An Overview of Cluster Headaches

Cluster headaches are characterized by intense headaches that usually start behind the eye and then spread to neighboring areas of the face. Episodes often occur several times over a 24-hour period with each one lasting half an hour to three hours. This happens every day for weeks or months. Most cluster headaches ensue at night and it is much more prevalent in men than women. Some people have “triggers” that initiate a headache and these often include: Alcohol, certain foods, especially ones that are high in nitrates, bright lights, tobacco products and hot weather or hot baths.

People experience an average of one to three headache each day for 4-8 weeks. Once the cluster headaches subside the individual may go without headaches for months to years. The cause of the cluster headaches is not yet clear but it is thought that a temporary imbalance of chemicals in the brain may be responsible.


Cluster headaches cause deep and explosive pain around the eye or temple that usually reaches maximum intensity five minutes later, often spreads to the cheek or jaw. Individuals may also experience the following symptoms on the affected side:

A bloodshot or tearing eye

A small pupil or droopy eyelid

A runny nose or blocked nostril

Many people report that they find relief from the headaches when they remain active. This contrast to individuals suffering from migraine headaches who often seek a dark, quite room to ease symptoms.


Your doctor will ask you for a medical history and headache symptoms in order to differentiate between cluster headaches or other underlying diseases.

He or she may also perform a physical examination to rule out other headache-causing factors. If the exam is normal and the symptoms fit into the typical cluster pattern then you may not be in need of further testing. If your symptoms are not typical of cluster headaches then the doctor may suggest a CT or an MRI scan of the head.

Many people note a decrease in symptoms when they remain active during their headaches. This is in contrast to those experiencing migraine headaches. Migraine sufferers tend to seek out a quiet, dark room.


There is no way to prevent the first occurrence of cluster headaches, but people who have already experienced these headaches can help to prevent attacks in the future. Avoid alcohol and smoking, maintain a regular sleep pattern and attempt to identify and avoid your “triggers”.


It is difficult to stop the pain of the first cluster headache you experience. The headache often disappears by the time you reach the emergency room or doctor’s office. Once you have been diagnosed, your doctor may prescribe a therapy for you to keep on hand. Inhaling 100% oxygen through a facemask for 15 minutes can help relieve the pain, but this must be prescribed by a doctor and obtained by a medical supplier. Certain drugs can be effective when used at the beginning of cluster pain including triptans, such as sumatriptan and rizatriptan, intranasal lidocaine and intranasal dihydroergotamine.

Your doctor will most likely suggest additional medication to break the cycle or decrease the frequency and length of active cluster headaches. The calcium-channel blocker verapamil is usually the most effective but it may take a week or two to start helping. Prednisone acts more quickly. A combination of prednisone and verapamil at the onset of headaches can be extremely helpful.

You may need to try multiple therapies to find the one that works best to relieve your symptoms. On rare occasions, neurosurgery may be considered if the headaches are not responding to medications. The surgery involves permanent nerve blocks and implantation of carefully placed electrodes in the brain, however, surgical procedures have variable success.


Cluster headaches are not completely preventable, but medical treatments can help shorten active periods by decreasing the number and severity of painful headaches.

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