What are cluster headaches?
Cluster headaches are named for the cyclical patterns, or clusters, in which they occur. Headache periods can last several weeks or months and be followed by pain-free periods that last months or years. Attacks generally occur around the same time each day and sometimes several times per day. Some people have a chronic form of the disorder, in which headaches occur for a year or more with pain-free periods of only a month or less.
Cluster headaches are primary headaches, meaning they occur independently rather than because of another medical condition. Cluster headaches arise suddenly, producing relatively brief but severe pain on one side of the head, often focused behind or around the eye.
Cluster Headaches Symptoms
Pain associated with cluster headaches usually has the following characteristics:
- Sudden and severe
- Felt on one side of the head
- Often focused behind or around one eye
- Peaks within 5-10 minutes of onset and continues at that intensity for 30 minutes to three hours
- Often begin at night, while sleeping
Headache pain may be accompanied by the following symptoms on the side of the face where the pain is felt:
- Swollen or drooping eyelid
- Congested or runny nostril
- Redness of the eye
- Excessive watering of the eye
- Abnormally small pupil size
- Forehead and facial sweating
- Red, flushed face
- Ear fullness or pressure
Cluster Headaches Treatments
Triptans are a class of medications commonly used to provide fast relief for migraine and cluster headache pain. Specifically, the drug sumatriptan (Imitrex) may be given as an injection.
Nasal spray triptan medications such as sumatriptan and Zolmitriptan (zomig) can be beneficial. These medications are available in pill form, but these are less likely to be effective.
Other medications used to treat cluster headaches can include:
- Breathing pure oxygen through the nose
- Galcanezumab (Emgality) injections
- Dihydroergotamine (DHE) infusion or nasal spray
- Lidocaine (Xylocaine) or other local anesthetics
Inhaling pure oxygen can provide substantial relief. However, some patients find oxygen canisters too bulky and inconvenient to have ready when a cluster headache strikes.
Identifying and avoiding your triggers can help prevent cluster headaches. Documenting the following in a “headache diary” can help you identify your triggers:
- Day and time the pain began
- What you ate and drank in the previous 24 hours
- How much you slept
- What you were doing when the pain began
- How long the pain lasted
- What made the pain stop
How common are cluster headaches?
Cluster headaches are relatively uncommon, affecting fewer than 1 in 1,000 adults.
Who gets cluster headaches?
Cluster headaches are more common in men than in women and in smokers than nonsmokers. The age of onset is typically between 20 and 40, but cluster headaches can begin at any age.
How are cluster headaches diagnosed?
Your doctor may use the following to diagnose cluster headaches:
- Personal and family medical history
- Physical and neurological examinations
- Imaging to rule out other headache causes