Learn About Cluster Headache

What is the definition of Cluster Headache?

A cluster headache is an uncommon type of headache. It is one-sided head pain that may involve tearing of the eyes, a droopy eyelid, and a stuffy nose. Attacks last from 15 minutes to 3 hours, occur daily or almost daily for weeks or months. 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.

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What are the alternative names for Cluster Headache?

Histamine headache; Headache - histamine; Migrainous neuralgia; Headache - cluster; Horton's headache; Vascular headache - cluster; Episodic cluster headache; Chronic cluster headache

What are the causes of Cluster Headache?

Doctors 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 allergic response) or serotonin (chemical made by nerve cells) in the area of a nerve in the face called the trigeminal nerve. 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 headaches can occur at any age, but are most common in the 20s through middle age. They tend to run in families.

Hypothalamus

Cluster headaches may be triggered by:

  • Alcohol and cigarette smoking
  • High altitudes (trekking and air travel)
  • Bright light (including sunlight)
  • Exertion (physical activity)
  • Heat (hot weather or hot baths)
  • Foods high in nitrites (bacon and preserved meats)
  • Certain medicines
  • Cocaine
What are the symptoms of Cluster Headache?

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. 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:

  • Burning, sharp, stabbing, or steady
  • Felt on one side of the face from neck to temple, often involving the eye
  • At its worst within 5 to 10 minutes, with the strongest pain lasting 30 minutes to 2 hours
Pain of cluster headache

When the eye and nose on the same side as the head pain are affected, symptoms can include:

  • Swelling under or around the eye (may affect both eyes)
  • Excessive tearing
  • Red eye
  • Droopy eyelid
  • Runny nose or stuffy nose on the same side as the head pain
  • Red, flushed face, with extreme sweating
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What are the current treatments for Cluster Headache?

Treatment for cluster headaches involves:

  • Medicines to treat the pain when it happens
  • Medicines to prevent the headaches

TREATING CLUSTER HEADACHES WHEN THEY OCCUR

Your provider may recommend the following treatments for when the headaches occur:

  • Triptan medicines, such as sumatriptan (Imitrex).
  • Anti-inflammatory (steroid) medicines such as prednisone. Starting with a high dose, then slowly decreasing it over 2 to 3 weeks.
  • Breathing in 100% (pure) oxygen.
  • Injections of dihydroergotamine (DHE), which can stop cluster attacks within 5 minutes (Warning: this drug can be dangerous if taken with sumatriptan).

You may need more than one of these treatments to control your headache. Your provider 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.

Surgical treatment may be recommended for you when all other treatments have failed. One such treatment is a neurostimulator. This device delivers tiny electrical signals to certain nerves such as the occipital nerve in the scalp. Your provider can tell you more about surgery.

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:

  • Day and time the pain began
  • What you ate and drank over the past 24 hours
  • How much you slept
  • What you were doing and where you were right before the pain started
  • How long the headache lasted and what made it stop

Review your diary with your provider to identify triggers or a pattern to your headaches. This can help you and your provider 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:

  • Allergy medicines
  • Antidepressants
  • Blood pressure medicines
  • Seizure medicine
Who are the top Cluster Headache Local Doctors?
Elite
Highly rated in
12
conditions
Neurology

UCLA Health System

Los Agneles, CA 

Peter Goadsby is a Neurologist in Los Agneles, California. Dr. Goadsby has been practicing medicine for over 37 years and is rated as an Elite doctor by MediFind in the treatment of Cluster Headache. He is also highly rated in 12 other conditions, according to our data. His top areas of expertise are Migraine, Familial Hemiplegic Migraine, Migraine with Brainstem Aura, and Headache. He is board certified in Neurology and licensed to treat patients in California.

Elite
Highly rated in
6
conditions

Migraine And Headache Clinic Königstein

Frankfurt Am Main, HE, DE 

Charly Gaul is in Frankfurt Am Main, Germany. Gaul is rated as an Elite expert by MediFind in the treatment of Cluster Headache. They are also highly rated in 6 other conditions, according to our data. Their top areas of expertise are Cluster Headache, Migraine, Headache, and Trigeminal Neuralgia.

 
 
 
 
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Elite
Highly rated in
4
conditions

Fondazione IRCCS Istituto Neurologico Carlo Besta

Milan, IT 

Massimo Leone is in Milan, Italy. Leone is rated as an Elite expert by MediFind in the treatment of Cluster Headache. He is also highly rated in 4 other conditions, according to our data. His top areas of expertise are Cluster Headache, Migraine, Headache, and New Daily Persistent Headache.

What is the outlook (prognosis) for Cluster Headache?

Cluster headaches are not life threatening. They usually do not cause permanent changes to the brain. But they are long-term (chronic), and often painful enough to interfere with work and life.

When should I contact a medical professional for Cluster Headache?

Call 911 if:

  • You are experiencing "the worst headache of your life."
  • You have speech, vision, or movement problems or loss of balance, especially if you have not had these symptoms with a headache before.
  • A headache starts suddenly.

Schedule an appointment or call your provider if:

  • Your headache pattern or pain changes.
  • Treatments that once worked no longer help.
  • You have side effects from your medicine.
  • You are pregnant or could become pregnant. Some medicines should not be taken during pregnancy.
  • You need to take pain medicines more than 3 days a week.
  • Your headaches are more severe when lying down.
How do I prevent Cluster Headache?

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.

Brain
Cause of headaches
What are the latest Cluster Headache Clinical Trials?
A Phase III, Double-Blind, Randomized, Vehicle-Controlled, Parallel-Group, Multicenter Evaluation of Civamide Nasal Solution 0.01% in the Prevention of Cluster Headaches During an Episodic Cluster Headache Period
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Interventional, Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Delayed-Start Study to Evaluate the Efficacy and Safety of Eptinezumab in Patients With Episodic Cluster Headache
What are the Latest Advances for Cluster Headache?
Cluster Headache: Clinical Characteristics and Opportunities to Enhance Quality of Life.
Clinical symptoms of androgen deficiency in men with migraine or cluster headache: a cross-sectional cohort study.
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Enlarging the spectrum of cluster headache: Extracranial autonomic involvement revealed by voice analysis.
What are our references for Cluster Headache?

Garza I, Schwedt TJ, Robertson CE, Smith JH. Headache and other craniofacial pain. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 103.

Hoffmann J, May A. Diagnosis, pathophysiology, and management of cluster headache. Lancet Neurol. 2018;17(1):75-83. PMID: 29174963 www.ncbi.nlm.nih.gov/pubmed/29174963.

Rozental JM. Tension-type headache, chronic tension-type headache, and other chronic headache types. In: Benzon HT, Raja SN, Liu SS, Fishman SM, Cohen SP, eds. Essentials of Pain Medicine. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 20.