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A cluster headache is a type of headache. It is one-sided head pain that may involve tearing of the eyes and a stuffy nose. Attacks occur regularly for 1 week to 1 year. The attacks are separated by pain-free periods that last at least 1 month or longer.
Cluster headaches may be confused with other common types of headaches such as migraines, sinus headache, and tension headache.
Histamine headache; Headache - histamine; Migrainous neuralgia; Headache - cluster; Horton's headache
Scientists do not know exactly what causes cluster headaches. They seem to be related to the body's sudden release of histamine (chemical in the body released during an allergy response) or serotonin (chemical made by nerve cells). A problem in a small area at the base of the brain called the hypothalamus may be involved.
More men than women are affected. The headache can occur at any age, but are most common in adolescence and middle age. They tend to run in families.
Cluster headaches may be triggered by:
A cluster headache begins as a severe, sudden headache. The headache commonly strikes 2 to 3 hours after you fall asleep. But it can also occur when you are awake. The headache tends to happen daily at the same time of day. Attacks can last for months. Or they can alternate with periods without headaches (episodic). Or they can go on for a year or more without stopping (chronic).
Cluster headache pain is usually:
When the eye and nose on the same side as the head pain is affected, symptoms can include:
Your health care provider can diagnose this type of headache by performing a physical exam and asking about your symptoms and medical history.
If a physical exam is done during an attack, the exam will usually reveal Horner syndrome (one-sided eyelid drooping or a small pupil). These symptoms will not be present at other times. No other nervous system (neurologic) changes will be seen.
Tests, such as an MRI of the head, may be needed to rule out other causes of the headaches.
Treatment for cluster headaches involves:
TREATING CLUSTER HEADACHES WHEN THEY OCCUR
Your doctor may recommend the following treatments for when the headaches occurs:
You may need more than one of these treatments to control your headache. Your doctor may have you try several medicines before deciding which works best for you.
Pain medicines and narcotics do not usually relieve cluster headache pain, because they take too long to work.
PREVENTING CLUSTER HEADACHES
Avoid smoking, alcohol use, certain foods, and other things that trigger your headaches. A headache diary can help you identify your headache triggers. When you get a headache, write down the following:
Review your diary with your doctor to identify triggers or a pattern to your headaches. This can help you and your doctor create a treatment plan. Knowing your triggers can help you avoid them.
The headaches may go away on their own. Or you may need treatment to prevent them. The following medicines may also be used to treat or prevent headache symptoms:
In rare cases, a device that delivers tiny electrical signals to a certain nerve near the brain may be placed. This device is called a neurostimulator. Your doctor can tell you if this treatment is right for you.
Cluster headaches are not life-threatening. They usually do not cause permanent changes to the brain. But they are chronic, and often painful enough to interfere with work and life.
Call 911 if:
Schedule an appointment or call your doctor if:
If you smoke, now is a good time to stop. Alcohol use and any foods that trigger a cluster headache may need to be avoided. Medicines may prevent cluster headaches in some cases.
Francis GJ, Becker WJ, Pringsheim TM. Acute and preventive pharmacologic treatment of cluster headache. Neurology. 2010;75:463-473.
Garza I, Swanson JW, Cheshire WP Jr, et al. Headache and other craniofacial pain. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, Pa: Elsevier Saunders; 2012:chap 69.
Weaver-Agostoni J. Cluster headache. Am Fam Physician. 2013;88:122-128.