Cluster Headache, Tension-Type Headache

by Food and Drug Administration (FDA)

(Page 3 of 4)

Cluster Headache

"This piercing pain," the man cries to his wife. His hand goes to his right eye, which is teary and red with irritation.

For a half hour, the man has been pacing, unable to keep still. Pausing to stub out his cigarette, he clenches and unclenches his fists, then wipes sweat from his right brow with a tissue. He blows his nose.

Finally, the pain is over. He collapses in a chair to wait, fearing the pain will return yet a fourth time today.

The patient is a fictitious composite of symptoms and behavior typical of cluster headache sufferers.

Cluster headache is so-named because it recurs in clusters, several times a day, for several weeks or months. A cluster may start at a certain time of year, perhaps with a change of season. Each headache lasts from 15 minutes up to 4 hours, but the cluster attack — repeated headaches — can go on for weeks or months. When the cluster series is over, in 90 percent of patients, it won't recur for months or years. The cause is unknown.

Nearly a million Americans have cluster headaches, the National Headache Foundation reports. Most cluster patients are men, usually smokers. Cluster has been called the "suicide headache," "demon of headaches," and, because it often wakens the person, "alarm clock headache."

Nearly always, only the blood vessels of one carotid artery are affected, making the intense, steady pain one-sided — usually centered behind the eye and in the temple.

Also, the pupil on the pain side may constrict, the eyelid may droop, and the brow may sweat. Nasal congestion may lead the person to suspect a sinus infection, but sinus headaches don't start and stop several times a day. Unlike migraineurs, who want to curl up in bed, cluster victims can't sit still.

Why these symptoms accompany cluster headache has not been established. One theory suggests involvement of the nerves supplying that area, according to Seymour Diamond, M.D., executive director of the National Headache Foundation and head of the Diamond Headache Clinic in Chicago.

One hundred percent oxygen inhaled through a mask for 8 to 15 minutes often stops an attack, Stark says. Painkillers tend not to work, he says. Drugs such as Cafergot lessen some acute attacks. Sansert is sometimes prescribed for prevention.

"We aren't certain how drugs work in cluster," Stark says.

Tension-Type Headache

The tension-type headache usually involves increased tension in the scalp and neck muscles. It has also been called "muscle contraction headache," "psychogenic headache," "stress headache," "ordinary headache," and "tension headache."

As some of those names suggest, tension-type headaches are the commonest, accounting for 90 percent of headaches not due to disease, and are most often caused by anxiety and stress — for instance, a mile-long traffic tie-up, work deadlines, standing sixth in a grocery check-out line, money worries.

Others susceptible to tension-type headache, Katz says, are people with poor posture, beauticians and others who move their neck and shoulders a lot, and people who work at stationary, repetitive tasks, as on an assembly line.

The pain often involves most of the head, from the forehead to the nape of the neck, and feels like a dull ache, as though the head were being pressed in a vise. Neck and shoulder muscles may be tense. The pain may go away after an hour. It may last several days.

"Usually, OTC pain relievers, hot packs, and relaxation will relieve occasional tension headaches," Katz says.

Patients with chronic tension-type headaches often are depressed. The depression may result from the pain itself, wrote Stephen Silberstein, M.D., and Marsha Silberstein, M.D., in recent articles in Pain Management. For these patients, some doctors prescribe antidepressants.

Other headaches are associated with physical problems, including dysfunction of the temporomandibular joint (which connects the jaw to the skull), brain disease, a blow to the head, arthritis, whiplash, metabolic disorders such as an overactive thyroid gland, and dental, sinus or ear infection. Treatment is based on the underlying cause.

Thanks to increasing knowledge about headaches, most headaches can be prevented or treated, if not cured. Bailey, for instance, has been treated with Inderal since 1983. Does she still have sick headaches?

"I don't know," she says. "I haven't quit taking my medicine long enough to find out."

About the Author

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