Key takeaways

  • Cluster headaches cause severe pain around the eye, usually on one side of the head. The pain can feel like stabbing, sharp, or burning rather than throbbing.
  • Cluster headaches are rare, affecting about 1 in 1,000 people. Six out of 10 cases involve men, and most of these are people who smoke. The headaches usually start after the age of 20.
  • Cluster headaches occur cyclically. A bout of regular attacks, known as a cluster period, can last a few days, weeks, or months. During remission periods, cluster headaches are rare.

Cluster headaches can last from 15 minutes to several hours at a time, and can recur daily for weeks in a row, and then go away until another “cluster” episode.

Although there is no known cure for cluster headaches, various medications and therapies can help lessen the intensity, duration, and frequency of attacks. These include oxygen inhalation and sumatriptan, a drug to treat migraine.

The primary goal of treatment is to ease symptoms, shorten the duration of headache episodes, and decrease how often they occur.

Person in a lot of pain from a cluster headache. Share on Pinterest
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Symptoms of cluster headaches include intense pain that starts rapidly and usually without warning. The pain is continuous rather than throbbing. It may cause a stabbing, sharp, or burning sensation.

The pain typically starts around the eye and may radiate to other parts of the head, including the face, neck, and shoulders. Pain may be present in a temple or a cheek. It remains on one side of the head.

There may also be:

  • restlessness
  • redness, swelling, or watering in the eye on the side of the pain
  • stuffy, blocked, or runny nose on the same side as the pain
  • pale skin
  • facial sweating
  • small pupil size
  • drooping of the eyelid on the same side as the pain

The pain can wake a person up during the night, and it may occur at the same time each night.

Each cluster can last from 15 minutes to several hours, but not usually more than 1 hour. After an attack, the pain will subside, but the person may feel extremely tired.

Timing

A cluster period usually lasts from 6 to 12 weeks.

Cluster headaches are either:

  • Episodic cluster headaches: A series of searing headaches typically recurring for 1 week to 3 months. There is usually a 6–12-month period of remission with few or no cluster headaches after an episode.
  • Chronic cluster headaches: The cluster period can persist for several months, 1 year, or longer. Periods of remission are short, lasting 3 months or less.

A cluster period may consist of any of the following:

  • daily occurrences, with symptoms appearing several times each day
  • one attack, lasting from 15 minutes to 3 hours
  • attacks that occur around the same time each day
  • attacks that occur during sleep and wake the person up

When to see a doctor

If a person is experiencing cluster headaches, it is best to see a healthcare professional to diagnose the occurrence and plan treatment accordingly.

However, anyone experiencing headaches with the following symptoms should seek immediate medical help, as they may indicate temporal arteritis, a severe inflammatory condition.

  • blurred or double vision
  • pain in the jaw
  • scal soreness
  • numbness or weakness in the arms or legs

Anyone with a severe headache that they have never had before should visit an emergency department, as this can be a sign of a brain bleed or stroke.

It is not clear exactly why cluster headaches occur. Some theories relate to inflammatory factors and neurotransmitters.

Researchers also think there could be a genetic link to the cause of the condition.

Some triggers can cause episodes of cluster headaches, such as alcohol, a sudden rise in temperature, or exercising in hot weather. There are also links between cluster headaches and smoking, irregular sleep-wake cycles, sleep apnea, and allergies.

There is currently no cure for cluster headaches, but drugs and therapies can reduce the incidence and severity of attacks, such as sumatriptan.

Treatment aims to relieve some of the symptoms, shorten the periods of headaches, and reduce their frequency.

Over-the-counter (OTC) pain medication, such as aspirin or ibuprofen, is typically not effective in managing the pain.

Fast-acting treatments

Approved treatment for cluster headaches includes:

  • Injectable sumatriptan (Imitrex): Triptans are a class of drug that can treat migraine. Sumatriptan can treat migraine and cluster headaches. The adult dose is a 6-milligram (mg) injection. People with high blood pressure or heart disease should avoid this drug.
  • Inhaling 100% oxygen: Breathing in oxygen through a mask at 7–10 liters per minute could reduce symptoms within 15 minutes. It is not always practical to have an oxygen cylinder and regulator close at hand, but some small units are available.
  • Dihydroergotamine: This migraine medication can be effective for treating cluster headaches, and it can be taken as a pill, inhaled, or given as an injection.

Doctors may also recommend off-label options, including:

  • Octreotide (Sandostatin): These are synthetic versions of somatostatin, a hormone. It is an effective treatment for cluster headaches that is safe for those with hypertension or heart disease.
  • Local anesthetic nasal drops: Lidocaine (Xylocaine) is an effective treatment for cluster headaches.
  • Surgery: This may be an option if drug treatments do not work, or if the person cannot tolerate the medications. The surgery could involve cutting part of the trigeminal nerve, which serves the area behind and around the eye.
  • Nasal triptans: These are available as nasal sprays that may act faster than some oral medications.

Possible future treatments

Some new treatment options under investigation include:

  • Occipital nerve stimulation: This involves implanting a small device over the occipital nerve. It sends impulses via electrodes.
  • Deep brain stimulation: This involves implanting a stimulator in the hypothalamus to change the electrical impulses in the brain.
  • Noninvasive vagal nerve stimulation: This treatment involves using an implantable electrode to administer electrical impulses to the vagus nerve. The vagus nerve is the largest nerve in the central nervous system.

Preventive treatment

Cluster headaches can be managed with short-term or long-term preventive therapies. Short-term therapies are used during cluster episodes for weeks or a few months at a time, while long-term preventatives are used all the time to prevent a cluster episode.

Short-term drugs

Examples of medications to provide short-term relief of cluster headaches include:

  • Corticosteroids: These steroids suppress inflammation. They are a fast-acting, preventive drug that can help those with new symptoms or those who have long periods of remission and short cluster periods.
  • Anesthetic on the occipital nerve: Injecting anesthetic can numb this nerve, which is at the back of the head. As a result, pain messages that travel along the nerve pathway are blocked.

Long-term drugs

People may take long-term drugs throughout the cluster period, such as:

  • Galcanezumab: This is a monoclonal antibody doctors prescribe for the treatment of cluster headaches and recurrent migraine.
  • Calcium channel blockers: People take these during the cluster period and then gradually reduce the dose, although some people may need to use them long term. Side effects include constipation, tiredness, and swollen ankles. Regular heart monitoring is necessary for people taking high doses.
  • Lithium carbonate: This is a treatment for bipolar disorder that is also effective in preventing chronic cluster headaches. Side effects include increased urination, diarrhea, and tremor. Regular blood tests will check for possible kidney damage.
  • Anti-seizure medications: These drugs may help prevent cluster headaches.

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Since the causes of cluster headaches remain unclear, there are no proven lifestyle measures for preventing them.

Identifying and avoiding triggers for cluster headaches could reduce their frequency or severity. Possible triggers include:

  • alcohol
  • some medications, such as inhaled nitroglycerin
  • exercising in hot weather
  • sudden rises in body temperature
  • smoking
  • irregular sleep patterns

Cluster headaches and migraine are both severe forms of headache, but they are different and need specific treatments.

Migraine can last for up to 72 hours, and commonly involve nausea, vomiting, and sensitivity to light.

A cluster headache starts and ends suddenly, and it lasts a shorter time. It can feature congestion, watery eyes, and a runny nose. It normally affects only one side of the head, and the eye that is watering is on the same side.

A person with migraine prefers to lie down during an attack, but people with cluster headaches may find that lying down worsens the pain.

Risk factors for cluster headaches include:

  • being male
  • being older than 30
  • drinking alcohol
  • prior experience of brain surgery or trauma
  • family history of cluster headaches or migraine headaches

Anyone who has regular headaches should see a doctor. Treatment can relieve symptoms, and it may be necessary to rule out any possible underlying causes.

Cluster headaches are painful headaches that can occur several times a day. Episodes typically come in cycles and may occur around the same time each year.

The symptoms of cluster headaches include sharp, stabbing pain on one side of the head. There can also be red, watery eyes, restlessness, nasal congestion, and skin paling

There is currently no cure for cluster headaches. However, treatments and preventive therapies can help relieve ongoing cluster headaches.