Headache

  • Medical Author:
    Benjamin Wedro, MD, FACEP, FAAEM

    Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

  • Medical Author: Danette C. Taylor, DO, MS, FACN
    Danette C. Taylor, DO, MS, FACN

    Dr. Taylor has a passion for treating patients as individuals. In practice since 1994, she has a wide range of experience in treating patients with many types of movement disorders and dementias. In addition to patient care, she is actively involved in the training of residents and medical students, and has been both primary and secondary investigator in numerous research studies through the years. She is a Clinical Assistant Professor at Michigan State University's College of Osteopathic Medicine (Department of Neurology and Ophthalmology). She graduated with a BS degree from Alma College, and an MS (biomechanics) from Michigan State University. She received her medical degree from Michigan State University College of Osteopathic Medicine. Her internship and residency were completed at Botsford General Hospital. Additionally, she completed a fellowship in movement disorders with Dr. Peter LeWitt. She has been named a fellow of the American College of Neuropsychiatrists. She is board-certified in neurology by the American Osteopathic Board of Neurology and Psychiatry. She has authored several articles and lectured extensively; she continues to write questions for two national medical boards. Dr. Taylor is a member of the Medical and Scientific Advisory Council (MSAC) of the Alzheimer's Association of Michigan, and is a reviewer for the journal Clinical Neuropharmacology.

  • Medical Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

View the Headache and Migraine Triggers Slideshow

Quick GuideMigraine or Headache? Migraine Symptoms, Triggers, Treatment

Migraine or Headache? Migraine Symptoms, Triggers, Treatment

What causes cluster headaches?

Cluster headaches are so named because they tend to occur daily for periods of a week or more followed by long periods of time -- months to years -- with no headaches. They occur at the same time of day, often waking the patient in the middle of the night.

The cause of cluster headaches is uncertain but may be due to a sudden release of the chemicals histamine and serotonin in the brain. The hypothalamus, an area located at the base of the brain, is responsible for the body's biologic clock and may be the source for this type of headache. When brain scans are performed on patients who are in the midst of a cluster headache, abnormal activity has been found in the hypothalamus.

Cluster headaches also:

  • tend to run in families and this suggests that there may be a role for genetics;
  • may be triggered by changes in sleep patterns; and
  • may be triggered by medications (for example, nitroglycerin, used for heart disease)

If an individual is in a susceptible period for cluster headache, cigarette smoking, alcohol, and some foods (for example, chocolate and foods high in nitrites like smoked meats) also are potential causes for headache.

What are the symptoms of cluster headaches?

Cluster headaches are headaches that come in groups (clusters) separated by pain-free periods of months or years. A patient may experience a headache on a daily basis for weeks or months and then be pain-free for years. This type of headache affects men more frequently. They often begin in adolescence but can extend into middle age.

  • During the period in which the cluster headaches occur, pain typically occurs once or twice daily, but some patients may experience pain more than twice daily.
  • Each episode of pain lasts from 30 to 90 minutes.
  • Attacks tend to occur at about the same time every day and often awaken the patient at night from a sound sleep.
  • The pain typically is excruciating and located around or behind one eye.
  • Some patients describe the pain as feeling like a hot poker in the eye. The affected eye may become red, inflamed, and watery.
  • The nose on the affected side may become congested and runny.

Unlike patients with migraine headaches, patients with cluster headaches tend to be restless. They often pace the floor, bang their heads against a wall, and patients can be driven to desperate measures including contemplating suicide.

How are cluster headaches diagnosed?

The diagnosis of cluster headache is made by taking the patient's history. The description of the pain and its clock-like recurrence is usually enough to make the diagnosis.

If examined in the midst of an attack, the patient usually is in a painful crisis and may have the eye and nose watering as described previously. If the patient is seen when the pain is not present, the physical examination is normal and the diagnosis will depend upon the history.

Medically Reviewed by a Doctor on 7/25/2016

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