- Cluster headaches are a rare condition affecting 1 in every 1,000 people. They are dramatic, painful, debilitating attacks of pain centered around one side of the head.
- People with cluster headaches are nearly twice as likely to take time off work than those without.
- New research has shown 92% of people with cluster headaches have at least one additional illness.
- People with cluster headaches and additional illnesses have nearly four times as many days off work compared to those with cluster headaches alone.
Cluster headaches are attacks of severe pain often felt on one side of the head and often around the eye.
The rare condition, affecting around 0.1% of the population, can be debilitating. People affected with cluster headaches can experience up to eight per day, with each one lasting anywhere between 15 and 180 minutes.
Speaking to Medical News Today, Prof. Peter Goadsby, chairman of OUCH(U.K.), whose aim is to raise awareness of the condition, explained that cluster headaches are relatively short-lasting compared to migraine. Still, he describes the pain as “very severe (more so than any other pain reported)” and can also be accompanied by other “prominent features of eye-watering, redness, and nasal congestion.”
The cause of cluster headaches is not fully understood. Previous research suggests that the condition may be linked to abnormalities in the hypothalamus – the area of the brain which controls circadian rhythm.
New research at Karolinska University Hospital and Danderyd Hospital in Sweden suggests that people with cluster headaches are more likely to have other illnesses and have time off from work.
The study appears in the journal Neurology.
Cluster headaches triggers
Unlike migraine and tension headaches, cluster headaches aren’t generally associated with triggers such as foods, hormonal changes, or stress.
MNT spoke with Dr. Medhat Mikhael, pain management specialist and medical director of the non-operative program at the Spine Health Center at Memorial Care Orange Coast Medical Center,who was not involved in the current study.
“There are some factors that can trigger cluster [headaches] including extensive alcohol consumption, cigarette smoking, strong smells, stress and lack of sleep. Avoiding all of those triggers and making lifestyle modifications can help,” Dr. Mikhael said.
Treating cluster headaches
Due to the severity of the condition, cluster headaches are unlikely to disappear with lifestyle changes, according to study lead author Dr. Caroline Ran, a research specialist at the Karolinska Institute, Sweden.
“There are speculations around lifestyle changes as a tool to lessen the disease burden, like smoking cessation or sleep management, but nothing has been proven In controlled studies,” Dr. Ran explained.
Treatments can reduce the duration and severity of the attack and the number of attacks.
Dr. Goadsby suggested treatments such as sumatriptan by injection, sumatriptan by nasal spray, zolmitriptan by nasal spray, non-invasive vagus nerve stimulation, verapamil, galcanezumab (in the U.S.), and corticosteroids.
“Treatment of the acute cluster headache starts with supportive care using Oxygen, also using abortive medications like triptans, and CGRP inhibitors are very helpful,” Dr. Mikheal added. “Also, preventive approaches using calcium channel blockers, B-blockers and CGRP inhibitors both injectables and oral.”
Cluster headaches and other illnesses
The study compared the works records and health data of 3,240 people diagnosed with cluster headaches to 16,200 people without cluster headaches.
Cluster headaches were associated with an increase in other diseases, including heart disease, mental disorders, and neurologic diseases. Indeed 92% of the people in the study with cluster headaches also had at least one other illness.
“We were surprised to see that so many patients suffered from additional disorders, this is something that we need to bring up with colleagues at the clinic in order to evaluate how this affects patient’s overall health, treatment options, and how we can provide the best healthcare possible to avoid them ending up in long term sickness absence.”
– Dr. Ran
Interestingly, despite cluster headaches affecting men more than women, researchers found that 96% of the female participants in the study with cluster headaches had an additional illness compared to 90% of men.
“We saw that also in the reference group, morbidity was higher in females. It is possible that, as cluster headache is already impacting the lives of these patients severely, adding on another morbidity simply makes the work-life balance impossible, leading to sickness absence and disability pension,” Dr. Ran explained.
Researchers found that during the study period, people with cluster headaches were almost twice as likely to take sick days as those without, 63 days compared to 34 days respectively.
In addition, people with cluster headaches and one other illness missed nearly four times as many work days compared to those with cluster headaches alone.
“I believe the most interesting part is showing how extensive the associated disability and loss of work and productivity among patients with cluster headache. Also, although cluster headache is much more common in men, it seems like the disability rate and loss of work is more common in women,” echoed Dr.Mikheal.
Study limitations and future research
The study authors highlight that the research is limited by a lack of information about primary healthcare events and personal data relating to lifestyle habits (alcohol consumption, smoking habits, and BMI) which may have resulted in underestimating some diseases.
It is also important to consider that the study was conducted within the Swedish population (which for this study was largely male) so may not be directly related to all populations. Interestingly, most of the large-scale epidemiological studies to date have been performed on Caucasians. As a result, less is known about the prevalence of cluster headaches in other populations.
Speaking about the potential differences between racial groups, Dr. Ran noted:
“It is difficult to say, there is no difference in cluster headache cases between different countries. It is more probable that we find differences related to socioeconomic factors than race. We have previously found that sickness absence in cluster headache patients is higher in subgroups of lower education, for example, this is likely to reflect socioeconomic status, which is also known to be correlated to overall health.”
When discussing the next steps for the work, Dr. Ran explained that it would be to investigate the higher-risk sub-groups.
“Having identified specific sub-groups of people we have identified mental health and cardiovascular disease as special risk groups and are looking forward to investigating these groups in greater detail,” she said.
For people experiencing cluster headaches, Dr. Goadbsy advised them to “seek support in a patient association, such as OUCH(U.K.) and seek a physician with experience with cluster headache.”
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