Cluster Headache

by Debra Wood, RN

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 one month.

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 thought to be caused by a combination of widening of the blood vessels and inflammation of the nerves of the face.

Other possible causes include:

• Alcohol use
• Changes in barometric pressure
• Changes in sleep pattern
• Tobacco use
• Drugs, such as nitroglycerin

Risk Factors

Factors that increases your chance of cluster headaches include:

• Sex: males
• Age: 20-50 years old
• Prior head surgery or head injury
• Positive family history of cluster headaches

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

© 2009 Nucleus Medical Media, Inc.

Diagnosis

The doctor will ask about your symptoms and medical history. A physical and neurological exam will be done. A neurological exam tests the following:

• Mental status
• Cranial nerve functioning
• Motor and sensory functioning
• Coordination
• Reflexes
• Gait (walking)

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.

Prevention

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

• Maintain a regular sleep routine.
• If you smoke, quit.
• Avoid alcohol, narcotic analgesics, bright sunlight, and emotional stress.
• Get moderate physical exercise.
• Practice relaxation techniques.

American Council for Headache Education
http://www.achenet.org/

National Headache Foundation
http://www.headaches.org/

Headache Network
http://www.headachenetwork.ca/

Help for Headaches
http://www.headache-help.org/index.html/

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American Medical Association website. Available at: http://www.ama-assn.org/ .

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Last reviewed January 2010 by Rimas Lukas, MD
Last Updated: 1/15/2010