What Is It?
Cluster headaches are very intense headaches that start in the area around one eye, then spread to nearby areas of the face. Each headache lasts about a half-hour to three hours, but episodes can occur several times during the same day or night (in clusters) for several weeks or months. On average, there are one to three headache episodes daily during a four- to eight-week period. However, once this cluster of episodes ends, the person may remain headache-free for months or years. Although the exact mechanism behind cluster headaches remains a mystery, researchers believe that these headaches may be related to abnormal cell activity in a region of the brain known as the hypothalamus.
Approximately 1 million people in the United States have cluster headaches, and the condition is 5 to 6 times more common in men than in women. The first cluster episode usually occurs sometime between ages 20 and 50. About 80% of cluster headaches occur at night. Cluster headaches are rarely triggered by food, bu often can be triggered by drinking alcohol.
Symptoms of cluster headache include:
Intense pain localized around one eye or sometimes near the temple—pain is deep and explosive, usually builds to maximum intensity within five minutes, and can spread to nearby areas of the cheek or jaw.
A bloodshot or tearing eye on the affected side
Smaller pupil or droopy eyelid on the affected side
Runny nose or blocked nostril on the affected side
Many people feel better when they remain active during their headaches. This is in contrast to those experiencing migraine headaches, who tend to seek out a quiet, dark room.
Your doctor will ask about your medical history and your specific headache symptoms to determine whether your headaches are cluster-type or if they may be related to an underlying disease. He or she also will examine you to check for other possible causes of your headaches. If your examination is normal and your headaches fit the typical cluster pattern, you may not need any further testing. However, your doctor may order additional tests to rule out more worrisome causes of your symptoms. These tests could include computed tomography (CT) or magnetic resonance imaging (MRI) scans.
Cluster headaches usually last a half-hour to three hours and occur one to three times daily for four to eight weeks. Once this cluster of episodes passes, it is not unusual for a person to remain headache-free for many months or sometimes years.
Because the mechanism behind cluster headaches remains a mystery, there is no way to prevent a first occurrence. However, people who have already experienced cluster headaches may be able to reduce the likelihood of future attacks if they avoid alcohol, quit smoking, and maintain a regular sleep pattern.
It is difficult to stop the pain of the first cluster headache you experience because the headache usually disappears by the time you reach the doctor's office or emergency room. Once the problem has been diagnosed, your doctor may prescribe a therapy for you to keep on hand. Inhaling 100% oxygen through a facemask for about 15 minutes has proven to help when it is done at the first signs of an attack. This oxygen must be prescribed by a doctor and obtained through a medical supplier. Other drugs that may be effective when used at the beginning of cluster pain include:
Drugs called triptans, including sumatriptan (Imitrex), rizatriptan (Maxalt), zolmitriptan (Zomig), almotriptan (Axert), naratriptan (Amerge) and others
Combining 100% oxygen with one of the triptans can be especially effective.
Your doctor will likely suggest a preventive medication to help decrease the frequency of headaches and to shorten the length of the active cluster period. Verapamil (Calan, Isoptin) at a dose of 360 milligrams to 480 milligrams per day is often the first preventive medication prescribed. Other drugs used as preventive therapy include prednisone (Deltasone and others), divalproex (Depakote, Depakene), topiramate (Topamax) methysergide (Sansert) and ergotamine (Cafergot).
There is no way to determine which medication will be most effective for any individual. You and your doctor may need to try a few different strategies to find the one that works for you.
On rare occasions, when cluster headaches occur more frequently and cannot be controlled with medication, neurosurgery might be considered. Procedures that have been used with variable success include permanent nerve blocks and brain implantation of precisely placed electrodes.
When To Call a Professional
If any form of headache occurs on a regular basis or begins to interfere with your daily activities, see your doctor
No therapies or lifestyle changes can consistently prevent cluster headaches. Medical treatment can help shorten the active periods and decrease the number and severity of painful episodes.
National Institute of Neurological Disorders and Stroke
P.O. Box 5801
Bethesda, MD 20824
National Headache Foundation
820 N. Orleans
Chicago, IL 60610
American Council for Headache Education (ACHE)
19 Mantua Road
Mt. Royal, NJ 08061