- What Is It?
- 2 Types
- Signs & Symptoms
What is a cluster headache?
A cluster headache is a pain that occurs along one side of the head. It's frequently described as pain that occurs around, behind, or above the eye and along with the temple in cyclic patterns or clusters. The pain of a cluster headache is very severe. Many patients describe a “drilling” type of sensation.
The treatment of cluster headaches can be divided into two distinct categories:
- Relief of the acute headache, and
- Prevention of future headaches.
What are two types of cluster headaches?
The two main types of cluster headaches include the following:
- Episodic cluster headaches: Occurs in cycles of headaches with periods of remission. These cycles last between 15 minutes to 3 hours and can occur daily or several times a day. Cluster periods may last several weeks to months.
- Chronic cluster headaches: Less common than episode cluster headaches, chronic cluster headaches do not stop completely during remission periods. These headaches last for a year or more without any break. Headaches occur daily or multiple times per day.
What is the reason of cluster headaches?
The specific cause and anatomic origination of cluster headaches aren't known. MRI studies suggest dilation of the ophthalmic artery during an acute cluster headache, while PET scans reveal activity within the cavernous sinus. However, many patients with other headache types also have revealed abnormalities in similar regions, so these tests aren't definitive. There is some evidence that the hypothalamus may be involved in the recurrence cycle of cluster headaches. Activation of the trigeminal ganglion can cause many changes associated with cluster headaches, but the trigger for activation of this region hasn't been identified.
Do women get more cluster headaches than men do?
Males are two to four times more likely to develop cluster headaches than females; however, the overall frequency is quite low, with a prevalence rate of about 1 per 1,000. Because of the rarity of the condition, limited information is available.
Although the majority of people are adults, cluster headache has been reported in children as young as 6 years of age.
What triggers cluster headaches?
Many patients report their headaches begin while sleeping. Additionally, alcohol can trigger cluster headaches in patients who are in the midst of a cycle. Histamines and nitroglycerin can trigger cluster headaches in patients. Seasonal variation has been described, although this is inconsistent for many patients. Some patients have clusters precipitated by environmental changes or changes in stress or activity levels. Hormonal factors, or menstruation, do not seem to trigger cluster headaches. Other risk factors include smoking and a family history of the problem.
What are the signs and symptoms of cluster headaches?
Cluster headache is always unilateral, or one-sided. However, some people may experience some variability of the side on which their headache occurs. Most people with cluster headaches describe their pain as occurring around or behind the eye. Pain may radiate along the forehead, into the jaw or along the gum line and into the teeth, or across the cheek of the affected side. Infrequently, pain may extend into the ear, neck, or shoulder.
In addition to head pain, many people with cluster headaches have symptoms and signs that may include:
- Watering of the eye (tearing). Some people may only experience some redness of the conjunctiva.
- Eyelid drooping or swelling
- Runny nose (rhinorrhea)
- People with cluster headaches also may have symptoms that are more commonly associated with migraine headaches, including sensitivity to light, sounds, or odors may occur. However, unlike a migraine headache, movement does not worsen the pain of a cluster headache. Many people describe a sense of restlessness during their pain.
- The headaches associated with clusters occur in groups. While the headaches themselves may be brief (as short as 15 minutes), the headaches can recur up to eight times in 24 hours. Headaches may last as long as 3 hours. Cluster cycles may last for only a single day, or may linger for many weeks.
What procedures and imaging tests diagnose cluster headaches?
The diagnosis of cluster headaches is typically made after the history of headaches has been explored and a physical examination is completed. Cluster headaches are unique in their presentation, and often the history is sufficient to make the diagnosis.
While no imaging study or specific blood test can confirm the diagnosis of cluster headache, an MRI or CT scan of the brain may be ordered to confirm that there are no other contributing factors that may mimic cluster headache symptoms. In some cases, ophthalmologic evaluation is needed to exclude problems within the eye itself that may be causing symptoms.
- Attachment Theory: What It Is, Stages & the Different Attachment Styles
- Gentle Parenting: What It Is, Techniques & Discipline
- U.S. Nursing Homes Fail to Report Many Serious Falls, Bedsores: Study
- The Younger You Get Diabetes, the Higher Your Risk for Dementia Later
- FDA Grants Full Approval to Paxlovid to Treat COVID-19
- More Health News »
How do you relieve cluster headaches?
The treatment of cluster headaches can be divided into two distinct categories -- relief of the acute headache and prevention of future headaches.
- Oxygen delivery: Delivering oxygen by a face mask has been shown to help a majority of people within a short period. However, this can be unwieldy, and most people are unable or unwilling to transport oxygen canisters if they need to travel.
- Injectable sumatriptan (Imitrex, Alsuma, Samavel DosePro): This is beneficial in many patients with cluster headaches. This treatment is contraindicated in patients with cardiac disease or untreated hypertension. Nasal spray or oral versions of this medication have been less effective than the injectable.
- Dihydroergotamine: Given intravenously, can be extremely effective in treating a cluster headache, but can be difficult to administer acutely and cannot be used if a patient has used sumatriptan in the preceding 24 hours.
- Intranasal lidocaine: Has been suggested as a treatment option, but must be administered in a specific manner and is ineffective if not given correctly.
- Steroids: These can be extremely effective to decrease the headache cycle. Steroids should not be used frequently, and are for short-term use only as long-term use can lead to significant complications.
- Verapamil (Calan, Varelan), lithium (Lithobid, Eskalith), valproic acid (Depakote, Stavzor), topiramate (Topamax, Quedxy, Topiragen, Trokendi XR), and melatonin: Can all be of benefit in reducing the frequency and severity of cluster cycles.
- Surgery: For intractable cases has been suggested. Radiofrequency lesioning of the trigeminal ganglion can decrease cluster headache frequency but is associated with significant side effects and nerve loss.
- Gamma knife lesioning and deep brain stimulation: These are being studied as possible options with less risk of permanent nerve change.
How do you break a cluster headache cycle?
While it may be challenging, you can try to break a cluster headache cycle through the following treatment options:
- Oxygen therapy
- Local anesthetics
- Prevention medications (verapamil, corticosteroids, and lithium)
- Nerve stimulation
How can you prevent cluster headaches?
Once cluster headaches have been accurately diagnosed, long-term treatment can be beneficial to decrease or prevent future cycles. However, as the specific underlying cause isn't known, it may take some time to control the headache cycles.
Are cluster headaches harmful?
Over time, cluster headache seems to diminish in frequency, but this may take many years. Cluster headaches can go into remission for an extended period and then recur. As such, a discussion with your physician regarding the need for continuation of treatment is warranted.
Cluster headache does not appear to be associated with other neurological illness, such as Alzheimer's dementia, Parkinson's disease, or multiple sclerosis (MS); however, many individuals with multiple sclerosis are known to experience severe headaches.
Subscribe to MedicineNet's General Health Newsletter
Health Solutions From Our Sponsors
Blanda, M, MD, et. al. Cluster Headache. Medscape. Updated: Apr 25, 2017.
Dodick, D. W., et al. "Cluster headache." Cephalalgia 20.9 (1994): 787-803.
Top Cluster Headaches Related Articles
Alcohol Abuse SlidesRead about the health risks of chronic heavy or binge drinking. Anemia, cancer, gout, cardiovascular disease and many more diseases can be caused by heavy or binge drinking.
Alcohol and TeensAlcohol is the most frequently used drug by American teenagers. Teens that drink are more likely to drive under the influence, have unprotected sex, and use other drugs, like marijuana, cocaine, and heroin. Symptoms of alcohol abuse in teens include lying, breaking curfew, becoming verbally or physically abusive toward others, making excuses, smelling like alcohol, having mood swings, and stealing.
Alcohol QuizTake the Alcohol (Alcoholism) Quiz to learn how your alcohol is processed by your body and your brain.
CT Scan vs. MRI
CT scan (computerized tomography) is a procedure that uses X-rays to scan and take images of cross-sections of parts of the body. CT scan can help diagnose broken bones, tumors or lesions in areas of the body, blood clots in the brain, legs, and lung, and lung infections or diseases like pneumonia or emphysema.
MRI (magnetic resonance imaging) is a procedure that uses strong magnetic fields and radiofrequency energy to make images of parts of the body, particularly, the organs and soft tissues like tendons and cartilage.
Both CT and MRI are painless, however, MRI can be more bothersome to some individuals who are claustrophobic, or suffer from anxiety or panic disorders due to the enclosed space and noise, the machine makes.
MRI costs more than CT, while CT is a quicker and more comfortable test for the patient.
Deep Brain StimulationDeep brain stimulation (or DBS) is a way to inactivate parts of the brain that cause Parkinson's disease and its associated symptoms without purposefully destroying the brain. In deep brain stimulation, electrodes are placed in the thalamus (to treat essential tremor and multiple sclerosis) or in the globus pallidus (for Parkinson's disease).
HeadacheHeadaches can be divided into two categories: primary headaches and secondary headaches. Migraine headaches, tension headaches, and cluster headaches are considered primary headaches. Secondary headaches are caused by disease. Headache symptoms vary with the headache type. Over-the-counter pain relievers provide short-term relief for most headaches.
Migraine TriggersDo you have frequent headaches? Learn the most common headache triggers for tension headaches, sinus headaches, cluster headaches and migraine. They include red wine, skipping meals, and smoke. Find medical treatments that work, like diet, exercise, massage, and physical therapy.
How Does Occipital Nerve Stimulation Work?Occipital nerve stimulation relieves pain in the back of the head (occipital region) by producing a tingling sensation in the occipital area. The electrical impulses from the pulse generator affect the occipital nerve’s function and block its transmission of pain signals to the brain. Occipital nerve stimulation can be used to help alleviate severe headaches and migraines.
Migraine HeadacheMigraine headache is a type of headache associated with a sensitivity to light, smells, or sounds, eye pain, severe pounding on one side of the head, and sometimes nausea and vomiting. The exact cause of migraine headaches is not known. Triggers for migraine headaches include certain foods, stress, hormonal changes, strong stimuli (loud noises), and oversleeping. Treatment guidelines for migraines include medicine, pain management, diet changes, avoiding foods that trigger migraines, staying hydrated, getting adequate sleep, and exercising regularly. Prevention of migraine triggers include getting regular exercise, drinking water daily, reducing stress, and avoiding trigger foods.
Migraine or Tension Headache? Symptoms, Triggers, TreatmentsWhat does a migraine headache feel like compared to a tension headache? Learn to spot migraine symptoms early, how to identify your triggers, and get more information on migraine headache medications and treatments. Learn to tell migraine from other types of headaches.
MRI (Magnetic Resonance Imaging Scan)MRI (or magnetic resonance imaging) scan is a radiology technique which uses magnetism, radio waves, and a computer to produce images of body structures. MRI scanning is painless and does not involve X-ray radiation. Patients with heart pacemakers, metal implants, or metal chips or clips in or around the eyes cannot be scanned with MRI because of the effect of the magnet.
Nausea and VomitingNausea and vomiting are symptoms of many conditions including motion sickness, pregnancy, emotional stress, gallbladder disease, and other illnesses. Learn about causes, treatment, and when to be concerned.
Sleep QuizTake our Sleeping Quiz to learn which sleep disorders, causes, and symptoms rule the night. Trouble falling or staying asleep? Find out which medical treatments fight sleep deprivation, apnea, insomnia, and more!
Smoking & Your LooksCigarette smoking can affect your looks and moods. But did you know smoking also affects your heart, causes wrinkles, and increases your risk of cancer? Learn the dangers of smoking.
Smoking QuizYou know it's time you quit smoking. Learn the myths and facts about quitting smoking with the Smoking Quiz. When it comes to smoking, quitters always win!
StressStress is a normal part of life, but chronic or severe stress can be harmful to your health. Learn what happens in your body when you are stressed and how you can manage your response.
What Does a CT Head Scan Show?A computerized axial tomography (CAT) or computerized tomography (CT) scan uses a series of X-rays taken at different angles to produce a detailed image of the head and brain. A CT scan is done to study the patient’s skull, brain, jaw, sinuses, and facial bones, and to investigate tumors, head injuries, aneurysms, and other conditions.