Cluster Headache Explained
By: Brooklyn A. Bradley, BS; Medically edited by Dr. Deena Kuruvilla, MD
Cluster headache is one of the most intense types of headache, and often come in intense bouts that profoundly affect one’s quality of life. In today’s blog post, we will dive deeper into the complexities of cluster headache, and shed light on their symptoms, underlying causes, and the most recent treatment options available.
Cluster headache is one of the most severe types of headaches and falls under the category of trigeminal autonomic cephalgias (TACs) [1]. These headaches are relatively uncommon, affecting only about 0.1% of the population, which presents challenges in studying the condition. TACs are characterized by intense trigeminal pain accompanied by autonomic symptoms like tearing, nasal discharge, nasal blockage, and pupil constriction (pupils become smaller) [2]. Often, nasal blockage may be mistaken for a sinus headache, leading to ineffective treatments such as decongestants.
Cluster headache tends to occur around the same time each day. Most individuals experience episodic clusters of attacks daily for weeks to months, followed by a remission period [1]. The pain is typically described as severe, intense, sharp and burning [3]. In the absence of treatment, cluster headache attacks can last between 15 minutes and 3 hours. A notable feature of a cluster headache attack is restlessness and agitation, which helps distinguish cluster headache from migraine, where patients usually prefer to stay still [3]. Typically, during a migraine attack, patients may want to lie still. Those suffering from cluster headache may pace or rock during attacks in an attempt to lessen the intensity of the pain by applying pressure to the affected area [4].
Cluster headache can be categorized into two types: episodic and chronic. The episodic form constitutes about 85 to 90% of cases [1]. In this category, patients may experience daily attacks for weeks to months and then go into remission for months to years. They may have 1 to 2 episodes yearly. The chronic cluster headache category accounts for approximately 15 to 20% of individuals. In this case, individuals experience attacks lasting more than a year without remission or remission that lasts less than one month [1].
The precise cause of cluster headache is still not fully understood, though theories suggest a relationship between the trigeminovascular system, parasympathetic nerve fibers in the trigeminal autonomic reflex, and the hypothalamus [1]. While the exact interaction between these structures is unclear, factors such as the circadian timing and seasonal variation of attacks suggest a role of the body’s internal clock – the hypothalamus [5]. Some factors that may put individuals at risk of developing cluster headache include age of more than 30, consumption of alcohol, prior brain surgery or trauma, family history of cluster headache, and male gender [1].
Managing cluster headache involves both immediate and preventive strategies, similar to other primary headache disorders. Immediate relief is often achieved through rapid, non-oral routes such as inhalation, nasal sprays, or injections [6]. On the other hand, preventive treatments include corticosteroids, verapamil, galcanezumab, and nerve blocks. Neuromodulation has become an increasingly popular option when some of these treatments have not proven effective [6]. In addition, it is important to identify and avoid personal triggers, such as alcohol, certain foods, and strong odors. It is important to keep a headache diary to help pinpoint these triggers. Lifestyle adjustments such as maintaining a regular sleep schedule and managing stress can also be helpful.
In summary, while managing cluster headache can be challenging, understanding the condition, identifying triggers, and following a well-rounded treatment plan can significantly enhance one’s quality of life. By making lifestyle adjustments, seeking support, and maintaining open dialogue with healthcare providers, individuals can effectively navigate the complexities of cluster headache and improve their overall well-being.
References:
- Kandel SA, Mandiga P (2024) Cluster Headache. In: StatPearls. StatPearls Publishing, Treasure Island (FL)
- Benoliel R (2012) Trigeminal autonomic cephalgias. Br J Pain 6:106–123. https://doi.org/10.1177/2049463712456355
- Wei DY-T, Yuan Ong JJ, Goadsby PJ (2018) Cluster Headache: Epidemiology, Pathophysiology, Clinical Features, and Diagnosis. Ann Indian Acad Neurol 21:S3–S8. https://doi.org/10.4103/aian.AIAN_349_17
- Dodick DW, Rozen TD, Goadsby PJ, Silberstein SD (2000) Cluster headache. Cephalalgia 20:787–803. https://doi.org/10.1046/j.1468-2982.2000.00118.x
- Shin Y-W, Park H-J, Shim J-Y, et al (2015) Seasonal Variation, Cranial Autonomic Symptoms, and Functional Disability in Migraine: A Questionnaire-Based Study in Tertiary Care. Headache 55:1112–1123. https://doi.org/10.1111/head.12613
- Peng K-P, Burish MJ (2023) Management of cluster headache: Treatments and their mechanisms. Cephalalgia 43:3331024231196808. https://doi.org/10.1177/03331024231196808