Cluster headaches

What is a cluster headache?

A cluster headache is an extremely intense headache that usually causes pain around your eye on one side of your head. They’re called cluster headaches because they come in clusters, or cyclical patterns, with bouts of headaches for a few weeks or months at a time, often at the same time of year.

What causes cluster headaches?

The exact cause of cluster headaches isn’t fully understood, but it’s thought to be linked to abnormalities in your hypothalamus (your body’s biological clock).

Other factors that may play a part include:

• Smoking

• A family history of cluster headaches

• Once a cluster period begins, headaches may be triggered by drinking alcohol or by strong smells, like paint, perfume or petrol

Anyone can get cluster headaches, but they are rare. They tend to affect people in their 30s and 40s, and men are more likely to get them than women.

Cluster headaches symptoms

During a period of cluster headaches, it’s typical to get several daily attacks, each lasting between 15 minutes and 3 hours at a time. The pain comes on suddenly, with no warning. This might involve:

• Intense pain on one side of the head – usually the same side during each attack

• Pain around one eye, and sometimes the temple and face

• A sharp, burning or piercing sensation

• Other symptoms can include:

• Feeling agitated and restless

• Pacing or rocking

• The eye on the affected side becomes red, watery, droopy or swollen

• The pupil in your eye on the affected side gets smaller

• Sweating

• A runny or blocked nose

A cluster period is usually followed by a period of remission, which can last for months or even years before they start again.

Diagnosing cluster headaches

See a doctor if you’re experiencing intense headaches. This can be a symptom of other conditions, and they may recommend a brain scan, like an MRI or CT scan, to rule these out first.

Diagnosis is usually made if the brain scan comes back normal and your symptoms are typical of cluster headaches.

Cluster headaches treatment

After diagnosis, you’ll usually be referred to a neurologist (brain specialist) to discuss treatment options.

Over-the-counter painkillers aren’t practical for cluster headaches as they don’t take effect quickly enough. Instead, you’ll need specialist treatment that must be taken as soon as the cluster headache starts. These should relieve pain within 15 -30 minutes.

Home treatment options include:

• Injections – You can give these to yourself at home up to twice a day. They contain a medicine called sumatriptan, a type of triptan medication that helps to relieve headache pain

• Nasal spray – Containing different types of triptan medications, these are a good alternative if you prefer not to have injections

• Oxygen therapy – Breathing pure oxygen from a cylinder through a special face mask to relieve pain

If these treatments aren’t helpful, the doctor may recommend other therapies. For example:

• Stimulation device implantation – This involves surgery where a small device is implanted in the side of your face. It gives off electrical currents that stimulate a part of the nervous system linked to cluster headaches

• Transcutaneous vagus nerve stimulation – Using a handheld device placed on the side of your neck to give off electrical currents that stimulate a nerve in the neck. This is quite a new treatment that can be used to treat cluster headaches and also prevent them from happening

Preventing cluster headaches

You may be prescribed a preventative medication. These are taken as soon as a bout of cluster headaches start and need to be continued until you think the bout has finished.

There is a range of medications that can help to prevent cluster headaches. The most commonly-used option is a calcium channel blocker medication, but you may also be recommended a corticosteroid, lithium medicine or local anaesthetic injections into the back of your head.

It’s also a good idea to understand any triggers that can bring on cluster headaches once a bout has started, and to avoid these during cluster periods.