Cluster Headaches

Overview

What are cluster headaches?

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:

  • Primary headaches: Start because of a response from the part of the brain that communicates pain. A primary headache is its own health challenge, not part of a larger issue.
  • Secondary headaches: Start because of another health condition. Several things can cause these headaches, including ear infections, nasal congestion and dehydration.

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.

Why are they called cluster headaches?

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.

Why do some people call them suicide 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.

Who gets cluster headaches?

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.

Symptoms and Causes

What causes cluster headaches?

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

What triggers cluster headaches?

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:

  • Triggers that start a new cycle (round) of headaches: Most people go months or years between cluster headache periods. When headaches start again, the shift often appears tied to changes in seasons. (The connection leads people to think they have allergies or sinusitis.) It may happen because of suspected ties between cluster headaches and the hypothalamus. This part of your brain contains your “circadian clock,” a built-in schedule that responds to sunlight.
  • Triggers that affect headaches during a cycle: During headache periods, the blood vessels in your brain change. These changes make you more sensitive to alcohol and nicotine. Drinking just a little alcohol can bring on a headache. Smoking can also make headaches feel worse or trigger a headache.

What are cluster headache symptoms?

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:

  • Often described as a burning or piercing feeling.
  • Lasts 15 minutes to 3 hours at a time.
  • Typically felt on the same side of the head in the current cycle — rarely may switch in the future.
  • Always centered behind one eye but can spread over the affected side’s forehead, temple, nose and gums.
  • Can make you feel like you can’t sit still and need to pace, unlike the relief lying down provides for migraines.

Other cluster headache symptoms

Cluster headaches may also cause:

  • Congestion: Your nose may run or become stuffy only on the side of the headache
  • Eye problems: You may experience a drooping eyelid, eye pain or a watering eye. Your pupil (black center of the eye) may also look smaller. These symptoms appear on the same side of the head as headache pain.
  • Face changes: You may start sweating and your face may become flushed on the side of the headache.

Are there warning signs for cluster headaches?

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.

Diagnosis and Tests

How are cluster headaches diagnosed?

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.

Management and Treatment

How are cluster headaches treated?

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:

  • Abortive treatment to stop attacks: Often, a headache will stop before you have a chance to see a healthcare provider. But if you get there in time, there are several effective ways to stop a cluster headache. A healthcare provider may give you injected medications or a nasal spray. These include sumatriptan, dihydroergotamine and zolmitriptan. The provider may also give you oxygen through a mask.
  • Medications to improve quality of life: Prescription medications can shorten a headache cycle. They can also make the headaches less severe. Calcium channel blockers, verapamil, lithium carbonate, divalproex sodium, melatonin or topiramate may help. There is a new preventive therapy that is a calcitonin gene-related peptide (CGRP) monoclonal antibody.
  • Other options when needed: Surgeons have tried operations for cluster headaches. But they haven’t had much success preventing them. Researchers are now testing newer therapies to see if they can work. One option uses mild electrical stimulation on the neck. Another creates electrical stimulation by placing a medical device through the upper gums.

What else can I do for cluster headaches?

Some alternative therapies may provide relief from cluster headaches, including:

  • Acupuncture: An ancient Chinese treatment, acupuncture uses small needles. They’re inserted into your skin at various points to relieve pain.
  • Physiotherapy: Treatment focuses on stretching, moving joints and massaging.
  • Spinal manipulation: This chiropractic adjustment adjusts the alignment of your spine.

Your healthcare provider can recommend what might help for your situation. Ask about your options.

Prevention

What can I do to prevent cluster headaches?

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.

Outlook / Prognosis

What can I expect if a doctor says I have cluster headaches?

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.

Living With

When should I see a doctor for a cluster headache?

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.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy