Cluster Headaches: Causes, Symptoms, & Treatment

What Is a Cluster Headache?

Cluster headaches are clusters of painful headaches, followed by pain-free periods. These headaches are generally characterized by pain that is often localized on one side of the head or around one eye, though pain may radiate to other areas of the face, head, neck, and shoulders.

There are two types of cluster headaches:

• Episodic: These headaches occur regularly for less than a year, and are followed by a headache-free period of one month or longer.

• Chronic: These headaches occur regularly for a year or longer, and typically have a shorter headache free period.

Most often, cluster headaches happen after you’ve fallen asleep. A minority of patients develop cluster headaches during their waking hours. For most, cluster headaches begin without any warning, though a small percentage experience visual disturbances like flashing lights and auras before the onset of any pain.

Cluster Headache Symptoms

The pain associated with cluster headaches is described as constant, severe, piercing, and burning, and it is often so intense that you may not be able to stay still. One marked difference between cluster headaches and migraines is that migraine patients will lie down to counteract their pain, while cluster headache patients will pace or rock back and forth. Cluster headaches begin suddenly, and become severe within 5-10 minutes, with pain lasting up to two hours at a time.

If you’re experiencing cluster headaches, you may also experience the following physical symptoms:

• Eye symptoms: You may also experience a droopy eyelid, constricted pupil, or excessive tearing or redness in the eye.

• Vision challenges: In addition to potential eye symptoms, you may also experience sensitivity to light.

• Facial discomfort: Swelling under one or both eyes, a congested or runny nose, and facial flush or pale skin are common cluster headache symptoms.

• Bodily discomfort: Nausea, restlessness, and extreme agitation are commonly associated with cluster headaches.

What Causes Cluster Headaches?

Cluster headaches are caused when the blood vessels that carry blood to your head and face dilate, in turn putting pressure on your trigeminal nerve, the nerve that sends pain signals to your brain. If you experience cluster headaches, some research suggests you may have abnormalities in your hypothalamus, the area of your brain that regulates sleep, body temperature, and hormones. In other cases, your cluster headaches may be a result of sudden releases of chemicals in your brain, including histamine—a chemical associated with allergies—or serotonin—a neurotransmitter that regulates mood.

Unlike tension headaches and migraines, cluster headaches do not appear to be triggered by your behavior, though you should avoid drinking alcohol and being around strong chemical smells while you’re experiencing a cluster.

Diagnosis of Cluster Headaches

When diagnosing your headache disorder, your doctor will make careful note of when, where, and how often you have your attacks. Cluster headaches are characterized by the frequency and length with which they cycle. You should be prepared to give your doctor a detailed description of your pain in order to get an accurate diagnosis.

After talking with you about your symptoms, your doctor may use other diagnostic approaches to identify whether or not you suffer from cluster headaches. You may be asked to undergo a basic neurological examination to test the function of your brain and nervous system. During the exam, your doctor may use instruments like a light and reflex hammer to check your motor skills, reflexes, senses, balance, coordination, and nerve function. Most exams are short and routine, and should not cause you any discomfort or pain.

If your doctor believes that further tests are warranted, they may order imaging tests to rule out other underlying conditions that might be causing you pain. The imaging tests they order include either:

• Magnetic resonance imaging (MRI) scans: An MRI is a non-invasive and painless technique that uses magnet radio waves and computer imaging to create a detailed image of your internal organs and tissues.

• Computed tomography (CT) scans: A CT scan is a painless imaging procedure that takes multiple x-ray images from different angles and, using computer processing, stitches them together into a detailed image.

Cluster Headache Treatment

Although there is no cure for cluster headaches, many patients find relief using a variety of medical treatments and techniques to treat and prevent their pain. Because attacks come on suddenly, fast-acting pain medications and other therapies are important in alleviating pain. Treatments that may be successful in managing your cluster headache pain include:

Therapies and remedies

• High flow oxygen therapy: You may find significant relief with high flow oxygen therapy which involves breathing in 100% pure oxygen through a face mask.

• Cold therapy and other home remedies: Cold water or cold packs applied to the pain location may alleviate symptoms. Additionally, ginger tea, deep breathing exercises, a regular sleep schedule, and over-the-counter supplements like magnesium, kudzu, vitamin B-2, and melatonin can help you manage your symptoms.

Medications

• Triptans: The same tryptamine-based medications that constrict blood vessels to treat migraines can help those who suffer from cluster headaches. Because cluster headaches develop suddenly, medications must either be injected or taken as a nasal spray to work as quickly as possible. Though triptans have few side effects, they can exacerbate heart conditions and should not be taken if you are pregnant or breastfeeding.

• Octreotide (Sandostatin): This injectable medication mimics somatostatin, a naturally-produced chemical that slows the release of hormones like serotonin also works by constricting blood vessels. Although drug trials have shown that the medication is an effective treatment for cluster headaches, it’s considered less effective than triptans and is usually only prescribed as a secondary option.

• Dihydroergotamine (DHE): This injectable medication can help relieve pain within five minutes. DHE is considered a safe and effective way to control cluster headaches, though it should not be used in conjunction with sumatriptan.

• Intranasal anesthetics (numbing medications): Medications like lidocaine have been studied as possible treatment options for cluster headache pain.

Researchers are continually exploring new treatment options for cluster headaches. The Federal Drug Administration (FDA) recently approved a noninvasive neuromodulation device called gammaCORE which applies mild electrical pulses to your vagal nerve at the base of your neck. Other therapies, including an electrical stimulator implanted in your gums and an injectable antibody-based treatment, are currently in clinical trials.

Cluster Headache Prevention

A doctor will recommend specific headache prevention measures based on the regularity and duration of your cluster headaches, and whether they are chronic or episodic in nature. Potential preventative treatments include:

• Lithium carbonate: This medication is often used to treat bipolar disorder, and can also be an effective treatment for chronic cluster headaches. Although scientists are still not sure why the medication works as well as it does, some believe it’s because it impacts REM sleep, the sleep stage when most people develop headaches. Others suggest that it beneficially affects serotonin and histamine levels.

• Corticosteroids: Inflammation-suppressing corticosteroids like prednisone are highly effective at treating cluster headaches that occur in short bursts with long remission patterns in between. They can be a great short-term option but can carry more significant risks, including hypertension, cataracts, and diabetes if they are taken for a long period of time.

• Surgery: If you don’t respond well to medications or other noninvasive therapies, your doctor may suggest surgery in which an electrode or neurostimulator is implanted in your brain. This implant stimulates the occipital nerve or the nerve cells that are linked to the trigeminal nerve where cluster headaches form.

Risk Factors and Complications

Cluster headaches are rare, affecting less than one in 1,000 patients. However, there are a few risk factors that may make you more susceptible to developing the condition, including:

• Sex: Men are 5-6% more likely to develop cluster headaches than women.

• Smoking: The majority of cluster headache sufferers are heavy smokers.

• Age: Cluster headaches usually develop in patients that are between 20-40 years old.

• Genetic predisposition: People with a family history of cluster headache are more likely to develop it themselves.

Cluster headaches are not life-threatening and do not cause brain damage. The attacks, however, can be intensely painful and sometimes debilitating, and the experience of that pain can significantly impair your overall well being.

When to See a Doctor

If you are experiencing intensely painful headaches that are unexplainable, occur regularly, wake you up in the middle of the night, or feel localized around a specific area of your face or eye, it’s time to make an appointment with your doctor.

Before your appointment, try to keep a headache diary that includes:

• Information about the date of your headache
• The duration and intensity of the pain
• Any possible triggers
• Symptoms you experienced before, during, or after the headache
• Medications and supplements you are taking
• Any remedies that provided you pain relief

Providing as much information to your doctor as you can will help them pinpoint the cause of your pain and recommend the best treatment options for you.

Occasionally a headache can signal a medical condition that requires emergency care. If you are experiencing any of the following, call 911 or visit your nearest emergency room:

• A headache that comes on explosively, violently, or “feels like a thunderclap”

• A headache that develops after weightlifting, aerobics, jogging, sexual activities, or a head injury

• A headache that is accompanied by slurred speech, memory loss or confusion, a change in vision, difficulty moving arms or legs, or loss of balance

• A headache that is accompanied by vision problems, pain when chewing, weight loss, fever, stiff neck, or nausea

• A headache that gets progressively worse over 24 hours

• A headache that is your first ever, your “worst ever,” or if you have just started getting headaches and you are over 50

• A new headache and you have a history of cancer

• A new headache and you are immunocompromised by diseases like HIV or medications that weaken your immune system like chemotherapy drugs and steroids

How K Health Can Help

Headaches may be painful but they are treatable. Did you know you can get affordable primary care with the K Health app? Download K to check your symptoms, explore conditions and treatments, and if needed text with a doctor in minutes. K Health’s AI-powered app is HIPAA compliant and based on 20 years of clinical data.