Pain Management: Cluster Headaches

Cluster headaches are recurrent, severe headaches that occur in "clusters" during periods of time called cluster periods or episodes. These headaches, which are said to be more painful than migraine headaches, result in an intense, stabbing pain around the eye or temple. The pain, which usually lasts between 15 and 180 minutes, may spread to the face and upper neck.

During a cluster period, an individual is more prone to having the headaches and may have several headaches every day. During a cluster headache cycle, the attacks of severe pain often occur at the same time each day.

Cluster headaches, which are more common in men than in women, can go into remission only to return months or years later.

What Causes Cluster Headaches?

The exact cause of cluster headaches is not known. Many experts believe that cluster headaches and migraine headaches have a common cause that begins in the trigeminal nerve, a nerve that carries sensations from the head to the brain and that ends in the blood vessels that surround the brain. Other experts link cluster headaches to the hypothalamus, an area of the brain. Either explanation would account for the periodic nature of the headache.

What Are The Symptoms of Cluster Headaches?

Cluster headaches often occur with the following symptoms:

• Deep, stabbing pain around the temple or the eye
• Stuffy or runny nose
• Tearing and redness in one eye
• Droopy eyelid

How Are Cluster Headaches Treated?

People with cluster headaches usually receive drug therapies. These treatments may be classified as abortive or preventive.

Abortive treatments are directed at stopping or reducing the severity of an attack, and include:

• Inhalation of high-flow, concentrated oxygen
• Injection of Depo-Medrol
• Imitrex injection
• Dihydroergotoamine injection and ergotomine tartrate tablets
• Zomig, Zomig-ZMT, and Zomig nasal spray
• Maxalt, Maxalt-MLT
• Axert
• Deltasone

Preventive treatments are used to reduce the frequency and intensity of cluster headaches and improve the person's quality of life. Preventive drugs include:

• Blood pressure medications, such as beta-blockers and calcium channel blockers
• Antidepressants
• Anticonvulsants
• Periactin
• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Naprosyn
• Sansert
• Calan, Verelan, Covera-HS
• Eskalith, Lithane, Lithobid, Lithonate, Lithotabs

Surgeries including nerve blocks, ablative neurosurgical procedures and radiosurgery have helped some people with cluster headaches. Nerve blocks involve the injection of pain medicine into or around a nerve or the spine. Ablative neurosurgical procedures are operations that involve the removal or destruction of a part of the brain, the spinal cord, or a nerve. Radiosurgery, a type of surgery that uses radiant energy and does not involve cutting, recently has been used to provide a less invasive alternative for people who have persistent cluster headaches.

Some people with cluster headaches have been helped by alternative or complementary therapies such as chiropractic, acupuncture, osteopathic manipulation, and herbal remedies.

Reviewed by the doctors at The Cleveland Clinic Pain Management Department.