Cluster headaches are a series of relatively short but extremely painful headaches every day for weeks or months at a time. You tend to get them at the same time each year, such as the spring or fall. Because of their seasonal nature, people often mistake cluster headaches for symptoms of allergies or business stress.
We don't know what causes them, but we do know that a nerve in your face is involved, creating intense pain around one of your eyes. It's so bad that most people can't sit still and will often pace during an attack. Cluster headaches can be more severe than a migraine, but they usually don't last as long.
These are the least common type of headaches, affecting less than 1 in 1,000 people. Men get them more than women do. You usually start getting them before age 30. Cluster headaches may disappear completely (go into remission) for months or years, but they can come back without any warning.
What Happens
You get a cluster headache when a specific nerve pathway in the base of your brain is activated. That signal seems to come from a deeper part of the brain called the hypothalamus, where the "internal biological clock" that controls your sleep and wake cycles lives.
The nerve that's affected, the trigeminal nerve, is responsible for sensations such as heat or pain in your face. It's near your eye, and it branches up to your forehead, across your cheek, down your jaw line, and above your ear on the same side, too.
An underlying brain condition, such as a tumor or aneurysm, won't cause these headaches.
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Characteristics of Cluster Headaches
There are a few things that set this type of headache apart. They include:
- Speed: Cluster headaches generally reach their full force quickly -- within 5 or 10 minutes.
- Pain: It’s almost always one-sided, and it stays on the same side during a period, the time when you're getting daily attacks. (When a new headache period starts, it might switch to the opposite side, but that's rare.) It's often described as having a burning or piercing quality. It may be throbbing or constant. You'll feel it behind or around one eye. It may spread to your forehead, temple, nose, cheek, or upper gum on that side. Your scalp may be tender. You can often feel your blood pulsing.
- Short duration: Cluster headaches usually only last 30 to 90 minutes. They can be as short as 15 minutes or as long as 3 hours, but then they disappear. You'll probably get one to three of these headaches a day. But some people have as few as one every other day, while others get them up to 8 times a day.
- Predictable: Attacks seem to be linked to the circadian rhythm, your body's 24-hour clock. They happen so regularly, generally at the same time each day, that they've been called "alarm clock headaches." They might even wake you up an hour or two after you go to bed. Nighttime attacks can be more severe than the daytime ones.
- Frequent: Most people will get daily headaches for 2 weeks to 3 months; in between these periods, they'll be pain-free for at least 2 weeks.
Symptoms
The pain usually starts suddenly. When that happens, you may notice:
- Discomfort or a mild burning sensation
- Swollen or drooping eye
- Smaller pupil in the eye
- Eye redness or watering
- Runny or congested nose
- Red, warm face
- Sweating
- You’re sensitive to light
Cluster headaches are more common in people who smoke or are heavy drinkers. During a cluster period, you'll be more sensitive to alcohol and nicotine -- just a bit of alcohol can trigger a headache. But drinking won't trigger one during headache-free periods.
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Possible Causes and Triggers
When you’re in the middle of a cluster period, any of these can bring on a headache:
- Cigarette smoke
- Alcohol
- Strong smells
Treatment
You have several options when it comes to treating these headaches:
Acute attack treatments: These help when the headache hits.
Triptans: These drugs are among the best ways to treat the pain. You might get:
- Sumatriptan (Imitrex, Onzetra Xsail, Sumavel, Zecuity, Zembrace SymTouch), which works both as a shot or inhaled
- Zolmitriptan (Zomig)
Dihydroergotamine (D.H.E. 45): This prescription medicine is based on the ergot fungus.
Lidocaine : This is a pain reliever, in the form of a nasal spray.
Oxygen: Your doctor might call it inhaled oxygen. You’ll breathe it in through a face mask for 15 minutes.
Preventive medicine can often stop a headache before it starts, Your doctor can prescribe medication to shorten the length of the cluster as well as lessen the severity of your attacks, including:
- Corticosteroid, like prednisone, for a short time
- Divalproex sodium (Depakote)
- Ergotamine tartrate (Cafergot, Ergomar)
- Gabapentin (Gralise, Neurontin)
- Lithium carbonate
- Topiramate (Qudexy XR, Topamax, Trokendi XR)
- Verapamil (Calan, Covera, Galcanezumab, Verelan)
Occipital nerve block (your doctor may also call it occipital nerve injection): The doctor will inject a mix of anesthetic and steroid into these nerves. Located at the base of your skull, they’re often the starting point for headaches. This is a temporary treatment until a preventive can start to work.
Nerve Stimulation: Some people who don’t respond to medication have better luck with:
Occipital nerve stimulation: Your doctor surgically implants a device that sends electrical impulses to this group of nerves at the base of your skull.
Neuromodulation: These FDA-approved noninvasive devices include:
- Cefaly: You put electrodes on your forehead and connect them to a headband-like controller that sends signals to your supraorbital nerve.
- gammaCore: This gadget, also known as a noninvasive vagus nerve stimulator (nVNS), uses electrodes to send signals to this nerve.
Surgery
If nothing else works, surgery may be an option for people who don't get a break from cluster headaches.
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Deep brain stimulation, which involves placing an electrode deep into the brain, is losing favor to less invasive options.
Most procedures involve blocking the trigeminal nerve, a main pathway for pain. It controls the area around your eye, but a misstep can cost weakness in your jaw and loss of sensation in your face and head.
Lifestyle Changes
These moves can help you avoid cluster headaches:
- Keep a regular sleep schedule: A change to your routine can kick off a headache.
- Skip alcohol: Any type, even beer and wine, can trigger a bout of headaches when you’re in a cluster series.
Alternative Treatments
Talk to your doctor about: