About 120,000 people a year are diagnosed with migraine through their primary care physician. In addition, approximately 17,000 patients in the Netherlands have cluster headaches  (about 0.1 percent of the population) 

It is more common in men than in women. Cluster headaches are a relatively rare condition, so it can take years before the disease is recognized.

Migraines and cluster headaches have a major impact on daily functioning.

Not only work or education often suffer from the headache attacks, but also social life.

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Cluster Period Attack

In cluster headaches, the attacks usually occur in clusters (episodes). This means that patients have alternating periods from weeks to months with many seizures and periods without seizures. These periods often fall during the same time of year. A small proportion of patients have the chronic form of cluster headache, in which they have several attacks every month (this can be very different from several attacks daily to a few attacks every month). Fortunately, the chronic form of cluster headache only occurs in fifteen percent of cluster headache patients, and is therefore very rare (still just under two thousand patients in the Netherlands).

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Migraine is not an ordinary headache 

Migraine susceptibility often runs in families and is partly hereditary. Some things provoke attacks at fixed times. As a woman, you can often have an attack during your period. In addition to headaches, migraines can also cause other complaints. For example, you may be very nauseous and vomit, or be extra sensitive to stimuli such as sound, light and smell. You may have trouble seeing. Migraines are often a condition that goes unnoticed. A migraine patient withdraws because normal life is not sustainable for a while.

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Treatment of cluster headaches and migraines

There are several ways to treat migraines and cluster headaches. The symptoms of migraine and cluster headaches can be suppressed reasonably well with medication, although this treatment does not work for everyone. The medication can be divided into two groups:

• Seizure treatment:  If one suffers from attacks less than 2 times a month or if the effects of an attack last for a relatively short time, medicines are prescribed to combat the attack immediately. This medication is taken as soon as the attack starts.  ​

• Preventive treatment (prophylaxis):    Do people have more frequent attacks or are the effects of an attack long-lasting or difficult to treat? In that case, people usually also receive preventive treatment. This means that one is prescribed medication to prevent or limit attacks in advance, or to make them less severe so that acute medication is more effective. This treatment can consist of already known medication or of newly developed medication such as anti-CGRP agents. These drugs target CGRP, a protein that plays an important role in seizures. This last class of resources is often only available in compassioniate user programs, in which the LUMC also participates, for example. This means that these medicines are not yet reimbursed and can only be prescribed in exceptional cases.

• Scientific research   For example, the LUMC is currently conducting an international scientific study into occipital nerve stimulation as a treatment for cluster headaches. It is being investigated whether electrical stimulation of the occipital nerve helps against the chronic form of cluster headache that cannot be treated with medication. (source LUMC)

• Medicinal oxygen therapy for cluster headaches   is an attack therapy that can suppress the symptoms of a cluster headache attack. As soon as one feels an attack coming on, one inhales pure oxygen. The sooner the patient does this, the better this treatment method works. Patients do not have to go to the hospital for this. People receive an oxygen bottle and a mouth cap at home to inhale the oxygen. 

• High-flow oxygen inhalation through a non-rebreather mask during cluster headache attacks is generally recommended. Patients with frequent seizures and/or drug intolerance may prefer oxygen treatment. In conclusion, high-flow oxygen is recommended as a more effective treatment for cluster headaches that have few complications, but the choice of appropriate cases and oxygen flow rate or devices, as well as the correct time for oxygen inhalation, require more research in the future.

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