points (DeLaune, 2008), relieving stress, and having a positive influence on numerous neuroendocrine chemicals, such as dopamine, serotonin, and cortisol. These chemicals Cluster headaches The last of the primary headaches is rather uncommon although may affect more sufferers than reported because it is often misdiagnosed as sinusitis or migraine long before being recognized as a cluster headache. This happens largely because of the severity of pain coupled with nasal congestion and redness of the eye on the affected side (International Headache Society, 2016; Wikipedia, 2017d). Also, cluster headaches are recurrent, like migraines, but last only a maximum of three hours, as opposed to migraines, which have a maximum of four hours (International Headache Society, 2016). Another differentiation from a migraine attack is that a cluster headache has been described as a stabbing hot poker behind the eye with such intensity the sufferer is unable to rest and rather fervently paces the room until the attack subsides (Lowth, 2015; Wikipedia, 2017d). During this time, suicidal thoughts may appear. The peak pain persists anywhere from 30 minutes to 2 hours, consequently earning the alternative name of suicide headaches (DeLaune, 2008). Following are the official criteria for diagnosis of cluster headaches in the ICHD-3 beta: 1. Must have at least five attacks consisting of the following criteria: 2. Excruciating pain behind the eye, above the eye, or in the temple region lasting 15 minutes up to 3 hours. 3. Either or both of the following: ○ At least one of the following signs: ■ Red eye with or without tearing. ■ Runny nose with or without congestion. ■ Swollen or drooping eyelid. ■ Sweating. ■ Flushing skin. ○ Restlessness. 4. Half of attacks recurring anywhere between once every other day and eight in a single day when not in remission. (International Headache Society, 2016) ■ Clogged feeling in the ear. ■ Contraction of the pupil. A unique feature of cluster headaches is the alarm-like frequency of recurrence. During an episode, or cluster, each individual attack occurs at the same time of day for the entire duration of that cluster period, which could last several weeks, months, or years. The pain is severe enough to awaken the sufferer from sleep. Typical onset is seen around 20 years of age but may occur as late as 40 years of age, with males being stricken significantly more than females by this disorder (Wikipedia, 2017d).
affect mood, sleep, motor control, pain sensation, and various structures of the body. The only contraindication for massage is an acute migraine attack (Fritz, 2015).
The true cause of cluster headaches is unknown. Inhaling pure oxygen at the onset of an attack has proven extremely helpful in relieving symptoms. However, this does not affect the recurrence of another attack (Wedro, 2017). Considering the clock-like timing plus imaging taken during an attack showing increased activity in this area, it is speculated that the hypothalamus plays a major role in this disorder (Wikipedia, 2017d). While researchers continue to seek the cause of cluster headaches, it is imperative for health care providers to be able to identify this headache type, and, at the same time, for the patient to maintain a headache diary. It has been reported that a cluster headache sufferer may seek help from several different disciplines of medicine for an average of seven years before receiving a correct diagnosis (Wikipedia, 2017d). Although treatment does not eradicate the condition, considering the excruciating pain that is characteristic of cluster headaches, having the means to diminish them will help immensely. Summary In summation, the three main headache types classified as primary headaches are tension-type, migraine, and cluster headaches. Each shares a direct biological cause although differing in origin. Tension-type headaches are generally caused by muscle tension that, over time, can alter the pain processing mechanism of the brain (Wikipedia, 2017c). Migraines and cluster headaches are neurological disorders to begin with that affect muscle tension as a secondary response or condition (International Headache Society, 2016). For migraine sufferers, this presents as a possible increase in trigger point activity (DeLaune, 2008). People afflicted with cluster headaches experience anxiety in anticipation of the next attack that usually results in excess tension of the muscles of the head and neck (Wedro, 2017). The type of pain experienced by primary headaches occurs unilaterally with the possibility of bilaterally in some cases and generally described as mild to moderate, with cluster headaches being the most localized and severe (International Headache Society, 2016). Of the three headache types, tension-type is the only one indicated for massage during the acute phase of an attack. Migraine and cluster headache sufferers will benefit from massage therapy when in remission. Table 2 compares the three main primary headaches.
Table 2: Three Main Primary Headaches Headache Type Demographic Cause
Signs and Symptoms • Mild, dull ache. • 30 minutes to 7 days. • Bilateral. • Light sensitivity OR
Massage Indicated
Tension- type
Yes.
Women more than men
• Primary mechanism: trigger points. • Central mechanism:
Desensitization of the spinal cord or brainstem.
• Auditory sensitivity, but not both. • Not aggravated by physical activity.
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