- Bernard-Horner Syndrome
- Oculosympathetic Palsy
Your QuestionMy sister was recently diagnosed with Horner syndrome. Last year I was diagnosed with cluster headaches. Are these two condition related?
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A cluster headache begins with severe pain strictly on one side of the head, often behind or around one eye. In some people, it may be preceded by a migraine-like "aura." The pain usually peaks over the next 5 to 10 minutes, and then continues at that intensity for up to three hours before going away. Typical attacks may strike up to eight times a day and are relatively short-lived. On average, a cluster period lasts 6 to 12 weeks. Autonomic symptoms may include: conjunctival injection (bloodshot eyes), swelling under or around the eye, excessive tearing of the eyes, drooping of the eyelid, runny nose and/or nasal congestion, and forehead and facial sweating. These symptoms generally occur only during the pain attack and are on the same side as the headache pain.
Cluster headaches usually begin between the ages of 20 and 50, although they can start at any age. Males are more commonly affected than females. Treatment can be divided into acute therapy aimed at stopping symptoms once they have started and preventive therapy aimed at preventing recurrent attacks during the cluster period.   
A small group of people develop a chronic form of the disorder, characterized by bouts of cluster headaches that can go on for years with only brief periods (2 weeks or less) of remission.
Alcohol (especially red wine) provokes attacks in more than half of those with cluster headaches, but has no effect once the cluster period ends. Cluster headaches are also strongly associated with cigarette smoking. Glare, stress, or certain foods may also trigger an attack.
An increased familial risk of these headaches suggests that there may be a genetic cause, though more studies are needed to confirm this suspicion and identify specific genetic changes associated.
Horner's syndrome, a rare condition that affects the nerves to the eye and face, may present during a cluster headache attack. The condition is not present between episodes. However, this fleeting presentation can evolve into persistent Horner's syndrome.
Horner's syndrome can be caused by any interruption in the sympathetic nerve fibers, which start in the part of the brain called the hypothalamus and run to the face. Sympathetic nerve fiber injuries can result from migraine or cluster headaches.
To read more about the association between cluster headaches and Horner's syndrome, you can visit PubMed, a searchable database of medical literature. Information on finding an article and its title, authors, and publishing details is listed here. Some articles are available as a complete document, while information on other studies is available as a summary abstract. To obtain the full article, contact a medical/university library (or your local library for interlibrary loan), or order it online using the following link. Using "cluster headaches AND Horner syndrome" as your search term should locate articles. Click here to view a search.
The National Library of Medicine (NLM) Web site has a page for locating libraries in your area that can provide direct access to these journals (print or online). The Web page also describes how you can get these articles through interlibrary loan and Loansome Doc (an NLM document-ordering service). You can access this page at the following link http://nnlm.gov/members/. You can also contact the NLM toll-free at 888-346-3656 to locate libraries in your area.
There are medications available to lessen the pain of a cluster headache and suppress future attacks. Oxygen inhalation and triptan drugs (such as those used to treat migraine) administered as a tablet, nasal spray, or injection can provide quick relief from acute cluster headache pain. Lidocaine nasal spray, which numbs the nose and nostrils, may also be effective. Ergotamine and corticosteroids such as prednisone and dexamethasone may be prescribed to break the cluster cycle and then tapered off once headaches end. Verapamil may be used preventively to decrease the frequency and pain level of attacks. Lithium, valproic acid, and topiramate are sometimes also used preventively.
More detailed information on medications can be found in the treatment and management sections of Medscape Reference's article on cluster headache.
- Campellone JV. Cluster headache. MedlinePlus. 11/05/2014; http://www.nlm.nih.gov/medlineplus/ency/article/000786.htm.
- Headache: Hope Through Research. National Institute of Neurological Disorders and Stroke (NINDS). 11/03/2015; http://www.ninds.nih.gov/disorders/headache/detail_headache.htm.
- Horner syndrome. MedlinePlus. May 20, 2014; http://www.nlm.nih.gov/medlineplus/ency/article/000708.htm. Accessed 10/1/2014.
- May A. Cluster headache: Epidemiology, clinical features, and diagnosis. UpToDate. 05/22/2014; http://www.uptodate.com/contents/cluster-headache-epidemiology-clinical-features-and-diagnosis. Accessed 7/14/2015.