Cluster headache (CH) is a relatively rare type of headache that belongs to a group of headache disorders called the trigeminal autonomic cephalalgias. While it is one of the most painful headache syndromes, there are cluster headache treatment options available. People can experience cluster headache in a variety of ways, although most experience attacks that recur one to eight times a day. For those with episodic cluster, these painful periods last one or more months and then stop for months or years at a time. However, people who have chronic cluster can go years without any pain-free days. Headache attacks are excruciatingly severe and last between 15 mins and three hours each. During these attacks of pain, people may experience a variety of symptoms, including: red or teary eyes, swollen or drooping eyelids, small pupils, nasal congestion or runny nose, and sweating or swelling of the face–all on the same side as the head pain. Show “We call cluster headache a primary headache (like migraine and tension-type headaches) in that it’s not due to other disorders,” says Dr. Stewart Tepper, professor of neurology at the Geisel School of Medicine at Dartmouth. “We don’t know the actual cause of cluster headache, but we do know the anatomy behind it.” Finding the Right Treatment Options for Cluster HeadacheDr. Tepper has one important piece of advice for patients living with cluster headache: Get to a headache specialist. “Most cluster patients we can treat,” he says. A headache specialist can help you determine the best course of treatment for your symptoms and your lifestyle. While cluster headache experiences can vary, in most cases it can be successfully treated by individualizing acute and preventive drug treatment. A full treatment plan might include a temporary medication bridge to provide initial relief with steroids, as well as daily preventive medication to help avoid attacks during these weeks-long cycles. It’s important to note that only sumatriptan and dihydroergotamine injections are FDA-approved for acute treatment of CH, while galcanezumab is approved for the prevention of episodic cluster. The FDA has approved a portable device without significant side effects—the non-invasive vagal nerve stimulator—for the acute headache attacks and preventative treatment of episodic cluster headache attacks. This device is now commercially available with a prescription. It is important to work with your doctor to arrive at the treatment plan that’s right for you. Read on to see some of the available treatment options that you might find in your plan. Acute Attack TreatmentAcute treatments for cluster headache include: OxygenDr. Tepper says one of the most, if not the most, effective treatment options for CH is oxygen. “We recommend patients breathe through a non-rebreathing mask at a high rate of oxygen flow,” he says. “Generally, around 80% of attacks can be terminated by oxygen within 20 minutes.” TriptansSumatriptan six mg subcutaneous, sumatriptan 20 mg, and zolmitriptan five mg nasal sprays may be effective in the acute treatment of cluster headache, and can help shorten an acute attack. The use of oral triptans to stop an individual cluster attack is not recommended, because cluster attacks reach their peak very quickly and last about an hour, which is sooner than when oral tablets are able to provide relief. DihydroergotamineIntramuscular injections may be effective in the relief of acute attacks of CH. An intranasal form, although less effective, may benefit some patients. LidocaineLidocaine nasal drops may be used to treat acute attacks of CH. A nasal dropper may be used and the dose (one mL of 4% lidocaine) can be repeated once after 15 minutes if necessary. This medication must be made up at a special compounding pharmacy. Preventive TreatmentsThe options for preventive treatment in CH are determined largely by the length of the attack, as opposed to the designation of episodic versus chronic CH. Preventives may be regarded as short-term or long-term, based on how quickly they act and how long they can be safely used. In general terms, monotherapy is preferred—although some patients, preferably managed by physicians with experience, will require more than one preventive. VerapamilVerapamil, a medication used to treat high blood pressure, is a commonly prescribed medication for CH prevention. Verapamil is traditionally started at a low dose, which might be increased to achieve treatment outcomes. EKG’s may be done prior to starting treatment and before the dose is increased, and each patient will need a different dose to achieve remission. Bridge TherapyPrednisone may be administered as a short-term bridge for 10-21 days, while waiting for the prevention medications to begin to work. It is often given in a gradually decreasing dosage over several weeks. Prednisone should be used no more than once a year to avoid serious side effects. Lithium CarbonateLithium carbonate is mainly used for chronic CH because of its side effects, although it is sometimes employed for the episodic variety. TopiramateStudies have shown that topiramate can be an effective option for the preventive treatment of episodic and chronic cluster headache. CGRP monoclonal antibodiesGalcanezumab received approval from the FDA for preventive treatment of episodic cluster headache.“There’s never been a more hopeful time for cluster patients than right now,” says Dr. Tepper. “The hope is that in three or four years our treatment will be vastly improved.” The American Migraine Foundation has an extensive collection of information on cluster headache and other disorders that cause severe headache in our resource library. Use our Find a Doctor tool to locate a headache specialist in your area, and discover your support community by joining the Move Against Migraine Facebook Group. Reviewed for accuracy by the American Migraine Foundation’s subject matter experts, headache specialists and medical advisers with deep knowledge and training in headache medicine. Click here to read about our editorial board members.
Cluster headaches cause severe, one-sided pain, occur up to eight times a day, in cycles of weeks to months before remission. Those 20 and 40 years old are most affected. Treatments include avoiding triggers, using abortive treatments (eg, oxygen, “triptans”) and preventive agents (eg, verapamil, CGRP). Newer treatment include electrical stimulation.
Dr. Papay & Dr. Tepper headache research. Cluster headaches are very severe headaches, more so even than migraines. Healthcare providers consider both types of headaches primary headaches, rather than secondary headaches. The difference:
Cluster headaches can disrupt your life for weeks or even months at a time. They tend to follow a pattern, often showing up at the same time each day. They can also wake you up an hour or two after going to bed. These nighttime headaches may feel more severe than those during the day. Cluster headaches get their name from how they affect you. They come on in clusters, or groups, before temporarily going away for most people. Each headache tends to last 30 to 45 minutes, though some are shorter and some longer. You may experience up to eight of these headaches within 24 hours. And this may happen for weeks or several months. Then the clusters usually pause, for reasons that aren’t yet understood. The headaches go into remission (go away) for months or years before returning. Some people never get much of a break, though. They experience chronic (ongoing) cluster headaches. This happens to about one in five people who get cluster headaches. Some people call cluster headaches “suicide headaches.” This name came from people taking their lives when experiencing a cluster headache or anticipating one. Unfortunately, some people feel like they have no hope with cluster headaches. But healthcare providers can help you with these headaches. Learn more about recognizing suicidal behavior or call the National Suicide Prevention Lifeline at 800.273.8255. Cluster headaches affect 1 out of every 1,000 people. That makes them less common than migraines, though some people get both types of headaches. Symptoms of cluster headaches usually start showing up between the ages of 20 and 40. Researchers once thought these headaches affected men more often. They now believe they affect men and women equally. Cluster headaches are also more common in people who smoke and frequently drink alcohol. Many people who get cluster headaches also have sleep apnea.
Experts still don't know a lot about cluster headaches, including exactly what causes them. Cluster headache is a type of trigeminal autonomic cephalgia -- involving the hypothalamus, a brain structure of the autonomic nervous system and involve the first branch of the trigeminal nerve. The symptoms are severe sidelocked pain, typically around and in the eye, tearing If you experience cluster headaches, you likely know the triggers. These are things that can start headaches or otherwise affect them. There are two ways to look at triggers:
Cluster headaches tend to have very recognizable symptoms. When symptoms set in, it usually only takes 5 to 10 minutes for them to reach their worst. Common symptoms include one sided head pain and other symptoms involving the eye, nose and skin on the same side as the pain. Pain from cluster headaches Pain from cluster headaches has a few notable features:
Other cluster headache symptoms Cluster headaches may also cause:
You may experience slight discomfort or a burning feeling on one side of your head just before a cluster headache. But cluster headaches often come on fast, so these signs don’t leave much time to prepare.
To diagnose a cluster headache, a healthcare provider will need to thoroughly check you. A specialist called a neurologist or a headache specialist will rule out other problems that can cause headaches. You’ll likely need to have imaging done, such as an MRI or CT scan.
Unfortunately, there is no cure for cluster headaches. But you do have treatment options that can make them a little less painful. Treatment options include:
Some alternative therapies may provide relief from cluster headaches, including:
Your healthcare provider can recommend what might help for your situation. Ask about your options.
The best way to prevent cluster headaches is to avoid triggers such as drinking and smoking. Also, if you suspect you have sleep apnea, get it treated. The sleep condition appears tied to cluster headaches in some way.
Your healthcare provider will work with you to find a treatment. Your treatment plan may include medications and other therapies. Make sure to follow your healthcare provider's recommendations for the most effective relief.
If you suspect you have cluster headaches, reach out to a neurologist or headache specialist to confirm the diagnosis and to exclude other causes that may mimic headache. You do not have to be in the midst of a cluster to be seen by a specialist to be diagnosed. A note from Cleveland Clinic Everyone gets headaches from time to time, for various reasons. But cluster headaches are no ordinary headaches. If you experience severe headaches in a pattern, talk to your healthcare provider. You could have cluster headaches and can get treatment for this painful condition.
Last reviewed by a Cleveland Clinic medical professional on 02/04/2021. References
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