First recognized in 1867, cluster headaches remain one of the most painful and frustrating headache syndromes. Their cause is unclear, and no treatment is fully effective. People with cluster headaches may go for more than a year without any attacks, and then suddenly the headaches appear and strike several times a day. Each headache lasts from 30 minutes to 2 hours and consists of very severe pain on one side of the head, generally in the region of the eye. These daily headaches continue for 4 to 8 weeks, and then disappear for another year or more. A more chronic, continuous form of cluster headaches can also occur.
Cluster headaches are different from migraine headaches (although they may possess some underlying similarities) and much more difficult to treat. During cluster headache episodes, rapid-acting treatments are used, including aerosolized ergotamine, pure oxygen, lidocaine nasal spray, and anesthetic inhalation. For prevention, drugs such as ergotamine, prednisone, methysergide, and lithium may reduce the severity and frequency of attacks.
Some evidence suggests that people with cluster headaches have lower than average levels of the hormone melatonin.1–4 In a double-blind, placebo-controlled study of 20 people with cluster headaches, use of melatonin (10 mg daily) for 14 days significantly reduced headache severity and/or frequency compared to placebo.5 About half the participants given melatonin responded well.
As noted above, inhalation of 100% oxygen is sometimes used to treat cluster headache attacks. In preliminary controlled trials, use of hyperbaric oxygen (oxygen under pressure) not only treated the headaches, but also helped prevent further attacks.6–8
1. Chazot G, Claustrat B, Brun J, et al. A chronobiological study of melatonin, cortisol, growth hormone, and prolactin secretion in cluster headache. Cephalalgia. 1984;4:213–220.
2. Leone M, Lucini V, D’Amico D, et al. Abnormal 24-hour urinary excretory pattern of 6-sulphatoxymelatonin in both phases of cluster headache. Cephalalgia. 1998;18:664–667.
3. Leone M, Lucini V, D’Amico D, et al. Twenty-four-hour melatonin and cortisol plasma levels in relation to timing of cluster headache. Cephalalgia. 1995;15:224–229.
4. Waldenlind E, Gustafsson SA, Ekbom KA, et al. Circadian secretion of cortisol and melatonin during active cluster periods and remission. J Neurol Neurosurg Psychiatry. 1987;50:207–213.
5. Leone M, D’Amico D, Moschiano F, et al. Melatonin versus placebo in the prophylaxis of cluster headache: a double-blind pilot study with parallel groups. Cephalalgia. 1996;16:494–496.
6. Di Sabato F, Fusco BM, Pelaia P, et al. Hyperbaric oxygen therapy in cluster headache. Pain. 1993;52:243–245
7. Di Sabato F, Giacovazzo M, Cristalli G, et al. Effect of hyperbaric oxygen on the immunoreactivity to substance P in the nasal mucosa of cluster headache patients. Headache. 1996;36:221–223.
8. Di Sabato F, Rocco M, Martelletti P, et al. Hyperbaric oxygen in chronic cluster headaches: influence on serotonergic pathways. Undersea Hyperb Med. 1997;24:117–122.
9. Mauskop A, Altura BT, Cracco RQ, et al. Intravenous magnesium sulfate relieves cluster headaches in patients with low serum ionized magnesium levels. Headache. 1995;35:597–600.
10. Mauskop A, Altura BT, Cracco RQ, et al. Intravenous magnesium sulfate rapidly alleviates headaches of various types. Headache. 1996;36:154–160.
Last reviewed December 2015 by EBSCO CAM Review Board
Last Updated: 12/15/2015
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