or are easily treated with over the counter (OTC) drugs.

Headache types

There are two main categories of headache: primary and secondary.

The major types of primary headaches include:

* Tension headache
* Cluster headache
* Migraine

Primary headaches are not caused by other underlying medical conditions. More than 90% of headaches are primary.

Secondary

Secondary headaches result from other medical conditions, such as cerebrovascular disease, head trauma, infection, tumor, and metabolic disorder. These account for fewer than 10% of all headaches. Head pain also can result from syndromes involving the eyes, ears, neck, teeth, or sinuses. In these cases, the underlying condition must be diagnosed and treated. Also, certain types of medication produce headache as a side effect.

Many people have occasional headaches that get better on their own or go away with OTC drug treatment. Most of these people never see a healthcare provider for their headaches, however, there are several circumstances in which an evaluation by a physician may be useful or important:

* Headaches that are getting worse over time
* Severe headaches that start suddenly
* Headaches that start after a head injury
* Headaches that always occur on the same side of the head
* Headaches that are not responding to treatment
* Severe headaches that interrupt work or the enjoyment of daily activities
* Daily headaches
* Aggravated by exertion, coughing, bending, or sexual activity

Tension Headache

Tension headaches are the most common type of headaches. They affect up to 75% of all headache sufferers. Tension headache is usually episodic but may be chronic, occurring daily or almost daily for more than 15 days a month. This type of headache is linked with tension in neck and scalp muscles, affecting blood flow within the skull.

Tension headaches often start in the afternoon or early evening. The pain is typically on both sides of the head, pressing or tightening. Some people get tension headaches in response to stressful events. Tension headaches usually do not get worse with physical activity (such as walking or climbing stairs).

Treatment

The occasional tension headache can be alleviated by a hot shower, massage, sleep, and through patient recognition and avoidance of stress factors.

For episodic tension headaches that occur less than three times per week, OTC pain relievers such as aspirin, acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) are convenient and effective. Combination products of pain medication with caffeine may help some people, but also may be habit forming. Use of any OTC pain reliever should be limited to no more than two or three days per week. If pain medications are overused, rebound headaches may occur on the days that medications are not taken.

Chronic tension headaches are more difficult to treat, because rebound headaches are common when pain relievers are stopped. The most effective medications for treatment of chronic tension headaches are tricyclic antidepressants (amitriptyline HCl, doxepin HCl, nortriptyline HCl). However, it is often more effective to prevent these headaches than to treat them.

Some people are able to treat their tension headaches without medications. An ice compress, a heating pad or a massage to any tight areas in the neck and shoulders can be extremely helpful. Relaxation techniques, such as deep breathing exercises or acupuncture, may help to decrease the frequency of headaches.

Cluster Headache

Cluster headaches are relatively rare, affecting about 1% of the population. They are distinct from migraine and tension headaches. Cluster headaches primarily affect men between the ages of 20 and 40. Attacks usually occur in a series, or “clusters” of 1 - 8 headaches per day over a period of several weeks to months. The pain is extremely severe but the attack is brief, lasting 15 minutes to 3 hours. The pain of cluster headache almost always occurs on one side of the head. During cluster headaches, the eye on the same side as the pain may become teary or droopy or develop a small pupil. There may also be nasal congestion on the affected side of the face.

About 80% of cluster headaches occur at night, and in about 70% of patients, drinking alcohol can trigger a cluster headache. Unlike migraine sufferers, those with cluster headache often feel better if they keep moving during the headache.

Treatment

It is difficult to stop the pain of a cluster headache that is in progress, because the headache usually disappears by the time the patient reaches the emergency room or doctor’s office. Because the onset of cluster headache attacks is rapid and may occur several times a day, the best approach to treatment is with daily preventive drugs to decrease the severity and frequency of headaches. Lithium (Carbolith, Duralith, Lithane, Lithobid, Lithonate and others) and verapamil (Isoptin, Calan, Chronovera, Verelan, Novo-Veramil) are the two drugs that are most effective at accomplishing this. Other drugs used for this purpose include prednisone (Deltasone, Meticorten, Orasone 1, Winpred and others), cyproheptadine (Periactin) and methysergide (Sansert). Prophylactic medications usually are begun early during a cycle of cluster headaches and continued for two weeks longer than the usual cycle.

Abortive treatments include inhalation of 100% oxygen. Inhaling 100% oxygen for about 15 minutes through a facemask has proven to be helpful when it is done at the first signs of an attack. This oxygen must be prescribed by a doctor and obtained through a medical supplier. Other types of drugs that may be effective when used at the outset of cluster pain include the triptans (Imitrex, Maxalt, Zomig, Axert, Amerge), ergotamine (Cafergot) and indomethacin (Indocin).

Migraine Headache

Migraine headaches are less common than tension headaches. About 6% of all men and 18% of all women experience a migraine headache at some time. Migraine headache occurs on one or both sides of the head. The pain is typically pulsating or throbbing in nature. Nausea, with or without vomiting, as well as sensitivity to light and sound often accompany migraines. Migraines are made worse by activity, bright lights and bright noises. In most cases, migraine attacks are occasional, or sometimes as often as once or twice a week, but not daily. Women who have migraines often find that their headaches occur or worsen around the time of their menstrual periods.

One unique feature of migraines is an unusual sensation that a migraine is about to occur. This sensation is called a prodrome. Prodrome symptoms can include fatigue, hunger and nervousness. Not all people who get migraines have prodromes.

An aura is a complex of neurological symptoms that occur just before or at the onset of migraine headache. An aura involves a disturbance in vision that may consist of brightly colored or blinking lights in a pattern that moves across the field of vision. Most patients with migraine have attacks without aura. About one in five migraine sufferers experiences an aura.

Treatment

How your migraines are treated will depend on the frequency and severity of attacks. People who have a headache several times per year often respond well to nonprescription pain relievers.

There are two types of medications to treat migraines:

* abortive medications - drugs that are taken when a headache starts
* preventive medications - drugs that are taken every day to prevent migraines

Abortive Medications
Migraine-specific abortive medications usually are necessary for moderate to severe migraine headaches. When possible, an abortive medication should be taken immediately after an aura or migraine headache starts. However overusing abortive medications can lead to chronic headaches, that occur day after day without a specific cause or diagnosis. Several prescription and nonprescription drugs are used as abortive medications: aspirin, ibuprofen (Advil, Apsifen, Motrin, Nuprin and other brand names) or naproxen (Aleve, Anaprox, Naprosyn)

Effective agents available by prescription include:

* Triptans - sumatriptan (Imitrex), naratriptan (Amerge), zolmitriptan (Zomig) and rizatriptan (Maxalt). Triptan drugs are effective in 60% to 65% of patients, completely or significantly relieving migraine pain and associated symptoms within 2 hours of administration. Triptans reduce inflammation and constrict the blood vessels. The triptan with the longest history of use is sumatriptan (Imitrex).
* Ergots - sublingual ergotamine (Ergomar) and dihydroergotamine (Migranal). Ergots cause constriction of blood vessels, but ergots tend to cause more constriction of vessels in the heart and other parts of the body than the triptans, and their effects on the heart are more prolonged than the triptans. Ergots are not as safe as the triptans.
* Midrin. It is a combination of isometheptene (a blood vessel constrictor), acetaminophen (a pain reliever), and dichloralphenazone (a mild sedative)

Preventive Medications
Preventive medication are prescribed when migraine attacks that don’t respond well to abortive medications or adverse reactions to abortive medications occur, migraine attacks occur too often, complicated migraines. Many drugs are listed as potentially useful to prevent recurrent migraine attacks. The drugs in the following classes are useful to prevent recurrent migraine attacks:

* Beta-blockers. Propranolol (Inderal) and nadolol (Corgard) have a good track record of being safe and effective. Metoprolol (Lopressor) and atenolol (Tenormin) are reasonable alternatives. Beta-blockers have been used for many years to prevent migraine headaches. It is not known how beta-blockers prevent migraine headaches.
* Tricyclic antidepressants. These medications are very effective, but often have troublesome side effects such as sedation, blurred vision, dry mouth and constipation. The first choice is often amitriptyline (Elavil). Nortriptyline (Pamelor, Aventyl), doxepin (Sinequan), imipramine (Tofranil) also can be tried.
* Anticonvulsants. Of the drugs in this class, valproate (Depakote, Epival) has the best evidence to support using it for prevention. Gabapentin (Neurontin) and topiramate (Topamax) also are effective. It is not known how anticonvulsants work to prevent migraine headaches.
* Serotonin antagonists. Methysergide (Sansert) has been available for many years and is very effective. Methysergide prevents migraine headaches by constricting blood vessels and reducing inflammation of the blood vessels. However, this medication has side effects that are potentially very serious and therefore is not widely used.

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If you suffer form very painful headaches and have done so since you were young, the chances are you may suffer from migraines which are often experienced by other members of a family group. More often than not it is just one side of the head that experiences miserable pain that lasts from four to 72 hours if not treated and usually requires the sufferer to have bed rest. Once the episode has finished, the victim will still require rest as they will probably feel very tired.

Some people are more fortunate than others and may only have a couple of attacks per year whilst others have one or more every month. Some symptoms seem to be consistent with most victims; those of a feeling like those associated with cold or influenza and a problem with bright lights. Most migraine attacks occur between the ages of 10 to 40 years old although why this is no-one really knows; strangely, very few individuals suffer with this condition after they reach fifty years old.

Members of the same family are often cursed with migraine and there is believed to be a hereditary link; if there is a genetic reason for the attacks, medical science has not yet found this link. There is a condition that causes an inflammation of blood vessels in the brain and it is possible that people who suffer have sensitivity in this area. With this condition, women do not fare as well as men with a ratio of 3 to 1 suffering from the condition regularly; only one in twelve men will experience an attack in their lives.

Another symptom that is not consistent is those people that know when they are going to have an attack anything up to 30 minutes before it happens; this sensation is called migraine with aura owing to the type of feeling they experience.

The warning signs may include:

* Queasiness
* Blinking or zigzagging lights
* Sense of smell and taste is affected
* Lack of sensation in victim’s face

Other symptoms exist but these appear to be the most common. Migraine without aura however, is the most prevalent type and may take place only in one area of the head; this condition can escalate and is made worse by any movement, loud noises and bright lights which can cause the person to vomit.

The current belief is that the blood vessels close to the brain might contract, increasing pressure which may cause the migraine with aura experience. Some suggest that it is the rapid expansion after this narrowing that causes the awful headaches; however, all suffers say the attack knocks them out and they are unable to carry out even the most simple of daily tasks. The range of possible triggers that create an attack is huge.

The most common are listed below:

* Weather
* Certain foods
* Being at great height
* Certain groups of drink
* Strong bright lights
* Lack of sleep or food
* Tension

It is for a person to keep a check to see if they have a pattern by which they can avoid situations that could lead to an attack.

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The following measures may help you avoid a cluster attack:

* Stick to a regular sleep schedule. Cluster periods often begin when there are changes in your normal sleep schedule. During a cluster period, follow your usual routine.
* Avoid afternoon naps. Once a cluster period has started, taking an afternoon nap brings on a headache for many people.
* Avoid alcohol. Alcohol, including beer and wine, almost always triggers a headache during a cluster period. This can happen quickly, even before you finish the first drink.
* Limit exposure to volatile substances. Prolonged exposure to substances such as solvents, gasoline and oil-based paints may trigger an attack.
* Be cautious in high altitudes. During a cluster period, the reduced oxygen at altitudes over 5,000 feet may trigger a headache. There may be drug interactions between medications for cluster headache and medications for mountain sickness.
* Avoid tobacco products. Nicotine may occasionally trigger a headache during a cluster period. If you’re prone to cluster headache, it’s best to stop smoking and avoid other tobacco products.
* Avoid glare and bright lights. For some people, excessive glare and bright lights can bring on a headache.

Coping skills

Living with cluster headache can be difficult. In addition to the physical symptoms, the chronic pain that often accompanies cluster headache attacks can make you anxious or depressed. Ultimately, it may affect your interaction with friends and family, your productivity at work, and the overall quality of your life.

You may find that talking to a counselor or therapist can help you cope with the effects of cluster headache. Or you may find encouragement and understanding in a headache support group. Although support groups aren’t for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences. If you’re interested, your doctor may be able to recommend a group in your area.

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Because the cause of cluster headache is unknown, you can’t prevent a first occurrence. However, a preventive strategy is crucial for managing cluster headache because trying to treat it with acute drugs only can seem hopeless. Prevention can help reduce the frequency and severity of the attacks and the risk of rebound headaches. Preventive medications can also increase the effectiveness of acute medications.

Preventive medications for cluster headache are generally used for either a short-term (transitional) strategy or a long-term (maintenance) strategy. The short-term medications work quickly but may have undesirable side effects. Long-term medications take effect more slowly but can be used safely throughout the cluster period.

Whenever a cluster period starts, you’ll likely start taking a long-term medication, many times accompanied by a short-term medication. After a couple of weeks, you’ll discontinue use of the short-term medication but continue with the long-term drug.

Short-term prevention

Short-term medications can prevent headache attacks during the period of time it takes for one of the long-term drugs to become effective. The main short-term preventive medications are corticosteroids and ergotamine. A nerve block also may be effective, particularly for some people who can’t tolerate the other medications.

* Corticosteroids. Inflammation-suppressing drugs called corticosteroids are fast-acting preventive medications. They belong to a general family of medicines called steroids. Your doctor may prescribe corticosteroids if your cluster headache condition has only recently started or if you have a pattern of brief cluster periods and long remissions. Although corticosteroids are an excellent treatment for several days, serious side effects make them inappropriate for long-term use.
* Ergotamine. Ergotamine available as a tablet that you place under your tongue or available as a rectal suppository, can be taken before bed to prevent nighttime attacks. Ergotamine medications are effective for short periods but shouldn’t be used for more than two to three weeks.
* Nerve block. Injecting an anesthetic (numbing agent) and corticosteroid into the area around the occipital nerve, located at the back of your head, can prevent pain messages from traveling along that nerve pathway. The occipital nerve converges with the trigeminal nerve, which connects to all the pain-sensitive structures in your skull. An occipital nerve block can be useful for temporary relief until long-term preventive medications take effect.

Long-term prevention

Long-term medications are taken during the entire cluster period. Some people with chronic cluster headache don’t respond well to the use of one long-term medication. In this situation, your doctor may recommend that you take two or more long-term medications simultaneously.

* Calcium channel blockers. The calcium channel blocking agent verapamil is often the first choice for preventing cluster headache, although the way verapamil works with cluster headache isn’t well understood. The medication may be used from the start of a cluster period until three to four weeks after the last headache. Then its use is gradually tapered and discontinued under your doctor’s direction. Occasionally, longer term use is needed to manage chronic headache. Constipation is a common side effect of this medication, as well as dizziness, nausea, fatigue, swelling of the ankles and low blood pressure.
* Lithium carbonate. Lithium which is used to treat bipolar disorder, is also effective in preventing chronic cluster headache. Side effects include tremor, increased thirst, diarrhea and drowsiness. Your doctor can adjust the dosage to minimize side effects. While you’re taking this medication, your blood will be drawn at regular intervals to check for the development of more serious side effects, such as liver or kidney damage.

Preventive medications under evaluation

Other preventive medications used for cluster headache include the hormone melatonin, capsaicin and anti-seizure medications such as divalproex and topiramate.

In addition, you may help reduce your risk of future attacks by avoiding alcohol and nicotine, which often precipitate cluster headaches.

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