What Are Cluster Headaches?

Cluster headaches are often said to be the most painful of all headaches. They have been described as "boring," "bearing," "burning," "like a hot poker in the eye," and as "suicide headaches."

The term cluster headaches comes from the fact that attacks usually occur in series (cluster periods) lasting for weeks or months, separated by remission periods usually lasting months or years. However, about 10 to 15 percent of patients have chronic symptoms without remissions. The age of onset for cluster headaches is most often between the ages of 20 and 40, and they are more common in men than women at a ratio of 2:1. For many years, that ratio was stated to be 3:1. Researchers theorize that women have long been misdiagnosed because cluster headaches were thought to be so predominant in men.

Cluster headache symptoms

Cluster headaches are attacks of severe pain lasting 15-180 minutes and occurring from once every other day up to eight times in one day.

The pain is:

• severe
• unilateral
• orbital, supraorbital, temporal, or a combination of those sites.

These attacks also include one or more of these symptoms ipsilaterally:

• conjunctival injection
• eyelid edema
• forehead and facial sweating
• lacrimation
• miosis
• nasal congestion
• rhinorrhea
• ptosis

Most cluster headache patients are restless or agitated during attacks and find it hard to be still. Cluster sufferers characteristically pace the floor during an attack.

Cluster headaches are diagnosed as "episodic" when the attacks occur in periods lasting seven days to one year and are separated by pain-free periods lasting one month or longer. In "chronic" cluster headaches, attacks occur for more than one year without remission, or with remissions lasting less than one month.

There are no diagnostic tests to confirm cluster headaches. Diagnosis is accomplished by reviewing the patient's personal and family medical history, studying their symptoms, and conducting an examination. Cluster headaches are then diagnosed by ruling out other causes for the symptoms. It is essential that diagnosis is approached methodically and other causes of the symptoms be ruled out.

Treatment of cluster headaches

• 100 percent oxygen administered by mask
• sumatriptan (Imitrex, Imigran) nasal spray or subcutaneous injection
• DHE-45

The most commonly used preventive medications are:

• verapamil
• lithium
• divalproex sodium (Depakote, Depakote ER)
• topiramate (Topamax)
• melatonin
  

In addition to being extremely painful, cluster headaches can be very challenging to treat. In most cases, the best course of action is to seek care from a neurologist or headache specialist.

_Sources:

"The International Classification of Headache Disorders, 2nd Edition." Cephalalgia 24 (s1). doi: 10.1111/j. 1468-2982.2003.00824.x

Stephen D. Silberstein, MD; Alan Stiles, DMD; William B Young, MD; Todd D. Rozen, MD. "An Atlas of Headache." Parthenon Publishing, 2002.

Randolph W. Evans, Nina T. Mathew. "Handbook of Headache, Second Edition." Philadelphia: Lipincott Williams & Wilkins. 2005.

Young, William B., MD; Silberstein, Stephen D., MD. "Migraine and Other Headaches." Ney York: AAN Press. 2004.

Stephen D. Silberstein, MD, Richard B. Lipton, MD, and Donald J. Dalessio, MD. "Wolff's Headache and Other Head Pain," seventh edition. Oxford University Press, 2001.

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Teri Robert, About.com's Headaches and Migraine Guide since 2000, is a nationally-known author and award-winning patient advocate. In addition to her work here, she is the Support Advisor for MAGNUM, the National Migraine Association, and serves on the education committee of O.U.C.H., the Organization for Understanding Cluster Headaches. To read more about Teri, read her full bio.