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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