What is a Cluster Headache?

Cluster headaches are a rare type of headache that affects 1 to 2 people in every 1,000. They produce excruciating attacks of pain in one side of the head and occur in cyclical patterns or ‘cluster periods’, which can last from weeks to months. This condition is more common in men, and is likely to start when a person is 30 to 40 years old. They can occur in younger adults and children but this is less common.

What causes Cluster Headaches?

The exact cause of cluster headaches is unknown, some patients can identify triggers such as drinking alcohol, smoking, exercise and strong smells, for example perfume. There is also a suggestion that the condition may be genetic causal factor as some cases run in families. Research has found that approximately 1 in 20 people with cluster headache have a family member who also has the condition.

Symptoms of a Cluster Headache

Defined as one of the most painful conditions known to mankind. The pain, which is described as sharp and piercing, often starts suddenly with no warning signs. The pain is usually centred on one side of the head, either around one eye, the temple or the forehead. Some patients find that the pain always appears on the same side, others find that the side can vary from time to time. Other symptoms include;

  • A red and watering eye
  • Drooping and swelling of one eyelid
  • A smaller pupil in one eye
  • A blocked or runny nostril
  • Pain down the neck and shoulders
  • A sweaty face
  • Sensitivity to light

Due to the intense pain people may feel restless and agitated, and they may react by rocking or pacing. During a cluster period, attacks can last anywhere between 15 minutes and 3 hours, and may occur between one to eight times every day. In approximately 80% of people with cluster headaches, the cluster period lasts from four to twelve weeks, once a year, normally in the Spring or Autumn. The remaining 20% of people have ‘chronic cluster headaches’ as they do not have these pain free periods.

Diagnosis of Cluster Headaches

Cluster headaches have a distinct pattern of attacks which can aid diagnosis. Unfortunately, there is no specific test to diagnose this type of headache. Instead, your consultant will ask you about the severity of the pain, the frequency of headaches and associated symptoms. To rule out other conditions the consultant may request a CT scan and MRI scan. They may also do a neurology exam to test your brain function as this may reveal signs of cluster headaches. The attacks usually last between 15 minutes up to three hours. In some cases, people can experience 1-8 attacks a day. There is a pattern with these attacks; the headaches will usually occur daily for around 4-12 weeks before they subside. Remission (a symptom free period) can last for months or even years before the headaches return.

Potential Treatment Options

Cluster headaches are not life threatening, however they can be extremely painful and affect your quality of life. Over the counter medications are generally not effective in treating cluster headaches as they do not work fast enough, this means that paracetamol and ibuprofen will usually not work. There are no cures for cluster headaches but there are treatments which help to manage the severe pain and improve quality of life. These include;

  • Oxygen. Breathing pure oxygen at a prescribed time and rate is one of the safest treatments to relieve pain.
  • Medication. Powerful pain killers such as corticosteroids can provide pain relief (Note that ordinary pain killers such as paracetamol are not effective, due to the extreme pain and they take too long to work). There are also medications such as verapamil which can be taken to prevent cluster headaches.
  • Nerve blocks. Corticosteroids and anaesthetic are injected near the occipital nerve at the back of the head.
  • · Vagal nerve stimulation. Low-voltage electrical currents stimulate the vagal nerve in your neck. This can reduce pain and the number of cluster headaches you have.
  • Deep nerve stimulation. Electrodes implanted in the brain emit low voltage currents to stimulate the occipital nerve. This can reduce pain and the number of cluster headaches you have.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.