Table of ContentsView AllTable of ContentsSymptomsCausesCluster Headache TimingWhat Helps?MedicationSelf-CareTriggers
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Cluster Headache Timing
What Helps?
Medication
Self-Care
Triggers
Cluster headaches cause significant pain on one side of the head, in thetrigeminalnervedistribution (generally in or around the eye or temple).
While debilitating and extremely painful, cluster headaches are not dangerous. Their precise cause remains unknown, although experts strongly suspect thehypothalamus(a gland in the brain) plays a role.
This article will review what a cluster headache feels like and how it’s managed. Potential causes and preventive therapies will also be explored.
Cluster Headaches: Describing Where Pain Is
Cluster headachesare one-sided (unilateral) headaches, localized in or around the eye, eyebrow, or near the temple area.
The pain of a cluster headache is sharp, stabbing, or burning in nature. It is reported as being more severe than childbirth, passing a kidney stone, or breaking a bone.
Cluster Headaches
Also, one or more cranialautonomicsymptoms are present on the same side as the cluster headache. Cranial autonomic symptoms occur when trigeminal pain-sensing nerve cells activate nerve fibers connected to facial structures like the eye and nose.
These symptoms include:
How Are Migraines Different From Cluster Headaches?Migraine headachesare throbbing, last longer (four to 72 hours), and are associated with nausea and/or vomiting, not restlessness. Also, migraine headaches can occur on both sides of the head, whereas cluster headaches are always one-sided.
How Are Migraines Different From Cluster Headaches?
Migraine headachesare throbbing, last longer (four to 72 hours), and are associated with nausea and/or vomiting, not restlessness. Also, migraine headaches can occur on both sides of the head, whereas cluster headaches are always one-sided.
Key Features of Cluster Headache vs. Migraine Symptoms
Causes: Why Do People Get Cluster Headaches?
While the exact cause of cluster headaches is unknown, experts suspect they start with activating the hypothalamus, a gland at the base of the brain that controls yoursleep-wake cyclesandcircadian rhythm(internal clock).
Activation of thetrigeminal-autonomicreflex (possibly via a connection with the hypothalamus) is suspected of generating cluster headaches.
The trigeminal-autonomic reflex describes an intricate nerve pathway connecting the trigeminal nerve to cranial nerve seven (facial nerve) and cranial nerve eight (vestibulocochlearnerve).These nerves carryparasympatheticsignals to structures within the head, like the tear glands, eyes, and nose.
What Is the Parasympathetic Nervous System?The parasympathetic nervous system is part of yourautonomic nervous system, which controls body functions that occur automatically (e.g., blood pressure, digestion, and sweat production).
What Is the Parasympathetic Nervous System?
The parasympathetic nervous system is part of yourautonomic nervous system, which controls body functions that occur automatically (e.g., blood pressure, digestion, and sweat production).
Lastly, genetics and hormone levels, namelymelatonin(sleep hormone) andcortisol(stress hormone), may also play a role in causing cluster headaches. One study found lower melatonin and higher cortisol levels in participants with cluster headaches.
Timing of Cluster Headaches
Interestingly, cluster headaches follow acircadian pattern, occurring around the same time each day, often at night, one to two hours after a person falls asleep, or in the early morning.
They also follow aseasonal pattern, recurring at the same time each year, often in the spring and autumn.The circadian and circannual pattern of cluster headaches supports the role of the hypothalamus in its origin.
An exception to this is individuals with chronic cluster headaches. They experience remission periods of less than one month.
What Helps When You Have Cluster Headaches?
If you have been diagnosed with cluster headaches, you must be prepared for an attack. This means carrying medication with you or having it near your bed (if you tend to get cluster headaches at night) and taking it immediately at the start of your symptoms.
You might also carry a water bottle with cold water or an instant cold pack during a cluster cycle. Applying cold water or a cold pack to the area of pain has been found to be soothing for some people.
Can Ice Packs Soothe a Headache?
How Are Cluster Headaches Diagnosed?Diagnosing a cluster headache involves giving a medical history, having aneurological exam, undergoingmagnetic resonance imaging (MRI) of the brain, and sometimes getting blood tests.The purpose of imaging or blood tests is to rule out mimicking conditions likegiant cell arteritis,sinusitis, orbrain tumor.
How Are Cluster Headaches Diagnosed?
Diagnosing a cluster headache involves giving a medical history, having aneurological exam, undergoingmagnetic resonance imaging (MRI) of the brain, and sometimes getting blood tests.The purpose of imaging or blood tests is to rule out mimicking conditions likegiant cell arteritis,sinusitis, orbrain tumor.
Diagnosing a cluster headache involves giving a medical history, having aneurological exam, undergoingmagnetic resonance imaging (MRI) of the brain, and sometimes getting blood tests.
The purpose of imaging or blood tests is to rule out mimicking conditions likegiant cell arteritis,sinusitis, orbrain tumor.
Medication for Cluster Headaches
Thetreatment of cluster headachesinvolves three components:
Abortive
Oxygen andtriptansare the primary abortive therapies for cluster headache attacks.Lidocainegiven through the nose is less well studied but is usually considered an appropriate alternative abortive therapy.
Oxygen
Research has found that more than 70% of people with cluster headaches benefit from oxygen therapy.
Oxygen therapy involves inhaling 100% oxygen with a flow rate of 6 to 15 liters per minute (L/minute). The oxygen inhalation is delivered via a face mask for 15 to 30 minutes, even if the pain eases up before then, to help prevent headache recurrence.
While a disadvantage of oxygen therapy is its lack of portability, there is no limit to how often it can safely be used. This makes it a good choice for those who endure multiple cluster attacks daily.
Triptans
Triptans are prescription drugs that target specificserotonin(a brain chemical) receptors (docking sites).
Research suggests that a triptan injectedsubcutaneously(in the fatty tissue, above the skin) or inhaled through the nose effectively treats acute cluster headaches. Oral triptans are inadequate at providing relief since the pain of a cluster headache peaks very rapidly.
The triptans primarily used for cluster headaches are Imitrex (sumatriptan), available as an injection or nasal spray, and Zomig (zolmitriptan), a nasal spray.
A drawback of triptans is that they cannot be used in people with certain underlying health conditions, namelyheart disease,stroke,peripheral artery disease, or significanthypertension(high blood pressure).
Lidocaine
Lidocaine (a numbing agent) administered through the nose (e.g., spray or drops) may be an option for people with cluster headaches who do not respond to oxygen or a triptan.
Transitional
Preventive
Preventive medications are intended to decrease the number of attacks and the duration and severity of the cluster cycle.
Verapamilis the most commonly used preventive medication for cluster headaches. Available under the brand name Verelan, verapamil is acalcium channel blocker, a class of drugs used to treat various heart conditions likeangina(a type of chest pain) andarrhythmias( irregular heartbeat)
Emgality(galcanezumab)is another preventive medication for cluster headaches. It’s acalcitonin gene-related peptide(CGRP) antibody injected monthly in the thigh, back of the upper arm, or buttocks.Emgality is usually stopped one month after the cluster cycle ends.
What Is CGRP?CGRP is a protein in the trigeminal nerve that dilates (widens) cranial blood vessels. It plays a role in the development of both cluster and migraine headaches.
What Is CGRP?
CGRP is a protein in the trigeminal nerve that dilates (widens) cranial blood vessels. It plays a role in the development of both cluster and migraine headaches.
Finally, surgical procedurestargeting specific nerves are under investigation to treat cluster headaches that do not respond to oxygen or medication.
One such treatment,occipital nerve stimulation,involves the surgical placement of electrodes at the base of the skull with leads connected to a pulse generator (a power source) implanted in the chest or abdomen. The pulse generator sends electrical charges to the occipital nerve, intending to interfere with pain signals.
Self-Care for Cluster Headaches
Cluster headache attacks are excruciating and debilitating and can negatively affect relationships, daily functioning, and quality of life.
Besides seeking care from aheadache specialist, you may consider seeing atherapistwith experience in cluster headaches or other pain disorders. This is because people with cluster headaches are more likely to experiencesymptoms of depressionandsuicidal ideationthan the general population.
Seek Emergency CareIf you have thoughts of suicide, dial988to contact the988 Suicide & Crisis Lifelineand speak with a trained counselor. If you or a loved one are in immediate danger, call911.
Seek Emergency Care
If you have thoughts of suicide, dial988to contact the988 Suicide & Crisis Lifelineand speak with a trained counselor. If you or a loved one are in immediate danger, call911.
Other self-care strategies to help optimize your cluster headache care include:
Whileacupressure (pressing on specific trigger points on the hand, head, neck, or foot)has been studied for some other primary headache disorders (such as migraine), research is lacking for cluster headache.
Avoiding Cluster Headaches Triggers
Scientists have identified variouscluster headache triggers. These factors may signal the brain (especially the hypothalamus) to undergo changes that create the headache and its associated symptoms.
Commonly cited triggers for cluster headaches include:
If you have cluster headaches, trying to avoid these triggers during a cluster cycle is essential. Once the cycle is over, confirm with your healthcare provider, but you can probably drink alcohol and/or be reexposed to the above triggers.
Lastly, smoking increases a person’s risk of developing cluster headache disorder.That said, smoking does not trigger individual cluster headaches. Whether stopping smoking can help is unclear, but it is recommended for many other health reasons.
Causes of Ongoing Cluster Headaches
Summary
Cluster headaches cause a sharp, piercing one-sided pain in or around the eye, eyebrow, or temple area. The cause is unknown but likely starts with activation of the hypothalamus (a gland in your brain).
Living with cluster headaches is not an easy feat, physically or mentally. Treatment often entails avoiding triggers during a cycle of cluster headache attacks, taking medication, and ensuring emotional support, as depressive symptoms are common.
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