"A healthy, robust man of middle age (was suffering from) troublesome pain which came on every day at the same hour at the same spot above the orbit of the left eye, where the nerve emerges from the opening of the frontal bone; after a short time the left eye began to redden and to overflow with tears; then he felt as if his eye was slowly forced out of its orbit with so much pain, that he nearly went mad. After a few hours all these evils ceased, and nothing in the eye appeared at all changed."
For those who have experienced them, cluster headaches are the most painful headache anyone can have. The pain has been described as "boring," "tearing," or "burning." Analogies also are used, such as "a hot poker in the eye", or as if "the eye is being pushed out." Anyone who has ever had a cluster headache has no doubt what they are. It's no exaggeration to say that the pain and desperation of cluster headaches have actually led to suicides.
As with any head pain, the place to start is with getting a diagnosis so you can get the proper treatment. A valuable tool in helping you and your doctor with a diagnosis is a headache diary.
Cluster headaches have been known by many names throughout the years - migrainous neuralgia, histamine cephalagia, petrosal neuralgia, sphenopalatine neuralgia, Sluder's Neuralgia and Horton's Headache, just to name a few. Its final designation came from the headache's pattern to cluster, both in number of headaches per day and number of days in an attack.
The universally accepted criteria for diagnosis and classification is that of the International Headache Society. The basic criteria for Cluster Headaches is:
- At least 5 attacks fulfilling B-D.
- Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15 to 180 minutes if untreated.
- Headache is accompanied by at least one of
the following:
- ipsilateral (occurring on the same side as the pain) conjunctival injection and/or lacrimation
- ipsilateral nasal congestion and/or rhinorrhea
- ipsilateral eyelid edema
- ipsilateral forehead and facial sweating
- ipsilateral miosis or ptosis
- a sense of restlessness or agitation
- Not attributed to another disorder³
Translated into English, all of that says the headache is accompanied by at least one of these symptoms on the same side as the pain: redness and/or swelling of the eye, tearing, nasal congestion and/or runny nose, swollen eyelid, forehead and facial perspiration, decreased pupil size, or droopy eyelid. Once the cluster starts, the pain intensifies rapidly and has often been called a "suicide headache" due to the extremely overwhelming pain.
It can be difficult, especially before diagnosis, to differentiate between cluster headaches and Migraine attacks. Adding to the confusion, it's not unusual for people to experience both clusters and Migraines, and possibly tension headaches as well. Clusters may vary from Migraines is some notable ways:
- Unlike Migraine, cluster headaches do not have discernible phases (i.e.. prodrome, aura, headache and postdrome). At the start of an attack, a cluster usually headache comes on without any warning; however, some individuals in a few studies have reported an aura or premonitory warning. Gastrointestinal symptoms are not usually reported with cluster headaches; although nausea has been reported in up to 40% of cases; vomiting is rare.¹
- Clusters, unlike Migraines, can be short in duration, anywhere from 15-180 minutes per attack, occurring several times a day over many days or weeks. Clusters can go into remission, giving the patient weeks, months or even years of relief from attacks. During an individual cluster period, the pain almost always occurs on the same side. Many patients report that clusters will wake them from a sound sleep in the middle of the night.
- During a cluster headache, it is more often very difficult to lie down, and people are known to pace the floor or keep moving in some other way. During a Migraine attack, movement most often worsens the pain, making it far preferable to lie down.
- Cluster headaches are more common in men than women. Interestingly, the estimated prevalence ration has been changing drastically over they years. By 1995, the ration was estimated to be 2.1:1, far closer than in the past. Researchers theorize that women have long been misdiagnosed because cluster headaches were thought to be so predominantly found in men. Migraines are more common in women than women at a ration of 4:1.
- Cluster headaches are far less common, occurring in 0.04% of the population. Migraine occurs in 12% of the population.
- Cluster headaches usually begin between the ages of 20 and 30. With Migraines, no similar age range can be estimated.
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