What Are Cluster Headaches?
Cluster headaches are severely painful headaches that occur in clusters.
You experience cycles of headache attacks, followed by headache-free periods.
The frequency of your headaches during these cycles may range
from one headache every other day to several headaches per day. Pain from cluster
headaches can be extremely severe.
Cluster headaches are most common between adolescence and middle
age, but can occur at any age.
Older studies showed that cluster headaches were more commonly
reported by men than women, such as a 1998 study published in Cephalagia, which shows that
before 1960, men reported cluster headaches six times more often than women.
Over time however, that gap has shrunk, and by the 1990s, cluster headaches
were found in only twice as many men than women.
Types of Cluster Headaches
There are two types of cluster headaches: episodic and chronic.
headaches occur regularly between one week and one year, followed
by a headache-free period of one month or more.
Chronic cluster headaches occur
regularly for longer than one year, followed by a headache-free period that
lasts for less than one month.
A person who has episodic cluster headaches may develop chronic
cluster headaches, and vice versa.
Distinguishing a Cluster Headache from Other Types of Headaches
Cluster headaches usually start suddenly. A small percentage of
people experience aura-like visual disturbances, such as flashes of light,
before headaches begin.
Most commonly, headaches begin a few hours after you fall asleep
and are often painful enough to wake you, but they may also begin when you are
Headache pain becomes severe 5-10 minutes after the headache
starts. Each headache usually lasts for several hours, with the most intense
pain lasting between 30 minutes and 2 hours.
Cluster headache pain occurs on one side of the head, but can
switch sides in some people, and is generally located behind or around the eye.
It is described as a constant and deep burning or piercing pain. People with this pain say it is like a hot poker being stuck into your eye. The pain may
spread to the forehead, temples, teeth, nose, neck, or shoulders on the same
Other signs and symptoms may be evident on the painful side of
the head, including:
- a droopy eyelid
- a constricted pupil
- excessive tearing from your eye
- eye redness
- sensitivity to light
- swelling under or around one or both of your
- a runny nose or stuffy nose
- facial redness or flushing
- agitation or restlessness
What Causes Cluster Headaches?
The pain from cluster headaches is caused by the dilation, or
widening, of the blood vessels that supply blood to your brain and face. This
dilation applies pressure to the trigeminal nerve, which transmits sensations
from the face to the brain. It is unknown why this dilation occurs.
Researchers believe that abnormalities in the hypothalamus, a
small area of the brain that regulates body temperature, blood pressure, sleep,
and the release of hormones, may be responsible for cluster headaches.
Cluster headaches may also be caused by a sudden release of the
chemicals histamine, which fight allergens, or serotonin, which regulates mood.
How Are Cluster Headaches Diagnosed?
Your doctor will ask you questions about your symptoms and give
you a physical and neurological exam. This may include an MRI or CT scan of
your brain to rule out other causes of the headaches, such as a brain tumor.
Treatment for Cluster Headaches
Treatment involves relieving and preventing your headache
symptoms using medication. In rare cases, when pain relief and preventive
treatment do not work, your doctor may recommend surgery.
Pain medication relieves your headache pain once it has begun. Treatments
- Oxygen: Breathing 100-percent pure oxygen when
the headache begins can help relieve symptoms.
- Triptan medications: A nasal spray medication
(Imitrex), or other tripitan medications constrict blood vessels, which can
help ease your headache.
- DHE: An injected medication called
dihydroergotamine (DHE), can often relieve cluster headache pain within five minutes
of use. Note: DHE can’t be taken with sumatriptan.
- Capsaicin cream: Topical capsaicin
cream can be applied to the painful area.
Preventive medications stop headaches before they start. These
medications may not be 100-percent effective, but they can reduce the frequency
of your headaches. These medications include:
As a last resort, a surgical procedure can be used to disable the
nerve. The surgery can cause permanent pain relief for some patients, but
serious side effects, such as permanent facial numbness, can result.
Tips to Prevent Cluster Headaches
You may be able to prevent cluster headaches by avoiding the
- high altitudes
- strenuous activities
- hot weather
- hot baths
- foods that contain large amounts of nitrates,
- hot dogs
- preserved meats
Cluster headaches are not life-threatening, but there is no cure
for them. With these tips and treatments, your headaches may become less
frequent and less painful over time, or they may eventually disappear