Cluster Headache

Man with Cluster Headache

Cluster headaches come in recurring patterns or clusters and take their name from that custom. They normally occur about the same time of year at the same time of day or night and involve the same location in the head. Cluster headaches are more painful than are most other types of headaches and routinely wake victims in the night with extreme pain originating in or around one eye and affecting only one side of the head. Cluster periods can last several weeks or several months, and periods of remission may continue for a few months or even a few years.

The condition is not common, and it is not fatal, but those who suffer from cluster headaches know about the intense pain they can create. Effective treatments may help shorten attacks and lessen their severity, and medications may decrease their frequency as well.


Researchers have been unable to determine exactly what causes cluster headaches, but some believe hypothalamus abnormalities may play a part in the painful condition. Imaging studies performed during cluster headache attacks have revealed increased activity in the hypothalamus gland, which contains the body’s biological clock. Because cycles of headache periods often coincide with yearly seasons and normally occur at the same time each day, the biological clock may be partly responsible for the condition.

Another theory suggests that the release of histamines and serotonin causes dilatation of blood vessels in the brain, which compresses and irritates the trigeminal nerve and creates intense pain.

Some risk factors that may incite cluster headaches include:

· Cigarette smoking and alcohol consumption
· Bright lights
· High altitudes
· Heat
· Physical exertion
· Illicit drugs such as cocaine
· Vasodilating drugs

After a period of cluster headaches begins, alcohol can quickly increase the attacks’ severity.


Unfortunately, most common over-the-counter medications have no effect on cluster headaches, but preventive therapies may decrease the severity and frequency of attacks. Avoiding nicotine and alcohol can also lower the risk of getting cluster headaches. Preventive medications may enhance the effectiveness of acute medications as well.

Some typically used therapies for the condition include fast-acting treatments for acute pain:

· Oxygen as the initial treatment
· Triptans along with oxygen
· Octreotide (sandostatin)
· Local anesthetics
· Dihydroergotamine (D.H.E. 45)
Medications for Headache
Preventive therapy is most efficient when it begins at the commencement of a cluster episode and may help overcome the attacks. Among other issues, a doctor considers the regularity and length of episodes when determining which medicine to use for therapy. After the anticipated length of a cluster period has passed, the doctor may gradually discontinue the drugs.

Preventive treatments include:

· Ergotamine (ergots)
· Capsaicin taken intranasally
· Calcium channel blocker (verapamil)
· Inflammation-suppressing drugs (corticosteroids)
· Lithium carbonate
· Melatonin
· Anti-seizure medications

Because cluster headaches are highly resistant to pharmacologic therapy, doctors may perform one of the minimally invasive surgical procedures effective in treating the condition. Sphenopalatine ganglion (SPG) blockade appears to provide the most successful results.


You cannot prevent a first attack of cluster headaches because their cause is unknown, but you can help manage subsequent events with preventive strategies. For example, changes in normal sleep patterns can possibly bring on a period of cluster headaches, so following a regular sleep routine may be helpful. However, if you have just begun suffering from cluster headaches, visit your doctor to identify the best treatment and to rule out the possibility of a serious medical condition.