Symptoms | Treatment

Choice Pain, Dr Tristan Shockley, pain management center Maryland, chronic pain treatment Washington DC, chronic pain treatment Maryland, spinal injections for back pain Maryland, non-surgical treatment for back pain Washington DC, non-surgical treatment for back pain Maryland, home remedies for back pain Maryland, home remedies for back pain Washington DC, spine injections for back pain Washington DC, pain care treatment options Washington DC, spinal injections Laurel Maryland, injections for back pain Washington DC, injections for back pain Washington DC The exact cause of cluster headaches is unknown. Certain evidence indicates that changes in the blood vessels walls of the head may lead to cluster headaches. There are several well-known triggers associated with cluster headaches, these include drugs that dilate or constrict blood vessels and alcohol. Some studies show that a low level of endorphins may cause frequent, severe, or chronic headache pain. Endorphins are described as painkilling compounds found in the brain.

Changes in barometric pressure and altitude, inclement weather, such as heavy rain or snow, and high winds are environmental factors that may lead to cluster headaches in some people.


  • Usually occurs daily over a period of weeks, sometimes months
  • Cluster headaches usually affect men between the ages of 20 and 40.
  • Sufferers of cluster headaches may have up to eight attacks per day, each attack could last 15 to 45 minutes or longer
  • Typically, attacks come in the early morning hours, and will waken the patient from sleep.
  • Cluster headaches are usually centered around one eye, and usually on one side of the head.
  • The pain experienced is often described as a knife or nail being driven into the head. Lying down can make the pain worse, unlike migraine pain.


The goal of treatment of cluster headaches is to lessen the severe, sometimes unbearable, pain during the headache, as well as to shorten the cluster episode. Acute treatment medications are similar to those used for migraine and include:

  • Sumatriptan, this medication is injectable or may be taken in nasal form for rapid onset. Other oral triptans may also be effective.
  • DHE (Migranal), this may be delivered as a nasal spray in order to experience a rapid onset. DHE is also available in an injectable form. Side effects may include nausea and dizziness.
  • In some cases, narcotics may be helpful, while the onset of most oral agents may not be rapid enough, due to the severity and brief duration of the headache.
  • Some people may find relief through breathing 100% oxygen during an acute headache. A tank of oxygen can be kept for home use if other medications do not work well.
  • Prednisone is a corticosteroid, a potent chemical that occurs naturally in the body. It is taken initially in high doses and then tapered over days or weeks, depending on the response. This medication is best if used for short periods of time.
  • Long-term corticosteroid use can cause many serious adverse side effects because it is involved in several different functions in the body. Potential side effects include an increase in intraocular pressure, osteoporosis, behavioral changes, ulcer, and diabetes.
  • Lithium carbonate may increase the levels of dopamine and norepinephrine in the brain. It is taken orally, usually twice a day, to interrupt a cluster headache. Concentration of lithium in the blood is closely monitored with periodic blood tests. Side effects include tremor, increased thirst, nausea, and frequent urination. Lithium carbonate typically is used to treat manic episodes in manic-depressive patients.
  • Verapamil dilates blood vessels. It can be taken twice daily in a sustained oral preparation. Side effects include nausea, dizziness, and constipation. Verapamil typically is used to treat angina, hypertension, and arrhythmias.


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Choice Pain is a regional specialty center for pain management, providing treatment and pain relief for a variety of pain conditions including: back pain, neck pain, pain from arthritis, headache pain, fibromyalgia, TMJ pain, cancer pain and myofascial pain.  Choice Pain — with offices in Hyattsville, Lanham, Gaithersburg, Dundalk, & Pikesville — is referred patients from across the Washington DC and Baltimore region, including nearby cities of: Silver Spring, Baltimore, Bethesda, Rockville, Annapolis, South Laurel.

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