by Amanda Becerra, PA-S

cluster headache is a deep, excruciating, and one-sided headache that occurs behind one eye. Other symptoms include drooping of the eyelid, constriction of the pupil, tearing of the eye, bloodshot eye, runny nose, and stuffy nose. These symptoms occur on the same side as the headache. A cluster headache attack usually lasts from 5 minutes to up to 3 hours. Attacks can occur every day, usually 1 to 8 times per day, for about 6 to 12 weeks “in clusters” and then they may go away for several months. About half of those with this disorder have attacks at night, which wake them up from sleep. During attacks, a person having a cluster headache usually paces or rocks back and forth unlike a person having a migraine who prefers to lie still.

What causes a cluster headache?

The cause is unclear. However, the most commonly accepted theory is that the part of the brain in charge of body temperature, hunger, thirst, and circadian rhythm (known as the hypothalamus) becomes abnormally activated, leading to pain. Cluster headaches affect men more than women and it is a rare problem affecting less than 1 in 100 people. Many people with cluster headaches tend to smoke and this disorder can run in families.

How are cluster headaches diagnosed?

Cluster headaches can usually be diagnosed through history and exam. The neurological exam, best performed by a neurologist, is very important for looking at brain function. Imaging of the brain with computerized tomography (CT) or magnetic resonance imaging (MRI) may sometimes be ordered but is typically normal.

What are treatment options for cluster headaches?

During an attack, inhaled oxygen is commonly used. Other options include injections of sumatriptan (a common antimigraine medicine). Sumatriptan or zolmitriptan delivered through the nose (intranasal) can also be used. If none of these treatments work, lidocaine (numbing medicine) delivered through the nose, ergotamine (antimigraine medicine) taken by mouth, or dihydroergotamine (antimigraine medicine) by injection could be considered.

Oral corticosteroids (i.e. prednisone) are commonly given to break a cluster cycle. This medication acts to reduce inflammation. If attacks are longer-lasting, preventive medications are used such as a calcium-channel blocker, lithium, or topiramate.

Do you suffer from excruciating daily headaches? Does your headache wake you at night? Get relief from your pain! Schedule an appointment with an OrthoNeuro Neurologist to evaluate your headache symptoms and prescribe effective treatment.

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Goadsby PJ, Raskin NH. Migraine and Other Primary Headache Disorders. In: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Harrison’s Principles of Internal Medicine, 19e New York, NY: McGraw-Hill; 2014. Accessed May 05, 2017.

May A. Cluster headache: Epidemiology, clinical features, and diagnosis. In: Post T, ed. UpToDate. Waltham, Mass.: UpToDate; 2014. Accessed May 5, 2017.

May A. Cluster headache: Epidemiology, clinical features, and diagnosis. In: Post T, ed. UpToDate. Waltham, Mass.: UpToDate; 2017. Accessed May 5, 2017.

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