Cluster Headache: What Is It and What Can You Do?

Cluster headache is an excruciatingly painful headache that can occur in groups or clusters. Considered perhaps the most painful of all headache types, they often begin an hour or two after going to sleep and awaken people in the middle of the night.¹

What is cluster headache?

Cluster headache is considered a primary headache disorder. Cluster headache is part of the trigeminal autonomic cephalgias (TAC) group of primary headache disorders.^1,2 The primary head pain symptoms of cluster develop on one side of the head, in the trigeminal nerve area, and have an array of symptoms that develop on the same side of the head as the headache, including watering eyes and drooping eyelid.¹

How often do cluster headaches occur?

Characterized by periods of daily painful headaches, cluster headache typically occurs at the same time each day with intense pain coming on quickly and often stopping as suddenly as it starts. Cluster headache can happen numerous times in a day where the pain experienced is severe and the symptoms produced are similar each time they develop.^1-5 Cluster headache can be exhausting but when each headache ends typically there are no ongoing or residual symptoms. They end as suddenly as they come on.¹

Pain and cluster headache

Cluster headache is cyclic, the head pain occurs in groups, and can be short or long term. People experience the same type of severe, unilateral pain (one-side) from a head pain that develops 1 to 4 times a day. People often describe this as a stabbing pain in one eye or behind their eye. These pain symptoms can last from 15 minutes to 2-3 hours, with the average lasting around half an hour.^1-3

Types of cluster headache

Cluster headache is classified into two types: episodic and chronic.

Episodic cluster headache

Head pain that occurs in groups that last between 1 week and 1 year, separated by pain-free periods of remission, are considered episodic.² These cluster periods are separated by months, sometimes years, of remission during which there is no further development of cluster headache.³

Chronic cluster headaches

People with the chronic form experience cluster headache with no period of relief or remission for more than a year, or a break period that is so brief (lasting less than a month) that it is not considered a remission. It is estimated that fewer than 20% of those experiencing cluster headache have a chronic form.^2,3

History of cluster headache

Cluster headache was first described in 1641.³ They have been identified by different names including after a London neurologist, Dr. Wilfred Harris (1926) and US neurologist Dr. Bayard Taylor Horton. Other names include:

• familial cluster headaches
• histamine cephalalgia
• vasogenic facial pain
• ciliary neuralgia
• erythromelalgia of the head
• erythroprosopalgia of Bing
• Horton’s headache
• Harris-Horton’s disease
• migrainous neuralgia (of Harris)

Cluster headache causes and triggers

Cluster headache has been associated with disruptions to the biological clock which is controlled by the hypothalamus area of the brain. This is why many people with cluster headache are awakened at night from the onset of an episode. There is no singular cause for cluster headache, though genetics may play a role. While the cause for cluster headache is unknown, there are some triggers that have been identified such as foods, medications, seasonal changes, and being at high altitudes.^1,4,5

Cluster headache treatments

There is currently no cure for cluster headache. The approach to treatment generally involves treatment for immediate pain relief as well as a plan for prevention. Therapeutic options for cluster headache treatment include using a 2-pronged approach to both manage episodic pain while reducing the number and severity of attacks.⁴ These involve both medication and lifestyle modifications.¹

Medications

There are a variety of medications prescribed to prevent cluster headache attacks that range from over the counter anti-inflammatories to prescription steroids, triptans, and calcium channel blocker medicines. They can be taken on a prophylactic basis which means they can delay or prevent the onset and intensity.^2,5

Finding relief

When a cluster headache develops, immediate relief is most frequently the desired goal. Some people use injectable triptans or hormones to bring about pain reduction. Breathing pure oxygen during a cluster headache attack is another approach that may offer some relief, especially when attacks occur at night when oxygen may be more available and convenient.^2,4

Cluster headache is believed to decline with age such that individuals experience less frequent bouts and prolonged periods of remission in between episodes.³

Talk to your doctor

If you experience a sudden change in headache type or pain, seek immediate medical help. If you think you are experiencing cluster headache or migraine but have not been diagnosed, call your doctor for an appointment, or ask for a referral to a specialist. Most likely you will need to see a headache specialist or neurologist to get a confirmatory diagnosis.^1,4

Resources for cluster headache

Cluster headache resources are available through the National Organization of Rare Disorders (NORD). Cluster headache affects a small percentage of the population; between 200,000 and 1 million people.² It had been considered a rare condition but recently researchers have asked for this condition to be reevaluated because of its increasing prevalence. According to the National Institutes of Health (NIH) a rare disease is defined as a condition that affects fewer than 200,000 people.