The Piercing Pain of Cluster Headaches


Minutes seem like hours if you're having a cluster headache. Learn how to recognize cluster headaches and how they're diagnosed and treated.


For a person with cluster headaches, seasonal changes may bring on severe, intense attacks of headaches. The attacks can come on suddenly and usually last from 30 to 90 minutes. They strike in cycles (or cluster periods) lasting a week to a year. During this time several headaches a day occur. There can be short or long headache-free periods. While the pain is intense, the headaches are not life-threatening. Treatment can lessen the pain and reduce the frequency of attacks.

What is a cluster headache?
A cluster headache is a series of headaches that occur in quick succession over a short time. The pain is often severe and usually is felt around or behind one eye. Cluster headaches may occur with clocklike regularity at the same times of day, or seasonally during the fall and spring when exposure to daylight changes. This suggests that the light-sensitive hypothalamus, the brain's biological clock, might be involved. But the cause of clusters headaches is still unknown.

Unlike migraine headaches, which tend to be more common in women, cluster headaches are more common among men in their late twenties. Cluster headaches are usually not linked with nausea or an aura (visual and other changes that often occur before a migraine headache).

What are the symptoms of cluster headaches?
Symptoms of cluster headaches include:

  • Intense pain. The pain is described as "sharp," and comes on rapidly over minutes.
  • One-sided headache. Pain is usually around or behind one eye.
  • Headaches occur in clusters, up to eight times in one day.
  • Headaches that last 30 to 90 minutes. They may occur at the same time each day.
  • Other symptoms. In addition to headache pain, you may have:
    • Sweating on the same side of the face as the pain
    • Watery or bloodshot eye
    • Runny or stuffy nose on one side
    • Constricted pupil
    • Restlessness

How are cluster headaches diagnosed?
Your doctor will ask if the headache is new or if it marks a change in existing headaches. Your doctor will do a neurological exam, testing for strength, sensation, reflexes and balance. If you have unusual headaches or an abnormal neurological exam, your doctor may order imaging tests (CT scan or MRI). Cluster headaches are diagnosed mostly from your medical history, so it's important to give your doctor as much detail as you can about your headaches. Make sure you mention:

  • How long headaches last
  • How many headaches you get in a day
  • A description of the pain - sharp, boring, piercing, burning
  • Symptoms other than pain, such as sweating, bloodshot eye or tearing
  • Triggers that bring on the headaches

How are cluster headaches treated?
There are two types of medications for cluster headaches: abortive and preventive. Abortive medications are used to stop symptoms once they have begun. Preventive medications are used to try to prevent cluster headache attacks. Surgery is also an option.

Abortive treatment

  • Oxygen. Inhaling oxygen through a mask over several minutes may help stop symptoms. Portable oxygen carriers are available, but this treatment may be most practical at night when you can keep oxygen at the bedside. Sometimes the headache comes back right after finishing an oxygen treatment.
    Triptans. Some of these medications are available as pills, injections or nasal spray. An injectable form of sumatriptan (Imitrex) often helps for cluster headaches and is commonly used to treat migraine headaches as well. Another triptan, zolmitriptan (Zomig), can also be taken as a nasal spray.
  • Dihydroergotamine. This is a type of medicine that narrows blood vessels in the brain, which may relieve headache attacks. It is usually used in an inhaled form.
  • Local anesthetics. These provide a numbing effect and are similar to the agents used by your dentist. Lidocaine (Xylocaine) is a local anesthetic available as nasal drops that is effective against cluster headaches.

Preventive treatment

  • Calcium channel blockers (such as verapamil). This is usually the drug of choice to prevent cluster headaches. These are the same medications that are used for high blood pressure. Side effects may include constipation, as well as swelling of the ankles, dizziness, nausea, fatigue and low blood pressure.
  • Lithium. This is a mood stabilizing drug used to treat bipolar disorder. It may also be effective in treating chronic cluster headaches. You need to have lithium levels in the blood monitored regularly.
  • Corticosteroids. These drugs suppress inflammation. The main drug used is prednisone, but only as a short-term option due to serious side effects. Headaches may come back after you stop taking them.
  • Medicines used to treat seizures (such as divalproex and topiramate). These have helped prevent cluster headaches in some people.

Surgical treatment

Surgery is a rare option that may be offered if you don't respond to medication.

  • Ablation procedures. These are surgical procedures to destroy nerves that send abnormal pain signals to the brain. Side effects may include muscle weakness and numbness.
  • Nerve stimulator. An experimental method that involves implanting a pacemaker-sized device in the back of the neck that blocks pain signals along nerve pathways.

What else do I need to know about cluster headaches?
There are certain things that may trigger an attack of cluster headaches. They include:

  • Sleep deprivation. Get enough sleep. Your headaches may get worse when your usual sleep pattern is disrupted.
  • Alcohol. Beer, wine and hard liquor are common triggers and can quickly trigger a cluster headache after you take a few sips.
  • Tobacco. Avoid all tobacco products - cigarettes, cigars, pipes and chewing tobacco.
  • Volatile solvents. The fumes from oil-based paints and gasoline can trigger a cluster headache.
  • Nitrates. Foods with nitrates include smoked and processed meats.
  • Nitroglycerin medication. If you take nitroglycerin for chest pain, talk to your doctor about an alternative medication.
  • Being at high altitude. If you sky dive, or hike at a high altitude, the reduced oxygen can trigger a cluster headache.




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