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Cluster headaches Content Supplied by NHS Choices
Introduction

Cluster headaches are excruciating attacks of pain in one side of the head, often felt behind the eye.

Sufferers often call them 'suicidal headaches' because they're so severe.

This page aims to explain the causes, symptoms, treatment and prevention of cluster headaches, and offer advice to anyone who suffers them.

Cluster headache attacks

Cluster headaches begin unexpectedly. They're much more painful than migraines or any other type of headache.

They're called cluster headaches because sufferers usually get one to three of these attacks every day, for several weeks or months, before they subside. A pain-free period will follow, which sometimes lasts months or years, before the headache attacks start again.

Each cluster headache lasts between 15 minutes and three hours (but often less than an hour). They may start in the early hours of the morning and wake the person from sleep. 

Because of the intensity of the pain, some people will pace the room, rock, or bang their head against the wall out of frustration, restlessness and despair.

See Cluster headaches - symptoms for more information.

Types of cluster headache

There are two types of cluster headache, episodic or chronic (long-term).

  • episodic - headache clusters are separated by headache-free periods of one month or more
  • chronic - headache clusters are separated by headache-free periods of less than one month, or are not separated at all

About 10% of cluster headache cases are chronic.

Who is affected

Cluster headaches are rare and affect around 1 in 1,000 people. Anyone can be affected, but approximately 8 out of 10 people who have them are men and most are smokers.

It's not known what causes cluster headaches, but they're more common in autumn and spring. In some people, an attack can be triggered by drinking alcohol or an extreme increase in temperature (such as from exercising in hot weather). See Cluster headaches - causes for more information.

Treatment and support

Cluster headaches can severely affect quality of life, so it's important that sufferers are referred to a specialist clinic for treatments to relieve and prevent the attacks.

Organisations such as Ouch UK and the Worldwide Cluster Headache Support Group offer advice and support.

Although cluster headaches can cause great suffering, they're not life-threatening. They can often be relieved with a medication called sumatriptan or with oxygen therapy (see Cluster headaches - treatment for more information).

These treatments may vary in effectiveness from person to person. A few treatments may need to be tried before the attacks are under control.

Symptoms of cluster headaches

The pain of a cluster headache starts quickly, without warning, and is described as excruciating.

The headache always affects one side of the head and is usually felt around the eye. Sometimes it affects the temples (forehead) and cheeks.

Most people feel restless and frustrated during an attack as the pain is so intense. They may react by rocking, pacing or banging their head against the wall.

An attack is relatively short, lasting between 15 minutes and three hours (but often less than an hour).

Pattern of attacks

Headache attacks occur in groups or clusters, which usually happen one to three (and up to eight) times a day. They occur every day for several weeks or months and are followed by a period of no headaches, which lasts for months or years (the average is one year). 

Cluster headaches usually affect the same side of the head, although they can sometimes move to the opposite side.

One in 10 people have chronic cluster headaches, where the attacks occur regularly without significant pain-free intervals.

During a period of cluster headaches, the headaches often occur at the same time each day. For example, people often wake up with a cluster headache within around two hours of going to sleep, at the same time each night or early in the morning.

Other symptoms

Cluster headaches are associated with one or more of the following symptoms:

  • inflammation (redness and swelling) of the eye
  • drooping and swelling of the eyelid
  • a smaller pupil during the attack
  • watering from the eye
  • sweating of the face
  • a blocked or runny nose on the affected side of the face
Causes of cluster headaches

The cause of cluster headaches is unknown and they usually occur unexpectedly.

Research suggests that when a cluster headache happens, there's a lot more activity in an area of the brain called the hypothalamus. It's thought that the hypothalamus releases chemicals that trigger the cluster headaches, possibly by causing blood vessels to widen, causing an increase in bloodflow to the brain.

It's not known what causes the hypothalamus to act in this way. However, in some people, cluster headaches are triggered by certain things, such as drinking alcohol or an extreme increase in temperature (such as from exercising in hot weather).

Treating cluster headaches

Cluster headaches can't be treated with over-the-counter painkillers, such as paracetamol, as they're too slow to take effect. You'll need to be treated at a specialist clinic.

There are two main types of treatment:

  • those that relieve cluster headaches
  • those that prevent cluster headaches

Relieving cluster headaches

Sumatriptan

A drug called sumatriptan (Imigran) is commonly used to treat cluster headaches. It works in a similar way to a brain chemical called 5HT. It causes your blood vessels to narrow, reducing bloodflow to the brain.

Sumatriptan is usually given as an injection, which you can give yourself as soon as the headache starts. It works very quickly (within about 10 minutes).

The adult dose in an injection is 6mg and you can take a maximum of two injections in 24 hours, as long as they're at least an hour apart.

If an injection is unsuitable, sumatriptan or zolmitriptan nasal spray may be used.

Some people have mild side effects, such as nausea, dizziness, tiredness and a dry mouth. If you have any side effects, talk to your GP. You shouldn't take it if you have heart disease or peripheral vascular disease.

Oxygen therapy

Your doctor may prescribe oxygen cylinders to use at home. You breathe a high flow of pure oxygen through a mask for about 15 minutes, up to five times a day. It's a safe treatment and there's evidence that it is effective in relieving cluster headaches.

Preventing cluster headaches

If attacks of cluster headaches happen often or last for more than three weeks, preventative treatments are usually necessary. This involves starting treatment as soon as the headaches begin, and taking it every day throughout the period of headaches until they end.

Preventative treatments must only be administered under the guidance and close monitoring of a specialist. Treatments are outlined below.

Verapamil

Verapamil tablets are usually used to treat heart problems but are also effective at preventing cluster headaches. The heart must be closely monitored with ECGs (electrocardiograms) when the dose of verapamil is increased.

Lithium

Lithium tablets are normally used to treat mood disorders, but can help cluster headaches. The level of lithium in your blood may need to be carefully monitored to avoid side effects.

Methysergide

Methysergide tablets are effective at preventing cluster headaches but should only be used when other treatment hasn't worked. Due to the risk of side effects, they shouldn't be used for longer than six months.

Occipital nerve anaesthetic block

The occipital nerve runs from the top of the spine to the scalp and is involved in the pain of cluster headaches. Occipital nerve block is the injection of a local anaesthetic, such as lidocaine, into the back of the head to relieve the pain of cluster headaches for a period of time (usually several weeks). Although there's a lack of research evidence on this treatment, it appears to provide relief for some patients.

Preventing cluster headches

Alcohol

Alcohol may trigger attacks of cluster headaches during the period that the headaches occur. Avoiding drinking alcohol during these periods will reduce the frequency of headaches. During headache-free periods, alcohol doesn't appear to trigger attacks.

Nitroglycerin

Inhaled nitroglycerin - a medication that causes the blood vessels to enlarge - can cause attacks of cluster headaches. It's recommended that you avoid this at all times.

Temperature

An extreme increase in temperature can trigger a cluster headache, so avoid exercising in hot weather and anything else that may make your body temperature suddenly increase.

See what the doctor sees with Map of Medicine

The Map of Medicine is used by doctors throughout the NHS to determine the best treatment options for their patients. NHS Choices offers everyone in England exclusive and free access to this cutting-edge internet resource, which lets you see exactly what your doctor sees.

The information in the Map has been approved by the UK's leading clinical experts, is based on the best available clinical evidence, and is continually updated. To take advantage of this unique resource go to:

Map of Medicine: headache in adults

 
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