Cluster Headaches

Cluster Headaches

Cluster headaches are an extremely painful type of headache that occurs every day for weeks or months at a time, often at a specific time of the year, such as during the spring or fall. They are the least common type of headache, affecting about 1 in 1000 people.

What causes a cluster headache?

Experts are not sure what causes cluster headaches but suggest that the hypothalamus of the brain is involved, since that is responsible for maintaining our biological clock. Because the pain centers around one particular area of the face, one nerve is involved as well.

Unlike other types of headaches, such as migraines, cluster headaches aren’t generally associated with triggers, although drinking alcohol during a cluster period may precipitate another headache. Smelling strong fumes, such as paint or petrol may also bring on a headache. Nitroglycerin, a medication used to treat angina, has also been known to precipitate headaches during a cluster period.

What are the symptoms of a cluster headache?

Cluster headaches are relatively short-lasting, and symptoms tend to include:

  • Severe, one-sided pain usually centered over one eye, the temple, or the forehead. The side it occurs on may vary from time to time and the pain may spread to a larger area as the headache goes on
  • The pain is so severe and intense that people cannot keep still during an attack and will often pace the room or even bang their head against a wall until the pain subsides
  • During the headache, other symptoms may occur such as a blocked or runny nose, flushing or sweating, or a drooping eyelid, eye redness or watering on the same side of the head as the headache
  • The headache pain is usually experienced at a similar time each day. In many people it starts at night, waking people one to two hours after they have gone to sleep
  • The headache pain reaches its full intensity within five to ten minutes and usually lasts at a severe intensity for 30 to 60 minutes, before abruptly stopping. For some people, the duration of the headache may be shorter, for others, longer
  • The headaches may occur every day, every other day or up to 8 times a day during the cluster
  • 80% of people experience episodic cluster headache, when the bouts of headache last for four to twelve weeks once a year before disappearing, sometimes for years at a time. Other people do not have these pain free intervals and are said to have a chronic cluster headache.

Who is at risk of cluster headaches?

People who are at higher risk of cluster headaches include:

  • Men (men are five to six times more likely than women to develop cluster headache)
  • People aged between 20 and 50, although the headaches can occur at any time
  • Heavy smokers
  • People with a family history of cluster headaches (ie, your parents or siblings get them).

How are cluster headaches diagnosed?

A doctor will take a detailed history of your symptoms and may order some other tests (such as an MRI scan, blood tests) to rule out other causes. There are no specific tests to diagnose cluster headaches.

How are cluster headaches treated?

Your doctor may refer you to a specialist or headache clinic for treatment for the best management of your condition. Treatments may include:

  • Oxygen
  • Sumatriptan injections
  • Sumatriptan or zolmitriptan nasal sprays.

Preventive treatments, such as verapamil, methysergide, lithium, or corticosteroids may also be considered.