Cluster Headaches

What Are Cluster Headaches?

Cluster headaches are one of the most severe types of pain a person can experience. They occur in cyclical patterns or "clusters" of attacks, followed by remission periods. The pain is typically one-sided, often described as a burning or piercing sensation around the eye. Though not life-threatening, they significantly impact quality of life.¹

Symptoms²

Pain Characteristics

• Extremely severe, one-sided pain
• Centered around or behind one eye
• Burning, piercing, or sharp quality
• Rapid onset (peaks in 5-10 minutes)
• Lasts 15 minutes to 3 hours
• Often at same time daily

Associated Symptoms (same side as pain)

• Tearing of eye
• Eye redness
• Drooping eyelid
• Nasal congestion or runny nose
• Facial sweating
• Restlessness and agitation

Patterns³

Episodic

• Clusters last weeks to months
• Remissions last months to years
• More common type

Chronic

• Attacks occur for over a year
• No remission or less than 3 months
• About 10-15% of cases

Triggers

• Alcohol (during cluster period)
• Strong smells
• Heat
• Bright light
• High altitude

Treatment

Acute (Abort Attack)

• High-flow oxygen (most effective)
• Sumatriptan injection
• Sumatriptan or zolmitriptan nasal spray
• OTC painkillers don't work (too slow)

Preventive

• Verapamil (first-line)
• Lithium
• Corticosteroids (short-term bridge)
• Topiramate
• Greater occipital nerve block

Living with Cluster Headaches

• Keep oxygen and medication readily available
• Avoid triggers during clusters
• Maintain regular sleep schedule
• Connect with support groups
• See a headache specialist

Diagnosis

• Based on symptom description
• Physical and neurological exam
• MRI to rule out other causes
• Often misdiagnosed initially

References

1. May A, Schwedt TJ, Magis D, et al. Cluster headache. Nat Rev Dis Primers. 2018;4:18006.
2. Headache Classification Committee. International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211.
3. Robbins MS, Starling AJ, Pringsheim TM, et al. Treatment of cluster headache: the American Headache Society evidence-based guidelines. Headache. 2016;56(7):1093-1106.