Cluster Headaches

Nearly a million Americans have cluster headaches, which are known for their extreme pain and their pattern of occurring in "clusters," usually at the same time of the day for a number of weeks. This headache is often described as constant, deep, excruciating pain, and the pain is always located on one side of the head. They do not appear to be linked to hormones or foods, as migraines have. Treatment options include lifestyle changes and medications.

What Is a Cluster Headache?

Cluster headaches, a type of vascular headache, are known for their extreme pain and their pattern of occurring in "clusters," usually at the same time(s) of the day for several weeks. These headaches have been called the "suicide headache," "demon of headaches," and, because it often wakens the person, "alarm clock headache."
  

Who Gets Cluster Headaches?

Nearly a million Americans have cluster headaches. Most sufferers are men, usually smokers. These headaches usually start between the ages of 20 and 40, although the syndrome can also start in childhood or late in life.
 

Types of Cluster Headaches

There are two type of cluster headache:
 
  • Episodic cluster headaches
  • Chronic cluster headaches.
 
Episodic cluster headaches are the most common type, occurring in up to 90 percent of people who have this condition. These headaches occur up to eight times per day for four to eight weeks, on average. This is followed by a six-month to one-year pain-free period, although this period can last for years.
 
Chronic cluster headaches, on the other hand, can go on for years with only brief periods (two weeks or less) of remission.
 
Either type can turn into the other for unknown reasons.
 

What Causes Cluster Headaches?

Headache research scientists do not know specifically what causes cluster headaches. They have not been linked to hormones or foods (as migraines have).
 
There are, however, certain factors that can increase a person's risk for developing cluster headaches. Specific risk factors include:
 
  • Family history of cluster headaches (up to a 14-fold increased risk)
  • Hazel eyes
  • Disruption of normal sleep patterns
  • Certain medications (such as nitroglycerin)
  • Heavy smoking or drinking.
     
(Click Causes of Cluster Headaches for more information.)
 

Symptoms of Cluster Headaches

Cluster headaches may begin as a minor pain or pressure around one eye or temple. They may also begin as a burning sensation on the nose. The pain quickly intensifies over several minutes, eventually spreading to that side of the face. A cluster headache is often described as constant, deep, excruciating pain, although occasionally it may be pulsing and throbbing. The pain is always on one side of the head.
 
The intense pain of a cluster headache often compels the victim to pace the floor or rock in a chair. This differs from a migraine attack, where the person wants to curl up into bed and be still.
 
 
  • Stuffed and runny nose
  • Droopy eyelid
  • Sweating forehead
  • Pale appearance
  • Red, tearing eye
  • Nausea.
     

Diagnosing Cluster Headaches

In order to diagnose cluster headaches, your healthcare provider will ask a number of questions about the headache, such as how often you have them or where the pain is. He or she will also ask about other symptoms that you may experience.
 
Your healthcare provider will also perform a physical exam, looking for signs of conditions known to cause cluster headaches. If your healthcare provider is unsure of the diagnosis, he or she may also order tests to rule out other, more serious causes.
 
(Click Cluster Headache Diagnosis for more information.) 
 

Treatment Options for Cluster Headaches

There are many different treatment options for cluster headaches, based on the headaches' frequency, severity, and level of disability.
 
In general, your healthcare provider may recommend one or several different treatment options, including:
 
  • Lifestyle changes
  • Medications for an acute attack
  • Preventive medications.
     
In chronic cases, certain facial nerves may be surgically cut or destroyed to provide relief from cluster headaches. However, these procedures have had limited success.
 
(Click Cluster Headache Treatment to learn about specific medicines used to stop an attack, as well as medicines used to prevent cluster headaches in the first place.)
 
Written by/reviewed by: Arthur Schoenstadt, MD
Last reviewed by: Arthur Schoenstadt, MD
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