Cluster Headache

• Definition • Causes • Risk Factors • Symptoms • Diagnosis • Treatment • Prevention

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 multiple 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 not known. It is thought that there is abnormal activation of the area of the brain that is 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 increase your chance of getting cluster headaches include:

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

Symptoms

Symptoms of cluster headache include:

Stabbing, penetrating, burning, or explosive head pain that:
- Begins suddenly
- 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
- Can occur daily or almost every day for multiple 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. 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

Diagnosis

The doctor will ask about your symptoms and medical history. A physical and neurological exam will be done. A neurological exam may include examining:

Mental status
Cranial nerve functioning
Motor and sensory functioning
Reflexes
Coordination
Walking

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

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

Pictures may be taken of your brain to rule out other disorders. This can be done with:

Treatment

Treatment aims to reduce the frequency of headaches and help relieve 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 medicines.
Find out what your triggers are and take steps to avoid them.

Medication

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

Drugs used to treat cluster headaches include:

Triptans given as a pill, injection, or nasal spray
Octreotide given as an injection
Corticosteroids, such as prednisone
Lidocaine nose drops or spray
Dihydroergotamine
Ergotamine
Pain relievers with caffeine
Glycerol given as an injection into the nerve—used when other treatments do not help

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

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

Other medicines may be given to prevent or reduce the frequency of headaches. Examples of these drugs include:

Intranasal civamide and capsaicin cream
Steroids—oral or via injections
Verapamil
Lithium
Melatonin
Valproate or gabapentin
Methysergide
Dihydroergotamine or a triptan
Topiramate
Baclofen
Beta-blockers
Clonidine
Amitriptyline
Selective serotonin reuptake inhibitors (SSRIs)

Oxygen Therapy

Breathing 100% oxygen for 10-15 minutes often relieves cluster headache pain. This is often viewed as the front-line therapy for cluster headache. 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, and there are risks with this therapy.

Surgery

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

Prevention

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

Maintain a regular sleep routine.
Avoid smoking.
Avoid alcohol, narcotic analgesics, bright sunlight, and emotional stress.
Get moderate physical exercise.
Practice relaxation techniques.
Take your medicine as directed.

RESOURCES:

American Headache Society Committee for Headache Education
http://www.achenet.org

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

CANADIAN RESOURCES:

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

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

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Last reviewed February 2013 by Rimas Lukas, MD
Last Updated: 2/21/2013

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