Cluster Headaches

Symptoms by body part:

Ear
Acute Pain
Frontal Sinus/Cranium (Head)
Acute Pain
Occipital region (Base of Skull)
Headache Pain
Orbit (Eye)
Stabbing Pain

Although not a lot is understood about Cluster Headaches in research, our experience at Portland Chiropractic Neurology has been successful in multiple cases. If you experience Cluster Headaches, it can be extremely debilitating, please call us to arrange an evaluation to see if we can help. 

What is a Cluster Headache?

Cluster headaches are rare when compared to other types of headaches. The pain they produce is severe and tends to recur in the same way each time. They occur in groups, or clusters, and each attack lasts about 1 to 3 hours on average. The frequency of occurrence may range from every other day to multiple times a day. Cluster periods are followed by remissions that may last months or years. Males are affected by cluster headaches more than females and they typically start around age 30. Researchers do not know exactly what causes cluster headaches. They seem to be related to the sudden release of histamine or serotonin in the body (1)

You get a cluster headache when a specific nerve pathway in the base of your brain is activated. That signal seems to come from a deeper part of the brain called the hypothalamus where the "internal biological clock" that controls your sleep and wake cycles lives.

trigeminal nerveThe nerve that's affected, the trigeminal nerve, is responsible for sensations such as heat or pain in your face. It's near your eye, and it branches up to your forehead, across your cheek, down your jaw line, and above your ear on the same side, too. (2)

 

An underlying brain condition, such as a tumor or aneurysm, won't cause these headaches.

These are common symptoms of a cluster headache (1):

  • Sudden onset of pain, generally around or behind the eye
  • Pain builds to a peak in about 10 to 15 minutes
  • Restlessness or agitation
  • Red or watering eyes
  • Nasal congestion
  • Sweating on the forehead
  • Eyelid drooping or swelling

The following may trigger cluster headaches (1):

  • Alcohol use or smoking cigarettes
  • Change to a high altitude
  • Bright light
  • Exercise or exertion
  • Heat, either weather or a bath
  • Foods that contain nitrates, such as bacon or lunch meat
  • Cocaine use

Cluster Headache Diagnosis

How can we diagnose what's causing your Cluster Headache? By evaluating the brain and nervous system in its entirety, but specifically along the autonomic and trigeminovascular pathway, we can localize regions that are dysfunctional and misrepresenting sensory information to the brain. Autonomic dysregulation is a hallmark of Autonomic Cephalgias and we perform careful evaluation of this potential involvement. Oxygenation is an important aspect of Cluster Headache and is also evaluated very carefully. We're essentailly looking at your brain from an integration perspective, ensuring all regions are sending appropriate afferent information to the brain, including the vestibular system, proprioceptive system, visuomotor system, autonomic system, oxygenation system. Our core model of care is multi-modal, ensuring that all potential regions that may contribute to Cluster Headache are properly assessed and treated to allow proper gating and function to occur along the Trigeminovascular pathway. In order to do this, we must reset the Central Integrated State of the dysfunction neuronal regions of the brain to reduce their resting membrane potential to an appropriate level that is healhy and approximately -65 mV, reducing hyperexcitablity. We attempt to achieve this through a specialized program that combines Neurology, Chiropractic, Physical Therapy, Vestibular Rehabilitation, Occupational Therapy and Oxygen. 

Neurological Core Testing:

  • Videooculography (VOG, sometimes referred to as VNG) that measure eye movements that relate to specific regions of the brain, brain stem and vestibular system.
  • Sensitive balance and coordination testing of proprioception and brain using Computerized Assessments of Posturography Systems (CAPS) that allow us to measure dysfunctional areas
  • Tilt Table Testing
  • Autonomic Assessment
  • Clinical Examination (Neurology, Proprioceptive, Respiration)
  • Gait analysis
  • Oxygen evaluation
  • Metabolic capacity
  • Objective measures
  • Spatial and Temporal Summation (Treatment Plan)

Neurological Core Treatment:

  • Tilt Table Treatment (TTT)
  • Non-Invasive Nerve Stimulation (NINS)
  • Vagus Stimulation (VS)
  • Oculomotor retraining (eye movement exercises) (OMR)
  • Vestibular Rehabilitation (VR)
  • Occupational Therapy (OT)
  • Rib Manipulation (RM)
  • Cervicovestibular rehabilitation (CVR)
  • Specific Chiropractic Neurological Manipulations for Oxygenation L/S/T (SCNM-O)
  • Mild Hyperbaric Oxygen Therapy (mHBOT)
  • Postural Restoration (PR)
  • Physical Therapy (PT)
  • Functional Neurological Rehabilitation/Neuroplasticity Retraining Exercises (FNR/NRE)
  • Co-treatment (Botox, Medications, etc..) (CT)
  • Migraine dietary recommendations (MDR)

How can our treatments change your Cluster Headache response? 

Neurons require Activation, Oxygen and Fuel (glucose) to maintain a healthy state of -65 mV and undergo Immediate Early Gene Response to create more cellular contents such as sodium/potassium pumps, mitochondria for ATP formation, axonal and dendritic connections with neighboring cells, etc. The list you saw is how we target the dysfunctional areas with activation, oxygen and carry fuel to those cells. This has to be done in a very graded, careful manner so as to not exceed the metabolic rate of the neurons involved. We observe metabolic capacity for each individual and maintain levels of treatment that stay below those levels so as to keep a steady progression of healthy return to a normal state of function. Neurons respond through Temporal and Spatial Summation, so we can develop treatment plans based on your severity that will allow maximal response and long-term changes. This is known as Neuroplasticity and is at the core of our Headache Neurology Program. I often tell people, I don't know how much I can help you, but if we're able to improve your Cluster Headache at least 25% with the understanding that our goal is much higher. Your response depends on multiple factors, including genetics, central sensitization (chronicity), following our treatment plan and so forth. We are very open and honest with our patients and do our best to provide accurate information, but it is a functional issue and it is sometimes difficult to be exacting in our predictions. 

Can Portland Chiropractic Neurology treat my Cluster Headaches  successfully? 

For many individuals, yes we can, and we've been doing it for over 12 years. However, that can range from 25% improvement to as close to 100% as possible, although most people will agree that an improvement of 50% is life changing. The rest we hope to control through lifestyle changes, dietary changes, Medical intervention such as medications, botox, etc.  Our goal is for your results to be long-lasting and permanent without our continued care because we utilize Neuroplasticity appropriately along all aspects of our treatment plan, patients don't return to their previous state when they are finished treatment. That being said, genetics and many other aspects play a role in your Cluster Headache physiology, so it is difficult to determine or know for sure at the beginning of treatment if you are a 50% improved patient or a 100%, or anything in between. Even those with genetic predispositions, which is not always known, respond well to care as our treatment aims to change the phenotypic expression of their genotype, or what your parents passed down to you (genetics). With the proper diagnosis, we can treat the areas that are the primary source of your Migraines through Neuroplasticity Retraining Excercises that will change your dysfunction causing your Cluster Headache. 

Reference:

(1) https://www.hopkinsmedicine.org/health/conditions-and-diseases/headache/cluster-headaches

(2) https://www.webmd.com/migraines-headaches/cluster-headaches#1