Definition

Cluster headache is a type of severe, recurring pain that is located on one side of the head. It received its name from the clustering or pattern of frequent headaches that usually occur.

There are two main types of cluster headaches:

  • Episodic cluster headaches—These occur one or more times daily for 4-8 weeks. The headaches then enter a period of remission and come back months or years later.
  • Chronic cluster headaches—These occur almost daily with headache-free periods lasting less than two weeks.

Either type of headache may convert to the other type.

Causes

The cause of cluster headaches is unknown. It is thought that there is abnormal activation of the area of the brain responsible for regulating temperature, blood pressure, hormone release, and sleep The pain is caused by a combination of widening of the blood vessels and inflammation of the nerves of the face.

Other possible causes include:

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:

  • Sex: males
  • Age: 20-50 years old
  • Prior head surgery or head injury
  • Positive family history of cluster headaches
  • History of a small hole in the heart (called patent foramen ovale)

Symptoms

  • Stabbing, penetrating, burning, or explosive head pain that:
    • Has a rapid onset
    • Is on one side of the head, but not both
    • Often starts around the eye and spreads to the same side of the head
    • Causes facial flushing
    • Occurs daily or almost every day for 4-8 weeks
    • Can occur 1-8 times per day
    • Lasts 15 minutes to 3 hours
    • Often occurs at about the same time each day
    • Increases in intensity over time
    • May start within two hours of going to sleep
    • Can awaken you from sleep
    • Aura—This can include visual disturbance, visual spots, or the inability to move one side of the body. This more often occurs with migraine . But, auras can also happen with cluster headaches in a minority of cases.
  • Restlessness and agitation
  • Nausea

During the headache other symptoms may occur on the affected side, including:

  • Stuffy or runny nose
  • Redness or watering of the eye on one side
  • Droopy eyelid
  • Constriction of the pupil of the eye
  • Facial swelling and flushing, sweating
  • Sensitivity to light and noise

Symptoms of a Cluster Headache

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Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical and neurological exam. A neurological exam tests the following:

  • Muscle strength
  • Coordination
  • Reflexes
  • Response to stimuli
  • Alertness

The doctor will ask about the frequency and pattern of your headaches. To help provide answers, keep a diary of:

  • When your headaches started and ended
  • What you were doing at the time
  • What you tried to relieve the pain

Tests are sometimes done to rule out other disorders. These tests may include:

  • MRI scan —a test that uses magnetic waves to make pictures of structures inside the head
  • CT scan of the brain —a type of x-ray that uses a computer to make pictures of structures inside the head

Treatment

Treatment aims to reduce the frequency of headaches and help relieve the pain.

Lifestyle Changes and Self-care

  • Maintain the same sleep routine. Avoid afternoon naps or sleeping in, which may bring on more headaches.
  • Do not drink alcoholic beverages. Even a small amount of alcohol can trigger a headache during a cluster period.
  • Learn stress management techniques. Stress can bring on a headache.
  • Do not smoke . Tobacco may interfere with medication to relieve the headache.

Medication

Drugs used to treat migraines often relieve acute attack of cluster headaches. These drugs must be taken at the first sign of a headache.

Drugs used to treat cluster headaches include:

  • Sumatriptan or other triptans
  • Dihydroergotamine (eg, Migranal)
  • Lidocaine—nose drops or spray on the affected side
  • Pain relievers with caffeine
  • Prednisone (eg, PredniSONE Intensol)
  • Ergotamine (eg, Ergomar)
  • Octreotide (given as an injection)
  • Glycerol (given as an injection into the nerve)—used when the other treatments are ineffective

In some cases, the headache does not last long enough for drugs to be beneficial. Sometimes, the drugs just delay an attack, rather than stopping an attack.

Pain killers, especially narcotic drugs, should not be used during an acute attack.

Other medications (usually used in combination) are given on a regular basis to prevent or reduce the frequency of headaches. These drugs include:

  • Verapamil (eg, Calan, Isoptin)—to relax and dilate the blood vessels
  • Lithium (eg, Eskalith)—blood levels of this drug must be monitored
  • Methysergide (eg, Sansert)—most helpful in younger people in early stages of disease
  • Prednisone—taken for a short period while other drugs are started
  • Dihydroergotamine or a triptan (medications to treat migraines)—for people who suffer from cluster headaches at predictable times, such as at night
  • Topiramate (eg, Topamax)
  • Baclofen (eg, Lioresal)
  • Valproate (eg, Depakote) or gabapentin (eg, Neurontin)
  • Beta-blockers
  • Clonidine (eg, Catapres-TTS)
  • Melatonin
  • Amitriptyline (eg, Apo-Amitriptyline)
  • Topical capsaicin cream
  • Selective serotonin reuptake inhibitors (SSRIs)

Oxygen Therapy

Breathing 100% oxygen for 10-15 minutes often relieves cluster headache pain. The oxygen appears to decrease blood flow to the affected area of the brain. People under age 50 who have episodic cluster headaches seem to benefit most from oxygen therapy.

Oxygen therapy can be expensive, though, and there are risks with this therapy.

Surgery

As a last resort, some doctors may recommend cutting or destroying a facial nerve to eliminate the pain.

Prevention

To prevent cluster headaches from getting worse, preventive medication may be given. In addition: